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.     

Teaching interactions of black and Cuban teenage mothers and their infants

Possible factors related to maternal teaching styles are socioeconomic status, ethnic group membership, maternal age, maternal locus of control, and the mother's “hidden agenda” or goals for her child. In this study, 32 lower income, Black and Cuban, teenage and adult mothers and their 12 month old infants participated in a simple task teaching their infant how to operate a “Jack-in-the-box”. The mothers were also interviewed on questionnaires designed to tap locus of control, “hidden agendas”, and demographic characteristics. The results showed that Cuban mothers demonstrated the task to their infant with verbalization significantly more often than the Black mothers. The groups did not differ on maternal “hidden agendas”. Adult mothers showed a more internal locus of control than teenage mothers. Infants of Black, teenage mothers vocalized significantly less often than infants of the other groups. Results of this study provide additional support for existing literature in which maternal age and cultural differences were reported for the amount of maternal verbalization during early teaching interactions.     

Teaching interactions of black and Cuban teenage mothers and their infants

Possible factors related to maternal teaching styles are socioeconomic status, ethnic group membership, maternal age, maternal locus of control, and the mother's “hidden agenda” or goals for her child. In this study, 32 lower income, Black and Cuban, teenage and adult mothers and their 12 month old infants participated in a simple task teaching their infant how to operate a “Jack‐in‐the‐box”. The mothers were also interviewed on questionnaires designed to tap locus of control, “hidden agendas”, and demographic characteristics. The results showed that Cuban mothers demonstrated the task to their infant with verbalization significantly more often than the Black mothers. The groups did not differ on maternal “hidden agendas”. Adult mothers showed a more internal locus of control than teenage mothers. Infants of Black, teenage mothers vocalized significantly less often than infants of the other groups. Results of this study provide additional support for existing literature in which maternal age and cultural differences were reported for the amount of maternal verbalization during early teaching interactions.     

Mother-infant interaction of teenage mothers and the effect of experience in the observational sessions on the development of their infants

Mother-infant interaction of 14 teenage mothers and their infants was observed in the laboratory or in the home when the infant was 16, 20, 24 and 52 weeks of age. This behaviour was compared with that of 12 women 20 years or older and their infants. To control for experience in the observational sessions, a third similar comparative group of teenage mothers and their infants was also included in the study who were seen only at the end of the study when the infant was 52 weeks old. At 12 months the Home Observation Measurement of the Environment Inventory #opHOME#cp was administered and the infants were assessed with the Bayley Scales of Infant Development #opmotor and mental scales#cp and the Ainsworth Strange Situation procedure. Face-to-face interactions scores at 12 and 16 weeks of age were consistently better for the older mothers than the younger mothers. Teenagers showed few significant differences from older mothers in their mothering skills as measured in the home when the infant was 24 weeks of age. At 12 months observation groups received higher Bayley motor and mental, HOME and Attachment scores than the control group.     

新生儿母传麻疹抗体水平与相关因素调查

目的:了解新生儿及其母亲麻疹抗体水平,探讨新生儿与母体抗体水平关系以及影响新生儿抗体水平的可能因素,为控制小月龄儿童麻疹发病提供有效建议。方法:采集孕妇产前静脉血和新生儿脐带血共156对,使用ELLSA方法进行麻疹IgG抗体水平检测。结果:母亲麻疹抗体几何平均浓度为546.48 mIU/ml,新生儿为746.64 mIU/ml,是母亲的1.37倍;母亲麻疹抗体对数浓度与新生儿的呈正相关,相关系数为0.883(P=0.000);母亲麻疹抗体水平与母亲年龄、户籍和出生地等因素的关系有统计学意义,30岁及以上组母亲的麻疹抗体几何平均浓度高于30岁以下组(t=-2.078,P=0.039),外省户籍母亲的麻疹抗体几何平均浓度高于北京市户籍组(t=-2.073,P=0.040),两两比较发现农村地区出生母亲的麻疹抗体几何平均浓度高于城市组(LSD法:P=0.005);胎传抗体能力与胎龄、母亲年龄的关系有统计学意义,两两比较发现胎龄38～40周的新生儿其胎传抗体能力高于胎龄小于38周的新生儿(LSD法:P=0.014),母亲年龄在30岁以下组的新生儿胎传抗体能力高于30岁及以上组(t=2.636,P=0.009)。结论:母亲麻疹抗体水平和胎传抗体能力是影响新生儿抗体水平的重要因素,育龄妇女加强免疫麻疹成分疫苗是现阶段控制小月龄麻疹发病的重要手段,早产儿和生育年龄过大母亲所生新生儿受到麻疹威胁时应考虑提前到6月龄接种麻疹疫苗。     

