A Qualitative Study Exploring Reproductive Desires and Parenting Attitudes among Ethnically Diverse Teens at Risk of Unintended Pregnancy.

OBJECTIVES: There is minimal research eliciting teen reproductive desires and parenting attitudes. Behavioral, educational, and public health interventions to prevent teen pregnancy often highlight the negative consequences of teen pregnancy or benefits of delaying parenting. However, limited empirical information is available regarding what factors teens perceive to influence the desire to delay pregnancy. In this study, we sought to identify teen perspectives regarding factors that influence their desire to delay parenting. STUDY DESIGN: A consensual qualitative research approach was used to identify reproductive desires, parenting attitudes, and any factors that influence the desire to delay parenting expressed by at risk teens. Forty participants were randomly selected from a larger clinical trial testing the efficacy of a brief, motivational interviewing-based intervention. During the brief intervention, participants were asked about their parenting attitudes and reproductive desires and factors that influence decisions to avoid teen pregnancy. These recorded segments were extracted, transcribed, and thematically analyzed. RESULTS: The study collected qualitative data on overarching key themes regarding teen parenting attitudes and reproductive desires, as well as factors that influence the desire to delay pregnancy, including education, financial stability, partnership, maturity/responsibility, friendships, and family. Many participants indicated that they wanted to delay parenting due to wanting to pursue future goals and/or not feeling ready for the responsibility of children. CONCLUSION: Overall, teens have a variety of reasons for delaying parenting that may not be explicitly captured by the general gain/loss messaging of current interventions. Allowing teens to explore their own beliefs and values around factors that they perceive to influence their desire to delay parenting creates autonomy and places the focus on the teens themselves and not perceived future losses or gains. IMPLICATIONS: This study analyzed the parenting attitudes and reproductive desires of teens undergoing a parenting prevention motivational interviewing intervention. Through a qualitative assessment, this article identifies themes of teen perspectives regarding factors that influence their desire to delay parenting.

Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa.

BACKGROUND: Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them. METHODS: Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval. RESULTS: Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years. CONCLUSION: Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.

Trends and factors related to adolescent pregnancies: an incidence trend and conditional inference trees analysis of northern Nicaragua demographic surveillance data.

BACKGROUND: We aimed to identify the 2001-2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20-24-year-old women. METHODS: A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004-2014 data on women aged 15-19 and 20-24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10-14 and 15-19 years reported by women aged 15-19 and 20-24 years, respectively, along with estimates of annual incidence rates reported by women aged 20-24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies. RESULTS: The number of first live births reported by women aged 20-24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies. CONCLUSIONS: Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings.

Insaka: mobile phone support groups for adolescent pregnant women living with HIV.

BACKGROUND: Mobile phone-based interventions have been demonstrated in different settings to overcome barriers to accessing critical psychosocial support. In this study, we aimed to assess the acceptability and feasibility of a phone-based, peer-to-peer support group intervention for adolescent pregnant women aged 15-24 years living with HIV in Zambia. METHODS: Sixty-one consenting participants were recruited from Antenatal Clinics of two large urban communities in Lusaka. They were invited to participate in the mobile phone-based intervention that allowed them to anonymously communicate in a small group led by a facilitator for 4 months. A mixed methods approach was used to assess acceptability and feasibility, including a focus group discussion, pre- and post-intervention interview and analysis of the content of the text message data generated. RESULTS: Participants reported finding the platform "not hard to use" and enjoyed the anonymity of the groups. Seventy-one percent of participants (n = 43) participated in the groups, meaning they sent text messages to their groups. Approximately 12,000 text messages were sent by participants (an average of 169 messages/user and 6 mentors in 6 groups. Topics discussed were related to social support and relationships, stigma, HIV knowledge and medication adherence. CONCLUSION: The study showed that the intervention was acceptable and feasible, and highlighted the potential of the model for overcoming existing barriers to provision of psychosocial support to this population.

Health and social outcomes of HIV-vulnerable and HIV-positive pregnant and post-partum adolescents and infants enrolled in a home visiting team programme in Kenya.

