Applied & Preventive Psychology 2:101-113 (1993). Cambridge UniversityPress. Printed in the USA.

Copyright © 1993 AAAPP 0962-1849/93 $5.00 + .00

Unwanted teenage pregnancies: Incidence,

interpretation, and intervention

DONN BYRNE AND KATHRYN KELLEY

State University of New York, University at Albany

W I L L I A M A. F I S H E R
University of Western Ontario

Abstract

The increased permissiveness of sexual attitudes and the increased incidence of teenage sexual activity in the
decades following World War II have been well documented in both North America and Western Europe.
Concomitant with these changes has been the pervasive neglect of effective and consistent contraception.
Among the deleterious consequences is an alarmingly high frequency of unintended and unwanted teenage
pregnancies, especially in the United States. Even the threat of human immunodeficiency virus infection has
not brought about dramatic behavioral changes involving either sex or contraception. Explanations for this
maladaptive adolescent behavior are conceptualized in terms of situational and dispositional factors. A
framework for intervention is presented, including procedures designed to identify deficiencies and to bring
about necessary changes in contraception-relevant information, motivation, behavioral skills, and situational
constraints. Examples of successful intervention programs are outlined.
Key words: Contraception, Sex, Teenage pregnancy

It is well documented that the sexual attitudes and behav-
iors of young people in North America and much of
Western Europe changed radically between the 1940s
and early 1950s (Kinsey, Pomeroy, & Martin, 1948; Kin-
sey, Pomeroy, Martin, & Gebhard, 1953) and that a
dramatically different era began scarcely a decade later
(Reiss, 1961). Attitudinal shifts were unidirectional--to-
ward increased sexual tolerance, acceptance, and permis-
s i v e n e s s - a n d changes in overt behavior were consistent
with these newly liberalized views (Kelley & Byrne,
1992).
Incidence of Premarital Intercourse, Contraceptive
Use, and Unwanted Pregnancies
By the 1970s, the most obvious behavioral changes in-
volved premarital sexual interactions that began at a
younger age, incorporated a wider array of sexual prac-
Send correspondenceand reprint requests to Donn Byrne, Depart-
ment of Psychology, State University of New York, University at
Albany, Albany, NY 12222.
tices, and included more partners than ever before
(Christensen & Gregg, 1970; DeLamater & MacCor-
quodale, 1979; Hunt, 1974; Rutter, 1980). Thus, in the
1970s, most men and women reported engaging in
premarital sex (Kelley, 1987a).
Contraceptive Neglect
However positively or negatively one might evaluate
this newfound sexual freedom, a concomitant fact
caused widespread concern. The sexual activity of teen-
agers was generally characterized as contraceptively
careless. All too often, coitus was practiced without the
consistent use of contraceptives or with the use of inef-
fective methods of contraception (Cvetkovich & Grote,
1981; Cvetkovich, Grote, Bjorseth, & Sarkissian, 1975;
Kantner & Zelnik, 1973, 1977; Kegeles, Adler, & Irwin,
1988; Morrison, 1985). The United States has been con-
spicuously less successful than other economically ad-
vanced nations in altering this pattern of behavior
(Jones et al., 1985).
In the threatening atmosphere that grew rapidly in the
1980s and early 1 9 9 0 s I b a s e d first on fears of genital

