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Journal of Reproductive and Infant

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Meeting the challenges of teenage

mothers with postpartum depression:
overcoming stigma through support
a a a
Elizabeth Hardie Boath , Carol Henshaw & Eleanor Bradley
a
Staffordshire University, Stoke on Trent, UK.
Published online: 11 Jun 2013.

To cite this article: Elizabeth Hardie Boath, Carol Henshaw & Eleanor Bradley (2013) Meeting the
challenges of teenage mothers with postpartum depression: overcoming stigma through support,
Journal of Reproductive and Infant Psychology, 31:4, 352-369, DOI: 10.1080/02646838.2013.800635

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 Journal of Reproductive and Infant Psychology, 2013
Vol. 31, No. 4, 352–369, http://dx.doi.org/10.1080/02646838.2013.800635

Meeting the challenges of teenage mothers with postpartum

depression: overcoming stigma through support
Elizabeth Hardie Boath*, Carol Henshaw and Eleanor Bradley

Staffordshire University, Stoke on Trent, UK

(Received 15 November 2012; final version received 25 April 2013)
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Objective: This study aimed to elicit and explore the experiences of teenage
mothers with postpartum depression focussing on their experiences of being a
teenage mother; support needs and the potential for support and education to be
delivered by healthcare workers, or peers. Background: Teenage mothers are
three times more likely to get postnatal depression than older mothers and are at
increased risk of poorer mental health for up to three years postpartum.
Method: Fifteen first-time mothers aged 16–19, living in Stoke on Trent, UK,
with an infant aged under one year and suffering from postpartum depression
were interviewed. Qualitative data were analysed using thematic framework
analysis to identify emergent patterns and themes. Results: Four key themes
emerged: stigma and perceptions of being judged; social and professional sup-
port; knowledge and information; and barriers to utilising support. Conclusion:
The results highlighted the stigma, both real and perceived, that teenage mothers
experienced as well as the lack of informal support networks for many and the
unavailability of relevant and appropriate information targeted at teenage moth-
ers. Some mothers highlighted the positive relationships they had with their
health visitor which was essential to them in building a trusting relationship.
However, not all had such good experiences, with some reporting that they did
not know who their health visitor was. The need for tailored services and
innovative methods of delivery are highlighted.
Keywords: teenage mothers; postnatal depression; postpartum depression; health
visitors

Introduction
Postnatal depression (PND) is a serious and debilitating psychiatric disorder that is
equivalent to a diagnosis of major or minor depressive disorder (Boath, Major, &
Cox, 2003). It is estimated that around 13% of women get PND (O’Hara & Swain,
1996). However, with teenage mothers, it is estimated that the true figure may be
much higher as many suffer in silence, or are unaware that their symptoms or how
they are feeling are due to PND (Rubertsson, Waldenström, & Wickberg, 2003).
One in 15 births in the UK in recent years was to a young woman under the age of
20 (Department for Children, Schools and Families, Department of Health, & Royal
College of Midwives 2008). For the first time, the Office of National Statistics
revealed that in 2011 the rate had fallen by 6%, but still 38.3 per thousand births

*Corresponding author. Email: [email protected]

Ó 2013 Society for Reproductive and Infant Psychology

 Journal of Reproductive and Infant Psychology 353

was to a woman aged between 15 and 17 (Office of National Statistics, 2011).

