Brief Reports
Rapid repeat pregnancy and experiences of interpersonal violence among low-income adolescents

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Abstract

Context: Rapid repeat pregnancy (RRP) among adolescents, usually defined as pregnancy onset within 12–24 months of the previous pregnancy outcome, has frequently been the target of public health interventions, due to the exacerbation of negative consequences associated with recurrent adolescent pregnancy (and more specifically with childbearing).

Objective: To examine what, if any, relationship exists between RRP and the experience of interpersonal violence and abuse among low-income adolescents at one semi-urban health center.

Design: Case-control study using retrospective chart review.

Participants and Setting: 100 women aged 13–21 who received prenatal care at one independent nonprofit health center that serves adolescents and their children from June 1994 through June 1996.

Main Outcome Measures: Number and timing of pregnancies, occurrence of physical or sexual abuse; other psychosocial risk factors were evaluated.

Results: In this population, the experience of any form of physical or sexual violence during the study interval was associated with RRP within 12 months (p = 0.01, OR = 3.46) and 18 months (p = 0.013, OR = 4.29). Other previously reported predictors of RRP, including family stress, financial stress, and other environmental stressors did not reach statistical significance at either 12 months or 18 months in this sample. Of additional note, young women who experienced any form of abuse during the 12-month study interval were substantially more likely to miscarry than were their nonabused peers, and spontaneous abortion was also very strongly associated with RRP (p < 0.00001; OR = 22.6).

Conclusions: The experience of interpersonal violence is correlated with rapid repeat pregnancy among low-income adolescents. This study strongly suggests a need for both extensive screening for partner and family violence among pregnant and postpartum adolescents, and follow-up safety planning support in combination with family planning interventions.

Introduction

R apid repeat pregnancy (RRP) among adolescents, usually defined as pregnancy onset within 12-24 months of the previous pregnancy outcome, has frequently been the target of public health intervention, due to the exacerbation of negative consequences associated with recurrent adolescent pregnancy (and more specifically with childbearing).1, 2, 3 Previous studies have documented adolescent RRP rates of 19–66%.4, 5, 6, 7 Identified RRP risk associations have included younger age, marriage during or immediately following first pregnancy, school non-attendance, and lack of positive parental relationships.6, 8, 9, 10 This brief report summarizes an investigation of the relationship between RRP and the experience of interpersonal violence and abuse among low-income adolescents at one semi-urban health center.

Section snippets

Methods

This study population consisted of 100 young women, aged 13–21, who received prenatal care, including the state funded Maternal Support Services Program (MSSP) at one independent nonprofit health center that serves adolescents and their children, from June 1994 through June 1996. The 100 cases were selected chronologically from the pool of women who had received prenatal care during the time interval, and for whom follow-up information was available. Approximately 35% of clients at this

Abuse

Thirty-five of all study participants reported having been sexually abused at some time during the lifecycle; 44% reported other experiences of physical abuse. Twenty-six percent of participants reported abuse experiences (partner abuse, domestic violence, or other forms of sexual and/or physical abuse) occurring during the study interval. Thirteen percent of participants reported a prior history of childhood neglect, usually characterized by protective intervention, such as removal from the

Discussion

This study examined the relationship between experiences of interpersonal violence or abuse and rapid repeat pregnancy among adolescents. Detailed chart review demonstrated that current experiences of sexual or other physical violence are significantly associated with RRP. In addition, young women who experienced any form of violence or abuse during the study interval were significantly more likely to miscarry than were their nonabused peers.

Despite the high prevalence of violence, abuse, and

Comments

Adolescent pregnancy prevention is often the target of public policy rhetoric and public health interventions. However, pregnancy (especially RRP) among teenagers and young adults is rarely understood as a consequence of violence or victimization. It is imperative that pregnancy prevention programs, including those which stress abstinence from sexual intercourse, include violence prevention education, and that obstetrical and family planning programs serving adolescent women include screening

Acknowledgements

The authors would like to thank Daniel Rosen, MSW, whose pilot interviews with adolescent clients suggested the direction of this quantitative research, and Joan Chesler, PhD, Executive Director of The Corner Health Center. The authors would also like to acknowledge the financial support of the Office of Student Biomedical Research Programs at the University of Michigan.

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