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24 December 2024

Exploring Teen Pregnancy as a Public Health Problem: A Critical Scoping Review of Public Health Research on Teen Pregnancy in Canada

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Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
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Societies2025, 15(1), 1;https://doi.org/10.3390/soc15010001
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Abstract

Inequities related to teen pregnancy are a complex social and health problem across the globe. Evaluation of research assumptions can help to move research forward when considering complex public health issues. Drawing on previous critical reviews, this scoping review sought to map not just what teen pregnancy research is available, but how current public health research was orienting to teen pregnancy in Canada. This review included studies focused on general or intended teen pregnancy within a public health Canadian context. Both grey and peer-reviewed literature were searched, with only studies in English and French included. In total 32 studies were analyzed. Taking a multifaceted approach to assessing research orientation this scoping review applied an adapted health equity framework to consider alignment between awareness and action and utilized discourse analysis to explore constructions of pregnancy intention. Results showed although a portion of research fell within the acknowledge and illuminate categories, most of the research utilized public health language rooted in biomedical and individualistic discourses and focused on influencing individual action, rather than greater societal change. Adding to the growing body of teen pregnancy research in Canada, this scoping review revealed potential epistemological barriers related to limited research approaches, applied public health action, and engagement with topic overall, leading to a call for more diverse, critically reflective, and disruptive approaches to teen pregnancy research in Canada to address teen pregnancy-related inequities at the root.

1. Introduction

In many parts of the world, including Canada, teenage pregnancy has long been positioned as a public health problem, with a complicated sociopolitical history [1,2]. In the 1970s teen pregnancy and parenting was typically presented as a social and moralist problem based on concerns of economic impacts and having children out of wedlock [3,4]. This societal perspective influenced the expanding teen pregnancy research in the 1980s and 90s, which in turn, through connecting adverse biological and social outcomes to teen pregnancy, further entrenched societal concerns related to teen pregnancy and parenting [1]. Even within reproductive rights and feminist spheres teen pregnancy was seen as a scapegoat for child and maternal inequities [5,6]. Thus, through a bidirectional influence of society on public health research, and public health on society, teen pregnancy evolved into the morally contentious and socio-politically complex topic of public health concern seen today.
Although there has been almost universal acceptance of teen pregnancy as a public health problem, there are still some sites of debate related to teen pregnancy research being done. Some scholars have challenged predominant teen pregnancy associations with adverse child and maternal health outcomes, pointing to concerns related to comparison groups, confounding variables, and social and structural factors at the root of health disparities [1,7,8]. Others have highlighted how, outside of a focus on race or ethnicity, much of health research considers pregnant teens as a homogenous group, ignoring potential influences such as specific age (early vs. late teen years), gender, relationship status, social supports, and pregnancy intention [9,10]. Some scholars have been leading work from a more critical perspective. For instance, in the U.S. public health researchers such as Maness and Geronimus have been researching teen pregnancy from social determinants and critical race perspectives [6,11]. Furthermore, scholars in Canada outside of public health, such as Kelly, Begun, and Eni have all researched teen pregnancy experiences from social and structural perspectives [5,12,13,14]. However, much of this research has tended to sit outside of mainstream public health in Canada.
Despite declining teen pregnancy rates since the 1990s, teen pregnancy in Canada today remains a prominent focus of public health with persistent social and health inequities existing for pregnant and parenting teens [2,15]. To overcome epistemological barriers and move research forward in health research, critical scholars challenge researchers to reflexively consider the underlying assumptions that shape our research, knowledge production, and overall understanding [16]. Given the complex sociopolitical history of teen pregnancy problematization in Canada, and the ability of public health to both influence and reflect societal attitudes and actions, there is arguably a need to critically examine research orientations to teen pregnancy as a public health topic itself [17].
Public health research is not simply about biomedical health but rather requires understanding in-depth the social and political complexity of health inequities and challenging the very conditions that create systemic differences [18]. Teen pregnancy-related health inequities in Canada are not driven by biology (age) alone, they are influenced by differences in our physical, social, and economic environments. Research that considers the contextual influences of teen pregnancy may provide an opportunity to move upstream and consider the “root causes” of teen pregnancy-related inequities by focusing on how the physical and social environments influence maternal and child health and well-being [11,18,19,20]. Exploring how teen pregnancy research is, or is not, working to address these contextual influences may provide some insight into how public health researchers are orienting towards teen pregnancy from a health equity perspective that considers factors both related to, and outside of, age categories. Plamondon’s [18] framework for health equity provides one avenue for highlighting disciplinary epistemological barriers by exploring alignment between researcher awareness of root causes of systemic differences and research action related to addressing root causes.
Public health works towards greater health of a population but populations, or groups, are diverse in terms of their wants, needs, experiences, and positions. Pregnant and parenting teens themselves are diverse, with teens who desire pregnancy occupying a marginalized position in Canada overall. Most teen pregnancies are presumed to be unintended and public health research has focused predominantly on researching unintended pregnancies and associated negative outcomes–leading to public health operating under the logical assumption that negative outcomes can be reduced by pregnancies being intended and of optimal timing [21]. This assumption is rooted in white middle class worldview and has been challenged as not being applicable to those outside of this social position [21,22]. The public health approach focused on unintended pregnancies has also been critiqued for converting the right to bodily autonomy into the responsibility to manage risks of pregnancy–something that is not necessarily within individual control for those who are in structurally marginalized positions [21]. Given the predominant assumption in public health that majority of teen pregnancies are unplanned, desired pregnancy offers a unique counter position from which to consider public health research regarding people (teens) who are acting outside of dominant societal expectations. Interrelated with reflective assessment of research awareness and action, analysis of language and discursive patterns can also highlight potential epistemological barriers such as worldviews, internalized discourses, normative assumptions, and disciplinary traditions that present challenges to action through conceptual limitations [16,18]. Paying attention to discourses can be helpful in that they reveal not only what is going on in a particular discipline but also how that discipline reflects dominant views in society [23]. Attention to the language and discourses being used regarding pregnancy intention may provide further insight into how public health research considers the complex and multifaceted nature of teen pregnancy and engages with the topic in a nuanced way.
Reviews of the literature, such as scoping reviews, can be helpful for providing a broad overview of a topic, mapping out key concepts, and identifying relevant gaps in the literature [24]. From a critical perspective, scoping reviews also allow for an exploration of other aspects of research such as the way(s) in which research was conducted, development of concepts in a field, discursive elements, and research positions that serve to highlight not only what is, or is not, being researched, but how and in what way it is being done [23,25]. Given the long history of public health research surrounding teen pregnancy, and our position as public health researchers and students who are outsiders to the pregnant/parenting teen community, we drew on previous critical scoping reviews, and focused our efforts on mapping how public health research in Canada is orienting to teen pregnancy as a public health topic in an act of disciplinary reflexivity meant to enhance researcher awareness of potential epistemological barriers [23,26,27]. Taking a multifaceted approach to assessing orientation, this scoping review was guided by two research questions:
  • How does current and past Canadian public health research awareness of the contextual influences related to general and intentional teen pregnancy align with research actions?
  • What language and discursive patterns related to teen pregnancy intention are being used in past and current public health research in Canada?