Teenage pregnancy and childbirth is associated with a number of poor outcomes for
both mother and infant. For example, babies of teenage mothers are more likely to
be born prematurely (Jolly, Sebire, Harris, Robinson, & Regan, 2000), 25% more
likely than babies of older mothers to be born at a low birth weight and have an
infant mortality rate 60% higher than babies of mothers aged 20–39 (Botting,
Rosato, & Wood, 1998; Hodgkinson, Colantuoni, Roberts, Berg-Cross, & Belcher,
2010). Their infants are at increased risk of hospitalisation for accidental injuries,
diarrhoea and vomiting, developmental delays, and poor nutrition during the first
year of life (Moffit, 2002; Peckham, 1993). Teenage mothers themselves have been
shown to be at greater risk of premature death compared to women who experience
first-time motherhood at mature age (Olausson, Haglund, Weitoft, & Cnattingius,
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2004; Webb, Marshall, & Abel, 2011). Research also suggests that teenage mothers
are three times more likely to get PND than older mothers and are at increased risk
of poorer mental health for up to three years postpartum (Moffitt, 2002; Rubertsson
et al., 2003).
Teenage mothers are at increased risk of experiencing isolation and a breakdown
of their relationship with the child’s father (Social Exclusion Unit, 1999) and sev-
eral studies have observed that they have higher levels of depression compared to
non-parenting teenagers or older mothers (Colletta, 1983; Hudson, Elek, & Camp-
bell-Grossman, 2000; Lanzi, Bert, Jacobs, & Centers for the Prevention of Child
Neglect., 2009; Piyasil, 1998; Schweingruber & Kalil, 2000). These high levels of
depression are of concern because maternal depression has a negative impact on
mother–infant interaction, attachment, and the subsequence emotional and cognitive
development of the child (Grace, Evindar, & Stewart, 2003; Martins & Gaffan,
2000). Indeed the 14-year-old children of mothers aged 18 or younger in Australia
have been shown to be more likely to have disturbed psychological behaviour,
poorer school performance, poorer reading ability, to have been in contact with the
criminal justice system and more likely to smoke regularly and to consume alcohol
than the offspring of older mothers (Shaw, Lawlor, & Najman, 2006). Distress
accompanying teenage motherhood is not time-limited to early parenting, but has
been found to adversely affect the psychological well-being of mothers for a period
extending well beyond the teenage years (Brown, Adams, & Kellam, 1981).
There is a close association between teenage mothering and low socioeconomic
status (SES) which has led to a notion among health professionals that the experi-
ence of depression during the postpartum period is precipitated by different factors
for teenage and older mothers (McCulloch, 2001; Turner, Sorenson, Turner, &
Blake, 2000). Indeed, an integrative review of 12 studies of depression in teenage
mothers identified family conflict, fewer social supports and low self-esteem as
being identified with depressive symptoms in adolescent mothers in the first post-
partum year (Reid & Meadows-Oliver 2007). Mothers under 18 have also been
observed to overestimate their support networks when pregnant compared to reality
when social support is assessed postpartum (Quinlivan, Luehr, & Evans, 2004) and
another study found social isolation, maternal competence and weight/shape con-
cerns predicted depression (Birkeland, Thompson, & Phares, 2005).
A variety of psychological interventions for postpartum depression including
those based on mother-to-mother peer support have been reported in systematic
reviews and meta-analyses (Cuijpers, Brännmark, & van Straten, 2008; Dennis,
2004; Lumley, Austin, & Mitchell, 2004) and appear to have moderate effects, but
 354 E.H. Boath et al.

the women included in these studies were over the age of 18. It is not known
whether these interventions would be as effective in younger mothers. A recent
review concluded ‘there is a lack of controlled clinical trials evaluating the efficacy
of psychosocial interventions for postpartum depression in adolescent mothers’
(Yozwiak, 2010).
The aims of the study were to elicit the experiences of teenage mothers with
postpartum depression and to further explore those factors associated with
depression in younger mothers. In particularly, the study focused on:

• their experiences of being a teenage mother;

• eliciting key support needs for provision by formal and informal support; and
• the potential for support and education to be delivered by healthcare workers,
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or peers.

Methods
Study design
Participants were first-time mothers aged 16–19 in Stoke on Trent, UK with an
infant aged under one year, who had been identified by their health visitor as suffer-
ing from postpartum depression following clinical assessment and by scoring >12
on the Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagovsky,
1987). The EPDS has been validated for use with adolescent mothers (Logsdon,
Usui, & Nering, 2009). Participants were all English-speaking and non-English
speakers were excluded as the research team were unable to interview and analyse
qualitative data in other languages and time and financial resources did not allow
this. Women unable to complete the questionnaire or interview as a result of
neurological illness, learning disability or cognitive deficits were also excluded.
Health visitors in Stoke on Trent and North Staffordshire Primary Care Trusts
were asked to identify teenage mothers meeting the study entry criteria. The teenage
mothers were then approached by one of the researchers (EHB, CH) and asked if
they were interested in taking part in the research project. Interested young women
were visited and given the study information sheet and allowed time (at least 24 h)
to consider it and to ask any questions. They were encouraged to consult others
during this time if they wished.
Written informed consent was obtained by the researchers. The women were
given a copy of the information sheet and consent form to keep. The study had
been approved by North Staffordshire Local Research Ethics Committee. The data
were collected using face-to-face semi-structured interviews, either at home or at a
local SureStart centre, depending on which the mother preferred. Recruitment
continued until data saturation occurred.