101
102 Byrne, Kelley, and Fisher
herpes and later on even greater fears of human im-
munodeficiency virus (HIV) infection--sexual behavior
has become somewhat more cautious, but behavioral
norms have not returned to the relatively constrained
levels of the 1940s and 1950s (Green, 1985; Wielandt,
Boldsen, & Jeune, 1989). For example, at least one out of
every five 15-year-olds is sexually experienced (Moore,
Nord, & Peterson, 1989), and a recent study of almost
1,500 students in the sixth grade through high school
reported that two out of five youngsters are sexually
active (Brown, 1991). Even in the midst of well-publi-
cized anxieties about acquired immunodeficiency syn-
drome (AIDS), the proportion of adolescents engaging
in sex increased by 7.4%; in fact, one third of the in-
creased teenage coital rates between 1970 and 1988 oc-
curred in the years 1985-1988 (Centers for Disease Con-
trol, 1991). By the time they reach age 19, over 50% of
both sexes have engaged in sexual intercourse. The HIV
epidemic has altered sexual practices primarily in specific
high-risk subgroups: gay men and prostitutes (Ehrhardt,
Yingling, & Warne, 1991).
Because of the threat of an incurable and fatal sexually
transmissible disease (STD) in addition to the threat of
unwanted pregnancy, much of the recent research on
contraception has focused on condom use. Nevertheless,
for most teenagers, ineffective contraception remains the
rule. The one documented change among adolescents is
the increased likelihood of using contraception during
first intercourse; between 1982 and 1988, this figure rose
from 48% of those surveyed to 65% (Forrest & Singh,
1990). The younger the age at which sexual acts begin,
however, the less likely is the use of condoms (Ingham,
Woodcock, & Stenner, 1991). A recent survey of more
than 16,000 women attending family planning clinics
found that, among those age 19 and younger, 60% never
used condoms during intercourse with a regular partner
and 67% never used condoms with casual partners (Sos-
kolne, Aral, Magder, Reed, & Bowen, 1991). Though
extreme youth is clearly associated with contraceptive
nonuse, even among single women in their 20s, one in six
regularly engages in intercourse without using any form
of contraception (King, 1986). Other data indicate that
the more sexual partners young women have had, the
more likely they are to use oral contraceptives and thus
less likely to use condoms (MacDonald et al., 1990). This
trend is associated with a spectacular increase in STDs
among women with multiple partners.
Unintended and Unwanted Pregnancies
Leaving aside the issue of STDs, the consequences of
engaging in contraceptively unprotected intercourse are
not surprising. By the mid-1970s, approximately 1 mil-
lion U.S. teenage women were impregnated each year;
30,000 of these 1976, annual pregnancies were among
girls 14 years of age or younger (Alan Guttmacher Insti-
tute, 1981). Each day in the United States, approximately
2,740 adolescents conceive (National Center for Health
Statistics, 1987). About half of these pregnancies result in
childbirth (Brody, 1991). In New York State, for exam-
ple, almost 9% of all young women between 15 and 19
give birth each year (Brown, 1991). The grim economic
and emotional effects of unwanted pregnancies and un-
wanted offspring have been documented in studies of
teenage parents, whether as single mothers or as hastily
married couples (Baizerman, Sheehan, Ellison, &
Schlessinger, 1971; Ellwood & Bane, 1985; Kempe &
Heifer, 1968; Klerman & Jekel, 1978; Marsiglio, 1987;
McCarthy & Radish, 1982; Semmens, 1970; Starr, 1979).
The unwanted offspring of young mothers tend to have
a higher than average incidence of low birthweight, in-
fant deaths, and mental retardation (Scales & Gordon,
1979). Children and adolescents whose mothers sought
abortions but were denied them are found to engage in
more maladaptive behaviors and to have more difficulties
in academic achievement than comparable youngsters
whose birth was desired (Matejcek, Dytrych, & Schuller,
1978, 1980).
Among these consistently depressing findings, it
should be noted that more positive outcomes are possible
when a young woman whose pregnancy is unwanted re-
ceives behavioral and emotional support in response to
the crisis (Furstenberg, Brooks-Gunn, & Morgan, 1987;
Nuckolls, Cassel, & Kaplan, 1972; Zuckerman, Walker,
Frank, Chase, & Hamburg, 1984). A potentially positive
outcome of unwed motherhood is that healthy, attrac-
tive, and racially "acceptable" newborns may have the
good fortune to be adopted by grateful couples unable to
conceive. This positive scenario is marred by the facts.
The rate at which unmarried white women give up their
babies for adoption is dropping; before 1973 19% did so,
from 1973 to 1981 the figure was 8% percent, and the
most recent data for 1982-1988 indicate that only 3%
chose this option (Lewin, 1992).
Though the number of teenage births is large, most
unwanted youthful pregnancies terminate in abortion or
miscarriage (E. R. Allgeier, A. R. Allgeier, & Rywick,
1979; Raspberry, 1976). Both prolife and prochoice ad-
vocates agree that abortion is not a desirable societal
goal. These groups differ, of course, as to what should be
done to make this surgical procedure unnecessary and
about how to resolve the conflict between the rights of
the fetus and those of its mother.
In summary, the problem is a serious one that raises
two crucial questions: (a) Why do young sexual partners
engage in unprotected intercourse? and (b) What can be
done to alter their behavior? We now turn to possible
answers to each question.