OBJECTIVES: HIV-positive and HIV-vulnerable pregnant adolescent girls and adolescent mothers face significant barriers and vulnerabilities. Infants born to adolescent mothers are also more likely to die and be exposed to life-threatening conditions. This paper presents findings from an evaluation of a programme that used a home visitation model and offered a case-management, team-focused approach to increase family and community supportiveness to enhance health and social service uptake among pregnant adolescent girls and adolescent mothers in Kenya. METHODS: The study used a quasi-experimental design with before and after comparisons among a non-randomised population to examine the effectiveness of bi-monthly household visits to 384 enrolled pregnant adolescent girls, adolescent mothers (ages 10-19) and their infants (0-24 months) between March 2018 and February 2019 in three counties in Kenya. RESULTS: During the programme, household support increased from 57% to 85%, while 100% of eligible participants were on ART and virally suppressed (total of 20 adolescents). Nearly all pregnant adolescent girls (94%) delivered under skilled care vs. 78% of those who were post-partum at the time of enrolment (P < 0.001); 100% of infants (total of 17 infants) had an up-to-date PCR test with no seroconversions. Uptake of modern family planning increased from 39% at baseline to 64% at end line (P < 0.001). The referral rate declined from 84% to 78% from baseline to end line with low uptake of referrals for mental health services (17.3%). CONCLUSIONS: A team-focused approach of home visits to HIV-vulnerable and HIV-positive pregnant and post-partum adolescent girls and their infants combined with efforts to reduce stigma and increase supportiveness of households and the community can help address critical socio-cultural and behavioural barriers to accessing and using health and social services.

An mHealth Intervention for Pregnancy Prevention for LGB Teens: An RCT.

BACKGROUND: Although lesbian, gay, bisexual and other sexual minority (LGB+) girls are more likely than heterosexual girls to be pregnant during adolescence, relevant pregnancy prevention programming is lacking. METHODS: A national randomized controlled trial was conducted with 948 14- to 18-year-old cisgender LGB+ girls assigned to either Girl2Girl or an attention-matched control group. Participants were recruited on social media between January 2017 and January 2018 and enrolled over the telephone. Between 5 and 10 text messages were sent daily for 7 weeks. Both experimental arms ended with a 1-week booster delivered 12 weeks subsequently. RESULTS: A total of 799 (84%) participants completed the intervention end survey. Participants were, on average, 16.1 years of age (SD: 1.2 years). Forty-three percent were minority race; 24% were Hispanic ethnicity. Fifteen percent lived in a rural area and 29% came from a low-income household. Girl2Girl was associated with significantly higher rates of condom-protected sex (adjusted odds ratio [aOR] = 1.48, P < .001), current use of birth control other than condoms (aOR = 1.60, P = .02), and intentions to use birth control among those not currently on birth control (aOR = 1.93, P = .001). Differences in pregnancy were clinically but not statistically significant (aOR = 0.43, P = .23). Abstinence (aOR = 0.82, P = .34), intentions to be abstinent (aOR = 0.95, P = .77), and intentions to use condoms (aOR = 1.09, P = .59) were similar by study arm. CONCLUSIONS: Girl2Girl appears to be associated with increases in pregnancy preventive behaviors for LGB+ girls, at least in the short-term. Comprehensive text messaging-based interventions could be used more widely to promote adolescent sexual health behaviors across the United States.

Género y juventudes Argentinas: ¿de qué estamos hablando cuando hablamos de "el problema del embarazo adolescente"? / Gender and Argentine youth: what are we talking about when we speak of "the problem of adolescent pregnancy"? / Gênero e juventudes Argentinas: do que estamos falando quando falamos sobre "o problema da gravidez na adolescência"?

Resumen Este artículo buscará echar luz acerca del embarazo adolescente como problema. A través de un recorrido histórico por fuentes bibliográficas, periodísticas y de un corpus de le- yes, se intentará dar cuenta de la naturalización propia del enfoque habitual en esta temática. Un punto central en la pregunta que nos orientará, concierne a la inclusión de la voz de lxs involucradxs, con el fin de pensar estrategias para acompañarlxs en ese momento (entendién- dose como una necesidad imperiosa para lxs mismxs).

Abstract This article examines the issue of adolescent pregnancy as a problem. Through a historical journey across journalistic sources and a legal corpus, the authors show the current naturalization when this topic is addressed. A guiding issue is the inclusion of the voices of those involved, to think about strategies that keep them company (which is understood as an important demand from the adolescents).

Resumo Este artigo examina o "problema da gravidez na adolescência". Por meio de um per- curso histórico por fontes bibliográficas, jornalísticas e um corpus de leis, tentaremos mostrar a naturalização da abordagem tradicional sobre o tema da gravidez ocorrida na adolescência. A questão que nos orienta levará em consideração a inclusão da voz dos envolvidos/as no que se refere a pensar estratégias para acompanhá-los/as (entendendo isso como uma necessidade imperiosa para os/as mesmos/as).

Exploring Knowledge, Beliefs, and Attitudes about Teen Pregnancy among Latino Parents in Arkansas.

