Social support in pregnant and parenting adolescents: Research, critique, and recommendations

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2002 by Logsdon, M Cynthia, Birkimer, John C, Ratterman, Amelia, Cahill, Krista, Cahill, Nancy

ISSUE AND PURPOSE. Adolescent pregnancies continue to occur at an alarming rate in the United States, resulting in adverse outcomes for both the adolescent and her baby. Since social support has been shown to improve pregnancy and parenting outcomes, a critique of research in this area is presented.

SOURCES. Published literature.

CONCLUSIONS. Multisite research studies, which are longitudinal in design, are needed, with particular attention paid to variations in the need for social support by stage of adolescence.

Search terms: Developmental differences, pregnant adolescent, relationships, social support

Despite decreases in recent years, the adolescent prenancy rate in the United States remains high. In 1995, an estimated 916,630 females under 19 years of age became pregnant, and 512,115 of the pregnancies resulted in a live birth (Allen Guttmacher Institute, 1998). This is troubling on many fronts.

Pregnant adolescents have an increased incidence of low-birth-weight and premature babies (Stevens-Simon & McAnarney, 1996), which are associated with an increased likelihood of poor developmental outcomes in infants (Field, Sostek, Goldberg, & Shuman, 1979). In addition, outcomes of adolescent parenthood include poorer psychological functioning, lower rates of school completion, lower levels of marital stability, additional nonmarital births, less stable employment, greater welfare use, higher rates of poverty, and slightly greater rates of health problems for both mothers and their children compared to adults (Chase-Lansdale & Brooks-Gunn, 1994).

Adolescent mothers have been shown to be less cognitively prepared, to experience more stress in the parenting role, and to be less adaptive in their parenting style when compared to adult mothers (Mercer, 1977; Sommer et al., 1993). In addition, the adolescent mother is less sensitive:Ragozin, Basham, Cmic, Greenburg, & Robinson, 1982) and less responsive to her infant during the postpartum period (Jones, Green, & Krauss, 1980), and more authoritative in her style of parenting (Coll, Voter, Hoffman, & Oh, 1986) compared to adult mothers. The pervasive negative outcomes associated with adolescent pregnancy and parenting indicate this is an area where continued efforts need to be focused by nurses in both research and practice roles.

Pregnant adolescents forced to deal with the simultaneous developmental tasks of adolescence and pregnancy often are ill prepared, perceive few resources, and are stressed. Previous research has demonstrated the effectiveness of increasing social support among highly stressed pregnant women with low social support resources (Norbeck & Anderson, 1989; Norbeck & Tilden, 1983). Indeed, there are a number of published research articles that describe the benefit of social support in pregnant and parenting adolescents. The purpose of this article is to review and critique the literature on social support in pregnant and parenting adolescents and to give recommendations for further research and clinical practice in this area.

Social support can be defined as a well-intentioned action that is given willingly to a person with whom there is a personal relationship and that produces an immediate or delayed positive response in the recipient (Hupcey, 1998). Social support has been linked with health and avoidance of disease by multiple researchers since the 1970s (Caplan, 1974; Cassel, 1974; Cobb, 1976). There is empirical evidence that social support may have both direct and buffering effects in its positive influence on health (Cohen & Syme, 1985).

Social support should be differentiated from professional support by both definition and measurement of outcomes. Supportive actions by professionals, such as teaching, role modeling, encouragement, counseling, and problem solving, are considered professional support (Hupcey & Morse, 1997). Outcomes of professional support for adolescents have been described elsewhere (Herrmann, Van Cleve, & Levisen, 1998; Robinson, 1993; Rogers, People-Sheps, & Suchindran, 1996).

Numerous studies of social support in pregnant and parenting adolescents have been published in the professional literature (Table 1). Although researchers have differed in the types of support measured, measuring instruments, and demographics of samples, there have been several common findings, as summarized here. Social Support Providers

The most frequent providers of social support to pregnant and parenting adolescents are their mothers and the fathers of the babies (Burke & Liston, 1994; Chen, Telleen, & Chen, 1995). The type of support these people provide varies, with mothers frequently providing informational and material support and the father of the baby providing emotional support. These individuals also are commonly sources of conflict for the adolescent mother (Barnet, Joffe, Duggan, Wilson, & Repke, 1996).

Most pregnant and parenting adolescents are unmarried and unemployed, and must rely on their mothers for basic necessities (material support), such as food and housing, for both themselves and their infants (Barrera, 1981). Their mothers frequently provide child care so they can continue with education/employment (deAnda & Beccera, 1984). This returns the adolescent to a dependent role with her mother, while simultaneously she may be struggling with her own developmental issues of achieving independence from parents. Conflict and relationship problems frequently occur (Davis & Rhodes, 1994; Kaplan, 1996), particularly if the grandmother feels angry and resentful about the pregnancy For the most part, the adolescent's own father is reported to exert minimal influence and provide little support (deAnda & Beccera).