A prospective study of 313 Black adolescents who were followed for 2 years after presenting for a pregnancy test at an inner-city clinic in Baltimore suggested the need for greater attention to the concept of ambivalence in analyses of adolescent pregnancy. 80% of respondents were 15-17 years of age, 62% were public assistance recipients, and 76% were from female-headed households. Outcome variables, measured at 6-month intervals during the 2-year study period, included contraceptive use, subsequent pregnancy, and childbearing. At baseline, only 8.5% of respondents indicated a desire to become pregnant, 3.3% stated they did not know, and the remainder expressed a desire not to become pregnant. Thus, when a single question was used to assess attitudes toward childbearing, a negligible percentage was unsure. When a multi-item construct was created and inconsistent responses to questions about the outcome variables were treated as ambivalence, the percentage of teenagers falling into that category rose to 47.3%. Added to the construct were perceptions of sexual partner's wishes, perceptions of contraceptive efficacy, and attitudes toward contraception and abortion. In bivariate analysis, a consistent desire to avoid pregnancy had a significant effect on contraceptive usage and avoidance of pregnancy. Adolescents whose responses to the attitudinal measures were coded as ambivalent/inconsistent were at high risk of non-effective use of contraception, pregnancy, and childbearing. For example, among adolescents who delivered a baby, 63% expressed negative attitudes about contraceptive effectiveness, 58% were ambivalent, and 42% expressed positive attitudes. Similarly, of those who carried a pregnancy to term, 54% were opposed to abortion, 57% were ambivalent, and 40% were pro-choice. Based on these findings, it is recommended that pregnancy counselors go beyond a single direct question regarding pregnancy desire, used several probing questions to assess the strength of the commitment to avoid pregnancy, and seek to strengthen that commitment.
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