 Unwanted Teenage Pregnancies
Why Do Teenage Couples Engage in
Unprotected Intercourse?
One analysis of contraceptive behavior (Byrne, 1983)
suggested that the prevention of unwanted pregnancies is
based on five discrete activities. Specific situational and
dispositional variables can interfere with adaptive re-
sponses in each instance (Kelley, 1991).
Step One: Acquiring Information About Conception and
Contraception
A basic requirement is the acquisition of correct infor-
mation about conception and its prevention (Gerrard,
1987; Reis & Herz, 1989). Among the many common
knowledge gaps is confusion about the relationship be-
tween intercourse frequency and the odds of conceiving
(Kelley, 1982). Although accurate information is clearly
a necessary prerequisite to effective contraceptive use, it
is not sufficient. Note, for example, that actual use of
condoms is unrelated to knowledge of the risks involved
in failing to use them (Roscoe & Kruger, 1990). An anal-
ogous finding is that female adolescents whose mothers
provide them with contraceptive information are no
more likely to utilize contraceptives during intercourse
than are adolescents whose mothers ignore the issue
(Furstenberg, Herceg-Baron, Shea, & Webb, 1984).
Situational Barriers: Educational Omissions and
Economic Pressures. Sexuality in general and contracep-
tion specifically remain controversial; as a result, many
parents fail to provide information to their offspring,
many schools offer limited sex education or none at all,
and the three major U.S. television networks have his-
torically been unwilling to accept condom advertise-
ments. In part, the cause is a culturewide conflict between
messages promoting the joys of sex and recurrent expres-
sions of shame and guilt about sexuality (Haddad, 1986;
Jones et al., 1985; Reiss, 1990). Beliefs about morality
("just say no to sex") often take precedence over such
goals as preventing unintended conception or STDs in
the structure of sex education, media efforts to promote
safer sex, or social provisions for easy access to contra-
ception (Kelley & Harvan, in press).
Among general situational factors, poverty has been
identified as an antecedent that facilitates premature
childbearing (Scales, 1990; Williams, 1991). Geronimus
and Korenman (1991) discussed the fact that economi-
cally disadvantaged young women have little positive
motivation to avoid pregnancy. In fact, such teenagers
may view pregnancy as a potential way to escape a dys-
functional family that has few realistic prospects for im-
provement (Romig & Bakken, 1990; Romig & Thomp-
son, 1988; Warren & Johnson, 1989).
In impoverished families, positive maternal attitudes
about teenage pregnancy serve to encourage youthful
103
conception (Giblin, Poland, & Sachs, 1987). Thus, the
daughter of a teenage mother, especially one with mar-
ginal education, is especially likely to engage in early
sexual activity and to become pregnant (Handler, 1990).
As a result, intrafamilial repetition of adolescent preg-
nancy is found to extend across three or more genera-
tions (Johnson, Lay, & Wilbrandt, 1988).
An added consideration is the fact that multiple un-
planned births among young women are associated with
an increased incidence of child abuse directed against
these offspring (Zuravin, 1991). The resulting emotional
deprivation (Ladner, 1987) helps motivate the abused
sons and daughters in this situation to seek emotional
closeness in adolescence through their own sexuality and
early parenthood (Horwitz, Klerman, Kuo, & Jekel,
1991).
Because black women are twice as likely as white
women to live in poverty and to have inadequate educa-
tion, they are also twice as likely to have an unplanned
and / or unwanted pregnancy (Williams, 1991). Further-
more, adolescent black males, compared to whites, begin
sexual activity at a younger age (by about 1 year), aver-
age about three more sexual partners and use contracep-
tives less frequently (Sonenstein, Pleck, & Ku, 1991; Sor-
ensen, 1973). Although blacks use family planning clinics
to a greater extent than whites, the impetus is often an
existing pregnancy rather than pregnancy prevention
(Mosher & Pratt, 1990). One barrier to changing these
patterns among young blacks is the widespread fear that
whites are utilizing contraception and abortion as agents
of racial genocide (Allen-Meares, 1989). Despite the dif-
ferences just noted, black-white similarity in sexual ac-
tivity (Centers for Disease Control, 1991) and childbear-
ing (Hofferth, Kahn, & Baldwin, 1987) is greater than
generally believed and is steadily increasing.
Although relatively few studies of Hispanic adoles-
cents have been reported, similarities to black adoles-
cents are evident. Peer influence on attitudes and behav-
ior is especially evident among young Hispanic women
(Gibson & Kempf, 1990). In comparison to other teenag-
ers, Hispanics also face culture-specific influences such as
positive attitudes about early pregnancy (Smith, McGill,
& Wait, 1987) and deemphasis of educational attainment
(Dore & Dumois, 1990). The generality of these Hispanic
findings in the United States is supported by cross-cul-
tural data; for example, in Guatemala only 10% of sexu-
ally active teenagers use contraception (Berganza, Peyre,
& Aguilar, 1989).
This bleak description of maladaptive adolescent sexu-
ality based on poverty and/or ethnic influences contrasts
sharply with experiences in Finland, a Western nation
with one of the lowest rates of teenage pregnancy. There,
comprehensive social services, sexual tolerance, and ac-
tive attempts to deal directly with adolescent problems
104 Byrne, Kelley, and Fisher