Young maternal age and infant mortality: the role of low birth weight

In 1980, there were 562,330 babies born in the United States to teenage mothers (19 years of age or younger). The offspring of teenage mothers have long been known to be at increased risk of infant mortality, largely because of their high prevalence of low birth weight (less than 2,500 grams). We used data from the National Infant Mortality Surveillance (NIMS) project to examine the effect of young maternal age and low birth weight on infant mortality among infants born in 1980 to U.S. residents. This analysis was restricted to single-delivery babies who were either black or white, who were born to mothers ages 10-29 years, and who were born in one of 48 States or the District of Columbia. Included were 2,527,813 births and 28,499 deaths (data from Maine and Texas were excluded for technical reasons). Direct standardization was used to calculate the relative risks, adjusted for birth weight, of neonatal mortality (less than 28 days of life) and postneonatal mortality (28 days to less than 1 year of life) by race and maternal age. There was a strong association between young maternal age and high infant mortality and between young maternal age and a high prevalence of low birth weight. Neonatal mortality declined steadily with increasing maternal age. After adjusting for birth weight, the race-specific relative risks for babies born to mothers less than 16 years of age were still elevated from 11 to 40 percent, compared with babies born to mothers 25-29 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)     

Teenage parenting skills

The purpose of the study was to investigate the relationship between teenage mothers' interactions with their male and female infants. Seventeen black teenage mothers were videotaped interacting with their 5‐ to 8‐ month‐old infants (9 male, 8 female) on ten tasks.

Later, trained observers watched the videotapes and coded the parents' interactions with their infants on five variables: physical contact, social/verbal stimulation, object/material play, effectiveness, responsiveness. These variables were observed and recorded on three coding sheets adapted from Koller (1979) and Clarke‐Stewart (1973).

The data were analyzed by means of a t‐test on all variables. The significant findings were as follows: Mothers of female infants displayed significantly more calls‐baby's‐name behavior (social/verbal subvariable) than the mothers of male infants (p <.014). Mothers of female infants displayed significantly more objects/material moves‐object‐to‐attract‐baby behavior (object/materials subvariable) than mothers of male infants (p <.018 level). In addition, mothers of female infants more often demonstrated how‐to‐use‐a‐toy than mothers with their male infants (p <.018 level). The mothers of male infants gave significantly more affectionate/tacile behaviors (subvariables of physical contact) than the mothers of female infants (p<.003).     

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.     

Is teenage pregnancy a neonatal risk factor?

Maternal characteristics and neonatal outcome of 421 primiparas aged 15–19 years who delivered at Bikur Cholim Hospital in Jerusalem were examined. The study group included 190 teenage mothers from the Mea Shearim community who marry young and who receive extensive social and economic support. The control group included 231 teenage mothers from other areas of Jerusalem, characterized by a predominantly low social class, Oriental ethnic origin, and a high rate of out-of-wedlock births (28.6%). The Mea Shearim mothers had a significantly lower incidence of low birth weight (<2500 g) infants compared to the control group (6.3% vs. 14.7%, p < 0.01). The differences could not be explained by maternal age distribution, ethnicity, smoking, or marital status. These results suggest that in a community that provides extensive social and economic support and good access to free prenatal care of high standard, teenage pregnancy is not a neonatal risk factor.     

