Teenage Childbearing,Reproductive Justice,and Infant Mental Health

Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.     

Family structure and community connectedness: Their association with teenage pregnancy in South Africa

This study aimed to examine the relationships between family structure and community connectedness on the one hand, as well as risk for teenage pregnancy on the other. Data were from the South African General Household Surveys 2011, 2012, 2013; N = 279 042, female teenagers = 9.9%, age range 10 to 19; black teenagers = 81%. We applied multilevel binary logistic regression to predict risk for teenage pregnancy by family structure and community affinity variables. Findings suggest teenage female teenagers from single-headed households and with higher numbers of male relatives are at elevated risk for teenage pregnancy. Similarly, female teenagers from families with parental divorce were at higher risk for pregnancy as were those from communities with lower coherence.     

The children of adolescent mothers: Physical,academic, and psychological outcomes

Teenage parenthood is believed to cause special problems for both the young mother and her children. In this review, individual differences in the expression of parenting by different-aged mothers are explored in light of two questions: How do parenting practices originate, and how do parental practices affect the young child's social, physical, and cognitive development? Approaches to the study of teenage pregnancy are considered. Then, the prevalence of teenage pregnancy is explored. Next, research on teenage parenting practices, on the likely antecedents of parenting practices, and on outcomes of teenage motherhood for the child is reviewed. Finally, problems in methodology and with the interpretation of findings about teenage parenting are discussed. Social and economic disadvantages and teenage parenting often cooccur; most studies have not separated out the relative effects of the two, making interpretation of the outcomes of teenage parenting difficult. In addition, most studies focus on the prototypic teenage mother (black, urban, poor, unmarried), making generalizations to other groups difficult. The major outcome findings may be summarized as follows. First, intellectual differences in children born to teenage and older childbearers become more pronounced as children develop. Small differences are seen in studies in the preschool years and larger differences are found by the elementary school years. Adolescents of early childbearers are not doing as well in school as adolescents of older childbearers. Second, behavior differences as a function of age of childbearing are more likely to be seen in the early years than intellectual differences. Problems appear in activity levels, hostility, and undercontrol of behavior. Third, boys are more affected by teenage childbearing than are girls, at least in the early years.     

The intergenerational cycle of teenage motherhood: an ecological approach

OBJECTIVE: Daughters of teenage mothers have increased risk for teenage childbearing, perpetuating intergenerational cycles. Using Ecological Systems Theory, this study prospectively examined risk factors for teenage childbearing among a national sample of adolescent girls. DESIGN: Data came from the National Longitudinal Survey of Youth 1997. Participants (N = 1,430) were recruited in early adolescence and interviewed yearly for 6 years. Survival analysis was used to examine the rate of childbirth across the teenage years by maternal age at first birth. Hierarchical Cox regression was used to identify multivariate predictors of teenage childbearing and to test whether risk factors differed between daughters of teenage versus older mothers. PRIMARY OUTCOME MEASURE: Age at first childbirth was based on cumulative information collected at yearly interviews. RESULTS: Daughters of teenage mothers were 66% more likely to become teenage mothers, after accounting for other risks. Individual (school performance), family (maternal education, marital status, number of children), peer (dating history), and environmental (race, enrichment) factors predicted teenage childbearing. Risks unique to daughters of teenage mothers were deviant peer norms, low parental monitoring, Hispanic race, and poverty. CONCLUSION: Results support multidimensional approaches to pregnancy prevention, and targeted interventions addressing unique risk factors among daughters of teenage mothers.     

A comparative analysis of infant mortality in major Ohio cities: significance of socio-biological factors

"Using linked birth and infant death records for Ohio for the 1984-87 birth cohorts, this paper examines differentials in neonatal, postneonatal, and infant mortality rates in four major Ohio cities....It was found that, compared to Toledo, Cleveland had 51% higher risk of infant death, Cincinnati had 45% higher risk, [and] Columbus had 13% higher risk of infant death. Although in each of these cities, black infants had significantly higher risk of death than white infants, controlling for race alone reduced but did not eliminate the infant mortality differentials among the cities. The results of the hazards analyses reveal that maternal education, marital status, maternal age, birth order, prenatal care, gestational age, and birth weight had a profound net impact on the risk of infant death and that, even after controlling for these and other maternal and infant characteristics, significant city differentials persisted in infant mortality."     