interact to prevent unwanted conception (Utrianinen,
1989).
Dispositional Barriers. Negative affective-attitudinal
reactions to sexual cues--sex guilt and erotophobia--(W.
A. Fisher, Byrne, & White, 1983; W. A. Fisher, Byrne,
White, & Kelley, 1988; Mosher, 1966, 1968) are associated
with failure to take an elective sex education course (W. A.
Fisher et al., 1988), poor retention of sexual information
(W. A. Fisher, 1980; W. A. Fisher, Miller, Byrne, & White,
1980; Schwartz, 1973)--especially when negative sexual
attitudes are combined with high self-esteem (Gerrard,
Kurylo, & Reis, 1990)--and diffÉculty with sexual course
content as the result of its relative unfamiliarity (Goldfarb,
Gerrard, Gibbons, & Plante, 1988). Negative sexual atti-
tudes have a detrimental educational effect on instructors
as well as on students; sex education teachers who are
erotophobic are found to be more likely to omit threaten-
ing topics such as birth control and abortion than are
erotophilic instructors (Yarber & McCabe, 1984).
Another dispositional impediment among teenagers is
the belief that they are uniquely invulnerable to misfor-
tunes such as illness, accident, and unwanted pregnancy
(Burger & Bums, 1988; Gruber & Chambers, 1987).
Among college women, ineffective contraception, per-
ceived personal invulnerability, and overestimates of the
vulnerability of others are most characteristic of those
who are relatively inexperienced sexually (Whitley &
Hem, 1991).
Step Two: Acknowledging the Possibility of Sexual
Intercourse
Males tend to seek sexual conquests that may be ac-
companied by positive interpersonal feelings, whereas
females tend to seek love and affection that may lead to
sexual involvement (Kelley, 1987b). Whatever the basis
for this sex difference (differential socialization experi-
ences or evolutionary reproductive success), youthful
male-initiated sex occurs almost at random--based on
opportunity rather than on foresight. Under such cir-
cumstances, initial teenage intercourse is most often
characterized by only a partial awareness of the risks
involved (Eastman, 1972).
Situational Barriers. Whatever sex education is pro-
vided by schools, parents, or other sources almost never
emphasizes "planned teenage sex." The underlying as-
sumption is that attempts to encourage sexual planning
would both condone and promote sexual activity.
Communications to young people about sex and con-
traception involve multiple sources and inconsistent mes-
sages (Milan & Kilmann, 1987). When parents perceive
that others will take responsibility for providing sex edu-
cation, they simply reduce their own sexual communica-
tions to their sons and daughters (Jaccard & Dittus,
1991). When permissive parents do discuss these matters
with their teenagers, there is an increased incidence of
premarital sex among daughters and of contraceptive use
among sons (T. D. Fisher, 1989). When relatively con-
servative parents communicate about sex with their off-
spring, the result is a decrease in adolescent sexual per-
missiveness (Wright, Peterson, & Barnes, 1990).
Dispositional Barriers. Erotophobic sexual attitudes
are associated with underestimating the likelihood of
one's own sexual activity, thus decreasing the probability
of contraceptive preparedness (W. A. Fisher, 1984).
Step Three: Obtaining Contraceptives
An important obstacle to effective contraception is the
necessity of acquiring contraceptives by interacting with
adult strangers--in a physician's office, clinic, drug store,
or elsewhere. The perceived threat of these interactions is
sufficiently great that many adolescents engage in inter-
course for as long as 12 months before using any form of
contraception (Zelnik, 1980). The first visit to a birth
control clinic most often occurs after an extended period
of unprotected intercourse (Zabin & Clark, 1983).
Situational Barriers. Cultural changes in recent
decades have increased the ease and decreased the stress
associated with obtaining contraceptives. Examples in-
clude open displays of condoms and spermicides on drug
store shelves, the availability of Planned Parenthood
clinics, and the distribution of condoms through special
school programs (Dryfoos, 1985). Under the best of cir-
cumstances, however, it can still be traumatic for a young
teenager to seek contraceptives in adult settings and,
thus, implicitly or explicly indicate his or her sexual in-
tentions. As might be expected, this kind of planful be-
havior is more apt to occur when parents support the use
of contraception (Nathanson & Becker, 1986).
Dispositional Barriers. Erotophobic sexual attitudes
are associated with unpleasant emotional and cognitive
reactions to the experience of purchasing contraceptives
(W. A. Fisher, J. D. Fisher, & Byme, 1977) and, thus,
with the avoidance of this aversive act (W. A. Fisher et
al., 1979). As a result, negative sexual attitudes interfere
with adolescent contraceptive behavior (Jorgensen &
Sonstegard, 1984; Levran, Shoham, Notzer, & Serr,
1988).
Failure to obtain the necessary preventive devices
prior to intercourse is sometimes based on risk-taking
behavior. Data indicate that sexually active, noncon-
tracepting teenagers also engage in other health-related
risks such as cigarette smoking (Biglan et al., 1990; Mills,
1988). Negative outcomes do not necessarily modify such
behavior; those having an unwanted pregnancy as the
result of nonuse of contraceptives subsequently engage in
equally unprotected intercourse (Kalmuss, 1986). Alto-
gether, the data indicate a pattern of chronic self-destruc-
tive behavior (Kelley, 1986, 1987c; Kelley et al., 1985;
