An Encounter at the Clinic

On my way to work one morning, a young, sad looking girl caught my eye. She could not have been older than thirteen. She was thin, no taller than four feet, and she was holding a baby in her arms. What is that young girl doing at home with an infant when she's supposed to be at school? I found myself wondering. The girl was bending over the child as if she were breast-feeding it, but that couldn't be, could it? When the girl saw me staring from the car as it passed slowly by her yard, she rushed into the house with the infant, as if ashamed at being caught doing something wrong.

I saw her again a few days later, this time at the Public Health Clinic, with the same baby. I was asking myself what she was doing here, when I noticed that the girl was being given birth control pills. Finally it dawned on me that the girl was not simply taking care of a younger sibling. No mistake about it, I thought; that little wisp of a girl is the mother of the baby she's holding. She looked so much like a child that it was hard to believe she was really a mother herself.

This girl is a perfect example of the problems I've been studying about teenage pregnancy in Micronesia. For the past four months, I have gathered whatever statistics can be found on births to teenagers. I have done dozens of interviews with women in Pohnpei, Kosrae and Chuuk, spoken to FSM state public health employees, FSM National Government Family Health Planning Coordinator, school counselors, church leaders, and many of the young mothers themselves. I've also collected data from the Health Planning and Vital Statistics, Ministry of Health and Environment of the Republic of the Marshalls Islands, and from the Bureau of Public Health in Palau.

The Figures on Teenage Births

The figures on births to teenagers in Micronesia extend back only fifteen years (see Table 1), so it is difficult to determine how much teenage delivery rates have risen from the past. Births to teenagers in Pohnpei and Chuuk seem to have increased during this fifteen-year period, although the figures for the other two states show little change. The figures do shed light on some striking differences between the island groups, however. Of all births to women in Kosrae and Chuuk, 8 and 9 percent respectively are to teenagers (girls aged 19 and below). The average percentage in Yap, at 14 percent over this total period, is over half again as high as the rate of Kosrae and Chuuk. Highest of all, however, is the rate in Pohnpei, where births to teenagers account for 18 percent of all live deliveries. This is double the teenage delivery rate in Kosrae and Chuuk.

The rate of teenage births in the Marshalls, which seems to be on the rise, is comparable to Pohnpei's high rate. At an average of 18 percent over the total period, the Marshalls' rate is much higher than other places. Palau, on the other hand, which was once reputed to have a high rate of teenage birth, has shown a considerable drop over the last ten years as its rate fell from 14 to 9 percent.

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Table l: Percentage of Total Deliveries to Teenagers

	1986-1990	1991-1995	1996-2000	Total Period
Pohnpei	16	19	19	18
Chuuk	7	9	10	9
Kosrae	8	8	9	8
Yap	13	15	13	14
Palau	n/a	14	9	11
Marshalls	16	21	19	18

Sources: Information on Pohnpei taken from Maureen Fitzgerald, Whisper of the Mother (Westport, CT: Bergin & Garvey,1999); annual reports on vital statistics from FSM Department of Health, Education and Social Affairs; statistics on Palau provided by the Family Health Section, Division of Primary and Preventive Health, Bureau of Public Health, Palau; statistics on Marshalls from Health Planning and Vital Statistics, Ministry of Health and Environment, Republic of the Marshall Islands.

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Another finding from the statistical data is even more disturbing–the number of children born to girls age 14 and under (see Table 2). In Pohnpei, 43 children were born to girls age 14 and down during the nine years for which we have figures–for an average of about five a year. The girl I saw at the clinic was not an exceptional case, it appears. The Marshalls shows almost as many births to very young girls, but since these are distributed over sixteen years, the average is about 2.5 per year.

The number of births to girls this young in other states of the FSM is much lower. Over a total of nine years between 1986 and 2001, Chuuk recorded 13 births to girls 14 years and younger–or about 1.5 a year. Yap had five births to girls this young during Those nine years, and Kosrae had only one. Palau had a total of seven births during ten years, or less than one per year.

