* * Anonymous Doc

Monday, December 12, 2011

Met a very pregnant 14-year-old today. It's weird, we see all sorts of people in the hospital who, I don't know, I started to write "who have made poor choices in their lives," but that's not entirely fair, and I know some situations are out of people's control, at least in part, or thrust upon them through no fault of their own-- but there are drug addicts, criminals in and out of prison, alcoholics, people mistreating their bodies in all sorts of ways, morbidly obese patients who won't change their diets, people who won't take necessary medication, people who can't seem to follow up and get the tests they need, etc. It's hard to keep from judging, but, in most cases, I don't think most judgments are necessarily obvious to the patients. I don't see people outwardly rude to their patients, for the most part. The goal is to help. But a pregnant 14-year-old, somehow-- and I wouldn't have guessed this-- seems to be far harder for a lot of people to deal professionally with than, say, a drug dealer, or an unreformable alcoholic. The tone, the looks, the attitude. Maybe it's because in medicine we don't generally see OB patients, this was an unusual circumstance, and so we're not sensitized to it. But I don't think that's it. I don't know quite how to put my finger on it. Yes, birth control is pretty accessible in today's society, but is getting pregnant at 14 objectively worse than a lot of other unfortunate situations seen in the hospital? I don't know. Maybe it would be different if I were female. Maybe it would feel like something more terrible, not that it makes any sense to be ranking terriblenesses. And, frankly, for me it tends to be the people-- especially the parents-- who won't quit smoking who I sympathize with the least. If I were a sociologist, this feels like an interesting research project-- what do people feel deserves the most stigma, off a list of unfortunate circumstances that are on at least some level within someone's control to prevent. By the end of the consult, I felt really bad for the patient and the attitudes she was surely dealing with to a much greater extent than just the 20 minutes I was with her. Yes, maybe she made some bad choices, and maybe it's going to seriously impact her chances of what the people who work in a hospital would call a successful life. But it is better than being a crack addict, no?


  1. Good post. I have looked after pregnant 13 year olds......and you are right....they are judged ... it's sad really....

  2. She problably did make at least one poor choice (unless she was raped), but a poor choice made by a 14 year old is, in my mind, much more forgivable than the mistakes made by full grown adults with the time to have gained sufficient maturity/life experience to make better decisions. Its just happens to be easier to judge a 14 year old who is pregnant, because her mistake is so visible.

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  4. Birth control isn't as accessible as you'd think, especially depending on what state you live in. And then people are going out of their way to make it even less accessible to teenage girls, the population that is most likely to be uneducated about how to go about having safe sex. Think about the recent developments in accessibility to Plan B. Though the FDA was ordered by a judge to make it available over the counter, it was recently decided (I can't remember by who, I haven't read up on this case much besides basic details so you might want to look it up) that they would keep it behind the counter and unavailable to women 17 and under without a prescription. Though he didn't make the decision, Obama reaffirmed that he supported this move, but, at least IMO, he didn't give any solid reasoning for it besides "because I have teenage daughters."

    Another good, extreme example of this predicament is a recent news story in which a woman who already had children got pregnant and knew she wouldn't be able to care for an extra child. With no car, there were no abortion clinics accessible to her, since the nearest one was 2 hours away and her state requires the 48 hour waiting period. Long story short, she asked her sister to buy her RU-486 online, and now, somehow, she's being prosecuted for self-induced abortion. Source with longer story here.

    This sort of drifted off-topic, but the point is that it's kind of a terrifying time to be a woman who is biologically capable of getting pregnant. The girl you saw today is a good example of that - there's really no way out of her situation that doesn't involve people heaping judgment upon her, and there will be health repercussions for the rest of her life, as well as financial repercussions should she choose to keep and raise the child. My second point is that (and I'm making a massive assumption here since I don't have many details about the girl), it's entirely possible that she did want an abortion at one point, but couldn't get Plan B, and, like the woman in the news story above, had no way to get access to an abortion center.

    I'm strongly considering approaching my doctor about getting sterilized (which is also difficult because doctors are more reluctant to sterilize women for whatever reason. You get a LOT of "are you suuuuure though?"). Husband and I don't want kids, and I don't want an accidental pregnancy interfering with my dreams of med school. I live in a state with pretty liberal abortion regulations now, but I don't want my future to rest in the hands of states' rights, waiting periods, accessibility and the like.

