Rapid Repeat Birth: Intersections Between Meaning-Making and Situational Support Among Multiparous Adolescent Mothers

Abstract

This study examined interpretations of motherhood among adolescents who have experienced rapid repeat births (second births within 24 months of the primiparous birth). Analyses of participants’ descriptions of their transitions to motherhood indicate four modal narratives that vary along two axes: the adoption of a motherhood identity, and the nature (or stability) of relational support available. By using subjective perceptions of motivation, stability, and feelings of competence, this study linked intrapersonal meaning-making with situational sources of support to describe various pathways through repeat adolescent childbearing in a way that both confirms and enriches extant literature. The implications of this study instruct home visiting programs and other interventions designed to forestall repeat pregnancies by elucidating pathways of reinforcement or increased risk inherent in some maternal trajectories. Following this logic, interventions directed at improving outcomes for young mothers and their children would do well to consider the interplay between internal meaning-making, relational support, and the transformative power of adopting the mother identity.

Keywords

rapid repeat birth multiparous young mothers interpretations of motherhood

Introduction

The overall teen birthrate in the United States has been declining for over 20 years, from approximately 60 births per 1,000 females in 1990 to a historic low of 24 births per 1,000 adolescent females in 2014 (Hamilton, Martin, Osterman, Curtin, & Mathews, 2015). Despite these decreasing rates, repeat teen births have remained a significant proportion of these births, representing about 20% of teen births (Martin et al., 2012).

Adolescent mothers frequently grow up in single parent and low-income households, experience residential mobility and challenging family relationships, including child maltreatment, and tend to have mothers who were young parents themselves (Child Trends, 2014; Coley & Chase-Lansdale, 1998; Coyne & D’Onofrio, 2012; Jaffee, Caspi, Moffitt, Belsky, & Silva, 2001; Manlove, Steward-Streng, Peterson, Scott, & Wildsmith, 2013; Meade, Kershaw, & Ickovics, 2008). These and other individual and family circumstances are associated with a host of developmental risks for the young mothers and their children (Koniak-Griffin & Turner-Pluta, 2001). Furthermore, multiparous adolescent mothers may find it even more difficult to negotiate their transitions to parenting; compared with first births, repeat teen births result in higher rates of physical, educational, and economic risks, both for the children and mothers (Boardman, Allsworth, Phipps, & Lapan, 2006; Manlove, 2011).

Adolescent births are widely viewed as accidental, unintended, and generally regretted (Herrman, 2006). Yet research designed to examine why some adolescents fail to prevent initial or subsequent pregnancies presents a more complex picture. For example, studies have located an animating sense of purpose associated with an identity shift that can occur when an adolescent female becomes a mother (Musick, 1993; Rolfe, 2008; SmithBattle, 2005). Herrman (2006) found that adolescent multiparous mothers cited increased optimism, responsibility, and decision-making skills attending their multiple childbearing. However, the intersection with varying circumstances was also apparent in the three distinct propositions that emerged regarding repeat birth, namely, that it improved an adolescent’s life, made a hard life harder, or had little to no impact on the mother’s life trajectory (Herrman, 2006).

The study reported here is based on the broad precepts of relational meta-theoretical (Overton, 2013) and sociocultural perspectives (Rogoff, 2003), and more specifically, on the integration of individual and context in development through meaning-making processes (Mistry & Dutta, 2015; Mistry, Li, et al., 2016). Both culturally oriented psychologists (Cole, 1996; Rogoff, 2003; Shweder et al., 2006) and relational developmental systems theorists (Lerner & Benson, 2013; Overton, 2013) have argued for the inseparability of person and context. Sociocultural theorists argue that all contexts (macro and micro) are infused with culture because all contexts are experienced through the symbolic lens of schemas, frames of reference, or particular understandings of the world (Mistry & Dutta, 2015; Rogoff, 2003; Shweder et al., 2006; Vygotsky, 1978). Thus, sociocultural theorists claim that individual factors and context are intertwined in development because individuals must make meaning of their environments.

The inseparability of individual meaning-making and the objective world is illustrated in Overton’s (2008) construct of embodiment in that the embodied person functions as a self-organizing dynamic action system, such that “action entails the projection of person-centered meanings, thus transforming the objective environmental world into an ‘actual’ or lived experience (that is, one that is known, felt, desired)” (p. 9). Embodiment, therefore, is “the body as lived experience actively engaged” (p. 6) with the physical and sociocultural world. This notion of lived experience is a particularly clear illustration of the inseparability of individual development and context in the developmental process. We apply these underlying theoretical notions in our study by focusing on both participants’ interpretations of motherhood (and multiparous motherhood) as well as on their reported life circumstances.

The dual focus on both interpretations of motherhood and life circumstances is consistent with ecological conceptualizations of resilience in which both environmental resources and the meaningfulness of these resources are considered a useful lens to examine how individuals deal with significant adversity (Ungar, 2011). The focus on interpretations and meaning-making is also highlighted in research on narrative studies of self and identity in which meaning-making is defined as the active reflection on what one has learned about the self from past events (e.g., McLean & Thorne, 2003; McLean, Wood, & Breen, 2013). McLean and colleagues document how meaning-making provides structure for both making sense of and constructing the world as it is individually experienced.

The intersection of internal meaning-making and contextual circumstances is emerging in recent research indicating that some adolescent mothers may be following a family-building script. Diez and Mistry (2010) located a family-building script common among a sample of adolescent Puerto Rican mothers, the majority of whom were cohabiting with a partner and had had rapid multiple births. Similarly, Manlove (2011) found adolescent mothers with more than one child more likely to be cohabiting with a partner than are those with one baby (Manlove, 2011). Klerman (2004) suggests that repeat births may strengthen an emerging adult identity by garnering positive attention from a young mother’s romantic partner and family.

