Reflections of Native American teen mothers

Child rearing and parenting programs among First Nations' populations in high-income countries: a bibliometric review

Objectives We set out to examine the volume, scope and quality of research related to First Nations peoples' perceptions of, and experiences with, child rearing and/or parenting programs. Methods We systematically reviewed the literature published between 2000 and 2020. Sixty-eight studies identified through electronic databases and references lists met inclusion criteria. Results The study found an 8% increase in publications in the field each year (P -value = 0.002), mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n  = 29, 41%). Scope included positive and negative experiences relating to: parenting from adult (n  = 19 studies) and teenager (n  = 4) perspectives; and pregnancy, antenatal and postnatal care from the perspective of adults (n  = 23) and teenagers (n  = 2). Descriptive studies included qualitative (n  = 40; 58%), quantitative (n  = 8, 12%) or mixed methods (n  = 7, 10%). Thirteen experimental studies reported the development, acceptability and/or effectiveness of programs (19%), of which three met the Cochrane Effective Practice and Organisation of Care design criteria. Conclusions Despite an overall increase in volume, research efforts do not demonstrate a clear scientific progression. Further methodologically rigorous studies examining child rearing and/or parenting programs developed in collaboration with First Nations populations are needed.

'Marriage is Going to Fix It': Indigenous Women's Experiences with Early Childbearing, Early Marriage and Intimate Partner Violence

Intimate partner violence (IPV), early childbearing (ECB) and early marriage (EM) are interconnected to the historical oppression of patriarchal colonialism imposed upon Indigenous peoples throughout the world by colonising nations, such as the UK. The artefacts of colonial oppression persist in both colonising nations and those that have been colonised through social norms of patriarchal oppression perpetuated upon women with far-reaching consequences. Indigenous women of the US experience higher rates of IPV, ECB and EM than any other ethnic group-which pose risks to women's physical, psychological, socioeconomic and educational status. The purpose of this study is to explore Indigenous women's experiences with ECB and EM through a critical ethnography with two US tribes. Through reconstructive analysis the following themes emerged: (i) ECB as a Precursor to Marriage; (ii) Unequal and Overburdened Marriages; (iii) ECB, EM and IPV; and (iv) Continued Harmful Effects of Multiple Abusive Relationships. Indigenous women's experiences of ECB and EM are connected to patriarchal historical oppression that systematically dehumanises and oppresses Indigenous women, who were once treated with respect and esteem. Decolonisation and re-visualisation to promote the status of women and girls are needed to offset women's constrained wellness, socio-political status and safety.

Early childbearing, family support, and staying in school in a Northern Plains American Indian reservation

American Indian youth experience teen birth and school dropout at higher rates than other racial and ethnic groups in the United States. Early childbearing is associated with adverse health and socioeconomic outcomes, including attenuated education. However, kinship childrearing norms among Northern Plains tribes can support positive experiences of early childbearing. Using a community based participatory research framework, this mixed methods exploratory study engaged high school students from a Northern Plains reservation community to examine youth perceptions of family support and belief in ability to stay in school should they have a child. We elicited youth observations of facilitators and inhibitors to academic achievement for young parents. This research supports the need for strengths-based, gender specific, and family inclusive sexuality education to support young people in their reproductive choices in reservation settings. We highlight the utility of including youth as co-authors and co-researchers in future studies.

Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities

OBJECTIVE

While one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities.

METHODS

Through a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention.

RESULTS

This collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby.

IMPLICATIONS

Committing to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname’s interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson’s χ²-test and the Mann–Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70–7.63) and PTB (OR = 3.43; 95% CI 1.48–7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.

Evaluation of child marriage in a Turkish sample: 8 years' data

This study aims to examine 167 adolescents who were referred by courts between 2008 and 2016 to prepare medical-legal reports on their suitability for marriage. Most were illiterate or graduates of primary/secondary school; only 17 (10.2%) were still at high school. A total of 95 girls (56.9%) had a religious marriage without a civil certificate, 63 girls (37.7%) were pregnant, and 15 (9%) had a child. According to medical reports, 91 of the girls were considered unsuitable for marriage; 76 girls who were pregnant and/or had a child were also considered unsuitable, so it was necessary to let the judge decide.