OBJECTIVES: Arkansas has the highest incidence of teen pregnancy in 15- to 19-year-olds in the United States, and Latinas remain one of the cultural groups that are most at risk of becoming adolescent mothers. Teen mothers and their children are more likely to face poor socioeconomic conditions and negative health sequelae that perpetuate the cycle of poverty. Tailored interventions meant for families, communities, and/or churches should address both abstinence and other types of contraception to educate young people how to stay healthy, prevent unwanted pregnancy, and empower them to make informed decisions. To develop effective educational interventions, it is essential to understand the current knowledge, beliefs, and attitudes toward teen pregnancy among Latino parents in Arkansas. METHODS: Adult Latino parents were surveyed at two clinical sites, one church and one school in Little Rock between January 16, 2019 and February 23, 2019. The survey instrument was conducted in Spanish and included questions on demographics, knowledge, attitudes, and beliefs about teenage pregnancy. Response frequencies, percentages and descriptive statistics were calculated for the dataset. RESULTS: A total of 181 individuals completed the survey. Participants almost unanimously agreed with the statement that it is important to talk about sex with their children for their sexual health development. Nearly all respondents, 96.1%, believe that it is important to prevent teenage pregnancy. Most respondents agreed that they speak with their sons and daughters differently on the topic of sexual health. In our sample, only 17.8% of parents believed that abstinence-only education should be the primary focus of reproductive health education. "My family values" was most frequently cited as the predominant factor in shaping participants' beliefs about teen pregnancy, followed by a desire for their child to attend college or be economically stable before having a child. CONCLUSIONS: Our findings indicate that based on attitudes toward sexual health, interventions should be tailored to certain groups based on children's sex and age and to parents who had children as teens themselves. Educational materials should emphasize the strengths of Latino culture, such as family values and desire for children to attain a college degree and economic stability before bearing children.

State Teen Birth Rates by Race and Hispanic Origin: United States, 2017-2018.

Objectives-This report presents changes in state-specific birth rates for teenagers between 2017 and 2018 by race and Hispanic origin of mother. Methods-Data are from birth certificates of the 50 states and the District of Columbia (D.C.). Teen birth rates, the number of births to females aged 15-19 per 1,000 females aged 15-19, are shown by state for all births and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic females for 2017 and 2018. Results-Birth rates for females aged 15-19 declined in 38 states between 2017 and 2018; nonsignificant declines were reported in eight additional states and D.C. Among non-Hispanic white teenagers, rates declined in 29 states between 2017 and 2018; nonsignificant declines were reported in 16 additional states. Teen birth rates for non-Hispanic black females declined in 10 states between 2017 and 2018; nonsignificant declines were seen in 21 additional states and D.C. For Hispanic teenagers, birth rates declined in 10 states between 2017 and 2018; nonsignificant declines were reported in 30 additional states and D.C. The magnitude of change between 2017 and 2018 varied by state for each race and Hispanic-origin group.

Experiences of pregnancy in adolescence of internally displaced women in Bogotá: an ethnographic approach.

BACKGROUND: Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement. AIM: This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia. METHODS: Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement. RESULTS: The main themes that emerged from participants' experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners. CONCLUSION: Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.

The Moral Valence of Intentionality and the Modern Reproductive Subject.

Critical appraisals of adolescent pregnancy invoke the neoliberal valuation of rational action as moral obligation. Adolescents are portrayed as autonomous modern subjects and expected to demonstrate the virtue of responsibility through the use of biomedical contraceptives. Drawing on sixteen months of ethnographic fieldwork focusing on adolescent pregnancy in a small, semirural community outside of Tijuana, Baja California Norte, Mexico, I elucidate the moral landscape within which assertions of intentionality might acquire meaning in the context of adolescent pregnancy. I argue that the stakes involved in normative evaluations of female sexuality and reproduction at my fieldsite are shaped by past and contemporary experiences of EuroAmerican imperialism and are superimposed upon moral scaffolds laid by EuroAmerican colonialism.

Incidence and Imminence of Pregnancy in At-Risk Teens After Emergency Department Visits.

