Towards child health: through mother's health and education

In India, mothers and children constitute 62% of the population, but they are also a special risk group as regards their childbearing and survival, respectively. The States of Bihar, Rajasthan, Madhya Pradesh, and Uttar Pradesh account for about 50% of the girls who are married off before age 16. Low levels of female literacy (ranging from 11.4% in Rajasthan to 65.7% in Kerala, with an all India average of 39.4%) are associated with early marriages, which expose girls to pregnancy in their teen years. Many studies report higher rates of low birth weight, prematurity, and neonatal and infant mortality in children of young mothers than in children born to women 20-29 years old. In a study conducted in a slum area of Bombay, teenage pregnancy appeared to be a risk factor for low birth weight when compared with pregnancies of women 21-30 years old. The incidence of low birth weight babies in India ranges from 30% to 40%, and they account for over 80% of neonatal deaths. The incidence of premature labor in teenagers in various Indian studies ranges from 11% to 31%. Perinatal mortality rates for Indian teenager pregnancies vary between 6% and 11%. Poverty associated with adverse sociocultural practices and the low status of women aggravates malnutrition and anemia in pregnant women. Female literacy is particularly important both for utilization and for provision of medical, health, and social welfare services. A national survey has indicated that the number of children born to couples was 4.03 when the husband was illiterate, declining to 2.16 when the husband had intermediate or higher level education. But the number was 3.8 when the wife was illiterate, dropping to 1.6 when the wife had intermediate or higher level education. If the mother is educated she will provide better child care, nutrition, and cleanliness, the factors which affect the health of her child.     

The children of teenage mothers: patterns of early childbearing in two generations

Twenty years after a mostly black group of Baltimore women became adolescent mothers, the majority of their first-born children had not become adolescent parents, a finding that challenges the popular belief that the offspring of teenage mothers are themselves destined to become adolescent parents. Almost all of the offspring had had intercourse by age 19. About half of the young women had experienced a pregnancy before that age, and approximately one-third of the young men reported having impregnated a partner before age 19. The Baltimore youths were just as likely to have had a live birth before age 19 as were the children of teenage mothers in a national sample of urban blacks, and both of these groups were more likely to have done so than were the children of older mothers in the national sample. In the Baltimore sample, maternal welfare experience only increased a daughter's likelihood of early childbearing if welfare was received during her teenage years. Within the Baltimore sample, a direct comparison of the daughters who became adolescent mothers with their own mothers at a comparable age reveals that the daughters have bleaker educational and financial prospects than their mothers had, and are less likely to ever have married. These results suggest that today's teenage parents may be less likely than were previous cohorts of adolescent mothers to overcome the handicaps of early childbearing. This trend could portend the growth of an urban underclass, even though only a minority of the offspring of teenage mothers go on to become adolescent parents.     

The effects of early childbearing on schooling over time.

CONTEXT: In recent studies, the effects of teenage childbearing on the schooling of young women have been smaller than those in earlier research. The discrepancy has been attributed to the use in the later studies of controls for unmeasured differences between young women who start childbearing early and those who do not, but could instead reflect changes in the effect of early childbearing over time. METHODS: Data from the National Longitudinal Survey of the Labor Market Experience of Youth and the Panel Study of Income Dynamics are used to identify the reasons for this difference. Logistic regression, ordinary least-squares regression and fixed-effects models examine the impact of early childbearing on rates of high school graduation and college attendance, and number of years of schooling completed through age 29. RESULTS: The two data sets show a significant negative impact of a teenage birth on rates and years of completed schooling. For example, teenage mothers complete 1.9-2.2 fewer years of education than do women who delay their first birth until age 30 or older. Moreover, compared with women who give birth at age 30 or older, teenage mothers have odds of high school completion 10-12% as high and odds of postsecondary schooling 14-29% as high. Unobserved differences between young mothers and their childless peers reduce, but do not eliminate, the effects of early births. Effects on high school completion declined in recent periods because more young women completed high school, regardless of the timing of their first birth. However, the gap between early and later childbearers in postsecondary school attendance widened from 27 to 44 percentage points between the early 1960s and the early 1990s. CONCLUSIONS: Given the current importance of a college education, teenage childbearers today are at least as disadvantaged as those of past generations.     

