“Pregnancy Changed Me from a Kid to a Mom”: A Qualitative Exploration of Teens' Perspectives on Pregnancy and Prenatal Health in the Context of Cumulative Adversity

Background and Purpose: Teen pregnancy that results in birth is associated with a range of negative proximal and distal consequences for teens and their children. This may be due to the intersection of multiple risk factors and to poor prenatal health habits, which are understudied in teens. Although pregnant and parenting teens are often seen as irresponsible, or as passive victims, there is a notable difference between this dominant viewpoint and teens' own views of their pregnancies and emerging role as mothers. Teens often feel empowered by their pregnancies and see them as a means to alter an unhealthy trajectory and as an adaptive response to adversity and poverty. The current study is the first to address this gap in knowledge by exploring pregnant teens' perceptions of their pregnancies and their prenatal health in the context of Adverse Childhood Experiences (ACEs) and environmental stressors. The inductive approach is designed to develop a grounded theory of why some teens view their pregnancies as a positive, adaptive choice that prompts them to alter their perspective and behavior, and some do not. Methods: Twenty-three in-depth, semi-structured interviews were conducted with English-speaking inner city teens (aged 15-19) receiving services from the Nurse Family Partnership of New York City (NFP-NYC). Teens were recruited by NFP nurses through flyers distributed at home visits. The sample was predominantly Hispanic (52%), and Black (40%). Teens were asked about their life experiences over time, including reports of Adverse Childhood Experiences (ACE), views of their pregnancies, views of the future, and what kind of parents they hoped to be. All interviews were transcribed verbatim and were then uploaded into Atlas ti for thematic coding and analysis; inter-coder reliability of coding reached 85% agreement. Findings: The central theme that emerged from the data was that most teens (75%) stated that pregnancy fostered greater responsibility overall, dedication to improving their lives, and ceasing risky health behaviors for the sake of their infants as the study title indicates. Most teens (80%) experienced cumulative adversity at multiple time periods including elevated violence exposure, both intra-familial and community-based, a topic not addressed in prior studies. A subgroup of ten (43%) had experienced four or more ACEs, predicting poor health and mental health outcomes. An analysis of co-occurring themes in teens' narratives showed that accumulating adversity seemed to potentiate both greater resilience and more positive views of pregnancy and parenting. Themes from the narratives of teens who were less positive about their pregnancies will also be presented. Conclusions and Implications: Findings of this study suggest that many pregnant teens, despite or perhaps due to experiencing trauma and adversity, demonstrate substantial adaptive capacity and may be utilizing the advent of pregnancy to pave the way toward a healthier life. Programmatic responses to assisting young pregnant women, like NFP or other home visiting interventions, are needed especially as they support teens' resilience and aspirations to become good mothers, helping to level the playing field for them as they plan for a positive future for themselves and their babies.