Teenage mothers in later life: Time for a second look

IntroductionTeenage motherhood is understood as a social problem by governments and in the public imagination. This is underpinned by studies linking teenage motherhood to a range of poor outcomes. This paper brings together key issues with measuring outcomes of teenage motherhood. It argues that to account for long-term change as well as an understanding of what drives, facilitates and impedes development, longitudinal qualitative methodology is needed. MethodsA narrative review of qualitative longitudinal studies of teenage motherhood was conducted with six studies meeting the inclusion criteria; (a) data collection at more than one point; (b) at least two points occurring after childbirth ResultsThe search demonstrated the insights that these methods can bring to the field. Such studies demonstrate the ways in which pre and post pregnancy contexts impact on attainment and experiences. They are able to present a complex and nuanced picture to contextualise the claims made in the quantitative literature. Furthermore, they provide voice to young mothers so they can narrate their own lives and make clear what is important to them. ConclusionThe paper argues that we need to work towards telling a more nuanced story of teenage motherhood by sensitising statistical work with qualitative studies. Moreover, research with teenage parents needs to take a longitudinal approach which accounts for change across the lifespan. Combining these approaches would enhance our understanding of outcomes as well as provide us with the means by which to better support young parents in the long-term.

A scoping review: The utility of participatory research approaches in psychology

Consistent with community psychology's focus on addressing societal problems by accurately and comprehensively capturing individuals' relationships in broader contexts, participatory research approaches aim to incorporate individuals' voices and knowledge into understanding, and responding to challenges and opportunities facing them and their communities. Although investigators in psychology have engaged in participatory research, overall, these approaches have been underutilized. The purpose of this review was to examine areas of research focus that have included participatory research methods and, in turn, highlight the strengths and ways that such methods could be better used by researchers. Nearly 750 articles about research with Indigenous Peoples, children/adolescents, forensic populations, people with HIV/AIDS, older adults, and in the area of industrial-organizational psychology were coded for their use of participatory research principles across all research stages (i.e., research design, participant recruitment and data collection, analysis and interpretation of results, and dissemination). Although we found few examples of studies that were fully committed to participatory approaches to research, and notable challenges with applying and reporting on this type of work, many investigators have developed creative ways to engage respectfully and reciprocally with participants. Based on our findings, recommendations and suggestions for researchers are discussed.

Assessing the Impact of a Healthy Relationships Curriculum on Native American Adolescents

This study suggests Discovery Dating, a healthy relationships curriculum, as one way of preventing teenage pregnancy, domestic violence, and sexual assault. This study seeks to determine what theory of change best aligns with Discovery Dating, by assessing the curriculum's impact on adolescent resilience, self-efficacy, and personal agency, which are suggested as protective factors against teenage pregnancy, domestic violence, and sexual assault. Authors describe the implementation of the Discovery Dating program in a western U.S. tribal middle school during the 2011-2012 school year. The resilience, self-efficacy, and personal agency outcomes of seventh grade students who received the Discovery Dating curriculum were investigated through pre- and posttest analysis and compared with the outcomes of an eighth grade comparison group that did not receive the Discovery Dating curriculum. Findings suggest that Discovery Dating affects Native American middle school students' sense of personal agency.

NATIVE-It's Your Game: Adapting a Technology-Based Sexual Health Curriculum for American Indian and Alaska Native youth

Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It's Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It's Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54-86 % agreement across lessons) and in comparison to other learning channels (57-100 %) and rated the lessons as helpful in making better health choices (73-100 %). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth.

Socio-economic and demographic factors influencing nutritional status among early childbearing young mothers in Bangladesh

Background

Early childbearing influences women’s health. This study aims to examine the effects of socio-demographic factors on nutritional status of early childbearing mothers in Bangladesh based on Body Mass Index (BMI) as the indicator.

