Teenage Mothers, Research Paper Example

Abstract

The rate of teenage pregnancy and births in the United States remains higher than that of any other Western nation (CDC, 2011, p. 2). In many cases, the mothers of teenage mothers are thrust into the role of raising two children: both the teenager and her dependent offspring. This creates the potential for a lack of physical and social care for their child. The educational needs of teenage mothers do not end with the birth of the child, inasmuch as teenage mothers are often unprepared for parenthood. This situation should be an important concern for nurses. The lack of life experiences places teen parents at risk for not knowing how to take care for the health needs of their children. Furthermore, teenage pregnancy and motherhood are fraught with many challenges and costs, to teenage mothers, their children, and to society generally. Given the considerable pressures of parenting, coupled with observed trends of poor socioeconomic outcomes for teenage mothers and their children, nurses must design effective interventions that are informed by teenage mothers’ learning needs. A review of the literature was conducted, utilizing the databases CINAHL, Medline, and EBSCOhost, and employing relevant key words such as “teenage mother”, “teen mother”, “infant care”, and “knowledge needs”. Five of the most relevant and informative articles were selected and analyzed. The analysis yielded the conclusion that teenage mothers have multivariate knowledge needs, ranging from the need for information about proper childcare, to the need for social and interpersonal empowerment, to the need for strategies to enhance the mother-infant bond and lessen the stresses of parenting.

Teenage Mothers

Despite recent declines, teenage pregnancy and births in the United States remain very high, and the attendant problems acute. Specifically, the costs incurred by teenage motherhood are both many in number, and severe in impact: poorer socioeconomic outcomes for teenage mothers and their children; behavioral problems, poorer learning outcomes, and higher rates of incarceration for the children of teenage mothers, not to mention a collective burden on society estimated at $9 billion a year due to all of these factors. The answer to the problem is improved strategies for intervention, informed by the actual knowledge needs of teenage mothers: if teenage mothers are empowered with relevant parenting knowledge and social support, they will be better equipped to meet the many tasks of parenting that lie ahead. Because of the contact that nurses have with teenage mothers postpartum, they are in a position of opportunity for designing and implementing effective interventions, interventions truly informed by the knowledge needs of teenage mothers.

The Center for Disease Control and Prevention (CDC) (2011) reported 409,840 births to mothers aged 15-19 years in 2009, yielding a live birth rate of 39.1 per 1,000 females aged 15-19 (p. 2). This figure is so low that it is of historic significance, with respect to the period of almost 70 years covered by national data; indeed, it stands at some 37% less than the 1991 rate of 61.8 births per 1,000 (Ventura & Hamilton, 2011). However, even the 2009 teen birth rate is sobering in light of the observation that American teen pregnancy and birth rates are still very high when compared to other Western nations with similar standards of living (CDC, 2011). By way of comparison, 22% of American women have reported giving birth before the age of twenty, compared with 15% of British women, 11% of Canadian women, 6% of French women, and 4% of Swedish women (Darroch et al., 2001, ctd. in McDonald et al., 2008).

Beyond these staggering statistics lies a sobering social reality: the costs to individuals, and to society as a whole, of teen pregnancy and motherhood. Babies born to teenagers are far more likely to be low birth weight or preterm, and their mortality rate is higher (Ventura & Hamilton, 2011). Teen mothers are far less likely to complete high school on time, if at all: according to the CDC (2011), by the age of 22 only half of teenage mothers have managed to obtain a high school diploma, an achievement secured by nearly 90% of their non-teenage mother counterparts. And because of the difficulties and challenges of parenting, children of teenage mothers are far more likely to exhibit fewer skills upon entering kindergarten, to display deleterious behavioral patterns, and to be afflicted with health issues. During their own adolescence, children of teenage mothers are incarcerated at much higher rates than their peers, are considerably more likely to drop out of high school, and are significantly more likely to become teenage parents themselves (CDC, 2011). And finally, as young adults, children born to teenage mothers are far more likely to be unemployed or underemployed. The collective burden on society is estimated at $9 billion a year (CDC, 2011).

The aforementioned evidences attest to the fact that the challenges of teen motherhood do not end with pregnancy: they extend throughout the lives of teenage mothers and their children. Nurses working with teenage mothers have an important responsibility to be aware of their patients’ learning needs, in order to increase the efficacy of their clinical practice. Teenage mothers tend to lack important sources of social support, particularly from adults (McDonald et al., 2008). Given the above-discussed negative outcomes for teenage mothers and their children, as well as the social stigma that many teenage mothers face, it is of paramount importance for nurses to take a leading role in educating teenage mothers in accordance with their learning needs (Bowman & Ruchala, 2006; McDonald et al., 2008).