BACKGROUND: Interventions aimed at reducing teen pregnancy rates in the United States have focused on clinics and schools. Teens disproportionately seek care in emergency departments (EDs), making these an important and understudied arena for interventions to prevent subsequent unwanted pregnancies. Establishing the risk of subsequent pregnancy (SP) in this population is a necessary prelude to effective interventions. Therefore, we set out to measure the incidence and imminence of pregnancy in sexually active teens after an ED visit. METHODS: A medical record review was conducted in an urban medical center with a general ED and a pediatric ED. Subjects were included if they were female individuals aged 13 to 19 years, were tested for gonorrhea and chlamydia in the EDs from 2004 to 2006, and were patients in the primary care clinics at the affiliated institution. Subsequent pregnancies were determined from the primary clinic charts. The duration of follow-up was 4 years. RESULTS: Three hundred ninety-eight subjects were included in the study. The mean age at ED visit was 17.3 years. A majority (70.1%) had a documented SP. For patients with an SP, the mean interval from ED visit to conception was 15.8 months. Patients who had an SP were significantly more likely to be an ethnic minority, to have tested positive for gonorrhea, and to have visited the adult ED. CONCLUSIONS: In this population of sexually active teens, 70.1% became pregnant within 4 years of being tested for gonorrhea and chlamydia in the ED. The encounter in the ED represents a potential opportunity for pregnancy-prevention interventions.

Child marriage in Ghana: evidence from a multi-method study.

BACKGROUND: Child marriage remains a challenge in Ghana. Over the years, government and development partners have made various commitments and efforts to curb the phenomenon of child marriage. However, there is little empirical evidence on the predictors, norms and practices surrounding the practice to support their efforts, a gap this study sought to fill. METHODS: The study employed a multiple-method approach to achieve the set objectives. Data from the women's file of the 2014 Ghana Demographic and Health Survey (GDHS) was used to examine the predictors of child marriage using frequencies and logistic regression methods. Data from Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) collected in Central and Northern regions of Ghana were used to examine norms and practices surrounding child marriage using thematic analysis. RESULTS: Two in ten (20.68%) girls in the quantitative sample married as children. The results revealed that girls who had never attended school compared to those who had ever attended school were more likely to marry as children (OR, 3.01). Compared with girls in the lowest wealth quintile, girls in the middle (OR, 0.59), fourth (OR, 0.37) and highest (OR, 0.32) wealth quintiles were less likely to marry as children. From the qualitative data, the study identified poverty, teenage pregnancy, and cultural norms such as betrothal marriage, exchange of girls for marriage and pressure from significant others as the drivers of child marriage. CONCLUSIONS: The findings show that various socio-economic and cultural factors such as education, teenage pregnancy and poverty influence child marriage. Hence, efforts to curb child marriage should be geared towards retention of girls in school, curbing teenage pregnancy, empowering girls economically, enforcing laws on child marriage in Ghana, as well as designing tailored advocacy programs to educate key stakeholders and adolescent girls on the consequences of child marriage. Additionally, there is the need to address socio-cultural norms/practices to help end child marriage.

Heterogeneous Consequences of Teenage Childbearing.

This study finds heterogeneous effects of teen childbearing on education and labor market outcomes across socioeconomic status and race. Using miscarriages to put bounds on the causal effects of teen childbearing, results show that teen childbearing leads to lower educational attainment, lower income, and greater use of welfare for individuals who come from counties with better socioeconomic conditions. However, there are no significant adverse effects for individuals who come from counties with worse socioeconomic conditions. Across race, teen childbearing leads to negative consequences for white teens but no significant negative effects for black or Hispanic and Latino teens.

Rural-Urban Disparities in Pregnancy Intentions, Births, and Abortions Among US Adolescent and Young Women, 1995-2017.

Objectives. To examine rural-suburban-urban disparities in intendedness and resolution of first pregnancies among adolescent and young women (aged 15-19 and 20-24 years) across racial/ethnic backgrounds in the United States.Methods. We used the National Survey of Family Growth and pooled pregnancy files from 2002 through the 2015-2017 surveys. We report baseline rural-suburban-urban disparities in first pregnancy intention and outcomes. We used multinomial logistic regression to estimate these disparities, accounting for sociodemographic background, religious upbringing, and other factors.Results. The first adolescent pregnancies of rural women were more likely to be unintended and end in live birth relative to their urban counterparts. Disparities were most striking among Black adolescents, with about 60% of first adolescent pregnancies among rural Black women being unintended and ending in live birth (urban: 51%). Newly collected state health department data on rural and urban adolescent births and abortions corroborate the findings from the National Survey of Family Growth.Conclusions. Rural-urban differences in the share of first adolescent pregnancies ending in live births are not accounted for by pregnancy intention or confounding individual-level characteristics. Future research should explore the role of structural barriers, including access to family planning and abortion services.

County-Level Clustering and Characteristics of Repeat Versus First Teen Births in the United States, 2015-2017.

