Abstract

PurposeThis study describes an interdiscursive evidence-based priority setting process with pregnant and parenting adolescents and their services providers.MethodsA mixed methods literature review identified studies reporting on perinatal outcomes and experiences of adolescents during pregnancy to 12 months post-partum published in Canada after 2000. We also calculated relative risks for common perinatal risk factors and outcomes for adolescents compared to adult populations from 2012 to 2017 based on data from a provincial database of maternal and newborn outcomes. Two trained peer researchers identified outcomes most relevant to their peers. We shared syntheses results with four service providers and 13 adolescent mothers accessing services at a community service organization, who identified and prioritized their areas of concern. We repeated the process for the identified priority issue and expanded upon it through semi-structured interviews.ResultsAdolescent mothers face higher rates of poverty, abuse, anxiety and depression than do adult mothers. Adolescents prioritized the experience of judgment in perinatal health and social services, particularly as it contributed to them being identified as a child protection risk. Secondary priorities included loss of social support and inaccessibility of community resources. The experience of judgment in adolescent perinatal health literature was summarized around: being invisible, seen as incapable and seen as a risk. Adolescent mothers adapted these categories, emphasizing organizational and social barriers.ConclusionsYoung marginalized women are disproportionately affected by inequities in perinatal outcomes, yet their perspectives are rarely centered in efforts to address these inequities. This research addresses health inequities by presenting a robust, transparent and participatory approach to priority setting as a way to better represent the perspectives of those who carry the greatest burden of health inequities in evidence syntheses. In our work, marginalized adolescent parents adapted published literature around the experience and consequences of social stigma on perinatal outcomes, shifting our understanding of root causes and possible solutions.

Highlights

  • Despite Canada’s investment in universal and accessible health services, people living in poorer socioeconomic conditions often have poorer outcomes than those with greater access to resources and educational opportunities [1, 2]

  • Young marginalized women are disproportionately affected by inequities in perinatal outcomes, yet their perspectives are rarely centered in efforts to address these inequities

  • Using a Charter of Rights for Children and Young People developed by Moore et al, we reviewed issues relating to participants’ rights to be heard, to participate in the way they prefer, to be treated well and not be hurt or discriminated against [13]

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Summary

Introduction

Despite Canada’s investment in universal and accessible health services, people living in poorer socioeconomic conditions often have poorer outcomes than those with greater access to resources and educational opportunities [1, 2]. Increased risks associated with adolescent pregnancies include preterm and very preterm delivery, having infants of low birth weight and/or small for gestational age, and for neonatal and infant mortality [4, 5]. In Canada, the age-specific birth rate among adolescents among both 15-17- and 18–19-year-olds has declined between 2009 and 2013 (from 8.2 to 5.3/100,00 live births among 15–17 year olds and from 25.8 to 18.6/100,000 live births among 18–19 year olds) [3]. Some authors suggest this is due in part to improved sexual education and increased access to contraception and abortion [4]

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