ADOLESCENCE, EARLY CHILDBEARING, AND PREVENTIVE HEALTH SERVICES: A CULTURAL ANALYSIS

Increasing numbers of adolescents in the United States are becoming pregnant, many unintentionally. In this study, it is hypothesized that the high rate of adolescent pregnancy and poor use of preventive health services by adolescents before, during, and after pregnancy are conditioned by factors in the adolescent's private culture. These factors are not always congruent with the pervasive public culture of the community. The hypothesis is supported by an analysis of the events of pregnancy and the attitudes, beliefs, and values (i.e., the private culture) which surround the pregnancy for a number of adolescent mothers. The adolescents were residents of a town in the southeastern United States called Farmville. Viewpoints of members of the community and of health providers are also presented to describe the community's prevailing public culture. Using a schedule, a questionnaire, open-ended interviews, and direct observation, the author collected data from 35 of 76 adolescents who had given birth in Farmville in 1976. Materials from ten of these interviews, when combined with data from reinterviews, were developed into case studies. The case studies provide the reader with an understanding of the pregnancy from the perspective of the adolescent. Data from the remaining 35 interviews were incorporated into the analysis which is organized in six themes: contraceptive knowledge, use, and responsibility; initial reactions to pregnancy; family relationships; supportive networks, acceptability of health care, and adolescent motherhood. The author concludes that adolescents and adults alike perceive early, unplanned pregnancy as a mistake. The high rate of adolescent pregnancy in Farmville is attributed to differences between the private culture of adolescents and the community's public culture. Specifically, adolescents lack information with respect to contraceptives, and they are often unable or unwilling to admit that their sexual activity violates certain cultural norms. Further, there is a lack of recognition and acceptance by health professionals of the culture of the adolescent. Lastly, there is a lack of commitment to health care providers by adolescents and a lack of viable alternatives for acceptable health care. Recommendations for establishing culturally appropriate services for adolescents are made in keeping with the conclusions named above.