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Table 2: Number of Births to Girls under age of 15

	1986-1990	1991-1995	1996-2001
Pohnpei	25a	11b	7c
Chuuk	1a	n/a	12d
Kosrae	1a	n/a	0d
Yap	4a	n/a	1d
Palau	n/a	5	2
Marshalls	8	7	24

a figures for four years only, 1986-1989 b figures for four years only, 1991-1994 c figure for 1996 only; other years not available d figures for five years only, 1997-2001

Sources: same as Table 1

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The Problem on Pohnpei

A friend of mine, in her mid-thirties, told me that she was embarrassed during her prenatal visits to the Public Health Clinic in Pohnpei because she and three other women were much older than the teenagers who crowded the waiting room. But what surprised her the most was that most of the girls didn't have a spouse, and after they delivered their babies, they opted to receive birth control.

Births to teenage girls are not a rarity on Pohnpei. According to one of the administrators at Pohnpei's public high school, five or six girls get pregnant every year. A few of the girls are able to continue their schooling until they deliver and afterward, but most opt to leave school when their pregnancy begins showing. More surprising than this is that just as many elementary school girls as high school students are getting pregnant each year. They, too, tend to quit school when they become pregnant, but the shock to parents, friends and community is usually much greater than when older teens are found to be pregnant. There were even a couple of instances when the parents of the girls had to fly them off island to avoid the scandal.

I went to visit one elementary school where an eighth-grade/young mother attends school. She had already given birth. The child is at home under the care of the girl's mother, who is nursing an infant of her own at the same time. On my visit to the school to see her, the girl was absent that day. According to her teacher, she's been absent off and on for most of the year because of her baby. That day happened to be exam day.

I met her the next day at the school. She looked so young and small that if I hadn't been told who she was before I met her, I would never have been able to tell that she was already a mother. Others find it hard to believe that she's had a child already. When I met her, my imagination wandered off to her baby and how difficult it must be for a very young girl like her to sustain the burden of raising a child. I had to force myself not to shed tears because I didn't want to let on to the girl how sad I was. A baby like her had no choice but to give up her childhood to become a mother.

The father of her baby is a seventeen-year-old neighbor who is still entirely dependent on his parents. It doesn't seem to bother him that the girl has had his child. I couldn't resist asking the girl how she felt about the boy who fathered her child. To my surprise, she didn't blame the boy at all; she seemed more ready to blame herself. She admitted that her pregnancy was the result of one big mistake–an accident, she said. The "accident" occurred while she was spending a weekend with her aunt away from her own parents' home. I wondered whether she might have tried to cover up the situation by going somewhere else for a weekend, so the parents wouldn't find out that the father of her baby is the boy next door.

Curtailed Education

Among its other effects, teenage pregnancy often brings a halt to a teenager's education. If she does not leave school for good when she becomes visibly pregnant, she may be forced out after she tries to return. The teenager who leaves school to deliver her baby always has to struggle to catch up in her classes. She has to split her time between her baby and her classes. Even though she tries very hard not to fall way behind in her classes, she has almost always missed some examinations which are hard for her to make up.

One girl, now seventeen years old, said she used to make good grades in elementary school, but she quit when she became pregnant. After she had her baby, it was very difficult to go back to school because her mother couldn't help to take care of her baby. Whenever she sees her former classmates who now go to high school, she feels so frustrated. The worst part is that she cannot even find a decent job to support herself and her baby. Everything she owns is provided by her parents, including food for her and her child.

There was another girl who used to be an outstanding student and very active in sports. Everyone in her family and friends were shocked when they found out she was pregnant. Her parents worked very hard to pay for her tuition at the private school she was attending because they had a dream of sending her off to college. Not only did she lose her chance to compete at school sporting events, but she couldn't keep up in school after she had her baby. All her friends have gone to colleges off island, while she remains at home caring for her child.

It's becoming harder and harder for people who lack a good educational background to make a living. Teenage mothers are no exceptions. It is not easy for a teenage mother without an adequate education to find a decent job to make a living. Even small family stores will often not hire elementary school drop-outs because they lack adequate skills.