Measures
An in-depth semi-structured interview was carried out with each of the women. The
interviews were carried out by EHB, ST, a research assistant, or CH and took between
40 min and 1.5 h. The women were assured of confidentiality before the interview
and asked for their agreement for the interview to be audiotaped to allow later tran-
scribing and analysis and for anonymised quotes to be used in any publication.
 Journal of Reproductive and Infant Psychology 355

The semi-structured interview schedule was designed in collaboration with two

teenage mothers who had participated in a previous study of teenage pregnancy
(Chambers, Boath, & Chambers, 2002). It was piloted on a group of teenage moth-
ers attending a SureStart support group and found to be acceptable, relevant and
appropriate. The interview schedule explored:

• formal and informal support mechanisms (father of baby, family, friends, pro-
fessionals) and the support that they would like;
• information, sources of information and the information that they would like
to have and the format of that information; and
• views about support groups for teenage mothers and barriers to attendance.
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Analysis
The qualitative data was analysed using thematic framework analysis to identify
emergent patterns and themes (Ritchie & Spencer, 1994). According to Ritchie,
Spencer, and O’Connor (2003), framework analysis is an inductive, matrix-based
process, which facilitates rigorous and transparent data management and enables
researchers to work through the process without losing sight of the raw data. The
audio recordings were listened to and the interview transcripts were read indepen-
dently by two of the authors, who devised their own individual index of key con-
cepts and themes drawing on a-priori issues linked to the study objectives, as well
as issues raised by the teenage mothers. They then met to compare and contrast the
frameworks that they had developed independently to agree a unified framework.
Data from the transcripts were then applied systematically to the framework fol-
lowed by mapping and interpretation.

Results
Sample
Twenty-four teenage mothers were approached and 15 agreed to be interviewed
(63%). Of the remainder, one was ill, one had recently experienced a family death
and two could not be contacted. The others refused to be interviewed. Their ages at
the time of the interview ranged from 17 to 19 years (mean 18.8). The age range at
the time of giving birth ranged from 16 to 18 years (mean 16.9). Ten were single,
one married and four cohabiting. Scores on the EPDS ranged from 13 to 28 (mean
18). Three were students at a Further Education college and 12 were not in educa-
tion, employment or training (NEET). Nine were being treated using a young
mother’s support group run by SureStart, three had been prescribed antidepressants
and one had been referred to a counsellor via SureStart due to suicidal ideation.
Two were not receiving any treatment, or help at the time of interview.
The following four interrelated themes emerged from the interviews and high-
light the multifarious support mechanisms required by teenage mothers. The key
themes were:

(1) Stigma and perceptions of being judged;

(2) Social and professional support;
(3) Knowledge and information; and
(4) Barriers to utilising support.
 356 E.H. Boath et al.

Stigma and perceptions of being judged

Stigma emerged as a consistent theme and in line with existing literature on teenage
mothers’ experiences of stigma (Hanna, 2001; Whitley & Kirmayer, 2008; Yardley,
2008). The teenage mothers felt devalued and that they had to cope with people
judging them for becoming mothers at a young age and that people perceived them
as being a ‘bad mum’ just because they were teenagers and not fulfilling the
contemporary social norms of motherhood (Yardley, 2008). In line with Whitley
and Kirmayer’s (2008) findings, the majority of perceived looks and comments
were from strangers in shops, buses and parks and this ‘societal surveillance’ had a
deleterious effect on the teenage mother’s perceived levels of competency as a
mother and on the affective, cognitive and behavioural aspects of their everyday life
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(Birkeland et al., 2005).

AN: You are being judged all the time. I have had experiences of going where there
is older people and they look down upon you because you have children and nitpick.
Sometimes children are a mistake. Like me, I cannot say it is a mistake, but when
they are older mothers, they make you feel more guilty. They [older mothers] are
good, but they make you feel negative sometimes.

BM: The only shop I’ve been in, cause you can tell when people are talking about
you and every shop I go in people do that all the time, and in Boots that’s the only
place it doesn’t happen. See, I don’t even get the courtesy of the hand over the mouth;
I get people in the shopping centre staring at me.

Many teenage mothers had initially tried to hide their symptoms of postpartum
depression as they were afraid of admitting how they felt. Mothers voiced a fear that
healthcare professionals could take their children away from them if they revealed
that they had postnatal depression and were judged as unable to cope. They felt that
they were particularly at risk of their child being removed because of their age.

LD: I hid it for months.

SA: You feel that they might try and take your baby off you because you’re young.

TF: I don’t know what the health visitors are like, or if they are going to say things or
twist things round to say that I can’t cope. The thing is, with health visitors they’re
scared of them going to social services, which is the main concern, that’s why people
don’t speak out about postnatal depression, they keep things bottled up.

CJ: you know when you have a baby and your baby has an accident, I don’t think
they [health visitors] help. My health visitor rang me up to ask why I had taken my
baby to the hospital and if he had an accident now I would feel too scared to take
him to the hospital.