2. Methods

This review followed Arksey & O’Malley’s [28] five stages of a scoping review: identifying the research question, identifying relevant studies, study selection, charting the data, and summarizing and reporting results. The review followed Joanna Briggs Institute guidelines for developing a scoping review protocol but was not produced nor registered as a formal protocol [24,25]. Consultation with a health sciences librarian provided guidance for developing a search strategy, search terms, and identifying key databases. The review used a reproducible search strategy, whereby a brief initial search of the literature yielded publications from a variety of sources that met the established inclusion/exclusion criteria. The identified publications’ titles, indices, abstracts, and texts were used to construct a more fulsome database search strategy. The database search results were then backchecked to reproduce the initially identified publications and adjusted if necessary, ensuring the final search strategy captured known key literature. This process was reproduced for each database, adapting any keywords and index terms where appropriate. Reference lists of all identified literature were screened for additional studies. In total, nine electronic databases (OVID Medline, OVID EMBASE, OVID Psych Info, CINAHL, Google Scholar, Grey net, ProQuest, SCOPUS, Web of Science) were searched between December 2021–February 2022. Search terms were developed around three key fields: subject area (teen/adolescent pregnancy), geographic area (Canada), and discipline (Public Health). See Appendix A for complete list of terms. Research studies on teen pregnancy in Canada, published from 2000 to present day were included, excluding articles outside of a research study (such as literature reviews and commentaries). Due to reviewer language limitations, only English and French studies were considered for review. Given the lack of research related to intentional or desired teen pregnancy, the review included general teen pregnancy studies, but excluded studies focused specifically on unintentional teen pregnancy. In total, following removal of duplicates, 449 citations were imported into COVIDENCE.
Title, abstract and full-text reviews were undertaken independently by two reviewers utilizing COVIDENCE software. Pregnant teens (as a population) and teen pregnancy (as a topic) overlap with many other areas including young motherhood/parenting, teenage sexual health, or as a comparison group to other focused areas. As such, title/abstract and full-text screening involved excluding studies that may have included pregnant teens as a population but did not focus on teen pregnancy as a substantial study topic. Studies were also screened to fall within a public health discipline. Reviewers included studies within pre-defined public health areas (adapted for a teen pregnancy context): Prevention (including prevention of teen pregnancy, health outcome studies, risk factors), Health promotion (including program evaluation), Population/Community Health assessment (including studies focused on SDOH), and Health Surveillance (including rates and demographic studies) [29]. Reviewer disagreements were settled through discussion. 130 articles were agreed upon for full text review. Upon careful review of the full texts, 32 articles were selected for extraction as 98 studies were excluded due to reasons mentioned in Figure 1. Research ethics approval was not needed as the scoping review did not involve primary research participants.
Figure 1. Prisma Flow Chart for Scoping Review of Canadian Public Health Orientation to Teen Pregnancy [30].

3. Analysis

Data analysis followed three approaches (see Appendix B for full details). Data related to study specifics such as general study information, publication details, and public health details (authorship, area of public health focus) were extracted. Alongside data extraction, the reviewers also assessed the studies on two aspects: assessment of research work related to the contextual influences and analysis of language and discourses related to teen pregnancy intention.
Plamondon’s [18] reflective tool for health equity work allows for prospective or retrospective assessment of work (research) directed at the root causes of health inequities. The tool was developed within a health equity framework, that recognizes the opportunities for health and well-being are largely determined by social and structural factors outside of individual control but influenced by human action [18]. Adaptation of this tool provided a framework for assessing public health orientation to the contextual influences (root causes) related to teen pregnancy in Canada (Table 1). Although we recognize that not everyone will view contexts as the “root” of health inequities related to teen pregnancy and that there has been some important work being done in “less productive” categories, the tool does operate on the assumption that more “productive health equity action” (i.e., moving towards the disruptive category) is justified [18]. As Plamondon describes, the tool is “a means of sparking greater wakefulness to the normative systems, structures, and processes that reinforce unearned advantage and disadvantage in society” [18]. As such, the tool is rooted in understanding that research operates within “a paradox, where our ideals clash with the systems and structures” we work within and are attempting to change [18]. Therefore, use of this tool is considered helpful because it allows researchers to assess alignment between intention and action regarding health equity action to reveal the challenges and epistemological barriers limiting researchers own actions [18].
Table 1. Research Orientation to Contextual Influences of Teen Pregnancy Framework.
Alongside mapping whether pregnancy intention was mentioned, the reviewers also considered what patterns or language themes (discourses) were being used when discussing teen pregnancy intention. Analysis of discourses includes a textual element (considering language, metaphor, and topics) and a contextual element considering the social, political, and ideological context in which the discourse is produced [31]. Therefore, using the research questions and a critical lens to guide the analysis, an inductive thematic approach was undertaken where the articles mentioning pregnancy intention were identified and read, with close attention being paid to how pregnancy intention was discussed, language used, surrounding sentences and paragraphs, and relation to contexts and research recommendations. Themes were developed through an iterative approach across the articles with initial themes revised through team discussions.