Lost Childhood

Pregnancy does more than rob a girl of her education. The girl must give up her freedom as a child to assume a mother's responsibilities. She is forced to deny herself the kind of pleasures and fun teenage kids usually enjoy–like hanging out with friends at school and going to a movie. Her whole life is affected. She is no longer considered a child, but now has become a young mother and may be treated as an "adult" among her own young friends. Now she has a baby to worry about, while her friends still enjoy the carefree life of being young.

Her life is "fast-forwarded" without allowing her to go through the normal process of development before becoming a parent. Naturally, she experiences difficulty in adjusting to a woman's life rather than a girl's life. She is bound to feel left-out in her groups of young friends, yet she does not feel comfortable among the adults. Many of the young mothers I interviewed said they sometimes miss the fun of just lazing around with young friends who have no one else to worry about. They also feel awkward among the older women, but they realize they have to accept the fact that they are no longer "young girls" as they used to be just a few months earlier. A teenage mother now has a child who depends entirely on her. She is expected to perform the same tasks a mature woman does with an infant: taking care of the baby day and night, giving it all the attention it needs, and being on call at any hour. The teenage girl has these responsibilities at the very time that she is undergoing rapid physiological and developmental changes in her life.

Those young mothers who have it hardest are those who do not receive help from their parents. A young Chuukese mother of two, who had her first child at the age of 15, has had a hard time raising her two children. She stays with her mother, who was also a single parent. She, like her mother, never finished elementary school, and neither of them is able to find a job. From time to time, relatives would give them a sack of rice or a can of mackerel, but they are unable to provide the children things like clothes, school supplies, and special treats. Since all these things cost money, the young mother ends up becoming a frequent visitor to relatives with jobs to ask them if they can spare a few dollars for food for her children.

A 16-year-old mother in Pohnpei had a baby without her own parents around to help her. She now lives with her relatives. Most of the time she and the baby have nothing to eat, so she goes from one relative's house to another to get food whenever they are both hungry. The baby is under-nourished and needs an older person's care. The young mother carries her around even when she hangs out with her young friends. The day I met her, the baby was half naked and I could see the ribs showing. From time to time, some relatives would bring her used clothes for her and her baby.

Effects on the Girl's Family

Many teenage parents are dependent on their mothers for everything when they are pregnant. The mother takes care of her during her pregnancy in order to keep her healthy and strong. Once the girl delivers, the parents take on more responsibilities since they have an additional dependent to provide with all the necessities of life. Some working mothers even quit their jobs in order to take care of their grandchildren.

Most families have great hope in their daughter's future, especially if she's doing well in school. Some even enroll their children in private schools with the hope that one day the child would go off to college, come back, and make a good living. When a girl gets pregnant, all the family's dreams and hopes for her future are shattered. The investment in her education goes down the drain. It's even worse if the boy who has fathered the child is not liked and accepted by the girl's parents, or if the boy decides not to marry the girl. I know of a family who sent their daughter to private schools through elementary school and high school. When the girl got pregnant during her junior year in high school, the parents were shocked. They couldn't believe their bright daughter could fall like that. It was such a tough hit for both parents to take that their friends had to console them.

Because of the cultural taboos, it is a big disgrace for Micronesian families to have unwed daughters. In Chuuk, many families still feel ashamed and embarrassed when a teenage relative gets pregnant and becomes a single mother. Some parents, reacting to the blame they receive for not taking good care of their daughter, step down from their community responsibilities, especially church positions, because of shame and embarrassment.

In some islands, young mothers find that their marital prospects are reduced because men are discouraged at the thought of an additional dependent to care for throughout life, or because some men consider that kind of girl to be "promiscuous" and may not trust her to become a wife. One girl told me she just missed an opportunity to marry a young man she loved after he learned that she was pregnant. They were planning to get married right after they finished high school and before they went to college.

What's the Explanation?

Most of the young mothers interviewed used the term "accident" for what happened to them when they got pregnant. Many of them said that they went out with friends and got drunk, and then they got pregnant by "accident." One girl said she got pregnant when she met a boy she liked during a "youth" group activity. Some parents assume that because their kids are so devoted to their church or youth activities, they are no longer susceptible to temptation. Other girls, when they were supposed to be attending school activities, met up with friends and did whatever they wanted on their own.