It is essential for nurses to find and identify effective interventions to support and guide teenage mothers in the many challenges of parenting. After all, the demands of parenthood exert tremendous pressures on vulnerable young mothers, often impeding their educational progress, development of work experience, and attendant socioeconomic outcomes (CDC, 2011). Moreover, there are many psychological ramifications of becoming a mother while still an adolescent: motherhood thrusts the young teen into an adult responsibility, even as she herself is faced with the considerable challenges of maturation. The teen’s own maturation process is made the more difficult with the additional responsibilities of parenthood, and often produces a situation wherein mothers of teenage mothers are forced to raise two children at the same time: their own teenage daughters, and their daughters’ infants. Erikson (1963) proposed that adolescence is a time when a sense of identity is developed. It is at this period of life when adolescents begin to define and shape their own idea of who they are as individuals. Foundationally, then, this is a time of transition from childhood to adulthood, with attendant hallmarks of physical, cognitive and social maturation.

Nurses must endeavor to increase their efficacy in meeting the learning needs of teenage mothers, a task that entails a comprehensive understanding of their learning needs. In order to understand the learning needs of teenage mothers, a review of the literature was conducted. The purpose of this literature review is to answer four important questions:

1. What are the learning needs of teenage mothers?
2. How can nurses design better interventions to meet teenage mothers’ learning needs?
3. How can nurses facilitate the social and interpersonal needs of teen mothers, particularly with respect to their own mothers?
4. How can nurses help to strengthen the mother-infant bond?

A comprehensive literature review was conducted using the databases CINAHL, Medline, and EBSCOhost. The search terms employed were “teenage mother”, “teen mother”, “infant care”, and “knowledge needs”. The searches yielded in excess of three hundred articles, which were then reviewed for relevancy to the subject matter. Many search results were rejected due to a focus which was incompatible with the needs of the review, i.e. results that were not primarily concerned with the educational needs of teenage mothers. As the focus of the literature review pertains to the needs of teens who have already given birth, results pertaining to prevention of teen pregnancy were not selected. Moreover, some results were opinion pieces rather than research articles, and were therefore omitted.

Ten articles possessed the desired characteristics: research articles with a focus on the knowledge needs of teenage mothers. These were reduced to five by selecting for particularly relevant and informative studies. In particular, some articles were similar to others, but were deemed inferior in terms of relevant evidences and robustness of methodology, and were therefore discarded on these grounds.

Finally, the five selected articles were presented in an order that exhibited a certain logical progression with respect to the life-cycles of pregnancy and rearing dependent offspring: Papamicheal, Pillai, and Yoong (2009) dealt with obstetric and fetal outcomes, and were thus presented first; Bowman and Ruchala (2005) dealt with postpartum learning needs, and so were presented second; Hunter (2008) dealt with postnatal care and breastfeeding, and was placed third; McDonald et al. (2008) with a socially-inclusive strategy designed to be applied not only to teenage mothers, but also to their families, and was duly presented fourth, though it could also have been presented fifth. Finally, Mayers, Hager-Budny, and Buckner (2008) reported on a mother-infant intervention, and so this article was presented fifth, though it could also have been presented fourth. McDonald et al. (2008) and Mayers et al. (2008) dealt with similar knowledge needs, specifically social and interpersonal skills, and thus could have been presented in either order.

In a case control study, Papamicheal et al. (2009) compared the “obstetric and fetal outcomes for mothers in three different age groups”: ?15 years (n=35), “with a mean age of 14.7±0.6 years”; “older teenagers between 16 and 19 years (n=35), with a mean age of 17.8±0.9 years, and women between 20 and 30 years (n=35), with a mean age of 25.1±2.6 years” (pp. 1284-1285). The results were matched for ethnicity and parity: 23% of all participants “were black Caribbeans; 20% were white British; 17% were black Africans; 23% were white non-British, and 17% were other” (p. 1285). As the authors explained, for each group the mean parity “was 0.8, with 91.4% being primigravidas and 8.6% having a parity of one” (p. 1285). On the evidence hierarchy, this study is assigned a ranking of three.