The quotes above were typical and highlighted the very real fears of teenage mothers
that their children could be removed from their care. These fears may discourage
teenage mothers from opening up about their feelings, and may act as a barrier to the
diagnosis of postnatal depression. Identifying PND and early intervention is critical as
research demonstrates that infants show developmental delays if symptoms of depres-
sion last over the first six months of the infant’s life (Field et al., 2000). They could
also discourage contact with other health care providers, which is a particular concern
 Journal of Reproductive and Infant Psychology 357

as research shows that infants of teenage mothers have increased risk of maltreatment,
and higher rates of illnesses, accidents, and injuries (Moffitt, 2002).
In addition, teenage mothers felt that the diagnosis of postpartum depression
caused other people and professionals to perceive them in a negative light and this,
yet again, undermined their confidence (Cronin, 2003).This was exacerbated if they
were refered to the Parent and Baby Day Unit (PBDU) a spacialist day hospital for
perinatatal mental health issues (Boath et al., 2003):

TF: As if to say, ‘what will other people think of me’ [about being referred to a spe-
cialist Parent and Baby Day Unit for depressed parents] about how people looked
down on me, as if to say ‘she can’t cope with a baby, what is she doing having a
baby anyway?’
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LD: I just get depressed really easily and I get paranoid, if I see two people talking
I’ll think they are on about me. They are trying to make out I’m a bad mum. I always
feel people judge me as a bad mum, because I got depressed.

Social and professional support

Research suggests that teenage mothers encounter significantly more challenges and
often have less social support and resources to deal with those challenges
(Birkeland et al., 2005). In line with previous research (Cronin, 2003), social
support emerged as a strong theme, with multiple sources of support being
identified from the teenage mother’s mother, father, partner, family members and
professionals. Having social support has been shown to ameliorate many of the
negative consequences of teenage motherhood (Clement, 1998). One of the most
valued resources to teenage mothers was peer support from the SureStart teenage
mothers group. Some of the teenage mothers also attended a parenting group. Peer
support gave these young women an opportunity to compare their experiences of
motherhood, with others in a similar situation, gain knowledge and advice and dis-
cuss some of the primary difficulties they had experienced as parents:-

AN: it was a good group. I met people my own age and they all had children.

So was it important to you that they were all your own age?

AN: Yes because they understand more what you feel may be your problems.

TF: it is easier to talk to A because she has got older children, her youngest one is
two so she kind of knows what I’m going through with him really as a toddler.

TF: it’s nice to meet different friends [at the support group] because it is hard when
your friends haven’t got children themselves. I have only got one main friend and she
hasn’t got a child of her own so it’s hard to relate to her about any problems.

However, one mother highlighted the limitations of peer support.

RB: I would be quite happy to go and sit there [with older mothers in a group]
because they could then say ‘oh as the children have grown up this happened and I
have had three and this happened to them’, they have had this illness and look out for
this whereas young mothers can’t experience you in anything because all the kids in
 358 E.H. Boath et al.

there are around the same age 3–6 months old and they are all doing the same things
and nobody can advise you on anything.

In line with previous research (Cronin, 2003), support from other professionals such as
midwives and health visitors was described by some of the teenage mothers as being
available in the short-term, but focussed primarily on any problems with the baby:

PR: The midwife explained all my birth plan, she went through all that with me, but
that was about it. My health visitor came out at first, she was helping me to feed him,
she was explaining all that to me, and the sleeping, he wouldn’t sleep at first in his
Moses basket, so she gave me advice in raising the Moses basket up. They helped me
with stuff like that, but they didn’t really do anything else.
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AM: my midwife, she was just helpful if I had something wrong at that moment, but
not after.

Developing confidence in parenting is often difficult for teenage mothers (Birkeland

et al., 2005). Similar to previous research (Moffitt, 2002), the teenage mothers had
less practical knowledge than the older mothers and felt that they would have bene-
fited from more information about household duties, as well as information about
interacting with their baby:

TF: I would like someone to help me to know how to play with him, how to do
things with him because I don’t know what to do with him, and with him coming up
to two, I don’t really know how to play with him which is kind of hard.

There were a number of different benefits from being offered professional support
via a group (Cronin, 2003). In particular, it was an opportunity for mothers to
have some respite from mothering as one mother attending a support group
indicated:

CJ: I think as well when you come here, you can say to one of the girls, can you just
watch him a sec while I go and have a fag, or while I go and get myself a drink and
when you have 10 minutes, it’s just enough to get your head together sometimes.

It was very important to mothers that the professional support they received was
responsive and easily accessible and having telephone contact with a professional
was particularly appreciated:

SA: My Health Visitor’s dead good, even if I need a tube of Bonjela [gel used to
relieve teething discomfort] she will write me a prescription.

LD: my health visitor, she’s brill, she is always there for me at the end of the phone,
if I ring her she comes straight away, if something is wrong with M she will come
straight away.

