PREGNANCY AMONG AMERICAN-INDIAN ADOLESCENTS - REACTIONS AND PRENATAL-CARE

Purpose: Adolescent childbearing is twice as common among Native Ameri cans as among all US races combined. Despite this, little is written a bout the psychosocial context or prenatal care of pregnant Native Amer ican adolescents. The objective of this study was to explore the react ions and prenatal care of Navajo and Apache adolescents delivering inf ants at Shiprock Indian Hospital, New Mexico, between January and Marc h 1991, and Whiteriver Indian Hospital, Arizona, between May and June 1991. Methods: Of the 25 eligible adolescents aged 19 years and younge r, 15 Navajo and 5 Apache participants were interviewed within 24 hour s of delivery. The interview consisted of 121 questions divided into 5 areas: sociodemographics, personal and family reactions to the pregna ncy, knowledge and attitudes toward prenatal care, barriers to care, a nd ways to improve access to care. Results: The mean age was 17.4+/-1. 1, 6 were married, and 13 were primiparous. According to the Maternal Health Services Index, 5 adolescents received adequate, 13 intermediat e, and 2 inadequate prenatal care. During the pregnancy, 3 adolescents used tobacco, 3 used alcohol, and none admitted to other drugs. Altho ugh only 1 adolescent planned the pregnancy, 15 were not using contrac eption when they became pregnant. In exploring reactions to the pregna ncy, 13 adolescents were afraid to tell their families and 4 concealed the pregnancy until confronted. During the pregnancy, 7 adolescents d escribed loneliness and 6 expressed suicidal ideation. Although, over half reported no barriers to obtaining prenatal care, barriers that we re noted by the remainder included transportation, family problems, an d missing school. Conclusion: We conclude that pregnancy among many Am erican Indian adolescents is unplanned and characterized by uncertaint y and fear of disclosure, resembling the reactions to pregnancy of oth er adolescent populations. Furthermore, despite universal access to he alth services, many American Indian adolescents continue to experience barriers to care and receive intermediate or inadequate prenatal care . These preliminary findings suggest further research may help clarify how adolescent reactions to pregnancy and knowledge of prenatal care affect health care utilization.