Moving Policies Upstream to Mitigate the Social Determinants of Early Childbearing

Abstract

The teen birth rate in the United States is one of the highest in the post-industrialized world. International comparisons suggest that U.S. rates reflect high levels of social disadvantage and misguided policies that frame teen parenting as costly for mothers, children, and taxpayers. Studies that control for background factors that predispose teens to become parents highlight the social inequities that contribute to early childbearing and unfavorable maternal-child outcomes, regardless of maternal age. After reviewing these studies, federal policies that target and scrutinize teenage and single mothers are described and critiqued for the ways they disregard the social determinants of early childbearing and further the marginalization and social exclusion of low-income families. This review calls for public health nurses to challenge the ideological assumptions driving downstream policies and to advocate for comprehensive reforms that reduce the wide and growing inequities in education, income, and health among U.S. citizens. Building the public support and political will to move upstream will remain daunting in light of the pervasive stereotypes of teen parents and the ideological assumptions that early childbearing and poor maternal-child outcomes stem more from individual choices and lifestyles than from social inequities.

“Having a Baby Changes Everything” Reflective Functioning in Pregnant Adolescents

“…Teens who live in such environments often have witnessed or experienced chronic or complex trauma due to violence, assault or significant losses (Courtois, 2008; Slade & Sadler, 2013). These exposures also reflect the diverse social inequities regularly experienced by many pregnant and parenting teens (SmithBattle, 2012). Childhood and ongoing trauma exposure has been associated with negative emotional or physical health, and may lead to distortions in perception and dysregulated affect, which interfere with the capacity for RF (Courtois, 2008; Slade & Sadler, 2013).…”

Early parenting: The roles of maltreatment, trauma symptoms, and future expectations

“…Such sex education interventions as described above would dovetail with ongoing education reform seeking to place children as more empowered players in their education and future attainment. On an individual and community-level, improving access to quality education for youth who are already parents and at risk of becoming teen parents is especially likely to improve long-term outcomes for both the youth and their children (SmithBattle, 2012). A great deal of attention has been paid to the “choices” young women make around pregnancy and child-bearing, and not enough on the circumstances of these choices, and the options available to them.…”

“…Despite a recent decline, teenagers in the United States become parents at rates roughly double those of other industrialized countries, and there are dramatic disparities within the United States in rates of early parenthood (Martin, Hamilton, Ventura, Osterman, Wilson, & Mathews, 2012; SmithBattle, 2012). Early parenting is associated with a variety of negative social outcomes, including school failure, poverty, child maltreatment, health problems, and possibly, mortality (Hardy, Astone, Brooks-Gunn, Shapiro, & Miller, 1998; Hardy, Lawlor, Black, Mishra, & Kuh, 2009; Woodward, Fergusson, & Horwood, 2001; Xie, Cairns, & Cairns, 2001).…”

“…Indeed, an alternative view of the co-occurrence of early parenting and poverty is that in such contexts, early parenting is more adaptive (Geronimus, 2003). As well, it is important to acknowledge that, even if it is a barrier to social mobility, early parenting is only one of many such barriers (Breheny & Stephens, 2008; Geronimus, 2003; SmithBattle, 2012). Nevertheless, the bulk of the research suggests that early parenting is associated with at least some risk for negative psychosocial outcomes.…”

Reducing the Stigmatization of Teen Mothers

“…Teen mothers are especially vulnerable to being stigmatized due to their age, class, and racial/ ethnic backgrounds. Scientifi c practices and policies contribute to their stigmatization by downplaying the social inequities that precede teen pregnancies (Sisson, 2012;SmithBattle, 2012). Scientifi c practices and policies contribute to their stigmatization by downplaying the social inequities that precede teen pregnancies (Sisson, 2012;SmithBattle, 2012).…”