Adolescent motherhood. Comparison of outcome with older mothers

The purpose of this study was to determine whether there were differences in maternal role attainment behaviors for three age groups (15-19, 20-29, 30-42 years) of 294 first-time mothers over a 1-year period. Interviews and questionnaires were completed at early postpartum, 1, 4, 8, and 12 months. Findings are in agreement with more recent research that the health status of adolescent mothers and their infants does not differ greatly from that of older mothers during the first year of motherhood. The adolescent's infant's growth and development were not handicapped. There were no group differences in feelings of love for the infant. The adolescent mother consistently scored lower than older mothers on observed and self-rated maternal competency behaviors. The adolescent mother derived greater gratification in the mothering role than older mothers through 8 months; at 12 months, the 20-29-year-old mother scored higher in gratification. The help received from the adolescent's mother declined at 8 and 12 months suggesting an increased need for social support from other sources at this time.     

The effects of race, residence, and prenatal care on the relationship of maternal age to neonatal mortality.

This population-based study explores whether excessive neonatal mortality rates (NMRs) among infants with teenage mothers are attributable to young maternal age or to a translation of environmental disadvantage into reproductive disadvantage. First births from the 1976-79 linked birth and infant death registers for three states are analyzed. The data set is sufficiently large (305,907 births) to measure maternal age in fine gradations while including several control variables in logit analyses. The associations of racial identification and prenatal care with low birthweight, short gestation, and neonatal mortality overshadow and confound the association between teenage and poor outcome. At every maternal age, higher NMRs are observed for Blacks compared to Whites. The hypothesis that excessive neonatal mortality among Blacks is due to the greater frequency of teenage childbearing among Blacks is refuted. Indeed, unlike White, Black primiparae above age 23 experience higher NMRs than most Black or White teenagers. These results suggest that teenage maternity is not the primary causal agent of all of the problems with which it is associated.     

Teenage childbearing, family size and birthinterval: A study in Singapore

Many studies have shown that women who begin childbearing as teenagers tend to have a larger number of children, and have them at shorter intervals than women who postpone childbearing. However, most of the reported studies were done in developed countries, while similar data from the less developed and Asian countries are limited. This paper presents data on the relationship of the age at mother's 1st birth and subsequent family size and birth interval in Singapore. The study group, comprising women who had their 1st birth below the age of 20 years, was compared with a control group, whose age at 1st birth was between 20 and 29 years. The socioeconomic status of the 2 groups were controlled and found similar. Findings reveal that the group of teenage mothers had an average of 3.18 pregnancies, while that of the control group was 2.54 pregnancies. The mean number of living children was 2.94 among the former and 2.44 in the latter group. Of the teenage mothers, 37.5% (compared with 14.6% of the older mothers) had children with average birth interval less than 24 months. The differences in the results between the 2 groups are statistically significant at the P=0.01 level. Socioeconomic characteristics of the study subjects were measured by the husband's occupation, combined income of husband and wife, and the average number of occupied rooms. Overcrowding can also be used as an indicator of socioeconomic status. People belonging to the higher socioeconomic status tend to occupy more living space per person. The ages of teenage mothers are on average 5.3 years younger than the controls. The only significant difference between the 2 groups was found in their education. The teenage mothers had better educational attainment than the older mothers.     

Maternal Health Literacy and Late Initiation of Immunizations Among an Inner-City Birth Cohort

To determine if maternal health literacy influences early infant immunization status. Longitudinal prospective cohort study of 506 Medicaid-eligible mother-infant dyads. Immunization status at age 3 and 7 months was assessed in relation to maternal health literacy measured at birth using the Test of Functional Health Literacy in Adults (short version). Multivariable logistic regression quantified the effect of maternal health literacy on immunization status adjusting for the relevant covariates. The cohort consists of primarily African-American (87%), single (87%) mothers (mean age 23.4 years). Health literacy was inadequate or marginal among 24% of mothers. Immunizations were up-to-date among 73% of infants at age 3 months and 43% at 7 months. Maternal health literacy was not significantly associated with immunization status at either 3 or 7 months. In multivariable analysis, compared to infants who had delayed immunizations at 3 months, infants with up-to-date immunizations at 3 months were 11.3 times (95%CI 6.0–21.3) more likely to be up-to-date at 7 months. The only strong predictors of up-to-date immunization status at 3 months were maternal education (high school graduate or beyond) and attending a hospital-affiliated clinic. Though maternal health literacy is not associated with immunization status in this cohort, later immunization status is most strongly predicted by immunization status at 3 months. These results further support the importance of intervening from an early age to ensure that infants are fully protected against vaccine preventable diseases.     

