Teenage Pregnancy: Barriers to an Integrated Model for Policy Research
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Roy Nash
Massey University College of Education
Palmerston North
Abstract
New Zealand has one of the highest teenage pregnancy rates in the developed world. In the UK, where the rate is lower than New Zealand's but twice the European average, a Cabinet-led programme has been launched to bring the problem under control. This paper argues the case for New Zealand research into teenage pregnancy - and the sexual activity of young people in general - in its full social and cultural context. Three conceptual barriers to this project are identified and discussed: (i) "at risk" positivism; (ii) "true effect" reductionism; and (iii) the concept of culture. It is suggested that a realist structure-disposition-practice model with a "numbers and narratives" methodology may be able to overcome these barriers, and thus widen the focus of an area of research currently dominated by a medical paradigm.
Introduction
New Zealand has one of the highest teenage pregnancy rates in the OECD. In 1997 the age-specific pregnancy rate for women 15-19 years of age was 33/1,000 for non-Maori and 94/1,000 for Maori (Dickson et al. 2000). Among developed countries, only the United States records a higher statistic.
The specific incidence of teenage pregnancy is not necessarily influenced by changes in the sexual activity of young people, but there is an obvious relationship between sexual activity and pregnancy, and there is much to be said for an integrated approach in this field. Reliable studies indicate that the age of first sexual intercourse in New Zealand is decreasing and that the proportion of sexually active young people at school is increasing (Silva and Stanton 1996, Dickson et al. 1998). It is safe to conclude that at least a third of New Zealand teenagers are sexually experienced before they are 16, the minimum school-leaving age, and that well over half are engaged in sexual activity while at school (Fenwicke and Purdie 2000).
It is appropriate that medical research should focus on matters of social and individual health. Studies within this paradigm emphasise the need for sex education aimed at the prevention of unwanted pregnancy and the control of sexually transmitted diseases. Specific health concerns, however, do not exhaust the reasons for taking a legitimate interest in the sexual activity of young people and its consequences in pregnancy (Cunningham 1984, Simms and Simms 1986). The long-term costs of teenage pregnancy to the state, in terms of sole-parent family benefits expenditure is substantial (Goodger 1998). These are acknowledged as the principal reasons for the recent determination to tackle teenage pregnancy in the United Kingdom, where the Cabinet has launched a multi-pronged campaign to address what is perceived there to be a serious problem (Social Exclusion Unit 1999:4).
This paper outlines an agenda on teenage pregnancy in New Zealand that would provide what policy makers need to know in order to carry out their tasks. This will include assessing the actual state of affairs and whether there is a problem to address, identifying the sectors of the population involved, developing policy options, and evaluating the results of intervention programmes. The challenge for sociologists with a responsibility to assist in these state tasks is to construct a realist framework within which the complex processes that generate social inequalities of various kinds can be modelled. An approach able to transcend the dichotomies that plague social research - qualitative versus quantitative, positivist versus hermeneutic, and theoretical versus applied - can be achieved. The realist framework developed here has been influenced by Archer (1995), Bhaskar (1993), Bunge (1998) and, despite the different ontological foundations of his work, Bourdieu (1993, 1998, 2000).
In a word, social structures generate socialised dispositions, socialised dispositions generate collective practices, and practices are adopted by individuals. Social practices should not be confused with the level of behaviour; they are socially recognised ways of doing things that are taken up, perhaps as "discourses", by people in a certain frame of mind. This theoretical agenda is combined with an integrated "numbers and narratives" methodology. The overall scheme is, in fact, the standard form of any systematic sociology (Nash 1999). "Numbers and narratives" is a slogan intended as a corrective to the unprincipled methodological division in social research between qualitative and quantitative methods. It is plain that numbers need narratives to explain them and it should equally be plain that unless the various magnitudes of a matter under investigation are known an explanatory narrative will be that much less valuable.
Although the interminable debates about sociological theory are likely to have minimal interest for policy makers confronted with pressing material problems, some discussion of these areas seems necessary. At least three powerful obstacles confront the development of a realist structure-disposition-practice research programme into the substantive area of teenage pregnancy and the sexual activity of young people. These can be identified as, (i) the privilege given to forms of statistical explanation that favour a positivist over a hermeneutic account, embedded in the practical-theoretical "at risk" concept; (ii) the preference for behaviourist and reductionist models that isolate behaviour from its social context; and (iii) the support given to an authoritative concept of culture that inhibits recognition of actual and lived cultural practices.
