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Indelicate Condition

Our Children's Children: Increasingly, the counselors working with pregnant teens are focusing on breaking the patterns of violence and abuse many teens face, which studies show can negatively impact development of their unborn children. Christopher Gardner Researchers have discovered that--aside from emotional and economic problems--pregnant teenage girls are also more likely to have babies with low birthweight and related health maladies By Traci Hukill 'How much is a cup of soup?" Emily inquires seriously. The clerk at the cafe raises an eyebrow. "A dollar sixty-two with tax." "I'll have that, then," the 19-year-old mother of one answers, and pays in exact change. At the table she digs through a sizable purse and murmurs, "I forgot my water bottle." Scrimping is something Emily does well. She's already stashed away several thousand dollars so she can buy a house for herself and her 2-year-old son through a low-income home-ownership program. When she's not in classes at San Jose City College, where she's pursuing a degree in social work so she can work as a substance-abuse counselor, she works as a receptionist. Choices for Children watches her son when she's working or in school. All in all, it looks like Emily has the world by the tail. But three years ago the straight-A student dropped out of high school and moved in with a boyfriend, then 19. He was jealous, she says, the kind of guy who would be up waiting and mad when she came home from a night with friends. Sometimes he hit her. "We had the cops called on us lots of times," she says. "One time he threw me up against the wall, and somebody passing by called the cops. "Mostly it was mental abuse," she recalls. "He would tell me that I'm ugly, that no one else would want me. Things like that." When Emily got pregnant, everything got worse. The abuse escalated, the jealousy, everything. By then, though, she was hooked. "I was too scared to get out," she explains. "I didn't want to go to my mom and have her say, 'I told you so.' " She was six months pregnant before she told her mother she was going to have a baby. Meanwhile, her boyfriend continued to slap her around throughout the pregnancy and even after the baby was born. "He'd try to hit me and miss, make holes in the wall, just to intimidate me. I'd be holding my baby, and I'd be so scared." Hit and Myth AT ONE TIME teenagers were considered healthy candidates for motherhood. Fertility rates in young women tend to be higher than in older women, and younger bodies recover quickly from pregnancy, labor and delivery. But lately researchers around the country have been documenting a troubling trend: that the offspring of teen mothers are less healthy than the babies of older women. They've found a disturbing link between physical abuse during pregnancy and low birth weight and discovered that pregnant teenagers in general are at higher risk of physical and emotional abuse than older women. These battered teenagers also tend to seek prenatal care late in pregnancy, if at all. And late or spotty prenatal care is in turn linked to low birth weight, which can lead to respiratory problems, learning disabilities and even cerebral palsy. In Santa Clara County, about 2,000 teenagers give birth each year. According to one study cited in a March of Dimes report, one out of every five pregnant teenagers experiences physical or sexual violence. If that's true of this county, then the toll for the South Bay is 400 battered pregnant teenagers every year. Include emotional and verbal abuse in the analysis, most experts agree, and that number skyrockets. Luckily, Emily sought prenatal care early on and delivered a healthy baby. "I was on top of that," she says, rolling her eyes. Not everyone, though, is so lucky. Joanne Rudinskas, medical social worker at Valley Medical, remembers a case in which a 16-year-old girl was battered so badly she lost her baby before coming to term. Between Emily and the girl who miscarried lies a shadowy population of battered pregnant girls who are ignored, depressed and invisible to the authorities. They may go to the doctor, or they may not. They may confide in their social worker--if they have one--that their boyfriends occasionally shove them or won't let them talk to their friends. Or they may not. They may just wind up dropping out of school, moving in with the boyfriend after their parents kick them out and hanging out at a 7-Eleven, drinking Slurpees and taking the occasional drag off a cigarette. Pushed to Limit THE INCIDENCE OF abuse among pregnant teenage girls is notoriously hard to track, and the link between abuse and low birth weight even harder. For one thing, field workers say, battered girls often don't identify themselves as such. Shannon Schauff, a case manager at Big Brothers Big Sisters of Santa Clara County, laughs when asked if she has a lot of girls who complain of abuse. "That complain about it? No. That have it? Yes. "To most of them," she explains, "it's not battery unless they're full-fledged beaten. The pushing, intimidation, even the occasional slap is not battery to them. We'll say, 'Are you abused?' The answer will be no. We'll say, 'Does your boyfriend push you?' The answer will be 'Well, yes.' " The social workers Metro interviewed backed up Schauff's assertion that the county's pregnant teens don't generally report abuse. Some are accustomed to abusive relationships, which occurred in their homes while