articolo 3 michela

1. ARTICLE IN PRESS
Social Science & Medicine 64 (2007) 112–124
www.elsevier.com/locate/socscimed
Irreconcilable differences: Health professionals’ constructions of
adolescence and motherhood
Mary BrehenyÃ, Christine Stephens
Massey University, Palmerston North, New Zealand
Available online 29 September 2006
Abstract
Adolescent motherhood has been associated with negative health outcomes for both adolescent mothers and their
children in many studies. Although the link between early motherhood and disadvantage has more recently been
questioned, professional understandings continue to focus on hardship and social exclusion. Social constructionism
provides a critical approach to the professional constructions of adolescent motherhood. Using discourse analysis,
transcripts of individual interviews with 17 New Zealand health professionals working in a variety of settings were
analysed to examine the discourses used to construct adolescent motherhood. During the interviews, doctors, midwives,
and nurses drew upon ‘Developmental’ and ‘Motherhood’ discourses to position adolescent mothers as problematic. The
‘Developmental’ discourse positions young mothers as ‘adolescents’ who are naive, distracted, and self-centred, and hence
unable to mother correctly. The health professionals also employed a ‘Motherhood’ discourse that attributes certain
behaviours to ‘good’ mothers. These discourses were drawn upon to illustrate how the characteristics of an ‘adolescent’
cannot be reconciled with the attributes of a ‘good’ mother. These constructions have implications for health care
provision for adolescent mothers in New Zealand.
r 2006 Elsevier Ltd. All rights reserved.
Keywords: New Zealand; Adolescent mothers; Motherhood; Adolescence; Health professionals; Discourse analysis
Introduction outcomes such as psychological functioning (Deal &
Holt, 1998; Hudson, Elek, & Campbell-Grossman,
Adolescent motherhood has typically been 2000), parenting competence (Flanagan, McGrath,
framed as a social problem. The standard approach Meyer, & Garcia Coll, 1995), child neglect and
has been to investigate associations between early abuse (Garrett & Tidwell, 1999), socio-economic
parenting and a range of negative outcomes for status, employment, and educational attainment
mother and child. Younger mothers have been (Coley & Chase-Lansdale, 1998). The public health
disadvantageously compared with older mothers on literature has drawn attention to the relationship
between adolescent motherhood and negative
ÃCorresponding author. Tel.: +64 6 356 9099 2069; health outcomes such as lower birth weight infants
(Corcoran, 1998; Koniak-Griffin & Turner-Pluta,
fax: +64 6 350 5673.
E-mail addresses: M.R.Breheny@massey.ac.nz (M. Breheny), 2001), and lower rates of immunisation than for the
C.V.Stephens@massey.ac.nz (C. Stephens). infants of older mothers (Morrow et al., 1998). The
0277-9536/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2006.08.026

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M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 113
children of adolescent mothers are less likely to adolescent mothers are often characterised as
attend newborn health visits (Specht & Bourguet, insensitive and impatient towards their children
1994), have increased rates of accidents and hospital and as having inferior mothering skills compared to
admissions (Corcoran, 1998), and are two to three older mothers (Ruff, 1990; Secco, Ateah, Wood-
times more likely to die in the first year of life than gate, & Moffatt, 2002). These understandings of
the children of older mothers (Phipps, Sowers, & adolescent mothers are supported by research which
Demonner, 2002). These associations between found that the physicians’ view adoption and
adolescent motherhood and poor psychological, abortion as preferable to becoming a mother in
socioeconomic, and health outcomes provide a adolescence (Powell, Griffore, Kallen, & Popovich,
bleak picture, suggesting that adolescence is an 1991). Most health professional literature draws
inappropriate period for childbearing and causes attention to the need to ‘manage’ adolescent
significant disadvantage for both mother and child. pregnancy (James, 2000) and ‘assess’ adolescent
Alternative approaches have drawn attention to mothers (Roye, 1995).
the positive impact of parenthood in adolescent Accordingly, adolescent mothers report feeling
mothers’ lives (Arenson, 1994; Kirkman, Harrison, under surveillance by health professionals. de Jonge
Hillier, & Pyett, 2001; Merrick, 2001; Seamark & (2001) found that adolescent mothers reported
Lings, 2004). Motherhood has been acknowledged feelings of being watched, and fear losing their
as one avenue of fulfilment and identity for poor baby if they were not seen to be coping. Adolescent
and disadvantaged women who are more likely to mothers experience health professionals as patron-
become pregnant early (Luker, 1991; McDermott & ising (Kirkman et al., 2001; Rozette, Houghton-
Graham, 2005; McRobbie, 1991). Early mother- Clemmey, & Sullivan, 2000), expect to be treated in
hood may also address the poor health and limited a condescending manner (de Jonge, 2001) and are
employment opportunities for disadvantaged min- relieved and grateful when treated well (Folkes-
ority group members (Geronimus, 1991; Geroni- Skinner & Meredith, 1997). Adolescent mothers’
mus, 1992; Geronimus, 2003; Geronimus & fear of surveillance by health professionals is viewed
Korenman, 1993). Despite this positive and con- as a problem to be addressed; however, reduction of
textualised view of adolescent motherhood, the surveillance cannot be reasonably achieved in the
professional view focuses on negative outcomes. social context in which adolescent mothers are also
For example, Macleod and Weaver (2003) generally viewed as dubious parents.