However complex this picture, interventions meant to forestall or prevent repeat births among young mothers generally reflect the dominant assumption, both about how they became pregnant, and what accounts for their suboptimal parenting, when it occurs. Teen mothers’ lack of motivation and poor choices are seen as largely responsible for their lack of success as mothers, students, and gainful employees (Schultz, 2001). These interventions also do not credit, with appropriate weight, the significant barriers that many teen mothers face in their proximate contexts—for example, the limited access to supportive educational and vocational resources within their communities (SmithBattle, 2007). This reflexive position complicates the design of effective interventions directed at forestalling or preventing repeat births among young mothers (Barnet et al., 2009; Corcoran & Pillai, 2007; El-Kamary et al., 2004; Klerman, 2004; Salihu et al., 2011).

This present study examines the interplay between participants’ circumstances, on one hand, and their interpretive understandings about childbearing, on the other, to provide insights about the heterogeneity of trajectories among multiparous adolescent mothers, and to identify implications for designing more promising interventions.

Method

The study reported in this article is based on a randomized controlled trial (RCT) of Healthy Families Massachusetts (HFM)—a statewide, universal, voluntary newborn home visiting program for first-time young parents under 21 years of age. An affiliate of Healthy Families America (HFA), it provides home visits, goal-setting activities, group-based activities, and referral services to these parents, beginning prenatally or until the child turns 1 year of age, and continuing until the child’s third birthday. The program’s stated goals are to (a) prevent child abuse and neglect by supporting positive, effective parenting; (b) achieve optimal health, growth, and development in infancy and early childhood; (c) encourage educational attainment, job, and life skills among parents; (d) prevent repeat pregnancies during the teen years; and (e) promote parental health and well-being. Eligibility requirements for participating in the RCT included being a consenting English- or Spanish-speaking female aged 16 years or older who had not received any HFM services in the past (i.e., no transfers or re-enrollments).

Participants agreed to grant access to administrative public agency data and to participate in telephone interviews at three time points: about 1 month after enrollment (Time 1, T1; n = 684, 97%), about 12 months after enrollment (T2; n = 564, 80%), and about 24 months after enrollment (T3; n = 594, 84%). Participants were also offered the option of participating in an additional 2 to 2.5 hr in-depth, in-person interview, completed by 473 mothers at T1 (69%), 401 at T2 (71%), and 409 at T3 (69%). Full details of the evaluation study have been presented elsewhere (Jacobs et al., 2016; Tufts Interdisciplinary Evaluation Research [TIER], 2015); methods relevant to the present analysis are presented here.

Sample for the Current Study

From the full sample of 704 mothers, 57 experienced rapid repeat births (RRBs; a second birth within 2 years of the initial birth) during the study period. Of those 57, about 60% (n = 34) were assigned to the Program group,¹ meaning that they received home visiting services and participated in in-depth, in-person research interviews (RIs). We selected the 19 participants from that group who had completed at least two RIs, resulting in a final sample of 19 participants. Participants in the current study reported their race/ethnicity predominately as non-Hispanic White (63%) and Hispanic (31%); they were, on average, 18 years of age at the birth of their first child.²

Data and Analysis

The current study was designed to explore the interplay between individual interpretations of motherhood and contextual supports among a sample of young women with RRBs. Data were drawn from the standard RI protocols administered to participants annually. The RI administered at Time 1 (T1) elicited a life course summary from each participant, including information about residential history, significant family peer and community relationships, and childhood experiences including major life events; in addition, participants provided a more detailed timeline of the year preceding the first child’s birth. The RIs at T2 and T3 elicited descriptions of major life events during the preceding year, reports of program utilization, and detail on approaches to, and experiences of, parenting.

Data were analyzed using an interpretative, phenomenological, and person-centered approach that highlighted participant perspectives and experiences. First, the detailed life histories were analyzed to document how participants made sense of their new status as mothers. Then, each participant’s interpretations of motherhood were placed in the context of the relative stability of her current relationships, living arrangements, and educational trajectory (see Table 1). Attempts to interpret patterns or link narratives to existing theories were executed in a way that is transparent, directly connected to the data, and with awareness of potential biases (Lester, 1999).

Table 1.

Participant Trajectory Assignment and Selected Characteristics.

Participant	Trajectory	Reported race/ethnicity	Age at birth of first child (C1)	Mother w/custody of both children at T3? (C1, C2)?	Relation-ship with FOB at T3?	Living with whom at T3?	Schooling by T3
Gabbi	Family-Building	Hispanic	19	Yes	Yes, married	FOB, C1, C2	Dropped out; no school since childbirth
Aisha	Family-Building	Hispanic	19	No, C1 w/Grandma	No contact with FOB1; Living w/FOB2	FOB2; C2	Did not complete GED
Diana	Family-Building	Hispanic	18	No, both in state custody	Together as couple	FOB	Dropped out; no school since birth
Denise	Family-Building	White	16	Yes	Together as couple	FOB, C1, C2, w/Mother’s family	Dropped out; no school since birth
Becky	Family-Building	White	19	yes	Married	FOB, C1, C2	GED; no school since childbirth
Crystal	Family-Building	White	20	yes	No contact with FOB1; together w/FOB2	FOB2, C1, C2	HS diploma; some online college
Emily	Family-Building	White	20	yes	Together as couple	FOB, C1, C2	Dropped out; GED test
Liz	Family-Building	White	19	yes	Together as couple	FOB, C1, C2	HS diploma; enrolled in community college at all three time points
Jess	Motivated Struggle	Hispanic	17	yes	Co-parenting	Independently w/C1, C2 (FOB is there ~4 nights a week)	HS diploma; enrolled in community college
Sam	Motivated Struggle	White	20	yes	Not together; “he helps when he can”	Independently w/C1, C2	HS diploma; professional certificates
Jenn	Motivated Struggle	Hispanic	17	yes	Co-parenting	Independently w/C1, C2, and roommate	Enrolled in GED/job training program
Maria	Motivated Struggle	White	17	yes	We’re living together; FOB in jail at T3	Independently w/C1, C2	GED
Michelle	(maybe) Motivated Struggle	White	18	yes	Co-parenting	Grandma, w/C1, C2	GED; professional certificates
Leah	Continued Adolescence	White	18	yes	No contact in 5 months prior to T3	Grandparents, w/C1, C2	HS diploma; no school since childbirth
Keisha	Continued Adolescence	Asian	20	yes	Co-parenting	Sister and family, C1, C2	HS diploma; no school since childbirth
Shannon	Continued Adolescence	White	19	No, C2 adopted	No contact	Grandparents, w/C1	HS diploma; professional certificates
Destiny	(maybe) Continued Adolescent	Hispanic	16	yes	No Data	No data	Enrolled in HS
Yvonne	Inability to Find Traction	White	18	No, both in state custody	Not together after partner violence	Sister, after being homeless	HS diploma; no school since childbirth
Kaya	Inability to Find Traction	White	16	No, both in state custody	Not together	FOB, after being homeless	Dropped out; no school since birth