Barrier One: The "At Risk" Concept
The "at risk" concept is so deeply embedded in the professional discourse of policy makers that to subject it to critique is not without risks of its own. Statistical models provide the standard form of analysis and explanation for the purposes of policy making and state management and a kind of shorthand has emerged in which behaviour is typically explained by "risk factors". This model, however, has its limitations. As an explanation of a social practice, to say that those who adopt it do so because they are the kind of people who probably will do so, does not explain why recognisable forms of social practice have emerged, or why particular individuals (rather than others with similar "risk" characteristics) should adopt them, or why their proportion might be 10% or 20% rather than some other figure. The related notion, that all students from a particular group, identified, for example, by its social or ethnic origin, are each equally "carriers" of a specified weight of disadvantage, a virtual handicap, is a further common error.
Those at home with this discursive framework, nevertheless, often allow the apparent practical utility of such accounts to obscure their fundamental weakness. The "at risk" concept, however, has no explanatory value and gives support to a "cycle of deprivation" model that is not necessarily supported by the evidence (Dean 1997, Jones et al. 1986). There is in reality no one-to-one correspondence between income and lifestyle and, just as family resources have a continuous distribution, so do social practices. The distribution of family resources - including income, cultural capital, and social networks - and the discourses of practice, follow a continuous distribution in which sharp breaks are difficult to detect.
It may be useful to illustrate the limitations of conventional "at risk" models - positivism in practice - through an examination of a report from the Dunedin multidisciplinary survey into the determinants of sexual activity before age 16 (Paul et al. 2000). The authors used logistic regression to discover the variables that discriminate between boys and girls who had sex before 16 and those who did not. The technique is a widely used and valuable statistical method. The first point to note is that only 12 variables, of the thousands available in this extensive longitudinal data set, were of any significance in discriminating between the two groups. Of these, two were structural variables (socio-economic status, mother under 20 at first birth); five were individual or dispositional (IQ, self-esteem, reading score, not attached to school, and plan to leave early); and two were practice variables (no home interests at age 13, no religious activity). Two other variables, diagnosis of conduct disorder and being in trouble at school, have an ambiguous status. The former is probably best regarded as a dispositional variable, but in as much as attention is drawn to conduct it might be regarded as a practice variable. In the same manner, being in trouble at school seems to be a practice variable, but draws attention to the structures of the school that define certain conduct as "troublesome" and might thus be regarded as a structural property of the institution. The variables are, of course, not discussed in these terms by the researchers, who treat them simply as "measures" of variables having an identical epistemological status. In this anti-realist convention, "measures" are regarded as "concepts" or "constructs" in a "nomonological net", and therefore with no ontological reference. A grasp of the different status of the variables in this set, however, is crucial to the construction of a realist account of sexual practices among young people.
The analysis shows that of this limited set of 12 variables, eight are significant for girls and five for boys, with only one variable shared. The cultural pattern suggested by the analysis appears, moreover, to have internal contradictions. Girls who have sex before 16 are more likely than others to smoke, to plan to leave school early, to be in trouble at school, and to be not attached to school, but they also have high esteem. This counterintuitive finding is difficult to explain. It is not surprising that the research is reduced to silence on the question of why boys and girls require a different theory to explain the same behaviour. The process of theory construction is characteristically under-specified both at the beginning and at the end of the research investigation. At the first stage, variables are often selected for inclusion in a model by a taken-for-granted theory, and at the final stage the output is interpreted by a second, and even more ad hoc, theoretical process. Any variable not included in the model, for whatever reason, cannot contribute to the theoretical interpretation. In this case, ethnic origin plays no part, almost certainly because only 3% of this Dunedin sample are Maori or Pacific children. The value of such research for policy makers must be regarded as problematic. It is obviously useful to know that those "at risk" can be identified - although identification on that basis is often very inefficient - and policy makers need to acquire some skill in the interpretation of such information for their purposes. It is far from clear that encouraging boys to take up a "home interest" or "religious activity", for example, would be sensible ways of persuading them to practise safe sex. There are good reasons to reduce the incidence of "conduct disorder", improve reading scores, and increase levels of attachment to school, but programmes directed at these ends cannot be expected to have much effect on sexual activity. It is a considerable challenge to develop a coherent theory from fragments of behaviour revealed by such positivist research.