Kelley et al., 1986; Kelley & Dawson, 1991).
 Unwanted Teenage Pregnancies
Step Four: Communicating About Contraception With
One's Sexual Partner
Although one partner can assume total contraceptive
responsibility and avoid the necessity for relevant com-
munication, the least risky approach is to exchange accu-
rate information about preventing conception (Kelley,
1983). Such communication is relatively rare and most
often occurs later in the relationship, after multiple acts
of intercourse have already occurred (Burger & Inder-
bitzen, 1985).
Situational Barriers. Neither educational efforts nor
the usual fictional presentations of sexuality ordinarily
provide appropriate role models for this kind of commu-
nication. When adolescents do possess sexual communi-
cation skills plus positive contraceptive attitudes, contra-
ceptive use increases (Catania et al., 1989).
Dispositional Barriers. Erotophobic attitudes are as-
sociated with negative affective and expectative re-
sponses to communicating about sex (W. A. Fisher et al.,
1980).
Step Five: Utilizing Contraception Correctly
The ultimate utility of the four previous steps depends
on the crucial final step: effective contraceptive use.
Situational Barriers. Contraception in the form of
condoms, diaphragms, and spermicidal products must be
readily accessible at the time of intercourse, and the par-
ticipants must know how and when to use these prod-
ucts. Other methods of contraception require consistent
attention to details such as a regular schedule for taking
birth control pills or for verifying the presence of an IUD
by checking its attached thread.
Dispositional Barriers. Negative sexual attitudes in
general and specific negative attitudes about particular
contraceptives are associated with failure to prevent con-
ception (W. A. Fisher, 1984; W. A. Fisher et al., 1979;
Gerrard, 1977; Kelley, 1979; Kelley, Smeaton, Byrne,
Przybyla, & Fisher, 1987; Richard & van der Pligt, 1991).
Ineffective contraceptive use is also related to such
personality variables as self-efficacy (Bandura, Cioffi,
Taylor, & Brouillard, 1988), sexual self-efficacy, per-
ceived control, self-esteem, and perceptions of sexual
self-worth (Blinn, 1987; Breakwell, Fife-Schaw, & Clay-
den, 1991; Freeman, Rickels, Huggins, & Garcia, 1984;
Hagenhoff, Lowe, Hovell, & Rugg, 1987; Levinson,
1984; Rosenthal, Moore, & Flynn, 1991).
Among other characteristics associated with the risk of
teenage pregnancy are feelings of hopelessness (Ortiz,
1987), a limited time perspective (Mindick & Shapiro,
1989), and the inability to judge the consequences of
pregnancy and childbirth realistically (Paikoff, 1990).
Still other factors include deficits in personality organiza-
tion (Hart & Hilton, 1988) and problem-solving skills
(Balassone, 1989; Dunn, 1988; Flaherty, Maracek, &
Olsen, 1983; Franklin, 1987; Marsiglio, 1985). Interest-
105
ingly, religiosity is among the dimensions unrelated to
contraceptive use (McCormick, Izzo, & Folcik, 1985).
Intervening to Prevent Unwanted Teenage Pregnancies
The preceding analysis makes it clear that numerous
situational and dispositional factors interfere with the
necessary sequence of contraceptive behaviors required
to prevent unwanted pregnancies among adolescents. It
follows therefore that intervention strategies must focus
on the modification of these obstacles in order to reduce
youthful procreational sexuality.
A Conceptual Framework
We now consider an intervention model developed by
Fisher and Fisher (J. D. Fisher & W. A. Fisher, 1992;
W. A. Fisher & J. D. Fisher 1993) that may be applied to
various settings in designing, delivering, and evaluating
pregnancy prevention procedures aimed at teenagers. Al-
though the emphasis here is conceptual, a more detailed
operational description of specific procedures is available
in a series of publications dealing with altering behavior
relevant to sexual health (W. A. Fisher, 1990a, 1990b; J.
D. Fisher & W. A. Fisher, 1992; W. A. Fisher & J. D.
Fisher, 1992, 1993). In the present context, four funda-
mental determinants of adolescent contraceptive prac-
tices are proposed.
First, information that is relevant to contraception,
easily accessible, and easily translated into personal pre-
ventive behavior is most likely to have an impact on
contraceptive behavior (Byrne, 1983; W. A. Fisher &
J. D. Fisher, 1992, 1993; Morrison, 1985).
Second, effective contraception is partially determined
by motivation to engage in the necessary acts--based on
the individual's emotional response to sexuality, atti-
tudes and norms about using specific contraceptives, and
perceived personal vulnerability to conception as a nega-
tive life event (Byrne, 1983; J. D. Fisher & W. A. Fisher,
1992, 1993; W. A. Fisher et al., 1983; Fishbein & Ajzen,
1975; Gerrard, 1982; Kirscht & Joseph, 1989).
Third, behavioral skills are necessary for even a well-
informed and highly motivated teenager to perform ef-
fectively the necessary sequence of acts required for preg-
nancy prevention (Byrne, 1983; J. D. Fisher & W. A.
Fisher, 1992; Kelly & St. Lawrence, 1988; Schinke, 1984).
Fourth, situational factors such as the availability or
nonavailability of contraceptive education and services
affect whether or not a teenager becomes informed, moti-
vated, and contraceptively skilled (Orton & Rosenblatt,
1981; Zabin, Hirsch, Smith, Streett, & Hardy, 1986).
These four propositions are consistent with literature
on the prevention of adolescent pregnancy (e.g., W. A.
Fisher, 1990b; Morrison, 1985), the related literature on
preventing HIV infection (J. D. Fisher & W. A. Fisher,
106 Byrne, Kelley, and Fisher