Note. FOB = father of baby; GED = general equivalency diploma; HS = high school.

In the first step of analysis, thematic internal experiences that were apparent both within and across participant cases were extracted. These constructs—adoption of the mother identity, feelings of agency and motivation, and security in stable life circumstances—are consistent with relevant literature (Burton, Obeidallah, & Allison, 1996; Clemmens, 2003; Guttmacher Institute, 1998; Herrman, 2006; Lesser, Anderson, & Koniak-Griffin, 1998; Musick, 1993; SmithBattle, 1995). Definitions of the constructs used to guide this analysis are presented in Table 2. These coding constructs appeared, to varying extents, in each participant’s story.

Table 2.

Coding Constructs that Operationalize the Adoption of Motherhood Identity.

Coding construct/literature base	Definition	Example
Motivation (Guttmacher Institute, 1998; Herrman, 2006; Musick, 1993; SmithBattle, 1995)	A sense of purpose; a revision of thoughts about the future; a new or increased value placed on school/work because of responsibility of motherhood; mentions of responsibility, ambition, and desires to achieve to be able to provide for child.	“I go to school so I could give him a better life.” (Liz)
Stability (Herrman, 2006; Lesser, Anderson, & Koniak-Griffin, 1998; SmithBattle, 1995)	Settling down, either in living arrangement or lifestyle; mentions of social removal or more careful friend selection; expression of being “saved” by child/motherhood from wild or destructive behavior.	“If I didn’t have my kids . . . I don’t know what I’d be doing . . . or if I would even maybe be alive.” (Jenn)
Comfort or Competency in New Identity (Burton, Obeidallah, & Allison, 1996; Clemmens, 2003; Lesser et al., 1998; Musick, 1993)	Signs of adoption of role of motherhood; a sense of accomplishment at mothering role; expressions of being comforted or kept company by child; feelings of competency and pride in role of mother; an expressed desire to parent in a way superior to the parenting they received as children; reparation (Lesser et al., 1998); positive comparisons of self, compared to other mothers.	“I didn’t grow up with the best lifestyle and I wanted to change it when I got pregnant. And when I had her everything changed. I want my daughter to have a better life.” (Emily)

In the second stage of our analysis, we connected this described internal experience with mentions of relational supports and situational contexts (see Table 1) and found that four distinct trajectories emerged. Exemplars were chosen to characterize experiences or interpretations that were shared across clusters of participants. As is common in an interpretive phenomenological analysis, the naming of these shared meanings was an iterative process (Crist & Tanner, 2003). Paradigm cases, or narratives that exemplified a particular pattern of experience, were selected to compare and contrast these clusters (Benner, 1994; SmithBattle, 1995). While staying close to the data, we attempted to unravel subjectivity, rather than propose objective conclusions. Thus, interpretations and patterned linkages among mothers are presented speculatively, with an emphasis on a descriptive portrayal of meaning-making.

Results

Four distinct paradigmatic cases, or narrative trajectories, were derived: (a) Family-Building; (b) Motivated Struggle; (c) Continuation of Adolescence; and (d) Inability to Find Traction; although not inclusive of the heterogeneity of experience among the participants, they are illustrative of the narratives elicited from the mothers in our sample. These trajectories also reflect elements of previous relevant research (e.g., Burton et al., 1996; Diez & Mistry, 2010; Herrman, 2006; SmithBattle, 1995).

The Family-Building Trajectory

The eight mothers in this trajectory displayed evidence of personal stabilization, the assumption of adult responsibilities, the enthusiastic enjoyment of motherhood, and the lack of motivation for continued schooling. These mothers expressed a strong sense of transformation of self with the advent of motherhood; their transformations occurred within the context of a partnership with the father of one or both of their children, residential stability, and independence from their nuclear families.

Emily³ is an exemplar of this trajectory. She transformed a tumultuous childhood into a relatively stable and positively interpreted identity as an adult and mother. Emily’s boyfriend deeply desired a child, and when Emily miscarried her first pregnancy, their relationship became strained. She became pregnant again within a year, pleasing herself and her male partner: “the only thing he was looking forward to was the baby.” Emily’s child also prompted a reunion between Emily and her own father, who had not been a part of her life until her baby was born. The strengthening of familial ties such as these has been demonstrated elsewhere (Diez & Mistry, 2010; Herrman, 2006) as a reinforcing aspect of early childbirth.

Emily described the stabilizing effects of motherhood, reflecting a positive adoption of the adult role of mother. When asked about accomplishments in her life, Emily cited her healthy babies as her primary source of pride. She describes what a good mother does,

[A good mother is] someone that takes care of their kid, spends time with them, goes to school, learns and takes care of their kid, not living off the government . . . not giving them off to their parents so they can go out even if they are a young parent . . . Just being the person that do everything for your kid, not having other people do it.