The authors identified live and stillborn births from 2004-2007 using the North Middlesex University Hospital database, and then stratified these pregnancies by maternal age as seen (Papamicheal et al., 2009). From the labor ward database they collected data pertaining to the patients during pregnancy, labor and delivery, and after delivery, as well as data on the newly-born offspring. Significantly, they found a much higher incidence of single-parent families of origin for the mothers ?15 years: 71.4% of mothers in this age demographic, compared with 42.8% for teenagers aged 15-19 years, and 14.3% for women aged 20-30 years (Papamicheal et al., 2009). Significantly, social services had files for some 80.0% of the ?15 group, compared with 14.3% of the 15-19 -year-olds, p<0.0001. Some 62.6% of the ?15 group had been sexually or physically abused, compared with 31.4% of the 16-19-year-olds, p<0.0001 (Papamicheal et al., 2009). The vast majority of the pregnancies of the ?15-year-olds were unplanned: 97.1%, compared with 82.9% of the pregnancies of the 16-19-year-olds, and 54.7% of the 20-30-year-olds, p<0.0001 (Papamicheal et al., 2009). Also, the ?15-year-olds had the highest incidence of singlehood: 88.6%, compared with 80.0% for the 16-19-year-olds, and 31.4% for the 20-30-year-olds, p<0.0001 (Papamicheal et al., 2009).

The ?15-year-olds attended antenatal appointments at 23±7 weeks, substantially later than their counterparts amongst the older teenagers—18±7 weeks—and the 20-30-year-old women at 14±4 weeks, p<0.0001 (Papamicheal et al., 2009). This group also had 7±3 antenatal visits, by comparison with 8±3 for the older teenagers and 9±4 for the 20-30-year-old women (Papamicheal et al., 2009). Some 52.9% of the ?15-year-olds had serum screening to detect the risk of Down’s syndrome, by comparison with 79.4% of older teenagers, and 77.1% of 20-30-year-old women, p<0.05 (Papamicheal et al., 2009). Moreover, a mere 34.4% of the ?15-year-olds received supplements of folic acid, compared with 39.4% of older teenagers, and a full 94.3% of 20-30-year-old women, p<0.05 (Papamicheal et al., 2009). Obstetric and fetal outcomes displayed similar trends: the ?15-year-olds had much higher rates of cesarean section (CS) delivery than the other two groups (“25.7% vs. 5.7% vs. 8.6%, p<0.05”) (pp. 1285-1286). Significantly, pertinent indications included “suboptimal cardiotocography (n=6), antepartum hemorrhage (n=1), and failed induction (n=1)” (p. 1286). Furthermore, the ?15-year-olds had a much higher incidence of “second or third degree perineal tears: 45.7%”, compared with “20.0%” and “25.7%”, respectively, “p<0.05” (p. 1286). However, they did not display higher incidences of suboptimal outcomes, such as low birth-weight infants (p. 1286).

Bowman and Ruchala (2005) did a study to understand the learning needs of two groups: both adolescent mothers, and their mothers. Specifically, Bowman and Ruchala sought to find out what differences there were between the learning needs and objectives of the adolescent mothers on the one hand, and their mothers on the other, whilst the former were hospitalized following the delivery of their newborn infants. In order to find out, they employed two questionnaires: PTQ-E for the teenage mothers, and PTQ-F for the mothers of the teenage mothers. Both questionnaires are in fact identical, each consisting of 23 items pertaining to specific learning needs after the delivery of an infant (Bowman & Ruchala, 2005). The participants were 100 in number, collectively consisting of “50 mother/daughter pairs”, a “convenience sample” drawn from “three Midwestern hospitals between October 2000 and October 2001” (p. 251). As such, this article receives a ranking of three on the evidence hierarchy.

The average age of the teenage mothers in the sample was 17, with the majority in the 11^th grade (Bowman & Ruchala, 2005). Much the majority were also single, as well as unemployed, and they had a pronounced tendency to reside in the homes of their mothers rather than on their own (“n=36, 72%”) (Bowman & Ruchala, 2005, p. 252). As for their mothers, most of them had completed high school and currently held a job, wherein they earned $12,000-$50,000 annually. Both teenage mothers and their mothers rated all the baby-care items on the PTQ as very important, evincing a very real congruity between both groups of women with regard to these particulars (Bowman & Ruchala, 2005). Where the two groups differed was with respect to maternal care items: the mothers of the teenage mothers were more likely than their daughters, the teenage mothers, to prioritize a number of specific items as “very important”: specifically, “emotional changes (Mdn=-.38, SD=0.70), t(49)=-3.86, p<.001”; “resumption of sexual activity (Mdn=-1.00, SD=1.40), t(49)=-5.05, p<.001”; and “birth control (Mdn=-.39, SD=1.00), t(48)=-2.7525, p=.009 (Bowman & Ruchala, 2005, pp. 252-253). The importance of this study is manifest, in as much as it highlights key points of congruence and dissimilarity between those particulars of learning prioritized by teenage mothers, and those particulars of learning prioritized by their mothers (Bowman & Ruchala, 2005). One key ramification for nurses pertains to when it is most efficacious to speak with teenage mothers and with their mothers, respectively, on “the resumption of sexual activity”: the advice given by Bowman and Ruchala (2005) is that practitioners should approach the former group “in the final postpartum visit” and the latter group, in the course of “the postpartum hospital stay” itself (p. 254).