4. Results

Alongside analysis of orientations and discourses, study descriptives were also extracted. These descriptive characteristics provided general context of the included studies and were incorporated in the overall analysis for the review (Table 2).
Table 2. Scoping Review Results [10,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].

4.1. Article Characteristics

The extracted articles ranged from 2001 to 2021, with only four published before 2011. No temporal trends were identified. The reviewed articles contained only one qualitative study, the rest being quantitative in nature. Of the included articles, only two studies were found to have been published in public health-specific journals and, following a brief assessment, approximately a third of authors were found to have a graduate degree (MPH/PhD) in Public Health.

4.2. Public Health Focus

The scoping review excluded articles outside a pre-determined public health focus. Therefore, the included articles were characterized based on their public health focus (with some focusing on multiple areas) (Table 2). More than half the articles discussed teen pregnancy demographics (n = 17), teen pregnancy risk factors (n = 20), and the social determinants of health (n = 18). Several studies had elements pertaining to teen pregnancy prevention (n = 7), surveillance/monitoring of teen pregnancy rates (n = 6), with a significant proportion of the articles focusing on the outcomes associated with teen pregnancy (n = 15).

4.3. Trends in Orientation to Contextual Influences

None of the articles were within the disrupt category following assessment (Table 2). The largest group fell within the acknowledge category with twelve articles, followed by the illuminate, and distract categories, each with six articles. Five articles were in the disregard category and three in the discredit category. Therefore, fourteen articles of our review fell within “less productive categories” (discredit, disregard, distract), focusing on research that either works against evidence supporting contextual influences, upholds arguments that pull attention away from the contextual influences (such as focusing on individualist behavioral theories) or overlooks the contextual influences surrounding teen pregnancy. Eighteen articles, however, did fall within the more productive half of the framework (illuminate, acknowledge), focusing on either a descriptive or interpretive approach to the contextual influences related to teen pregnancy.

4.4. Discursive Analysis Results

As previously mentioned, analysis of discourses within the studies helped to provide a multidimensional understanding of how public health research was orienting to intentional teen pregnancy. The approach to discourse analysis was outlined in the analysis section and included an inductive approach to reading the articles, focusing on both textual and contextual elements (see Section 3). Regarding pregnancy intention, thirteen articles were devoid of any mention of pregnancy intention. Out of the nineteen articles that mentioned intention, two were studies examining intentional teen pregnancy explicitly and seventeen focused generally on teen/adolescent pregnancy. Five articles included pregnancy intention as a distinct variable, five mentioned absences of the variable as a potential study limitation, and three mentioned it was not considered due to majority of teen pregnancies being unplanned. In total, sixteen articles expanded on pregnancy intention as part of the introduction, discussion, and/or conclusion sections. In terms of pregnancy intention related to orientation: one study falls within the distract category, one within the disregard, nine in the acknowledge category, and five are in the illuminate category. Four overarching discursive themes, or patterns were developed: Insider vs. Outsider positions, Biomedical vs. Sociological Positioning, Individual vs. Societal Responsibility, and Priority vs. Problematic Groups. The themes are titled here as binaries to highlight the binary approach seen within public health, rather than reinforcing binary thinking itself. Such titles are employed for calling attention to underlying binaries that are often seen within public health research and practice, as well as dualistic meaning to some public health approaches such as “priority groups” being negatively reinforced as “problematic”.

4.4.1. Insider vs. Outsider Positions

Within the articles analyzed, desired pregnancy was often recognized as a unique, outsider, position, as most teen pregnancies are considered unplanned [10,34,62]. This highlighted an important consideration in public health–as public health serves populations or groups, how best to consider those who fall “outside” group conformity? For some studies this was tackled through a targeted approach [10]. But in other cases, teens who desired pregnancy were acknowledged but ultimately overlooked when it came to recommendations that focused on contraception and prevention efforts [62]. Although one study alone cannot address everything, the consistent positioning of intentionally pregnant teens as outsiders potentially inhibits a deeper understanding of teen pregnancy through simply identifying diversity and then disengaging from it, rather than meaningfully integrating those diverse perspectives and positions into public health understanding and action.

4.4.2. Biomedical vs. Sociological Positioning

The reviewers also noted a predominant biomedical approach to desired teen pregnancy, reinforced by the frequent use of medicalized or pathologizing language. Clinical terms such as “cognitive distortions regarding sexuality and expressed greater pregnancy desire” and “increased internalized preference for motherhood” reinforced a biomedical perspective on teen pregnancy [35,54]. Family relations and values were also often medicalized through language such as “intergenerational transmission of values” and passing on “risky” characteristics or “biological heritability” [54]. This use of biomedical language positions intentionally pregnant teens as an object, desired pregnancy a disease, legitimizing adult authority over teens and reinforcing paternalistic interventions [9].

4.4.3. Individual vs. Societal Responsibility

As teen pregnancy is often strongly correlated with social disadvantage, many articles focused on desired pregnancy in relation to adversity. Sekharan et al. [10], for instance, sought to further investigate this in relation to pregnancy intention. Although this may create an opportunity for more in-depth understanding about the social and contextual influences related to teen pregnancy, for some articles the focus was on teen pregnancy as a poor individual choice of someone in adversity, rather than adversity itself as problematic [33,36]. This individualized discourse ties into the observation that majority of research did not reside within the more productive categories of our framework (illuminating or disrupting categories). For example, Fairthorne [33] acknowledged “disillusioned” teens of low SES backgrounds may desire pregnancy but focuses on recommendations highlighting teen pregnancy as a poor choice because of additional challenges, rather than working to address the “disillusioning” environment itself. Likewise, Liu et al. [36] states when facing “challenges for societal advancement” a teen may engage in sexual activity rather than pursue “educational or career routes that... delay parenting” without any expansion as to how educational/career pursuits are blocked for many of lower socioeconomic status. For many studies within our review, ultimately the research focused on assessing individual behavior and supporting adjustments to poor social conditions, rather than disrupting those conditions [9].