report that many adolescent mothers are well There has been little attention paid to the role of
adjusted to their pregnancy, but this ‘rosy’ picture health professionals themselves in mediating ado-
must be considered in the context of poor antenatal lescent mothers’ access to health care and subse-
care and low levels of educational participation. quent impact on health outcomes. Research on
Similarly, Merrick (2001) acknowledges adolescent factors related to seeking or delaying prenatal care
mothers’ positive hopes but questions their ultimate in pregnant adolescents identified factors such as
success. Consequently, positive views of adolescent adolescents’ health during pregnancy and relation-
mothers are often interpreted as indicative of ship with their own mother as important in
youthful idealism, and compared to statistics differentiating early and late attenders for
of disadvantage and social exclusion that dominate prenatal care (Lee & Grubbs, 1995; Simms & Smith,
professional understandings of adolescent mother- 1984). These studies did not investigate any
hood. influence of the health provider characteristics on
attending for prenatal care. Lee and Grubbs (1995)
Health professionals did report that young mothers who sought
early care were more likely to agree to be
Adolescent mothers are viewed within the health interviewed than those who received late prenatal
professional literature as presenting ‘‘unique chal- care, suggesting that those who delay prenatal
lenges’’ (Davis, Burke, & Braunstein, 2001, p. 478; health visits may not trust the health care system.
see also Robinson, 1992). They are assumed to lack Others have suggested that health care providers do
parenting skills, be unable to provide accurate contribute to utilisation of health care (Ray, 1997),
observations of the infant, and require cautious that the relationship with health professionals
handling as they are often intimidated by health can empower or diminish adolescent mothers
professionals (Davis et al., 2001). In addition, (SmithBattle, 2000), and that mothers’ experience

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114 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124
of health care reflects the prevailing values of health Method
professionals (Lawlor & Shaw, 2002). Focusing on
health professionals deflects attention from adoles- Participants
cent mothers as deficient, and addresses the social
context of the health of adolescent mothers and Seventeen health professionals from the Mana-
their children. watu/Whanganui region of New Zealand who were
working with teenage mothers participated in inter-
views with the first author. The participants
The social context of health care included five doctors, five nurses, six midwives,
and one antenatal education worker. They worked
In response to adolescent mothers’ perception of in a variety of settings, including a community-
surveillance, there are suggestions in the health based health centre, private practice, medical centre,
professional literature that adolescent mothers Family Planning Clinic, rural health centre, com-
require non-judgmental care by health professionals munity nursing, independent midwife practice or
(see Better health services for teenage mothers, hospital. The experience of the participants included
1998; Clark, 2001; Hawksley, 1996; James, 2000; providing antenatal and postnatal care, general
Michels, 2000; SmithBattle, 2000), who are seen as practitioner care, education for pregnant teenagers,
the locus of negative views. Salladay (1997) reflects and coordinating young mother groups.
this understanding when describing prejudice
against adolescent mothers which ‘‘involves stereo- Procedure
typing and thrives on ignorance’’ (p. 28).
Within a social constructionist framework, these Ethical approval for this project was gained from
‘prejudicial’ attitudes are understood not as located the Massey University Human Ethics Committee,
in individuals but within wider social understand- Manawatu/Whanganui Ethics Committee, and the
ings. Social constructionism is an epistemological Plunket Society Ethics Committee. Information
position, which maintains that knowledge is inti- sheets outlining the study and requesting participa-
mately entwined with social process and social tion were distributed to health care practitioners in
structure and draws attention to the role of a variety of settings and health professionals
language in providing the categories we use to responded by telephoning the researcher to discuss
construct the world (Gergen, 1985). Health profes- the study or to make an appointment for an
sionals’ construction of adolescent mothers can be interview.
considered as discursive practices, which involve The interviews, which were audio-taped following
claims that categorise adolescent mothers in certain information and consent, ranged between 30–90 min
ways. One social function of these categories is to in length. They followed a semi-structured
separate adolescent motherhood from later mother- format with questions about the participants’
hood. These discursive practices of categorisation experience of providing health care for adolescent
involve comparing adolescent mothers to older mothers and their views of the health care needs
mothers on medical statistics, on marriage and of adolescent mothers. Additional questions
welfare receipt, and by drawing on understandings were asked as issues arose in the interview.
of appropriate adolescent development and mother- The interviews were professionally transcribed,
hood to justify separation. Thus, ‘attitudes’ towards the transcripts checked by the interviewer, returned
adolescent mothers do not reflect individual pre- to participants who had requested this, and correc-
judice or mistaken stereotypes, but the socially tions to the transcripts by these participants were
shared constructions of development, family struc- made.
ture, and motherhood that adolescent mothers
challenge. This focus on the social construction of Analysis
adolescent motherhood and the role of health
professionals in mediating health care provides the The discourse analysis used in the present
impetus for the present research, which examines research is based on the assumptions of social
the constructions of adolescent mothers drawn on constructionism and ‘‘sees discourse as embedded in
by health professionals involved in the care of relations of power that form systems of constraint
young mothers. which regulate social actions’’ (Burkitt, 1999, p. 69).

