Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers
Program Components - Hospital-based, multifaceted program for low-income, first-time adolescent mothers and their infants
- Special teens’ baby clinic offering well-baby care, contraceptive counseling, and infant care education
- Scheduled well-baby visits at two weeks and at two, four, six, nine, and 18 months, with appointments alternating between a nurse practitioner and a pediatrician
- Social worker interviews with each mother at her two-week visit, including referral to a contraceptive clinic, as appropriate
- Questions at each visit regarding the mother’s plans to return to school, her use of contraception, and her satisfaction with her family planning method
- Health teaching about infant care
- Calls and regular reminders after missed appointments
- New copies of infant immunization records, if forgotten or lost
For Use With - Urban, African American, low-income, first-time adolescent mothers
Evaluation Methodology - Experimental health care intervention, including treatment and control groups in a large, urban, teaching hospital
- Adolescent mothers (n=243) and their infants, randomly assigned to treatment (120) and control (n=123) conditions
- Baseline data collected from mothers during their postpartum stay in the hospital (n=243); follow-up at two weeks, six months, and 18 months (n=221 or 223, depending on the outcome measured)
Evaluation Findings - Reduced incidence of repeat pregnancy
- Improved attendance to recommended health care for infants
Program DescriptionThis program provides routine well-baby care to the infants of first-time, socio-economically disadvantaged, adolescent mothers. The comprehensive program has four goals:
- Reduce repeat pregnancy among adolescent mothers
- Increase adolescent mothers’ return to school
- Increase the proportion of infants having up-to-date immunizations; and
- Reduce use of the emergency room for non-emergency infant care.3
The program provides well-baby care at a teens’ baby clinic within the hospital. As recommended by the American Academy of Pediatrics, each mother and her baby are scheduled for visits at two weeks post-partum and at two, four, six, nine and 18 months after the baby’s birth. At each visit, the teen mother and infant see, alternately, a nurse practitioner or a pediatrician. At the two-week visit, the mother also sees a part-time social worker who counsels her about contraception and refers her to a birth control clinic, if appropriate. The social worker also models good parenting behaviors—such as how to hold an infant or how to feed a baby—and is available at other visits, if the mother requests her presence.3
At each visit, the pediatrician or nurse practitioner asks the adolescent mother about her plans for returning to school, her use of family planning methods, and her satisfaction with her chosen contraceptive method. Further referrals to the social worker follow, if necessary. In the waiting room of the teens’ baby clinic, a nurse practitioner and trained volunteers provide health education, using videos, slide shows, and one-on-one demonstrations. Finally, if an adolescent mother misses a scheduled appointment, she receives reminder phone calls and letters for up to eight weeks after the missed appointment. Regardless of how many times an adolescent mother might lose or forget to bring her infant’s immunization record, the clinic provides another free copy, along with a reminder about the importance of the immunization record for the child’s eventual school or program registration.3
Evaluation MethodologyThe population eligible for this study consisted of a consecutive series of 330 adolescents delivering their first baby at a large urban teaching hospital located in the eastern United States. The mothers were all 17 years of age or under. Mothers who had been pregnant previously but who had no children were included in the sample; however, those who intended to place the child for adoption were not. When asked during their postpartum stay to participate in the study, 18 percent of the mothers (n=58) refused; another 29 were lost to the study because of staff vacations or communication problems between the hospital and the researchers. The remaining sample of 243 mothers, consenting as emancipated minors, and their infants were randomly assigned to the study’s treatment or control condition. Mothers and infants in the control condition received routine well-baby care that included no reminders regarding missed appointments. Mothers and infants in the treatment condition received routine well-baby care in addition to special care—including attendance at a special teens’ baby clinic, health education, encouragement to return to school, referral for contraceptive services, encouragement to continue with a contraceptive method, health education regarding the care of infants, and repeated reminders to reschedule missed well-baby appointments.3
At baseline, there were no statistically significant differences, at the .05 level, between those in the experimental group, those in the control group, and those who refused to participate. Groups were similar in regard to maternal age, length of prenatal care received, history of previous pregnancy, or complications at delivery. For example, the mean age of the mothers in the experimental group was 16.5 years; mean age in the control group was 16.3 years; mean age in the refusal group was 16.7 years. Mean length of prenatal care received was 5.0 months in the experimental group and in the refusal group and 5.1 months in the control group. Twenty-four percent of women in the experimental group had a history of previous pregnancy, versus 18 percent of those in the control group and 16 percent of those who refused to participate. All (100 percent) of women in all three groups were black, unwed adolescents and were recipients of Medicaid.3
Information about these demographic variables was obtained at the initial interview during the mothers’ postpartum stay. Attendance at clinic and use of the emergency room were measured by audits of the hospital’s charts. Return to school was measured by: 1) interviewing the mother, either at the clinic during her infant’s 18-month check-up or at home, if the mother did not keep the appointment; and 2) checking school attendance records. Repeat pregnancy was determined at the final interview by asking the mother, “Have you been pregnant since your baby was born?” Immunization data were gathered from audits of the hospital’s charts and the charts of the city health district’s clinic or, if the mother so indicated, the charts of a private physician.3
Outcomes
- Behaviors—
- Attendance at well-baby clinic—At the initial two-week visit, 92 percent of mothers in the treatment group brought their babies to the clinic, compared to 76 percent of mothers in the control group, a statistically significant difference that persisted and increased throughout the study. Both groups had high rates of dropout from attending the well-baby clinic; but by 18 months after baseline, mothers in the treatment group were half as likely to have dropped out as those in the control group. Forty versus 18 percent, respectively, still attended the well-baby clinic.3
- Immunization status of infants—After 18 months, 60 percent of the infants in the treatment group whose mothers continued to attend the well-baby clinic had received all their immunizations, compared to 36 percent of infants in the control group whose mothers continued to attend the well-baby clinic. The difference was statistically significant for mothers and their infants who continued to attend the well-baby clinic.3
- Use of the emergency room for infant care—After 18 months, there was no significant difference in the proportion of all participants who used the emergency room at least once for infant care (76 percent, or 84 of 110 mothers, in the experimental group versus 85 percent, or 96 of 113 mothers, in the control group). However, among mothers who returned for all the scheduled well-baby visits (continuers), there was a significant difference between those in the experimental group and the control group. Among continuers, 81 percent of mothers in the experimental group (39 of 48) used the emergency room at least once, compared to 100 percent (22 of 22) in the control group.3
Long-Term Impact
- Reduced incidence of pregnancy—At 18 months after baseline, 12 percent of the mothers in the experimental group had experienced another pregnancy (n=13 of 108). By comparison, 28 percent of the mothers in the control group had experienced another pregnancy (n=32 of 113). Analysis showed that the repeat pregnancy rate in the experimental group was significantly lower than in the control group. Both participants and dropouts from the treatment group, who were followed for 18 months, had a repeat pregnancy rate approximately half that of the corresponding control group. Dropouts from the experimental program (n=60; nine repeat pregnancies) experienced significantly fewer pregnancies than did dropouts from the control program (n=91; 29 repeat pregnancies).3
Note: In regard to the other goal of the program (encouraging a return to school), the program had less effect. More than half of participants in each group returned to school (60 of 108 in the experimental group and 62 of 113 in the control group); the difference between the two groups was not significant.3
For More Information, Contact - Sociometrics, Program Archive on Sexuality, Health & Adolescence Phone, 1.800.846.3475; Fax, 1.650.949.3299; E-mail,
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; Web, http://www.socio.com
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