4.4.4. Priority vs. Problematic Groups

Finally, within the review there was a pattern around identifying high-risk or priority groups. The identification of high-risk populations can be useful for guiding equitable action, but there is also concern that targeting and identifying “high-risk” individuals can lead to further stigmatization or harm [4]. Within the articles reviewed, some highlighted specific populations more likely to be associated with desired teen pregnancy such as Indigenous Peoples and those of single-parent or multigenerational teen parent families [33,40,46,54,56]. Regarding families, some studies explored family members as potential sources of influence or looked to identify “vulnerable” families who might benefit from intervention [33,54]. Other studies associated teen pregnancy as desirable or normalized within single-parent or low socioeconomic families [40,46]. Often families and family members were not contextualized themselves, however, and rather became sources of intervention, with public health work focused on targeting and intervening at the family level as they were seen as a risk factor for teen pregnancy.
A similar concern is seen regarding Indigenous teens. Within our review, some studies, such as Xavier et al.’s [56], provided a more nuanced discussion on Indigenous Peoples’ relationship with teen pregnancy. Others, however, identified high-risk groups without contextualization regarding colonialism and oppression [46]. This absence of a sociopolitical context, highlights race/ethnicity as the meaningful association, rather than colonialism and white supremacy [4,9]. And, the lack of proper contextualization, paired with the frequent use of biomedical language, positions certain groups as “not only at risk, but as a risk” [4,9,23,63]. Rather than using priority group knowledge for public health advocacy for larger societal change, this decontextualization works to further legitimize public health surveillance and management of “high-risk” groups through reinforcing disease concepts of infection risk and deficit views of race/ethnicity [9,10,13,23,63].

5. Study Limitations

Although the review sought to provide a comprehensive overview of existing research, there are some limitations related to this study. Despite using a reproducible search strategy, there is the potential for key studies to have been missed. This could be related to language limitations, as well as the possibility of missing studies given the trans- and interdisciplinary nature of public health work. We focused on yielding results within a narrow public health field and capturing literature within health-related journals, but we acknowledge that there could have been articles published by public health scholars in disciplinary journals outside of our scope. Similarly, the topic of teen pregnancy is often cross explored with other topics (teen sexuality, sexual health, young parenting etc.). As we attempted to include only those studies strongly focused on teen pregnancy itself, we may have overlooked some studies that explored several topics at once. However, we felt this narrow scope of focus was necessary, especially given publishing constraints where it may be difficult to appropriately contextualize multiple concepts.
Limitations regarding the use of Plamondon’s tool [18] should also be considered. To our knowledge the tool itself is relatively new and has not been widely used, limiting understanding of potential challenges and limitations for using this tool. Within our study we encountered some challenges in applying the tool for retrospective use. For instance, although the tool provides an assessment of alignment between perceived researcher intention and action, it does not necessarily reveal the processes that shape that alignment. As well, retrospective use is itself limited by publication biases and influences, since the project may have incorporated other elements and aspects that were not, or could not be, included for various reasons, limiting assessment of the overall work. However, used in a multifaceted approach alongside discourse analysis, it does provide a way for reflecting on the topic from a critical perspective through consideration of how research is, or is not, putting health equity knowledge into practice.
A common critique of discourse analysis is that of bias, and that researchers read what they want to find in the texts they analyze [64]. Subjectivity is an inherent and necessary component of discourse analysis and critical research [31,64]. We approached the analysis through an inductive approach, discussing the themes and meanings amongst the team and acknowledge the subjectivity in the analysis. We do not present the results as the only derived meaning but sought to explore patterns in language surrounding teen pregnancy and pregnancy intention from a critical perspective as a way of further exploring public health orientations to the topic.
We also want to acknowledge that there are also pressures and potential constraints enacted on researchers themselves, such as via funding bodies and publication sources, and therefore our analysis may not necessarily reflect in entirety the perspectives of the studies’ researchers themselves. Similarly, we acknowledge the complexity of the issue and challenges for the field of public health given the intersecting systemic and structural influences and heterogeneity of the population. Our goal was not to critique specific authors, but to assess broadly the public health scholarship produced as a mechanism of constructing and (re)producing knowledge about teen pregnancy. Overall, within scoping reviews appraisal of the quality of work that is being presented is also not commonly included [28]. However, as a notable sub-population of teen pregnancy, for which there is a relative paucity of literature, a scoping review provides an insightful first step in mapping out public health research related to intentional and general teen pregnancy in Canada.

6. Discussion

Research is both informed by and shapes our ways of understanding people [65]. Public health researchers represent authoritative voices of teen pregnancy contributing to knowledge production, policy development, and the provision of services–all of which have significant implications for pregnant and parenting teens [17,65]. Given the sociopolitical history in which the problematization of teen pregnancy has been developed and the legacy of a public health involvement, this review focused on gaining a better understanding of not only what research exists, but how current public health research was orienting to the topic of teen pregnancy itself. To achieve this, an adapted framework for health equity action was used to assess how general and intentional teen pregnancy research was aligning awareness and action related to the contextual influences of teen pregnancy. The discourses related to pregnancy intention were also explored to gain insight into how this topic was being constructed and discussed within public health literature. As an act of disciplinary reflexivity, this review highlighted several points of consideration, both from a methodological and theoretical standpoint. These points represent potential epistemological barriers seen within our review, but also reveal new directions for future research in public health.

