中文摘要

【研究目的】
　　探討未成年媽媽(未滿20歲)，生育第一胎後至目前約6-8年間的生活狀況。

【研究材料及方法】
　　本研究採用回溯性研究法。研究對象為未成年母親，其個案來源是高雄縣1994年6月至1995年5月間的出生登記，其中初產在15至19歲的母親共576名，對照組選取當時收集的596位成年媽媽為對象。利用結構式問卷，商請公衛護士進行家訪。其生活事件的結果變項包含婚姻狀態、教育程度、再次懷孕、家庭收入主要來源、第一個小孩的主要照顧者、同住情形及健康行為等。預測變項包含未成年母親及第一個小孩生父的社會人口學資料、抽菸喝酒行為和家庭情況。

【研究結果】
　　完訪個案共947名，分別是未成年組431名(46%)、成年組516名(54%)。在未成年組個案的基本資料包含年齡多在18至19歲(57%)，生第一胎當時其生父的年齡以20至24歲(43%)為主，未成年母親目前以生育兩個小孩為主(53%)，在產第一胎後93%有再次懷孕，且過去懷孕的過程中有墮胎經驗者約41%。
　　未成年母親目前的生活狀況，相較於生第一胎當時，在教育程度方面有顯著的改善，較多完成的高中(職)學業(56% vs.58%、P=0.04)；有工作的比例大幅增加(26% vs. 49%、P<.0001)，且為家庭收入的主要來源者；居住方面，與公婆同住的比例下降(83% vs.62%、P<.0001)，與配偶且為孩子的父親同住者(62% vs.67%、P=0.008)，或是自行居住者亦有顯著增加(2% vs.6%、P<.001)；但在抽菸喝酒等習慣上亦有所增加(抽菸：6% vs.10%、P<.001；喝酒：4% vs. 11%、P<.0001)。
　　影響未成年母親自覺家庭收入較差者的因素，在未成年母親其生育對象目前有抽菸者的危險性較高(OR=2.07、95%CI=1.04~4.10、P=0.04)。其生第一胎當時的家庭收入主要來源為自己者，短期再次懷孕的危險性較低(OR=0.37, 95%CI=0.20~0.71, P=0.003)。未成年母親生第一胎當時為沒有結婚者其家庭暴力危險性較低(OR=0.41, 95%CI=0.18~0.92, P=0.03)。但在控制生第一胎當時的婚姻狀態及目前的職業下，未成年母親目前與自己父母同住者，且生第一胎當時其生育對象的喝酒習慣為沒有喝酒者，其家庭暴力的危險性較高(OR=33.45, 95% CI=3.69~330.3、P=0.04)。未成年母親自覺家庭收入較差者(P=0.002)、目前有抽菸習慣者(P=0.05)，或生第一胎當時家庭收入主要來源為自己父母者(P<.001)，其有憂鬱傾向的危險性較高。
　　未成年母親相較於成年母親而言，呈現出相當不利的情況，包含有較多的墮胎及家庭暴力經驗、較低的教育程度、職業較多為無業或家庭主婦、較多的抽菸和喝酒習慣、較多有憂鬱傾向；第一個小孩的主要照顧者方面，較多為女方父母照顧、較少為自己及小孩生父，較多與公婆同住；家庭收入主要來源方面，較多為男方父母、較少為先生或同居男友。未成年母親其生育對象，相較於成年母親其生育對象而言，亦呈現出不利的情況，包含：低教育程度、較多的抽菸和喝酒習慣、職業多為非技術或部分技術性工人。而未成年母親在自覺家庭收入較差、短期再次懷孕、家庭暴力及憂鬱傾向等方面，具有較高的危險性。

【結論】
　　從生第一胎後到產後六至八年的時間，未成年母親在教育程度及有工作的比例上已大幅增加，顯著減少對公婆在居住或是經濟上的依賴，但相較於成年母親來說，其生活狀況仍處於相當不利的狀態，包含有較多的墮胎及家庭暴力經驗、較多的抽菸喝酒習慣及憂鬱傾向、教育程度較低且多為無業、接受社會補助的比例較高等。對於未成年母親生育的後續問題，不只是對健康、家庭或是社會層面的影響，更是跨領域的公共衛生議題，值得我們共同來重視。