Teenage childbearing and long-term socioeconomic consequences: a case study in Sweden

CONTEXT: Whether long-term socioeconomic problems experienced by many teenage mothers are a reflection of preexisting disadvantage or are consequences of teenage motherhood per se remains unclear. METHODS: National data on all women born in Sweden from 1941 to 1970 who were younger than age 30 when they first gave birth (N=888,044) were analyzed. The outcome measures, assessed during adulthood, were employment status, socioeconomic status, educational attainment, single motherhood, family size, receipt of disability pension and dependence on welfare. Multiple logistic regression techniques were used to adjust for maternal birth cohort and for socioeconomic background of the woman's family. RESULTS: Compared with Swedish women who first gave birth at ages 20-24, those who were teenage mothers had significantly increased odds of each unfavorable socioeconomic outcome in later life, even after the data were adjusted for family socioeconomic situation and maternal birth cohort. For example, teenage motherhood was positively associated with low educational attainment (odds ratios of 1.7-1.9, depending on the specific age during adolescence when the woman gave birth), with single living arrangements (odds ratios, 1.5-2.3), with high parity (odds ratios, 2.6-6.0), with collecting a disability pension (odds ratios, 1.6-1.9) and with welfare dependency (odds ratios, 1.9-2.6). These trends were usually linear, with the highest odds ratios corresponding to women who had had their first child at the youngest ages. CONCLUSIONS: A longitudinal analysis of record-linkage data from Sweden supports the view that childbearing during adolescence poses a risk for socioeconomic disadvantage in later life--even for adolescents from relatively comfortable backgrounds and for those who studied beyond elementary school.     

Infant health consequences of childbearing by teenagers and older mothers

The association of childbearing at early and late ages with various adverse outcomes of pregnancy was explored in data collected in the 1980 National Natality and Fetal Mortality Surveys. The characteristics of interest for teenage mothers were marital status at conception and the trimester of pregnancy in which prenatal care was begun. For married mothers aged 30 years and older, the variables considered were employment status and occupation during the year preceding childbirth and smoking status before and during pregnancy. The pregnancy outcome variables analyzed were the same for both groups of mothers: fetal loss, low birth weight, and low 1-minute Apgar scores. Although more than half of all births to teenage mothers were to unmarried women, an additional one-quarter of these births were to women who married between the time of conception and the birth of the child. Generally there was little difference in outcomes for teenage mothers who were married at the time of delivery, regardless of their marital status at the time of conception. Pregnancy outcomes for teenagers who did not marry prior to delivery were considerably less favorable. Nearly 90 percent of women aged 30-34 years who had a first birth in 1980 were employed during the year before delivery, an extraordinarily high labor force participation rate. More than half of these employed mothers were in professional occupations, consistent with their very high levels of educational attainment. Although the analysis is limited by the small numbers of births involved, it appears that professionally employed women generally have the best pregnancy outcomes. When mother's smoking status is taken into account,nonsmokers had more favorable outcomes, with births to professionally employed mothers generally most favored.     