6.1. Methodologies and Perspectives in Public Health Research

Overall, public health research appears to be limited in terms of methodological approaches and perspectives regarding teen pregnancy in Canada. From the beginning there was a notable lack of mixed methods and qualitative research studies regarding teen pregnancy. This overreliance on study designs that exclude teen perspectives and experiences creates a narrow and limited understanding of the lives of young pregnant and parenting people [1]. All research has limitations, but without diversity in the field, repeated research practices can limit the knowledge gained and inhibit the progress of research. This was seen within quantitative studies; as well several studies using large population data sets recognized the need for other variables (such as pregnancy intention and family/partner support) that simply were not available due to the practice of secondary data analysis [51,59]. Without primary data collection and diverse methodologies, limitations of data analysis and understanding are continuously encountered, unresolved, and then reproduced. And methodological considerations may also be important for this type of health equity work as different methodologies may be better aligned with dismantling oppressive structures than others [66].
Arai’s work with young mothers, for example, highlights the importance of incorporating lived experiences and perspectives by illustrating how integrated qualitative research with policy analysis can lead to new insights and strategies for improving health and social well-being for young families [67]. However, as Breheny & Stephens [65] point out, much of the research that has included teen perspectives is often conducted by outsiders whose lives are quite different than pregnant and parenting teens, resulting in research that often is not deeply engaged in understanding the social world of pregnant/parenting teens themselves and fails to reflexively consider the underlying assumptions of the research. This relates to the lack of teen voices in research but also to the exploration of many contexts and experiences related to teens. Outside of race or ethnicity, pregnant teens are not often differentiated in research. The lack of consideration for circumstances (working/social assistance, married/unmarried, social supports, older/younger etc.), limits understanding of the social world for pregnant and parenting teens and tends to imply that the outcomes are identical, regardless of other factors [1]. As a result, overall, the studies seemed to lack meaningful inclusion of young parents or teens themselves, leading to research done “on” pregnant or parenting teens, not “with” them.

6.2. Addressing the “Root Causes” in Public Health Research

Although the largest category represented studies that acknowledge the contextual influences, none of the studies identified within the scoping review fit within the disruptive category. Even with increased attention towards the social and contextual influences of health inequities, public health research within this scoping review tended to focus on downstream interventions that ultimately work towards altering or supporting individuals to adjust to circumstances, rather than altering society itself [9]. This was seen not only in terms of the health equity framework, but also through discourses being used within research. For instance, the identification of high-risk groups, coupled with a downstream approach and absent sociopolitical contextualization, often resulted in a public health concern that focused on highlighting individual and group level deficits rather than addressing social, structural, and contextual inequities [4]. As a result, specific groups are either situated outside of a general Canadian public health concern or targeted to modify their behaviors to adjust to dominant group expectations, limiting public health’s ability to challenge the very conditions that create systemic inequities [4].
As well, although the reviewers only conducted a precursory search of author credentials and recognize the potential to miss education/training related to public health, it is of potential interest that despite being long heralded as a public health concern, much of the research that fit into the review was done by researchers without a graduate degree in public health and published in more medically focused health journals. It should be noted that this represents only a narrow view of public health training and the implications of this are uncertain. We also recognize the propensity of public health training, itself, to be situated in a biomedical and individualized perspective [68]. Therefore, regardless of researcher credentials or methodological approach, there may be a need for public health research that draws more on critical perspectives, such as Indigenous worldviews, critical race theory, queer theory etc., moving beyond the individual level to address more fulsomely the social and structural contexts and influences related to inequities [5,23]. For example, Smith-Carrier and Benbow [69] employed a matricentric feminist lens to explore the implications of basic income on mothers’, particularly single mothers’, well-being. Expanding such critical perspectives to include young motherhood may provide new directions for disruptive research regarding teen pregnancy. Within public health research, this could also include mainstream focus on epistemology in research, as some scholars have argued for public health to push back against claims of neutrality and take a specific social justice stance [66].

6.3. Nuance in Teen Pregnancy Research

This leads to the final finding, that there is a lack of nuanced research and literature engaging with the multiple facets of teen pregnancy, including that of desired pregnancy. Through shared orientations, ideologies, and language, research can construct a dominant focus on teen pregnancy that ignores or overlooks other ways in which teen pregnancy is experienced [65]. Rather than engaging in-depth with desired pregnancy, or other complex positions that challenge dominant assumptions, research often disengaged from this complexity to focus on areas that fall within more typical societal, and public health, perspectives, such as through recognition that teens may choose pregnancy but not that pregnancy may be a viable option [9]. Within our review some studies did acknowledge the potential positive outcomes of teen pregnancy [10,37,39,46]. However, this was couched within a deficit-based approach, with a strong focus on adverse health outcomes and risk factors, that continued to highlight teen pregnancy as a problem requiring prevention [4]. As Eni and Philips-Beck [14] describe, most young mothers do not describe themselves as “social problems” and so framing teen pregnancy as a problem relies on excluding many facets and perspectives of teen pregnancy itself.
This leads to a final reflection on “teen” itself as a meaningful category–as this review highlights, languages and discourses can be important sites of power and knowledge production, and the continued focus on teen pregnancy as an important categorization may serve to reinforce the position of young mothers as objects of deficiency based on age [65]. The public health construction of teenage motherhood also includes discourses informed by dominant views of individual development, family structures, and motherhood [4]. But highlighting age when it comes to teen pregnancy risk and adverse outcomes blurs the problems of youth with the problems of disadvantage, of which age alone may not overcome [4]. Future discussions and research of teen pregnancy should include critically examining the implied intrinsic requirement to separate teens from other pregnant and parenting groups [65].

7. Conclusions

Long considered a public health concern, this scoping review highlights how public health research related to teen pregnancy remains limited in terms of diversity in research approaches, public health action, and often engages in the topic of teen pregnancy in a narrow and downstream manner. Use of Plamondon’s [18] adapted framework showed how although some research acknowledges or even works to further explore the contextual influences, there is a lack of research that addresses the contextual, social, or structural influences related to teen pregnancy inequities in Canada. Furthermore, analysis of the discourses revealed public health perspectives of teen pregnancy intention that are rooted in biomedical and individualistic conceptualizations that further marginalizes and decontextualizes pregnant and parenting teens. As a result, public health research and recommendations often invariably attribute health inequities to that of flawed individuals, rather than upstream systems and structures [4]. These findings point to some epistemological barriers (disciplinary assumptions, practices, and norms) within public health research that may limit actioning research to address the “root causes” of teen pregnancy-related inequities. Although not able to address the potential structural constraints within research itself, as an exercise of disciplinary reflection, this scoping review brings forward some areas to consider within public health research, while shining a light on possible new directions.