　　Purpose: This study aimed to unveil the trajectory of major life events in a cohort of teenage mothers, occurring between the birth and 6-8 years of age of their firstborn, and delineate the affecting factors for the trajectory.
Subjects and Methods: A retrospective review of major life events was undertaken among a sample of teenage mothers (n=576) who gave their first births at ages of 15-19 between April 1994 and May 1995 in Kaoshiung county. A group of adult mothers (n=596) who had their first births in the same period of time was recruited for comparison with the teenage group. This review was based on a structured questionnaire administered by public health nurses. The major life events included marital status, schooling, repeat pregnancy, parity, employment, family economic status, child care, residency and health behavior. Predictors of these events included the fathers and mothers’ demographic characteristics, smoking and alcohol drinking behaviors, and family characteristics.
　　Results: A total of 947 study subjects completed the interview, including 431 teenage mothers and 516 adult mothers. Most of these teenage mothers were 18 to 19 years old (57%) when they gave their first births. Majority of the biological fathers of these firstborn were aged between 20 and 24 years (43%) at childbirth. By the time of the interview, most of the teenage mothers have had a second birth (93%). Nearly 93% had at least a pregnancy and 41% had at least an abortion between the first birth and the interview.
　　There was a significant increase in completion of high school education (56% vs.58%, P=0.04), and employment rate (26% vs. 49%, P<.0001) in the teenage mothers. Both a decline in cohabitation with the biological fathers’ parents (83% vs.62%, P<.0001) and an increase in having a nuclei family were noted (62% vs.67%, P=0.008). However, the proportions with smoking or alcohol drinking habits had risen (smoking: 6% vs.10%, P<.001；drinking: 4% vs. 11%, P<.0001).
　　Higher percentage of self-perceived low family income was observed in the teenage mothers with spouses who were current smokers (OR=2.07, 95%CI=1.04~4.10, P=0.04). Short term repeat pregnancy rate was significantly lower in the teenage mothers who had her own income at the first childbirth (OR=0.37, 95%CI=0.20~0.71, P=0.003). Risk of domestic violence was significantly lower in the couples who were unmarried at the first child birth (OR=0.41, 95%CI=0.18~0.92, P=0.03). After controlling for other significant predictors, effect of living with the parents of teenage mothers was significantly modified by whether the biological fathers had alcohol drinking habits at the first childbirth. Teenage mothers who lived with their parents and their partners with no alcohol drinking habit at the firth childbirth have the highest risk of domestic violence (OR=33.45, 95% CI=3.69~330.3、P=0.04). Teenage mothers, who perceived having low family income (P<.001), were current smokers (P=0.05), or needed financial support from her own parents at the first childbirth (P=0.002) had significantly higher scores in Beck Depression Index.
Compared with adult mothers, teenage mothers had higher incidence of abortion, more with domestic violence experience, more with lower education, more being unemployed, more with smoking or alcohol drinking habits, and more with depressive symptoms. Primary caregivers of the firstborn were more the parents of the mothers and less the mothers themselves and the biological fathers in teenage mother group. Teenage mothers more lived with the parents of the biological fathers. More income came from the parents of the biological fathers and less from the biological fathers or cohabited partners. Percentage of self-perceived low family income and proportion of receiving social welfare money were higher. Percentage of being a single at the first childbirth was higher in the teenage mother group. Compared with the fathers in the adult mother group, fathers in the teenage mother group had lower education, more with smoking or alcohol drinking habits, more with unskilled or semi-skilled jobs. Teenage mothers were at higher risks of self-perceived low family income, short repeat pregnancy, domestic violence and depression.
　　Conclusions: During the 6-8 years of follow up, teenage mothers had achieved an improvement in the rates of completion of high school education and employment. Dependency on the family support from the parents of their husbands had been reduced. However, they were still a disadvantageous group compared with the adult mother group in many regards including more with abortion and domestic violence experience, more with smoking or alcohol drinking habits, more with lower education and being unemployed, and more receiving government assistance. Teenage childbearing caused many adverse health, social, and educational consequences. This problem requires concerted efforts from public health sectors.

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