婴儿血铅与母亲血铅和乳铅等因素的相关性研究

目的了解婴儿血铅与母亲血铅和乳铅等因素的相关关系,为防治儿童铅中毒提供参考依据。方法2002年11至12月,采用石墨炉原子吸收光谱法,测定厦门市177名0～11个月的婴儿及其母亲的血铅,并对小儿出生情况及其母亲、家庭环境等相关因素进行问卷调查。结果177例婴儿血铅的几何均值为(0.37±0.15)μmol/L,范围为0.12～1.36μmol/L,≥0.48μmol/L者46例(占25.99%);母亲血铅的均值为(0.50±0.14)μmol/L,范围为0.21～2.38μmol/L;177例中有160例为母乳喂养儿,其中105例采集出乳汁,乳铅的几何均值为(0.17±0.08)μmol/L,婴儿血铅与母亲的血铅和乳铅密切相关,表明母体的铅可以通过乳汁影响到婴儿血铅水平。旧商业区婴儿的血铅、婴儿母亲乳铅水平均高于其他地区,婴儿血铅水平主要与母亲血铅、婴儿月龄和母亲在职等呈正相关关系,而与母亲身高等因素呈负相关关系。结论母乳喂养儿的血铅水平除了与母亲血铅水平相关外,还与乳铅密切相关,因此在婴儿喂养方式的选择和家庭抚育行为方面须引起重视。     

Use of the HOME Inventory With Medically Fragile Infants

The purpose of this study was to determine the extent to which the Home Observation for Measurement of the Environment (HOME; Caldwell & Bradley, 1980) Inventory provides useful information about the social environment of medically fragile infants. The HOME was scored, and maternal and infant interactive behaviors were observed in the home at 6 and 12 months corrected age for 60 medically fragile infants (28 who were neurologically normal and 32 who were neurologically compromised) and their mothers. The Bayley Scales of Infant Development-II (Bayley, 1993) Mental Development Index (MDI) was administered at 16 months. The total HOME score showed high internal consistency, with moderate consistency for the subscales. The HOME correlated with observed maternal and child behaviors, but the relations were stronger for the neurologically normal infants. The HOME Inventory at 6 and 12 months was related to the Bayley MDI for both neurologically normal and compromised infants. These results indicate that the HOME Inventory can provide useful information for medically fragile infants, even those infants with neurological impairments.     

Stress in mothers of preterm infants in Bangladesh: associations with family, child and maternal factors and children's neuro-development

Background   The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development.
Methods   Within a follow-up study of preterm infants <33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined.
Results   Low income mothers were more compliant (54%) compared with the defaulters (31%) ( P  = 0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients ( P  = 0.026) and higher maternal age ( P  = 0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association ( P  = 0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively.
Conclusions   Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.     

Vitamin C nutrition during prolonged lactation: optimal in infants while marginal in some mothers

Prolonged breast-feeding is practiced by mothers in the hope of improving their infants' health and preventing diseases. In this study of the nutritional adequacy of breast-feeding, 200 mothers with healthy, full term newborns were encouraged to breast-feed exclusively. At age 6 months 116 infants and at age 9 months 36 infants remained exclusively breast-fed. The control infants were weaned early and they received vitamin C through a supplemented milk formula and solid food. The exclusively breast-fed infants were able to maintain their plasma vitamin C concentration at the same or a higher concentration than the vitamin C-supplemented controls. Their plasma concentration was about 2-fold compared with the maternal concentration. It was relatively independent of maternal nutrition and of vitamin C concentration in milk. The mother's intake of vitamin C influenced their plasma and milk concentrations. About 6% of the mothers had subnormal plasma concentrations without symptoms. The lowest concentrations occurred 2 months postpartum and during the spring. Thus, exclusively breast-fed infants are well protected against vitamin C deficiency, but marginal intake in lactating mothers is more common than assumed for a well-nourished population.     

Maternal age as a risk factor for wheezing lower respiratory illnesses in the first year of life.

