Contextualizing the Association Between Maternal Incarceration and Teenage Motherhood

Globally, 18% of births occur to adolescent women, with higher rates in low- and middle-income countries.1 In this issue of Pediatrics, Bell et al. used linked administrative data from Western Australia to examine the impact of maternal incarceration on rates of teenage motherhood.2 In the study population, 34% of teenage mothers experienced their own mother’s incarceration before the birth of their child. Adolescents who experienced maternal incarceration had a 1.7 times higher risk of teenage motherhood than those whose mothers were not incarcerated, demonstrating an association between maternal incarceration and increased risk of teenage pregnancy. The authors stratified the analysis by Aboriginal and non-Aboriginal background to account for higher rates of incarceration and adolescent pregnancy within Aboriginal communities in Western Australia. Maternal incarceration was more strongly associated with an increased risk of teenage motherhood among non-Aboriginal adolescents.In the United States, births to teens have decreased every year since 1991 to 13.1 births per 1000 females in 2023, although rates vary geographically and by race, with higher birth rates among American Indian/Alaska Native, Native Hawaiian/Pacific Islander, Black, and Hispanic adolescents.3,4 Youth from low-income backgrounds, along with those who have experienced maltreatment and foster care, have higher rates of teen motherhood than the general adolescent population.5 The health and developmental outcomes of teen mothers and their children are variable and can be positively impacted by social support and effective intervention. Adolescent mothers experience mood disorders such as postpartum depression at higher rates than adult mothers.6 The children of adolescent mothers are at risk of cognitive and language deficits and lower school readiness; however, parental educational and socioeconomic factors also play a role in these outcomes.6 Many outcomes are modifiable and depend on the family and social context. For example, adolescent mothers report less stress if their partners and families are involved and supportive through the pregnancy.7 Supportive programs such as economic benefits, two-generation home visiting programs, and high-quality medical services all improve the health and development of young mothers and their children.6In this study, Bell and colleagues focus on the specific impact of maternal incarceration on teenage motherhood, building on prior work showing that parental incarceration is an adverse childhood experience (ACE) that influences health outcomes.8,9 ACEs have long been shown to have a strong and graded impact on teenage pregnancy rates.9 Importantly, the authors identified numerous concomitant adversities that were also associated with increased rates of teenage motherhood in this sample: teens with mothers who experienced a mental illness or substance use disorder; teens exposed to family domestic violence; teens placed in out-of-home care; teens who experienced sexual abuse; and teens who were born to teenage mother, an unemployed mother, or lived in areas of lowest socioeconomic status. The authors found an association between maternal incarceration and teenage motherhood even after adjusting for these factors; however, the presence of these overlapping adversities within the study population demonstrates the noteworthy family and socioeconomic context impacting this group of adolescents. Maternal incarceration, in many cases, likely both stems from and exacerbates preexisting risk factors in addition to being a unique risk factor for teenage motherhood.As the authors note, additional study is needed to replicate and better understand the association between maternal incarceration and teenage motherhood in other populations. In future work, a mixed-methods approach incorporating qualitative inquiry could add a youth-centered perspective about the factors driving this association. Additionally, the available data does not specify the frequency and duration of maternal incarceration nor the guardianship of their children during the period of incarceration. The impact of guardianship may be particularly meaningful as children who live with their fathers or other family members may have different experiences than those who experience homelessness or are in foster care while their mothers are incarcerated. Determining the impact of these conditions may be useful to direct future study. As both risk and protective factors are clarified, resources can be directed to bolster social supports and support healthy sexual decision-making among children of incarcerated mothers. Regardless of other contextual influences, understanding factors such as maternal incarceration, which are associated with higher rates of adolescent parenthood, can help target secondary prevention interventions using a public health model. Further study should evaluate the effectiveness of new interventions and whether there are specific components that are particularly critical for this specific population of adolescents.This study highlights a group of adolescents who may be particularly vulnerable to adolescent parenthood and the potential poor outcomes associated, who face additional family stressors because of maternal incarceration and the associated psychosocial circumstances. 10,11 The authors reference the concept of the “triple dividend,” noting that “increased investment in support services for teenage mothers could yield broad benefits for their children and future generations.”2 Supportive, trauma-informed programs may improve outcomes for parenting youth who have experienced maternal incarceration. For example, teen-tot clinical programs have been shown to increase contraception use and prevent subsequent unintended pregnancy.10 School-based programs combining case management and peer support groups can increase attendance and graduation rates.11 Psychosocial interventions with mental health workers can positively impact mental health and improve school attendance.1 The American Academy of Pediatrics recommends pediatricians offer comprehensive adolescent-centered contraceptive counseling to all adolescents, and advocates for systemic approaches to expand reproductive health access, including same-day, telehealth, and pharmacist prescriptions, along with increasing access to over-the-counter options.12,13 Increasing access to contraception may reduce pregnancy and birth rates among children of incarcerated mothers.As the authors additionally indicate, support for pregnant and parenting teens is likely to be most effective when combined with population-wide efforts to support families and communities. Programs aiming to mitigate poverty, reduce family stress and child abuse, and treat mental illness are likely to also reduce unintended teen pregnancy and improve outcomes for parenting teens. It is worth noting the higher baseline rates of teen pregnancy and other potential risk factors in the Aboriginal study population; this suggests that for this group of adolescents, there may be a greater influence of systemic barriers and structural racism on outcomes.14 Population-level interventions should consider these factors and work to address root causes.15,16 By examining the relationship between maternal incarceration and adolescent motherhood, the authors highlight the need for broad family and community support to improve outcomes across 3 generations.