Assessing the patterns that prevent teenage pregnancy

Adolescence is a time of rapid developmental change and emotional upheaval as teenagers strive to assert their autonomy. In a similar vein, pregnancy--even under optimal circumstances with an adult mother--has been labelled a developmental crisis. Pregnancy during the teenage years has a synergistic effect, magnifying maturational changes in both the teenage girl and her infant. Recommended intervention strategies in cases of adolescent pregnancy should address not only the imminent mother-infant relationship, but the dyad's future transformations. One intervention technique is previewing, which is derived from the rhythms of adaptive exchange between mature mothers and their infants. The aim of previewing with adolescent parents is to help the teenager become more attuned to the infant's imminent developmental skills and to heighten their rapport.     

Fear of a black (and working-class) planet: young women and the racialization of reproductive politics

Racialized and class specific as well as gendered heterosexuality is compulsory for young women. Substantial academic literature addressed the incidence of premarital adolescent heterosexual intercourse paying particular attention to young working-class women and (especially in the US) to young women of color. During the 1980s, journals and academic texts in the US debated the so-called black underclass disregarding the effects of Reaganomics: increasing poverty, homelessness, ill health, and unemployment, which affected young African-American women. From a traditional (hetero)patriarchal standpoint, any teenage pregnancy is a problem. Hence pregnancy avoidance and planned parenthood focus on young working-class women and young women of color presumed to constitute the problem of the (hetero)sexually active teenager. The ideology of fetal rights as used in anti-abortion and pro-life arguments represents the life of a pregnant woman as in direct opposition to that of her fetus. The ideology of adolescence constructs all young people as inherently prone to irresponsibility, especially if they are female, working-class, and black. In the Third World, young women considered as irresponsible mothers more likely face enforced sterilization than access to abortion in the guise of genetic counseling for disabilities or without explicit consent during other gynecological operations. Feminists point out that under current legislation in England and Wales, fetuses defined as seriously handicapped can be aborted up to the moment of birth. The legacy of eugenicist ideas lives on in assumptions about the inherent deficiencies of young working-class women, young women of color, and young women with disabilities as potential mothers. Yet despite the institutional, cultural, and ideological force of appropriate heterosexual and reproductive activity, young women continue to challenge common sense definitions of normality and deviance.     

Attitudes toward premarital sex and family planning for single-never-pregnant teenage girls

Black AFDC clients who attended a family planning day at a rural Georgia county public health department were polled on their attitudes toward premarital sex, family planning for single-never-married teenage girls, and illegitimacy. The sample was only 50 women and the poll has the limitations of a small sampling. Younger and unmarried or separated women tended to approve of premarital sex more than older and married women. Dichotomized by age and by marital status, the differences were statistically significant at the p less than .001 level. None of the respondents approved of illegitimate pregnnacy, and 92% favored providing contraceptives for never-pregnant teenage girls who engage in sexual relations. There was no correlation with age or marital status in the approval of providing contraception. Results of this poll indicate that if family planning advice is supplied, the rate of illegitimate pregnancy among teenagers in this group of the population (black and low-income) will fall.     

Sexual decision making in young black adolescent females

Participant observation and a questionnaire guide were used to conduct in-depth interviews with five 14-year-old, black, pregnant or recently delivered girls to obtain a broad and detailed view of perceptions and interpretations of the factors that led to the initiation of sexual activity and the decision to maintain the pregnancy that resulted. Four key and several supporting factors that influenced the girls' sexual decisions emerged from the data. The key factors centered around the girls' attempt to establish a relationship based on trust, a belief in their lack of vulnerability to become pregnant, family structure, and their beliefs about the alternatives available once a pregnancy was confirmed. Some of the findings were consistent with those reported in the literature, while others were not. Further research is needed on the father of the infant as well as the mother of the adolescent girl to assess their perceptions of the factors they believe influence teenagers' sexual decisions.     

The “making” of teenage pregnancy

I will do two things in this paper. First, I examine the issue of construction in the social sciences by using “teenage pregnancy” as an example. Following Michel Foucault's genealogical studies, I show that new categories were constructed to study teenage pregnancies, but that the construction involved does not support an extreme theory of construction—a theory which allows of nothing like “reality”. Second, I study the interaction between the categories used in investigations of teenage pregnancies and those to whom such categories are applied, namely the young mothers themselves. The interaction illustrates what Ian Hacking has described as a “looping effect” characteristic of categories used to study people and their behaviour. I claim that with teenage pregnancy, the looping effect is much more complex than Hacking suggests.     

