“Like the Arms of an Octopus”

GS Your research—and that of others—seems to say that even though a variety of factors come into play when teens get pregnant, most of these can be traced back to family issues in one way or another.

TH I’d say that’s accurate. I’ve researched sexual abuse and physical abuse as well as teen pregnancy and there’s no doubt that family dysfunction has a big impact in these areas.

GS Could you call that a common denominator across the spectrum of your research?

TH There’s no single bullet, of course. We all come from families so yes—you could say that’s the common denominator. But I wouldn’t rule out the importance of education especially in trying, for example, to prevent repeat pregnancies. In your article, “Teen Pregnancy: Home Remedies” you end saying, “By the time a teen becomes a mother it’s too late to rely either on education or contraception.” When you consider the importance of preventing repeat pregnancies, that statement isn’t entirely true.

Sometimes after a teenager experiences one pregnancy, she ends up pregnant again within the next couple of years. And then pregnant again after that—not necessarily marrying the father, or even setting up a household with the father or fathers. So the story isn’t over once a teen gets pregnant the first time. There is still a need for education.

GS That would be an important point to make—it may be one thing to be concerned about preventing a first pregnancy, but you’re saying that even if that effort fails, further efforts aimed at prevention of repeat pregnancies shouldn’t be abandoned. You’re referring to the 24-month study you published a few years ago on the subject of repeat teen pregnancies right? I had gathered from your conclusion that you found that the interventions didn’t significantly reduce the number of repeat pregnancies in that time frame.

TH True, but when you get to the end of the 48-month study, which will come out in the spring of 2009 in the Journal of School Health, it turns out that the intervention, especially the school-based program, does have an effect. It doesn’t prevent repeat pregnancies but it does delay them significantly.

GS After having a first child as a teen and discovering the inherent challenges, why would anyone knowingly repeat the experience?

TH As you well know there are a variety of interrelated factors that lead to teen pregnancy. But one of the factors for children who come from dysfunctional families or from backgrounds of abuse is that they’re not making a conscious decision to become pregnant; it’s simply a matter of drifting through life.

Someone who has been abused is more likely to be sexually active earlier. And there is a self-esteem factor. When a girl is pregnant, she suddenly moves to center stage. Everyone wants to know how she’s doing—which is tremendous positive reinforcement for being pregnant. Once she has the baby, of course, the special attention begins to drop off rather quickly. After a while it disappears completely and she wants to recapture it.

Keep in mind that this is not—by any stretch of the imagination—universal. Why do the young ladies in the school-based programs delay their pregnancies? They begin to focus more on caring for the child and on caring for themselves to the point that they slowly begin to develop the kind of genuine self-esteem that isn’t based upon being pregnant. So they aren’t looking for an outside source of attention.

Another connection is substance abuse. There’s an article in the November 2008 issue of the Journal of Health on the subject of sexual activity among high school students. It points out that 50 percent of teen alcohol users are sexually active, whereas only 20 percent of the non-users are sexually active. So alcohol use—which of course is illegal at that age anyway—may make people more open to being sexually active at that age. And about 20 percent of the teens that are sexually active don’t use any contraception.

GS Is that also a function of “drifting through life”?

TH Yes. They’re not planning their actions with consequences in view. That’s a characteristic of those who have been abused. For example, we’ve found that some kids who have been sexually abused end up as runaways. But many of these runaways don’t make a conscious choice to run away. Perhaps they run into a friend at a local hangout, and the friend says “Hey, let’s go see Las Vegas,” and then they’re gone.

GS Do you think some of the alcohol abuse that occurs among abused teens is a form of self-medicating?

TH That does follow. There would be a relationship between many of these factors: alcohol abuse, substance abuse and sexually acting out. The sexual acting out comes from being sexualized at an earlier age through unwanted sexual experiences. You’re right about family relationships being very important, because as you noted in one of your articles, our study found that early unwanted sexual experiences led to early wanted sexual experiences and early sexual experience leads to an increased likelihood of teen pregnancy.

There’s a long list of risk factors with regard to sexual abuse that can be conceptualized in terms of family. First—and primary—would be the presence of a stepfather or other father figure who is not the father. Other factors include mother absence, lack of maternal education (the mother didn’t finish high school), presence of an emotionally distant or sexually repressive mother, or presence of a physically distant (unaffectionate) father. Each of these factors increases the child’s likelihood of being abused by about 10 to 20 percent. So for instance, if you have five of those factors present you almost have a target on your forehead.

