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The best way to help teen moms: treating pregnancy as more than a medical event

Kayjanet Moore, 18, has birth control options explained to her by social worker Cindy Covell at Children’s Hospital Colorado’s Colorado Adolescent Maternity Program in Denver on Aug. 19, 2014. (Marc Piscotty/For The Washington Post)

Arlin Rueda is one of about 500 pregnant young mothers a year who come through the Colorado Adolescent Maternity Program (CAMP).

They range in age from 14 to 22 years old. But most, if still in school, are high school juniors and seniors. In a typical year, seven in 10 reported to CAMP staff that their pregnancies were unintended. Roughly one-third of the moms are white, one-third Hispanic and one-third African-American. Nearly all come from low-income families and are unmarried. Medicaid pays for their health care.

Their first visit to the CAMP clinic at Children’s Hospital Colorado in the sprawling Denver suburb of Aurora usually turns out to be something of a surprise to them. For one, they do not first meet a doctor. They meet a client coordinator, which is a sterile, bureaucratic-sounding name for the two warm women who bear the title. For more than an hour, the young patient and the client coordinator talk. The coordinator works from a questionnaire first developed 30 years ago at University of Colorado Hospital, Children’s longstanding partner in the program.

The questionnaire changes over time, but its purpose remains the same. It is a tool with which the people who care for these young mothers peer below the surface, beyond that which can be determined by blood tests and ultrasounds and stethoscopes and measuring tapes. “How old did you plan to be when you got pregnant? Do you have a new boyfriend, not the baby’s father? Is there anyone who kicks, punches or physically hurts you? Have you contemplated suicide? Why were you not using birth control?”

Anywhere from one-third to one half of CAMP mothers have histories of trauma “whether domestic violence from parents or siblings or intimate partner violence,” says Dr. Stephen Scott, director of the program. About one-fourth suffer from depression or anxiety or other mental illness, he says.

CAMP operates on a model that recognizes what should be obvious to all: The outcome of a pregnancy is not dependent solely upon a mother’s physical health. A mother suffering from depression or post-traumatic stress syndrome or undiagnosed bi-polar disorder is a mother less likely to make her prenatal visits, to take care of herself during pregnancy, to deliver a healthy child.

The research here is clear. Teen mothers are more likely to deliver prematurely and more likely to have low-birth weight babies. Children of teen mothers tend to suffer poorer health and are at greater risk of child abuse or neglect, though this particular risk drops if mom is living with an adult relative. Those born to the youngest mothers are more likely to perform poorly in school and to drop out of high school.

The daughters of teen mothers are more likely to become teen mothers themselves. They are less likely to escape poverty than their mothers.

So, every CAMP patient sees a doctor, nurse or midwife, a caseworker, a nutritionist and a social worker, and in many cases, a psychologist. They see that team before pregnancy and for at least a year after delivery. After baby is born, mother and child move to the second phase of CAMP, which involves parent education classes, transitional housing, social services and counseling in the use of birth control.

CAMP mothers are by definition a higher-risk population and the program still faces a stubborn challenge in reducing pre-term births, but it has seen a steady increase in birth weights, higher immunization rates for its babies than comparable clinics and its repeat teen pregnancy rates are consistently lower than those nationally.

Whatever the stereotype may be of adolescent mothers, Scott says, what the CAMP team knows is that these young women want to be good, strong, healthy parents – and that their children and communities need them to be.