• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Irreconcilable differences

Irreconcilable differences



articolo 3 michela

articolo 3 michela



Total Views
Views on SlideShare
Embed Views



0 Embeds 0

No embeds


Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

    Irreconcilable differences Irreconcilable differences Document Transcript

    • ARTICLE IN PRESS Social Science & Medicine 64 (2007) 112–124 www.elsevier.com/locate/socscimedIrreconcilable differences: Health professionals’ constructions of adolescence and motherhood Mary BrehenyÃ, Christine Stephens Massey University, Palmerston North, New Zealand Available online 29 September 2006Abstract Adolescent motherhood has been associated with negative health outcomes for both adolescent mothers and theirchildren in many studies. Although the link between early motherhood and disadvantage has more recently beenquestioned, professional understandings continue to focus on hardship and social exclusion. Social constructionismprovides 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 wereanalysed 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 henceunable to mother correctly. The health professionals also employed a ‘Motherhood’ discourse that attributes certainbehaviours 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 careprovision for adolescent mothers in New Zealand.r 2006 Elsevier Ltd. All rights reserved.Keywords: New Zealand; Adolescent mothers; Motherhood; Adolescence; Health professionals; Discourse analysisIntroduction 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 andhas been to investigate associations between early abuse (Garrett & Tidwell, 1999), socio-economicparenting and a range of negative outcomes for status, employment, and educational attainmentmother and child. Younger mothers have been (Coley & Chase-Lansdale, 1998). The public healthdisadvantageously 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 theC.V.Stephens@massey.ac.nz (C. Stephens). infants of older mothers (Morrow et al., 1998). The0277-9536/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.doi:10.1016/j.socscimed.2006.08.026
    • ARTICLE IN PRESS M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 113children of adolescent mothers are less likely to adolescent mothers are often characterised asattend newborn health visits (Specht & Bourguet, insensitive and impatient towards their children1994), have increased rates of accidents and hospital and as having inferior mothering skills compared toadmissions (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 ofthe children of older mothers (Phipps, Sowers, & adolescent mothers are supported by research whichDemonner, 2002). These associations between found that the physicians’ view adoption andadolescent motherhood and poor psychological, abortion as preferable to becoming a mother insocioeconomic, and health outcomes provide a adolescence (Powell, Griffore, Kallen, & Popovich,bleak picture, suggesting that adolescence is an 1991). Most health professional literature drawsinappropriate period for childbearing and causes attention to the need to ‘manage’ adolescentsignificant 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 feelingmothers’ lives (Arenson, 1994; Kirkman, Harrison, under surveillance by health professionals. de JongeHillier, & Pyett, 2001; Merrick, 2001; Seamark & (2001) found that adolescent mothers reportedLings, 2004). Motherhood has been acknowledged feelings of being watched, and fear losing theiras one avenue of fulfilment and identity for poor baby if they were not seen to be coping. Adolescentand 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 inhood may also address the poor health and limited a condescending manner (de Jonge, 2001) and areemployment 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 viewedKorenman, 1993). Despite this positive and con- as a problem to be addressed; however, reduction oftextualised view of adolescent motherhood, the surveillance cannot be reasonably achieved in theprofessional view focuses on negative outcomes. social context in which adolescent mothers are alsoFor 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 ofadjusted 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 onSimilarly, Merrick (2001) acknowledges adolescent factors related to seeking or delaying prenatal caremothers’ positive hopes but questions their ultimate in pregnant adolescents identified factors such assuccess. 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 inyouthful idealism, and compared to statistics differentiating early and late attenders forof disadvantage and social exclusion that dominate prenatal care (Lee & Grubbs, 1995; Simms & Smith,professional understandings of adolescent mother- 1984). These studies did not investigate anyhood. 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 prenatalprofessional literature as presenting ‘‘unique chal- care, suggesting that those who delay prenatallenges’’ (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 doparenting 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 professionalshandling as they are often intimidated by health can empower or diminish adolescent mothersprofessionals (Davis et al., 2001). In addition, (SmithBattle, 2000), and that mothers’ experience