Effects of a comprehensive program for teenage parents: five years after project redirection

A fifth-year follow-up of teenage mothers who had enrolled in Project Redirection, a comprehensive program of services for pregnant and parenting teenagers, revealed many long-term benefits of the program. Administered when the young mothers were, on average, 22 years old, the follow-up found that program participants had better employment records, higher average earnings and lower rates of welfare dependency than a comparison group of similar young mothers who had not enrolled in Project Redirection. Moreover, participants had higher scores on a test of parenting, were more likely to have breastfed their infants and were more likely to have registered their children in Head Start. The children of the Project Redirection participants (whose average age was five and one-half) were better off than their comparison-group counterparts in terms of cognitive, social and emotional development. The two groups of young mothers were similar in terms of their educational attainment after five years, but differences in fertility were observed. Although the two groups had experienced similar numbers of pregnancies, Project Redirection participants were less likely to have terminated a pregnancy by means of induced abortion, and as a result had had a higher average number of live births. The economic status of women who were able to limit their child-bearing was generally more favorable than for those who were not able to do so, but participation in Project Redirection was associated with improved employment outcomes and greater self-sufficiency among all of the women, regardless of the size of their family.     

Risk factors for childbearing during adolescence in a population-based birth cohort in southern Brazil.

OBJECTIVE: To use a case-control study to analyze risk factors associated with teenage childbearing among adolescents who were in a birth cohort study that began in 1982 in the city of Pelotas, Rio Grande do Sul, Brazil. METHODS: Adolescent mothers in Pelotas who gave birth between January 1995 and March 2001 and who had been born in 1982 were identified through the local birth information system. These subjects from the 1982 birth cohort were compared to adolescents from the same cohort who had not given birth before March 2001. Standardized interviews were used in 2001 to obtain information about socioeconomic, maternal reproductive, demographic, and lifestyle characteristics. This information was combined with data obtained in earlier phases of this 1982 birth cohort study. Unconditional logistic regression was used to analyze the risk factors associated with childbearing during adolescence. RESULTS: A total of 420 parous adolescents from the 1982 birth cohort were identified and then compared with 408 cohort adolescents who had not given birth by March 2001. Higher family income in 1982 and more parental schooling in 1982 were inversely related to childbearing among the birth cohort adolescents. Cohort girls whose mothers were under age 20 when they gave birth in 1982 had a higher risk of becoming pregnant while still an adolescent. Cohort girls who, during childhood, lived with siblings from different fathers were twice as likely to become an adolescent mother. Compared to cohort adolescents who had not failed during the first four years of school, those girls who had done so had twice the risk of giving birth during adolescence. Among the cohort girls a positive association was found between younger age at first intercourse and childbearing in adolescence. CONCLUSIONS: The results indicate that the educational level of the adolescent mothers must be considered in planning policies that attempt to disrupt successive cycles of socioeconomic deprivation. Early interventions to improve sex education and to increase the motivation of young girls to achieve higher levels of education are needed. The interventions should aim for a reduction in the risk of long-term poverty and poorer educational achievements of teenage mothers and their children.     

A comparison of pregnancy and child health outcomes between teenage and adult mothers in the slums of Nairobi, Kenya

The study assessed and compared pregnancy and child health outcomes of teenage (aged less than 20 years) and adult (20-34 years of age) mothers. A total of 226 teenage and 205 adult mothers met the study criteria out of the 3,256 women in the reproductive age group (15-49 years) and 318 adolescent girls (12-14 years of age) covered by the Nairobi Cross-sectional Slums Survey (NCSS). The main comparison involved socio-demographic variables, events during pregnancy, obstetric outcome, child morbidity and mortality and care provided during an illness episode. Results showed that a significantly higher percentage of teenage mothers and their partners had lower educational achievement compared with adult mothers and their partners. They were more likely to be economically disadvantaged than the adult mothers. Teenage mothers and their parents were also less likely to have ever been married. The two groups of mothers were comparable in terms of the rate and timing of antenatal care visits, place of delivery, rate of operative deliveries, reported size of the baby at birth, child vaccination status and reported morbidity and health care practice during an illness episode. The index child was alive during the survey period for 89.4% of the teenage and 96.6% of the adult mothers (OR = 3.36; 95% CI = 1.34, 8.79; P = 0.004). Child survival rates in the two groups of mothers were found to be quite similar after controlled analysis for the influence of socio-economic factors. The study concluded that bad obstetric outcomes were not associated with maternal age. Although teenage and adult mothers were not significantly different on child health practices, children born to the former group died most frequently probably due to their poor socioeconomic achievements.     

