Pregnancy and protection: Perceptions, attitudes and experiences of Australian female adolescents

Summary

Background and purpose

Despite decades of research, development and evaluation of educational and promotional strategies to prevent teenage pregnancy, we have only a limited understanding of the strategies that are effective and why. This study sought to explore female teenagers’ attitudes, perceptions and experiences of contraceptive use, and describe the influence of this on pregnancy risk.

Methods

A qualitative approach was used to explore the contraceptive behaviour in a purposive sample of sexually active Australian females aged 14–19 years. Teenagers were drawn from three sub-groups: antenatal and postnatal services (pregnant-continuing); termination services (pregnant-terminating); and sexual health clinics (never-pregnant). Sixty-eight individual, semi-structured interviews were conducted. Thematic analysis was employed to analyse the data and generate a rich, description of contraceptive behaviour.

Results

Whilst participants were familiar with contraception, many used it inconsistently. Commitment to pregnancy prevention was firmly located within participants’ attitudes toward teenage pregnancy and parenthood, perceptions of pregnancy risk and perceptions of the costs and benefits of using contraception. Further, motivation to use contraception fluctuated in different contexts, such as romantic relationships.

Conclusions

Our research highlights the importance of attitudes toward contraception, pregnancy and parenthood in shaping teenagers’ motivation to use contraception. Educational and prevention programs must address the spectrum of attitudes underlying teenagers’ contraceptive and reproductive decisions in order to alter pathways to teenage pregnancy and early parenting.

Introduction

Teenage pregnancy and parenthood remain significant adolescent health and social issues.1, 2 At 16 per 100 per year,³ Australia's teenage fertility rate is higher than most developed countries outside the United States and the United Kingdom.4, 5, 6, 7 In addition, Australia has one of the highest abortion rates in this age group, with the proportion of pregnancies ending in abortion having increased from 20% to over 50% over the past 30 years to 1999.7, 8 This figure has since remained stable.

Extensive literature confirms poorer outcomes for teenage mothers. Consequently, much research has been devoted to understanding the dynamics of adolescent pregnancy, in particular the underlying causes and consequences.9, 10, 11, 12 Whilst this has provided a useful conceptual basis for programs seeking to reduce adolescent sexual risk behaviour, such research has also been preoccupied with demonstrating the negative consequences of pregnancy for these young women and their children.¹³ Further, the perspectives of teenagers themselves are also often ignored.14, 15

A growing number of studies now suggest that, although teenage pregnancy may be perceived as problematic by society, young people may regard it differently.16, 17, 18, 19, 20, 21 Further, in a climate where contraceptive use is considered the standard practice for sexually active adolescents,²² clinicians and educationalists often assume that adolescents want to avoid pregnancy, and those who do conceive do so unintentionally.²³ Yet increasing evidence suggests this is not always the case. Longitudinal research has shown that the level of control an adolescent maintains over their contraceptive behaviour is the strongest predictor of pregnancy outcomes; inconsistent and non-users of contraception have much higher odds of becoming pregnant compared to consistent users.²⁴ However, despite this obvious link between behaviour and outcome, we do not fully understand the basic processes influencing adolescents’ sexual and reproductive choices, including contraception use. Some have suggested that inadequate contraception use may result from more positive or ambivalent attitudes toward pregnancy and parenthood.17, 21, 25, 26 Alternatively, teenagers with a stronger commitment to avoid pregnancy have been shown to use contraception more consistently.²¹

The contraceptive behaviour of adolescents is a complex issue that must be investigated within multiple domains of influence.9, 27 Survey research in this area often fails to capture the dynamic nature of contraceptive use in different contexts and over time. To overcome this, qualitative methods offer an effective way to explore the meanings assigned to personal experiences and describe the reasons underlying behaviour in its social context.²⁸

The findings presented in this paper form part of a larger study exploring the biopsychosocial antecedents of pregnancy and parenthood in sexually active female teenagers. Approval to conduct this study was obtained from the relevant hospital Ethics Committee. This paper reports upon teenagers’ attitudes, perceptions and experiences of contraceptive use and how these influenced pregnancy risk.