For one of the teenage mothers, being signposted to support groups had been an
opportunity to make new friends who had babies themselves:

LS Everyone’s got their own kind of people they go off with and they change num-
bers and text in the week, or ring each other.
 Journal of Reproductive and Infant Psychology 359

Similar to Cronin (2003), the teenage mothers had a clear sense that they needed to
‘know’ their healthcare professionals well before they felt comfortable enough to
talk to them openly about their feelings and any difficulties they were experiencing.
Once trust was built up between mother and professional, they could become a
resource to provide practical advice, support and information and focus on signpo-
sting to informal peer support.

RG: With [the Surestart worker] I talk about anything really because I have known
her since I was pregnant, so I have known her for four years now. We go out for a
coffee and we are just like friends really.

PG: Once I have met them I tend to be alright after that, but it’s just the first bit really,
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the first bit of meeting them. Once I met them and spoken to them a couple of times I
would probably be alright. I was the same with my health visitor, I didn’t really know
what to say to her, but once she came for a couple of weeks I was fine then.

However, the availability and appropriateness of professional support was also

brought into question. Some of the teenage mothers felt that professional support
was far from ideal, feeling that professionals could be condescending, patronising
and distant when they offered advice about mothering and there was a sense that
they were only interesting in giving instructions, rather than discussing various
aspects of parenting (Cronin, 2003; Hanna, 2001).

SS: My first health visitor, I didn’t really get on with her, it wasn’t like she was help-
ing me, it was more like she was telling me, so I had a go at her and said I didn’t
want to see her again.

TF: When I was at the hospital they would say that you’re not doing this right but
they weren’t showing you how to do things.

Worryingly, three teenage mothers reported no support from professionals, particu-

larly health visitors, saying they had never met their health visitor.

AD: I know I have a health visitor, but I have never met her.

SA: I don’t have anything to do with my health visitor, I don’t actually know who my
health visitor is …

MS: I thought I am feeling really down and I don’t want to carry on feeling
down because it will just get worse so I would go to the doctors … but they said that
you have to go to the health visitor first and do a scale and see how you come
out. But I didn’t because I haven’t really seen the health visitor, I don’t know
who she is.

Despite research that demonstrates that teenage mothers have less human and social
capital than older mothers (Moffitt, 2002), in line with previous research (Cronin,
2003), the teenage mothers in this study, primarily received their support and
derived a lot of advice and help from local family members from family members.
Having family members geographically nearby was perceived as an important
supportive resource:
 360 E.H. Boath et al.

MS: I’ve got my mum, step-dad, got my dad, I’ve got my sister. There you go I don’t
need a man!

CJ: My dad helps me a lot because he wasn’t really there when I was little, he helps
me loads.

PG: My mum and dad, my partner’s mum and dad, they watch him and have him for
a couple of hours. My mum and dad live round the corner and his dad doesn’t live
too far away.

TF: people that live quite far away say, ‘I’m here if you need me’, but it’s not as
much as you would like someone to sit with you and talk to you.
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PG: most of the stuff I needed to know I got from my sister who has had kids and
my mum and dad, so I have never needed advice from anyone else, I just turn to my
mum and dad.

There were key times when a source of constant, ongoing support was felt to be
helpful and the night-time was particularly challenging. While the teenage mothers
appreciated support that they received from family and friends, but wished that they
had someone around at times when they found mothering difficult, rather than
having to arrange specific times when support could be made available:

LD: My Nan, my uncle and auntie and from M’s fathers parents, they help a lot. Yes
and my brother and his girlfriend, they help out a lot. It’s just I still feel lonely at
night when nobody is here.

Consistent with other research (Cronin, 2003), some of the teenage mothers experi-
enced difficulty coming to terms with the responsibility associated with being their
baby’s primary carer:

PR: I’m in the middle of nowhere, on my own struggling, cause M’s dad did not
really come up much, so I always got her, so I had to cope …

Previous research demonstrates that the partners of teenage mothers are less reliable
and less supportive, both emotionally and economically (Moffitt, 2002). Few of the
teenage mothers had supportive partners to help with their babies and although
fathers were sometimes described as a good source of respite and practical support,
there was little discussion of the role they could play in the provision of emotional
support during early parenthood:

PR: When she was first born he got up in the middle of the night and everything then
it started wearing off, then he’s gone alright with her again a bit, but he won’t have
her if I want to go out somewhere … It’s hard with dads with their baby because they
just choose when they want to come and pick the kids up.

As such, fathering was often done on the fathers’ terms, rather than negotiated
between both parents. When support was provided by fathers, it was predominantly
practical support including looking after the baby, helping with housework, and
minding the baby while the mothers completed household duties. Only two of the
teen mothers interviewed reported positive support from the baby’s father:
 Journal of Reproductive and Infant Psychology 361

PG: He will take him up the park, so I can have some time on my own, he cleans up
for me, he watches him while I clean up, just bits like that really.

