Developing Culturally-Congruent Interventions for Unwed Adolescent Mothers in Need of Care and Protection in Jordan: Can Community-Based Alternatives to Institutional Placement Reduce Stigma?

Background: Adolescent girls who become pregnant outside of marriage often face heightened stigma and social exclusion. Within the Middle East, girls may also encounter the danger of increased violence from their families from violating traditional social and gender norms, including extreme acts, such as honor crimes. Consequently, in Jordan at-risk pregnant girls are sometimes placed in protective custody, using an institutional model of congregate care. A growing body of research indicates that children placed in institutional care often experience multiple deficits, including higher levels of health and mental health problems, as compared to those placed in foster care models. Family foster care, particularly non-kinship care, is not a commonly accepted practice in the Middle East. As countries, such as Jordan, seek to develop alternatives to institutional care for children, they must contend with concerns about the cultural congruence of new models, which may exacerbate issues of stigma and exclusion. Using an experimental vignette approach, this study examined whether foster care alternatives may reduce the stigma attached to unwed pregnant girls placed in institutions within an Arab context. We further examined whether stigma differs based on whether the sexual activity resulting in pregnancy was consensual.

 Methods: A community sample of adults (n=181) in Amman, Jordan were presented with vignettes varying by type of intervention (institutional versus foster care) and circumstances surrounding the pregnancy (consensual versus non-consensual), followed by questions concerning stigma toward the girl. Variation in demographic variables across experimental vignette conditions was assessed using chi-square and ANOVA; significant differences were found in participant’s education and employment. Subsequently, those variables were controlled for in two-way ANCOVAs examining stigma items in relation to the main and interaction effects of type of intervention and nature of consent.

 Results: A main effect was found for type of care, indicating that personal stigma was significantly lower when the girl was described as placed in foster care rather than institutional care. A main effect was also found for consent, with personal stigma lower when pregnancy was due to non-consensual abuse rather than consensual sexual activity. Consent status did not moderate the effect of placement type on personal acceptance.

 Conclusions: Unwed adolescent mothers in Jordan are likely to experience high levels of stigma, including concerns related to future marriageability. These findings indicate that, for those in need of protection and care, placement in foster care has the potential to lessen stigma and allow girls at deep risk of social exclusion to integrate back into the community and ease their transition to adulthood, especially when pregnancy occurs because of abuse. Additionally, while current practice is to separate infants from their young mothers, this study finds that overall public sentiment is that the baby would be slightly better off with their mother. As developmental research evidences multiple risks to healthy development for infants placed in institutional care, foster care placement that keeps mother and infant together may be a culturally-acceptable alternative providing numerous benefits. Findings support alternative options for the nascent profession of social work in the Middle East.