Reflections on falling teenage pregnancy rates

DMacA_3Domhnall MacAuley is a CMAJ associate editor and a professor of primary care in Northern Ireland, UK

Teenage pregnancy rates have fallen in England and Wales according to recent reports. Teenage pregnancy was one of the great failures of society- scandal, horror, tragic headlines often accompanied by photographs of bulging girls in school uniforms. From a public health and societal perspective, the trend downwards is to be welcomed. Pregnancy changes the lives of every parent and teenage pregnancy creates particular difficulties.

For many teenagers coming to the surgery, periods were a distant memory and the bump palpable, so urine testing was unnecessary. Mothers stormed out of the consulting rooms at hearing the news, fathers wouldn’t speak to their daughters, schools scandalized and neighbors whispering. And, on a few occasions, there were completely concealed pregnancies. But, a new baby seems to melt even the hardest heart, sisters rallied around, and the new young grandmother took charge. On one occasion, after a delivery during the week, the new mum was at the disco on a Saturday night. Some of these pregnant schoolgirls are now old enough that their children are successful young adults and the past a forgotten memory. Although I wouldn’t wish the trauma of an unplanned pregnancy on any young women, it never appeared to me to be the awful tragedy painted by the self-righteous guardians of society’s morals.

The forgotten mums are the middle class, successful career women in their late twenties or thirties. Their expectations have been fed by a decade of shiny magazines full of happy smiling infants and glamorous super mums. The reality for them is very different. Suddenly they are faced with this 24 hour unpredictable creature with no off button and no instructions, an expectation of perfection, and complete lack of control. No one really explained about the end of sleep-ins, coffee with friends, or even time to answer the phone. Endless feeding and nappy changing. When you have been in complete charge of your life, this can be devastating. Often living away from their mothers and sisters, and their partners at work all day, the loneliness and isolation can be overwhelming. A little bundle of unlimited commitment, crying for no reason and with endless needs is not a bundle of joy.

Thankfully, it usually works out in the end. Memory is benignly selective and the human race continues. Children are wonderful but it’s not always perfect. For anyone.

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