Beyond the immediate social problems of the estimated 1.1 million teen-agers who become pregnant every year lies a growing concern for their babies.
More and more, these young women -- often mere children themselves -- are opting to keep their babies. National statistics suggest that if the pregnancies are carried to term, 90 percent of the teen mothers will keep the children.
Most of these infants were conceived by accident. Many of the mothers have no lasting relationships with the fathers and minimal financial resources. Most have little education in general, little knowledge about coping with motherhood and even less understanding of infant care.
In most instances their own futures are compromised -- most drop out of school and never return, for example.
It has been well established that teen-agers' infants are physically at risk -- for prematurity or other handicaps associated with poor prenatal care.
But now, infant development specialists are becoming concerned that the crucial early weeks and months, even years, of these infants' lives may be troubled as well, adding a threat to the emotional wellbeing of child as well as mother.
The interactions of infants with their families was a central theme of the recent meeting of the National Center for Clinical Infant Programs, a Washington-based umbrella organization for the study of infants.
Reflecting the growing concern among experts for the babies of teen mothers, two seminars and a dozen or so reports were specifically oriented to this problem. The seminars involved approaches in two specific intervention programs designed to provide unique and individualized assistance.
One of these is a federally financed demonstration project out of Howard University Hospital in the District; the other, a research/clinical program from the Menninger Foundation in Topeka, Kan.
Teen-age pregancy figures in the District soar above the national average with 24 percent of live births in D.C. to mothers under 19 -- about 10,000 girls -- according to education specialist Roberta J. Clark, who heads the Howard program.
At Howard University Hospital alone, says Clark, there were 234 adolescent births in the last year, with 14 percent under age 15.
"This is the group we are especially concerned about," says Clark. "Now that the adolescent pregnancy problem is becoming better known, there are high school programs. But what do you do for the 13-year-old who is pregnant and still in elemntary school?"
To deal with this younger group, the Howard program works within the context of the family wherever possible, and is aimed as much at the child who is the mother as at the infant. Says Clark, "We feel the adolescent needs to develop as a child as well as a mother."
Clark's team -- a staff of five with some student volunteers from Howard and George Washington University education and psychology programs -- will accept as many referrals from anywhere as they can handle. Numbers vary, but usually about 20 to 30 moters are enrolled in the program.
Basically the program involves intensive one-to-one services to the very high risk or very young teen mother, especially if the infant is physically handicapped. "We try to help the mother find social services, perhaps get back into school, help coordinate services for the infant. We're talking about a young girl who may have to take her child to six different clinics -- something that's overwhelming for an adult," Clark says.
The program at Menninger is more oriented toward research than the Howard program, with services provided for one group of its client population, and observations, examinations and assessments for the others.
Topeka's teen pregnancy problem is not as dramatic as those in the country's big cities, and two thirds of the participants in the program are Caucasian. But there are common threads, said Joy Osofsky, the project director.
These include risks. "Although our population is socioeconomically disadvantaged, it is not so much so as in D.C. Yet we're still finding consistencies in terms of outcomes in cognitive -- intellectual and learning -- performances, socio-emotional development -- bonding to the mother, learning to play, to respond and elicit responses -- and enormous other developmental delays early on."
Both the D.C. and Topeka programs are about 3 years old and already the positive effects of strong support systems has emerged in both sets of mothers. Where the young mother lives with a supportive family, or has supportive friends and relatives easily available, her relationship with the baby, the baby's health and the young girl's ability to cope, perhaps even to return to school, are all enhanced.
The Menninger project is studying three groups of teen mothers. Group 1 is made up of 65 mothers already participating in a city/county program. The Menninger project adds regular home visits, as often as twice a week, periodic assessments and educational techniques and respite provisions. The latter is a once-a-week center where mothers can either drop off the babies for a few hours or stay for discussions about how to be a parent. Mothers also are given direction in simple things "like learning how to take care of a kitchen, housekeeping types of things." They also receive color coded material "with very simple developmental tasks you can do with a baby like peek-a-boo, smiling, talking and information about why this is important."
Group 2 was also recruited from the public program, but the 65 mothers receive no additional intervention. The public program provides for physical needs, such as appropriate prenatal nutrition, but the developmental home visits are reserved for the first group. Group 3, of 35 mothers, is simply monitored, with no formal intervention from either program. In Topeka, these mothers tend to be in a higher socioeconomic group with family support.
Osofsky, working collaboratively in some aspects of the project with other research groups around the country, has found that watching a mother feeding her baby is a powerful window into the mother/child relationship on many levels. "I push that enthusiastically," she said at her seminar. "We have found longitudinal looks at feeding interaction to be one of the most interesting measures in the study. Yet almost no work has been done on this. But looks at how feeding interaction changes over time raises all kind of issues that go on around control and autonomy and learning of rules and discipline and all kinds of socializations."
The Menninger researchers watch mothers feeding their babies (through one-way glass) at 6, 13, 20 and 30 months. They are also assessed at birth. Preliminary analyses indicates that self-esteem, knowledge about birth control and a positive rating from a social worker correlated positively to how she touched the baby during feedings in the hospital.
The more negatively the mother felt about the pregnancy prenatally, the less adept she was with a six-month old during feeding. There was also a relationship with good feeding interaction with the new born infant and doing well at six months. Also, newborns who responded to mother's stimulation made more eye contact and were more social at six months.
Feeding observations, said Osofsky, "also showed up aggression and anger. You can see very angry mothers and when you do, in two years you see very angry babies." Resources
For information on brochures prepared by the Howard University Adolescent-Infant Development Program (free to participants, $10 to general public) write Roberta J. Clark, Department of Pediatrics & Child Health, Howard University Hospital, 2401 Georgia Ave. NW, Washington, D.C. 20060.
For general information on infant programs, write National Center for Clinical Infant Programs, 733 15th St. NW. Suite 912, Washington, D.C. 20005.
This is the first of two reports on the National Center's Training Institute.