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Adolescent Pregnancy Project

Sunday, January 1, 2006

About the Project

In 2006 in North Carolina more than 6500 girls and young women, aged ten through 17, became pregnant and 74 percent of them gave birth. Although they, their parents, and other adults responsible for them confront difficult legal questions, the law relevant to the situation may be hard to locate or interpret. For example, may a person under 18 act as a parent, obtain or refuse an abortion, place a child for adoption, marry, leave school or insist on staying? May she seek her own health care? What are her partner's and their families' responsibilities and rights?

The Adolescent Pregnancy Project offers information on North Carolina law and resources to pregnant and parenting adolescents and those who care for them. It consists of legal guides accompanied by resource lists, one each for health providers, social services employees, school employees, the parents of pregnant
and parenting adolescents, and adolescents themselves.

The project's goals are listed below:

  • Help adolescents to understand their legal choices
  • Ensure that adolescents, while pregnant or parenting, have access to health care, education, and social services
  • Help adults recognize that teens are sometimes lawful decision makers
  • Help caregivers not overlook the possibility of abuse, neglect or coercive sexual relationships
  • Clarify the role of adult advisors--either family members or professionals--and provide resources for them

The project is funded by the School of Government at the University of North Carolina at Chapel Hill; the Z. Smith Reynolds Foundation; the Karl and Anna Ginter Foundation and the Mary Norris Preyer Fund. Anne Dellinger and Arlene M. Davis are co-directors of the project.

Reading List on Adolescent Pregnancy and Parenting

Abstinence Clearinghouse-This website, www.abstinence.net, offers information encouraging abstinence before marriage to teachers, parents, and adolescents. It contains a resource center and speakers' bureau and sells an Abstinence Education Directory ($20), which identifies curricula.

The Alan Guttmacher Institute. Fulfilling the Promise: Public Policy and U.S. Family Planning Clinics. New York, NY and Washington, D.C., 2000. Also available at www.guttmacher.org/. The report describes the history and current status of publicly funded family planning services in the United States, especially "Title X." It notes the importance of such programs to teenagers. Half of the teens who obtain family planning services get them from a public clinic.

The Alan Guttmacher Institute, Sex and America's Teenagers. New York, NY and Washington, D.C., 1994. The book presents statistics about adolescent sexuality, pregnancy and motherhood. AGI's position is that "If adults are going to help teenagers avoid the outcomes of sex that are clearly negative, they must accept the reality of adolescent sexual activity and deal with it directly and honestly."

Ambuel, Bruce and Rappaport, Julian, "Developmental Trends in Adolescents' Psychological and Legal Competence to Consent to Abortion," 16 Law and Human Behavior 129-154 (No. 2, 1992).  This study of decisional capacity finds that minors, with the exception of girls under 15 who did not consider abortion, are as competent as adults to consent to medical care.

American Academy of Pediatrics, Policy Reference Guide. A.A.P.: Elk Grove Village, IL, 1998. (Also available at www.aap.org.) 

  • "Adolescent Pregnancy," 1989, reaffirmed April 1992.
  • "The Adolescent's Right to Confidential Care When Considering Abortion," 1996.
  • "Adolescents and Human Immunodeficiency Virus Infection: The Role of the Pediatrician in Prevention and Intervention," 1993.
  • "Age Limits of Pediatrics," 1988.
  • "Care of Adolescent Parents and Their Children," 1989, reaffirmed April 1992.
  • "Confidentiality in Adolescent Health Care," 1989, reaffirmed January 1993, reaffirmed November 1997.
  • "Consent for Medical Services for Children and Adolescents," 1993.
  • "Contraception and Adolescents," 1990.
  • "Counseling the Adolescent About Pregnancy Options," 1989, reaffirmed April 1992, revised 1998.
  • "Hospital Stay for Healthy Term Newborns," 1995, reaffirmed October 1998.
  • "Informed Consent, Parental Permission, and Assent in Pediatric Practice," 1995.
  • "Issues of Confidentiality in Adoption: The Role of the Pediatrician," 1994.

American Academy of Pediatrics, "Privacy Protection of Health Information: Patient Rights and Pediatrician Responsibilities (RE9927)," 104 Pediatrics 973-977 (October 1999).  "This statement describes the privacy and confidentiality needs and rights of pediatric patients and suggests appropriate security strategies to deter unauthorized access and inappropriate use of patient data."

American Civil Liberties Union-North Carolina, Know Your Rights: A Guide for Public School Students in North Carolina. Available at www.acluofnorthcarolina.org. The guide answers questions on school attendance, freedom of speech and religion, federal law on pregnant students, searches, rights of noncitizens, discipline, due process and equal protection.

The American College of Obstetricians and Gynecologists, "Confidentiality in Adolescent Health Care," ACOG Educational Bulletin. No. 249, Washington, D. C. August 1998. (These publications also available at www.acog.org.)

            "Reproductive Health Services for Adolescents," ACOG Statement of Policy. Revised July 1996.

            "Statement on Providing Effective Contraception to Minors," ACOG Statement of Policy. Reaffirmed July 1987.

American Psychological Association, Violence and the Family: Report of the APA Presidential Task Force. American Psychological Association: Washington, D.C., 1996. The report defines family violence as child and elder abuse and intimate partner abuse and examines its incidence, causes and effects.

Katherine Arnoldi, The Amazing "True" Story of A Teenage Single Mom.  Hyperion: New York, NY, 1998.  This is an autobiography in cartoons, slightly altered for privacy reasons, according to the author. It describes a teen mother's struggles to succeed against obstacles including poverty, abuse, her family's hostility, and rape.