It’s interesting that physical closeness is actually a protective factor in father-daughter relationships. A father who is involved in the physical nurturing of the child as an infant—in terms of changing diapers, feeding the infant daughter, and expressing physical affection—is less likely to abuse than a father who doesn’t participate in those nurturing activities. To be able to abuse someone, the abuser needs to do a certain amount of objectifying. When the father is engaged in the day-to-day care of his daughter, it’s hard to objectify her. So the physical bonding is not something only the mother needs to do; it’s very important for the father to do as well.

GS Yes, when I spoke with Linda Nielsen of North Carolina’s Wake Forest University, she emphasized that fathers are just as important for girls as they are for boys, even though it’s more common to think in terms of a boy’s need in that area. But certainly boys also play a role in teen pregnancy—teen girls don’t get pregnant by themselves, after all. What are the factors in the boys’ lives that might predispose them to contributing to the problem?

TH Like sexually abused females, males who have been sexually abused are also more likely to have early sexual encounters. While 1 out of every 3 girls in the United States has been sexually abused before the age of 18, 1 out of every 6 boys is also sexually abused before the age of 18. A focus on prevention would certainly address that problem for both boys and girls. And where is the primary prevention going to take place? Initially in the family.

Of course that doesn’t mean we don’t need government programs and effective education, especially in terms of repeat pregnancies. This is after the cow’s already gotten out of the barn, so to speak. So if you want to try to get the cow back in the barn, the family of origin can’t be the only focus anymore—you’ve got to focus on the young lady herself too. Certainly you’ve got to do both. But the young mothers we’re dealing with are creating a new generation and that new generation is going to be vulnerable as well.

In fact a teenage mother who doesn’t marry the father often ends up with a series of boyfriends living with her. In these situations, her children are more vulnerable to abuse than in other family milieus. So the young mother needs to be educated in terms of school retention—staying in school—but she also needs to be educated in terms of various aspects of child care and in how to find external support so she doesn’t take her frustrations out on her children through either physical abuse, emotional abuse or neglect.

GS I can certainly see your point that the community needs to be involved after the first pregnancy. Especially when the teen mother has come from a dysfunctional family, her family dynamics are not likely to change dramatically after her baby is born, so she may not receive the support she needs from that quarter to ensure the next generation doesn’t repeat her experience.

TH Yes, so the community needs to supply these resources. There was a certain amount of insight in the comment that it does take a whole village to raise a child. One of the ways a community is able to provide a young lady with support is through government programs.

GS What about the responsibility of extended family, neighbors, friends, schools?

TH It’s very important not to make these girls pariahs. Fortunately that’s happening less and less. But it’s also important to develop programs within schools to help support these young ladies in terms of putting them in contact with the various agencies that are available in the community. These programs should also teach them how to take care of themselves and their child. In fact, a complex web of support is needed so that the same standard of care is available to all girls who get pregnant.

And of course the boys need to accept responsibility too. I’m a firm believer that boys and girls in high school—and perhaps earlier—need classes that teach infant care. We talked earlier about the new insights into the importance of fathers involving themselves in the physical nurturing of infants. There should be classes for both boys and girls to prepare them for the realities of infant care so that young men learn it is the manly thing to do. If they aren’t seeing that example in the home, they need to be learning about it at school.

In the new study we found that school-based interventions had a greater effect than the home-based interventions alone, which involved case management—a caseworker visiting the mother in her home. But involvement in the school-based intervention helped promote retention in school, which had a greater impact. Although case management did help in delaying repeat pregnancies, it didn’t have as much impact as the school-based curriculum, This is because even though consistent case management was available to them, when the girls weren’t involved in the curriculum-based intervention they didn’t avail themselves of it as much.

GS You’ve viewed teen pregnancy from many different angles in your research. What’s the ideal approach toward this problem from a sociological point of view?

TH The ideal approach is one of prevention. And one of the big factors leading to teen pregnancy—not the only one, but a big one—is sexual abuse. Another big one is family dysfunction in any form: physical abuse, emotional abuse, neglect, domestic violence taking place in the home, violence against the children themselves and substance abuse. By the way, as you probably know, substance abuse is no more prevalent among the poor than it is among the wealthy—where it just looks nicer.

But the fact is that many of the other dysfunctions in this list can be traced to parental substance abuse. Not all of them, by any stretch, but many of them. So in the way of prevention,we need to provide much more education with regard to the effects of alcohol abuse and drug use. In fact, we need a comprehensive program of prevention aimed at all of the factors we’ve talked about.

These family dysfunctions are like the arms of an octopus. Each of them leads to the strangling of children in their childhood and it comes out in their adulthood. I wish I could say there was a silver bullet—you just do this one thing, and everything will fall into place and be wonderful. Life isn’t like that—but that doesn’t mean we shouldn’t keep trying.