Author Contributions

Conceptualization, S.D.; Methodology, S.D.; Software, S.D. and M.S.A.M.; Formal Analysis, S.D. and M.S.A.M.; Data Curation, S.D.; Writing – Original Draft Preparation, S.D.; Writing – Review and Editing, S.D. and M.S.A.M. and C.M.D.; Supervision, C.M.D.; Funding Acquisition, S.D. and C.M.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Canadian Institutes of Health Research grant number 457914.

Data Availability Statement

Data for this scoping review is available in the Appendix A and Appendix B.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Scoping Review Search Strategies

Please note: keywords with an asterisk indicate truncated forms of a word, with all subsequent variations stemming from that word being included in the keyword search.
Table A1. OVID MEDLINE Search Strategy.
Table A1. OVID MEDLINE Search Strategy.
Term 1
Pregnancy		Term 2
Canada		Term 3
Public Health
KeywordsInten * adj3 Pregnancy
Adolescent Pregnancy
Teen * Pregnancy
Teen * Mother *
Teen * Mom
Young Mother *		Canadian *Public Health Policy
Public Health Policies
Public Health Program *
Determinants of Health
Sociocultural Factors
Health Program *
Prevention
Subject HeadingsPregnancy in AdolescenceExp Canada/Exp Socioeconomic Factors/
Exp Public Health/
Exp Population Health/
Exp Health Promotion/
Exp Health Policy/
“Social Determinants of Health”
Health Status Disparities/Harm Reduction/
Primary Prevention
Secondary Prevention
Tertiary Prevention
Exp Health Services/
Exp Demography/
Risk Factors
Ovid Medline—156 references uploaded.
Table A2. OVID EMBASE Search Strategy.
Table A2. OVID EMBASE Search Strategy.
Term 1
Pregnancy		Term 2
Canada		Term 3
Public Health
KeywordsInten * adj3 * Pregnancy
Teen * Pregnancy
Teen * Mother *
Teen * Mom
Young Mother*		 Public Health Policy
Public Health Policies
Public Health Program *
Sociocultural Factors
Teen Pregnancy Rates
Subject HeadingsAdolescent Pregnancy
Adolescent Mother		Exp Canada/
Canadian		Exp Socioeconomics/
Public Health
Population Health
Exp Health Promotion/
Exp Health Care Policy/
“Social Determinants of Health”
Health Disparity
Harm Reduction
Exp Prevention/
Exp Demography/
Exp Health Service/
Exp Risk Factors/
OVID EMBASE—155 references uploaded.
Table A3. OVID PsycInfo Search Strategy.
Table A3. OVID PsycInfo Search Strategy.
Term 1
Pregnancy 		Term 2
Canada 		Term 3
Public Health
KeywordsInten * adj3 * Pregnancy
Teen * Pregnancy
Teen * Mother *
Teen * Mom
Young Mother *		Canada
Canadian		Public Health Policy
Public Health Policies
Public Health Program *
Determinants of Health
Subject HeadingsAdolescent Pregnancy
Adolescent Mother		 Exp Socioeconomic Factors/
Exp Socioeconomic Status/
Exp Public Health/
Population Health
Health Promotion
Exp Health Care Policy/
Health Disparities
Exp Harm Reduction/
Exp Prevention/
Exp Demographic Characteristics/
Exp Health Care Services/
Risk Factors
Public Health Research
Exp Sociocultural Factors/
OVID Psych Info—27 references uploaded.
Table A4. CINAHL Search Strategy.
Table A4. CINAHL Search Strategy.
Term 1
Pregnancy		Term 2
Canada 		Term 3
Public Health
Keywords Inten * adj3 * Pregnancy
Teen * Pregnancy
Teen * Mother *
Teen * Mom
Young Mother *		Canada
Canadian 		Public Health
Population Health
Risk Factors
Health Promotion
Harm Reduction
Health Disparities
Health Care Policy
Prevention
Health Care Services
Demographic Characteristics
Determinants of Health
Public Health Program *
Public Health Policy
Public Health Policies
Subject Headings Pregnancy in Adolescence
Adolescent Mothers 		Psychosocial Factors
Socioeconomic Factors
CINAHL—66 references uploaded.
Table A5. Grey Literature Database Search Strategies.
Table A5. Grey Literature Database Search Strategies.
Database Name and URLSearch StrategyNumber of Search ResultsNumber of References Identified
Google Scholar
(11 January 2022)
Advanced Search Options Used 		“Teen pregnancy or adolescent pregnancy or young mother” AND “Canada” in the title

Limit 2000–2021		1515
Google Scholar
(16 January 2022)
Advanced Search Options Used		“Teen pregnancy or adolescent pregnancy or young mother” AND “Canada” AND “public health”

Limit 2000–2021		9930 (teen)
7740 (adolescent)
(Hand scanned first 25 pages–several pages past any relevant studies)		98 + 22 = 120
Grey Net No Searchable Field00
ProQuest Dissertations and Theses Global“Teen pregnancy” OR “adolescent pregnancy” AND Canada AND “public health”

Limited to 2000-present publication year		3535
SCOPUS“Teen pregnancy OR adolescent pregnancy OR young mother” AND “Canada” in title-abstract-keyword

Limited to 2000 to present publication year		3939
Web of Science “Teen pregnancy” OR “adolescent pregnancy” OR “young mother” AND “Canada” AND “public health”

Limited to 2000 to present publication year		4444
Note: Total COVIDENCE Citations Imported 449 (with duplicates removed).