Boggs, Kathleen and Huberman, Barbara, Barriers to Prenatal Care in Rural North Carolina Counties' Adolescent Births 1994-1995. In this unpublished study completed in 1995 the authors survey 95 11- to-19-year old mothers (average age less than 16) in three rural counties and make recommendations.  One-third of the young mothers had inadequate prenatal care. The major problem identified was a mother's lack of knowledge of her pregnancy and consequent physical needs. 28% reported fear of discomfort during prenatal visits, and a significant number "forgot" or did not want to keep appointments.

Blum, Robert William, et al., "Don't Ask, They Won't Tell: The Quality of Adolescent Health Screening in Five Practice Settings," 86 Amer. J. of Public Health 1767-1772 (1996).  Researchers find that in none of five practice settings are adolescents screened as thoroughly as recommended by AMA guidelines.  Community family practices did better than private pediatric or family practices. Community teen clinics did best.

Brake, Deborah, Goals 2000 and Pregnant and Parenting Teens: Making Education Reform Attainable for Everyone. National Women's Law Center, Council of Chief State School Officers, and National Association of State Boards of Education: Washington, D.C., March 1995. The book describes the application of federal legislation (Goals 2000: Educate America Act) to pregnant and parenting students and reminds school personnel of the requirements of Title IX of the Education Amendments of 1972.

Brake, Deborah, "Legal Challenges to the Educational Barriers Facing Pregnant and Parenting Adolescents," Clearinghouse Review (June 1994) 141-155. The article tells lawyers how to advocate and litigate for these groups.

Brustin, Stacy L., "Legal Responses to Teen Dating Violence," 29 Family Law Quarterly (No. 2, Summer 1995) 331-356.  The author describes the incidence, causes, and particular characteristics of violence in teen dating relationships and criticizes the states that offer legal remedies only to adult women. (North Carolina's domestic violence law applies to dating relationships.)

Buescher, Paul A., Statistical Brief No. 14, Repeat Teen Pregnancy in North Carolina. State Center for Health Statistics: Raleigh, NC, January 1998. (Available at www.schs.state.nc.us/SCHS.) Seventeen per cent of minors’ pregnancies reported in North Carolina in 1996 were second or higher order pregnancies. More than 70 per cent of these minors gave birth.

Cauffman, Elizabeth and Steinberg, Laurence, "The Cognitive and Affective Influences on Adolescent Decision-Making," 68 Temple L. Rev. 1763-1789 (1995).  The authors recommend treating older adolescents, and younger ones too if they are especially mature, as adults for decision-making purposes.  

Centers for Disease Control, MMWR. 1997;46:819-822, "Chlamydia Screening Practices of Primary-Care Providers-Wake County, North Carolina, 1996," reprinted in 278 JAMA 1229 (No. 15, October 15, 1997). The report "documents low rates of routine chlamydia screening of sexually active adolescent women in an area with known high reported rates of infection," warns providers not to rely on demographic factors to assess risk of infection, and encourages routine screening for all sexually active adolescent women.

Chase-Lansdale, P. Lindsay, Brooks-Gunn, Jeanne, and Paikoff, Roberta, "Research and Programs for Adolescent Mothers: Missing Links and Future Promises," 40 Family Relations 396-403 (1991).  The article reviews research on how parenting affects young mothers, children, and the mother's mother. The authors criticize intervention programs for not grasping that 1) young mothers have a chance to improve their lives when their children enter school; 2) they are particularly needy when leaving their mothers' homes; 3) married adolescent mothers require support too; and 4) young grandmothers need help themselves, which would also benefit their daughters and grandchildren.

Codega, Susan A., Pasley, B. Kay and Kreutzer, Jill, "Coping Behavior of Adolescent Mothers: An Exploratory Study and Comparison of Mexican-Americans and Anglos," 5 J. of Adolescent Research 34-53 (January 1990). The study finds the groups' coping mechanisms quite similar. Both most often coped by taking nonprescription drugs or talking with a companion. However, Mexican-Americans relied more on religion and family authority.  Differences among individuals are noted.

Coles, Robert, et al.  The Youngest Parents: Teenage Pregnancy As It Shapes Lives. W.W. Norton: New York 1997. These interviews reveal teen mothers' and their boyfriends' motives, fears, hope and, often, mutual mistrust.

Collett, Teresa Stanton, “Seeking Solomon’s Wisdom: Judicial Bypass of Parental Involvement in a Minor’s Abortion Decision,” 52 Baylor L. Rev. 513-601 (2000) The author supports parental involvement laws and urges judges to be reluctant to waive involvement at a minor’s request.

Dash, Leon, "At Risk: Chronicles of Teen-age Pregnancy," The Washington Post, a six-part series, January 26-31, 1986.  The reporter lived a year in a poor neighborhood of Washington, D.C., getting to know teen parents.  He records their difficulties, but emphasizes that to a significant extent early parenthood is chosen and embraced.  The reporting was the foundation for a book, When Children Want Children: The Urban Crisis of Teenage Childbearing. William Morrow: New York, 1989.

Dowling, Claudia Glenn, Teenaged Mothers Seventeen Years Later. The Commonwealth Fund: New York, 1987.  The report "makes the strongest possible case for formal education, confirming that adolescent mothers who complete at least high school are more likely to achieve self-reliance than those who do not.  It also confirms the importance of avoiding repeated pregnancies."