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M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 115
This approach to analysis concentrates on how Results and discussion
current power relations are reproduced through
discourse, and acknowledges the role of the This section focuses on two important discourses
discursive in constructing inequality. Power cannot identified in the analysis, which have been labelled
be reduced to the discursive, however, as it also the ‘Developmental’ discourse and the ‘Mother-
functions through the social relations and institu- hood’ discourse, with examples of how they were
tionalised practices in which the discourses are used by the participants. Examples from the data
embedded. Based on the writings of Foucault, this demonstrate how these two discourses were used
approach to discourse analysis attends to issues of together in practice to position adolescents as ‘bad’
power and knowledge and how they are created and mothers. Finally, the implications that these con-
maintained through language (Parker, 1990a, structions have for the health care of adolescent
1990b, 1992). mothers will be considered.
Discourse analysis involves identifying the so-
cially available ‘discourses’ around which language ‘Developmental’ discourse
is organised. A discourse is a set of meanings,
images and statements that work together to The health professionals used a ‘Developmental’
construct an object, or a class of people in a discourse to talk about young mothers as having a
particular way (Burr, 1995). These constructions do set of shared characteristics common to the devel-
not merely describe phenomena, they enable some opmental stage of ‘adolescence’ and which, in turn,
ways of being in and seeing the world and constrain determined their mothering abilities. The ‘Develop-
the other ways. Consequently, discourses make mental’ discourse includes adolescence as a devel-
possible different subject positions (Korobov, opmental category, which is distinguished from
2001), which include related rights and obligations childhood and adulthood and described by one
for the subject, and a location for a person within midwife in this way:
this set of rights. This approach has been used to
Teenagers are not adults and they’re not children
focus on how health professionals construct adoles-
and they’re really in their own development stage
cent motherhood, how these constructions provide
(Midwife 2).
subject positions for adolescent mothers, and how
they serve to reinforce existing power relations and Positioning young mothers as ‘adolescents’ draws
institutional practices. attention to their position in this transitional stage
To conduct the analysis, extracts from the from childhood to adulthood. This transition was
transcribed interviews were coded into categories. constructed as a normal part of the development of
For example, the category ‘Teenage Characteris- a young person and as a stage of life that must be
tics’, with its subheadings, was developed from the traversed to achieve maturity as an adult. Although
discussions of the variety of attributes typical of adolescence was often seen as a time of difficulties,
adolescents. The categories were grouped into wider this development towards maturity was generally
themes, and these themes were used as a basis for seen as quite separate from the maturing effects of
the identification of the sets of words, images, and life experiences such as pregnancy and birth. Thus,
tropes that constitute ‘discourses’, or coherent ways development through the stage of adolescence is a
of talking about particular objects. The focus on process of simply adding years to the young
adolescents having particular shared characteristics women’s age, rather than negotiating particular life
related to their age was seen as part of a wider stages and skills. The health professionals described
discourse of life span development that was labelled the development of adolescents as requiring only
the ‘Developmental’ discourse. In addition, we time, which would result in:
looked for evidence for the subject positions;
Just the general maturity and confidence, quite
that is, the ways in which a discourse of develop-
different when you’ve just got a little bit, a few
ment positions a person of a certain age as a
years under your belt (Nurse 3).
subject with particular rights and responsibilities.
Extracts for the different categories were used to Although some participants said that individuals
illustrate the broader discourses being drawn upon matured at different rates, the maturing effect of age
by health professionals in discussing adolescent itself was constructed as paramount. These under-
motherhood. standings of development and shared adolescent

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116 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124
characteristics formed the basis of what it means to They’re teenagers, distracted (Midwife 1).
be an adolescent. The ‘Developmental’ discourse is Teenagers live by the seat of their pants; they
privileged in psychological and developmental don’t think ahead generally (Doctor 5).
theory, where psychosocial development is under-
The adolescents’ inability to plan was drawn upon
stood to occur across the lifespan in universal
to account for their pregnancy, their poor atten-
stages. Adolescence is viewed as a transitional stage
dance at health visits and antenatal classes, and
between childhood and adulthood that prepares the
their haphazard approach to baby care. As one
person for adulthood (MacLeod, 2003). The ‘Devel-
midwife stated:
opmental’ discourse is widely available as a resource
in the scientific literature, as when Flanagan et al. These youngsters, oh well, pregnant, baby, we’ll
(1995) state that irrespective of individual differ- have it to love and all the rest of it, but you don’t
ences, ‘‘it is clear that adolescent mothers are think further ahead (Midwife 6).
adolescents first. Motherhood does not confer
The typical teenager was also constructed as
adulthood, nor does motherhood necessarily hasten
possessing a number of socio-emotional character-
developmental progression’’ (p. 276).