Methods

Data was extracted from Bangladesh Demographic and Health Survey (BDHS)-2011. The survey was performed on 17,842 married women aged 15–49. We focused on early childbearing mothers (age ≤ 24, and who had delivered their first child ≤ 20). Mothers who were underweight (BMI ≤ 18.5 kg/m²) would be further classified into various grades of chronic energy deficiency (CED): mild (17.0 ≤ BMI < 18.5 kg/m²), moderate (16.0 ≤ BMI <17.0 kg/m²), and severe (BMI < 16.0 kg/m²). Multiple logistic regression model was used to examine the effect of socio-demographic factors on nutritional status.

Results

Mean age of the mothers was 20.49 ± 2.37 years (ranged 15–24 years). The prevalence of underweight among early childbearing mothers was 32.1 % (urban 25 % and rural 35.1 %). Most of the underweight mothers had mild (62.2 %) CED, while the remaining had either moderate (25.9 %) or severe (11.9 %) CED. Multiple logistic regression analysis demonstrated that young mothers from rural areas, poor families, and those who were illiterate or with low level of education, working, and married to unemployed husband were at higher risk for being underweight. Young mothers who had non-caesarean delivered, delivered at home, or married at early age and had more than two children were also at higher risk for being underweight.

Conclusions

The prevalence of underweight among early childbearing mothers in Bangladesh is very high (32.1 %), associated with the still common practice of teenage marriage. Education level, wealth index, occupation, place of residence, age at first marriage and parity were important predictors for their nutritional status. The government and non-government organizations should take initiatives to reduce the prevalence of underweight mothers in Bangladesh.

Developing an obesity-cancer intervention for workplaces: Indigenous, Native American, Māori and other minority occupational settings

There is growing evidence for links between obesity and certain types of cancer. Studies done within Native American, Māori, and other Indigenous populations suggest the need to promote healthier lifestyles, including the maintenance of optimal body weight through nutrition and physical activity, to lower the risk factors of obesity-related cancers. What is missing is a program that combines culturally attuned workplace interventions that deal with obesity reduction as it relates to cancer prevention. The main purpose of this project was to discuss the process of developing an employee assistance program module to reduce the risk for obesity-related cancers. Expert curriculum developers specialising in workplace disease management assisted with the creation of a unique obesity and cancer prevention program. Several national leaders in Indigenous and minority health were consulted for feedback. The completed intervention included a six-session model with cultural features wrapped around topics of obesity-related cancer warning signs, diet and physical activity guidance, stress management, goal-setting, and resource linkage. A Native American workplace was selected for feasibility and pilot testing. Preliminary results are also discussed. Ultimately, this paper presents a novel intervention approach to address health issues for Native Americans, with indicators for use in other Indigenous populations globally.

Factors Associated With Early Sexual Experience Among American Indian and Alaska Native Youth

PURPOSE

American Indian and Alaska Native (AI/AN) youth experience disparities associated with sexual and reproductive health, including early age of sexual initiation. Identifying factors that are most proximally related to early sexual intercourse and that are modifiable through health promotion interventions may help to reduce these disparities. Using a multisystem approach, we assessed individual (biological, psychological, and behavioral), familial, and extrafamilial (peer behavioral) factors associated with lifetime sexual experience among AI/AN early adolescents living in three geographically dispersed U.S. regions.

METHODS

We analyzed cross-sectional data from 537 AI/AN youth aged 12-14 years, recruited from 27 study sites in Alaska, Arizona, and the Pacific Northwest. We used multilevel logistic regression models to estimate associations between independent variables and lifetime sexual intercourse (oral and/or vaginal sex) individually, within discrete systems, and across systems.

RESULTS

The analytical sample was 55.1% female, with a mean age of 13.2 years (standard deviation = 1.06 years); 6.5% were sexually experienced. In the final model, we found that lower next-year intentions to have oral or vaginal sex (psychological factors), avoidance of risky situations, and nonuse of alcohol (behavioral factors) were associated with lower odds of lifetime sexual intercourse (all p ≤ .01). No other variables were significantly associated with lifetime sexual intercourse.

CONCLUSIONS

Interventions that reduce sexual intentions, exposure to risky situations, and alcohol use may help to delay sexual initiation among AI/AN early adolescents.

