We know that getting teens to use birth control is not just a matter of providing guidance counselors with fishbowls full of condoms. There are many, many complicating factors. We know, for one thing, that some teen girls feel they want to get pregnant. And based on the results of a qualitative study published in this month's Ambulatory Pediatrics, we also know that some teen boys not only want their girlfriends to get pregnant but, in some cases, are doing what they can to force them to. The study is said to be "the first in the general adolescent health literature to document the role of abusive partners in promoting teen pregnancy."
According to one of the study's authors, Elizabeth Miller, M.D., of UC-Davis, who spoke with Broadsheet today, one girl interviewed by researchers told them her boyfriend "tried to get me pregnant on purpose and then made me have an abortion." Of such cases, Davis says, "This is clearly out-and-out control of a woman's body. Control for control's sake."
The study was based on interviews with a racially and ethnically diverse group of 61 girls from Boston's poorest neighborhoods. All had histories of intimate-partner violence; 53 of them were in abusive and sexually active relationships at the time of the interview. Of those girls, 26 percent reported that their partners were "actively trying to get them pregnant by manipulating condom use, sabotaging birth control use" or simply sweet-talking them about "making beautiful babies" together.
Miller says that when you talk to young men with histories of intimate-partner violence, they often say it was their girlfriends who tried to manipulate them into becoming fathers. "The reality is probably somewhere in the middle," she says. Not all the girls in the study were 100 percent averse to getting pregnant; others, however, did report having to hide their birth control from their boyfriends. Both boys and girls, Miller says, could be motivated to bear children by a (misguided) search for a certain intimacy and stability lacking in their own family situations. Gang membership, in which babies translate into status, may also be a factor for the young men. And some girls, Miller noted, said they didn't want to be pregnant, but they didn't want their boyfriends to be unhappy. Sigh.
But the real focus of the study is not the psychological whys of teen pregnancy; it's teen pregnancy as a canary in the coal mine of partner violence.
"Our study suggests that those providing care, especially reproductive care, to adolescent girls need to ask questions that reveal the complexities of partner violence, specifically whether a partner is actively trying to get her pregnant when she doesn't want to be," Miller said in a statement. "Our data argues for including questions, for instance, about whether a boyfriend is flushing birth control pills down the toilet or saying he used a condom when he didn't. And pregnancy prevention programs should include discussions about reproductive control as a form of abuse in relationships." (Miller herself is still haunted by a teenage girl who came in for a pregnancy test and who was, two weeks later, shoved by her boyfriend down a flight of stairs. "I wondered what I had missed," she says.)
"When we see girls who cannot consistently use contraception, who are requesting frequent emergency contraception, or who seek repeat pregnancy testing, we need to be asking very directly about abuse from male partners and find ways to support [the girls] and promote their safety," added Jay Silverman, director of Violence Prevention Programs for the Harvard School of Public Health and senior author on the study.
Miller is currently planning larger local and national studies on the same phenomenon. "Our work is aimed at documenting the severity and prevalence of intimate-partner violence in teens," she said. "Ultimately, we want to reduce teen pregnancy and the devastating effects of partner violence."