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Growing
Up Fast
By Joanna Lipper
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Review
by Richard J Moldawsky, MD
New
York: Picador; 2003. ISBN 0312422229
336 pages. $25.00 (to be published November 2003)
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On the
subject of teenage pregnancy, we might suppose that the right combination
of parental supervision, community support, personal values, and education
would effectively neutralize the impulsivity and hormonal surges of
adolescence. Written for a general audience, this book examines these
opposing forces by presenting indepth stories distilled from conversations
between Joanne Lipper and six teenaged mothers. The introductory chapter
sets the stage effectively, but the closing chapter does not summarize
as well as the reader might hope.
The setting
for these stories is Pittsfield, a small city in western Massachusetts
in the Berkshire Mountains. This area boasts many cultural offerings--Tanglewood
and Jacob's Pillow are among the better-known attractions. Pittsfield
has benefited from this environment but even more so from its long relationship
with the General Electric Corporation (GE), the area's main employer
for decades. This situation changed in 1986, when GE decided to shift
many of its operations abroad; this action greatly disrupted the Pittsfield
economy and combined with an earlier crisis--toxic waste disposal into
the local river--to set the city on a prolonged course of decline.
This decline
occurred at a time of plentiful coverage for inpatient treatment for
substance abuse, and a local hospital contracted with Medicaid to provide
such treatment for New York beneficiaries. Consequently, Pittsfield
became a hub for drug dealers and drug abuse. The impact of this phenomenon
on a poor community is the powerful theme of this book and illuminates
the social, economic, familial, and psychological factors which lead
to early sexual activity and pregnancy.
Ms Lipper
cites a study1 coauthored by Vincent Felitti, MD, of SCPMG
in San Diego (and Book Review Editor of The Permanente Journal)
which found that girls younger than 15 years of age are more likely
to engage in sexual behavior if they have been subjected to emotional,
physical, or sexual abuse; have witnessed domestic violence; live with
an adult who has a history of substance abuse, mental illness, or a
prison record; or has experienced a combination of these factors, which
fill each chapter of the book. Readers must try to imagine how a teenage
girl could cope with the deprivations caused by these factors. Most
of the girls are themselves children of teenage mothers--mothers so
entrapped by their own problems that they cannot provide the basic necessities
for their children. These children naturally continue to seek security--no
matter how illusory or temporary--wherever possible. The immensity of
the problems seems insurmountable.
But perhaps
they are not insurmountable. A community resource such as the Teen Parent
Program can become a lifeline for pregnant adolescents in Pittsfield.
This program (a day school housed in a church building) offers counseling,
daycare, tutoring, and--perhaps most important--caring adults who help
these girls through family turmoil, medical needs, and the public welfare
system. The program is no panacea but is a beginning.
We would
hope for happy resolutions for all the girls described in the book.
Instead, however, the book describes heroic victories--a high school
graduation and ending the need for public welfare assistance--as well
as horrendously bad choices such as returning to a physically abusive
boyfriend or selling drugs. The reader is left to worry about the kind
of parents the babies will become--and how soon.
Ms Lipper
largely allows the stories to speak for themselves but does offer some
psychological and sociological insight into these teens. Given how well
she has come to know these young mothers, her insights ring true. The
final chapter, "Community," attempts to synthesize what Ms
Lipper has learned from the girls (and from others) about coping with
teen pregnancy. Although Ms Lipper identifies and describes some of
these approaches, I would be interested to know more about how she envisions
the roles of schools, churches, health care agencies, and government.
And, of course, what about the families and the girls themselves? Ms
Lipper sees all these entities as having a place, but the final chapter
would have benefited from more detail in this regard. Nonetheless, those
with any interest in adolescence will appreciate this book and will
find these stories worth reading.
The book
forcefully reminds those who interact with pregnant teenagers that these
girls are usually the victims of deeply troubled families. More awareness
of the predictors of teenage sexual activity and pregnancy may provide
an opportunity for health care professionals to make appropriate referrals,
offer counseling, and provide medical information to such children,
who must be considered at high risk for a life of extraordinary challenges.
Reference
- Hillis
SD, Anda RF, Felitti VJ, Marchbanks PA. Adverse childhood experiences
and sexual risk behaviors in women: a retrospective cohort study.
Fam Plann Perspect 2001 Sep-Oct;33(5):206-11.
Richard
J Moldawsky, MD, is a psychiatrist who joined SCPMG in the Bellflower
Service Area in 1983. He now works in the Orange County Service Area
at the Anaheim and Aliso Viejo Medical Offices.
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