PURPOSE: Approximately 16% of U.S. births to women aged 15-19 years are repeat (second or higher order) births. Repeat teen mothers are at elevated risk for poor perinatal outcomes. Geographic clustering and correlates of repeat teen birth are unknown. METHODS: Data from birth certificates on N = 629,939 teen births in N = 3,108 U.S. counties in 2015-2017 were merged with data on county-level demographic, socioeconomic, and health provider characteristics. We identified contiguous clusters of counties with significantly elevated rates of first teen births only, repeat teen births, both, or neither between 2015 and 2017 and compared demographic, socioeconomic, and medical provider characteristics of counties between 2010 and 2016 in each cluster type. RESULTS: A total of 193 counties (6.21%) had high rates of repeat births only; 504 (16.22%) had high rates of first teen birth only; 991 (31.89%) had high rates of both repeat and first teen births; and 1,420 (45.69%) had neither. Counties with high repeat (vs. first only) birth rates had higher rates of poverty and unemployment, higher levels of income inequality, lower high school graduation rates, a higher share of racial and ethnic minority residents, fewer publicly funded family planning clinics per capita, and more women receiving contraceptive services at publicly funded clinics. CONCLUSIONS: First and repeat teen births cluster in differentially resourced geographic areas. Counties with high repeat teen birth rates have lower socioeconomic conditions than counties with high rates of first teen births only. These counties are more reliant on publicly funded family planning clinics but have fewer of them per capita.

Maternal Self-Efficacy Is Protective for Child (but Not Mother) Body Mass Index Among Mexican-Origin Children with Negative Temperament.

OBJECTIVE: Childhood obesity persists as a serious public health concern, particularly among Mexican-origin youth. Teen mothers are also at heightened obesity risk. Multiple factors may exacerbate this risk, including stressors associated with parenting. Indeed, difficult child temperaments pose unique parenting challenges, which may also be linked to physical health outcomes in mothers. The purpose of this study was to examine whether the interaction between negative child temperament and parenting self-efficacy is related to the body mass index (BMI) of young children and their adolescent mothers while controlling for important contextual factors. We also examined which pathways differed for girls versus boys. METHODS: Data were from a longitudinal study spanning 5 years that included 204 Mexican-origin young mothers and their children (with data collected at birth, age 4 years, and age 5 years). A multigroup structural equation modeling framework was used. RESULTS: The rate of early childhood obesity was low in comparison with national averages, whereas the rate of adolescent mother obesity was notably higher than the national average. Negative child temperament was associated with higher child BMI among those adolescent mothers with low parenting self-efficacy. Among the children with a negative temperament, their mothers' high parenting self-efficacy may have served as a protective factor against unhealthy child BMI. This significant interaction held for both boys and girls. CONCLUSION: Research evaluating the potential effectiveness of interventions that promote parenting self-efficacy during early childhood as a means to reduce the rate of obesity among children of adolescent mothers should be conducted.

"Scribble Scrabble": Migration, Young Parenting Latinas, and Digital Storytelling as Narrative Shock.

The nexus of migration and family offers a conjuncture to enrich understanding of teen pregnancy and parenting. This article draws findings from a project centered on participant-produced new media to reveal how young mothers negotiate reproductive health disparities. We focus on young mothers' experiences of migration and movement, captured in local vernacular through participants' digital story depictions and follow-up interviews. We argue that disparities link up with the single story of teen mothering, involve public shaming, continue hand-in-hand with institutional humiliation, and are exacerbated through migration and movement. To disrupt the normative notions that shadow young mothers, we take seriously the young women's narratives. We theorize how the richness of stories and storytelling may serve as a potent intervention-a narrative shock-for articulating meanings and cultivating dignity for young mothers and their families, especially those who do not fit the sedentary and age biases of parenting ideals.

Cultural Immersion Isn't About Diabetes: Understanding the Lakota Sioux Culture on the Pine Ridge Indian Reservation.

This article discusses the historical trauma and modern struggles of Oglala Lakota Sioux tribal members on the Pine Ridge Indian Reservation in southwestern South Dakota. In order for healthcare providers to understand why patients from this region have soaring rates of diabetes, teen pregnancies and premature death, it is important to have exposure to their culture and daily life. As part of their medical school curriculum, students at the Sanford School of Medicine take part in cultural immersion trips in order to better understand and relate to the people on the Pine Ridge Reservation. These experiences are led by local Lakota people and allow students to be exposed to the modern healthcare and government facilities, and also take part in traditional ceremonies such as drumming circles and art shows. By the end of the journey, future physicians leave with a better understanding of day-to-day Lakota life and increased empathy and understanding for their Native American counterparts.