Expressions of competence, confidence, and enjoyment of motherhood and parenting were universal among these mothers. Their positive adoption of the motherhood identity and their efforts to construct an independent nuclear family suggest a transformative quality to their childbearing—one, however, that also drew them off the usual adolescent’s path toward completing high school and/or enrolling in postsecondary education. Disengagement from school and cohabitation with a partner were consistent elements across the stories in this trajectory, aligning them clearly with a family-building (Diez & Mistry, 2010) adult narrative.

Still, differences exist within this subgroup that merit note: Although living with her partner and displaying a positive interpretation of motherhood, Diana lost custody of both of her children by T3. Liz, unlike the others, was enrolled in school at all data points. Crystal and Aisha were living with the fathers of their second, not first, children, with partner infidelity or disinterest having diverted their family-building trajectories.

Participants exemplifying this trajectory described an emerging adult identity centered on motherhood. They strongly identified as mothers and derived feelings of purpose and improved self-concept from that identity. The combination of an internal adoption of a motherhood identity and the security of an intimate relationship primarily defined this group as having family-building priorities.

The Motivated Struggle Trajectory

A second subset of four participants also appeared to be working toward independent adult lives through the experience of motherhood, though here the emphasis was on self-sufficiency, not family-building. Expressions of increased responsibility and motivation were common, as were feelings of comfort and improved self-concept drawn from the motherhood role. Circumstantially, however, this group was predominately living independently, and beset with challenges common to young single parenthood.

Jenn dropped out of high school in ninth grade: She recalled hating school and not feeling successful in an academic setting. After giving birth to her first child, Jenn described tangible feelings of competence and enjoyment in her role as a mother. She explained that she had not thought that she would be able to parent successfully, and was proud of her personal growth, prompted by the birth of her children.

[I]f I didn’t have my kids I wouldn’t be where I am right now. I don’t know what I’d be doing . . . or if I would even maybe be alive . . . I was an out of control teenager . . . my kids changed me a lot. When I got pregnant with her, I realized that, well, I need to start doing this . . . and I stopped smoking cigarettes and hanging out with people that were doing bad stuff. To take care of my kids.

Although the children’s father was intermittently involved in Jenn’s life (he lived apart), Jenn described a network of supportive peers, including her roommate at T3, who is also a teen mother. Jenn credited her children with causing the positive, structuring, and motivational changes in her life, rescuing her from her a destructive adolescence.

The four mothers grouped here all completed some additional schooling after their initial pregnancies. Three were not in relationships with the fathers of their children at T3, and all four lived on their own, away from their families of origin. All reported feelings of happiness or improved confidence as a result of motherhood, demonstrating the positive, transformational effect motherhood had on their lives.

Nonetheless, these mothers also identified significant challenges, primarily surrounding lack of money, feelings of stress due to work and parenting demands, and the desire for better or more stable jobs. Although striving, the mothers in this group, then, did not seem to interpret their trajectory as entirely successful. Jenn noted,

I feel like if I was to wait longer, I would’ve been—I would’ve had a good job and everything, and my kids could have everything that they need. But—it’s better to wait, when you’re older—but it’s the same. I love them.

Interviews of a fifth mother, Michelle, did not contain enough data to definitively place her in one of the narrative subgroups. She was in a relationship with the father of her children at T3, but experienced homelessness during her pregnancies; she lived on friends’ couches and at one point in her car. Still, Michelle described feeling stronger, more intelligent, and more mature since having her children:

You have to love them. You have to love yourself. Be really caring and supportive and strong for yourself, as well as for them . . . ’Cause now it’s pretty much your life is over, so you have to start again with their life.

This transformation was reflected in her attainment of a general equivalency diploma (GED) and professional certificates after the birth of her second child. Michelle’s interpretation of motherhood as motivating, despite her residential instability, suggests that she may well fit within the motivated struggle subgroup, although since her interviews are less robust, this is a tentative conclusion.

The Continuing Adolescence Trajectory

A narrative suggesting the continuation of adolescence, or the lack of developmental transformation resulting from motherhood, emerged in the cases of three mothers. These mothers all derived pleasure—fun and good company—from motherhood, but they did not express motivation for altering their priorities or adopting a new identity. They described less maturation and intrapersonal change resulting from their childbearing than did those in the two earlier trajectories.

These mothers continued to live with their families of origin; two lived with their parents, the third with her sisters. Leah, who lived with her parents throughout her pregnancies and births, had a tumultuous adolescence, including foster care placement, juvenile justice involvement, and drug rehabilitation. She credits her sister’s pregnancy, and the anticipation of being an aunt, for her sobriety.

Leah became pregnant for the first time a month after meeting the father of her children. Their relationship was unstable, and by T3, they had no contact, yet her original uncertainty about pregnancy was reframed and quelled by relational, familial schemas:

I was debating on keeping it and getting an abortion, because I really didn’t know what to do, I didn’t have anything for the baby. My sister just had one and I figured it would stress out my parents even more, but, I don’t know, it was stressful for me. I was up and down with thinking about different things . . . Because I seen how happy my sister was and they’re like, you know, it’s not really expected when you get pregnant, you don’t really plan these things, sometimes it just happens, but afterwards you look through it and you look at the baby and you forget everything that you went through.

Leah enjoyed being with her children and “seeing them laugh,” but she did not report feeling motivated in the arenas of work, school, or other responsibilities. Shannon, another mother in this subgroup, described mothering as, “Good. You have somebody to play with and when you’re down they make you feel happy. They make you forget about your worries. Just fun.”

All of the mothers who align with this narrative described the happiness and company that they received from their children, without mention of increased feelings of competence or motivation to accept responsibility. Shannon, whose child “makes the time go by,” gave her second child up for adoption and ended contact with both children’s fathers. (Her parents strongly disapproved of her first pregnancy.) At T3, she remained living in her parents’ house.

Keisha was in a relationship with the father of her children throughout the study, although they never cohabitated. Instead, she alternated between the houses of her two sisters, each of whom had three children. She did not mention feelings of transformation from motherhood and when asked whether her first child represented a big change for her, she noted that her life was “about the same. It’s a little harder now.” By T3, Keisha was pregnant with her third child.