Hunter (2008) conducted an audit of teenage mothers’ perceptions and experiences of postnatal care, with a particular emphasis on how these experiences have affected adolescent mothers’ decisions to breastfeed their infants. The study was conducted in Oxford, where teenage mothers are provided with specific care by a specially-trained teenage pregnancy support worker. The sample population was 108 teenagers, aged 19 and younger, all of whom lived in the area circumscribed by the range of the Oxford City midwives, and all of whom had given birth between October-December 2006 (Hunter, 2008). Of these 108, 91 were sent questionnaires, with closed questions dealing with care received in the hospital, as well as care received after delivery at their own homes (Hunter, 2008). Respondents were also asked about any changes in feeding method of their infants. Twenty-nine questionnaires were returned (Hunter, 2008). As such, this article receives a level of three on the evidence hierarchy.

Hunter (2008) found that 6 respondents out of the 29 spent no nights in hospital post-delivery, while another 17 spent only one. While some 89% (25/28) reported satisfaction with the care given them for their own postpartum health and recovery, and 78% (21/27) reported that they were satisfied with the information and support they were given about the health and progress of their infants, a mere 57% (16/28) felt that they had received a sufficiency of instruction and guidance with regard to the feeding of their offspring (Hunter, 2008). Access to information proved to be a key problem commented on by many respondents: with regards to help and advice concerning washing their infants, only 46% (13/28) were satisfied with what they had received, and with regard to handling, settling, and looking after their infants, only 39% (11/28) of respondents were satisfied with what they had received (Hunter, 2008). Another very specific problem that many respondents—79% (19/24)—expressed was that “’information was only given when asked for’” (Hunter, 2008, pp. 786-787). And a mere 42% (11/27) felt that “’information was freely given’” (Hunter, 2008, p. 786). Moreover, although the majority (81%, 22 out of 26) expressed a desire to breastfeed, a mere 14 (48%) actually made the attempt (Hunter, 2008, p. 787). The respondents who switched feeding methods cited problems such as infants failing to latch on, sore nipples, inability to breastfeed, hungry infants, and infants who were reluctant to breastfeed (Hunter, 2008). And again, a key problem was lack of help and support, with some respondents citing this as the reason they desisted from breastfeeding (Hunter, 2008). Clearly, there is a great need for practitioners to be more responsive to teenage mothers’ learning needs in a number of infant-care topics.

McDonald et al. (2008) described the implementation of an intervention strategy employing an approach focusing on communities and multiple family groups: the program known as “Families and Schools Together (FAST) babies” (p. 45). The objectives of FAST babies were as follows: firstly, a promotion of social inclusivity towards the teenage mothers; secondly, working on the bond between mothers and infants, with the aim of empowering teenage mothers to be more effective and self-actualized parents, and thirdly, utilizing the aforementioned increased social inclusivity to obtain a situation where in the teenage mothers would experience an amelioration of the deleterious conditions of “stress, social isolation, and intergenerational family conflict” (McDonald et al., 2008, p. 45). The program consists of eight weekly meetings, each consisting of two-and-a-half hours, wherein teenage mothers, their mothers, fathers of babies born to teenage mothers, and three professionals engage in interactive, structured activities (McDonald et al., 2008). As for the specialists, each possessed a particular professional qualification: the first, an experienced specialist in the field of social group work; the second, a specialist of health, and the third, a masseuse specializing in infants (McDonald et al., 2008). The program itself utilizes the theoretical underpinnings of theories of learning pertaining to adults, and theories of conflict pertaining to families, and aims to empower teenage mothers in making choices and letting their voices be heard (McDonald et al., 2008).