istics. These included being self-centred, moody,
The health professionals drew on this discourse to
insecure, irresponsible, unreliable, and having low
construct adolescents as sharing a number of
self-esteem. The following quote shows how ado-
cognitive, social, emotional and behavioural char-
lescents are constructed as self-centred, and how
acteristics because of their developmental ‘stage’.
this inevitable focus on the self can be used as a
Sometimes, the speakers indicated this shared
device to encourage adolescents to follow profes-
construction of adolescence by describing them as
sional advice:
a ‘typical teenager’. Often, additional descriptions
of typical teenage behaviour were offered: If you give advice say, it’s very important you put
it in a way so it benefits them, only them, because
I think one of the reasons [they don’t attend
they’re No. 1 in the world, so instead of saying
antenatal classes] is just being a teenager, I can’t
well if you for example breast feed your baby will
be bothered. I don’t need it, that kind of thing, or
be really well off because it gets a lot of, the
just poor time management (y) Just again
immune system is boosted say for the baby and
typical teenager behaviour like often smoking,
it’s really good because it will thrive, it is the best
drinking, partying, you know (y) it’s just the
food for the baby. It’s probably not going to
normal teenage situations that you have to be
make any difference to them. But if you say
aware of (Midwife 4).
you’re breast feeding and boy, your body will get
This speaker drew upon the shared understanding so much better because you’re doing it, it will
of what it means to be a teenager to invoke an make more sense and that’s what they will grasp
explanation of lack of attendance at antenatal (Midwife 2).
classes and then provided some specific examples
In this extract the adolescent mother is constructed
of what it means to be a teenager. In this way
as unable to place the needs of the baby ahead of
smoking, drinking and partying are constructed as
herself and this self-centred approach is part of the
typical of those positioned by their chronological
developmentally appropriate view that they are
age as ‘adolescents’ within a ‘Developmental’
‘‘No. 1 in the world’’.
discourse.
Financial priorities were described as poor, as in
A number of characteristics and situations are
the following extract where a midwife describes
constructed as typical of individuals positioned as
adolescent mothers as having enough for lotto
‘adolescents’ within a ‘Developmental’ discourse.
tickets, smoking, and spending extravagantly on
Not all of these attributes were drawn upon by all
gifts while their family has insufficient food.
health professionals interviewed, but together they
illustrate what it means to be an ‘adolescent’ within They haven’t got the money, and finances has
this discourse. Across the health professionals’ talk, become an issue. But there are things um, for a
an ‘adolescent’ was constructed as displaying poorly lot of these kids the smoking and the lotto ticket
developed cognitive abilities. The typical teenager and everything else are far more important than
was constructed as distracted, having a short things for the baby. And then when they get
attention span, and lack of foresight. pregnant their friends will come in with these

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M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 117
exotic, exotic toys that cost an absolute fortune, Usually teenagers are healthy, strong people who
and their family’s missing out on food because grow pretty healthy babies (y) usually they’ve
they’re not, they’re buying the flash things that got, they’re healthy, they’re very young, very
you see on television (Midwife 6). forgiving bodies (Midwife 4).
I think physically we were made to have children
The immaturity exemplified by poor financial younger and I do honestly believe that and I
priorities is also highlighted by the young mother‘s think that looking at women who have children
choice to spend their money on toys that have been later, it’s physically very hard on them (y) So I
seen advertised on television. The adolescent mother think energy wise we were supposed to have them
is positioned as developmentally unable to avoid the younger (Nurse 1).
enticing advertising of toys.
The typical teenager was also described as prone A ‘Developmental’ discourse is used to position
to poor eating habits, risk-taking behaviours, an both adolescent mothers and older mothers’ out-
active social life, and risky living situations. The comes as determined by their age. The youth of the
teenager’s nutrition during pregnancy was the adolescent mother is constructed as providing
subject of comment by health professionals, as in: energy and health, while the older mother suffers
physically from pregnancy and childbirth.
Teenagers eat a lot of takeaways and muck and In summary, adolescence is seen as a necessary
you know (Nurse 5). and normal part of development, but a time when
teenagers are seen as self-centred, naive, and image
The nourishment adolescent mothers provided for
conscious, sociable and healthy. These traits were
their children was also seen as poor:
seen as aspects of adolescence that would be
They didn’t have the fundamental information resolved given the adolescent had time to mature.
on what is a good diet for my baby, is it okay to In these interviews, health professionals used the
give my baby Milo in a milk bottle, a bottle for ‘Developmental’ discourse, in which age is the
their milk, is it okay to give my baby a king size defining feature of individual maturation, to attri-
Mars bar for breakfast as well as some Cheezels bute a number of negative, though age appropriate,
(Educator). characteristics to adolescent mothers. Age and stage
of maturity are assumed to play a crucial role in
Adolescents were seen as socially gregarious, explaining parenting among adolescents.