f ( Contraception
Information

Situational
Factors
) ~
"
(Contraception '~
~ehavioralSkillO
_ ( Contraceptive
~ ~_ Behavior )
Contraception
Motivation

Figure 1. Conceptualizing situational and dispositional factors that affect contraceptive behavior (after J. D.
Fisher & W. A. Fisher, 1992; W. A. Fisher & J. D. Fisher, 1993).

1992), and recent studies linking information, motiva-
tion, and behavioral skills to sex-related preventive be-
havior (J. D. Fisher, W. A. Fisher, Williams, & Malloy,
1992).
As depicted in Figure 1, contraceptive information
and motivation can directly affect contraceptive behav-
ior; they can also trigger the use of relevant behavioral
skills to initiate and maintain patterns of effective contra-
ception. Situational factors function as behavioral ante-
Providing Improved Contraceptive Information
Eliciting Informational Gaps. Within subsamples of
the target population, informational lacunae must be
identified. In responding to prompted questions, adoles-
cents often reveal the limits of their practical information
(A. R. Allgeier, 1983; E. R. Allgeier, 1983; Morrison,
1985; Zelnik & Kantner, 1980). To pinpoint additional
ELICITATION

1
cedents as well. Elicitation of Pre-Intervention
Although these constructs are assumed to be general- Levels of Contraception
Phase I
ized determinants across diverse populations and diverse Information, Motivation, Behavioral Skills,
contraceptive techniques, specific details of the four Situational Factors, and Behavior
determinants are expected to differ. For example, the
variables that affect condom use may well differ from
those affecting use of the pill. Similarly, the specifics may
be different for middle class white adolescents than for
working class blacks.
INTERVENTION
Design and Implementationof
Population-Specific Interventions
Phase 11 to Modify Contraception
Design, Delivery, and Evaluation of Interventions
Information, Motivation, BehavioralSkills,
Beyond specifying the variables that constitute the prior- Situational Factors and Behavior
ity targets for interventions, this conceptualization also
specifies a general process for designing, delivering, and
evaluating these interventions, as outlined in Figure 2.
Elicitation research is critical for the identification of
information gaps, motivational obstacles, skill deficits,
1EVALUATION

