PRB

Deirdre Quinn was a participant in PRB’s 2016-2017 Policy Communication Fellows Program, funded by the U.S. Department of Health and Human Services—National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). This article, written as part of the program, is based on the author’s research and does not necessarily reflect the views of PRB.

Despite an almost continuous decline over the past twenty years, the rate of teenage pregnancy in the United States remains substantially higher than in other industrialized nations. Teenage childbearing often leads to a higher risk of negative physical, social, and psychological outcomes for mothers and their children. Teenage mothers also have a high likelihood of experiencing a second teenage pregnancy, which tends to increase the likelihood of negative outcomes for them and their children.

Teenage mothers who consistently use effective contraception are less likely to become pregnant again. However, evidence shows that teenage mothers face many barriers to using contraception after the birth of their first child, including access to health services, unstable or unpredictable romantic relationships, and lack of institutional and social support. But new research shows that when teenage mothers continue to receive emotional support from their own mothers, and when they all live together, teenage mothers are much more likely to be able to maintain effective contraceptive use. Strengthening relationships between teenage mothers and their own moms may be the key to reducing the number of repeat teenage pregnancies.

The birth rate for teenagers ages 15 to 19 in Washington, D.C. is the 13th highest in the nation, with more than half of those births in Wards 7 and 8. These wards, which are 93 percent and 94 percent African American respectively, each represent approximately 15 percent of the city’s female teenage population, but account for more than half of all teenage births in the District. Wards 7 and 8 also have the city’s highest rates of new infections for a variety of sexually transmitted infections (STIs), persons living below the poverty level, households headed by single women, and persons receiving food stamps and/or Temporary Assistance for Needy Families (TANF) or welfare.

Mothers of Teenagers Play a Role in Their Contraceptive Use

Previous research has shown that teenagers’ support relationships with their mothers play a major role in their overall success. Higher levels of perceived social support during pregnancy and following the birth of a child have been associated with decreased postpartum depression and stress, higher parenting self-efficacy and satisfaction, and overall improved pregnancy and parenting outcomes among teenage mothers. The strongest influences on a teenage mother’s successful adjustment during her transition to parenthood come first from her own mother, and next from her romantic partner. These support relationships may also play a key role in helping teenage mothers maintain contraceptive use over time and prevent repeat teenage pregnancy.

Consistent use of effective contraception is the best way to prevent unintended repeat pregnancy. Among teenage mothers, rates of contraceptive use tend to be highest immediately following a birth, but decrease significantly over time, placing teenage mothers at increased risk of experiencing a repeat pregnancy. Despite research showing the potential positive effects of social support on health outcomes for teenage mothers, however, few studies have examined the relationship between social support and contraceptive use. 

A new study examines the extent to which a teenage mother’s important interpersonal relationships (with her own mother and with the father of her baby) predict her successful maintenance of contraceptive use over time.

As part of a larger study on the overall effectiveness of a comprehensive “teen-tot model” of pediatric primary care, researchers interviewed a group of 124 African American teenage mothers, some of whom were participating in the teen-tot program and others who were receiving traditional pediatric primary care at clinics around Washington, D.C. The mothers were interviewed when their children were, on average, 3 months old, and again 12 months later, on a variety of questions about their own mental and physical health, as well as their children’s health and development.

The teen-tot intervention offers three main components: family-centered primary care, comprehensive social work services, and mental health screening and treatment. The same providers evaluate teenage parents and their children, often during the same visit, and social workers support the family during and between medical visits. 

The findings, which were published in early 2017 in the Journal of Pediatric and Adolescent Gynecology, suggest that a teenage mother’s relationship with her own mother plays a major role in her ability to continue using effective contraception during the first year after her child’s birth.

Among teenage mothers in both the intervention group and the group receiving traditional pediatric primary care, male condoms were the most frequently used method of contraception. Most who used male condoms also used an additional method, either a hormonal method or a form of long-acting reversible contraception (LARC), such as an intraueterine device (IUD) or a contraceptive implant.

Teenage mothers who reported that their mothers were emotionally supportive were nearly four times more likely to maintain contraceptive use from baseline to 12-month follow-up, and teenagers who lived with their mothers were more than five times more likely to maintain contraceptive use over time. Staying in school was also associated with maintaining contraceptive use over time.

Support From Teenagers’ Own Mothers Matters

Previous studies have considered social support as an all-or-nothing construct – either a person has support, or they do not. This study suggests that ‘support’ is a variable with many facets (emotional, tangible, cognitive), and each facet plays a different role in predicting outcomes for teenage mothers.

Despite previous research suggesting that a teenage mother’s relationship with the father of the baby (both romantic, and supportive but not romantic) could be an important factor in preventing repeat pregnancy, in this sample teenage mothers are making decisions about contraceptive use independent of the role the baby’s father plays in their lives.