Quantitative methodologies can, of course, provide essential information about sources of variance in the behaviour of students and, through multivariate analysis, can offer an investigator at least a shrewd idea of the various social processes through which it has been generated. It remains true, however, that the interpretation of statistical patterns without any direct knowledge of the social processes by which they were created lacks the evidence necessary to a complete explanation. Although it is not always easy to identify the social processes responsible for specific system effects, an integrated, realist approach is more likely to reveal what is happening than research legitimated as "quantitative", or even "evidence-based", where that concept excludes integral contextual investigations of social process. The taken-for-granted theory of measurement in social science, which gives support to operationalism and nominalism, is fundamentally anti-realist. The theory of statistical explanation associated with it is equally inconsistent with a realist concept of explanation. These are serious issues for the practice of a social science that attempts to provide evidence of the linkages between the stratified entities of the social world, and directly affects the substantive problem under discussion.
Barrier Two: Reduction to the "True Effect"
The second barrier to an integrated approach to social research is posed by a variant of reductionism with a strong following among economists. I would argue that a complete explanation of social processes would include an account of social structures, individual dispositions, and practices. Social explanations are thus multi-layered, and in their attempt to reflect the complexity of the world typically construct narratives that integrate rather than disintegrate. In sociology the struggle to explain the complexity of the real world generates complex multivariate models, but in contemporary economics there is an influential tendency to search for "true effects" with overly simplified models. A literature review of research into family and community effects, commissioned by the Ministry of Education (Nechyba et al. 2000), is almost exclusively concerned with studies conducted within this paradigm. The review is particularly influenced by Mayer (1997) who is engaged in a search for the "true effect" of income, which she defines as "the effect controlling all parental characteristics, both observed and unobserved, that influence the parents' income and the children's outcomes" (Mayer 1997: 8). Mayer points out that "the fact that poor children fare worse than rich children does not suffice to prove that low parental income per se hurts children", and notes that children with certain attributes "do well even when their parents do not have much money" (Mayer 1997:3).
The point of Mayer's analysis seems to be that as poverty is not the cause of educational drop out and other undesirable behaviours - when the effect of all other factors, most of them associated with poverty, have been statistically removed - it follows that the attempt to improve such outcomes in low-income groups is unlikely to be achieved by increasing their income. If children from low-income homes do not usually fail unless, like those involved in the Milwaukee Project New Hope, they are also affected by "alcohol abuse, dysfunctional family relationships, conflicts with employers, problems with baby-sitters and cars, and simply depression" Nechyba et al (1997:55) - then it is those specific circumstances of their environment that should be the target of policy interventions. More usefully, a sociological perspective would lead these patterns of "lower class" living to be interpreted as the product of specific habitus generated by poverty and oppression. The two stances lead to different policy interventions: programmes designed to effect narrowly specified behavioural changes as opposed to the reconstruction of effective dispositions and their origins in structural conditions.
What I have termed "economic reductionism" effectively negates the value of collective sociological concepts, including class and ethnicity, except as nominal categories useful only for monitoring the efficiency of service provision. What is characteristic to a sociological account, its structure-disposition-practice scheme, is thus "deconstructed" in such a way that the complex relations of causality between social variables, e.g. income, associated class "cultures", and social practices, cannot even be investigated. It seems absurd to argue that a set of dispositions and practices cannot be caused by class location on the grounds that a given "culture" is not adopted by all members of a class and not only by them. This is a failure of the "sociological imagination" on a gigantic scale. The existence of such multiple cultural responses within a broadly defined economic social class has long been recognised by sociology and, indeed, is a commonplace notion, as the traditional concept of the "deserving" and "undeserving" poor illustrates.
The study of lived cultures, particularly where class and ethnicity intersect, is particularly difficult. Social theorists are understandably reluctant to invoke the discourse of "deficit theory" in its various guises, "cycles of disadvantage", "dependency culture", "culture of poverty", and such like. This cannot, however, be allowed to prevent the realist investigation of the patterns of life produced by class-located families as they respond with their different levels of material and symbolic resources to the structures of oppression and constraint that characterise all societies fragmented by class and ethnic division. It is necessary to insist that the same objective structural conditions may give rise to different kinds of socialised dispositions and cultural practices. The fact that the majority of people from groups defined in terms of their income, ethnic origin, employment status, or any other social attribute, do not adopt a given habitual mode of practice does not alter the fact that a substantial minority may do so. Social theorists may need to give these issues of lived cultural practice a more detailed analysis (Poata-Smith 1996, Rata 1996).