Community member perceptions of influences on teenage pregnancies

This exploratory qualitative study aimed to provide insight into the factors contributing to the high prevalence rate of teenage pregnancy in South African communities. Focus group were conducted with 193 community members (females = 44.6%; adults = 50.8%, teenagers/youth = 44.0%) and followed by thematic content analysis to interpret the data. Several overarching themes regarding the increasingly common occurrence of teenage pregnancy emerged from the data. These included: (1) the increased acceptability of teenage pregnancy to families and communities for economic and material gain; (2) the influence of social pressure; and (3) the lack of sexual knowledge and provision of sex education. Community members perceived teenage pregnancy as an increasingly common occurrence in their communities. Community members perceived teenage pregnancy to be driven by multiple factors and to require holistic interventions at the individual, family and community level.     

Sibling Teenage Pregnancy and Clinic-Referred Girls’ Condom Use: The Protective Role of Maternal Monitoring

Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use 2 years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents’ condom use 2 years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy.     

Adolescents' knowledge and beliefs about pregnancy: the impact of "ENABL"

Finding effective ways to prevent adolescent pregnancy is a concern of public health officials, educators, social workers, parents, and legislators. Numerous programs exist, but there is debate as to whether it is the specific program itself or other factors that are responsible for participants' successful outcomes. Using a quasi-experimental design, this study sought to determine which factors predicted changes in knowledge and beliefs among middle school students (N = 1,450) after exposure to Postponing Sexual Involvement (PSI), the curricular component of Education Now and Babies Later (ENABL), a pregnancy prevention program. It was found that the single most important predictor of improvement in knowledge and beliefs about pregnancy prevention was PSI itself, not background variables. The findings contradict some of the previous studies on factors impacting teenage pregnancy and lend support for the continued examination of ENABL as a promising component of pregnancy prevention efforts.     

How you can help,without making a difference

There are many cases in which people collectively cause some morally significant outcome (such as a harmful or beneficial outcome) but no individual act seems to make a difference. The problem in such cases is that it seems each person can argue, ‘it makes no difference whether or not I do X, so I have no reason to do it.’ The challenge is to say where this argument goes wrong. My approach begins from the observation that underlying the problem and motivating the typical responses to it is a standard, intuitive assumption. The assumption is that if an act will not make a difference with respect to an outcome, then it cannot play a significant, non-superfluous role in bringing that outcome about. In other words, helping to bring about an outcome requires making a difference. I argue that the key to solving the problem is to reject this assumption. I develop an account of what it is to help to bring about an outcome, where this does not require making a difference, and I use this explain our reasons for action in the problem cases. This account also yields an error theory that explains why the standard assumption is so tempting, even though it is mistaken.     

Community-based Peer Groups: an Intervention Programme for Teenage Mothers

This paper assesses the use of community-based peer groups as an intervention strategy to provide teenage mothers with an opportunity to share common experiences, receive social support and identify links between personal and social problems. The method utilized in a recent community project on teenage pregnancy is outlined. Over a period of 8 weeks a group of 10 teenage mothers met weekly to share their experiences of pregnancy and motherhood. The facilitators used various games and audio-visual aids to build rapport and to enhance willingness to discuss sensitive topics. The final session comprised a 1-day training workshop to enable the participants to act as co-facilitators for similar groups in the future. The evaluation indicated that the participants felt empowered by the opportunity to discuss common experiences and to have their perceptions affirmed by their peers. The potential value of this programme within the broader mental health context of South Africa is briefly discussed, and also the possibility of adding a consciousness-raising element to such groups.     

Evaluating associations between maternal social support and cognitive development for infants in poverty

Infant cognitive development may be associated with maternal social support, although these relations have not been well-examined for infants living in poverty. We explore whether maternal social support is associated with cognitive development for 113 infants living in poverty. Infant cognition was measured at age 9–12 months using the Bayley Scales of Infant and Toddler Development 3rd edition. Mothers provided information regarding perceived social support received from fathers, family, friends, and community members. Controls included maternal race and infant sex. Linear regression revealed no significant relationships between maternal social support and infant cognition in this sample.     

