Madeline Goodfellow and Dr. Janelle Macintosh, College of Nursing

Introduction:

Over three quarters (79.6%) of rape victims are assaulted before the age of 25 years (Black et al., 2011). In a nationwide survey, 11.8 percent of female high school students report being abused (hit, slapped, or physically hurt on purpose) by their significant other in the last year (Eaton et al., 2012). It has been suggested that traumatic childhood experiences affect many adjustment processes (Liang, Williams, & Siegel, 2006). Although teen pregnancy rates are the lowest they have been in years, teens that have experienced maltreatment, abuse, or sexual abuse are at a higher risk for becoming pregnant (Noll, Shenk, & Putnam, 2009). The abuse can result in maladjustment problems of the adolescent mother and also influence the ability to provide nurturing care for the child. This is a systematic literature review to address adolescent mothers with a history of physical and/sexual abuse and their perceptions of maternal identity and parenting self-efficacy.

Methodology:

Articles were collected from the databases CINAHL, Medline, and Academic Search Premier. The search terms used were as follows: teen pregnancy, childhood sexual abuse, maternal self efficacy, adolescent pregnancy, and high risk sexual behaviors. Inclusion criteria for the study consisted of females age 13-21, history of/current pregnancy, and publication date post 2007.

Results:

A total of 41 articles were found. Out of those articles, 30 articles were excluded for the following reasons: they did not meet the inclusion criteria, they were duplicate articles, or they were not related to the study focus. This left 11 articles, which were carefully analyzed. Findings included increased risk of pregnancy and abortion in adolescent females who had experienced childhood sexual abuse. Depression and low maternal self efficacy were also found in adolescent females who were pregnant or had given birth.

Discussion:

The review findings revealed that adolescent mothers share similar characteristics such as being more likely to have a difficult family situation, experience school failure, display a health-risk behavior, perceive less support, feel less self-esteem, and endure increased depressive symptoms (Wahn & Nissen, 2008). The review of the literature also exposed common risk factors for teenage pregnancy. These risk factors included: early sexual debut, lack of contraceptive use during first time of intercourse, history of childhood/adolescent sexual abuse, family disruption, and history of residing in a very poor household (Goicolea, Wulff, Öhman, & San Sebastian, 2009). Correlating risk factors for both teenage pregnancy and childhood sexual abuse included: female gender, younger age, parent-child conflict, substance use/abuse, mother disengagement, and family constellation (Francisco, Hicks, Powell, Styles, Tabor, & Hulton, 2008). Next, the literature review uncovered a study with information concerning extreme teenage pregnancies, defined as pregnancies that occur in the age group of 13-15 years of age. These adolescent mothers aged 15 or younger had an increased likelihood of having experienced childhood physical or sexual abuse, being from a single-parent family, attending doctors’ appointments later and less often during pregnancy, incurring perineal trauma, and having an emergency C-section (Papamicheal, Pillai, & Yoong, 2009). Another area delved into by the literature review was the relationship between childhood maltreatment and teenage pregnancy. The review produced a study that showed abused females could experience difficulties in regulation of behaviors, emotions, and cognitions (Noll, Haralson, Butler, & Shenk, 2011). Abused females also display an increased inclination to explore materials that are sexually explicit and entertain sexual thoughts. Along similar lines they have increased probability of following sexual impulses and using high-risk sexual behaviors. In addition, those adolescents who have experienced childhood sexual abuse are more likely to become pregnant and therefore have more abortions as a group because of their increased pregnancy rates (Boden, Fergusson, & Horwood, 2009). The next topic examined by the review was depression among pregnant adolescents. The review demonstrated that pregnant adolescents have a higher risk of depression. In one particular study, 50% of the pregnant adolescent participants involved had a history of abuse and trauma (Meltzer-Brody, et al., 2013). These same adolescent mothers were 5-times more likely to experience prenatal depression as well as 4-times more likely to have postpartum depression. The infants of depressed mothers are also affected. Infants born to mothers suffering from antenatal depression are at a higher risk for preterm birth and low birth weight (Hodgkinson, Colantuoni, Roberts, Berg-Cross, & Belcher, 2010). Infants born to teenage mothers’ experiencing suicidal ideation specifically are also more likely to have lower birth weights. After depression, the review examined the parenting behaviors of teenage mothers. The findings confirmed that teenage mothers are at greater risk for poor parenting behaviors, which include: psychological aggression, spanking, and other physical aggression (Lee, 2009). Criteria that put the teenage mother at additional risk for harsh parenting behaviors were having a lower education level and if the mother worked the first year post birth. The review continued by disclosing information about the importance of emotional readiness. One study showed that emotional readiness should be considered more pertinent than pregnancy planning. The reasoning for this is that pregnancy planning did not prove to have a significant effect while pregnant teenagers classified as unprepared emotionally were significantly more likely to have inadequate prenatal care, delayed prenatal care, and self-reported depression (Phipps & Nunes, 2012). The last area of literature covered by the review was the issue of caregivers. The selected article compared the differences between having the adolescent mother and father act as caregivers compared to the adolescent mother and her parents (the child’s grandparents) act as the caregivers. The study results showed that when the adolescent mother and father acted together as caregivers the mother reported less negative child emotions, less parenting stress, and less child dysfunction (Arnold, Lewis, Maximovich, Ickovics, & Kershaw, 2011).

Conclusion:

More effort needs to be given toward preventing childhood sexual abuse as a way to decrease teen pregnancy. Also, more research should be conducted on programs that will support adolescent mothers in enabling them to feel self efficacy and personal satisfaction with their new role as a mother. Additional research on factors that encourage involvement of the adolescent father in care giving would also be useful. Nurses can contribute in their practice by being aware of the risk factors that predispose adolescents to pregnancy so that they can provide primary prevention such as teaching. Nurses also need to be prepared to identify compounding problems in a pregnant teenager/teenage mother’s life such as abuse, health issues, and inadequate medical care. Pregnant mothers may also require increased care, when compared to adult mothers, during the antenatal stage such as earlier and more thorough depression screenings