In adolescent pregnancies, we need to pay more attention to the increasingly negative effects of shocks such as COVID-19, displacement, and natural disasters.
The COVID-19 pandemic has reignited concerns about the effects of crises on the development of children globally. Within this realm of concern is an area that continues to be overlooked: the particular vulnerability of adolescent mothers and mothers to be, and by proxy, their children. Countries with high rates of adolescent childbearing also tend to struggle with reaching education goals and reducing poverty. It’s not that adolescent motherhood is rare; in many parts of the world, marriage and childbearing under age 18 is very common. An estimated 12 million girls aged 15 to 19, and nearly 777,000 girls younger than 15, give birth each year – and most of their pregnancies are unintended. But the particular risks for this subdemographic often go overlooked because governments and the development community prefer to think about preventing adolescent pregnancies than supporting adolescent mothers. Our research addresses this gap, noting that, around the world, shocks like a global pandemic make adolescent mothers and their offspring exponentially more vulnerable.
Adolescent mothers are already among some of the most vulnerable, even in the best of times and regardless of cultural perceptions (in some contexts, adolescent pregnancies are stigmatized; in others they are celebrated). Most teenage pregnancies occur in low- and middle-income countries and are often concentrated among the parts of society of the lowest incomes. Pregnancy at an early age often means mothers leave school and transition to domestic roles, resulting in lower levels of education, fewer economic resources, and less bargaining power in the home; these outcomes coincide with restricted access to sexual and reproductive health services. Adolescent childbearing is also associated with higher risks to maternal health. In fact, pregnancy and birth complications are the leading causes of death among 15- to 19-year-old girls worldwide.
“Adolescent mothers are already among some of the most vulnerable, even in the best of times and regardless of cultural perceptions (in some contexts, adolescent pregnancies are stigmatized; in others they are celebrated).”
However, not all of the risk is contextual. At least some of it lies “below the skin.” We argue in a forthcoming article that part of the risk adolescent mothers and their offspring face stems from neurobiological processes specific to adolescent development, for instance, heightened sensitivity to reward and stress. This becomes particularly salient when exploring how these processes interconnect with stressful life events. In short, adolescents’ heightened sensitivity to stressful events leads to higher levels of physiological stress, which has been demonstrated to affect adolescent development as well as pregnancy outcomes (e.g., preterm labor and low birthweight) and child development. Stress is transmitted to children prenatally through neuroendocrine pathways and postnatally through caregiving. In fact, recent studies link stress related to COVID-19 to pregnancy outcomes and early caregiving. Ultimately, we argue that the physiological stress response is a key factor in why adolescent moms and their offspring, on average, have worse developmental outcomes later in life, a fact that is supported by abundant evidence.
Given the scale and urgency of the COVID-19 pandemic, we are asking questions about the impact of the pandemic on early child development broadly, and adolescent motherhood more specifically. We already know that large shocks, such as financial crises, pandemics, natural disasters, and armed conflict, are accompanied by massive social and institutional disruptions and cause substantial stress in individuals, families, and communities; we also know that these often lead to widespread displacement and insecurities in housing and livelihood. Higher rates of adolescent pregnancies have been observed in contexts of displacement, often due to inadequate availability of sexual and reproductive health and family planning services for adolescent girls. By mid-2020, more than 15 million people were newly displaced internally due to conflict or disaster. Their situations are made even more precarious by the fact that, in response to the pandemic, in many places, non-essential services and programs closed their doors or refocused to respond to the pandemic. Moreover, stigma associated with COVID-19 has drastically reduced clinic visits for prenatal care.
Pregnant adolescents and adolescent mothers are even more at risk when sexual and reproductive health services become scarcer. In contexts of displacement, high rates of gender-based violence and poverty-driven transactional sex contribute to the increase in adolescent pregnancies. With lockdowns, there is the added risk of increased domestic violence and abuse in the home. For instance, both Kenya and Paraguay have reported increasing adolescent pregnancy rates during COVID-19 lockdowns. High rates of and increases in adolescent pregnancies during such stressful times should sound alarm bells.
“High rates of and increases in adolescent pregnancies during such stressful times should sound alarm bells.”
There is little evidence on how to best support adolescent mothers and mothers-to-be effectively, but some innovative interventions are pioneering the way. Countries such as Zimbabwe have started to change laws around school attendance for pregnant adolescent girls, allowing them to continue their education and ensuring that pregnant and mothering girls stay in school. A program in Ethiopia, “Meseret Hiwott,” used community women as mentors to facilitate group discussions for married adolescent mothers, focusing on increasing voluntary counselling and testing for HIV, as well as sexual and reproductive health awareness, family planning, motherhood, gender and power dynamics, and financial literacy. And a recent experimental evaluation of a home visiting program for low-income adolescent moms in São Paulo, Brazil, demonstrated positive effects on caregiving and maternal well-being. Such programs are promising, but more rigorous research is needed to better understand their impact and how to take them to scale successfully.
Unfortunately, most efforts in this area have focused on preventing adolescent pregnancies. Many of these initiatives have largely failed to produce substantial change, and can contribute to stigmatization and drive underage marriage practices underground, increasing the risks to adolescent mothers and their offspring. They also fail to acknowledge that adolescent motherhood will not be going away in many parts of the world anytime soon. We need more investigation and inquiry into the most effective ways to support adolescent mothers and their children – particularly in contexts of acute stress. The effects of the current pandemic are likely to be felt for a while to come and new crises are inevitable. Understanding how crises affect adolescent girls and how to effectively support their development, education, and reproductive health, with or without children, will likely yield long-term returns, not just to them and their families, but to society at large and generations to come.
Header photo: Fixers on Flickr. Creative Commons.
Yoshikawa H, Wuermli AJ, Britto PR, Dreyer B, Leckman JF, Lye SJ, Ponguta LA, Richter LM & Stein A (2020), Effects of the global COVID-19 pandemic on early childhood development: Short- and long-term risks and mitigating program and policy actions. Journal of Pediatrics
Wuermli AJ, Yoshikawa H & Hastings PD (forthcoming), A bioecocultural approach to supporting adolescent mothers and their young children in conflict affected contexts. Development and Psychopathology