Dunkle, Margaret C., Teenage Pregnancy and Parenting: Evaluating School Policies and Programs from a Sex Equity Perspective. Council of Chief State School Officers' Conference: Washington, D.C., 1984, 1-46.  The paper explains federal (Title IX) protections for pregnant and parenting students and offers a "step-by-step guide" for assessing compliance.

Earle, Janice, Keeping Pregnant and Parenting Teens in School. National Association of State Boards of Education (NASBE): Alexandria, VA, 1990.  The book describes typical treatment of pregnant and parenting students and the positive results of NASBE's three-year counseling program, which it advises schools to adopt.  From the Executive Summary: "The most common institutional response is to send [pregnant and parenting students] to an alternative school...or, even more troubling, quietly encourage them to leave."  "Schools must provide (or provide access to) a variety of services if they are serious about keeping the highest risk students in school."

Elstein, Sharon G. and Davis, Noy, Sexual Relationships Between Adult Males and Young Teen Girls: Exploring the Legal and Social Responses. ABA Center on Children and the Law: Washington, D.C., October 1997. The report describes responses to these relationships from the criminal justice system and youth service agencies and advises that "All girls ages 10-15 should be legally protected from 'consensual' sexual intercourse with men age 20 and above."  It recommends educating children and the public on the issue, criminalizing the behavior, eliminating mistake-of-age as a legal defense, and increasing prosecution and penalties in certain circumstances.

Farrow, James A., et al., “Homeless and Runaway Youth Health and Health Needs,” 13 J. of Adolescent Health 717-726 (1992). (Available at www.adolescenthealth.org.) The authors describe the problems, including pregnancy, that these youth face globally and within the U.S, as well as model programs for serving them. It is estimated that half of ‘hard-core’ street youth resort to prostitution.

Federle, Katherine Hunt, "Looking Ahead: An Empowerment Perspective on the Rights of Children," 68 Temple L. Rev. 1585-1605.  The author states that "[f]rom a legal, psychological, or sociological perspective, it is unclear whether children are competent beings." Still, she recommends treating them as such.

Feldman, S. Shirley and Elliott, Glen R. (eds.), At the Threshold: The Developing Adolescent. Harvard University Press: Cambridge, MA, 1990. The book is a collection of articles. Of particular interest are Doris R. Entwisle, "Schools and the Adolescent" 197-224; Herant Katchadourian, "Sexuality" 330-351; and Susan G. Millstein and Iris F. Litt, "Adolescent Health" 431-456 Entwisle notes that pregnancy affects educational attainment, but she does not treat it in depth.  She believes pregnant and parenting   students are harmed by their socioeconomic status, gender discrimination, and the expectation that they will drop out.  Katchadourian writes that "the second half of the twentieth century has seen the widest separation in human history between the timetables of biological maturation and the socially acceptable expression of sexual behavior." He observes that ethnicity, socioeconomic status and religious affiliation influence sexual behavior and explains why American parents may avoid discussing sex with adolescents. He credits sex education with reducing pregnancy rates. Millstein and Litt list sexually transmitted diseases, sexual abuse, and pregnancy as major adolescent health problems.  They state that information alone will not change teens' behavior-- particularly that of "disenfranchised" teens.

Fleming, Gretchen, O'Connor, Karen G., and Sanders, Joe M., Jr., "Pediatricians' Views of Access to Health Services for Adolescents," 15 J. of Adolescent Health 473-478 (1994).  Most pediatricians surveyed want pregnant 13-to-15 year olds to have to seek their parents' consent for abortion. Large majorities also support parental notification for diagnosis and early management of pregnancy in girls that age. Pediatricians with these views are significantly more likely to be male, older, and self-employed than the cohort.

Flores, Glenn, et al., “The Health of Latino Children: Urgent Priorities, Unanswered Questions, and a Research Agenda,” 288 JAMA 82-90 (July 3, 2002).

Isabel Fonseca, Bury Me Standing: The Gypsies and Their Journey. Vintage: New York, 1995. Fonseca notes that in Gypsy communities very young adolescents bear children.  Describing these young mothers, who play with dolls while their mothers care for the babies, she comments, "Sometimes one mistakes girls for young women because they have children."

Ford, Carol A., Bearman, Peter S., and Moody, James, "Foregone Health Care Among Adolescents," 282 JAMA 2227-2234 (December 15, 1999). UNC Chapel Hill faculty, analyzing data from the 1995 National Longitudinal Study of Adolescent Health, found that nearly 19 per cent of 12,079 adolescents thought they had needed care the preceding year but not gotten it. Teens at greater risk compared with the rest were older, uninsured, of lower socioeconomic status, had no medical exam that year, minority race, from single-parent homes, and more often engaged in health risk behaviors.  The major reason stated for foregoing care (given by 63+%) was the adolescent's mistaken belief that the problem would go away. Next was fear of physician reaction (15+%), inability to pay (14%), confidentiality concerns (11+%),
adult's refusal to accompany adolescent to care (11+%) and difficulty making an appointment (nearly 9%).

Foster, Victoria A., Adolescent and Young Adult Females Making an Abortion Decision: A Profile of Ego and Moral Development. (unpublished dissertation) NCSU Department of Counselor Education: Raleigh, 1989. This is a study of 30 youth, aged 12-14, 17-19, or 23-25, who came to a medical facility for an abortion.  The author found that, while the older adolescents reasoned hypothetically at a higher level, and the moral reasoning of all three groups was lower in the real situation than the hypothetical one, "No significant differences were found in levels of moral reasoning regarding the abortion decision among the three groups....This unexpected finding indicated that moral reasoning regarding an actual choice may be an independent domain."