The work of critical social theorists is often unwelcome in the circles of the state. It seems that government policy makers are all but bound to turn to economists when sociology is seen to privilege advocacy over analysis. The reasons why sociology, in particular, seems to have lost favour, even to be distrusted, by policy makers, should be a matter for serious self-reflection within the discipline. It is one thing to mount a critique of the limitations of economic theory to comprehend the nature of social practice, but it is quite another to address the need to develop systematic and, where appropriate, quantitative models with some value to those with practical functions within the state.
The lessons for critical social theory point directly at the need for closer attention to the study of lived cultures and actual social practices in our fragmented national community. The resource "gaps" of recent political discourse are caused by relations of social class and ethnic domination, but the precise nature of the connections between these structures, the dispositions associated with them, and the multitude of practices generated, cannot be taken for granted. On the contrary, the real implications of the post-modern insight that discourses, as narratives of practice, are not determined should be thrust home. We live in a society in which the adoption of social practices by individuals is increasingly likely to be de-coupled from their socio-economic and even ethnic location, but that must not be allowed to encourage the view that such practices, in themselves, do not have their origin in structural conditions. Economic models based on rational action are particularly likely to fail when confronted with the reality of behaviour that stems from habituated frames of mind acquired through socialisation into practices with a high degree of cultural integrity.
Barrier Three: The Concept of Culture
A third barrier to studies of how people live in contemporary society can be recognised in the influential definition of culture as practices deemed authentic in the customary repertoire of an ethnic community. In Bunge's scientific realism the cultural system includes all those social practices that involve the production and dissemination of information of all kinds. The sphere of culture embraces religion, education, the arts, the media and all related activities. A culture is thus conceptualised as a concrete system brought into being as people engage in activities of an appropriate kind. This materialist concept differs fundamentally from idealist concepts of culture as a set of ideas or "meanings". This analysis makes it possible to distinguish between two questions: (i) how do social groups create practices of a certain kind, and (ii) how are they acquired by individuals? The first question requires an historical and functional account in which social groups devise specific practices as they attempt to meet the central needs of survival and reproduction. The second question must be answered with a theory of socialisation that describes how a society's members acquire the habitual routines that ensure its continued functioning. These different questions are at the heart of realist sociology.
The specific task of social anthropology is to describe and analyse the practices of social groups. In the paradigm case, these social groups are distinct communities more or less bounded by social and geographical isolation. In modern societies with an historical class structure and a multi-ethnic population, there is often so high a degree of integration and pluralism that social groups, as communities known by a distinct set of practices, can be difficult to identify with any precision. This situation raises an issue that has yet to gain the theoretical attention it merits. Given a social practice, in the fields of sexual activity, education or domestic relations, for example, what criteria should be used to describe it as either a class or an ethnic practice? Let us be clear about what is at stake. The pregnancy rate for Maori girls is three times that of Pkeh girls. Maori girls in some areas of New Zealand are more likely than not to be mothers before the age of 20. Can this be said, however, to be a Maori cultural practice?
There are, in fact, several distinct criteria that may be used to distinguish a practice as characteristic of a particular social group: (i) statistical frequency, (ii) collective interest, and (iii) traditional origin. Economists seem to have an exclusive preference for statistical frequency. In this concept, the culture of a group is known by its common practices, in other words, by its actual and observed way of life. Statistical methods certainly have a useful contribution to make to the specification of social groups, even to the extent of defining them. The identification and analysis of culture by a principle of interest or generation in which, for example, the practices of a group are held to be derived from the nature of its objective or structural position, is also supported. Indeed, the study of political conditions by the analysis of classes and other social groups in a social formation may be recognised as an approach with a long tradition. The position of Marxist political sociology that the working class has a collective interest in resisting the demands of capital has directly influenced cultural studies, where the lived culture of resistance, formal and informal, actual and symbolic, has become the specific object of analysis. Finally, the culture of a group may also be regarded as comprising those practices, even if adopted only by a small minority of its defined members, that can be recognised as traditional and thus part of its authentic heritage. This is actually the position generally adopted by contemporary New Zealand theories of ethnic culture and may become definitive.