requiring sustained peer interactions and an active
social life: ‘Motherhood’ discourse
You know like getting out and about which is An important resource used by the health
what all young teenagers like doing, they like professionals was a ‘Motherhood’ discourse. This
getting out and about and going out to this and ‘Motherhood’ discourse includes the prescription of
going out to the next thing (Nurse 3). certain behaviours as appropriate for mothers and
The fact that they don’t actually want to be tied of others as inappropriate. The discourse of
to these kids, they want to, they still want to ‘Motherhood’ draws upon love or affection for the
go out with their friends and play and do child as the most basic aspect of motherhood. The
all the things that teenagers should be doing maternal love of the adolescent mother for her child
(Midwife 6). is constructed as equivalent to that of the ideal
family, which is epitomised by the ‘‘devoted
The second extract emphasises that a focus on
couple’’:
friends and play is necessary for the life stage of
adolescents and is what they should be doing. The, certainly though, the love that the teenage
Within this catalogue of teenage attributes, was mother feels for her baby, especially in the first
one positively regarded aspect: physical health. year is exactly the same as the love that that
Teenagers were described as being beautiful, dy- devoted couple feel, so you couldn’t compare the
namic, and energetic and this was related to their affection in that first year from either, I would
physical health. Some participants described ado- say it would be on a par that would be my
lescence as a good time for childbearing physically, opinion. Possibly it starts to deteriorate after
with easy birth and recovery and healthy babies. that. As the child gets older and gets a mind of its

7. ARTICLE IN PRESS
118 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124
own, the couple that have the support and the about food and rather than just diving down and
money of each other are going to go down a getting fish and chips and, they don’t sort of
different road than maybe the teenage mother think about the whole family thing because
who’s trying to find herself, yes, I think it starts maybe they haven’t been in a family thing
to deteriorate after the first year. Not always, but (Midwife 6).
often (Nurse 2).
This quote shows how the ‘good’ mother is
Maternal love was constructed as a basic prerequi- contrasted and defined by the adolescent mother’s
site of the ‘good’ mother. Throughout the interviews behaviour. The ‘good’ mother does all those things
many health professionals constructed adolescent that the young mothers described here do not. In
mothers as capable of this basic aspect of ‘good’ general, ‘good’ mothers were viewed as attending to
motherhood. These aspects can be seen as reflecting the child’s needs first and placing their own needs
motherhood as a basic natural instinct that is second. Here, it is shown by the young mother
attached to physical motherhood (Guendouzi, either lugging the baby around or alternatively,
2005; MacLeod, 2001). reluctantly caring for the child at all: ‘‘I suppose I
However, there is more to being positioned as a ought to feed it’’. The ‘good’ mother eats a
‘good’ mother than displaying love and affection for nutritionally adequate diet to ensure good health,
your child. The health professionals in this study unlike the diet of takeaways and packet meals of the
described the ‘good’ mother as having parenting adolescent mother. Convenience foods and lifestyle
skills: were seen as incompatible with the appropriate
Because they’re young and so, it’s not something situation for raising a child, that is, within an intact
that comes, parenting skills don’t come naturally, nuclear family structure that involved preparing
you have to be taught parenting skills, I mean meals at home, restricted social life, and a struc-
there are obviously, you feel for your child tured routine.
because you’re a parent but apart from that ‘Good’ motherhood involved speaking to the
you need to learn those parenting skills baby, and stimulating the baby’s development. Part
(Doctor 4). of this care also involved having realistic expecta-
tions of the child’s development and responding
The adolescent mother is constructed as posses- accordingly. The following extract show how the
sing the feelings that any mother would feel, but not adolescent mother is constructed as an inadequate
having sufficient skills and abilities to qualify as a mother through a lack of attention to the baby:
‘good’ mother. Most constructions of ‘good’
motherhood in the health professionals’ talk was And after the first week she decided, I’m bored
illustrated by examining how adolescent mothers [laugh]. In fact, I want to go back to work. I
deviated from the attributes of ‘good’ mothers, or don’t find it much fun looking after this baby.
how they differed from older mothers, (who were And she started going out at night for long
usually automatically attributed with ‘good’ mother periods of time and of course that’s when her
status). Thus, the ‘good’ mother provides the unseen mum got involved again and kept phoning me
backdrop against which the adolescent mother is the and saying you know I’m really worried about
pathologised other (MacLeod, 2001). The following her, that she’s not looking after the baby, that
quote shows how the adolescent mothers’ behaviour she lets him cry, she just feeds him and she puts
was used to describe an alternative ‘good’ mother him down because she’s bored with him, and
position: she’s, there’s [only] so much dressing and
undressing you can do (Midwife 3).
They, well, they’ll either go absolutely overboard
and just the kid’s lugged around the whole time, The adolescent mother is constructed as a child
which doesn’t do baby any good at all because playing with a doll; when she becomes bored she
they actually need a fairly placid, peaceful wants to toss it aside. The adolescent mother is
existence to begin with. Or else they, ‘‘Oh, I’ve denied the ‘good’ mother position as her interaction
got a baby there, I suppose I ought to feed it, it’s is constructed as engaging the child as an inanimate
crying’’, um, they don’t, I mean think like let’s object. When she does not provide this care she is
get and sort of vaguely have a routine in our viewed as having bored of the game. Within this set
lives, and go out and go for walks and think of possibilities, the adolescent cannot be constructed

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M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 119
as a ‘good’ mother who is genuinely responding to assumption that the discussion of adolescent
her child with interest and affection. motherhood is based upon. The relationship be-
Other characteristics of the ‘good’ mother in- tween the mother and child are foregrounded and
cluded the expression of emotions such as pride in the wider structural relations are obscured (Bur-
pregnancy and parenthood, and joy in motherhood. man, 1994). These structural inequalities limit the
Being interested in reading about and planning discursive possibilities of adolescent mothers’ iden-
pregnancy was also seen as an important part of tities, relationships and mothering practices
‘good’ mothering. Some health professionals indi- (McDermott & Graham, 2005).