1
and inhibiting situational factors within a given target
population. Population-specific interventions must be Evaluation of Intervention
Impact on Contraception
designed on the basis of the knowledge provided by the Phase III
Information, Motivation, Behavioral Skills,
elicitation procedures, and they must be instituted. The Situational Factors and Behavior
final step is to determine the effectiveness of the interven-
tions by means of evaluation research in order to clarify
whether or not and to what extent changes in the relevant Figure 2. A three-phase process for implementing pregnancy
factors resulted in more effective and adaptive adolescent prevention interventions (after J. D. Fisher & W. A. Fisher,
contraceptive behavior. 1992; W. A. Fisher & J. D. Fisher, 1993).
 Unwanted Teenage Pregnancies
knowledge gaps, open-ended questions are useful in as-
sessing unprompted, top-of-the-head contraceptive in-
formation and misinformation in the target group (W. A.
Fisher & J. D. Fisher, 1992). For example, teenage sub-
jects may be asked, "How can a person avoid getting
pregnant (or getting someone pregnant)?"
Population-specific Intervention. Based on the findings
of the elicitation research, interventions can focus on sup-
plementing teenagers' contraceptive knowledge. Those
in a given subgroup might be aware of various prescrip-
tion and nonprescription contraceptives, for example,
but unaware of where to obtain these items comfortably,
cheaply, conveniently, and during after-school hours
and/or of how to use them effectively. An intervention
program would stress the missing information.
Increasing Procontraceptive Motivation
Eliciting Motivational Impediments. In a subsample of
the target population, motivational obstacles to contra-
ception can be assessed using measures of emotional re-
sponse to sexuality, attitudes and norms involving con-
traceptive use, and perceived vulnerability and risk-taking
proclivities. For example, ambivalent affective responses
to sexuality may result in a teenager being sufficiently
positive about sex to "do it" and sufficiently negative to
avoid planning in advance to prevent conception.
Population-specific Motivational Intervention. In the
example just given, the inhibiting effects of ambivalent
sexual attitudes could be targeted for intervention proce-
dures. The goal would be systematically to desensitize
negative emotional reactions to anticipating intercourse,
acquiring contraception, and communicating with one's
partner about the prevention of conception (W. A.
Fisher, 1983).
In contrast, if the negative attitudes and norms in-
volved only specific contraceptive acts (such as using
condoms), the modification techniques would focus di-
rectly on the benefits, pleasures, and social support rele-
vant to condom use (Ajzen & Fishbein, 1980; Fishbein &
Ajzen, 1975; W. A. Fisher, 1984).
Analogously, if perceived personal invulnerability to
pregnancy were the major motivational problem, inter-
vention would concentrate on providing a realistic ap-
praisal of the risks and consequences of pregnancy. Pos-
sible strategies include the presentation of social
comparison others (Festinger, 1954) who have experi-
enced unwanted pregnancy and its negative personal
consequences (W. A. Fisher & J. D. Fisher, 1992) and the
use of computer simulations (Paperny & Starn, 1989).
Improving Contraceptive Skills
Eliciting Behavioral Inadequacies. The determination
of relevant behavioral skills involves three measurement
strategies: (a) a representative subsample of the target
107
population can be asked to engage in role-playing in-
teractions such as engaging in a presex discussion of
contraception and negotiating its use with a contracep-
tively reluctant partner, (b) closed-ended questionnaires
can be used to assess perceived self-efficacy involving
one's ability to perform the relevant behaviors, and (c)
focus group discussions can be conducted to obtain in-
formation about behavioral skills. For subgroups differ-
ing in gender, ethnicity, and other demographic charac-
teristics, variations in the necessary skills may very well
include specific idiosyncratic elements.
Population-specific Behavioral Intervention. Based on
the information provided by the elicitation research,
standard behavioral training techniques (e.g., modeling,
rehearsal, feedback, performance refinement) can focus
on targeted behavioral deficiencies (Kelly & St. Law-
rence, 1988; Schinlic, 1984).
Altering Situational Factors That Inhibit Contraception
In addition to assessing and modifying the behavior of
individuals, it is necessary to examine environmental fac-
tors that impact negatively on contraceptive informa-
tion, motivation, and behavioral skills.
Eliciting Information-relevant Situational Factors.
Currently, both formal (e.g., sex education courses) and
informal (e.g., television programs) information chan-
nels seem to be guided by the implicit assumption that, to
be acceptable, contraceptive content must be irrelevant,
incomprehensible, sexist, frightening, dangerous, or oth-
erwise counterproductive. Compare, for example, the
frequency of presentations consisting of factually correct
though behaviorally irrelevant details of the hormonal
inhibition of ovulation by means of pills to the frequency
of presentations indicating where to get them, how to use
them, and how to converse with a partner about this
topic. Consider, also, a hard-to-understand though pop-
ular informational source: the seven-by-eight matrix of
fine print that provides a multitude of factual bits com-
paring contraceptive methods. Implicitly sexist public
health information is suggested by the stress placed on
messages to women about condom use rather than simi-
lar messages directed to men. Contraceptive education is
often unnecessarily frightening in its graphic emphasis on
the possible side effects associated with the pill, IUDs,
and so forth. Finally, dangerous information is exempli-
fied by a failure to point out that oral contraceptives do
not prevent STDs; unsurprisingly, research indicates that