    • ARTICLE IN PRESS114 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124of health care reflects the prevailing values of health Methodprofessionals (Lawlor & Shaw, 2002). Focusing onhealth professionals deflects attention from adoles- Participantscent mothers as deficient, and addresses the socialcontext 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 participantsThe 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 included1998; Clark, 2001; Hawksley, 1996; James, 2000; providing antenatal and postnatal care, generalMichels, 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 prejudiceagainst adolescent mothers which ‘‘involves stereo- Proceduretyping 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 theings. Social constructionism is an epistemological Plunket Society Ethics Committee. Informationposition, 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 instructure and draws attention to the role of a variety of settings and health professionalslanguage in providing the categories we use to responded by telephoning the researcher to discussconstruct the world (Gergen, 1985). Health profes- the study or to make an appointment for ansionals’ construction of adolescent mothers can be interview.considered as discursive practices, which involve The interviews, which were audio-taped followingclaims that categorise adolescent mothers in certain information and consent, ranged between 30–90 minways. One social function of these categories is to in length. They followed a semi-structuredseparate adolescent motherhood from later mother- format with questions about the participants’hood. These discursive practices of categorisation experience of providing health care for adolescentinvolve comparing adolescent mothers to older mothers and their views of the health care needsmothers on medical statistics, on marriage and of adolescent mothers. Additional questionswelfare 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, returnedadolescent 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 wereshared constructions of development, family struc- made.ture, and motherhood that adolescent motherschallenge. This focus on the social construction of Analysisadolescent motherhood and the role of healthprofessionals in mediating health care provides the The discourse analysis used in the presentimpetus for the present research, which examines research is based on the assumptions of socialthe constructions of adolescent mothers drawn on constructionism and ‘‘sees discourse as embedded inby health professionals involved in the care of relations of power that form systems of constraintyoung mothers. which regulate social actions’’ (Burkitt, 1999, p. 69).
    • ARTICLE IN PRESS M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 115This approach to analysis concentrates on how Results and discussioncurrent power relations are reproduced throughdiscourse, and acknowledges the role of the This section focuses on two important discoursesdiscursive in constructing inequality. Power cannot identified in the analysis, which have been labelledbe 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 weretionalised practices in which the discourses are used by the participants. Examples from the dataembedded. Based on the writings of Foucault, this demonstrate how these two discourses were usedapproach 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 adolescent1990b, 1992). mothers will be considered. Discourse analysis involves identifying the so-cially available ‘discourses’ around which language ‘Developmental’ discourseis 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 aparticular 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 from2001), which include related rights and obligations childhood and adulthood and described by onefor 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 childrenfocus on how health professionals construct adoles- and they’re really in their own development stagecent motherhood, how these constructions provide (Midwife 2).subject positions for adolescent mothers, and howthey serve to reinforce existing power relations and Positioning young mothers as ‘adolescents’ drawsinstitutional practices. attention to their position in this transitional stage To conduct the analysis, extracts from the from childhood to adulthood. This transition wastranscribed interviews were coded into categories. constructed as a normal part of the development ofFor example, the category ‘Teenage Characteris- a young person and as a stage of life that must betics’, with its subheadings, was developed from the traversed to achieve maturity as an adult. Althoughdiscussions 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 generallythemes, and these themes were used as a basis for seen as quite separate from the maturing effects ofthe 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 aof talking about particular objects. The focus on process of simply adding years to the youngadolescents having particular shared characteristics women’s age, rather than negotiating particular liferelated to their age was seen as part of a wider stages and skills. The health professionals describeddiscourse of life span development that was labelled the development of adolescents as requiring onlythe ‘Developmental’ discourse. In addition, we time, which would result in:looked for evidence for the subject positions; Just the general maturity and confidence, quitethat is, the ways in which a discourse of develop- different when you’ve just got a little bit, a fewment 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 individualsillustrate the broader discourses being drawn upon matured at different rates, the maturing effect of ageby health professionals in discussing adolescent itself was constructed as paramount. These under-motherhood. standings of development and shared adolescent
    • ARTICLE IN PRESS116 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124characteristics 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; theyprivileged in psychological and developmental don’t think ahead generally (Doctor 5).theory, where psychosocial development is under- The adolescents’ inability to plan was drawn uponstood 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, andbetween childhood and adulthood that prepares the their haphazard approach to baby care. As oneperson for adulthood (MacLeod, 2003). The ‘Devel- midwife stated:opmental’ discourse is widely available as a resourcein 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’tences, ‘‘it is clear that adolescent mothers are think further ahead (Midwife 6).adolescents first. Motherhood does not confer The typical teenager was also constructed asadulthood, 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 lowconstruct 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 howacteristics because of their developmental ‘stage’. this inevitable focus on the self can be used as aSometimes, 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 descriptionsof 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 getThis speaker drew upon the shared understanding so much better because you’re doing it, it willof what it means to be a teenager to invoke an make more sense and that’s what they will graspexplanation of lack of attendance at antenatal (Midwife 2).classes and then provided some specific examples In this extract the adolescent mother is constructedof what it means to be a teenager. In this way as unable to place the needs of the baby ahead ofsmoking, drinking and partying are constructed as herself and this self-centred approach is part of thetypical of those positioned by their chronological developmentally appropriate view that they areage 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 describesconstructed as typical of individuals positioned as adolescent mothers as having enough for lotto‘adolescents’ within a ‘Developmental’ discourse. tickets, smoking, and spending extravagantly onNot all of these attributes were drawn upon by all gifts while their family has insufficient food.health professionals interviewed, but together theyillustrate what it means to be an ‘adolescent’ within They haven’t got the money, and finances hasthis discourse. Across the health professionals’ talk, become an issue. But there are things um, for aan ‘adolescent’ was constructed as displaying poorly lot of these kids the smoking and the lotto ticketdeveloped cognitive abilities. The typical teenager and everything else are far more important thanwas constructed as distracted, having a short things for the baby. And then when they getattention span, and lack of foresight. pregnant their friends will come in with these
    • ARTICLE IN PRESS 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 childrenThe immaturity exemplified by poor financial younger and I do honestly believe that and Ipriorities is also highlighted by the young mother‘s think that looking at women who have childrenchoice to spend their money on toys that have been later, it’s physically very hard on them (y) So Iseen advertised on television. The adolescent mother think energy wise we were supposed to have themis 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 positionto 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 theteenager’s nutrition during pregnancy was the adolescent mother is constructed as providingsubject 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 imageThe nourishment adolescent mothers provided for conscious, sociable and healthy. These traits weretheir 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 activesocial 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 ‘‘devotedThe second extract emphasises that a focus on couple’’:friends and play is necessary for the life stage ofadolescents 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 firstone positively regarded aspect: physical health. year is exactly the same as the love that thatTeenagers were described as being beautiful, dy- devoted couple feel, so you couldn’t compare thenamic, and energetic and this was related to their affection in that first year from either, I wouldphysical health. Some participants described ado- say it would be on a par that would be mylescence as a good time for childbearing physically, opinion. Possibly it starts to deteriorate afterwith easy birth and recovery and healthy babies. that. As the child gets older and gets a mind of its
    • ARTICLE IN PRESS118 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 isMaternal love was constructed as a basic prerequi- contrasted and defined by the adolescent mother’ssite of the ‘good’ mother. Throughout the interviews behaviour. The ‘good’ mother does all those thingsmany health professionals constructed adolescent that the young mothers described here do not. Inmothers as capable of this basic aspect of ‘good’ general, ‘good’ mothers were viewed as attending tomotherhood. These aspects can be seen as reflecting the child’s needs first and placing their own needsmotherhood as a basic natural instinct that is second. Here, it is shown by the young motherattached 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 thedescribed the ‘good’ mother as having parenting adolescent mother. Convenience foods and lifestyleskills: 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 thesing the feelings that any mother would feel, but not adolescent mother is constructed as an inadequatehaving 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 boredillustrated by examining how adolescent mothers [laugh]. In fact, I want to go back to work. Ideviated 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 longusually automatically attributed with ‘good’ mother periods of time and of course that’s when herstatus). Thus, the ‘good’ mother provides the unseen mum got involved again and kept phoning mebackdrop against which the adolescent mother is the and saying you know I’m really worried aboutpathologised other (MacLeod, 2001). The following her, that she’s not looking after the baby, thatquote shows how the adolescent mothers’ behaviour she lets him cry, she just feeds him and she putswas used to describe an alternative ‘good’ mother him down because she’s bored with him, andposition: 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