cated that older mothers had considered what sort
of mother they would like to be and this planning Adolescent mothers
was seen as an important aspect of ‘good’ mother-
ing. This analysis has focussed on three aspects of the
They haven’t read much, they haven’t experi- health professionals’ use of the ‘Developmental’ and
enced many other friends with babies, because ‘Motherhood’ discourses to construct adolescent
when you’re in your 30 s or whatever you’ve seen mothers. First, teenage mothers were constructed
quite a few kids around and you think well, and primarily as adolescents—as distracted, self-ob-
you’ve seen different situations and you think sessed, and image-conscious—which meant that
well, I’m not going to do that with mine young mothers were most likely to be positioned
(Nurse 3). as ‘bad’ mothers on the basis of their age alone.
Second, these discourses offer positions that are
The construction of the ‘good’ mother with the potentially contradictory because the behaviours
health professionals talk can be seen to reflect one attributed to adolescents are not those appropriate
sort of motherhood—that is, middle class mother- for mothers. Third, this primary positioning as
hood among educated women. Such women can be adolescents in a ‘Developmental’ discourse meant
expected to read about and plan pregnancy, to take that the contradictions in the two discourses were
pride in their developing pregnancy and the positive often used to position adolescent mothers as ‘bad’
response that they receive to their pregnancy. mothers in the health professionals’ talk. In this way
Having access to the norms of appropriate devel- the positive identity of motherhood as conferring
opment and the current professional wisdom on self validation and social approval is denied
appropriate discipline, they are likely to respond to adolescent mothers (McDermott & Graham,
their children in ways viewed as positive by health 2005). These three aspects of the analysis are
professionals. Motherhood for middle class women illustrated in turn below.
has meaning in a particular way that it does not for
poor working class women under 20. Many of these
young women are not planning pregnancy (Seamark Adolescent positioning as primary
& Lings, 2004), and consequently have not con-
sidered the type of parent they intend to be. They do Becoming a mother was viewed as not altering the
not see motherhood as something that must be primary position as an ‘adolescent’, as shown in the
undertaken only after they have reached maturity, following quote:
but as a route to maturity and adulthood (Davies, Just because they’re having a baby doesn’t make
McKinnon, & Rains, 1999). In addition they may them grow into adults, and people, health
read little and see motherhood as a natural and professionals I think, think that, that if a
spontaneous role that they will develop (Abel, Park, teenager has a baby that she becomes the mother,
Tipene-Leach, Finau, & Lennan, 2001) rather than that’s true, but she becomes a teenage mother
a set of correct behaviour and principles that must and so therefore she is still a teenager
be mastered. As such, the ‘good’ mother is as much (Midwife 2).
who she is as what she does (Chase & Rogers, 2001).
The ‘good’ mother is White, middle class, married, This midwife constructed adolescent mothers as
heterosexual. MacLeod (2001) argues that the fundamentally developmentally unchanged by
literature on adolescent parenting relies on the motherhood and emphasised that the developmen-
invention of ‘good’ mothering. The characteristics tal life stage is the most important defining feature
of the ‘good’ mother are the taken-for-granted of parenting status.

9. ARTICLE IN PRESS
120 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124
As the young woman was positioned primarily as This speaker suggests that prioritising nice clothing
an ‘adolescent’, then her behaviours were ascribed over accommodation needs is typical for an
to this primary positioning. ‘Adolescent’ behaviours adolescent while also showing that these are poor
are not appropriate to ‘good’ mother behaviours priorities by comparing them to the choices an older
and so the teenage mothers were positioned as ‘bad’ mother might make. This same sort of comparison
mothers. The adolescent was constructed as self- was often made either with women of a specified
obsessed and less concerned about her babies than age, as above, or by comparing the adolescent
herself. Respondents talked about the concern with mother with a ‘‘more mature woman’’:
body image, young mothers’ desire for social
Whereas a more mature woman knows that the
activities, and their ignorance about nutrition, as
baby’s there and has to be the first, you know,
attributes that were detrimental to parenting. Such a
has to take the first preference or priority and she
self-centred approach to pregnancy and childcare is
wouldn’t be looking at having a night on the
contrary to our notions of appropriate mothering
town, that type of thing (Doctor 4).
and this was often explained by using the contrast
with the concerns of an older mother. For example, In this way, the health professionals indicated that
one participant stated that adolescent mothers’ adolescent mothers behave as ‘adolescents’ and
preoccupation with self and concern about stretch consequently do not make behavioural choices
marks and body shape rather than the health of her compatible with ‘good’ motherhood.
