I was taking the history on a teen who was beginning her prenatal care with us. When she told me that her little sister was also pregnant, and passing out at rave parties, but would not come in for care, I thought how rough this must be for their mother. Their mother, she then told me, had died a few years ago from an untreated chronic disease. After she left that day, I ran the numbers: it turned out 61% of my clients were essentially motherless. Wow.
Unplanned teen pregnancy is a public health problem because the teens themselves have lower high school graduation and college rates, lower lifetime earning potential and higher stress levels, and their children have all those problems and more, and significantly, the baby girls tend to then have unplanned teen pregnancies themselves.
The good news is that the rate of unplanned teen pregnancy is down in the U.S. This is due in part to the concerted efforts of policy makers, teachers, health care providers and parents over many years. I was working in Washtenaw County, Michigan, home of Ann Arbor, which has one of the lowest teen pregnancy rates in the State. Contraception and abortion are readily available in this County, and the schools were opening talking about reproductive choices and sexual health. I worked at the outstanding Corner Adolescent Health Center, which provided prenatal care for approximately 50% of all the pregnant teens in the County, and I was the OB Case Manager.
The pregnant teens in my care had the option of abortion, but had chosen for one reason or another, against it. Some of these teens, a minority, planned to become pregnant, were in stable relationships, were free of mental and behavioral dysfunctions, and had the resources to provide for their children. Most did not. Their stories varied widely, but involved running away from home, escaping from sex slavery or prostitution, heroin use, violence of every description, bipolar disorder, anorexia, homelessness, cognitive impairment, and/or other complex social and health problems. Their racial and ethnic background was varied, and the parents were usually low-income but not consistently. The one thread that was most prevalent was motherlessness.
Mothers were dead or lost in various other ways. One was incarcerated for the foreseeable future, several others had left the State for some reason, some were schizophrenic or delusional, others were mired in addictions or abusive relationships themselves to the extent that they were completely estranged from their daughters. These young women without mothers to worry about them, lecture them, nag them, and simply care for them, engaged in all sorts of unhealthy behaviors, not least of which was casual, high-risk sexual encounters. One girl said to me, “When I found myself with him, even though I was really drunk, I knew that God had put us together so I could have a baby to make up for everything that I had been through.” Needless to say, this did not go as she had planned. Eventually she lost her parental rights due to some very bad choices she made, and baby was placed in foster care. But as I got to know her, I could see that, deep down, she wanted to fix what had been wrong about her own childhood. I suspect she wanted to become the good mother she had never had.
The pregnant teens who did not have mothers in their lives also had poor pregnancy outcomes. Often they did not go for their ultrasounds or prenatal appointments, they did not gather baby supplies, they did not make a plan for labor or decide in advance how they were going to feed their babies. One of my clients disappeared, only to return after her due date, in smelly rags, wanting me to get the baby out. It took half the staff most of the day to set her to rights, and Children’s Protective Services was set up to follow her. The two sisters I mentioned earlier had only one prenatal visit each, in which they were tested for diabetes. Both had alarmingly high diabetes screening results, but never returned for follow up. After the first one gave birth at the local hospital, they piled in a car and drove off to parts unknown. I still worry about them.
In another case, my client had an aunt who stepped in to play the role of mother. She had a baby shower, which is as good an indicator as any of social support, and her aunt brought her to her prenatal appointments. She had a good outcome. Another girl had a distant relative who took her under her wing. She called and asked her how she was doing every few days, and made sure she had what she needed. And she did well, too. So, watching this, I began a different approach.
When a motherless girl began her care with me, I would talk with her about older women in her life, and identify one who could play an active part. After obtaining the girl’s permission, I would call this “aunt” from time to time to get her input, and affirm her value whenever I encountered her. When the girls missed their appointments, I had someone to help me get them back on track. This worked very well, and required little in terms of time or resources on our part.
I would like to see more attention paid to motherlessness in the health care setting and in schools. It should get as much attention as smoking, at least. When a girl is identified as motherless, effort should be directed at preventing her from high-risk behaviors, including unprotected sex. This effort should include tagging a mentor from her life.
We are getting down to the difficult heart of the unplanned teen pregnancy problem. To make further progress, we could focus on the absence of a mother figure, and target resources on preventing high-risk behaviors by these girls in particular. These girls are the future mothers of teens with unplanned pregnancies, and they are likely to be dead, addicted, crazy, incarcerated, abused or otherwise absent themselves for their daughters.