Furstenberg, Frank F., Jr., Lincoln, Richard, and Menken, Jane (eds.), Teenage Sexuality, Pregnancy, and Childbearing. U. of Pa. Press: Philadelphia, 1981.  These 28 articles focus on teens' sexuality and knowledge of the facts, law, and consequences of sexual activity on themselves and their children.

Gershenson, Harold P. et al., "The Prevalence of Coercive Sexual Experience Among Teenage Mothers," 4 J. of Interpersonal Violence 204-219 (No. 2, June 1989).  61% of 445 young women who had been pregnant as teens reported coercive sexual encounters.  The mean age of first abuse was 11.5 years. 54% of the sample was African-American; 38%, white; 8%, Hispanic. "Initial abusive encounters decline sharply as girls reach their middle and late teens.... 50% reported being abused between two and ten times.  The remaining one-fourth reported abuse as occurring more than ten times."  Almost one-third were abused by a family member and more  than half by a friend (not mutually exclusive categories). Nearly half of abusers were more than 10 years older than the girl and fewer than 20% were within two years of her age.

Grossman, Jean Baldwin, et al., Adult Communication and Teen Sex: Changing a Community. Public/Private Ventures: Philadelphia, 2001. This document is a report on an Annie E. Casey Foundation demonstration project to create an environment in which parents and teen children in five low-income, urban communities 1) would talk to each other about reproductive health 2) teens would have easy access to contraceptives and 3) sexually-active teens would act more responsibly. According to the authors, the project succeeded on each point but it was “a slow and difficult process.” A notable finding was that, as shown in other studies, teens much prefer to discuss their own sexual behavior with a nonparental adult.

Hartman, Rhonda Gay, “Coming of Age: Devising Legislation for Adolescent Medical Decision-Making,” 28 American J. of Law and Medicine 409-453 (2002). The author sees a “deepening chasm between scientific findings and legislation that discounts the decision-making ability of adolescents,” and concludes that “Far greater thought should be given to the policy concerns specific to adolescent patient care…and how legislation should protect and promote these interests.”

Hatcher, Sherry Lynn Marcus, "The Adolescent Experience of Pregnancy and Abortion: A Developmental Analysis," 2 J. of Youth and Adolescence 53-102 (1973).  The author analyzes the psychology of early, middle and late adolescence, tracing developmental themes in 13 girls of these ages who were faced with pregnancy and possible abortion.

Cheryl D. Hayes (ed.), Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing. (Vol. 1), National Academy Press: Washington, D.C., 1987. The book contains the findings and recommendations of the Panel on Adolescent Childbearing of the National Research Council.

Patricia Hersch, A Tribe Apart: A Journey into the Heart of Adolescence. Fawcett Columbine: New York, 1998. The author studied a group of suburban middle and high school students intensively over several years. Pregnancy, abortion, and teen parenthood were important issues for some of them.

Hill, David Lloyd, "Epiphany," The Independent. Durham, North Carolina (June 23-29, 1999), at 15.  A North Carolina physician writes about an emergency room diagnosis of pregnancy in a non-English-speaking teen.  He acknowledges initial failure to serve the patient well and the heroic role played by a 10-year old translator in improving the doctor-patient encounter.

Huberman, Barbara and Wild, Pamela, Teenspeak: A Summary of Health Behaviors, Resources, Attitudes and Risk Experiences of Selected Adolescents in 15 North Carolina Public School Systems Utilizing the Search Institute Youth Risk Behavior Survey. Adolescent Pregnancy Prevention Coalition of North Carolina: Charlotte, 1995.  The report suggests that NC girls (about 20% of whom reported sexual abuse) are abused 2% more frequently than the national average. "[M]any of our young teens who have had intercourse and then become pregnant may have been victims of sexual abuse." "With so few children receiving realistic instruction at an age-appropriate time, North Carolina youth are in the indefensible state of ignorance and vulnerability to sexual abuse."

Humphrey, John A. and White, Jacquelyn W., "Women's vulnerability to sexual assault from adolescence to young adulthood," 27 J. of Adolescent Health (December 2000) 419-424.  In this study of 1,569 undergraduate women (presumably at UNC-Greensboro) "[c]hildhood victimization increased the risk of adolescent victimization, which in turn significantly affected the likelihood of revictimization among college women."  Victims, who rarely report assaults to law enforcement, know most assailants.  Noting that sexual assault victims seek medical care far more often than other women, the authors conclude that "[e]arly
detection of sexual victimization of children and adolescents by primary care physicians is imperative to break the pattern of revictimization later in life."

Kaiser Family Foundation, 1999 National Survey of 9-12th Grade Public School Students About Sexual Health Issues and Services. (Available at http://www.kff.org). A random sample of 1,012 students, 1/3 of them sexually active, revealed broad ignorance about contraception, including emergency contraception, STD risks, the link between STDs and HIV, and how and where to get confidential health care for these conditions.

Krowchuk, Daniel P., Satterwhite, William, and Moore, Beverly Campbell, "How North Carolina Laws Affect the Care of Adolescents: Issues of Confidentiality and Consent," NCMJ, Vol. 55, No. 11, (November 1994), at 520-24.  Eight cases show clinicians the legal rules for providing health care to minors in North Carolina.