    • ARTICLE IN PRESS M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 119as a ‘good’ mother who is genuinely responding to assumption that the discussion of adolescenther 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 andcluded 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 theBeing 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 sortof mother they would like to be and this planning Adolescent motherswas 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 behaviourshealth professionals talk can be seen to reflect one attributed to adolescents are not those appropriatesort of motherhood—that is, middle class mother- for mothers. Third, this primary positioning ashood among educated women. Such women can be adolescents in a ‘Developmental’ discourse meantexpected to read about and plan pregnancy, to take that the contradictions in the two discourses werepride 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 wayHaving access to the norms of appropriate devel- the positive identity of motherhood as conferringopment and the current professional wisdom on self validation and social approval is deniedappropriate 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 areprofessionals. Motherhood for middle class women illustrated in turn below.has meaning in a particular way that it does not forpoor working class women under 20. Many of theseyoung 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 thenot see motherhood as something that must be primary position as an ‘adolescent’, as shown in theundertaken 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 makeMcKinnon, & Rains, 1999). In addition they may them grow into adults, and people, healthread little and see motherhood as a natural and professionals I think, think that, that if aspontaneous 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 mothera set of correct behaviour and principles that must and so therefore she is still a teenagerbe 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 asheterosexual. MacLeod (2001) argues that the fundamentally developmentally unchanged byliterature 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 featureof the ‘good’ mother are the taken-for-granted of parenting status.
    • ARTICLE IN PRESS120 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 clothingan ‘adolescent’, then her behaviours were ascribed over accommodation needs is typical for anto this primary positioning. ‘Adolescent’ behaviours adolescent while also showing that these are poorare not appropriate to ‘good’ mother behaviours priorities by comparing them to the choices an olderand so the teenage mothers were positioned as ‘bad’ mother might make. This same sort of comparisonmothers. The adolescent was constructed as self- was often made either with women of a specifiedobsessed and less concerned about her babies than age, as above, or by comparing the adolescentherself. 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 theactivities, 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 sheself-centred approach to pregnancy and childcare is wouldn’t be looking at having a night on thecontrary to our notions of appropriate mothering town, that type of thing (Doctor 4).and this was often explained by using the contrastwith the concerns of an older mother. For example, In this way, the health professionals indicated thatone participant stated that adolescent mothers’ adolescent mothers behave as ‘adolescents’ andpreoccupation with self and concern about stretch consequently do not make behavioural choicesmarks and body shape rather than the health of her compatible with ‘good’ motherhood.baby would seem ludicrous to an adult, but this wasjust 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 thoseThis self-centred approach was often contrasted things going on in their head, whereas peoplewith the views of an adult mother, who was that are, mothers that are in their late 40 s or sounproblematically positioned as the mother who have been through the teenage years yandfocuses 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 fromboth the ‘adult’ and the ‘good’ mother who makes the adult mother is achieved here by comparingresponsible 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
    • ARTICLE IN PRESS M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 121demands of motherhood that would be common- explicitly, such as when the social activity ofplace 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 youngchildren closely spaced, and concludes that this level babies. At other times the talk drew upon theof demand would be untenable for the young socially available position of the ‘good’ mother (ormother. 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, anyto 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 childwould be very problematic and concludes with the Some, the younger women tend to get all cluckyvery vague warning that ‘‘things go wrong shall we and if they want to carry on this pregnancy, it’ssay’’ to suggest that unspeakable difficulties will lovely and the scan was gorgeous and nobodybefall the young mother with more than one child. sort of seems to take on board that this is goingThe doctor above has also already categorised the to be you know years of broken sleep and yearsadolescent mother as single and unsupported and of not being able to go out, years of dirty nappiesthis unquestioned categorisation is drawn upon to and so on and so on and so on, they think it’sjustify the outcome that ‘‘things go wrong’’. It is not wonderful, they think it’s like y It’s immature, Iclear whether the youth of the mother is being mean these are immature people, they have andrawn upon to account for these outcomes, or the immature reaction to it (Doctor 3).assumed single status and lack of support, andultimately it does not matter, as the talk works to This enjoyment was described as a naı¨ ve andconstruct the adolescent mother as on the brink of immature reaction that failed to acknowledge thetragedy. These quotes are used to separate adoles- hard realities of parenting. Yet this same joy incent 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 adolescentadolescent mother. In this way the same practice is mothers was their ability to provide the physicalviewed very differently for an adolescent mother care the baby required. Their youth and health werecompared to an older mother. seen to contribute to good births, and their energy and practical abilities often surpassed those of olderAdolescent 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 adolescentteenager’’ is largely incompatible with the ‘good’ taste in TV shows, or desires for a night out, despitemother position. At times this point was made good practical mothering.