Early childbearing and completion of high school

This article uses data from the National Longitudinal Survey of Work Experience of Youth (NLSY) for 4696 US women who were aged 20-26 in 1983, and thus were past the normal age of high school completion, to examine patterns of high school termination and completion associated with teenage childbearing. The role of the General Educational Development (GED) program is examined as the means by which teenage mothers obtain high school credentials once they have dropped out of school. Most employers, training programs and colleges accept the GED certificates in the same manner as they do regular high school diplomas. Tabulated data indicate that high school completion rates for women aged 20-26 in 1983 range from only 53% among women who gave birth within 7 months after leaving school, to 79% among those who became pregnant after leaving school. Among Hispanic mothers who gave birth shortly after leaving school, the proportion completing their 2ndary education is 20 points lower than it is among whites or blacks (33% vs. 55%). Among Hispanic mothers who became pregnant after leaving school, the proportion is nearly 30 points lower (55% vs. 81-85%). Overall, only 5% of young women obtain their high school credentials through the GED equivalency program. However, young mothers are about 2-3 times as likely to go this route as are childless women. The GED program emerges as the predominant means of high school completion among white mothers (51% of those with accreditation), whereas it is considerably less important among black mothers (28%). The data also indicate how age at childbearing is closely associated with the probability of school completion and the type of credential received. The analyses highlight the importance of the GED program for women who bear children at an early age. Among women who complete high school but bear a child prior to the date of high school accreditation, about 40% obtain their credential through the GED program. Most of the women who 1st give birth at ages 15-16 do not finish high school by their early 20s, but those who do finish are almost as likely to obtain a GED credential as they are to receive a standard diploma. Although it is possible that availability of the GED option may encourage some young mothers to prematurely terminate their formal schooling, in all likelihood it permits a greater number to receive high school accreditation.     

The relationship between age of mother and child health and development.

This study investigates the relationship between age of mother and children's health and development at birth and at approximately three years of age. The sample is composed of Black and Hispanic women and their firstborn children who were delivered on the wards of a large New York City hospital in 1975. There were no differences between children of teenage and older mothers in terms of prematurity or birthweight, but the children of younger mothers had higher Apgar scores than those of older mothers. Age of mother was not significantly related to hospitalizations, the need to see a physician regularly, or abnormal weight. Although the number of injurious conditions and the incidence of burns were higher among the children of adolescent mothers, the effect of age of mother was not independent of other factors. The children of teenage mothers scored better than those of older mothers on the total Denver Developmental Screening Test, as well as on the Fine Motor sector. These findings thus suggest that when relevant background characteristics are controlled, children of teenage mothers are as healthy and develop as well as children of older mothers.     

Health implications of early childbearing on pregnancy outcome in Botswana: insights from the institutional records

Early childbearing can have deleterious effects on pregnancy outcome. This study in Botswana found that both birth injuries and congenital abnormalities were common among infants born to teenage mothers compared to infants of women aged 20-34 years. This statistically significant relationship disappeared, however, when controls were introduced. Based on the results of this study, it appears that in order to improve pregnancy outcomes, frequent and early prenatal visits and improvements in the socioeconomic environment are needed. Thus, postponement of childbearing beyond teenage years alone would not necessarily improve pregnancy outcomes in Botswana.     