Others seem to get pregnant out of boredom. One of the women explained that most of the girls in her village who left school during their elementary years got married or pregnant at ages 15-17. She recalled two of her classmates quitting school in the sixth grade; both got married during the summer and fall of that same year. She was not surprised that they got married so early because there was nothing else to do other than to take care of house chores.

Peer pressure seems to play a large role in teen pregnancy. Some parents complain that their daughters have been influenced by the daughters' friends. One couple on Pohnpei, whose favorite daughter became pregnant to a boy who lives a few houses away, said that their daughter felt left out because everyone in her social circle except her had a boyfriend. After she got a boyfriend in order to fit into the group, she got carried away on her first date and became pregnant.

Many parents, however, would say that the increase in the number of births to teens is no accident. They blame teenage pregnancy on the growing popularity of what they call the western lifestyle. This can mean just about anything: boys and girls hanging out together at school, walking hand in hand down the streets, attending school functions together. Some point to the changes in women's clothing as an example of the most dangerous of these changes. Girls, who once wore long dresses, now wear pants or short skirts, not to mention lipstick and eye shadow. Worse still, they go out with their friends to drink in the bars or just hang out in their cars. Then, of course, there is the very un-Micronesian custom of dating. Schools are also blamed in that they encourage pupils to attend school-sponsored dances or other activities at which boys and girls can meet in an unchaperoned environment. Movies and television are also blamed for seducing young people who have no firm anchor in their lives.

Two ladies relayed some stories about young girls in their village who always wore pants ever since they came back from high school on Guam. The young boys in the village enjoyed hanging out with these girls because they acted so "cool" and, unlike the girls in the village who never went off island, could smoke and drink with them. What seemed to annoy the older women was the fact that the parents of the girls didn't even bother to stop their daughters from conducting themselves in these strange ways. Most people in the village are still very old fashioned and anything like this enrages the community. Then one day, the group seemed to simply disband when one of the girls got pregnant, and none of the boys wanted to accept responsibility for the child.

Where Are the Parents?

In the past, many people in the extended family and in the community could be counted on to help correct children. Whenever a child was found to misbehave or do something wrong, he/she would be scolded and corrected immediately by any elder in the extended family or any community member. There was a strong feeling of responsibility among the elders to make sure the children were well disciplined. Parents were more concerned over their children's behavior, and the community helped make sure the young were well supervised and guided. When a child was found guilty of doing something wrong, some disciplinary action was almost always expected.

A further advantage during those days was that most of the young person's activities took place in the community close to home. The child was never far from someone who could guide him or her. If the parents needed to take a short fishing trip or off-island visit, there were always other people to fill in. Children were seldom left unattended.

One lady teacher said, nowadays, people ignore the kids even if they see them do something wrong because some parents take their children's side. She said even if she knows a kid is doing something wrong, she does not stop him or her, but ignores the misbehavior because she doesn't want to get in trouble with the child's parents. She claimed that even her own sister got mad at her for scolding her children when they misbehaved. I heard the same thing from a Catholic deacon as he reminisced about the way extended families used to help discipline the children thirty or forty years ago. He said that at that time children in his village were all considered nephews and nieces of everyone. Nowadays, he said, even his own brother would get upset if he scolded his brother's sons. He feels that teenage pregnancy is on the rise because people don't look after each other anymore as they used to, and the parents are getting very lax about disciplining their children.

Today most of this responsibility has fallen on the parents, but they often are disengaged from child-rearing. Their community activities and social rounds at the market prevent them from supervising the family–and there is no one to take their place, as there once was in the old days. Before, if the parents were not around, there was always an aunt or uncle to look out for the children. Nowadays, when the parents are not around, that means the children are unattended or unchaperoned.

One young girl I spoke to said she babysat for her young siblings because her mother always played bingo at the neighbor's house when the dad went out drinking. Her boyfriend would come by to visit when the parents weren't home, but the neighbors never bothered to tell on her. Another girl said she often would sneak out with her friends to cruise in their cars, often drinking with them until late in the evening. On one of those times she got careless and became pregnant. Usually when she went out, her parents were out drinking. Once, when she returned especially late, after one in the morning, both of her parents were too drunk even to notice.