Postneonatal mortality due to respiratory illnesses is known to be inversely related to maternal age, but the possible role of young motherhood as a risk factor for respiratory morbidity in infants has not been thoroughly explored. The authors studied the incidence of lower respiratory tract illnesses during the first year of life, as ascertained by health plan pediatricians, in over 1,200 infants enrolled at birth between 1980 and 1984 in Tucson, Arizona. The incidence of wheezing lower respiratory tract illnesses increased significantly (p = 0.005) with decreasing maternal age, whereas the incidence of nonwheezing lower respiratory tract illness was independent of maternal age. A logistic regression was used to control for the effects of several known confounding factors. When compared with infants of mothers aged more than 30 years, adjusted odds ratios were 2.4 (95% confidence interval 1.8-3.1) for infants whose mothers were less than age 21 years (p < 0.0001), 1.8 (95% confidence interval 1.4-2.3) for infants whose mothers were aged 21-25 (p < 0.0001); and 1.4 (95% confidence interval 1.1-1.6) for infants whose mothers were aged 26-30 (p < 0.001). These results suggest that young motherhood is an important risk factor for wheezing lower respiratory tract illnesses during the first year of life. Both biological and social factors related to maternal age may explain these findings.     

Birth rates and reproductive risk in adolescents in Chile, 1990-1999]

OBJECTIVE: For Chilean teenage mothers under 15 years old and from 15 to 19 years old, to evaluate the trends in birth rates and reproductive risk for the period of 1990-1999. METHODS: A database was constructed using data from the Demography Yearbook (Anuario de demografía) volumes published by Chile's National Institute of Statistics (Instituto Nacional de Estadísticas) for 1990-1999. From that database we calculated the trends in the number of live births and in the rates of maternal mortality, late fetal mortality, neonatal mortality, and infant mortality among the teenage mothers under 15 and from 15 to 19 years old. We calculated the risk odds ratio (OR) for both of those age groups in comparison with women from 20 to 34 years old. The groups were compared using Fisher's exact test or the chi-square test, and the analysis of trends in the period studied was carried out with Pearson's correlation, with an alpha level of 0.05. RESULTS: In the period studied, for the teenage mothers under age 15, the respective rates for maternal mortality, late fetal mortality, neonatal mortality, and infant mortality were 41.9 per 100 000 live births, 5.1 per 1 000 live births, 15.2 per 1 000 live births, and 27.4 per 1 000 live births. For the adolescents from 15 to 19 years, the corresponding rates were 19.3, 4.1, 8.1, and 16.6; for the women 20-34 years old, they were 26.8, 5.0, 6.7, and 12.1. The adolescents under 15 had higher risks of maternal mortality (OR = 1.56; 95% confidence interval (CI): 0.50 to 4.31; P = 0.372) and of fetal mortality (OR = 1.02; 95% CI: 0.76 to 1.36; P = 0.890), but those differences were not statistically significant. However, the younger adolescents did have significantly higher risks of neonatal mortality (OR = 2.27; 95% CI: 1.92-2.68; P < 0.0001) and of infant mortality (OR = 2.39; 95% CI: 2.04 to 2.62; P < 0.0001). In comparison to the women 20-34 years old, the teenage mothers from 15 to 19 years old had significantly lower risks of maternal mortality (OR = 0.72; 95% CI: 0.56 to 0.92; P < 0.008) and of fetal mortality (OR = 0.81; 95% CI: 0.77 to 0.86; P < 0.0001) but significantly higher risks of neonatal mortality (OR = 1.20; 95% CI: 1.16 to 1.25; P < 0.0001) and of infant mortality (OR = 1.38; 95% CI: 1.35 to 1.42; P < 0.0001). Among both the older teenage mothers and the mothers 20-34 years old there was a significant downward trend in maternal, fetal, neonatal, and infant mortality rates in the period studied; in the younger adolescents only neonatal mortality and infant mortality declined significantly. There was a rising trend in the number of live births among the two groups of teenage mothers, but that trend was statistically significant only for the mothers under 15; among mothers 20-34 years old there was a statistically significant downward trend. CONCLUSIONS: In the period studied, the Chilean teenage mothers faced greater reproductive risk than did the women 20-34 years old. The number of live births among teenage mothers tended to rise during the 1990-1999 period, but the change was significant only for the mothers under age 15. These results point to the need to develop programs that improve both sex education and birth control practices starting in early adolescence.