A total of 17 MFGs were conducted, producing average graduation rates of seven families per each, and average participation rates per family of more than “90%” of the various meetings (Hunter, 2008, p. 50). In all, 92% of interested families attended one session or more “(n=128)”, and out of this number, some 90% “(n=115)” duly graduated (McDonald et al., 2008, p. 50). The 115 young mothers ranged in age from “15-28,” with the mean age being “19.44 years (standard deviation-2.79)” (McDonald et al., 2008, p. 50). The results for the teenage mothers were very positive: participants from this group reported significant increases in “general self-efficacy (P<0.01),” and “social self-efficacy (P<0.01),” although they reported no changes in family functioning and social support (McDonald et al., 2008, p. 51). However, they also reported significant positive changes with respect to the bond they enjoyed with their infants “(P<0.05),” and a reduction in “total parenting stress (P<0.01)” (McDonald et al., 2008, p. 51). Their mothers reported positive changes as well, notably with regard to a reduction of conflicts within their families, and improvement of both family relationships in general and the support that they themselves received in raising their adolescent daughters in particular (McDonald et al., 2008, p. 51). Unlike the teenage mothers, the grandmothers reported improved family functioning, with notable decreases in conflict scores “(P<0.01),” and notable improvements in “total relationship scores (P<0.01)” (McDonald et al., 2008, p. 51). While the parents of the teenage mothers reported no changes with respect to social relationships, they did report significant positive changes in both “tangible support (P<0.01)” and “total support (P<0.01)” (McDonald et al., 2008, p. 51). Grandparents also reported decreases in “total parenting stress (P<0.01) ,” and in “moodiness/emotional lability” of their teenage offspring within the “adolescent domain (P<0.05)” (McDonald et al., 2008, pp. 51-52).

Mayers, Hager-Budny, and Buckner (2008) described an intervention which was conducted to serve impoverished teenage mothers and their infants. This intervention, the “Chances for Children Teen Parent-Infant Project”, was conducted in a setting of public high schools offering daycare for infants of teenage mothers on the premises, provided by the group “Living for Young Families Through Education (LYFE)” (Mayers et al., 2008, pp. 320-322). The aim of the project is an expansion of childcare services, by means of therapeutic interventions operating on the levels of the individual, the mothers and their infants, and groups. By these means, the project sought to foster an enhanced bond between teenage mothers and their infants, especially by ministering to the educational and interpersonal needs of the teenage mothers with respect to their offspring (Mayers et al., 2008). The intervention recruited eighty-five teenage mothers and their infants from a total of seven high schools located in inner-city environs; of these, some three hosted the project, yielding a treatment group consisting of n=52 teenage mothers, while the remainder (n=33) constituted the comparison group (Mayers et al., 2008, p. 327). The mean age of mothers was “17 years” of age, with a range of “12-22”; as for the infants, their mean age was “11 months”, and the range given was “2-34” months (Mayers et al., 2008, p. 327). In terms of ethnicity, there were two groups: mothers who were African-American constituted “63%” of the sample, whilst mothers who were Hispanic constituted the remainder, “37%” (Mayers et al., 2008, p. 327). Finally, forty-two of the 85 infants were female (Mayers et al., 2008). This article warrants a level of two on the evidence hierarchy.

Mayers et al. (2008) analyzed mother-infant behavior using the Maternal Behavior Rating Scale (MBRS), an 18-item metric which utilizes a scale of five points and four factors: “Responsive/Child Oriented”, “Affect/Animation”, “Achievement Orientation”, and “Directive” (pp. 327-329). Higher scores are counted as improvements for all factors save the Directive, as this indicates the degree to which the mother attempts to direct her infant (Mayers et al., 2008). Infants’ behavior was assessed using a scale of the authors’ own devising; said scale possessed ten items and was of the Likert type (Mayers et al., 2008). The authors found that the intervention significantly improved maternal behavior with regard to three factors: Responsive/Child Oriented (“3.21-4.19”, before and after, p<0.001”), Affect/Animation (“3.07-3.59, p<0.001”), and Directive (“3.32-2.59, p<0.001”) (Mayers et al., 2008, p. 330). No such improvements were noted for the control group (Mayers et al., 2008). There was also a slight but statistically insignificant improvement for the Achievement Orientation factor in the treatment group (“2.04-2.27, p<0.001”) (Mayers et al., 2008, p. 330). With regards to the infants, infants in the treatment group showed improved interest in their mothers (t=-2.52, p=0.16), responsiveness to “physical contact” (“t=-2.12, p=.043”), and “general emotional tone” (“t=-2.85, p=.007”), while the control infants registered no improvement (Mayers et al., 2008, pp. 330-331).

