Women who were pregnant as teenagers are more likely to die before age 31 compared to those who had no teen pregnancies, suggests an Ontario study that calls for more programs to support vulnerable youth and their children. THE CANADIAN PRESS/AP-Teresa Crawford

Women who were pregnant as teenagers are more likely to die before age 31 compared to those who had no teen pregnancies, suggests an Ontario study that calls for more programs to support vulnerable youth and their children.

The study of 2.2 million females between the ages of 12 and 19 found that the risk of premature death was 1.5 times higher in those who had one teen pregnancy and 2.1 times higher among those with at least two teen pregnancies — with the risk especially pronounced in those who were pregnant before age 16.

Those findings were pulled from an analysis of anonymized health data of all residents in the province between April 1991 and March 2021. More than 163,000 people in that group became pregnant at a median age of 18, with most of them having an induced abortion while about 60,000 gave birth.

The study, published Thursday in JAMA Network Open, shows that teenagers whose pregnancy ended in an induced abortion were at somewhat higher risk of premature deathwhile the risk was even greater for those who gave birth or had a miscarriage. The study considered factors including income, level of education, and comorbidities.

Dr. Ashley Vandermorris, a pediatrician in the Young Families Program at Toronto's Hospital for Sick Children and one of the authors of the study, said teens with two or more pregnancies were at double the risk of prematuredeath through a range of causes including self-induced and unintentional injury.

The program, which also includes a nurse practitioner, a registered nurse and two social workers, supports adolescent mothers and their children until the child's second birthday.

The team manages any chronic illnesses and provides education on parenting, nutrition, birth control and early childhood literacy, said Vandermorris, adding it also connects families to community services that could help with housing and daycare.

However, many young mothers are suspicious of health-care providers because of their past experience, she said.

"We often hear about societal judgments and stigma and assumptions about these adolescents in terms of their decisions with regards to parenting, despite often demonstrating remarkable resilience."

The adolescents trying to meet their kids' developmental needs while still developing themselves may have grown up poor and endured stressors including physical, sexual or emotional abuse, domestic violence, substance use and mental illness in their homes, said Vandermorris.

Those early experiences could be strongly associated with unprotected sex, teen pregnancy and a lower likelihood of completing high school, she added.

However, the young parents are unlikely to have disclosed those challenges to a care provider, especially if they have faced stigma and racism in the health-care system, Vandermorris said.

One of the listed limitations of the study is that it did not explore race or ethnicity as contributors to the association between teen pregnancy and early death. Researchers said they did not have a data source for that information, and were unaware of the reasons why it would be linked to premature death, beyond knowing that some racialized groups experience higher rates of economic disadvantage and structural racism.

A key message of the study is that teen pregnancy may be an opportunity to identify people at greater risk of early death and provide them with supports that could change their lives, including a chance to finish high school, she said. They can then transition to community-based services close to where they live.

However, such services may not be available everywhere,Vandermorris said.

"We advocate strongly for improved access to this sort of comprehensive model of care in communities where we know there are higher rates of adolescent pregnancy," she said.

"This kind of work is best done in an interdisciplinary team. That's not feasible in a family doctor's office that is functioning independently."

Gillian Thompson, a nurse practitioner in the Young Families Program, said many teenage moms hesitate to access services because they fear their children could be apprehended if they are judged as unfit parents.

"Trauma is a huge part, and intergenerational trauma. And their experiences within child protection have not always been protective," she said.

"It takes quite a bit of engagement, relationship building with a trauma-informed, youth-friendly approach before they feel safe and access supports, whether it's the health-care system, the school system or social services or mental health resources."

Teen pregnancy rates have been steadily dropping in Canada due to a greater availability of birth control and sexual health services.

Statistics Canada data on fertility rates for those aged 15 to 19, based on live births per 1,000 females, shows the overall rate declined to 4.4 in 2022 compared to 6.7 in 2018.

British Columbia reported the lowest fertilityrate in that age group, at 2.7 in 2022 versus 3.7 in 2018. Ontario's rate was three, down from nearly five.Nunavut had the highest teenage fertility rate in the country at 67.2, down from 101 in 2018.

This report by The Canadian Press was first published March 14, 2024.

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