    • ARTICLE IN PRESS122 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. Ourcents are not positioned as ‘good’ mothers, as they analysis has shown that the way that adolescentspossess 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 thatmothers as having parenting skills is in contrast to can be justifiably held against them. In one way thisthe previous section where adolescents were viewed frees adolescent mothers from responsibility foras 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 normalloving 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 andare deployed in different ways to deny adolescent self-image. However, this construction also deniesmothers 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 adolescentteenaged women who have children as ‘bad’ mothers used by health professionals are likely tomothers. 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 healthusing the ‘Motherhood’ discourse in which certain professionals talk about the behaviour of youngattributes, 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 whichmore, 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 andfunction 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 youngtheir age they are doubly positioned as ‘adolescent’ women are distrustful of health professionals, thenand, because the subject positions of ‘adolescent’ they may be less likely to follow professional adviceand ‘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
    • ARTICLE IN PRESS M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124 123and fully supported by those who care for their infant health survey. American Journal of Public Health, 88,health and that of their children. Any attempt to 266–270.improve the health care provision for adolescent Flanagan, P., McGrath, M., Meyer, E., & Garcia Coll, C. T. (1995). Adolescent development and transitions to mother-mothers needs to take into account the wider hood. Pediatrics, 96, 273–277.discursive context of ‘judgemental’ health care Folkes-Skinner, J., & Meredith, E. (1997). Teenage mothersprovision. This can only be achieved by questioning and their experiences of services. Health Visitor, 70,the shared understandings of appropriate behaviour 139–140.that adolescent mothers challenge. Consequently, Furstenberg, F. F., Jr., Brooks-Gunn, J., & Morgan, S. P. (1987). Adolescent mothers in later life. Cambridge: Cambridgethis analysis does not reflect the ‘prejudice’ of health University Press.professionals, but the narrow boundaries of appro- Garrett, S. C., & Tidwell, R. (1999). Differences betweenpriate motherhood and normal adolescent develop- adolescent mothers and nonmothers: An interview study.ment which constrain these out of the mainstream Adolescence, 34, 91.parents from being viewed as successful mothers. Gergen, K. J. (1985). The social constructionist movement in modern psychology. American Psychologist, 40, 266–275. Geronimus, A. T. (1991). Teenage childbearing and social and reproductive disadvantage: The evolution of complex ques-References tions and the demise of simple answers. Family Relations, 40, 436–471.Abel, S., Park, J., Tipene-Leach, D., Finau, S., & Lennan, M. Geronimus, A. T. (1992). The weathering hypothesis and the (2001). Infant care practices in New Zealand: A cross-cultural health of African–American women and infants: Evidence qualitative study. Social Science & Medicine, 53, 1135–1148. and speculations. Ethnicity & Disease, 2, 207–221.Arenson, J. D. (1994). Strengths and self-perceptions of parenting Geronimus, A. T. (2003). Damned if you do: Culture, identity, in adolescent mothers. Journal of Pediatric Nursing, 9, privilege, and teenage childbearing in the United States. 