Nothing to do or be: Adolescent mothers on social justice and unintended pregnancy

Pregnant and parenting teens are the targets of numerous health education programs, but are rarely asked to offer their thoughts on issues such as the social determinants of health or the possibilities for social justice. Public health research and interventions aimed at this population are often focused narrowly on the prevention of future pregnancies. The purpose of our project was to broaden the discourse surrounding pregnant and parenting young women by incorporating their views on important issues of justice and health. These are issues that have considerable power to move the field of health education forward and achieve its stated goals of reducing health disparities. We conducted 20 individual in-depth semi-structured interviews with young mothers ages 16-20 who attend a community-based alternative education program in western Massachusetts. Interviews were transcribed verbatim and coded inductively. Through a constant comparison method, we identified a number of constructs that challenge common understandings of adolescent pregnancy and highlight structural determinants of health. Participants identified that a lack recreational, social, and educational opportunities resulted in “[nothing] that we can be in, instead of being in a man's house.” This perspective is consistent with a capabilities approach to justice. In the case of adolescent pregnancy, the lack of opportunity to “do and be” in low-income, resource-poor neighborhoods results in a literally fertile environment for unintended pregnancy. Our results provide evidence for expanded understandings of the antecedents to adolescent pregnancy and a shift in focus to structural determinants of health.