PREVALENCE OF CHILD MARRIAGE AMONG BANGLADESHI WOMEN AND TREND OF CHANGE OVER TIME

Many Bangladeshi women marry early, and many marry before the legal age of 18 years. This practice has been associated with a higher risk of health and medical morbidities, and also early pregnancy with higher pre- and postnatal complications. The aim of this study was to determine the prevalence, and factors associated with, child marriage among Bangladeshi women using multiple binary logistic regression analysis of data from the BDHS-2011. Further analysis on the trend of age at first marriage was performed with additional data sets from previous surveys. The mean and median of ages at first marriage of Bangladeshi women in 2011 were 15.69±2.97 and 15.00 years, respectively. A remarkably high percentage (78.2%) married before the age of 18; of these, 5.5% married at a very early age (before 13 years of age). Binary logistic regression analysis demonstrated that uneducated women were more likely to be married early (p<0.001) than those with secondary and higher education. Child marriage was especially pronounced among women with uneducated husbands, Muslims, those with poor economic backgrounds and those living in rural areas. Further analysis including data from previous BDHS surveys showed that child marriage among Bangladeshi women had a decreasing trend from 1993-94 to 2011. These results show that child marriage was very common in Bangladesh, and closely associated with low level of education and low economic status. The decreasing trend in child marriage indicates an improvement over the past two decades but more effort is needed to further reduce and eventually eliminate the practice.

Storytelling: A Qualitative Tool to Promote Health Among Vulnerable Populations

Storytelling is a basic cultural phenomenon that has recently been recognized as a valuable method for collecting research data and developing multidisciplinary interventions. The purpose of this article is to present a collection of nursing scholarship wherein the concept of storytelling, underpinned by cultural phenomena, is explored for data collection and intervention. A conceptual analysis of storytelling reveals key variables. Following a brief review of current research focused on storytelling used within health care, three case studies among three vulnerable populations (American Indian teen mothers, American Indian cancer survivors, and African American women at risk for HIV/AIDS) demonstrate the uses of storytelling for data collection and intervention. Implications for transcultural nursing regarding storytelling are discussed.

Weaving dreamcatchers: mothering among American Indian women who were teen mothers

AIMS

The aim of this study was to explore the mothering experience and practice among reservation-based adult American Indian women who had been adolescent mothers.

BACKGROUND

Adolescent American Indian women are at an elevated risk for teen pregnancy and poor maternal/child outcomes. Identifying mothering practices among this population may help guide intervention development that will improve health outcomes.

DESIGN

A collaborative orientation to community-based participatory research approach.

METHODS

Employing interpretive phenomenology, 30 adult American Indian women who resided on a Northwestern reservation were recruited. In-depth, face-to-face and telephone interviews were conducted between 2007-2008.

FINDINGS

Women shared their mothering experience and practice, which encompassed a lifespan perspective grounded in their American Indian cultural tradition. Four themes were identified as follows: mother hen, interrupted mothering and second chances, breaking cycles and mothering a community. Mothering originated in childhood, extended across their lifespan and moved beyond mothering their biological offspring.

CONCLUSION

These findings challenge the Western construct of mothering and charge nurses to seek culturally sensitive interventions that reinforce positive mothering practices and identify when additional mothering support is needed across a woman's lifespan.

Embodied meanings of early childbearing among American Indian women: a turning point

INTRODUCTION

American Indian women often have poor perinatal outcomes and are at risk for early childbearing. The purpose of this qualitative study was to understand the experience and meaning of early childbearing among American Indian women.

METHODS

Employing interpretive phenomenology and a semistructured interview guide, we interviewed 30 adult American Indian women residing in a northwestern American Indian reservation about their experiences and meaning of early childbearing.

RESULTS

Three overarching themes were tied to their eventual positive evaluation of the experience: 1) mourning a lost childhood, 2) seeking fulfillment, and 3) embodying responsibility.

DISCUSSION

Women indicated that despite their tumultuous childhoods, early childbearing presented an opportunity to effect positive change in their lives. Women's health care providers are positioned to help women change their lives, thereby, improving health outcomes.