In this subgroup of mothers, the motherhood identity was not spoken about as a transformative experience or distinctive break from their previous identities. Unlike other mothers in our sample, these three mentioned significant help with child care from family members and essentially maintained their positions within their families of origin, rather than moving into a new adult life of their own creation.

The story of a fourth mother, Destiny, lacked sufficient data to be definitively placed in this narrative grouping, although it is the group to which she appears most closely aligned. Destiny lived at home and was enrolled in high school throughout the study period. She displayed trepidation about and ambivalence toward motherhood, noting that unlike her babysitting jobs, her son is “going to be here forever . . . It’s happy, but I still can’t believe it. It’s like, wow.”

The Inability to Find Traction Trajectory

For two mothers, external circumstances overrode their interpretations of motherhood and their intended adoption of the adult mother role. Both of these mothers had spent significant stretches of their own childhoods in protective placements; they experienced homelessness during their pregnancies and births, and were no longer in relationships with their children’s fathers by T3. Both had lost custody of their children by the end of the study. These mothers differed in their interpretations of motherhood, but are grouped here to highlight the consequences of lack of resources and support, even in the face of good parenting intentions.

Yvonne’s parents were both addicted to drugs during her childhood, and Yvonne described acting as “mother” until age 10 years, when she and her nine siblings were split up into various foster homes. Yvonne had a difficult time and did not stay in any one foster family for longer than a couple of months. She became pregnant at 17 years and, although she had previously been involved in drinking, drugs, fighting, and skipping school, the pregnancy motivated her to settle down and graduate from high school.

Yvonne expressed motivation, comfort, and happiness in response to her first child, “My baby—that’s my femur. That’s like—he’s the reason why I stand tall . . . He was the reason why I woke up every morning.” However, with her second pregnancy, Yvonne was kicked out of her foster home, then her boyfriend moved away without telling her. She found herself “running on nothing”—on her own with two children, taking college classes, striving to be an adult and a mother.

The lack of support and instability seemed to frustrate her efforts to transform into the role of mother. Despite her loss of custody, Yvonne described her identity as a mother, as giving her life purpose:

. . . if I didn’t have two kids, I probably would be partying. I’d probably be an alcoholic. I—you don’t know what kind of drugs I’d be doing. I wouldn’t be going to school. I wouldn’t be working. I’d probably be house-hopping, you know, not settling down. Like, not wanting to be better for myself. Once I had my son, I realized I needed to be better for myself because I needed to be better for him . . . Those are my children. So I want to be a part of their life. I want to raise them. My name is mom. That’s it. I am a mother.

Kaya reported a less powerful identification with the role of mother. With both of her children taken into state custody only weeks after their births, perhaps she had less time to assume the motherhood identity. Kaya came from a background with little relational or residential stability, and although she expressed a desire to regain custody, she did not convey the strong motivation to become a successful mother that Yvonne appeared to possess.

Although Kaya did not express a feeling of motivation connected to her role as a mother, she did observe the relationship between childbearing and personal responsibility in her own mother:

she’s a lot better and I think it’s because she has a new boyfriend . . . she had a kid with him . . . And I think that’s probably what turned it around. She said, “I don’t want to lose this kid too, I lost all four of mine,” so my mom’s doing a lot better.

Kaya did not vocalize many internally reinforcing aspects of motherhood, but throughout the study period, her efforts toward independence and stability (e.g., applying for an independent living program, making weekly visits to see her children) conveyed elements of a motivated struggle, derailed by external instability.

Discussion

These findings present strong evidence of the motivational, stabilizing, and identity-forming effects of an initial adolescent childbirth (Herrman, 2006; Seamark & Lings, 2004), suggesting that positive interpretations of teen pregnancy and early parenting, among a sample of mothers who do not prevent future births, could be reinforcing of the motherhood role and dissuasive of pregnancy prevention. The psychological constructs (motivation, stability, and competency in a new identity; see Table 2) that guided this thematic analysis were identified by SmithBattle (1995) within a trajectory in which adolescent mothers saw motherhood as a catalyst for positive change in their lives.

By positioning those constructs within the mother’s situational context, this study extends previous research by identifying a more nuanced relationship between internal and external factors, as mothers make sense of RRBs and progress with varying success along a trajectory of maturation.

The four narrative patterns that emerged from this analysis roughly reflect what has been observed in uniparous adolescent mothers. The Family-Building Trajectory, with which a majority of mothers in this sample were aligned, has been noted in the literature (Diez & Mistry, 2010) as heavily dependent on contextual norms, cohabitation with a partner, and a lack of motivation to achieve educational or career-oriented goals. Our results are confirmatory and expanding, connecting this trajectory to increased feelings of stability and competency within the motherhood role. The identification of this trajectory in our sample also extends recent research correlating adolescent childbearing to increased educational ambitions (O’Brien Cherry, Chumbler, Bute, & Huff, 2015) by introducing an interpretation of the motherhood role that supersedes the more traditional trajectory of school completion.

The Motivated Struggle Trajectory, to which four mothers in this sample aligned, is similar to the trajectory of “inventing a future from a diminished past” (SmithBattle, 1995, p. 26). Mothers in this trajectory were motivated toward independence and reevaluated their goals and priorities for the future. Whereas school success had been a low priority before pregnancy, the responsibility of caring for a child provided a compelling reason to reinvest in education as a pathway to future opportunities, a finding that is consistent with prior research (Camarena, Minor, Melmer, & Ferrie, 1998; Kendall et al., 2005; O’Brien Cherry et al., 2015; Pillow, 2004; Rains, Davies, & McKinnon, 1998; Schultz, 2001).