This study demonstrates that teenage mothers’ knowledge needs pertain to a number of quite disparate domains, ranging from more antenatal care and dietary supplements, to educational information about feeding, washing, and caring for their newborns, to social and interpersonal needs, such as strengthening the mother-infant bond and improving feelings of self-efficacy as an individual and a parent. Effective interventions do make very real differences in the learning outcomes of teenage mothers, with positive ramifications for them and their infants.

Nurses can play an important role in facilitating improved outcomes for teenage mothers and their infants in all of these areas. A key ramification of these findings is that nurses must endeavor to connect with teenage mothers and their mothers, by understanding their need for a supportive and helpful clinical environment. By providing helpful information and facilitating the development of effective parenting and interpersonal and social skills, practitioners can empower teenage mothers to face the challenges of parenting.

These findings cast a great deal of light on the four questions posed at the beginning of the study. In answer to the first question, it is apparent that teenage mothers have many learning needs: they need to learn the importance of antenatal visits and appropriate dietary supplements, such as folic acid; they need to learn how to properly feed, wash, and care for their newborn offspring, and they need to learn how to interact with their offspring in positive, productive ways. They also have social and interpersonal needs which are made the more complex by their new role as parents. By understanding these needs, nurses can design interventions which actually address them: interventions which teach the crucial skills of childcare, responsibility, and skills for interacting with dependent offspring that teenage mothers need to know—and this is the answer to the second question. Thirdly, teenage mothers’ social and interpersonal needs, especially those pertaining to their own mothers, can best be addressed by 1) understanding the different learning needs and objectives of teenage mothers and their mothers, and 2) implementing highly social, family-level interventions designed to teach teenage mothers, their mothers, and other family members about the importance of listening to each other, supporting each other, and pursuing more harmonious strategies for conflict resolution. Lastly, nurses can help to strengthen the mother-infant bond by teaching teenage mothers effective strategies for interacting with their offspring, in order to increase their responsiveness to their infants—and vice-versa (Mayers et al., 2008).

Conclusion

The challenges of parenting are especially difficult if one is thrust into a parental role as a teenager. Teenage mothers face the difficult task of trying to raise their infants even as they endeavor to pursue their own maturation process, including education, social life, and employment. Given the tremendous costs of teenage motherhood to the mothers themselves, their children, and to society as a whole, it is clear that effective interventions to improve the learning and interpersonal outcomes of vulnerable teenage mothers and their infants must be responsive to their learning needs. Effective interventions respond to very specific learning needs of teenage mothers, from postpartum care to improving interpersonal skills, strengthening the mother-infant bond, and feelings of self-efficacy as a parent. As highly-trained specialists, nurses play a key role in offering knowledge and support for effective interventions. Future research should explore other effective interventions, in order to improve clinical practice.

References

Bowman, K. G., & Ruchala, P. L. (2006). A comparison of the postpartum learning needs of adolescent mothers and their mothers. The Association of Women’s Health, Obstetric and Neonatal Nurses, 35(2), pp. 250-256. DOI: 10.1111/J.1552-6909.2006.00032.x

Center for Disease Control (CDC). (2011). Teen pregnancy: Improving the lives of young people and strengthening communities by reducing teen pregnancy. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Teen-Pregnancy-AAG-2011_508.pdf

Hunter, L. (2008). Teenagers’ experiences of postnatal care and breastfeeding. British Journal of Midwifery, 16(12), pp. 785-790. Retrieved from http://www.britishjournalofmidwifery.com/

Mayers, H. A., Hager-Budny, M., & Buckner, E. B. (2008). The Chances for Children Teen Parent-Infant Project: Results of a pilot intervention for teen mothers and their infants in inner city high schools. Infant Mental Health Journal, 29(4), pp. 320-342. DOI: 10.1002/imhj.20182

McDonald, L., et al. (2008). An evaluation of a groupwork intervention for teenage mothers and their families. Child and Family Social Work, 14, pp. 45-57. DOI: 10.1111/j.1365-2206.2008.00580.x

Papamicheal, E., Pillai, R., & Yoong, W. (2009). Children having children: Outcome of extreme teenage pregnancies (13-15 years). Acta Obstetricia et Gynecologica, 88, pp. 1284-1287. DOI: 10.3109/00016340903229427

Ventura, S. J., & Hamilton, B. E. (2011). U.S. teenage birth rate resumes decline. NCHS Data Brief, (58), pp. 1-8. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db58.pdf