  5. Until access to birth control, Plan B, and abortions are granted to all women of reproductive age, it's hard to lump pregnant teens in the same category as the others you list in your article.

    Pregnancy is super-visible, and afflicts only one of the two people who 'made a bad choice' -- intuitively, it seems less likely that people would judge a 14-year-old boy who knocked his girlfriend up than the girl you treated.

    I'm a psychologist who has always always always wanted to study this phenomenon, but the stigma is too great. As a PhD and someone who has had two abortions herself (and who knows that getting an acadmic job in the sciences while pregnant is nearly impossible), the issue of when and why we judge women for getting pregnant is understudied and totally fascinating. Unfortunately, few people want to put such studies on their CV, and few institutions will smile upon such contentious work.

  6. I know I'll be the unpopular one here as a conservative Catholic. But I don't think this girl's problem was that she didn't have access to an abortion clinic. I'm going to say that children/teens should not be having sex - even though that's an unpopular thing to say. Everyone makes mistakes, and I think it's terrible that this young girl is being unfairly judged, and certainly suffering more stigmatism than the young man who helped her into this situation. There are options other than abortion. If she chooses not to raise the child there are many American families looking to adopt infants (of any color). She needs forgiveness, and compassion, and support... not better access to abortions.

  7. Sheesh. In the UK birth control is free and the morning after pill available via GPs and chemists. And I've never heard anyone protest against providing birth control and sex ed on grounds of moral outrage.

    On the other hand, our teen pregnancy rates are still way too high for other reasons. Teens make dumb choices, there aren't enough good jobs, and the benefits system allows it.

  8. Fourteen-year-olds' brains are not fully developed, and they should not bear complete responsibility for their decisions. Even the criminal courts recognize this. I have seen some home environments in which a girl that age simply wouldn't be able to make a free decision to have or not have sex. That is one reason we have statutory rape laws.

    It is a shame that these girls are judged, but I know they are. It is a bigger shame that they cannot get free of whatever is holding them captive. Childhood experiences and home environment are so very important.

    One can only hope that they get a chance to grow up sooner rather than later.

  9. She probably didn't get pregnant without someone else making a decision, too. He's not visible, though.

    We really do need universal sex ed and access to birth control (including condoms) and abortion.

  10. It's not uncommon for a 14-year-old to get pregnant. The stigma is perhaps related to the fact that this one STAYED pregnant.

  11. Anonymous just below my previous comment: Right. Back when I was a teen, when we whispered about a girl being "in trouble" and "needing to get married" - even back then I couldn't understand why girls who got pregnant were kicked out of school, but the boys who got them pregnant kept attending the same school.

  12. Well, um... since she's pregnant, and she's fourteen, you can be sure she's been raped. Could that be what's bothering you? Statistically, the rapist is probably one of her relatives. Her father, her brother, or an uncle, maybe. Maybe that's what's bothering you.

    Or maybe not.

  13. "Yes, maybe she made some bad choices, and maybe it's going to seriously impact her chances of what the people who work in a hospital would call a successful life. But it is better than being a crack addict, no?"

    Actually, no! With a child you are responsible for protecting, providing for and raising another human life. With a crack addiction, you are only harming yourself. If she's not capable of either using birth control properly or avoiding sex, can she really be responsible enough to raise a child? And at 13/14, can ANYONE be responsible to raise a child?

    In addition, even though it is monumentally hard to do so, a crack addict CAN get help and reform in a matter of years. Get their life back on track. A child sticks around for 18-25 years-- no matter what.

    So, yes, having a teen pregnancy is FAR worse than a crack addiction.

  14. Anon doc -- I can tell you why some people think it's worse. It's because YOU HAVE TO HAVE SEX TO GET PREGNANT. (God forbid)

    Being a crack addict is way worse. Crack addicts destroy not only their own lives, but the lives of everybody around them. They steal. They lie. Some people actually believe that it's worse to have sex as a 14 year old? Some people really need to get a grip.

    Raising a baby is a big deal, especially for a teenager. In order for her to be able to do it she needs help from friends, family. Lots of people. Judgement and moral superiority is completely counterproductive.

  15. 14 is too young to legally give consent. Anon 4:03 has it right.

    Statistics say that someone getting pregnant that young was likely molested/raped at a young age and doesn't believe she has any rights over her body, doesn't believe it's okay to say no.