they were growing up. Others are afraid to get their boyfriend in trouble, or that their boyfriends will retaliate. The Connection is the county's adolescent-services program and includes a department devoted to teen mothers. When a pregnant girl comes to The Connection, she is asked if she has suffered sexual, physical or emotional abuse. The department doesn't get a lot of checks in the "yes" box next to these items on the intake forms, but the staff knows better. "When they do these intakes, it's usually at the beginning,'' says Maria Reyes, a social work supervisor at The Connection's Adolescent Family Life Program, "and it's not the kind of thing most girls will readily volunteer. Sometimes it doesn't come up until you've developed a relationship with the girl." Even though The Connection records data from the questionnaires and also records the birth weight of the babies born to its clients, no one has bothered to tease out the numbers that would indicate a link between physical abuse and low birth weight. And for the aforementioned reasons, such computer-generated data wouldn't be very reliable anyway. Depressed Condition SOME OF THE PEOPLE who work with pregnant teenagers say they haven't noticed a direct connection between physical abuse and unhealthy babies. The teachers of the high school parenting programs, for example, reported seeing very few small or unhealthy infants born to their girls. "We don't have too much of that because we have classes geared to preventing it," says Joyce Taylor, who directs the pregnant and parenting teen program at Foothill High School. She concedes that abuse is "certainly a problem," but attributes late or inadequate prenatal care to depression, not abuse. "We have a lot of students who are depressed. The whole situation is depressing, usually. And when you're depressed, it's just common sense that you might not get the help you need." Taylor's analysis hints at an elusive aspect of domestic violence: emotional abuse. When a girl endures insults from her boyfriend and feels cut off from her family and friends--and abusive men frequently isolate their partners--the end result is the same as if she were beaten up. She becomes depressed and withdrawn, and that much less likely to take care of herself or make an appointment with a doctor. The only difference is that there are no bruises or broken bones for teachers or neighbors to report. Sparky Harlan directs the Bill Wilson Teen Center, home base for a runaway shelter and transitional housing program for teen mothers. She estimates that half the pregnant teens who seek refuge there have suffered abuse by their partners or parents. Usually it's the emotional kind. "The 50 percent are not walking in bruised or battered," she says. "I'm talking about emotional abuse, where the guy says to her, 'You're stupid, you're fat, no one's going to want you now'--that kind of thing." The fact that emotional abuse is so much harder to detect than physical abuse makes it difficult for social workers and educators like Taylor to locate a direct causal line between abuse and inadequate prenatal care. But one social worker suggests another reason why people may not see a connection between battering and infant health. Maria Elena Chavez, a caseworker at The Connection and teen foster parent for 20 years, points out that the girls who are the worst off are the ones who've missed the social services safety net altogether. "If you are in school, you've gone over some hurdles already," she says. "When we get these girls [at The Connection], it's because they've been referred by their school or somebody or they've referred themselves. It's the ones who have their babies at home who are really in trouble, and they're very difficult to document." But to Chavez the equation makes perfectly good sense, with or without statistics to back it up. She talks about the anxiety and fear that riddle pregnant girls and about "the contradiction between what life should be and what it is." "Because they're going through all this," she says, "they're not getting the nutrition they should, they're not taking that short brisk walk around the block, they're not taking time out to rest, to think about their baby and nice things. "To me, it's kind of common sense. If you eat good, you'll be OK. I'm talking about the emotional intake, too; and when these things are absent, then yes, that baby will [have a] low birth weight." Chavez is using the term loosely. What she means are babies who are smaller than desirable, unhealthy or somehow developmentally delayed. The truth is that the definition of low birth weight shifts according to the population being measured. Right now, for babies born at full term, the low-birth-weight babies are those who weigh less than 6 pounds. Paul Hensleigh, chief of obstetrics at Valley Medical Center, says that teenagers are at higher risk of delivering low-birth-weight babies, but cautions that no single factor is to blame. "Nobody's made the connection about why they've had more than the expected number of small babies," he says. "It's a compound, multicausal kind of thing. You find more of these women who are not taking care of their health needs or their general needs in many ways. They may not be getting adequate health care, they may be under stress--many of them are under stress--and they may be abusing drugs or alcohol or smoking cigarettes. All of these things are associated with low birth weight." [ San Jose | Metroactive Central | Archives ]