Pregnancy Intentions and Teenage Pregnancy Among Latinas: A Mediation Analysis

More than half (53%) of Latinas in the United States become pregnant at least once before age 20.1–3 In 2006, the pregnancy rate among adolescent Latinas was nearly double the national average (127 vs. 72 pregnancies per 1,000 women aged 15–19),4 and Latina teenagers were twice as likely as others to give birth (83 vs. 42 births per 1,000).5 Teenage childbirth may have substantial adverse health and social consequences for both mother and child,6 and adolescents who have children have an elevated risk of dropping out of school, living in poverty and being single mothers.5,7 In addition, high pregnancy rates are indicative of unprotected sexual behavior and risk for STDs. Although numerous social, economic and cultural factors play a role in the high rates of teenage pregnancy among Latinas, increased desire for pregnancy may be one important contributing factor. In the 2002 National Survey of Family Growth, Latina adolescents were twice as likely as their non-Latino white and black counterparts to report that they would be “very pleased” if they became pregnant.8 Analyses from the National Longitudinal Study of Adolescent Health9,10 and several smaller scale studies11–13 found similar ethnic differences in adolescents’ attitudes and intentions regarding pregnancy. Given the relatively favorable attitudes toward pregnancy and high pregnancy rates among Latina adolescents, a greater understanding of the relationship among pregnancy intentions, other risk factors and pregnancy itself would provide insight that could guide the design of interventions for reducing unintended pregnancy in this group. The role that pregnancy intentions play in adolescent pregnancy has been a topic of much debate.14–18 It is unclear whether underlying risk factors for teenage pregnancy influence attitudes toward pregnancy—which, in turn, affect pregnancy incidence—or whether pregnancy intentions are a risk factor in their own right. Studies of U.S. adolescents indicate that many predictors of pregnancy are also associated with favorable attitudes toward pregnancy; these include older age, lower socioeconomic status, having low educational aspirations or not being in school, and having a partner who is older or controlling.9,10,12,13,19–22 Although these findings have been interpreted as evidence that pregnancy intentions mediate the relationship between other risk factors and teenage pregnancy, this causal pathway is only conjectured. Alternatively, pregnancy intentions may operate independently of other risk factors, and differences in pregnancy rates between adolescents with different social and cultural backgrounds may be due to other influences, such as disparate access to contraceptives. Indeed, data from a racially diverse group of 3,070 females aged 14–19 participating in the National Longitudinal Surveys of Labor Market Experience of Youth revealed that birth intentions did not appreciably mediate the associations between various risk factors— including socioeconomic status, race and ethnicity, and family structure—and teenage pregnancy.17 Similarly, an analysis of data on 2,812 non-Hispanic white women aged 19–39 from the National Survey of Families and Households found that although fertility intentions were a strong predictor of pregnancy, they did not mediate the apparent effects of the other predictors, including age, income, education, mother's education and school enrollment.23 Examining pregnancy intentions and attitudes poses challenges. The term “pregnancy intentions” has been defined and measured in myriad ways, including whether a woman is planning or wants pregnancy, and how happy or disappointed she would be if she became pregnant.24–26 Furthermore, many women have ambivalent or conflicted attitudes about pregnancy, and they hold these attitudes with varying degrees of conviction.27–30 In particular, teenagers may be less likely than older women to plan or time pregnancies consciously or to have clearly defined fertility objectives.31,32 Teenagers also are likely to modify their attitudes toward a potential pregnancy as their life circumstances and sexual partnerships change.33 Despite these complexities, delineating the relationships among pregnancy intentions, other risk factors and pregnancy itself has important implications. Assessing the roles of factors thought to lie on a causal pathway can elucidate the mechanisms through which risk factors influence the outcome and thus can help identify causes of pregnancy.34 Furthermore, an improved understanding of the relationship between pregnancy intentions and teenage pregnancy may address long-standing questions regarding the extent to which differences in pregnancy rates between groups are a function of choice or, alternatively, reflect differences in social, familial and personal factors that place some adolescents at risk of unintended pregnancy.14–16,18