by Doortje Braeken, Senior Advisor on Adolescents, Gender and Rights 

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and post-traumatic stress disorder. Adolescent mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behaviour outcomes for their children like was discussed before.

I am not a midwife or an expert in Maternal Care Health (MCH). My background is in sexual and reproductive health programming for adolescents and young people, with a focus on girls. And I have to be honest, most colleagues who work in the area of Adolescent Sexual and Reproductive Health (ASRH) are not so focussed on young pregnant girls or mothers; we are more obsessed with the prevention of pregnancy and seem to lose interest the moment a girls gets pregnant. To the ASRH world, it seems that each young girl that becomes pregnant is a failure. Although we all believe in a life cycle or a life course approach it seems that we have made pregnancy as the cutting of point of work with young people. Most international discussion on adolescent childbearing focus mainly on the medically hazardous issues and complications and the emotional aspects of pregnancy are hardly ever mentioned.

I remember in IPPF we organized an international meeting some years ago on girls’ empowerment under the title Girls decide. We had workshops and of course we discussed issues like gender inequity, education, prevention of pregnancy etc. We also had a workshop on girls: Who want to get pregnant. The reaction of some of the participants was astonishing. They said that this was not appropriate because girls shouldn’t get pregnant. And that tells us a lot.

The Sexual and Reproductive Health (SRH) and Maternal Care Health programmers/providers are often in different worlds, with each their own professional values, standards and approaches and that doesn’t help the young pregnant girl or young mother, especially if she has mental health problems.

Young girls are often unseen in their communities; are seen as a burden have little power over their own lives and their sexuality. Most adolescent girls who give birth for the first time,  do this with sparse knowledge, health care, and support. Too few young women are empowered enough to access critical sexual and reproductive health services. Compared to older women, many adolescent girls are more likely to give birth without a skilled attendant, which further compounds their risks and will certainly not help when they suffer emotional or mental health issues.

In many predominantly patriarchal societies (South Asia and Africa), the customary thought of people is that "girls are born to be fed throughout their lives" and "boys are born to earn and support the whole family".

This thought is reflected through discriminative behaviours of people towards girls, also during and after their pregnancy. We know that in some parts of the world suicide is one of the main causes of adolescence mortality; often caused by SRH issues including pregnancy. So there is a great need to address the emotional and mental health aspects of teenage pregnancy, not only for the young mothers but also for their children.

But also in western societies young pregnant girls and teenage mothers face plenty of challenges, from dealing with the shame and stigma of an unplanned pregnancy to finishing school and finding employment. But many must also deal with the challenges of mental illness. Researchers have found that twice as many teen moms are at risk of developing postpartum depression (PPD) as their older counterparts. And nearly three times as many adolescent girls with mental illness get pregnant as adolescents without a disorder.

According to a survey of 6,400 Canadian women published in the journal Paediatrics in May 2012, the highest incidence of postpartum depression occurred among girls age 15 to 19 – at a rate twice as high as PPD in mothers older than 25.

The stigma of teenage pregnancy can be a barrier to recognition and treatment and we as adolescent SRH programmers should be much more aware of that.  Gloria Malone,  co-founder of #NoTeenShame, a social media campaign to raise awareness of the shame and stigma faced by teenage  mothers says ‘ According to society, pregnant and parenting teens must be punished and used for political prevention campaigns, instead of being treated as the fully human individuals that we are."

Girls age 15 to 19 with a diagnosis of a major mental illness, such as bipolar disorder, depression and schizophrenia, are almost three times as likely to give birth as adolescents without mental health issues. When adolescent girls with mental illness become mothers, they may find it "very, very difficult to parent a child in a healthy way," especially if there's a history of trauma or abuse and breastfeeding may feel inappropriate and too intimate," according to Simone Vigod, researcher at Women's College Hospital in Toronto. -

Supporting teenage mothers with mental health issues can also bring opportunities for prevention. A pilot study at Women & Infants Hospital of Rhode Island found that an intervention program which included good reproductive health counselling cut the incidence of postpartum depression in teen moms by half.

What are recommendations for improvement?

In the ASRHR community we are working hard to address the SRH rights of young people., and these should include the rights of young pregnant girls and young  mothers.

We believe all young people under 18 years should enjoy the full range of human rights, including SRH rights. The importance and relevance of some rights change as a person transitions from infancy to childhood to adolescence; these are the dynamics between autonomy and protection Therefore, the rights of young people must be approached in a progressive and dynamic way. Often people talk about protection of young people more than autonomy.  A general and vague notion that children need ‘protection’, broadly, can be counterproductive. Protection is actually about challenging power – protection shouldn’t be about restricting young girls’ agency, but rather protecting and promoting their  agency by recognising and addressing the unequal social contexts in which children are embedded. It is the unequal social position of young girls in relation to adults that gives rise to protection needs. For us, it is about empowerment of young women and girls, whether they have chosen to prevent pregnancy, to end their pregnancy, or be pregnant or a young mother: they all need support to be literate about SRHR, have the confidence and competence to choose for prevention of pregnancy, abortion or for pregnancy.

It is also about our own values as programmers ,educators  policy makers and health providers; what are our values on teenage pregnancy; we need to ask ourselves, how will we react  if our teenage daughter or cousin  gets pregnant when she is 15; what do we want for during and after her pregnancy? This will help us to from our ideas how can we prevent and/or address emotional and mental health issues during and after pregnancy; how can we work together to ensure that girls get pregnant when they choose to, without force because of early marriage, without being discriminated or neglected or without being forced into a transition from an adolescent world to an adult world . What will we do for young girls after pregnancy; even if there are policies they can go back to school, the reality is different; they often cannot go back at all or to another school they were in before their pregnancy, because again of fear of discrimination, bullying and self- stigmatization.

Some recommendations

1. Individual: self- care/empowerment : young pregnant girls need to be well informed about protecting their own health and their babies to be; they need information and support to make a health plan; need post -natal care/information etc. on emotional and mental health issues.; prevent second pregnancy if they want
2. Father/Intimate partner/Family: need information how to support adolescent; send her or accompany her to  health facilities; help to prepare child birth; support her when baby is there
3. Community: need to support by addressing stigma and discrimination; arrange financial support during pregnancy; advocate having special facilities for young mothers; ensure that young mothers can go back to school etc.
4. Health care providers; need to know the specific risks of early pregnancy; can arrange prompt transfer to emergency care; give medical , mental and emotional support  before,
5. Policy makers; developing SRH policies for young people. It should not only address the risks of sexuality and young people, should not only look at prevention in education and service delivery; it is about giving equal attention to girls who choose to become pregnant or who are pregnant both in education and service delivery
6. We need much better collaboration and synergy between professionals from the ASRHR, RH and MCH worlds; get rid of the pillars and start communicating and collaborating
7. But most of all, listen  to young people, involve them and give them a voice to express their needs and wants

We need to support young pregnant girls and mothers helping to them in balancing parenthood with their own needs, and helping them create better chances for their children. We need encourage self-expression and help young parents deal with difficult emotions by challenging feelings of loss, low self-worth and lack of ability and give them back agency over their own lives for their own heath and that of their children.