Ladner, Joyce, Tomorrow's Tomorrow: The Black Woman. Doubleday: Garden City, NY, 1971. The author distinguishes low-income African-American views on unmarried pregnancy from those in "a white middle-class value context." To the former, she says: "The first premarital pregnancy is perceived as a 'mistake,' more than a sin, and the girl is entitled to forgiveness. A very general attitude of acceptance of one's mistakes prevailed among the majority of the girls and their parents."

Lawson, Annette and Rhode, Deborah, (eds.), The Politics of Pregnancy: Adolescent Pregnancy and Public Policy. Yale Univ. Press: New Haven, 1993. The essays present differing views of whether and if so, why adolescent pregnancy is problematic:" the perspective of the United Kingdom versus the United States. whites versus minorities.the individual versus the community."

Levin-Epstein, Jodie, State TANF Plans: Out-of-Wedlock and Statutory Rape Provisions. Center for Law and Social Policy: Washington, D.C., August 1997. (Available at www.clasp.org.) Under the Welfare Reform Act of 1996 states must submit plans that explain how they will reduce out-of-wedlock births and encourage enforcement of statutory rape laws. This report charts the states' responses.

Levin-Epstein, Jodie, Teen Parent Provisions in the New Law. Center for Law and Social Policy: Washington, D.C., November 1996. (Available at www.clasp.org.) The article discusses the Welfare Reform Act's provisions on teens and state responses.

Kristin Luker, Dubious Conceptions: The Politics of Teenage Pregnancy. Harvard Univ. Press: Cambridge, MA, 1996. The author regrets the strong tendency to blame teen mothers for social ills that may not be causally related. "[E]ven before she bears a child, a teenager who becomes a mother is already subject to significant limits that will affect her in many ways no matter when she bears her first baby."

Madara, F.G., “Marriage or Pregnancy of Public School Student As Ground for Expulsion or Exclusion, or of Restriction of Activities,” 11 A.L.R. 3d 996 (1967). This report on case law shows a much greater judicial deference then than now to penalties imposed on pregnant and parenting students. Even then, a number of courts had refused to uphold such penalties.

Manson, Andrea Bazan and Verbiest, Sarah Zuber, Hispanics and the North Carolina Health Care System. National Association of Social Workers-North Carolina: Raleigh, 1994. ($10 to nonmembers of NASW-NC. 1 (800) 280-6207 or NASW-NC@aol.com). The book describes the Latino population of the state including its health issues and advises health providers how to work with these patients. It contains Spanish translation of parts of health interviews and a resource list.

Manson, Andrea Bazan, et al., Latina Reproductive Health in North Carolina: Demographics, Health Status, and Programs. Office of Minority Health, NC Department of Health and Human Services: Raleigh, NC, August 1999. OMH No. 20. (Single copies are available from the Office, (919) 715-0992.) The book describes the rapidly growing Latino/a population of the state, Latina women's reproductive health status, language and other access barriers to health care, and the most useful programs.

Mason, Janet, Reporting Child Abuse and Neglect in North Carolina. Institute of Government, UNC CH: Chapel Hill, N.C., 1996. The book explains the purposes of the laws on reporting possible child maltreatment, legal terms, the reporting process, the reporter's rights and potential liabilities and offers helpful advice. 
Appendices contain the reporting laws and related criminal laws.

Moore, Kristin A., and Sugland, Barbara W., "Piecing Together the Puzzle of Teenage Childbearing," Policy and Practice of Public Human Services: The Journal of the American Public Human Services Association (June 1999), at 36. The article states that the recent 15% decline in the teen birth rate in the United States "does not erase the 24 percent increase.between 1986 and 1991." The decline is in pregnancy, not in the abortion rate and the authors attribute the decline to higher rates of abstinence and improved contraceptive practice. Teens with family, school or behavior problems, in poverty or with low incomes are more likely to bear children. The authors urge rigorous evaluation of abstinence programs, combining sex education and skills building, supporting families and helping teens set goals.

Musick, Judith S., Young, Poor, and Pregnant: The Psychology of Teenage Motherhood. Yale U. Press: New York and London, 1993. The author states, "One of the major tenets of this book is that in order to avoid teenage motherhood, girls growing up in poverty need to possess not just average but above-average psychological resources and strengths, self-concepts, and competencies. Considering the many forces drawing poor females toward early unprotected sex and early parenthood, the scarcity of viable alternatives steering them toward school and work, and the responses of family and peers, which validate pregnancies once they have occurred, it is remarkable that rates of adolescent childbearing are not even higher.  As it is, these ever-present forces interact with developmental need and psychological vulnerability to draw many poor young women-even those
with considerable promise-into early parenthood."

Musick, Judith S., Handler, Arden, and Waddill, Katherine Downs, "Teens and Adoption: A Pregnancy Resolution Alternative," Children Today (November/December 1984) 24-29. The authors ask why so few teens choose adoption. Their answers include the strong belief of teens, their families and communities that a pregnant girl shows responsibility by bearing and raising a child; family/community support for teen pregnancy and parenting; minority communities' fear that minority- or mixed-race babies will not be adopted; teens' and providers' lack of knowledge about adoption; providers' failure to discuss alternatives with a pregnant teen; and pregnant teens' difficulty envisioning their own and an infant's future needs.

Nash, Margaret A. and Dunkle, Margaret, The Need for a Warming Trend: A Survey of the School Climate for Pregnant and Parenting Teens. Equality Center: Washington, D.C., 1989. A survey of twelve schools on their treatment of pregnant and parenting students reveals that few have clear policies and most violate federal law (Title IX).