LK: ‘R is dead good, he comes home from work, plays with L and takes L in the bath
with him and does the dishes after I’ve done the tea.

Friends, who were not mothers, were also highlighted as unreliable, with one mum
describing how quickly her friends lost interest in her once she had the baby:

LD: I decided to go into ARCH [supportive housing] and none of my friends would
come up to see me that often and then when I found out I was pregnant they said they
would baby sit all the time, but since he has been born nobody bothers with me
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anymore. They are all just busy doing their own thing.

Two of the teenage mothers felt that they did not have anybody acting in a support-
ive role and that they were left to cope with their babies on their own:

TF: As a single mum anyway ... I haven’t got that person to rely on, or anyone to help
me at home.

AM: Nobody, gives me a hand with her. Where can I go for support, because as soon
as I came out of hospital I just come home and I thought, what a life and what have I
got at this age … when you’re in the hospital people are just like, ‘young mothers,
young mothers’ and everything seems to revolve around 16–19 year olds, but when
you come out there is nothing.

Knowledge and information

Concomitant with previous research (Cronin, 2003), there was evidence of a wide-
spread lack of knowledge about postpartum depression. Teen mothers felt that they
had experienced clear symptoms, but they were unable to attribute these to any
clear cause.

RB: I didn’t really know the meaning of it [postpartum depression] really, nobody has
ever told me about it. Nobody has ever told me what it is really … I just sit here
sometimes and I am crying for no reason, but I could have detected it earlier if some-
one had explained to me what your first symptoms were, but nobody told me.

This lack of knowledge was recognised as preventing early intervention.

AD: I think if somebody can have that information before then you know that there
might be something not right, OK people feel like this. Now I know that what I have
is a problem, but before I thought, ok maybe everybody feels like this.

LM: my health visitor thought that I might have postnatal depression and I told my
support worker and she got me information on postnatal depression, but I didn’t read
it, because I didn’t and I still don’t think I have got it, because I feel I am too young.

Three of the teenage mothers felt that presenting information electronically would
make it accessible to them as they didn’t have to leave their home and could watch
it while the baby was asleep:
 362 E.H. Boath et al.

LS: If you got some information about it on a DVD, or something for the computer
would that be useful for you to work your way through something?

PG: Yes I’m always working on the computer so it would be something else I could
do,so that would probably help.

LK: Yes because you can watch while I have got the baby on my knee, or while I’m
on the settee while he’s asleep, so yes I think that might work.

Leaflets were outlined as another potential source of information, but they would
need to be brief and targeted at teenage mothers:
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PG: I don’t really mind leaflets because if I do need to read them I do read them, but
if I don’t I won’t. So I don’t really mind leaflets, or picking them up myself, but it
would probably be best if the doctor gave them to you, when they were talking to
you about his injections or something. If they give you leaflets then it’s probably
easier than trying to find them yourself.

TF: some leaflets are just bullet pointing information. I think I would be more inter-
ested in reading about teenage mums … If you can read something quick whilst
you’re having a cup of tea, or doing something quick.

However, teen mothers were concerned about the lack of good, accessible informa-
tion about parenting and postpartum depression:

TF: just a guide on things that might come up and how to cope with things. If you do
have a bad time, how to cope with them because they don’t actually tell you …

The teenage mothers felt that the only methods of support that they were offered
for postnatal depression were antidepressants and counselling. They felt that they
had little or no choice about the type of care they received:

PG: If we had more choices really of what you could have, besides anti-depressants or
counselling, because I don’t really like taking tablets because I know what I’m on
now haven’t worked, they aren’t making me feel any better and I’ve been on them
over a month now and I don’t really like talking to counsellors.

TF: I was scared really [about being referred to a specialist Parent and Baby Day Unit
for counselling]. So it scared me really.

In line with the findings of Cronin (2003), support groups were a particularly
popular source of information for the teenage mothers. There was a feeling that the
groups gave women an opportunity to discuss their mothering skills and experi-
ences with others in similar situations:
AD: I would like much more if they help people like me. Before I started the group I
felt scared to talk, but now I feel ok and other people feel the same. If there is a
group, then I will go and you can share and support … I got leaflets, they were ok,
but I felt better when you can talk to somebody rather than just books.

TF: The support group … it’s nice because it isn’t loads of us either, like in a big
class, so it’s quite nice.
 Journal of Reproductive and Infant Psychology 363

Interviewees were asked to consider the types of information they would like to
receive from support groups, and the opportunity to discuss feelings about bringing
up a baby was a key issue:

LK: It would be useful to discuss your problems and what’s going on and how you
feel, because nobody seems to ask you that now you have got a baby, it’s ‘how’s the
baby?’, it’s never ‘how are you today?’.

