title: Pregnancy among American Indian adolescents: reactions and prenatal care.
abstract: OBJECTIVE
  Adolescent childbearing is twice as common among Native Americans as among all US races combined. Despite this, little is written about the psychosocial context or prenatal care of pregnant Native American adolescents. The objective of this study was to explore the reactions and prenatal care of Navajo and Apache adolescents delivering infants at Shiprock Indian Hospital, New Mexico, between January and March 1991, and Whiteriver Indian Hospital, Arizona, between May and June 1991.
  
  
  METHODS
  Of the 25 eligible adolescents aged 19 years and younger, 15 Navajo and 5 Apache participants were interviewed within 24 hours of delivery. The interview consisted of 121 questions divided into 5 areas: sociodemographics, personal and family reactions to the pregnancy, knowledge and attitudes toward prenatal care, barriers to care, and 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 intermediate, and 2 inadequate prenatal care. During the pregnancy, 3 adolescents used tobacco, 3 used alcohol, and none admitted to other drugs. Although only 1 adolescent planned the pregnancy, 15 were not using contraception when they became pregnant. In exploring reactions to the pregnancy, 13 adolescents were afraid to tell their families and 4 concealed the pregnancy until confronted. During the pregnancy, 7 adolescents described loneliness and 6 expressed suicidal ideation. Although over half reported no barriers to obtaining prenatal care, barriers that were noted by the remainder included transportation, family problems, and missing school.
  
  
  CONCLUSIONS
  We conclude that pregnancy among many American Indian adolescents is unplanned and characterized by uncertainty and fear of disclosure, resembling the reactions to pregnancy of other adolescent populations. Furthermore, despite universal access to health 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.
authors.affiliation: Craig-Dalsimer Program in Adolescent Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: L L
authors.initials: LL
authors.lastname: Liu
authors.forename: G B
authors.initials: GB
authors.lastname: Slap
authors.forename: S B
authors.initials: SB
authors.lastname: Kinsman
authors.forename: N
authors.initials: N
authors.lastname: Khalid
mesh_terms: D000293:Adolescent; D001130:Arizona; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006768:Hospitals, Federal / Q000458:organization & administration; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D009516:New Mexico; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology*; D011295:Prenatal Care / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States; D016549:United States Indian Health Service