TEEN PREGNANCY: Sexual Abuse Increases Risk, Elders Says
While calling the 12% reduction in the nation's teen pregnancy rate "welcome news," former U.S. Surgeon General Joycelyn Elders noted that adolescent victims of incest and sexual abuse run an increased risk of pregnancy. Writing in this week's Journal of the American Medical Association, she states, "The incidence of nonvoluntary sexual experiences that occur in adolescence, and thus, could lead to teen pregnancy, appears greater than previously assumed." Elders says that "whether this observed link between sexual abuse and pregnancy is causal or, instead, due to shared environmental risk factors requires further investigation." She asserts that of the approximately 800,000 U.S. adolescents who become pregnant each year, "up to 66%" of them report "histories of abuse." She cites several high-risk behaviors of sexual abuse victims that may lead to earlier pregnancies: earlier age of initial sexual activity, "failure to use contraception, prostitution, physically assaultive relationships and abuse of alcohol and other drugs." Other factors include "a greater desire to conceive and increased concerns about infertility." Moreover, Elders says that pregnancy itself "may be a sign of ongoing sexual abuse."
13-16: Critical Years
Elders cites a Los Angeles, CA, study of "a mixed-ethnic sample of almost 2,000 middle and high school students" that found "20% had unwanted sexual experiences, with 51% of adolescent girls having their first coercive sexual act between the ages of 13 and 16 years." In a similar study conducted in the Southwest, "almost 36% reported a history of sexual abuse, with more than 27% of abuse occurring between the ages of 13 and 16 years." Elders also noted another study that found 42% of sexual intercourse involving girls younger than 15 is "nonconsensual." "One study found that 74% of girls who had intercourse before the age of 14 years, and 60% of those who had sex before the age of 15 years" had nonconsensual sex. In addition, "61% of sexually active girls aged 13 years and younger and 43% of sexually active girls aged 14 years and younger had only experienced involuntary intercourse."
Identify Early And Keep Talking
"Early identification and treatment of sexual abuse are crucial for several reasons," Elders says. "First, women with histories of sexual abuse are significantly more likely to" be suicidal "during pregnancy than nonabused counterparts." Also, the emotional complications of sexual abuse means victimized teens are more likely to give birth prematurely, and are more likely to continue the cycle of abuse than their nonabused peers. Rather than focusing on prosecuting the perpetrator, Elders recommends that clinicians conduct a complete medical examination when treating a pregnant teen. She notes, however, "It is critical that the clinician be sensitive and communicate with the teen throughout the examination so that the patient does not experience the examination as a continuation of the trauma." Elders concludes, "Breaking the code of silence can be the first step to halt ongoing abuse and begin the healing process" (Elders, JAMA, 8/19 issue).