Original StudiesCharacteristics of adolescent street youth with a history of pregnancy
Introduction
Thousands of youth live on the streets of urban centers in North America. In Canada, there are an estimated 45,000 to 150,000 street youth1 and in United States estimates range from 500,000 to 2 million.2, 3, 4 Many youth run away because of experiences of emotional, sexual, and physical abuse and neglect. Others leave their homes in search of adventure or self-actualization, or are forced out of home over conflicts about drug use and sexual orientation.5, 6, 7, 8 The social and economic hardships of street life can seriously jeopardize the mental and physical health of these adolescents and often predispose them to increased risk behaviors.8, 9, 10, 11 Many articles have reported on the extreme vulnerability of homeless youth.8, 9, 10, 11, 12, 13, 14 Their high rates of substance abuse, mental health problems, victimization, and risky sexual behaviors lead to many health problems while their access to both mental and physical health services is often limited and untimely.15, 16, 17 Adolescent girls living on the streets are especially vulnerable for sexual health problems such as sexually transmitted infections and pregnancy.5, 18, 19, 20, 21 In fact, studies on health issues important to street youth report that pregnancy is one of the most common youth-identified problems.16, 22
In industrialized nations, adolescent pregnancy is considered a major public health concern because of the serious social, economic, and health consequences for both teenagers and the children born to these young mothers.23, 24, 25, 26 Even though teenage pregnancy rates have fallen over the last decade in North America, pregnancies still occur in 4% of teenagers in Canada and in almost 10% in the United States.27, 28
Certain groups of adolescents are at higher risk of pregnancy, such as youth in shelters, runaways, and homeless youth.9, 20, 21 Among these groups, adolescents living on the streets have the highest risk of teen pregnancy. In the U.S., a 1992 multi-city survey among 14–17 year olds reported lifetime pregnancy rates of 48% among girls currently living on the streets (n = 85) compared with 33% among girls living in shelters (n = 169) and less than 10% among adolescents living at home (n = 379) 20. Other studies have reported lifetime rates of pregnancy on a wider age range of young women living on the street. In a survey of street youth aged 13–23 years old in Hollywood, CA, Anderson documented that 60% of the 263 young women had ever been pregnant.9 A cross-sectional study carried out in Montreal in 1999 among street youth aged 14–25 reported a 44% rate of lifetime pregnancy among the 78 female participants and among those ever pregnant, 42% had been pregnant at least twice.19
Two studies comparing pregnant homeless youth with pregnant teens living at home provide information on the characteristics of homeless pregnant teens.29, 30 Yordan reported that almost half of the homeless pregnant teens had a history of physical abuse (47%) and sexual abuse (46%), a quarter (24%) had used illicit drugs or alcohol, and 15% had exchanged sex for drugs, food or shelter.29 A clinic-based study by Pennbridge et al30 noted that 30% of homeless adolescents were depressed or had previously attempted suicide, 48% were diagnosed as having a major mental disorder or as drug abusing, and 33% reported histories of sexual and/or physical abuse.
These studies highlight the increased vulnerability of homeless pregnant adolescents and document several important psychosocial and behavioral risk factors among adolescents living on the streets. However, the reasons why some of these girls are more likely to become pregnant than their peers living in the same conditions remain unclear. The objective of this study is to determine the social and behavioral factors associated with a history of pregnancy among adolescent street youth and compare these adolescents with their never pregnant peers in order to better understand factors that may influence pregnancy rates in this vulnerable population.
Section snippets
Methods
A prospective cohort study on risk behaviors for HIV infection took place among Montreal street youth between January 1995 and September 2000. The study method has been fully detailed in a previous paper.31 Briefly the entry criteria for this cohort were: being “street-active”; being between 14 and 25 years old; English or French speaking; and being able to provide informed consent and to complete an interviewer-administered questionnaire. Youth were considered “street-active” if they had, in
Statistical methods
Analyses for this paper were based solely on the information from the entry questionnaires of female street youth between 14 and 19 years of age (inclusively). Socio-demographic and behavioral variables were compared among two groups of youth, adolescents ever pregnant (AEP) and adolescents never pregnant (ANP) based on the question “Have you ever been pregnant?” Subjects answering “not sure” to this question were not included in the analysis.
Pregnancy history prevalence rate was calculated
Results
A total of 1013 youth were recruited in the Montreal Street Youth Cohort from January 1995 to September 2000. The refusal rate of participation was estimated at approximately 12%. Almost one third of participants (32.6%, n = 330) were females and 70.3% (n = 232) of them were between 14 and 19 years of age. Seven girls reported not being sure if they had ever been pregnant and were excluded from the final analyses, which were based on the 225 remaining female teenagers.
Among the 225 selected
Discussion
The lifetime rate of pregnancy among adolescents living in the streets of Montreal is very high despite the availability of sexual health education through outreach community workers and free reproductive health care in local community clinics. The past histories of the girls who had a pregnancy is very disturbing even in comparison with their street peers. The characteristic that most differentiates the two groups of girls is certainly the experience of sexual abuse.
A greater proportion of
Limitations
Limitations of this study must be taken into consideration in the interpretation of the results. One area of concern may be the generalizability of the results to other homeless adolescents. Given the entry definition and recruitment strategy we used, we are confident that youth in our study are representative of the larger Montreal street youth population. Subjects were recruited in all major non-governmental organizations offering services to street youth. A previous study showed that over
Conclusions
In conclusion, our results show that pregnancy is a common reality among adolescent street youth in Montreal. This study has allowed us to clarify the amplitude of the problem and to describe two important characteristics that distinguish girls with a history of pregnancy from their never pregnant peers. Past history of sexual abuse, and especially severe intra-familial abuse, is significantly associated with pregnancy among street involved girls. As well, early initiation into injection drug
Acknowledgments
The authors would like to thank the street youth and street youth community organizations that collaborated in this study, the research interviewers that gathered the information, and Manon Hudson for her secretarial support. This study was supported by a grant from the Medical Research Council of Canada, Health Canada, the Fonds de recherche en santé du Québec, and the Ministère de la Santé et des Services sociaux du Québec. The study was conducted in Montreal, Quebec, Canada.
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2014, Journal of Adolescent HealthPregnancy Attitudes, Contraceptive Service Utilization, and Other Factors Associated with Los Angeles Homeless Youths' Use of Effective Contraception and Withdrawal
2013, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Homeless youth experience high rates of sexual abuse and victimization,10 which may increase their likelihood of pregnancy; as sexual abuse victims are more likely to engage in risky sex behavior that can lead to pregnancy,7,8,24 and if forced to have sex, may not have the option to use contraception.11 Foster care history is also associated with both higher rates of homelessness27 and pregnancy;28 and homeless youth with a lifetime history of pregnancy are more likely to have been involved in foster care.7 Exchange sex (ie, trading sex for money, drugs, food, a place to stay, or other means) is pervasive among homeless youth7,29 and is further associated with pregnancy in this population.4