Teenage children of teenage mothers: psychological, behavioural and health outcomes from an Australian prospective longitudinal study

In many industrialised countries teenage pregnancy and teenage parenthood have in recent years been identified as social and public health problems that need to be tackled. A number of studies have looked at various outcomes for teenage mothers and their offspring, and many report a strong association with poverty for the mother both before and after having a child. Few studies, however, adequately control for socioeconomic circumstances when examining health and related outcomes. Most studies have focused on perinatal outcomes in the offspring with few looking at later health and development. In Australia, where the rate of teenage pregnancy is relatively high compared to other comparable countries, teenage pregnancy is a not prominent policy concern. As such, Australia offers the opportunity to study the outcomes of teenage parenthood in a country where there may be less stigma than in countries that portray teenage parenthood as a major health and/or social problem. This paper reports findings from the Mater-University Study of Pregnancy (MUSP) and its outcomes, a prospective study of women, and their offspring, who received antenatal care at a major public hospital (Mater Misericordiae Hospital) in South Brisbane, Australia, between 1981 and 1984. We have examined the associations of maternal age (< or =18 years (n=460) versus >18 years (n=4800)) at first antenatal visit with offspring psychological, behavioural and health characteristics when the offspring--the teenage children of teenage mothers--were aged 14 years. Multiple logistic regression was used to determine the effect of maternal and family characteristics on associations between maternal age and childhood outcomes at age 14. Results show that the 14 year old offspring of mothers who were aged 18 years and younger compared to those who were offspring of older mothers were more likely to have disturbed psychological behaviour, poorer school performance, poorer reading ability, were more likely to have been in contact with the criminal justice system and were more likely to smoke regularly and to consume alcohol. However, maternal age was not associated with health outcomes in their offspring at age 14 years. Indicators of low socioeconomic position and maternal depression were also associated with poorer psychological, cognitive and behavioural outcomes among 14 year olds. In addition children from poorer socioeconomic backgrounds and whose mothers were depressed were more likely to have self-reported poor health, asthma, to have been admitted to hospital twice or more since birth and to be bed-wetters at age 14. The associations between maternal age and psychological distress, school performance, and smoking and alcohol use were all largely explained by socioeconomic factors, maternal depression, family structure and maternal smoking. These findings confirm that not all teenage mothers and their offspring have adverse outcomes, and that many if not the majority have good outcomes.     

Health aspects of early marriage and reproductive patterns

Some of the most compelling World Fertility Survey (WFS) findings for 40 developing countries are those dealing with fertility and related factors that influence maternal and child health. Mother's age at 1st marriage and at birth of the 1st child, intervals between consecutive births (spacing), and birth order, among other factors have been found to have a strong bearing upon a child's chances of surviving infancy and early childhood. The WFS data also indicate that these factors, in addition to the total number of children ever born to a woman, affect the mother's health. The WFS surveys also provide information for identifying the service needs of young married people and highlight the importance and need for such services. The WFS surveys verified that early marriages are associated with very early childbearing and achievement of large families by the end of the reproductive period. It can also be implied from the data that, because of presumed juvenile infertility, the early years of adolescent marriages are often barren and may be followed by later infecundity. Girls who marry or begin sexual intercourse before or around puberty, i.e., under age 15, tend to experience a longer interval between marriage or conjugal union and 1st birth than do their counterparts who marry later. Early marriage also influences the well-being of children. Babies born to mothers who were under age 20 (or over 39) at the time of their birth have poorer chances of surviving the first 5 years than do those whose mothers were 20-39 years of age when they were born. Infant mortality is exceptionally high among babies whose mothers were under age 15 at the time of their birth. In many countries, primarily on the Indian subcontinent and in sub-Saharan Africa, where women marry and have their 1st child at an early age, the 1st born is the child least likely to survive infancy and early childhood. The WFS data provide compelling, robust evidence that the length of the inter-birth interval is a stronger determinant of infant and early childhood mortality than many of the other explanatory variables examined. In each region, infants born at short intervals have considerably higher mortality than better (longer) spaced children. The association between the conditions created by child marriages, harmful reproductive patterns, infecundity, and infant and child mortality sets important tasks for the family planning movement while arming its workers with strong arguments for planned parenthood.     

Teenage pregnancy and motherhood.