baby would seem ludicrous to an adult, but this was
just the way that teenagers were. Adolescent mothers as separate from older mothers
And so an adult might just think this [concern The subject position of an ‘adolescent’ in a
with stretch marks] is absolutely ludicrous ‘Developmental’ discourse does not fit well with
because, so what if you’ve got stretch marks, the subject position of mother, and the health
it’s much better for this baby to come out professionals often attempted to make the two
healthy, what can they do? Well that’s just not different positions clear. One nurse explained:
how it works for young women, and we just need
Well they’re still, just because they become
to understand that and change our way of
mums, they don’t stop being teenagers. So
providing the care for them (Midwife 2).
they’ve still got the teenage tendencies, problems,
whatever you like to call it, they’ve still got those
This self-centred approach was often contrasted
things going on in their head, whereas people
with the views of an adult mother, who was
that are, mothers that are in their late 40 s or so
unproblematically positioned as the mother who
have been through the teenage years yand
focuses on the child rather than herself.
they’ve got a different set of things that are
Indeed, much of the positioning was achieved by
concerning them at the time (Nurse 3).
comparing adolescent mothers to older mothers.
The older mother was positioned compatibly as A clear separation of the adolescent mother from
both the ‘adult’ and the ‘good’ mother who makes the adult mother is achieved here by comparing
responsible choices for her child. teenagers to much older mothers in their late forties.
This comparison emphasises the different concerns
I think sometimes their priorities are, yeah, of these groups who are separated by 25 years of age
different, you know, they’re concerned about I because the same gulf of separation may not be as
suppose like clothing, the baby has to have the apparent if teenage mothers were compared to
right pram and the right clothes, but perhaps she mothers in their twenties. One reason that such
doesn’t have the best accommodation or um extreme comparisons must be used is that, although
yeah, that’s all, that image is all important for child and adult are very clear subject positions,
them and an adolescent that’s quite true, but ‘adolescence’ does not always have the same well-
yyou know, say a 28-year-old may not see the defined status. It has unclear boundaries that are
importance of having nice baby clothes where she further confused by the addition of motherhood
thinks perhaps the accommodation they live in status.
and the amount of food that they get is more This separation is also achieved by showing that
important (Midwife 5). the adolescent mother cannot cope with the

10. ARTICLE IN PRESS
M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 121
demands of motherhood that would be common- explicitly, such as when the social activity of
place for the older mother. In the following quote a teenagers was seen as detrimental to the develop-
midwife explains how difficult it is coping with two ment of routine and good sleeping habits in young
children closely spaced, and concludes that this level babies. At other times the talk drew upon the
of demand would be untenable for the young socially available position of the ‘good’ mother (or
mother. at least, one social group’s version of the ‘good’
mother), to illustrate how adolescents deviate from
And the ones that I have been involved they’ve
these practices. In this way, the primary subject
found it really really difficult and the baby had to
position of ‘adolescent’ was made compatible with
be adopted out or given to somebody else to care
the position of ‘bad’ mother within the ‘Mother-
for: it’s just very difficult (Midwife 2).
hood’ discourse.
However, having two children closely spaced is Because the young mothers were primarily posi-
commonplace among adult mothers and is unlikely tioned as ‘adolescents’ on the basis of their age, any
to be viewed as a difficulty or considered as grounds of their behaviours were more likely to be inter-
for adoption. The doctor quoted below also preted in terms of this ‘adolescent’ subject position.
concluded that closely spaced children were parti- This resulted in some anomalies in the descriptions.
cularly problematic for the younger mother: For example, the behaviours attributed to ‘good’
mothers included pride and pleasure in pregnancy
It’s hard enough bringing up one child, and it’s
and parenting, but only if the mother was an adult.
hard enough bringing up one child with a
In contrast, adolescent pride and pleasure was
partner, it’s really difficult. Without support
constructed differently. Health professionals said
and without, and then if you want two or three
that many young women responded with pleasure at
children it’s, things go wrong shall we say
the thought of pregnancy, even if the pregnancy was
(Doctor 3).
unplanned:
The doctor here suggests that more than one child
would be very problematic and concludes with the Some, the younger women tend to get all clucky
very vague warning that ‘‘things go wrong shall we and if they want to carry on this pregnancy, it’s
say’’ to suggest that unspeakable difficulties will lovely and the scan was gorgeous and nobody
befall the young mother with more than one child. sort of seems to take on board that this is going
The doctor above has also already categorised the to be you know years of broken sleep and years
adolescent mother as single and unsupported and of not being able to go out, years of dirty nappies
this unquestioned categorisation is drawn upon to and so on and so on and so on, they think it’s
justify the outcome that ‘‘things go wrong’’. It is not wonderful, they think it’s like y It’s immature, I
clear whether the youth of the mother is being mean these are immature people, they have an
drawn upon to account for these outcomes, or the immature reaction to it (Doctor 3).
assumed single status and lack of support, and
ultimately it does not matter, as the talk works to This enjoyment was described as a naı¨ ve and
construct the adolescent mother as on the brink of immature reaction that failed to acknowledge the
tragedy. These quotes are used to separate adoles- hard realities of parenting. Yet this same joy in
cent mothers from older mothers and suggest that motherhood is seen as a requirement of the ‘good’
normal life course progression such as having mother when combined with adulthood.
further children is not possible for the less capable A positive attribute often ascribed to adolescent
adolescent mother. In this way the same practice is mothers was their ability to provide the physical
viewed very differently for an adolescent mother care the baby required. Their youth and health were
compared to an older mother. seen to contribute to good births, and their energy
and practical abilities often surpassed those of older
Adolescent positioning compatible with ‘bad’ mother mothers. Nevertheless, their adolescent behaviours
continued to deny them the ‘good’ mother position.
