The wide interindividual variability of the outcome of the mother-child couple after birth is well known. The stereotype of the ‘single unwed mother’ with no qualifications and no resources who is inclined to abandon her child needs to be reevaluated. Several studies clearly showed that, when adequately supported during this difficult period, the adolescent mother or young family is perfectly capable of having a good parental attitude.
The birth of the child establishes his direct progenitors as parents, who, as such, have rights and responsibilities. Because in some cultures fathering a child is evidence of virility, the young men impregnating adolescent girls may be more likely to be involved in other activities, such as fighting and carrying weapons or gang membership, that also symbolize virility. In this social context, it is thought that ‘getting a girl pregnant proves that you are a man’.
In terms of parenting, adolescent mothers have been described as being more strict, punitive and physically aggressive, and less interactive with their children.
Teenage fathers are rarely a strong source of financial support for their adolescent partners and their children: 50% of teenage fathers live with their partner and child for some time after the birth but the divorce rate among adolescent mothers is high.
The child also has rights defined by the International Convention of the Child, ratified in 1989: the right to protection of his identity and his integrity.
The most important consideration at birth for the future of the mother and the child is the way the mother-child bond develops. These mothers, who are still steeped in adolescence, are by all accounts rather skilled with their babies, but their investment in this task can prove rather unstable. They often have a good ability to play with the infant but are stricter than other mothers in their convictions: ‘he’s hungry’, ‘he must sleep’, etc. In this sense, which readily reminds one of a child playing with a doll, she cuddles and hugs then forgets the ‘toy’ in a corner only to pick it up again several hours later. The adolescent mother considers her child as her confidant and her comforter but also as her scapegoat, responsible for all her problems. One sees here the rising contradiction between the logic of the teenager, on the one hand, and that of the child, on the other. And, in this climate of contradictions, underlying suffering can come to the surface.
It is thus essential to assure that the adolescent can be adequately assisted to assume her role as mother without the helper usurping it. Too often these young mothers are watched over and judged rather than helped to pursue their dual itinerary: their uncompleted adolescence and their too early entry into the process of parenting.
Good performance in school before the pregnancy and the return to school after the baby’s birth are factors of good prognosis and constitute an essential element to the success of future familial and social function.
In France, the Haby Law of 1975 specifies that ‘the pregnancy and maternity of students cannot serve as the basis for exclusion from school or the refusal of enrollment’. However, in practice, the return to school is far from being the general rule in as much as many adolescents are already ‘disconnected’ from the school environment, which is a place associated with failure, not unlike the conception of her child.
It is primordial that: (1) contraception be prescribed for the young mother to prevent the occurrence of a second pregnancy soon after the first, and (2) she be integrated into a social support program. The lack of social and affective support is a factor contributing to a very poor prognosis and assistance under such conditions is far from easy.
For probably the most frequent situation, in which the return to school is impossible, the adolescent must rapidly be guided in a professional choice. The present state of employment of youth in France is not rosy, with jobs requiring ever higher degrees. Thus, a line of work must be found that can, in a relatively short time, open the way to a real job with a decent income. Social, medical and child-care specialists, guidance counselors and the personnel of adapted facilities have the heavy responsibility of helping the young mother be a mother, the young father to be a father, the grandparents not to be overprotective or jailers or excessively removed, and to allow the young mother or couple to also be teenagers.
Upon returning home, the new teenage mother often requires particular assistance and attentions for herself and her child. The French Department for the Protection of Mothers and Children, notified as of the official declaration of the pregnancy, has a capital role to play in protecting the legal rights and defending the social entitlements of both. Specialists in child welfare and/or social workers have to assure the liaison and coordination among the family physician, newborn consultations, adequate housing, an at-home helper…; indeed, an entire network has to be established.
In addition to being accountable for the infant, the young mother may need to entrust her child to the care of someone else for a day or longer periods.
Social structures must be able to advise and help the young mother in the search for the best adapted facility. It is probably the isolation of the young mother after leaving the hospital that is to be most feared, because this situation can be a source of profound distress that, in turn, can degenerate into violence directed against and abuse of the infant. Furthermore, it is known that, for this population, the rates of sudden death of the newborn and mortality attributable to infections are higher during the first year of life.
Prevention of child abuse must be initiated as early as possible during pregnancy. For this reason, our so-called ‘parenting’ meetings, bringing together all the healthcare actors – medical, psychological and social – have been organized in the maternity departments over the past 3 years to discuss the files of those patients known during the pregnancy to be in a precarious situation and for whom the mother-child relationship may be compromised. Among these patients, pregnant teenagers represent a predominant subpopulation.
As of their fetal life, these babies run the risk of being confronted with their mothers’ adolescent conduct, e.g., their projections, actions, absences, regressive or depressive behavior, and their sometimes uncontrollable ambivalence.
If these situations persist, the babies risk having severe difficulties in constructing their own feelings of coherence and continuity; living, existing and developing in complete security becomes an act of defiance for them.
An adult woman’s pregnancy is a wish that is fulfilled, a satisfaction that is savored and a pleasure that is shared. None of this is true for the pregnant adolescent, who is usually isolated, anxious, angry…
Pregnancy in an adolescent is a risk of an adolescence aborted. We should attempt to manage this suffering so that, if the young woman chooses her adolescence and requests an abortion, she does not immediately repeat the experience, and if she chooses the child at the expense of her adolescence, she can be assisted because, although raising a child is certainly a source of much pleasure, it also forces the parent to confront her capacity to wait and cope with frustration.
All these elements converge to emphasize that a primary public health priority should be the prevention of these pregnancies by distribution of emergency contraception.
Revision date: June 11, 2011
Last revised: by Jorge P. Ribeiro, MD