In a random sample of British-born women from a deprived inner London borough who were expecting their first baby, 31% were teenagers at the time they gave birth. The teenage mothers were compared with a group of older women randomly selected from the sample and both groups were followed up for 6 1/2 years after the birth. The teenage mothers were more likely to have had a deprived background and to have experienced material disadvantage. Despite this, they and their children did as well as the older women on a wide variety of measures of physical and mental health. A comparison of the teenagers with another sample of women who did poorly (those who had been brought up in care) suggests that the lack of an adverse result amongst the teenagers was at least in part due to support from the womens' own mothers.     

Teenage Pregnancy: A Socially Inflicted Health Hazard

Background:

Early marriage and confinement are contributing factors to high maternal and perinatal mortality and morbidity.

Objective:

To assess the magnitude of the problem of teenage pregnancy and its complications.

Materials and Methods:

A hospital-based cohort study was undertaken over 4 months among women admitted to a rural hospital in West Bengal. The study cohort comprised of teenage mothers between 15-19 years old and a control cohort of mothers between 20-24 years old. Data included demographic variables, available medical records, and complications viz. anemia, preterm delivery, and low birth weight. Anemia was defined as a hemoglobin level below 10 gm% during the last trimester of pregnancy, preterm delivery was defined as occurring within 37 weeks of gestation, and low birth weight was defined as babies weighing less than 2500 grams at birth.

Result:

Teenage pregnancy comprised 24.17% of total pregnancies occurring in the hospital during the study period. The study group had 58 subjects and the control group had 91 subjects. The prevalence of anemia was significantly higher (P<0.05) in the women in the teenage group (62.96%) than in the women in the control group (43.59%). However, severe anemia with a hemoglobin level below 8 gm% was only found in the control group. Preterm delivery occurred significantly more (P<0.001) in the study group (51.72%) than in the control group (25.88%). The incidence of low birth weight was significantly higher (P<0.0001) among the group of teenagers (65.52%) than among the women in the control group (26.37%). Not a single newborn was above 3 kg in the study group, while none were below 1.5 kg in the control group. The mean birth weight was 2.36 kg in the study group and 2.74 kg in the control group; the difference was strongly significant (P<0.001).

Conclusion:

The study shows that anemia, preterm delivery, and low birth weight were more prevalent among teenagers than among women who were 20-24 years old. This indicates the need for enhancing family welfare measures to delay the age at first pregnancy, thereby reducing the multiple complications that may occur in the young mother and her newborn baby.     

Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation.

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation for socially disadvantaged women bearing first children. Eighty-five per cent of the participating women were either teenagers (less than 19 years at registration), unmarried, or of low socioeconomic status. Women were randomly assigned to either nurse home visitation or comparison services (free transportation for prenatal and well-child care and/or sensory and developmental screening for the child). During the first four years after delivery of their first child, in contrast to their counterparts in the comparison group, nurse-visited White women who had not graduated from high school when they registered in the study returned to school more rapidly; nurse-visited, poor, unmarried White women showed an 82 per cent increase in the number of months they were employed, had 43 per cent fewer subsequent pregnancies, and postponed the birth of second children an average of 12 months longer.     

Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study

BACKGROUND: Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. METHODS: We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. RESULTS: All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. CONCLUSIONS: Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.     

不同年代育龄妇女婚育观及其变化的回顾性研究

目的:了解50～60年代和80年代育龄妇女的婚姻观念和多子女生育的原因。方法:以村为单位整群或随机抽样,问卷调查70周岁以上和50～60周岁的两组多子女母亲。比较初婚平均年龄、实际生育子女数、理想生育子女数、性别偏爱、非意愿生育、避孕节育等方面的差别。结果:80年代育龄妇女的初婚平均年龄比50～60年代育龄妇女晚2.22岁;前者的非意愿生育明显低于后者,后者的意愿生育明显高于前者,两构成比较差异高度显著(χ2=72.86,P<0.01);对子女性别偏爱差异不显著。结论:50～60年代的育龄妇女今天已经变成老妇,但她们传统的婚育观念也在随时间的变化而变化,其儿女随时代婚育观已发生变化。     

How can family planning programs delay repeat teenage pregnancies?