Appendix B

Table A6. Data Extraction Table.
Table A6. Data Extraction Table.
TitleAuthor(s)Journal TitleDate of PublicationStudy Design DescriptionStudy Type Objective of Study (Taken from the Article)Population Description (Taken from Article)Pregnancy FocusMention of Intentional PregnancyPublication FieldPublic Health Credentials (MPH/PhD) IdentifiedPublic Health Focus Orientation to Contexts Related to Teen Pregnancy
Characteristics of adolescent street youth with a history of pregnancyHaley, N. et al. [32]Journal of Pediatric and Adolescent Gynecology2004Quantitative–prospective cohort studyManuscriptDetermination of social and behavioral factors associated with a history of pregnancy among adolescent street youthFemale adolescent street youth (ever compared to never pregnant)General PregnancyYesHealth JournalNoRisk Factors; Social Determinants of HealthAcknowledge
The risk of teenage motherhood decreases in a dose response fashion with increasing SES: A population-based study from British Columbia, CanadaFairthorne, J. et al. [33]Journal of Women’s Health and Gynecology2017Quantitative–nested retrospective cohort study ManuscriptAssessment of risk of teenage motherhood in relation to SES Mothers whose first child was born in BC from 1 January 1999 to 31 December 2009General PregnancyYesHealth JournalYesRisk Factors; Social Determinants of HealthAcknowledge
Desire for pregnancy among adolescents in an antenatal clinicKives, S., & Jamieson, M. A. [34]Journal of Adolescent and Pediatric Gynecology2001Quantitative–cross sectional studyConference AbstractDetermination of percentage of Canadian adolescents presenting for antenatal care desired pregnancy All pregnant adolescents presenting to an adolescent obstetric clinic between March 1999 and December 2000Intentional PregnancyYesHealth JournalNoTeen Pregnancy Prevention; Other: assessing attitudes related to pregnancyDistract
A matched cohort study of the association between childhood sexual abuse and teenage pregnancyFortin-Langelier, E. et al. [35] The Journal of adolescent health: official publication of the Society for Adolescent Medicine2019Quantitative -matched cohort studyManuscriptDetermination of history of child sexual abuse and teen pregnancy risk of pregnancy complications and fetal lossTeens with CSA report made by CPS between 1 Jan 2001, and 31 Dec 2010, was matched to teen general population General Pregnancy Yes,Health JournalNoRisk factors; Social Determinants of Health; Health OutcomesAcknowledge
Intergenerational teen pregnancy: A population-based cohort studyLiu, N. et al. [36]BJOG: An International Journal of Obstetrics and Gynaecology2018Quantitative–population-based retrospective cohort studyManuscriptEstimation of intergenerational association in teenage pregnancyDaughters between 1 April 1988 and 31 March 1996 born to mothers born between 1 April 1973 and 31 March 1980 in OntarioGeneral PregnancyYesHealth JournalNoTeen Pregnancy Prevention; Demographics; Risk factors; Social Determinants of HealthAcknowledge
“It was kind of like if it happens it happens. It wasn’t planned, it wasn’t intentional”: Young mothers’ experiences with subsequent pregnancy in Ottawa, CanadaFortier, E. & Foster, A. [37]Facets Journal 2017Qualitative–semi-structured interviewingManuscriptBetter understand the dynamics shaping “rapid repeat pregnancy” among young mothers in Ottawa for service improvementYoung mothers currently residing in Ottawa who have conceived their first child before the age of 20General PregnancyYesOtherNoRisk factors; Social Determinants of Health; Other: experiences of teen pregnancy servicesIlluminate
Weakening the links between violence exposure and teen pregnancy involvement in western Canada: Protective factors that may promote resilienceSaewyc, E.M. & Chen, W. [38]Journal of Adolescent Health2012Quantitative–cluster designConference AbstractEstimation of the probability of teen pregnancy involvement with violence exposurePublic school students in Western Canada between grades 7–12 who completed the BC Adolescent Health Survey in 2008General PregnancyNoneHealth JournalNoTeen Pregnancy Prevention; Risk factors; Social Determinants of HealthAcknowledge
Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British ColumbiaSaewyc, E. M. et al. [39]Canadian Journal of Human Sexuality2008Quantitative–cross sectional survey designManuscriptExploration of trends in pregnancy involvement, related sexual behaviors, and exposure to forms of enactedstigma for gay, lesbian, and bisexual youth inCanada Students in grades 7 to 12 in public schools of BC as part of the BC Adolescent Health Survey in 1992, 1998, and 2003General PregnancyYesHealth Journal NoDemographics; Surveillance and Monitoring; Risk factors; Other: social outcomesIlluminate
Teenage pregnancy in Nova Scotia communities: Associations with contextual factorsLangille, D., Flowerdew, G., & Andreou, P. [40]The Canadian Journal of Human Sexuality2004Quantitative–ecological Study ManuscriptAssessment of the distribution of teenage pregnancy in Nova Scotia communities and identification of community contextual factors associated with teenage pregnancyWomen with first pregnancies aged 15–19 between 1995–2000 in Nova ScotiaGeneral PregnancyYesHealth JournalYesDemographics; Surveillance and Monitoring; Social Determinants of HealthIlluminate
Outcomes of teenage pregnancies on the Avalon peninsula of Newfoundland and Labrador between 2001–2008 in comparisons to their 20–24 year old counterpartsMurphy, D., Delaney, T., & Murphy, P. [41]Journal of Pediatric and Adolescent Gynecology2011Quantitative–retrospective cohort studyConference AbstractAssessment of pregnancy outcomes at a tertiary care center within the province of Newfoundland and LabradorPregnancy in girls ≤ 19 years of were compared to their adult counterparts aged 20–24 years oldGeneral PregnancyNoneHealth Journal NoDemographics; Health OutcomesDiscredit
Outcomes of adolescent pregnancy in Nova Scotia: A retrospective cohort studyJain, L., Van Eyk, N., & Kuhle, S. [42]Journal of Pediatric and Adolescent Gynecology2017Quantitative–retrospective cohort studyConference Abstract Examination of the health determinants and outcomes of adolescent pregnancies compared to adult pregnancies in Nova Scotia2000–2013 singleton births of women in Nova Scotia Atlee Perinatal Database General Pregnancy None Health Journal YesDemographics; Risk factors; Social Determinants of Health; Health Outcomes Disregard
