No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography

Abstract

BackgroundYoung mothers face mental health challenges during and after pregnancy including increased rates of depression compared to older mothers. While the prevention of teenage pregnancy in countries such as the United States and the United Kingdom has been a focus for policy and research in recent decades, the need to understand young women’s own experiences has been highlighted. The aim of this meta-ethnography was to examine young women’s perceptions of their mental health and wellbeing during and after pregnancy to provide new understandings of those experiences.MethodsA systematic review and meta-ethnographic synthesis of qualitative research was conducted. Seven databases were systematically searched and forward and backward searching conducted. Papers were included if they were from Organisation for Economic Co-operation and Development countries and explored mental health and wellbeing experiences of young mothers (age under 20 in pregnancy; under 25 at time of research) as a primary research question – or where evidence about mental health and wellbeing from participants was foregrounded. Nineteen papers were identified and the Critical Appraisal Skills Programme checklist for qualitative research used to appraise the evidence. Following the seven-step process of meta-ethnography, key constructs were examined within each study and then translated into one another.ResultsSeven translated themes were identified forming a new line of argument wherein mental health and wellbeing was analysed as relating to individual bodily experiences; tied into past and present relationships; underpinned by economic insecurity and entangled with feelings of societal surveillance. There were ‘no straight lines’ in young women’s experiences, which were more complex than dominant narratives around overcoming adversity suggest.ConclusionsThe synthesis concludes that health and social care professionals need to reflect on the operation of power and stigma in young women’s lives and its impact on wellbeing. It adds to understanding of young women’s mental health and wellbeing during and after pregnancy as located in physical and structural factors rather than individual capacities alone.

An Umbrella Review of Qualitative Research on Teen Mothering

“…As qualitative studies proliferated, reviewers from nursing and other disciplines began targeting subgroups or specific experiences of teen mothers such as breastfeeding (MacVicar et al, 2015), homelessness (Meadows-Oliver, 2006), and those who experienced partner violence (Bekaert & SmithBattle, 2016) or foster care (Connolly et al, 2012). Other reviews addressed mothers’ perspectives on mental health (Lucas et al, 2019), the transition to parenting (Anastas, 2017), pregnancy intention (Macutkiewicz & MacBeth, 2017), and schooling (Peterson & Bonell, 2018). Anastas (2017) reviewed primary studies to categorize how teen mothering was framed as a problem located in the teen, her family, or society.…”

“…Regardless of the discipline of the authors and the aims of the reviews, the transformative power of mothering was apparent from the earliest (Clemmens, 2003) to the most recent primary review (Lucas et al, 2019), and across vulnerable subgroups including teen mothers who were homeless (Meadows-Oliver, 2006); had experienced violence (Bekaert & SmithBattle, 2016); or had spent time in foster care (Connolly et al, 2012). Reviewers referred to this transformational potential with language and metaphors describing how mothering provides meaning and fulfillment, and serves as a catalyst for becoming mature, reducing risky behavior, repairing relationships, reinventing the self, and seeking a better life anchored by the baby (Clemmens, 2003; Erfina et al, 2019; Graham & McDermott, 2005; Lucas et al, 2019; Meadows-Oliver, 2006) precisely because teens who became mothers lacked options for gaining meaning and independence (McDermott & Graham, 2005, p. 75). On the background of social disadvantage and difficult childhoods, and with few avenues for developing other identities, mothering was rewarding, provided purpose, and filled an emotional void (Bekaert & SmithBattle, 2016; Connolly et al, 2012; Macutkiewicz & MacBeth, 2017).…”

“…Anastas (2017) reported that the majority of qualitative primary studies reviewed attributed the perils and challenges of mothering to the high risk behavior of “problem girls” and their families; other reviewers corroborated Anastas’ finding by ascribing parenting difficulties to young mothers’ limited practical skills and knowledge (Erfina et al, 2019; MacVicar et al, 2015; Whitaker et al, 2016). Being rejected by peers, partners, or family members also contributed to social isolation and parenting challenges (Clemmens, 2003; Lucas et al, 2019). Broader obstacles were continuous with, and compounded by, difficult childhoods, substandard education, material hardships, toxic environments, and housing instability (Bekaert & SmithBattle, 2016; Connolly et al, 2012; Graham & McDermott, 2005; Lucas et al, 2019; Meadows-Oliver, 2006; Peterson & Bonell, 2018).…”

“…Being rejected by peers, partners, or family members also contributed to social isolation and parenting challenges (Clemmens, 2003; Lucas et al, 2019). Broader obstacles were continuous with, and compounded by, difficult childhoods, substandard education, material hardships, toxic environments, and housing instability (Bekaert & SmithBattle, 2016; Connolly et al, 2012; Graham & McDermott, 2005; Lucas et al, 2019; Meadows-Oliver, 2006; Peterson & Bonell, 2018). These roadblocks reflected systemic inequities in housing, education, health care, and social welfare (Anastas, 2017; Clemmens, 2003; Connolly et al, 2012; Graham & McDermott, 2005; Lucas et al, 2019; McDermott & Graham, 2005).…”

Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial

“…During pregnancy and childbirth, parturient women often experience both physical and psychological changes, resulting in a significantly increased probability of mental problems after childbirth [16]. Clinical studies have shown that sudden changes in social roles of women after childbirth, coupled with rapid changes in social relationships and functions, exacerbate negative emotions such as anxiety and depression, leading to recurring unhealthy mental states [17]. Among these unhealthy mental states after delivery, postpartum depression is a common, disabling and treatable reproductive complication [18].…”