CJ: Group should talk about how to look after babies properly and just sit down and
talk about my feelings.

Some of the teenage mothers felt that there would be value in these being mixed
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groups, with older and younger mothers in attendance, as well as those from different
sociodemographic backgrounds as they could learn from the experiences of other
women.

CJ: I do sometimes think it’s ok with teenage mothers, but if they have older mothers
who have been through it once and they are going through it a second time, they
could help and say, ‘well you do get over it, it may be a long dark tunnel, but you
come out of it at the other side’.

TF: it’s kind of interesting listening to other people really and the problems they are
going through. Everyone on that course comes from a different background altogether,
like people who have come out of care, people whose partners have come out of
prison, so it’s kind of a nice change really for listening. It isn’t lots of writing either …

However, not all the women felt they would be comfortable talking about their feel-
ings in front of a group of women. Some of them felt that they would find it diffi-
cult to talk in front of others as they could be judged and ‘talked about’. These
women would prefer to access a source of 1-to-1 support:

RB: you don’t always want to talk about everything when others are there because
you are wondering what they are thinking about me.

TF: It’s scary sitting in front of other people and talking about your problems, because
you don’t know what people are thinking bad against you, so it’s nice to have some-
one to speak to privately.

The gender and previous experience of the individual giving support was also high-
lighted as critical. The teen mothers felt that it was preferable for this 1-to-1 support
to be provided by a female and particularly an older female that has some life expe-
rience and had not previously been involved with the individual’s care:

RG: Not a man, because you can tell women more and not like a young woman nei-
ther, but someone in their 30s, 40s then I would be more confident then. I think with
the younger mothers, they can talk to women who are 30s, 40s because they see them
as a role model to their mum, because you can’t talk to your mum about things like
that.

TF: I suppose speaking to someone who is absolutely different, who hasn’t seen you
as a person, doesn’t know my background, it will be easier to talk. Whereas somebody
 364 E.H. Boath et al.

who already knows everything about you, it is really hard to relate to something
because you can’t just open up, because they already know things about you.

Two of the women felt that support could be provided in a more generalist environ-
ment, where there were activities for babies and young children. This was felt to be
an appropriate environment for the distribution of information about postnatal depres-
sion to women who may not have gone to a healthcare setting to seek out advice:

RG: Is there not places to go where the government should be thinking what can the
parents do, is there things that we can delegate to mothers and babies, mothers and
toddlers, mothers and kids to go and do. Is there like an activity place, can we build a
place for families to go to and not just big schools to go to?
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Barriers to utilising support

A number of barriers were outlined when the women discussed the utilisation of
support. A lack of knowledge and information about relevant local services was a
major barrier to access:

TF: you don’t really know about a lot of the support networks that are there for you.
It is daunting when you’re a young mum and you think you’re stuck on your own
now, so unless you know anything about the networks, like gingerbread for lone
parents then you’re not going to speak to anyone …

One of the mothers felt that many of the groups were aimed at women with
babies, rather than those with toddlers too. This perhaps reflects the misconcep-
tion that postpartum depression is always diagnosed within 3–12 months of child-
birth:

TF: It’s a bit awkward for me because J is two and the other young mothers all their
babies are 3 months and 9 months, so they aren’t actually at that point where they are
coming into a toddler, so it’s quite different with having a toddler and a very young
baby.

There were key difficulties where mothers didn’t have access to a car as public
transport was felt to be difficult to use, and expensive:

LK: there just isn’t enough room for pushchairs on buses and even if there is room,
some people don’t move for the prams, they think they have got the right to sit there,
so we have to wait for the next bus.

Discussion
The results are consistent with previous research and highlight the real and per-
ceived stigma that teenage mothers encounter for having a baby at a young age, a
stigma that was further enhanced when they were diagnosed with postnatal depres-
sion (Birkeland et al., 2005; Whitley & Kirmayer, 2008; Yardley, 2008).
The teen mothers’ lack of awareness of and knowledge about postnatal depres-
sion was striking, and is consistent with the findings of Logsdon and Hines-Martin
(2009). A focus on the key symptoms of postnatal depression could help to identify
postnatal depression and to elicit early intervention. Reassuring them that they are
 Journal of Reproductive and Infant Psychology 365

‘normal’ and that postnatal depression is common among teenage mothers could
allay their fears that they are ‘different’. In addition, providing reassurance to allevi-
ate their fears of their children being taken into care will be essential in meeting the
needs of this group.
In line with the findings of Cronin (2003), the need for practical, emotional and
social support was highlighted in this study. Mercer (1986) highlighted that those
teenagers who had support from their mothers and partners moved into the maternal
role more easily. Some of the mothers in this study benefitted from wider family
support networks and strengthening and enhancing these valuable support mecha-
nisms would be a useful service developments (Cronin, 2003).
However not all teenage mothers have these familial support systems and in line
with the HV Implementation Plan (Department of Health, 2011a), additional support
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may therefore be required in these circumstances.

