Teen Mothers: When Stigma Trumps Compassion (and Research)

By Jean Wittenberg, MD and GAP's Committee on Adolescence

Samantha is a first-generation American and middle child of three. She was born and raised in Boston and attended a small high school in Cambridge where she made the dean’s list each semester. During junior year of high school, her mother discovered Samantha was 10 weeks pregnant and kicked her out of their home. In school, her school nurse spread the news of her pregnancy to teachers at school, who then either ignored her entirely or shook their heads in disapproval when she walked by. She was removed from honors classes and discouraged from applying for college.

After her daughter's birth, the school refused to provide Samantha with accommodations to pump breastmilk. They refused to excuse her absences for doctor's appointments and accused her of lying or making up illnesses so she could skip school. At the hospital, one nurse lectured her on teenage pregnancy and warned her not to be like other “welfare girls” who get pregnant back-to-back just for “some free government handouts.” At her 6-week postpartum exam, her mental health symptoms were ignored, but she was given a depo birth control shot and told it was a necessary part of postnatal care because the nurse did not want to see her back in the clinic with another pregnancy in a few months.

Sadly, teen mothers are routinely perceived as having physical, psychological, mental, emotional, and social problems, and as being poor parents. Many people assume teen mothers are troubled, dependent, promiscuous, exploitive—the list of pejorative adjectives goes on and on. However, these descriptors malign young mothers. Ironically, negative stereotypes people hold about young mothers may make it more likely they will become pregnant again: Pregnancy rates are higher in disadvantaged groups.

However, the last teen mother I met ultimately became an academic child psychiatrist, making a presentation at a major, international conference. And Samantha, now an adult, has a career in healthcare technology, has posted her own TED, and has her own consulting company. Both of these women have happy successful daughters. And they are not unique.

Many would be surprised to know that a significant proportion of young women who have babies in their teens go on to do better in their lives than peers who do not have babies. They have better jobs. They are independent. They move up the social gradient. In fact, a significant number further their education. Researchers have often concluded that teen mothers are disadvantaged relative to their age equivalents, but if we compare those teen mothers to their social equivalents who do not have babies in their teens (i.e., young women of the same ages who come from the same social populations), many do better. If you are surprised, you are not alone, and this stigma can play a role in worsening health care outcomes.

Most teen mothers do come from disadvantaged populations—racialized, marginalized and traumatized populations that are already stigmatized. Some grow up poor in families that are stressed by food insecurity, divorce, separation, or transient relationships; live with adults who have mental health or substance or alcohol use problems; live on streets that are unsafe and in neighborhoods that are environmentally challenged. They are witnesses to violence. Many are victims of mistreatment themselves. These women are survivors of adverse childhood experiences, which impose stress and threaten health in all domains. Making things even more difficult for them, these are all groups that are highly stigmatized. Pregnant and mothering teens and their families have spoken about their experiences of stigma. Unfortunately, healthcare professionals all too often share those biases and play a role in perpetuating stigma.

Indisputably, many teen mothers, like those I see in my clinical practice, are struggling, as are their children. Even so, as I sit in my office, I think, “This young woman is smart; but for chance and the fate of being born with profound social disadvantages, she could be as successful as my own kids, the medical trainees I teach, and the colleagues I work alongside.” But some young mothers do pull themselves out of the chaos of their childhood, even as more fortunate members of our communities—including healthcare providers, teachers, and policy makers—assume they are where they are because they deserve it. We may believe they brought it on themselves; that they are less capable, less smart, lazier, less honest than we are, and these biases change the way professionals view and treat young mothers. That is the essence of stigma—and stigma hurts.

Among other things, stigma causes stress. It piles up on itself and multiplies its impact. It can add to the stress of adverse childhood experiences and continue throughout teen mothers’ lives to make every step more difficult for them and their children. Stigma reduces access to resources: Schools, parks, healthcare access, housing, shops, etc. are all better in better neighborhoods. Many teen mothers live in marginalized communities and are victims of discrimination. Stigma is manifested through interpersonal interactions in shops, on public transit, in healthcare offices, and in schools. It acts systemically and is embedded in policy.

In the face of these challenges, it is remarkable that some of these young mothers fashion successful lives for themselves and their children. For many, having a baby becomes a call to setting life goals and organizing their lives. Some, like Samantha, find their new role as an opportunity to examine their purpose and change conditions for their children. Even for them, though, stigma makes it harder to succeed and causes stress that is passed on to their children. All too often, young mothers succeed despite the oppression of the stigmatizing beliefs imposed on them by their presumed support system. Undoubtedly, some are defeated by stigma. This is a systemic failure resulting in tragedy for them, their children, and, ultimately, society.

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What society at large can do

• Adopt a more compassionate stance because these are young girls and women who have babies they can love and grow with. Adolescents have always had babies and we know that they can be successful young women and mothers if given support, dignity and respect.
• Acknowledge that support from teachers and school administrators can keep them in school and facilitate their education, which is associated with better planning, better work trajectories, better health, etc. Be aware that under U.S. federal law, expectant and parenting students are protected from discrimination in school.
• Keep in mind that for these young women, parents, clergy, social support workers, and other adults may be intimidating figures who can provide or withhold approval and resources—and that adult disapproval hurts.
• Policy makers need to acknowledge that stress in early childhood not only blights the quality of life for children and their parents but also causes huge downstream costs in health, education, social supports, and in the legal system. A dollar spent for young children and their families saves many multiples over time.

What healthcare workers can do

• They can ask themselves about their own often unconscious beliefs. How might they manifest in their interactions? How might they oppress teen mothers? And how might they disadvantage their babies and children?
• They can ask themselves, their colleagues, and their office staff about resources they can make available to teen mothers and their babies. How do these compare to resources offered to older mothers or to less marginalized teens who are not pregnant? How might they evaluate the language they use with peers and young families?
• They can ask themselves what it would be like to be a teen parent, and what might they need to be successful.
• They can question policies that disadvantage teen mothers and their babies, and support policies that help them.
• They can ask patients and clients about their experiences working with healthcare professionals and use that feedback to guide future interactions and challenge professional beliefs.

When the goal is to improve health, everyone can stop adding to the stigmatizing of teen mothers while playing an important role that focuses on the strength of young parents, supports their goals of doing the best they can to raise their children, helps them get the resources they need, gives them hope and optimism, and views them as having the capacity to be good parents and successful adults.