Pregnant again? A qualitative assessment of rapid repeat pregnancy among African-American adolescents

Background: African-American adolescent females consistently have one of the highest birth rates among all races, with approximately 50% experiencing a rapid repeat pregnancy (RRP) within 24 months of initial pregnancy. Despite existing hypotheses about the factors influencing RRP, it is unclear what distinguishes adolescents who have only one pregnancy from those with multiple pregnancies. Through the use of qualitative methods, this study aimed to better understand individual and familial factors that affect adolescents' risk for RRP.

Methods: Face-to-face, semi-structured individual interviews were conducted with 20 unmarried, African-American females (14-20 years) participating in a randomized controlled HIV prevention trial who experienced at least one prior pregnancy. Half of the sample (n = 10) had a RRP; half did not. Participants were recruited from reproductive health clinics in a southern metropolitan city. Interviews were audio-taped, transcribed verbatim, and content analyzed for predominant themes.

Results: Adolescents experiencing RRP were more likely to be influenced by factors such as aggressive behavior, prior pregnancy with intent to deliver, current partner/boyfriend, and family acceptance of the initial pregnancy. Conversely, key factors differentiating adolescents without a RRP, from those experiencing RRP, were their future goals, educational aspirations, and family disapproval of initial pregnancy.

Conclusions: Differences in individual and familial influences exist between rapid repeaters and non-repeaters. Pregnancy prevention interventions may prove more efficacious by incorporating peer mentors as positive role models to enhance adolescents' future orientation, decision-making skills, and self-efficacy. Additionally, parent involvement could create a family environment that discourages pregnancy and supports adolescents' positive youth development.