As Cronin (2003) highlights, the young women only felt comfortable once they
had built up a trusting and valued relationship with their health visitor and other
professionals. However, not all of the young mothers had such a good relationship
with their health visitor and extremely worryingly, given the vulnerable nature of
these young women and their infant, a number reported that they did not know
who their health visitor was, or had had little or no contact with them. Building
rapport is central to any therapeutic interaction (Shakespeare, Blake, & Garcia,
2006) and this study highlights the need for professionals to be particularly aware
of the need to develop a good rapport with teenage mothers. In line with the HV
Implementation Plan (Department of Health, 2011a), additional support may be
required to build a positive and therapeutic relationship with teenage mothers
(Department of Health, 2011b).
Concordant with prior research (Logsdon, Foltz, Stein, Usui, & Josephson,
2010), the teenage mothers were clear about what support mechanisms they would
like, by whom and what methods of delivery would be most relevant and accessible
to them. Providing information specifically targeted at teenage mothers, tailored to
individual preferences, including electronic or telephone-based interventions was
highlighted.
In addition, they experienced negative public attitudes directed towards them
wherever they went, and this included their visits to community child health
centres.
Although this article has highlighted a number of key issues for teenage moth-
ers, there are several limitations. First, as all the teenage mothers we included were
in contact with services, the results may not represent the ‘hard to reach’ groups,
such as younger, less well-educated young women who are more likely to exclude
themselves from Health Visitor support (Murray, Woolgar, Murray, & Cooper,
2003). However, despite these reservations, three of the young mothers who
participated in this study reported that they did not know who their Health Visitor
was and so not all participants were fully engaged with the full range of services
available.
One of the teenage mothers (TF) was more vocal and this could have introduced
bias. However, attempts were made to select a broad range of quotes and all women
taking part were encouraged to express any views they had.
This study was carried out in Stoke-on-Trent, which has widespread deprivation
(Communities and Local Government, 2007) and associated challenges for health
and well-being that are likely to present specific challenges to working in the city
 366 E.H. Boath et al.

(National Health Service, 2011). Therefore, the findings of this study may not be
generalisable to less deprived areas.
A number of community-based interventions aimed at improving the outcomes
for teenage mothers and their children have been developed (McDonald et al.,
2009). However, this study was carried out prior to the inception of the Family
Nurse Partnership (FNP) in Stoke-on-Trent. The FNP is a model of intensive,
nurse-led home visiting for vulnerable, first-time young parents, originally devel-
oped in the US (Olds, 2006). The FNP regular visits from early pregnancy until the
child is 2 years old, building a close, supportive relationship with the mother and
guiding her to adopt healthier lifestyles, improve her parenting skills and become
self-sufficient. Stoke-on-Trent is taking part in a national evaluation of FNP due for
completion 2013. However, a recent multifaceted evaluation of Stoke-on-Trent FNP
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highlighted its main strength as long-term client engagement, strengths-based

working, use of a multi-disciplinary team, reflective practice and shared learning
(Gidlow, Ellis, Punnett, Boath, & Stewart, 2012). In light of the FNP intervention
and the specialist nurses who support teenage parents, the results of this study are
not replicable in Stoke-on-Trent, but may be in other similar areas that do not have
this service provision.
Overall, this study highlights the need for both professional and familial support
that takes into consideration the individual needs of each teenage mother. In addi-
tion, information should be specifically tailored to teenage mothers needs and this
could be targeted at reducing stigma as well as providing information about postna-
tal depression and the treatment that they need.
Service providers need to base their interventions on research carried out on
teenage mothers, instead of generalising from adult mothers (Cronin, 2003) and in
line with Hanna (2001) it is suggested that health professionals take a different
approach when working with teenage mothers. Just as research has been carried out
to identify and explore the support needs of adolescents in order to promote a
positive childbirth experience (Sauls, 2010), similar research is needed in order to
promote a positive parenting and postnatal life and care experiences for teenage
mothers. Thus further research is needed to explore the postnatal needs of teenage
mothers.
A recent Lancet editorial on infanticide by a mother with postnatal depression
concluded: ‘we can help change the culture in this country. We can insist that
everyone counts. That everyone matters. And that no-one dealing with any form of
illness should be ashamed’ (Lancet, 2012). For teenage mothers, this culture change
is well overdue.

Acknowledgements
The study was funded by North Staffordshire Medical Institute the authors are very grateful
for the data collection undertaken by Stephanie Tooth, Research Assistant.

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