National Association of Social Workers, Client Confidentiality and Privileged Communications: Office of General Counsel Law Notes. 1997. The memorandum reviews clinical social workers' obligation to keep clients' confidences.

National Association of Social Workers, Standards for the practice of social work with adolescents. NASW: Washington, D.C. 1993. (Available at www.naswdc.org.) The pamphlet contains 10 standards, followed by interpretations, for social workers as counselors and advocates for adolescents. It identifies these needs as essential: "a safe environment, adequate health care, .education., opportunities to develop skills, constructive outlets for leisure time, legal protection and redress, and the right to needed services."

National Association of State Boards of Education, Counselor/Advocates: Keeping Pregnant and Parenting Teens in School. NASBE: Alexandria, VA, 1990.  The document identifies these factors as affecting dropout: schools' lack of data on pregnant and parenting students; lack of concern; programs for pregnant but not parenting students; programs' isolation from other dropout prevention efforts; districts' failure to change policy or practices system wide; and schools' lack of regular contact and cooperation with other agencies. Changes and strategies are suggested.

National Coalition of Hispanic Health and Human Services Organizations, The State of Hispanic Girls. COSSMHO Press: Washington, D.C., 1999, (Available at www.hispanichealth.org/.) The report, based on focus groups of preteens, teens, youth workers and parents, chronicles the severe problems facing Hispanic teens in the U.S. and finds that acculturation magnifies the problems. The authors ask, however, that Hispanic girls be considered "at promise" instead of 'at risk.' "The four most serious threats to the health and education of American girls today are pregnancy, depression, substance abuse, and delinquency. These threats are more prevalent among Hispanic girls than among their non-Hispanic white or African American peers. Hispanic girls have the highest national rates of teenage pregnancy, suicide attempts, alcohol and drug abuse, and self-reported gun possession. It is chilling that about one in three Hispanic girls report seriously considering suicide, the highest rate of any racial or ethnic group." 

N.C. Department of Administration and Youth Advocacy and Involvement Office, Youth Rights and Responsibilities: A Handbook for North Carolina's Youth. Raleigh, North Carolina, Spring 1999. The book consists of 163 questions and answers about young North Carolinians' legal rights in these areas: school, work, money, transportation, health, controlled substances, abuse and neglect, the criminal justice system, parenting, emancipation, marriage, and citizenship.

N.C. Department of Public Instruction, Procedures Governing Programs and Services for Children with Disabilities. Raleigh, 1999. The book describes several categories of children with disabilities and the help and process each is entitled to under state law.  The department recognizes that pregnancy can be disabling, but pregnant students do not have the rights and remedies of those with other disabilities.  The most significant difference is the absence of a requirement for an individualized education program.  Instead, the state Board of Education directs that, "Local education agencies shall develop a written program to meet the special educational needs of pregnant students."

O'Leary, Kathleen M., Shore, Milton F., and Wieder, Serena, "Contacting Pregnant Adolescents: Are We Missing Cues?" Social Casework: The Journal of Contemporary Social Work (May 1984) 297-306. The authors describe the difficulty of providing services to this group and the long-term investment required. Despite the adolescents' absenteeism and apparent apathy, the authors think they benefited significantly, forming close bonds with caseworkers and taking what they needed of the services offered.

Orloff, Leslye E., Jang, Deeana, and Klein, Catherine F., "With No Place to Turn: Improving Legal Advocacy of Battered Immigrant Women," 29 Family Law Quarterly  (No. 2) (Summer 1995) 313-329. Although partially outdated, the article offers practical advice for those working with battered immigrant women.

Parker, Barbara, et al., "Physical and Emotional Abuse in Pregnancy: A Comparison of Adult and Teenage Women," 42 Nursing Research (May/June 1993) 173-177. The authors find a significantly higher percentage of pregnant teens (31.6%) reporting abuse in a year than adult women (23.6%). 21.6 % of teens reported abuse during their pregnancy compared to 15.9% of adults.

Plotnick, Robert D., "The Effects of Attitudes on Teenage Premarital Pregnancy and Its Resolution," 57 American Sociological Review (December 1992) 800-811.  This study of non-Hispanic white adolescents, based on data from the National Longitudinal Survey of Youth, sought factors that influenced both the likelihood of teen pregnancy for an individual and its resolution. The author concludes that "the likelihood of resolving a premarital pregnancy by abortion is positively related to high self-esteem and high educational expectations."

Presti, Susan M. and Blanche Glimps, "Pregnant Teenagers: Their Education is Suffering," N.C. Insight 2-8, vol. 4, no. 3 (September 1981). The authors recount the ambivalent history of North Carolina's treatment of pregnant and parenting students. In 1974 the General Assembly recognized them as students with special needs, but without state or federal funding for the group state education officials failed to address its problems.

Reddy, Diane, et al., “Effect of Mandatory Parental Notification on Adolescent Girls’ Use of Sexual Health Care Services,” 288 JAMA 710-714. The authors conclude “Mandatory parental notification for prescribed contraceptives would impede girls’ use of sexual health care services, potentially increasing teen pregnancies and the spread of STDs.”

