Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
... if we could successfully intervene and change a woman's age at first birth and nothing else about her up to that point?1
Scally argues that we do not deal with the much more important issues of the educational and social effects of early motherhood and focus on a narrow medical definition of public health. We would argue that we deal primarily with the detrimental effects, for mother and child, of social deprivation. However, we do not feel that these problems are the preserve of one particular age group. We agree with Scally, Rich-Edwards and Smith that some teenage mothers in the UK, US and Nepal have blighted lives, but we do not believe that labelling a woman who chooses to have a baby under the age of twenty as a public health problem actually helps the mother or her child. We believe that the underlying problem lies in society's attitudes towards young people and specifically in attitudes towards women's reproductive lives.
It seems that we are all agreed that there are no inherent health or medical problems associated with becoming pregnant and having a child before the age of twenty. Therefore, if society were such that a 16-year-old could begin her family at that age, and then say in her mid-twenties, return to education or a chosen career path, without prejudice and undue uphill struggle, there would be no problem. Referring to very different contexts Rich-Edwards and Smith suggest that if young women are provided with education, income-earning potential and empowerment then an additional benefit will be that early motherhood will be delayed. But we would argue that opportunities, support and services should be available to women regardless of their age and regardless of whether or not they have children. Provision should suit and support the reality of women's lives, rather than limit their opportunities and choices unless they organize their reproduction in a socially acceptable way. Changing society's attitude towards young women and their reproductive choices may facilitate better opportunities and support, labelling them as a public health problem is unlikely to.2 Understanding that an unwanted pregnancy is NOT the same as an unwanted child or a child automatically doomed to fail in society is also important. Labelling any aspect of teenage pregnancy as shameful is unlikely to be beneficial. Concerted efforts to reduce poverty and inequalitiesa clear public health threatfor women and men of all ages is clearly where public health policy should be focused.3
References
1 Hoffman SD. Teenage childbearing is not so bad after all ... or is it? A review of the new literature. Fam Plann Perspect 1998;30:23639, 243.[ISI][Medline]
2
Lawlor D, Shaw M, Johns S. Teenage pregnancy is not a public health problem. BMJ 2001;323:1428.
3 Mitchell R, Dorling D, Shaw M. Inequalities in Life and Death: What If Britain Were More Equal? Bristol: The Policy Press, 2000.