The Adolescent Family Clinic of Sinai Hospital in Baltimore which opened in 1965 and which provides family planning services to pregnant adolescents and teenage parents in the hope of preventing early repeat pregnancies is partially evaluated. Evaluation of family planning programs working with teenage mothers is complicated by the variability and instability both to the critical socioeconomic contingencies associated with the young woman's motivations to have or avoid having children and in their ongoing exposure to the risk of pregnancy. The problem is to determine how the experiences of these young women who receive family planning services affect those circumstances that alter the timing of subsequent pregnancies. A life table approach in studying the factors related to the onset of the 2nd pregnancy has been used. This technique is designed specifically to study the temporal pattern of events in the fertility process, and its modification allows the tracing of the probability that a 2nd pregnancy has occurred at various durations into the postpartum period. All pregnant women under age 18 who entered the hospital were eligible to participate in the special program; however, because of staff limitations, 40% of 404 women were assigned on a random basis to the hospital's regular prenatal program. The difference in the 2 programs was the degree of education and encouragement offered. Most of the women were seen during their 2nd trimester. After a 1st visit they were closely supervised through the early months of the postpartum period. In all respects the 2 groups of women were identical. All the young women were interviewed shortly after they registered for prenatal care. A year after delivery, over 95% were interviewed again. 2 years later 90% of the original 404 were reinterviewed. The results are from all 3 interviews. The Adolescent Family Clinic program had limited success in preventing unwanted 2nd pregnancies. 3 years after the 1st delivery approximately 50% of both groups had become pregnant again. Analysis of the data reveals that the risk of pregnancy alters markedly as marital situations, motivation to avoid pregnancy, and use of contraception change. A family planning program must deal with these changes. Most young women want to postpone a 2nd pregnancy and are willing to use birth control. However, when frightening or disturbing side effects occur, they often stop using their method. If they are not offered reassurance when problems arise, they may choose to leave matters to chance. Long-term programs offering initial and ongoing family planning services have the best chance of achieving long-term results with teenagers.     

Socioeconomic inequality in birth weight and gestational age in Denmark 1996–2007: Using a family-based approach to explore alternative explanations

A large body of literature has reported associations between socioeconomic position and adverse pregnancy outcomes even in affluent egalitarian welfare states. This study explored the nature of this relationship by examining women who changed socioeconomic position between pregnancies and women who were siblings but were different in terms of socioeconomic position. Data consisted of 471,215 live born singletons born in Denmark 1997–2007 with at least one sibling or one first cousin. We examined parental educational attainment and household income in relation to preterm birth and small for gestational age using Cox regression. Household income was only weakly related to these outcomes. Paternal education was strongly associated with the outcomes only in the cohort analyses. Maternal education was inversely associated with preterm birth only in the cohort analyses, where the least educated women had the highest risk. Maternal education was inversely associated with the risk of small for gestational age in cohort analyses, attenuated between mothers who were siblings, and not present between children who were siblings. For example, the hazard ratio of preterm birth of women with a college/university degree when compared to women with only mandatory education was 0.64 (95% confidence interval: 0.60–0.67) in the cohort analysis, 0.90 (0.78–1.04) between mothers who were siblings, and 1.01 (0.82–1.24) between children who were siblings. The corresponding hazard ratios of small for gestational age were 0.54 (0.52–0.56), 0.72 (0.63–0.83), and 1.02 (0.84–1.24). This suggests that the associations were partly explained by factors shared between mothers who are siblings. In conclusion, the early life circumstances of mothers appear to be important in understanding the association between education, preterm birth and small for gestational age.