Teenage pregnancy: barriers to an integrated model for policy research.

• Author: Nash, Roy

Abstract

New Zealand has one of the highest teenage pregnancy rates in the developed world. In the UK, where the rate is lower than New Zealand's but twice the European average, a Cabinet-led programme has been launched to bring the problem under control. This paper argues the case for New Zealand research into teenage pregnancy -- and the sexual activity of young people in general -- in its full social and cultural context. Three conceptual barriers to this project are identified and discussed: (i) "at risk" positivism; (ii) "true effect" reductionism; and (iii) the concept of culture. It is suggested that a realist structure-disposition-practice model with a "numbers and narratives" methodology may be able to overcome these barriers, and thus widen the focus of an area of research currently dominated by a medical paradigm.

INTRODUCTION

New Zealand has one of the highest teenage pregnancy rates in the OECD. In 1997 the age-specific pregnancy rate for women 15-19 years of age was 33/1,000 for non-Maori and 94/1,000 for Maori (Dickson et al. 2000). Among developed countries, only the United States records a higher statistic.

The specific incidence of teenage pregnancy is not necessarily influenced by changes in the sexual activity of young people, but there is an obvious relationship between sexual activity and pregnancy, and there is much to be said for an integrated approach in this field. Reliable studies indicate that the age of first sexual intercourse in New Zealand is decreasing and that the proportion of sexually active young people at school is increasing (Silva and Stanton 1996, Dickson et al. 1998). It is safe to conclude that at least a third of New Zealand teenagers are sexually experienced before they are 16, the minimum school-leaving age, and that well over half are engaged in sexual activity while at school (Fenwicke and Purdie 2000).

It is appropriate that medical research should focus on matters of social and individual health. Studies within this paradigm emphasise the need for sex education aimed at the prevention of unwanted pregnancy and the control of sexually transmitted diseases. Specific health concerns, however, do not exhaust the reasons for taking a legitimate interest in the sexual activity of young people and its consequences in pregnancy (Cunningham 1984, Simms and Simms 1986). The long-term costs of teenage pregnancy to the state, in terms of sole-parent family benefits expenditure is substantial (Goodger 1998). These are acknowledged as the principal reasons for the recent determination to tackle teenage pregnancy in the United Kingdom, where the Cabinet has launched a multi-pronged campaign to address what is perceived there to be a serious problem (Social Exclusion Unit 1999:4).

This paper outlines an agenda on teenage pregnancy in New Zealand that would provide what policy makers need to know in order to carry out their tasks. This will include assessing the actual state of affairs and whether there is a problem to address, identifying the sectors of the population involved, developing policy options, and evaluating the results of intervention programmes. The challenge for sociologists with a responsibility to assist in these state tasks is to construct a realist framework within which the complex processes that generate social inequalities of various kinds can be modelled. An approach able to transcend the dichotomies that plague social research -- qualitative versus quantitative, positivist versus hermeneutic, and theoretical versus applied -- can be achieved. The realist framework developed here has been influenced by Archer (1995), Bhaskar (1993), Bunge (1998) and, despite the different ontological foundations of his work, Bourdieu (1993, 1998, 2000).

In a word, social structures generate socialised dispositions, socialised dispositions generate collective practices, and practices are adopted by individuals. Social practices should not be confused with the level of behaviour; they are socially recognised ways of doing things that are taken up, perhaps as "discourses", by people in a certain frame of mind. This theoretical agenda is combined with an integrated "numbers and narratives" methodology. The overall scheme is, in fact, the standard form of any systematic sociology (Nash 1999). "Numbers and narratives" is a slogan intended as a corrective to the unprincipled methodological division in social research between qualitative and quantitative methods. It is plain that numbers need narratives to explain them and it should equally be plain that unless the various magnitudes of a matter under investigation are known an explanatory narrative will be that much less valuable.

Although the interminable debates about sociological theory are likely to have minimal interest for policy makers confronted with pressing material problems, some discussion of these areas seems necessary. At least three powerful obstacles confront the development of a realist structure-disposition-practice research programme into the substantive area of teenage pregnancy and the sexual activity of young people. These can be identified as, (i) the privilege given to forms of statistical explanation that favour a positivist over a hermeneutic account, embedded in the practical-theoretical "at risk" concept; (ii) the preference for behaviourist and reductionist models that isolate behaviour from its social context; and (iii) the support given to an authoritative concept of culture that inhibits recognition of actual and lived cultural practices.

BARRIER ONE: THE "AT RISK" CONCEPT

The "at risk" concept is so deeply embedded in the professional discourse of policy makers that to subject it to critique is not without risks of its own. Statistical models provide the standard form of analysis and explanation for the purposes of policy making and state management and a kind of shorthand has emerged in which behaviour is typically explained by "risk factors". This model, however, has its limitations. As an explanation of a social practice, to say that those who adopt it do so because they are the kind of people who probably will do so, does not explain why recognisable forms of social practice have emerged, or why particular individuals (rather than others with similar "risk" characteristics) should adopt them, or why their proportion might be 10% or 20% rather than some other figure. The related notion, that all students from a particular group, identified, for example, by its social or ethnic origin, are each equally "carriers" of a specified weight of disadvantage, a virtual handicap, is a further common error.

Those at home with this discursive framework, nevertheless, often allow the apparent practical utility of such accounts to obscure their fundamental weakness. The "at risk" concept, however, has no explanatory value and gives support to a "cycle of deprivation" model that is not necessarily supported by the evidence (Dean 1997, Jones et al. 1986). There is in reality no one-to-one correspondence between income and lifestyle and, just as family resources have a continuous distribution, so do social practices. The distribution of family resources -- including income, cultural capital, and social networks -- and the discourses of practice, follow a continuous distribution in which sharp breaks are difficult to detect.

It may be useful to illustrate the limitations of conventional "at risk" models -- positivism in practice -- through an examination of a report from the Dunedin multidisciplinary survey into the determinants of sexual activity before age 16 (Paul et al. 2000). The authors used logistic regression to discover the variables that discriminate between boys and girls who had sex before 16 and those who did not. The technique is a widely used and valuable statistical method. The first point to note is that only 12 variables, of the thousands available in this extensive longitudinal data set, were of any significance in discriminating between the two groups. Of these, two were structural variables (socio-economic status, mother under 20 at first birth); five were individual or dispositional (IQ, self-esteem, reading score, not attached to school, and plan to leave early); and two were practice variables (no home interests at age 13, no religious...