The third pathway—the Continuation of Adolescence Trajectory—identified mothers with strong networks of support and little mention of the motivational effects of motherhood. This trajectory demonstrates a possible tipping point of social support, where strong contextual supports can protect an adolescent from the need to strive toward self-sufficiency. This finding, too, is consistent with previous literature (Herrman, 2006; SmithBattle, 1995). The two mothers who were categorized within the Inability to Find Traction Trajectory failed to achieve the adoption of a motherhood that would enable adequate care for their children. Both articulated some desire that their own development lead them in that direction; they both also lacked the external supports that would have made that more possible. This trajectory aligns with Herrman’s (2006) “made a hard life harder,” and SmithBattle’s (1995) “inherited a diminished future.”

The current analysis, therefore, confirmed previously located narrative patterns, but also enriches the literature through its inclusion of a conceptually grounded focus on the mothers’ interpretations of the transition to motherhood. The illustrations of how individual meaning-making and context were intertwined in the varying narrative paradigms documented in this study represent a potentially useful heuristic to operationalizing the broad precepts of sociocultural and relational meta-theoretical perspectives in empirical research (Mistry, Li, et al., 2016; Overton, 2008). The inseparability of individual meaning-making and environmental circumstances is represented in participants’ detailed descriptions of their lived experiences.

Although the thematic analysis emphasizes feelings of motivation, stability, and competence stemming from motherhood, our sample’s descriptions of their lives during the study period contained significant indications of risks and challenges. The internal axis of meaning-making reveals a continuum of transformation which affected the trajectories followed by these mothers over the 2-year study period. However, situating subjective interpretations within the context of external circumstances and profiles of support may help with identifying repeat birth mothers most at risk for negative outcomes.

Implications for Programs

Decreasing rates of rapid repeat adolescent birth is a goal of many programs serving young mothers, including HFM. The data used to support the inclusion of this reasonable goal consist of outcome measures that highlight risks associated with repeat birth among adolescent mothers. The current study, however, emphasizes the importance of taking individual interpretations and contextual circumstances into account during policy and program design.

Three points from the current analysis merit particular attention: First, the overwhelmingly positive interpretations of motherhood found in this sample following a first birth suggest a strong presence of reinforcing elements that must be considered when encouraging adolescents to prevent future births. Second, the modal narratives reveal a dynamic intersection between interpreted sequelae to childbearing and extant sources of support and stability within the mother’s social ecology. These findings suggest that programs might focus on differentiating levels of meaning-making and relational support among adolescent mothers, rather than aiming to curtail the numbers of repeat births among participants altogether. Finally, these narratives suggest that young mothers enrolled in support and intervention programs such as HFM may well set their own goals when enrolling, prioritizing some of the official goals over others (see also Mistry, Easterbrooks, et al., 2016; TIER, 2015). Continuing one’s education or finding employment, for example, might not rank as highly as does being a good parent, completing one’s family, and so forth. Rather than considering all RRBs as failures, programs might take a longer view, orchestrating community supports in the service of immediate positive functioning along certain critical dimensions (e.g., adequate parenting), and eventual positive outcomes in other domains.

Recommendations for Further Study

This investigation is meant to call attention to the complexity and importance of person-centered research regarding adolescent mothers. A specific investigation of how sequelae of initial childbearing affect attitudes and behaviors around future pregnancies would fill in the missing link between potentially reinforcing interpretations of motherhood and a subsequent failure to prevent future births.

The dynamic between subjective interpretations and environmental support established here could be investigated longitudinally among a sample of uniparous mothers. Research identifying similarities and differences in meaning-making among mothers who do and do not prevent subsequent teenage pregnancies will elucidate correlates of repeat birth, better positioning programs to decrease RRBs rates. The location of modal trajectories prior to repeat births can highlight specific profiles of mothers most at risk, identifying needed supports that could, perhaps, ameliorate the outcomes of these mothers and their children.

Limitations of the Current Study

The interpretive phenomenological approach is uniquely adept at describing, in-depth, the experience and interpretation of an event from the participant’s perspective. Therefore, it was an ideal method for the current analysis. Nonetheless, limitations to the data compromised the thoroughness of the analytic approach in its ideal form.

First, the main data source—the RIs—did not focus specifically on the advent of repeat birth, nor did they consistently gather participants’ perspectives on the motherhood identity. Information about each participant’s transition to motherhood had to be extracted from the interviews, which were of varying lengths and detail.

Second, only intervention group participants who had completed at least two RIs were included in the present study, excluding the majority of HFM participants who experienced RRBs. Control group mothers were summarily excluded. However, the extent to which the larger study had difficulties finding and interviewing a number of the multiparous intervention group mothers likely reflects the instability in their lives—a contextual factor that might well define additional trajectories, or impel revision to the four identified here.

Nonetheless, this study benefitted from the richness of narrative detail in the RIs, allowing qualitative analyses to be firmly rooted in direct quotes and supported by detailed descriptions of situational outcomes. We see it as a modest contribution to understanding how young mothers think about their entry into parenting.

Footnotes

Acknowledgements

We thank the Massachusetts Children’s Trust for funding this research, and the many study participants who allowed us into their homes and their lives during the course of this study. We also acknowledge our colleagues at Tufts Interdisciplinary Evaluation Research (TIER) for their guidance and assistance, and offer special thanks to the outside reviewers who strengthened the manuscript with their helpful comments.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received following financial support for the research, authorship, and/or publication of this article: Massachusetts Children’s Trust.

Notes

Author Biographies

Julia Reddy, MA, received a master’s in child development from the Eliot-Pearson Department of Child Study and Human Development at Tufts University in 2013. Her graduate research focused on intervention design, program evaluation, and parent–child interaction. Currently, she serves as the statewide perinatal substance use systems coordinator and trainer at the Institute for Health and Recovery, in Cambridge, Massachusetts.