The main implication throughout these descrip- The following quotes work towards the condemna-
tions is that the normal stage of ‘‘just being a tion of younger mothers on the basis of adolescent
teenager’’ is largely incompatible with the ‘good’ taste in TV shows, or desires for a night out, despite
mother position. At times this point was made good practical mothering.

11. ARTICLE IN PRESS
122 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124
I have a young mum that’s 14 who, she could social world, which makes it extremely difficult for
bath a baby brilliantly, the physical cares were young women to resist this negative construction of
excellent, but her main objective for a particular adolescent motherhood. The negative constructive
duty, having just given birth was she wanted to power of this double positioning is difficult to
watch the Saturday night Colgate feature on TV, escape, as the social construction of young mothers
that was her priority. And I thought well actually as deviant is embedded within wider social values
love you’ve got a wee baby, and it may not fit and structures (McDermott & Graham, 2005). In
(Midwife 5). addition, this positioning does not conclude at the
So, and caring for them in the sense of say end of adolescence, as adolescent mothers and their
bathing and clothing and things like that, I think children are separated out and constructed in
probably, no, I think it’s more, it’s not that they various negative ways throughout their lives (see
get neglected from that point of view, it’s more Furstenberg, Brooks-Gunn, & Morgan, 1987).
that you know that a 16–17-year-old has, wants These dominant discourses as drawn upon by the
to go out and have funy Whereas a more health professionals in the present study to con-
mature woman knows that the baby’s there and struct adolescent mothers, have important implica-
has to be the first you know has to take the first tions for young mothers who must resist the
preference or priority and she wouldn’t be ‘adolescent’ position to have any of their behaviours
looking at having a night on the town, that type seen as those of ‘good’ mothers.
of thing. (Doctor 4) The health professionals rhetorically managed the
judgement of adolescent mothers by attributing it to
In spite of good mothering skills, these adoles- adolescence rather than to individual failing. Our
cents are not positioned as ‘good’ mothers, as they analysis has shown that the way that adolescents
possess priorities and interests constructed as behave is seen as the result of simply being
‘adolescent’. These representations of adolescent teenagers, and is consequently not something that
mothers as having parenting skills is in contrast to can be justifiably held against them. In one way this
the previous section where adolescents were viewed frees adolescent mothers from responsibility for
as incapable of the requisite parenting skills. In the their actions, as they are constructed as behaving,
previous section adolescent mothers were viewed as even if they are mothers, in ways that any normal
loving and bonding with their babies, but as teenager should (and developmentally must): socia-
incapable of parenting skills. These constructions lising, eating junk food and focussing on self and
are deployed in different ways to deny adolescent self-image. However, this construction also denies
mothers the ‘good’ mother position. young women respect and confidence as mothers, as
they cannot be expected to behave as ‘good’
Conclusion mothers. This construction of adolescents as du-
bious mothers legitimates surveillance by health
The use of the ‘Motherhood’ and ‘Developmen- professionals’ (MacLeod, 2001).
tal’ discourses in these ways functions to position The socially available constructions of adolescent
teenaged women who have children as ‘bad’ mothers used by health professionals are likely to
mothers. For women in this society, what it means have an impact on the relationships of doctors,
to be a particular type of mother can be negotiated nurses and midwives with young mothers. If health
using the ‘Motherhood’ discourse in which certain professionals talk about the behaviour of young
attributes, actions, and emotions are ascribed to the mothers in ways that are essentially negative, then
‘good’ mother (Phoenix & Woollett, 1991). Further- those women may well avoid situations in which
more, the subject positions of ‘adult’ (in the they are viewed as deficient. There is evidence that
‘Developmental’ discourse) and ‘good’ mother young mothers do often feel stigmatised and
function compatibly. Young mothers have far less alienated by health professionals (e.g. de Jonge,
space for this sort of negotiation. By the virtue of 2001; Melhuish & Phoenix (1987–1988)). If young
their age they are doubly positioned as ‘adolescent’ women are distrustful of health professionals, then
and, because the subject positions of ‘adolescent’ they may be less likely to follow professional advice
and ‘bad’ mother are generally compatible, as a or even seek such advice. If health outcomes for
‘bad’ mother. At present the intersection of these young mothers and their babies are to be improved,
two subject positions has a powerful meaning in our it is important that these mothers feel confident in

12. ARTICLE IN PRESS
M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 123
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health and that of their children. Any attempt to 266–270.
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