251–257. Social Science & Medicine, 57, 881–893.Better health services for teenage mothers (1998, September). Geronimus, A. T., & Korenman, S. (1993). The socioeconomic Community Nurse, 9. costs of teenage childbearing: Evidence and interpretation.Burkitt, I. (1999). Between the dark and the light: Power and the Demography, 30, 281–290. material contexts of social relations. In D. J. Nightingale, & J. Guendouzi, J. (2005). ‘‘I feel quite organised this morning’’: How Cromby (Eds.), Social constructionist psychology: A critical mothering is achieved through talk. Sexualities, Evolution and analysis of theory and practice (pp. 69–82). Buckingham: Open Gender, 7, 17–35. University Press. Hawksley, B. (1996). Targeting services for single teenageBurman, E. (1994). Deconstructing developmental psychology. mothers. British Journal of Community Health Nursing, 1, London: Routledge. 71–75.Burr, V. (1995). An introduction to social constructionism. Hudson, D. B., Elek, S., & Campbell-Grossman, C. (2000). London: Routledge. Depression, self-esteem, loneliness, and social support amongChase, S. E., & Rogers, M. F. (2001). Mothers & children: adolescent mothers participating in the new parents project. Feminist analyses and personal narratives. New Brunswick: Adolescence, 35, 445–453. Rutgers University Press. James, D. C. (2000). Managing teen pregnancy. Mother BabyClark, T. (2001). Enhancing access to health services for young Journal, 5, 53–55. people. New Ethicals Journal, 37–40. Kirkman, M., Harrison, L., Hillier, L., & Pyett, P. (2001). ‘IColey, R. L., & Chase-Lansdale, L. (1998). Adolescent pregnancy know I’m doing a good job’: Canonical and autobiographical and parenthood: Recent evidence and future directions. narratives of teenage mothers. Culture, Health & Sexuality, 3, American Psychologist, 53, 152–166. 279–294.Corcoran, J. (1998). Consequences of adolescent pregnancy/ Koniak-Griffin, D., & Turner-Pluta, C. (2001). Health risks and parenting: A review of the literature. Social Work in Health psychosocial outcomes of early childbearing: A review of the Care, 27(2), 49–67. literature. Journal of Perinatal and Neonatal Nursing, 15(2),Davies, L., McKinnon, M., & Rains, P. (1999). ‘On my own’: A 1–17. new discourse of dependence and independence from teen Korobov, N. (2001). Reconciling theory with method: From mothers. In J. Wong, & D. Checkland (Eds.), Teen pregnancy conversation analysis and critical discourse analysis to and parenting: Social and ethical issues (pp. 39–51). Toronto: positioning analysis. Forum: Qualitative Social Research, University of Toronto Press. 2,(3) (On-line journal available at: /http://www.qualitative-Davis, C. J., Burke, P. J., & Braunstein, J. E. (2001). Acute research.net/fqs/fqs-eng.htmS). abdomen in infants of adolescent mothers: Diagnostic Lawlor, D. A., & Shaw, M. (2002). Too much too young? challenges. Pediatric Emergency Care, 17, 478–481. Teenage pregnancy is not a public health problem. Interna-de Jonge, A. (2001). Support for teenage mothers: A qualitative tional Journal of Epidemiology, 31, 552–554. study into the views of women about the support they Lee, S. H., & Grubbs, L. M. (1995). Pregnant teenagers’ reasons received as teenage mothers. Journal of Advanced Nursing, 36, for seeking or delaying prenatal care. Clinical Nursing 49–57. Research, 4, 38–49.Deal, L., & Holt, V. (1998). Young maternal age and depressive Luker, K. (1991). Dubious conceptions: The controversy over symptoms: Results from the 1988 national maternal and teen pregnancy. The American Prospect, Spring, 73–83.