Jayanthi Mistry, PhD, is an associate professor in the Eliot-Pearson Department of Child Study & Human Development at Tufts University. Her research and scholarship is based on cultural perspectives on children’s development and the use of interpretive methods. Her current research projects include investigations of multiple ethnic identities among ethnic minority, immigrant, and underrepresented communities in the United States; an evaluation of a teen parenting program, with a focus on understanding the lived experiences of young immigrant and ethnic minority mothers; and a research and curriculum development project based on homeschool collaborations with teachers and parents of dual language learners in Head Start classrooms serving two distinct communities of recent immigrants (from China and Central America).

Francine Jacobs, EdD, is an associate professor in the Eliot-Pearson Department of Child Study and Human Development and the Department of Urban and Environmental Policy and Planning at Tufts University, Medford, Massachusetts. Her research interests include the evaluation of programs for young families, and the nature of relationships between young parents and home visitors. Her five-tiered approach to evaluation—a developmental framework for undertaking both process and outcome program studies—has been broadly applied both in the United States and abroad.

References

Barnet

Liu

Devoe

Duggan

Gold

Pecukonis

(2009). Motivational intervention to reduce rapid subsequent births to adolescent mothers: A community-based randomized trial. Annals of Family Medicine, 7, 436-445. doi:10.1370/afm.1014

Benner

(1994). The tradition and skill of interpretive phenomenology in studying health, illness, and caring practices. In Benner

(Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 99-129). Thousand Oaks, CA: SAGE. doi:10.4135/9781452204727

Boardman

Allsworth

Phipps

Lapan

(2006). Risk factors for unintended versus intended rapid repeat pregnancies among adolescents. Journal of Adolescent Health, 39, 597.e1-597.e8. doi:10.1016/j.jadohealth.2006.03.017

Burton

Obeidallah

Allison

(1996). Ethnographic insights on social context and adolescent development among inner-city African-American teens. In Jessor

Colby

Shweder

(Eds.), Ethnography and human development (pp. 395-418). Chicago, IL: The University of Chicago Press.

Camarena

P. M.

Minor

Melmer

Ferrie

(1998). The nature and support of adolescent mothers’ life aspirations. Family Relations, 47, 129-137. doi:10.2307/585616

Child Trends. (2014). Teen births. Retrieved from http://www.childtrends.org/?indicators=teen-births

Clemmens

(2003). Adolescent motherhood: A meta-analysis of qualitative studies. The American Journal of Maternal Child Nursing, 28, 93-99.

Cole

(1996). Cultural psychology: A once and future discipline. Cambridge, MA: Belknap/Harvard.

Coley

R. L.

Chase-Lansdale

P. L.

(1998). Adolescent pregnancy and parenthood: Recent evidence and future directions. American Psychologist, 53, 152-166.

10.

Corcoran

Pillai

(2007). Effectiveness of secondary pregnancy prevention programs: A meta-analysis. Research on Social Work Practice, 17, 5-18. doi:10.1177/1049731506291583

11.

Coyne

C. A.

D’Onofrio

B. M.

(2012). Some (but not much) progress toward understanding teenage childbearing: A review of research from the past decade. Advances in Child Development and Behavior, 42, 113-152.

12.

Crist

Tanner

(2003). Interpretation/analysis methods in hermeneutic interpretive phenomenology. Nursing Research, 52, 202-205. doi:10.1097/00006199-200305000-00011

13.

Diez

Mistry

(2010). Early childbearing and educational attainment among mainland Puerto Rican teens. Journal of Adolescent Research, 25, 690-715. doi:10.1177/0743558410366592

14.

El-Kamary

Higman

Fuddy

McFarlane

Sia

Duggan

(2004). Hawaii’s healthy start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics, 114(3), e317-e326. doi:10.1542/peds.2004-0618

15.

Guttmacher Institute. (1998, January). Teenagers pregnancy intentions and decisions: A study of young women in California choosing to give birth. Retrieved from http://www.guttmacher.org/pubs/or_teen_preg_survey.html

16.

Hamilton

B. E.

Martin

J. A.

Osterman

M. J. K.

Curtin

S. C.

Mathews

T. J.

(2015). Births: Final data for 2014. National Vital Statistics Reports, 64, 1-64. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_12.pdf

17.

Herrman

(2006). The voices of teen mothers: The experience of repeat pregnancy. The American Journal of Maternal Child Nursing, 31, 243-249. doi:10.1097/00005721-200607000-00009

18.

Jacobs

Easterbrooks

M. A.

Goldberg

Mistry

Bumgarner

Raskin

. . . Fauth

(2016). Helping young families: Randomized controlled trial of a home visiting program to improve adolescent parenting. American Journal of Public Health, 106, 342-349. doi:10.2105/AJPH.2015.302919

19.

Jaffee

Caspi

Moffitt

T. E.

Belsky

Silva

(2001). Why are children born to teen mothers at risk for adverse outcomes in young adulthood? Results from a 20-year longitudinal study. Development and Psychopathology, 13, 377-397. doi:10.1017/S0954579401002103

20.

Kendall

Afable-Munsuz

Speizer

Avery

Schmidt

Santelli

(2005). Understanding pregnancy in a population of inner-city women in New Orleans—Results of qualitative research. Social Science & Medicine, 60, 297-311. doi:10.1016/j.socscimed.2004.05.007

21.

Klerman

(2004). Another chance: Preventing additional births to teen mothers. Washington, DC: National Campaign to Prevent Teen Pregnancy.

22.

Koniak-Griffin

Turner-Pluta

(2001). Health risks and psychosocial outcomes of early childbearing: A review of the literature. The Journal of Perinatal & Neonatal Nursing, 15(2), 1-17. doi:10.1097/00005237-200109000-00002

23.

Lerner

R. M.

Benson

J. B.

(Eds.). (2013). Embodiment and epigenesis. In Advances in child behavior and development (pp. 44-45). Boston, MA: Elsevier Press.

24.

Lesser

Anderson

Koniak-Griffin

(1998). “Sometimes you don’t feel ready to be an adult or a mom”: The experience of adolescent pregnancy. Journal of Child and Adolescent Psychiatric Nursing, 11, 7-16. doi:10.1111/j.1744-6171.1998.tb00425.x

25.