Reeg, Bob, et al., Families on the Edge: Homeless Young Parents and Their Welfare Experiences. Center for Law and Social Policy (CLASP): Washington, D.C., 2002. Available at www.clasp.org. This document reports on interviews of 120 homeless young parents about their own welfare eligibility, knowledge of and access to benefits, and the effect on them of the requirement that minor parents receiving welfare must live with a parent. The survey showed that while 84% were eligible, only 40% received welfare assistance. Half of the remainder did not know of the program. Fourteen service organizations (of 20 surveyed) said homeless parenting youth had difficulties with access. Thirty-one per cent of youth subject to the living-with-parent rule said it had placed them in an unsafe setting.

Roberts, Paula, “Child Support—an Important but Often Overlooked Issue for Low-Income Clients,” Poverty Law Manual for the New Lawyer. CLASP: Washington, D.C., 2002. The author explains child-support collection, emphasizing the needs of low-income single parents.

Quinn, Pammela S., "Preserving Minors' Rights After Casey: The 'New Battlefield' of
Negligence and Strict Liability Statutes," 49 Duke L. J. 297-337 (1999).  The author argues "that statutes that would hold abortion providers liable for failing to ensure that their minor patients have actually obtained legal consent are generally unconstitutional." She takes special notice of Jackson v. A Woman's Choice, the NC Court of Appeals decision.

Ruch-Ross, Holly S., Jones, Elizabeth D., and Musick, Judith S., "Comparing Outcomes in a Statewide Program for Adolescent Mothers With Outcomes in a National Sample," 24 Family Planning Perspectives (March-April 1992) 66-71.  The study concludes that a year of intensive family support can significantly improve school enrollment, employment and subsequent pregnancy figures for adolescent mothers,  even though program participants were poor, minority race, and young compared to a national sample.

Sandven, Kari and Michael D. Resnick, "Informal Adoption Among Black Adolescent Mothers," 60 Amer. J. of Orthopsychiatry 210-224 (1990). The study consisted of 54 mothers who chose "shared parenting" with a family member, made a "gift" of their child to another, or became "exclusive" parents by moving out on their own.  (80% of the last group retained contact with the baby's father.)  The researchers say why the mothers rejected legal adoption. The reasons included a very high expectation of negative reaction from partner, friends, and family. 

Satcher, David, The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. Office of the Surgeon General: Washington, D.C., June 28, 2001. The report recommends frank discussion with teens about sexuality and health problems related to it. The Surgeon-General also urges "thorough and medically accurate sex education."

Sawhill, Isabel V., "Welfare Reform and Reducing Teen Pregnancy," The Public Interest. No. 138 (Winter 2000). The author, who is president of the National Campaign to Prevent Teen Pregnancy, reviews statistics about teen pregnancy in the United States and considers the problems it poses for welfare reform. She describes how states have used federal abstinence education funds and concludes by urging states to work "in partnership with civic and faith-based institutions" to align the culture's values against sexual activity for teens.

Saxon, John, "Confidentiality and Social Services (Part I): What Is Confidentiality?" Janet Mason (ed.), Social Services Law Bulletin. No. 30, Institute of Government: Chapel Hill NC, February 2001, and "Confidentiality and Social Services (Part II): Where Do Confidentiality Rules Come From?" Social Services Law Bulletin. No. 31, Institute of Government: Chapel Hill NC, May 2001. These articles begin a series on confidentiality, describing what is confidential and why; common exceptions to confidentiality; and what rules govern DSS' acquisition, use, protection and disclosure of confidential information.

Scott, Elizabeth S., "Judgment and Reasoning in Adolescent Decisionmaking," 37 Villanova L. Rev. 1607-1669 (1992). The article tells how the law sees adolescents as medical decision makers. The author objects to researchers' observations that adolescents "do not think or act like children" and that the cognitive abilities of teens 14 and over are the same as adults'. Instead, she urges recognition that judgment increases with age. 

Scott-Jones, Diane, "Educational Levels of Adolescent Childbearers at First and Second Births," 99 American J. of Education. U. of Chicago: (August 1991) 461-480. The author finds a negative relationship between marriage and educational attainment for African-American, white and Hispanic teen mothers; lower educational status for Hispanic mothers; "significantly higher educational levels" for black second child-bearers than white or Hispanic; older male partners, especially for Latinas.  Most significantly, early adolescent mothers, even mothers of two, were barely below the national median in educational attainment and black mothers exceeded it.  She concludes that early adolescents in general have school problems, but also that schools should concentrate their efforts to prevent school failure on the youngest mothers.

Silberman, Pam, North Carolina Programs Serving Young Children and Their Families. NC Institute of Medicine: Chapel Hill, NC, 1999. The book explains "more than 30 publicly-funded social services, public health or mental health programs available to serve young children and their families," as well as some programs for older children.

Sigman, Garry, Silber, Tomas, English, Abigail, and Gans, Janet, Confidential Health Care for Adolescents: Position Paper of the Society for Adolescent Medicine. 21 J. of Adolescent Health 408-415 (1997). The Society considers confidentiality an essential element in adolescent health care and advises providers to inform adolescents and their parents of confidentiality requirements.

 Society for Adolescent Medicine, "Homeless and Runaway Youth Health and Health Needs: A Position Paper of the Society of Adolescent Medicine," 13 J. of Adolescent Health 717-726 (1992). (Also available at www.adolescenthealth.org.) The paper estimates the international magnitude of youth homelessness (U.S. estimates range from 1/2 to 2 million) and notes the difficulty of counting the group. It lists the major reasons for leaving home, the dangers youth encounter living on their own, their survival mechanisms, and health threats including unintended pregnancy. It concludes with recommendations.