    • ARTICLE IN PRESS124 M. Breheny, C. Stephens / Social Science & Medicine 64 (2007) 112–124Macleod, A. J., & Weaver, S. M. (2003). Teenage pregnancy: Woollett, & E. Lloyd (Eds.), Motherhood: Meanings, prac- Attitudes, social support and adjustment to pregnancy during tices, and ideologies. London: Sage. the antenatal period. Journal of Reproductive and Infant Powell, V., Griffore, R. J., Kallen, D. J., & Popovich, S. N. Psychology, 21, 49–59. (1991). Physicians’ preferences for adoption, abortion, andMacLeod, C. (2001). Teenage motherhood and the regulation of keeping a child among adolescents. Research in the Sociology mothering in the scientific literature: The South African of Health Care, 9, 33–47. example. Feminism & Psychology, 11, 493–510. Ray, K. L. (1997). Adolescent mothers’ experience with infantMacLeod, C. (2003). Teenage pregnancy and the construction of health care utilization. Ph.D. thesis, University of Alabama, adolescence. Childhood, 10, 419–437. Birmingham. Unpublished.McDermott, E., & Graham, H. (2005). Resilient young mother- Robinson, T. M. S. (1992). Special teaching needs of teen parents. ing: Social inequalities, late modernity and the ‘problem’ of Neonatal Network, 11, 65–66. ‘teenage’ motherhood. Journal of Youth Studies, 8, 59–79. Roye, C. (1995). Go aheads: Simplifying the assessment ofMcRobbie, A. (1991). Feminism and youth culture. London: teenage mothers. Nurse Practitioner, 20(5), 13–14. Macmillan. Rozette, C., Houghton-Clemmey, R., & Sullivan, K. (2000). AMelhuish, E., & Phoenix, A. (1987–1988). Motherhood under profile of teenage pregnancy: Young women’s perceptions of twenty: Prevailing ideologies and research. Children & the maternity services. The Practising Midwife, 3(10), Society, 1, 288–298. 23–25.Merrick, E. (2001). Reconceiving Black adolescent childbearing. Ruff, C. C. (1990). Adolescent mothering: Assessing their Boulder, CO: Westview Press. parenting capabilities and their health education needs.Michels, T. M. (2000). ‘‘Patients like us’’: Pregnant and parenting Journal of National Black Nurses Association, 4, 55–62. teens view the health care system. Public Health Reports, 115, Salladay, S. A. (1997). Ethical problems: Unmarried mothers, 557–575. everyone has a story to tell. Nursing, 27(7), 28.Morrow, A., Rosenthal, J., Lakkis, H., Bowers, J., Butterfoss, F., Seamark, C. J., & Lings, P. (2004). Positive experiences of teenage Crews, R. C., et al. (1998). A population-based study of access motherhood: A qualitative study. British Journal of General to immunization among urban Virginia children served by Practice, 54, 813–818. public, private, and military health care systems. Pediatrics, Secco, M. L., Ateah, C., Woodgate, R., & Moffatt, M. E. K. 101(2), E5. (2002). Perceived and performed infant care competence ofParker, I. (1990a). Discourse: definitions and contradictions. younger and older adolescent mothers. Issues in Comprehen- Philosophical Psychology, 3, 189–204. sive Pediatric Nursing, 25, 97–112.Parker, I. (1990b). Real things: Discourse, context and practice. Simms, M., & Smith, C. (1984). Teenage mothers: Late attenders Philosophical Psychology, 3, 227–233. at medical and ante-natal care. Midwife Health Visitor &Parker, I. (1992). Discourse dynamics: Critical analysis for social Community Nurse, 20, 192–200. and individual psychology. London: Routledge. SmithBattle, L. (2000). The vulnerabilities of teenage mothers:Phipps, M. C., Sowers, M., & Demonner, S. M. (2002). The risk Challenging prevailing assumptions. Advances in Nursing for infant mortality among adolescent childbearing groups. Science, 23, 29–40. Journal of Women’s Health, 11, 889–897. Specht, E., & Bourguet, C. (1994). Predictors of nonattendance atPhoenix, A., & Woollett, A. (1991). Motherhood: Social the first newborn health supervision visit. Clinical Pediatrics, construction, politics and psychology. In A. Phoenix, A. 33(5), 273–279.