Lester

(1999). An introduction to phenomenological research. Taunton, UK: Stan Lester Developments.

26.

Manlove

(2011). Teen pregnancy and repeat teen pregnancy: Data and key determinants. A Presentation to OAPP Grantees: Child Trends. Retrieved from http://www.childtrends.org/wp-content/uploads/2011/12/Child_Trends-2011_12_06_SP_-OAPPpresentation.pdf

27.

Manlove

Steward-Streng

Peterson

Scott

Wildsmith

(2013). Racial and ethnic differences in the transition to a teenage birth in the United States. Perspectives on Sexual and Reproductive Health, 45, 89-100. doi:10.1363/4508913

28.

Martin

J. A.

Hamilton

B. E.

Ventura

S. J.

Osterman

M. J. K.

Wilson

E. C.

Mathews

T. J.

(2012). Births: Final data for 2010. National Vital Statistics Report, 61(1), 23.

29.

McLean

K. C.

Thorne

(2003). Late adolescents’ self-defining memories about relationships. Developmental Psychology, 39, 635-645. doi:10.1037/0012-1649.39.4.635

30.

McLean

K. C.

Wood

Breen

A. V.

(2013). Reflecting on a difficult life narrative construction in vulnerable adolescents. Journal of Adolescent Research, 28, 431-452. doi:10.1177/0743558413484355

31.

Meade

C. S.

Kershaw

T. S.

Ickovics

J. R.

(2008). The intergenerational cycle of teenage motherhood: An ecological approach. Health Psychology, 27, 419-429. doi:10.1037/0278-6133.27.4.419

32.

Mistry

Dutta

(2015). Human development and culture: Conceptual and methodological Issues. In Overton

W. F.

Molenaar

P. C.

(Eds.) & Lerner

R. M.

(Editor-in-Chief), Theory and method: Volume 1 of the handbook of child psychology and developmental science (7th ed., pp. 369-406). Hoboken, NJ: John Wiley.

33.

Mistry

Easterbrooks

M. A.

Fauth

R. C.

Raskin

Jacobs

Goldberg

(2016). Heterogeneity among adolescent parents and home visiting program outcomes. Children and Youth Services Review, 65, 86-93. doi:10.1016/j.childyouth.2016.04.002

34.

Mistry

Yoshikawa

Tseng

Tirrell

Kiang

. . . Wang

(2016). An integrated conceptual framework for the development of Asian American children and youth. Child Development, 87, 1014-1032. doi:10.1111/cdev.12577

35.

Musick

J. S.

(1993). Young, poor, and pregnant. New Haven, CT: Yale University Press.

36.

O’Brien Cherry

Chumbler

Bute

Huff

. (2015). Building a “better life”: The transformative effects of adolescent pregnancy and parenting. SAGE Open, 5. doi:10.1177/2158244015571638

37.

Overton

W. F.

(2008). Embodiment from a relational perspective. In Overton

W. F.

Miller

Newman

J. L.

(Eds.), Developmental perspectives on embodiment and consciousness (pp. 1-18). New York, NY: Lawrence Erlbaum.

38.

Overton

W. F.

(2013). A new paradigm for developmental science: Relationism and relational-developmental-systems. Applied Developmental Science, 17, 94-107. doi:10.1080/10888691.2013.778717

39.

Pillow

(2004). Unfit subjects: Educational policy and the teen mother. New York, NY: RoutledgeFalmer.

40.

Rains

Davies

McKinnon

(1998). Taking responsibility: An insider view of teen motherhood. Families in Society, 79, 308-319. doi:10.1606/1044-3894.994

41.

Rogoff

(2003). The cultural nature of human development. New York, NY: Oxford University Press.

42.

Rolfe

(2008). “You’ve got to grow up when you’ve got a kid”: Marginalized young women’s accounts of motherhood. Journal of Community & Applied Social Psychology, 18, 299-314. doi:10.1002/casp.925

43.

Salihu

August

Jeffers

Mbah

Alio

Berry

(2011). Effectiveness of a federal healthy start program in reducing primary and repeat pregnancies: Our experience over the decade. Journal of Pediatric & Adolescent Gynecology, 24, 153-160. doi:10.1016/j.jpag.2011.01.001

44.

Schultz

(2001). Constructing failure, narrativizing success: Rethinking the “problem” of teen pregnancy. Teachers College Record, 103, 582-607.

45.

Seamark

Lings

(2004). Positive experiences of teenage motherhood: A qualitative study. British Journal of General Practice, 54, 813-818.

46.

Shweder

R. A.

Goodnow

Hatano

LeVine

R. A.

Markus

Miller

(2006). The cultural psychology of development: One mind, many mentalities. In Lerner

R. M.

Damon

(Eds.), Handbook of child psychology: Vol. 1 theoretical models of human development (6th ed., pp. 716-792). New York, NY: John Wiley.

47.

SmithBattle

(1995). Teenage mothers’ narratives of self: An examination of risking the future. Advances in Nursing Science, 17(4), 22-36. doi:10.1097/00012272-199506000-00004

48.

SmithBattle

(2005). Teenage mothers at age 30. Western Journal of Nursing Research, 27, 831-850. doi:10.1177/0193945905278190

49.

SmithBattle

(2007). “I wanna have a good future”: Teen mothers’ rise in educational aspirations, competing demands, and limited school support. Youth & Society, 38, 348-371. doi:10.1177/0044118X06287962

50.

Tufts Interdisciplinary Evaluation Research. (2015). The Massachusetts Healthy Families Evaluation–2 (MHFE-2): A randomized controlled trial of a statewide home visiting program for young parents (Final report to the Children’s Trust of Massachusetts). Medford, MA: Tufts University.

51.

Ungar

(2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychiatry, 81, 1-17. doi:10.1111/j.1939-0025.2010.01067.x

52.

Vygotsky

L. S.

(1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.