This research offers new insight into the lives and needs of D.C.’s teenage mothers, and points to possible new solutions to reduce repeat teenage pregnancy. Preventing discontinuation of contraceptive use among teenage mothers has presented an ongoing challenge for service providers. Existing school- and clinic-based programs have struggled to recruit and retain teenage participants, and teenagers often seem uncomfortable discussing family planning in a classroom environment. Home-based programs have shown some success, but most are driven by the home visit of a medical practitioner. Interventions that more directly attend to the quality of the teenage mother’s relationship with her own mother during the postpartum period may be more effective in improving teenage mothers’ contraceptive maintenance over time.

What’s Going On with DC’s Teenage Mothers?

First, emotional support from her own mother is protective of a teenage mother’s contraceptive use. We know that maintaining contraceptive use over time requires active engagement on the part of the teenage mother, not only to maintain regular contact with health care providers but also to effectively communicate with others around the topics of sex and contraception. Emotional support, which is characterized by feelings of closeness and trust, may create an environment in which teenage mothers feel empowered to exert control over their own futures.

Living with her own mother after the birth of the baby is by far the strongest predictor of a teenage mother maintaining contraceptive use in this study population. When a teenager lives at home, her mother is likely to be involved in her daily business, asking questions and sharing opinions or advice. Having a positive residential relationship with her mother, which is consistent with perceived emotional support, might lead a teenager to behave in a way that meets her mother’s approval (for example, using effective contraception) or to feel empowered to take control of her future. Teenagers who feel supported may be better-equipped to look beyond their short-term needs to plan for their social, educational, and romantic futures.

Recommendations for Action

Together, D.C.’s health and education officials are perfectly situated to help teenage mothers reduce their chances of having a second unplanned pregnancy by helping them build and strengthen their relationships with their mothers. In schools and clinics around the city, we can support teenage mothers by:

• Conducting focus groups with teenage mothers and their families, in schools, health clinics, or community organizations, in order to ensure that any new, innovative program incorporates the actual needs and lived experiences of the city’s teenage mothers.
• Using the information gained in the focus groups to create and launch a pilot program with the goal of strengthening and sustaining relationships between teenage mothers and their own mothers.

The “D.C. Healthy People 2020” framework, released in June 2016, highlights adolescent health and maternal, infant, and child health as priority targets for intervention, and commits community resources to improving not only access to high quality care but also physical, emotional, and social health. 

Without the help of D.C. health and education officials, D.C.’s teenage mothers will continue to face a high repeat teenage pregnancy rate with fewer resources in place to help them achieve better health and well-being. Local leaders have the power to reduce the number of repeat pregnancies in D.C, and to further reduce the overall teenage pregnancy rate by breaking the cycle of poverty to pregnancy through information sharing, community outreach, and program replication to improve the health and well-being of D.C.’s teenage mothers and their children.

References

M. Angley et al., “Social Support, Family Functioning, and Parenting Competence in Adolescent Parents,” Maternal and Child Health Journal 19, no. 1 (2015): 67-73.

P.L. East, S.T. Khoo, and B.T. Reyes, “Risk and Protective Factors Predictive of Adolescent Pregnancy: A Longitudinal, Prospective Study.” Applied Developmental Science 10, no. 4 (2006): 188-99.

K. Kaye, (2012). “Why It Matters: Teen Childbearing and Infant Health,” National Campaign to Prevent Teen and Unplanned Pregnancy, Washington, D.C.

D. Kirby, “Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Summary),” American Journal of Health Education 32, no. 6 (2001): 348-55.

L.V. Klerman, “Another Chance: Preventing Additional Births to Teen Mothers,” (2004), National Campaign to Prevent Teen and Unplanned Pregnancy, Washington, D.C.

J.A. Martin et al., “Births: Final Data for 2013,” National Vital Statistics Report 64, no. 1 (2015).

D.F. Polit and J.R. Kahn, “Early Subsequent Pregnancy Among Economically Disadvantaged Teenage Mothers,” American Journal of Public Health 76 (1987): 167-71.

D.A. Quinn, S.M. Mitchell, and A. Lewin, (2017). “The Role of Teen Mothers’ Support Relationships in Maintenance of Contraceptive Use,” Journal of Pediatric and Adolescent Gynecology 30, no. 1 (2017): 35-40.

L.G. Raneri and C.M. Wiemann, “Social Ecological Predictors of Repeat Adolescent Pregnancy,” Perspectives on Sexual and Reproductive Health 39, no. 1 (2007): 39-47.

E.K. Wilson et al., “Adolescent Mothers’ Postpartum Contraceptive Use: A Qualitative Study,” Perspectives on Sexual and Reproductive Health 43, no. 4 (2011): 230-37.

Acknowledgments

This study was supported by HRSA, Maternal and Child Health Bureau, R40 MC21512; PI: Lewin.