Getting to Know One Another

All too often it seems that girls and their parents live in separate worlds. The teenage mothers I interviewed did not complain about being left alone. They thought that their mothers were "cool" because, as their mothers went about doing their own things, they themselves were left on their own. Since their parents are busy at work all day and continue to have social activities during the evening, they have very little time to spend with their children. But the girls said they like it that way because they are free to do their own thing when their parents are busy. To these girls, the ideal up-to-date mother is one who minds her own business rather than interferes with her daughter's life.

On the other hand, there are women who very much want to have an influence on their daughters' lives. I was told about one woman who forbids her daughter to participate in school activities that take place in the evening. Although the mother locks the door before she goes to bed, her daughter sneaks out anyway. Usually the girl is still drunk the next morning when the mother confronts her and starts yelling at her. The next thing she knows, the daughter grabs her bag and leaves the house. When she returns, her mother ignores her completely, refusing to speak to her. Another concerned mother, who also refuses to let her daughter participate in school extracurricular activities, warns her daughter that she will get pregnant if she continues to go out as she wishes. This mother once called her daughter a whore, but the girl says that she is used to the nagging and has learned to come and go as she pleases.

This girl once told the school counselor that she does not understand what her mother is complaining about when her mother tells her that she is disregarding their culture. She says that she doesn't know much of culture besides what she sees all around her: her friends partying, drinking, dancing, and holding hands with boys. For young people her age this is the only world they know; they have never lived any other life. On the other hand, parents are not well prepared to understand this world, which is so different from the one in which they were raised. Somehow the gap must be bridged. Parents need to give their children a chance to explain what's on their mind.

Starting the Conversation

A man I was interviewing one day was still upset when he told me how his daughter, whom he and his wife always left home to care for the younger children, got pregnant. He told me that he and his wife blamed each other for what happened to their daughter until they finally settled down and tried to analyze how things went wrong. His wife started to cry as she admitted that she kept treating their daughter like a small kid even though she was already a high school senior. The woman admitted that her daughter must have had her own interests and needs and wants, but she and her husband never once included her in their family discussions. Never did she sit down with her daughter and ask her how her day went or what she wanted to do the next day.

A role-playing session that was held for a group of twenty mothers and daughters revealed how little the mothers and daughters knew about each other. Most of the girls, for instance, did not know their mother's favorite color or hobby. Only a few of the girls knew their parents' wedding date. Many mothers were just as ignorant of their daughter's interests. When I asked the girls I interviewed if their mothers were their friends, they laughed at the question. They think of their parents as their superiors, but certainly not friends to whom they can talk about themselves, their hopes and their problems.

There are exceptions, however. One woman I spoke to, a working mother, said she always takes her daughter wherever she goes. Ever since the girl was young, the woman always made sure she had time to talk with her daughter. They have dinner together and spend time with each other as often as possible. There are times, she said, that her daughter has to be on her own with her friends during unchaperoned school activities, but her daughter seems to be able to take good care of herself when she is alone. The woman does not seem worried about her daughter, for she feels that the open conversations they have provide the support and guidance the girl needs to make good decisions.

Another of the mothers interviewed proudly said she and her daughters have no problem communicating with each other because she's always at home as a full-time housewife. As a widow, she has had to raise her eight daughters all by herself, but none of them has gotten pregnant.

Times have changed. The support system that parents once had from their extended family in raising their children is no longer present. Yet, parents are generally busier today than they were in the past and can no longer be around to supervise their daughters as closely as they might have formerly. To instruct and instill values, mothers need time to talk with their daughters and to listen to them as well. A strong relationship between mothers and daughters might, in the end, be the strongest way of protecting them and teaching them to make smart decisions. I recall the forceful words that a counselor once spoke to me when he insisted that in his experience most teenage girls who became pregnant had confessed that they felt that their families were not interested in them because they rarely communicated with them.