Pregnant teens deserve optimal care: Why comprehensive, developmentally appropriate prenatal care is essential

While rates of teen pregnancies have significantly declined overall, decreases have been more modest for African American and Hispanic teens, with their rates remaining almost four times as high than those of their Caucasian peers (Osterman et al., 2024). Provisional data from 2023 confirm this continued decline in birth rates among Caucasian teens, with a rate of 5.6 births per 1,000 females aged 15–19 (Hamilton et al., 2024). However, among African American teens, the birth rate is 24.9 births per 1,000, and for Hispanic teens, it is also 24.9 births per 1,000 (Hamilton et al., 2024). Consequently, while progress has been made in reducing teen birth rates across all groups, systemic disparities persist, leaving African American and Hispanic teens at significantly higher risk of early parenthood compared to their Caucasian counterparts. Little attention has been given to making sure that those who become pregnant as teens receive specialized care and subsequently young ladies and their babies experience poor health across a variety of outcomes. Given the scope of this problem and the systematic pattern of who is most affected, we need policies that mandate comprehensive prenatal care tailored to still developing teens who become mothers. 

Teenage mothers are not little adults; they are still children and each of their pregnancies should be considered high-risk. Policies to support funding for care that is more age-aligned is urgently needed so we don't leave these children and their infants behind and unsupported which results in generations of children who have children. Solutions include evidence-based standards that provide a framework for addressing the special developmental, social, and emotional challenges faced by pregnant teens, ensuring they receive the specialized support necessary to improve health outcomes for both mother and child. For example, a comprehensive care model for pregnant teens would include age-appropriate medical care, mental health support, nutritional counseling, and social services tailored to address the developmental, emotional, and socioeconomic challenges unique to adolescents. This model would also incorporate education on parenting skills, peer support networks, and trauma-informed approaches to empower young mothers and improve outcomes for both them and their babies. 

Teenage pregnancy is not a new phenomenon. In 19th Century America teenagers were either "married off" and babies given up for adoption or aborted whether their mothers agreed or not (Domenico & Jones, 2007).  When women in the 1960’s began to view single parenthood as a viable option this too affected choices for adolescent moms, with teens more likely to keep their babies despite the associated shame (Domenico & Jones, 2007). Consequently, the demand for public assistance increased, amplifying societal preconceptions about young women who become pregnant during their teen years and the families perceived to have "allowed" such pregnancies. These stereotypes and judgments further fueled stigma and misunderstanding, creating additional barriers for pregnant teens and their families (Furstenberg, 2007). In response, policymakers have focused on preventing teenage pregnancy by promoting abstinence or safe sex to decrease the number of teens bearing children before they are financially ready for them. I believe that judgment and stigma interfere with the motivation to direct money towards mitigating the risks for teens who become parents before they are financially and emotionally prepared to do so. Policymakers fail to realize that when we don’t spend the money to provide adequate care, we still end up paying for it by way of increased medical costs, welfare, crime rates, substance use, child abuse etc. 

Americans may disagree on many issues, but one thing unites us as a society: our commitment to protecting children. Few would support the idea of children receiving anything less than optimal healthcare, especially knowing that such care is essential to their physical and psychological well-being and to the health of future generations. This understanding is why we provide specialized pediatric and pediatric dental care tailored to the unique needs of children—they have needs that cannot be adequately addressed with standard care in the adult healthcare system. Pediatric care is the gold standard for children under 18 years old, unless one of them becomes pregnant. 

When a pregnancy occurs, the minor child typically is transferred to a system of prenatal care designed for adults, receiving care from prenatal care providers who were trained to treat mostly adult patients. Consequently, pregnant children (usually teenage children) often leave their prenatal appointments feeling overwhelmed, confused and uncertain about how to navigate pregnancy and prepare for motherhood. As one teen said, "Sometimes you don't feel ready to be an adult or a mom" (Lesser et al., 1998).

Optimal healthcare is realized when individuals receive care that aligns with their medical and developmental needs, ensuring equitable opportunities for health and well-being. However, our current prenatal care system, designed primarily for adults, fails to address the unique needs of pregnant teens, leading to significant health disparities (Fleming et al., 2015; Hacker et al., 2021). By offering standard prenatal care to pregnant teens, it simultaneously places societies most vulnerable—young women, children, racial and ethnic minorities, the disenfranchised and the economically disadvantaged in a position where their challenges are amplified. By design, standard adult focused prenatal care fails to address the unique intersectional challenges faced by teens, such as mental health struggles, substance use, limited, social support and socioeconomic disparities, etc. It overlooks the young mothers’ developmental differences, as teens are not yet cognitively, emotionally, or socially at the same level as adults. Standard prenatal care leaves critical gaps in care that are essential for their well-being and positive pregnancy outcomes and therefore becomes another intersectional barrier, making their ability to navigate the social determinants of health even more challenging. 

Pregnant teens are at an increased risk for medical, psychological, developmental, and social problems (Harrison et al., 2017; Powers et al., 2021; SmithBattle & Freed, 2016). Moreover, they are more vulnerable than adult mothers for giving birth to low birthweight, preterm infants with developmental problems (Payne & Anastas, 2014). Compared to women who give birth when they are 20-24, adolescents are more likely to develop pre-eclampsia and eclampsia, anemia, puerperal endometriosis, and chronic infection (Rowlands et al., 2021). 

Research indicates that we should provide pregnant adolescents with evidence-based comprehensive prenatal care to assure the health and well-being of both the pregnant moms and their infants (Black et al., 2012; Fleming et al., 2015). Unfortunately, without clear guidelines and mandates the components of comprehensive care are not well defined and are often inconsistently implemented. As a result, many adolescents are left without the emotional and psychological support necessary for a healthy pregnancy. Additionally, socio-economic barriers—such as poorly resourced neighborhoods, transportation challenges, and financial constraints—worsen disparities, particularly among marginalized populations. These gaps in implementation reinforce the urgent need for increased investment, advocacy, and policy changes to ensure that comprehensive prenatal care becomes a reality for all pregnant adolescents, not just an ideal.

—Written by Denise R. Moore, Doctor of Social Work (Clinical Leadership) student