Teenage parenting and child development: a literature review

Research on teenage parenting together with medical and behavioral research related to child development is reviewed in an effort to determine causal factors related to reported developmental deficits among children of teenage parents. 4 general conclusions are suggested: 1) several researchers agree that children of teenage parents show poor social and intellectual competence when compared with children on non-teen parents. However, the amount of sound empirical data to support this view is minimal. For example, there are few published studies of the longterm effects of teenage parenting or of actual behavioral interactions of teenage mothers and their children. 2) It is unlikely that research along the lines of the "continuum of reproductive casualty" will lead to identification of causal factors sufficient to account for developmental deficits in children of teenage mothers. 3) Research along the lines of "the continuum of caretaking casualty" suggest numerous behavioral and environmental variables that may be related to the development of children of teenage mothers. 4) Research designs applied to the study of teenage parenting must shift from linear models to complex multivariate models that permit simultaneous analysis of organismic, environmental, and behavioral determinants of development. Finally, mental health specialists, government agencies, and researchers alike, must be willing to entertain the hypothesis that much of our knowledge of the childrearing skills of teenage mothers is based on myth rather than empirical fact. 1 such myth may be that below 19 years of age, maternal age in and of itself is an important determinant of infant development and parent-infant interaction. Poor social-economic status, family support systems, marital stability, nutrition and prenatal care may be far more important determinants of development for these children than the age of their mothers.     

The perception of poverty and wealth among teenage university students

This study is concerned with the perception of poverty and wealth among teenage university students. Two hundred twenty students completed a questionnaire which probed their perceptions of the attributions and consequences of poverty and wealth, requested them to estimate the job prospects of a school leaver with and without a certificate qualification, and also requested that they estimate the income for both a specified "poor" and "rich" man. The students also provided information about their economic preferences, religious position, and family financial position. Results indicate that the sample emphasized the significance of the family and placed little weight on luck when dealing with poverty and wealth. The sample emphasized the economic consequences of poverty and wealth, and did not rate their psychological consequences as being of much importance. Certain groups within the sample showed some deviations in their perceptions. The most substantial group differences were between the capitalist-religious and socialist-religious groups.     

Relationship‐based intervention with at‐risk mothers: Outcome in the first year of life

This study shows that a home‐visiting, relationship‐based intervention, as defined in the UCLA Family Development Project, affects certain areas of family functioning by the time an infant reaches 12 months. Within a randomized trial design, we compared two samples of mothers who were identified as at risk for inadequate parenting in the third trimester of pregnancy with their first child. The primary risk characteristics were poverty and a lack of support. Thirty‐one of these mothers experienced the intervention and thirty‐three did not. Mothers given the opportunity of a positive, trusting, and working relationship with a weekly home visitor as well as a mother–infant group scored significantly higher on measures of their experienced partner and family support. The intervention also made a significant impact on three critical social‐emotional mother–infant transactions in the first year of life. Thus, on a variety of indices including the responses to the Ainsworth Strange Situation, the children in the intervention group were more secure and their mothers more responsive to their needs. Children experiencing the intervention were also more autonomous and task oriented and were encouraged in this regard by their mothers. ©1999 Michigan Association for Infant Mental Health.     

“On the outside: Interventions with infants and families at risk”

Infants and families at high psychosocial risk may be considered “on the outside,” that is, outside of the mainstream for healthy development and for well-being because of many different factors. They may be lacking the crucial ingredients that are necessary for healthy physical and emotional development that include good nutrition and health care, predictable caregiving, and guidance to develop the intellectual and emotional skills to succeed in school and in life. Some of the risk factors that may keep infants and families “on the outside” include poverty, teenage pregnancy, and violence exposure. In this paper, I will discuss different types and levels of intervention for infants at risk taking place in different settings around the world carried out by WAIMH members including a naturalistic intervention an orphanage in St. Petersburg, Russia, a community-based intervention program in Puerto Allegre, Brazil, and a community-based violence prevention and intervention program in New Orleans, Louisiana. Variety and levels of evaluation and assessment are also discussed. Finally, as President of WAIMH, I consider different perspectives on the future for WAIMH. © 1998 Michigan Association for Infant Mental Health