Rickie Solinger, Wake Up Little Susie: Single Pregnancy and Race Before Roe v. Wade. Routledge: New York and London, 1992. This history of unmarried motherhood in U.S. society post-World War II emphasizes the quite different-though both painful--experiences typical for black and white women.

Stam, Paul, "The End of the North Carolina Abortion Fund," 22 Campbell L.J. 119-142 (1999). The author traces the history of the fund, stating that "In 1967, North Carolina became the second state in the nation to remove meaningful restrictions on abortions performed by doctors..In 1978, North Carolina became the only state in the South to begin a fund for payment of elective abortion. This fund for all practical purposes, ended in 1995."

Stamm, Monica J., "A Skeleton in the Closet: Single-Sex Schools for Pregnant Girls," 98 Colum. L. Rev. 1203 (1998). The author challenges "the current disparate legal treatment of [single-sex schools and pregnancy schools] and the legal validity of the ventured justifications for distinctive treatment of pregnant students." She is concerned that courses for the latter are inferior in quality to regular course work and recommends better enforcement of Title IX's regulations requiring pregnancy programs to be both comparable to mainstream programs and voluntary. She states that "failure of a regular school to provide students with the accommodations necessary for them to remain in regular school programs, coupled with the existence of a separate program that does provide accommodations, may force pregnant students to choose between enrolling in a separate program and dropping out of school just as effectively as a policy requiring them to do so." (The author is quoting from Deborah Brake's work listed above.)

Stone, Rebecca and Waszak, Cynthia, "Adolescent Knowledge and Attitudes About Abortion," 24 Family Planning Perspectives 52 (1992). The authors questioned 11 groups of teens (one in Waynesville, North Carolina) about abortion.  A majority of teens opposed both abortion and parental involvement laws. They did not know that abortion was legal, nor whether their state required parental involvement. They believed that abortion was usually physically and emotionally dangerous. The authors conclude that teens "need factual information on unplanned pregnancy and abortion as an option."

Surles, Kathryn B., Adolescent Health in North Carolina: The Last 15 Years (Bulletin No. 89). State Center for Health and Environmental Statistics: Raleigh, NC, January 1995.  The bulletin contains data on contraception, STDs, abortion, childbirth, repeat pregnancies, marriage, and fetal and infant mortality.

Suro, Roberto, Strangers Among Us: Latino Lives in A Changing America.Vintage: New York, 1998.  The first chapter of this book on U.S. policy and practice with respect to Latino immigration focuses on the problems of the second generation of
immigrants, including high rates of teen pregnancy. The author states that "The danger posed by Latino dropout rates is compounded by a parallel crisis in teenage
pregnancies. The rate of teenage births among Latino women rose by 32 percent between 1989 and 1995."

U.S. Department of Education, Office for Civil Rights, Teenage Pregnancy and Parenthood Issues Under Title IX of the Education Amendments of 1972. (July 1991). The pamphlet restates the regulations in simple terms.

Weimann, Constance M., et al., "Pregnant Adolescents: Experiences and Behaviors Associated with Physical Assault by an Intimate Partner," 4 Maternal and Child Health J. 93-101 (2000). 724 girls (aged 12 to 18) delivering at the U. of Texas Hospital in Galveston were interviewed about domestic violence. 11.9% reported that the baby's father had physically assaulted them within the preceding year. The authors recommend that health providers make "comprehensive assessments for all adolescent females at risk of assault, and [ask] direct questions about specific behaviors or situations.."

Zabin, Laurie Schwab, “Ambivalent Feelings About Parenthood May Lead to Inconsistent Contraceptive Use—and Pregnancy,” 31 Family Planning Perspectives. Alan Guttmacher Institute: New York, NY, September/October 1999. Available at http://www.agi-usa.org. Commenting on others’ research on contraceptive use, the author notes the many areas of uncertainty as to American women’s intent to conceive and willingness to use contraception effectively and to bear children under less than ideal circumstances. She concludes, “We do not value children enough to believe that unprotected sex should occur only when two persons share a positive and conscious desire for parenthood.”

Zellman, Gail L., A Title IX Perspective on the Schools' Response to Teenage Pregnancy and Parenthood. The Rand Corporation: Santa Monica, 1981.  Under contract with the U.S. Department of Education, Office for Civil Rights, and the National Institutes of Education, the author studied the operation of federal law on pregnant and parenting students in 12 schools. She concluded that 1) "schools neither seek nor want an active role in student pregnancy and parenthood;" 2) special programs for these students usually result from a single advocate's efforts and reflect her or his views; 3) the quality of such programs is quite varied; 4) each program meets some student needs but none meets all; 5) "Very little information is available concerning longer-term outcomes for adolescent parents." 6) a school usually views a special program as sufficient effort on its part; and 7) "Title IX has had only a limited and indirect impact at the school site level."  Zellman thinks the absence of Title IX enforcement or of state or local policies on treatment of these students, allowed school staffs' attitudes to dominate.  Since staff members' attitudes ranged from negative to neutral, pregnant and parenting students got little help.

Zellman, Gail L., The Response of the Schools to Teenage Pregnancy and Parenthood. The Rand Corporation: Santa Monica, 1981. The study, for the National Institutes of Education, probes students' decisions about schooling and marriage and the schools' role in keeping pregnant and parenting girls in school. It also describes exemplary school programs. The report criticizes schools' reluctance to acknowledge these students' problems or help solve them. While urging that help be offered to the entire group, the study's main finding "is the enormous diversity among these young people."

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