pill use is associated with condom nonuse (MacDonald
et al., 1990). One result is that HIV prevention programs
designed to increase condom use can inadvertently in-
crease pregnancy risk (Jaccard, 1992).
Eliciting Motivation-relevant Situational Factors. The
social milieu of teenagers often consists of conflicting
positive and negative emotional communications about
108 Byrne, Kelley, and Fisher
sexuality from parents, teachers, and peers. The resultant
sexual confusion interferes with presex discussions with a
partner and with contraceptive planning and acquisition.
Depending on the specific social environment, positive or
negative attitudes may come to be associated with sexual-
ity in general, interacting with a health-care professional,
using a condom, or whatever.
Environmental factors may also encourage underesti-
mations of risk in that negative outcomes (e.g., a class-
mate's pregnancy) are hidden while positive outcomes
(e.g., a happy teenage marriage) are highly visible.
Eliciting Skill-relevant Situational Factors. Elicitation
research suggests that there is considerably more social
facilitation of behavioral skills related to foreplay and
intercourse than of skills related to contraceptive use.
Among the "instructional materials" for sex are teen-
age conversations about sex and romance, articles in
Seventeen about how to flirt, and letters to Penthouse
describing effortless seductions and danger-free sex in
explicit detail. For those who are successful in learning
and performing the requisite behaviors, social and sexual
rewards are often forthcoming (Perper & Weis, 1987).
In contrast, social models for anticipating intercourse,
acquiring contraceptives, communicating with a partner,
and engaging in nonprocreative sexual acts are rarely
encountered in peer interactions, educational presenta-
tions, or the media.
Eliciting Behavior-relevant Situational Factors.
Whether or not inexpensive contraceptive services are
readily available can directly affect the behavior of teen-
agers. Examples include the absence of accessible clinics,
legal restrictions on providing services to underage ado-
lescents, government failure to fund contraceptive pro-
viders, and lack of access to condom machines during
evening hours; all such barriers decrease the probability
of contraceptive use (e.g., Orton & Rosenblatt, 1981;
Zabin et al., 1986, 1988).
Situational Interventions. Guided by elicitation re-
search, specific interventions can be designed to modify
inhibiting situational factors. As suggested by the previ-
ous discussion, modifications may concentrate on the
content of contraceptive education, the problem of
mixed emotional reactions to sexuality, the realities of
vulnerability, the unrealities of sexual interactions as de-
scribed by peers and the media, and environmental im-
pediments to contraception.
Evaluation Research
The short-term and long-term effectiveness of an inter-
vention should be ascertained by measuring changes in
the proposed behavioral determinants and in the behav-
ior itself. In the informational example, the open-ended
measure could be readministered to provide evidence of
changes in knowledge about the availability of contra-
ceptive services and the use of chosen contraceptive
methods. Similarly, elicitation assessments of motiva-
tion, skills, and situational constraints would be repeated
following intervention.
The ultimate criteria of effectiveness are provided by
outcome measures such as self-reported contraceptive
use, the results of pregnancy tests, pregnancy-induced
school dropout rates, and data on abortions and births.
Concluding Notes
The foregoing model is intended to provide a basis for
analyzing dispositional and situational determinants of
teenage contraceptive behavior, for intervening to mod-
ify these determinants, and for evaluating the outcome of
the interventions. The specifics must be tailored to partic-
ular subpopulations and particular environmental set-
tings.
Despite the seeming intractability of the problem of
unwanted teenage pregnancies, it is possible to close this
discussion on a somewhat hopeful note. Interventions
focusing on teaching relevant information, strengthening
motivation, and improving behavioral skills have
demonstrated positive effects on adolescent contracep-
tive behavior (e.g., Eisen, Zellman, & McAlister, 1990;
W. A. Fisher, 1990b; Schinke, 1984) and on the practice
of other sexual health behaviors (such as AIDS preven-
tive behaviors) in variot~s populations (e.g., Rotheran-
Borus et al., 1991; Solomon & DeJong, 1989; Valdiserri
et al., 1989). In a similar way, other successful interven-
tions have sought to bring about situational changes as
well as to modify personal attributes relevant to contra-
ception (e.g., Zabin et al., 1986, 1988). Beyond unwanted
pregnancies and STDs, this approach is also applicable
to other concerns such as preventing sexual coercion and
promoting satisfying sexual relationships.
Approximately one decade ago, Byrne and Fisher
(1983) suggested that contraceptive education is as
much a political issue as a pedagogical one, and this
appraisal is equally true today. The major change at
this time is our ability to point to successful interven-
tions (as already noted) as well as to unsuccessful absti-
nence-oriented efforts (Scales, 1987). Despite the empir-
ical evidence, the official policy of the U.S. government
under President Bush was to support programs that
emphasize sexual restraint and ignore contraception
(Bass, 1992). The time has come for the public to be
informed about the availability of intervention strate-
gies that actually work. Equally important is to let peo-
ple know that adherence to the status quo is function-
ally a strong statement favoring unwanted pregnancies,
reliance on legal or illegal abortions to terminate such
pregnancies, and an enduring cycle of poverty and vic-
timization for teenage parents and their children.
 Unwanted Teenage Pregnancies
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