These three modes of the determination of cultural dispositions and practices are not necessarily in opposition, but nor are they always compatible, and analyses based on one or another often lead to quite different social movements. They certainly require different modes of investigation and analysis. It is relatively easy to specify a practice as one characteristic of a group by observing whether it is common or not; whether a practice is traditional to a group must be established by historical inquiry and rests ultimately on legitimate authority; and to demonstrate the relationships between structural conditions and the emergence of practices in response to them requires rigorous sociological and anthropological analysis.
Thinking within this three-model framework is useful when dealing with the multitude of problems that arise when the common practices of a defined group are not traditional to that group (hence, "inauthentic"), seem to be generated by an actual principle with a different character (such as "assimilation"), and perhaps stand in contradiction to a theoretical principle derived from other defining criteria (such as "autonomy"). In this area, indeed, conceptual clarity - or the lack of it - may have directly practical consequences. It threatens, at the very least, to inhibit the study of lived cultures by denying their conceptual validity. Indeed, the crucial question of who defines teenage pregnancy as a social problem, cannot fully be answered if the voice of those to whom it may well seem not a problem but a solution, is silenced by the failure to acknowledge lived cultures in all their real complexity.
The concept of authentic culture is particularly problematic in contemporary - that is, non-traditional - multi-cultural societies. In conditions of inter-ethnic oppression, many social practices common to minority groups acquire an altogether new layer of meaning. They are no longer simply the way life is lived but become symbolic expressions demonstrating that a distinct form of life is lived. The maintenance of traditional ceremonial customs and practices and the continued production and display of traditional Maori arts necessarily takes place in a transformed social context in which an element of self-conscious tradition-maintenance and identity-creation is ever present. Such elements have become so important, in fact, that the concept of "ethnic culture" has been introduced in an attempt to reflect their character.
The Maori "renaissance" is essentially and necessarily concerned with the reactivation, recultivation and regeneration of the "authenticity" in Maori cultural practice lost and transformed as the result of colonisation. Hence, Mahuta and Ritchie (1988:30) define "authentic" Maori culture as: "the culture that has sustained Maori difference over time, made meaningful the persistence of the language, the social forms such as the tangi, the cultural manifestations in arts and oral literature and the sense that these things are ineradicably indigenous and will prevail". The term "ethnic culture" here refers to cultural performances and artifacts that contribute specifically to the maintenance and celebration of the collective identity of a people as a group with a certain origin and history. Nevertheless, the search for "cultural authenticity" in social practice has a troubled history, and may have ambivalent social and political consequences. In the context of this paper it threatens, at the very least, to inhibit the study of lived cultures by denying their conceptual validity.
The definition of ethnic practices provides an instance where the analysis of discourse as power is especially apposite and is a concept increasingly accepted and institutionalised by ethics committees. However, the whole question of what information can be regarded as the property of a given collective, constructed on whatever basis, needs a more rigorous examination than it currently receives. There are certainly matters private to families and corporate entities of different kinds, and there may also be information in certain domains (economic, genetic, medicinal and so on) that should be protected, but whether patterns of life, or access to them, belong in that category is at least arguable. Policy makers accept the prevailing default definitions, which are inevitably those established by political power in its customary alliance with practical positivism (Webster 1998, Urry 1995, Lunt 1999).
Discussion
It is not the author's purpose to outline policy initiatives that are more appropriately developed by specialist agencies directly charged with that responsibility. The following remarks may, however, offer such readers insights from a sociological perspective that could transcend the narrow focus of medical discourse. It is important to distinguish between a legitimate and an illegitimate interest in the sexual activity - which sometimes does lead to unwanted pregnancy - of young people, and reach out with appropriate assistance to those who require help in any form. Changes to the legislative provisions for young people to gain access to sexual health services should certainly be considered (Collins 2000), although it is improbable that earlier sexual activity by New Zealand teenagers and a rise in the unwanted pregnancy rate are the result solely of a parallel rise in misinformation and ignorance. Schools should attempt to create an ethos of mature and civilised acceptance of sexuality in which privacy from intrusive surveillance, including gossip, is inhibited. Schools may also need to recognise in policy and in practice that it is no longer appropriate - if it ever was - to regard sexual activity, even under-age and promiscuous sexual activity, as a taken-for-granted signifier of resistance to education. Sex education is continuously expanding its scope so that physical, social, and emotional aspects - life-skills - are incorporated in the curriculum. The earlier young people are able to come to terms with this central aspect of their lives, at an appropriate level, the more control over their destiny they are likely to achieve (Hollibar and Wyllie 1992).
