Adolescence is a time of ‘finding yourself’; exploring the type of person you want to be and future you want to have. As a result, many adolescents are influenced by their peers and partake in risk-taking behaviours, some of which include substance abuse and unprotected sex. Teenagers from lower socioeconomic backgrounds are six times more likely to become pregnant and less likely to opt to terminate the pregnancy, due to financial constraints and lack of family support.1 2 This is a time of pivotal change for young women who, by deciding to continue with the pregnancy, may accept that there is a heightened need to discontinue risk-taking behaviours.3 It is therefore important that these women receive supported care and referral to allied health services as needed.4 5
Managing adolescent pregnancy involves providing tailored, holistic care that addresses the current issues affecting young women, free from societal stigma and judgment.6 7 The ideal way to improve patient attendance and engagement involves minimising barriers, by ensuring services are easily accessible and free of charge.8 Issues faced by young women include increased exposure to domestic violence and family abuse, bullying through social media, mental illness, self-harm, substance abuse, sexually transmitted infections, financial stress and homelessness.9 10 11 12 Given the significance of these various psychosocial issues, it is imperative to provide a place of acceptance and belonging.
Studies have found that community-based group antenatal care empowers young women and thus improves their wellbeing through continuity of care, peer support and easy access to allied health professionals.13 14 This, in turn, reduces feelings of isolation and improves emotional wellbeing and mental health outcomes. With the right antenatal and postnatal support within a community setting, these young women can demonstrate their ability to transform into attentive and effective mothers.
Domestic violence and abuse
Many young pregnant women have been further disadvantaged by prejudicial childhoods, including childhood abuse and poor parental role modelling. Evidence reports that adolescent mothers are more susceptible than older women to domestic violence from intimate partners.15 16 17 It is therefore imperative that antenatal care includes screening for domestic violence and ensures that there are available and accessible services in place to respond to safety needs. Children born to young mothers are more vulnerable to neglect or poor living conditions due to a range of risk factors and are less likely to establish independence and financial security to provide for themselves, as they are less likely to complete their education. 18 This is often in addition to domestic violence, including family conflict, unstable housing, poverty, mental illness and low socioeconomic backgrounds.19 20 ‘To the young teenage mother, life course outcomes tend to be characterised by negative public attitudes, social isolation, poverty and prolonged welfare dependence.’21 While there are financial costs associated with the provision of community-based antenatal care, this is more than offset by the substantial social and economic savings to the wider community.22 23
Social media and mental illness
Adolescents are now faced with social media concerns unique to previous generations. They are more vulnerable to new forms of bullying and they cannot escape the opinions of others around them. Many adolescents perceive their self-worth and self-image via social media platforms and by how many likes or comments they receive when posting on social media.24
Young pregnant women have an increased vulnerability to mental illness.25 26 Depression, anxiety and borderline personality disorders are now more common and are often multifaceted.1 Unplanned pregnancy challenges the woman’s idea of who she is and what she wanted her life to become, including career, travel, friendships and relationships. She experiences grief around these lifestyle changes, subsequently impacting on her mental health and view of herself. Many young women have thoughts of self-harm or a history of self-harm attempts. There is evidence to suggest that young women are more likely to develop postnatal depression than older mothers.27 28 29 Therefore, mental health intervention may be required and young women benefit from community linking, such as child health and mother’s groups with peers.
There is also a greater risk for substance abuse within this age group.30 31 Common examples of this include alcohol, smoking cigarettes and/or cannabis and the use of amphetamines, such as ice. Many of their peers continue to party on the weekends, and to escape the habits or addiction, young women are often forced to discontinue their friendships and social behaviours, which can result in social isolation. In the absence of new positive peer relationships, young women are at risk of relapsing to previous substance use. This highlights the need for community-based and peer-responsive care.
Sexually transmitted diseases
Adolescents are less likely to practise safe sex and are at an increased risk of developing sexually transmitted infections.32 For example, chlamydia is much more prevalent in this age group.33 Therefore, routine care should incorporate screening for these infections.
Financial stress is a huge concern for many young pregnant women. The WHO states that the adolescent mother often lacks knowledge, education, experience, income and power relative to older mothers.34 Due to their lack of education, income and maturity, young women can lack budgeting and financial management skills.35 Financial stress and instability can lead to poor financial decision-making, such as engaging in pay day loans to meet their immediate needs. Subsequently, debt is increased at an exorbitant interest rate that they cannot afford. This is further compounded by lack of family support, which forces young women into homelessness and ‘couch surfing’ between friends. Possessions are often removed due to the ongoing repayment cost of keeping them in storage containers. Lack of funds for fuel and public transport makes it difficult for young women to attend appointments and lack of credit on their phones means they are difficult to contact. Financial restraints also impact on weekly groceries and they are more prone to poor diets and cannot afford to take pregnancy multivitamin supplements, resulting in an increased risk of having a baby with low birth weight.36 37 38
Group antenatal care
Unless young pregnant women are meeting their basic needs of food, housing, safety and security, they are unable to see beyond these needs to receive any antenatal education. Therefore, the significance of multidisciplinary care cannot be overstated.39
Evidence strongly indicates the significance of community-based care when working with adolescent pregnant women.40 Community-based antenatal education recognises that approximately 50 per cent of young women will not have a male partner when their baby is born and the inclusion of other support people is essential.41 Many young women will attend the groups with either their partner, mother, friend, family member or on their own. This education is aimed at facilitating optimal growth in anticipation for parenting as stigma can affect the way a young mother feels about her capacity to parent. Young pregnant women are reluctant to attend hospital-based care due to financial restraints, transport issues and societal stigma associated with being young and pregnant. This is made more difficult by having to navigate a complex healthcare system that is inflexible, with power imbalances commonly evident between health professionals and young patients.
The benefits of antenatal care within the community have been widely documented and include increased rates of attendance, relationship-based care and a sense of community and belonging.42Furthermore, improved psychosocial functioning, higher rates of satisfaction with care and exclusive breastfeeding in the first six months are evident in women who have been assigned group antenatal care during pregnancy.43
The strength of antenatal education within a group setting with peers is that it provides a point of connection between peers and facilitates a sense of belonging. It also promotes the potential for young women to develop healthier positive behaviours as they become parents. Continuity of care with the same midwives at each appointment who already know the women’s history, assists with developing rapport and trust. Consequently, they are more engaged within the group and committed to maintaining their appointments.44 Research states that young pregnant women benefit from targeted interactive education appropriate to their developmental needs.45 The key to its success is that this care is given by health professionals that are non-judgemental and aware of the issues relevant to these young women and their families.46 47 48 Empowering young women in this environment transforms not only the mother, but also through continued support within the community, provides a positive impact on the child’s future.