The changing patterns of sexual activity by young people in the school system need to be studied with a sociological imagination. The entire area, in fact, should be situated within a theory of social and cultural reproduction. In a forthcoming paper (Nash 2001), drawing on Bourdieu et al. (1999), an extended discussion of the themes briefly noted in this paragraph is presented. The paper argues that middle class, gendered strategies of family reproduction for sons and daughters have converged in recent times inasmuch as the educational system, both as a source of credentials with a market value and as an agency with a distinctive function in the maintenance of class endogamy, has become vital to the success of offspring of both genders. This trajectory, however, is massively threatened in the case of daughters - a clear demonstration of gender inequity - by the possibility of pregnancy. Middle-class families that once "protected" their daughters through traditional practices - the directly patriarchal business of the father - now achieve the same strategic purpose through an intensification of the personal relationship between mother and daughter, which effectively ensures a shared basis for relevant preferences and a context in which relatively unobtrusive surveillance and monitoring can be maintained.
Working-class family strategies have undergone an equally distinct transformation. It is no longer taken for granted in working-class culture either that sexual activity need result in pregnancy or that a sexual relationship should lead to marriage. Indeed, there are indications that many young, working-class women are maintaining separate affectual friendships and sexual contacts with young men, which suggests their sexual relationships are becoming increasingly casualised. Differences in sexual behaviour are based on social class as well as ethnic group membership. Working-class girls, in particular, should be encouraged to extend their lifestyle options and strategies found to counteract the culture of fatalism in which many, in a sense, allow themselves to become pregnant. It is in this area, where the economic costs are becoming increasingly burdensome, that research-based programmes of intervention are required. There is an urgent need for further research into the social conditions that give New Zealand one of the highest teenage pregnancy rates in the world.
Conclusion
Policy makers cannot assume that research from the United States and the United Kingdom will provide information directly applicable to our own society. It is important to investigate the specific micro-cultures - associated with social class and ethnic origin - that emerge in response to our specific structural conditions. Even in a global culture, such micro-cultural forms have their own local character. As Fenwicke and Purdie (2000:463) have pointed out, New Zealand is a "culturally and economically diverse country which is information-poor about differing social behaviour, attitudes and future aspirations of our young people". In this context, it is important to recognise that the "differing influences and beliefs which affect the onset of sexual risk-taking behaviour", cannot adequately be studied outside a systematic sociological framework (Lungley 1993). The task for such social research is to go beyond conventional positivism (even when naturalised as "evidence-based") towards an integrated, three-dimensional model, of realist social science. Social research is increasingly dominated by the concerns of policy makers who define the problem and invite bids from those prepared to supply the desired outcomes. University-based sociologists, while bound to respond to this market situation, have their own statutory concerns to act as the critical conscience of society. Although the activities of independent critique and market provider are not necessarily compatible, it may be that in many areas - including this substantive issue of teenage sexual activity and pregnancy - a basis for principled accommodation can be found.
The idea that it is unnecessary for policy makers to understand the specific cultural forms that shape the behaviours their policies are designed to modify and eradicate cannot be sustained. It may, perhaps, seem sufficient to support provider agencies in the assumption that they possess adequate theories of practice, and allow the successful among their number to flourish and the others to wither. This mandarin approach, however, has its drawbacks. There is every reason to believe that the structure-disposition-practice model, which has a utility in application as well as in explanation, would provide information of direct benefit to policy makers. The range of policies introduced in the UK, for example, recognised these three levels as appropriate sites for intervention and that, although targeted principally at one level, they were more likely to achieve success when their intended effects at all levels were identified. The interventions were aimed at changing structural relations (through specialised housing and income support), transforming individual dispositions (through advice and counselling aimed at generating useful skills and heightening self-esteem), and creating alternative practices (through modelling desired approaches to sexual conduct, and so on). New Zealand research into the sexual behaviour of young people and its specific consequence in teenage pregnancy should be organised within a realist framework able to respond to the levels of structure, disposition and practice discussed in this account.
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