Is young maternal age really a risk factor for adverse pregnancy outcome in a Canadian tertiary referral hospital?Shrim, A. et al. [43]Journal of Pediatric and Adolescent Gynecology2011Quantitative–retrospective cohort studyManuscript Assessment of risk of adverse pregnancy outcome among teenage mothers within a large tertiary referral center in CanadaNulliparous single births in McGill University Health Centre during 2001–2007 General Pregnancy NoneHealth Journal NoHealth Outcomes Discredit
Seasonal trends in adolescent pregnancy conception ratesTurnbull, K. et al. [44]Journal of Pediatric and Adolescent Gynecology2011Quantitative–retrospective chart reviewManuscriptDetermination of seasonal trends in adolescent pregnanciesAll pregnancies in adolescents over a 5-year period from 2004 to 2008, inclusive, at a tertiarycare hospital. General PregnancyYesHealth JournalNoTeen Pregnancy Prevention; Surveillance and MonitoringDistract
Comparison of adolescent, young adult, and adult women’s maternity experiences and practicesKingston, D. et al. [45]Journal of Pediatrics2012Quantitative–cross sectional studyManuscriptComparison of maternity experiences, knowledge, and behaviors of adolescent, young adult, and adult women in Canadawomen who had completed the 2006 Canadian Census of Population and met study inclusion criteriaGeneral PregnancyYesHealth JournalNoDemographics; Risk factors; Health OutcomesAcknowledge
Prevalence and characteristics of teen motherhood in CanadaAl-Sahab, B. et al. [46]Journal of Maternal and Child Health2012Quantitative studyManuscriptExamination of prevalence and characteristics of adolescent mothers throughout the provinces of CanadaWomen aged 15 years and above, who had singleton live births between 15 February 2006 and 15 May 2006, in Canadian provinces and between 1 November 2005 and 1 February 2006, in Canadian territoriesGeneral PregnancyYesHealth JournalYesDemographics; Risk factors; Social Determinants of HealthAcknowledge
Adolescent pregnancy outcomes in the province of Ontario: a cohort studyFleming, N. et al. [47] Journal of Obstetrics and Gynaecology in Canada2013Quantitative–retrospective cohort studyManuscriptCharacterization of association between adolescent pregnancy and specific adverse, maternal, obstetrical, and neonatal outcomes, and maternal health behaviorsUse of BORN database of singleton births between January 2006 and December 2010General PregnancyNoneHealth JournalYesRisk factors; Social Determinants of Health; Health OutcomesDistract
Fertility rate trends among adolescent girls with major mental illness: A population-based studyVigod, S.N. et al. [48]Pediatrics2014Quantitative–cross-sectional studyManuscriptExamination of temporal trends in fertility rates among adolescent girls with major mental illness.girls 15–19 years of age in Ontario Canada between 1999–2009General PregnancyNoneHealth JournalNo Teen Pregnancy Prevention; Demographics; Surveillance and MonitoringDistract
The effect of social support around pregnancy on postpartum depression among Canadian teen mothers and adult mothers in the Maternity Experiences SurveyKim, T. H., Connolly, J. A., & Tamim, H. [49]BMC Pregnancy and Childbirth2014Quantitative–cross-sectional studyManuscriptExamination of effects of social support received during and after pregnancy on postpartum depression among Canadian teen and adult womenWomen who gave singleton live births between theperiod of November 2005 and May 2006, aged 15 years and olderGeneral PregnancyYesHealth JournalYesRisk factors; Social Determinants of Health; Health OutcomesAcknowledge
Strategically timed preventive education and media strategies reduce seasonal trends in adolescent conceptionGauster, A., Waddington, A., & Jamieson, M. A. [50]Journal of Pediatric and Adolescent Gynecology2015Quantitative–quasi-experimental non-randomized intervention studyManuscriptAnalysis of effect of strategically timed local preventive education on reducing teen conception rates during known seasonal peaksPregnant adolescents between March and April 2010, 2011, 2012General PregnancyNoneHealth JournalNoTeen Pregnancy Prevention; Surveillance and Monitoring; Program EvaluationDistract
Factors associated with breastfeeding initiation in adolescent pregnancies: A cohort studyLeclair, E., Robert, N., Sprague, A. E., & Fleming, N. [51]Journal of Pediatric and Adolescent Gynecology2015Quantitative–retrospective cohort studyManuscriptDetermination of association between multiple high-risk characteristics of pregnant adolescents with intention and initiation of breastfeedingAdolescent women who gave birth in an Ontario hospital and who delivered a singleton liveborn infant at term gestation from 1 April 2006, to 31 March 2012.General PregnancyYesHealth JournalNoHealth Outcomes; Other: Factors associated with breastfeeding in adolescent pregnancyDisregard
The collection and analysis of carbon monoxide levels as an indirect measure of smoke exposure in pregnant adolescents at a multidisciplinary teen obstetrics clinicLopez, A. et al. [52]Journal of Pediatric and Adolescent Gynecology2015Quantitative–prospective observational studyManuscript Analysis of CO levels as an indirect measure of smoke exposure in pregnant adolescentsPregnant adolescents who attended a multidisciplinary teen obstetrics center at a tertiary Southeastern Ontario Hospital over an 18-month period (February 2012–July 2013)General PregnancyNoneHealth JournalNoHealth Promotion; Demographics; Risk factors; Health OutcomesDisregard
Prevalence and characteristics of intended adolescent pregnancy: an analysis of the Canadian Maternity Experiences SurveySekharan, V. et al. [10]Reproductive Health2015Quantitative–secondary analysis ManuscriptExamination of prevalence and characteristics of Canadian adolescent women who intended to become pregnant.Adolescent women between 15–19 years of age at the time of the infant’s birth who gave birth between 15 Feb 2006 and 1 Nov 2006, for provinces and 1 Nov 2005 and 1 Feb. 2006, for territories. Intentional PregnancyYesHealth JournalNoDemographics; Risk factors; Social Determinants of HealthIlluminate
Gestational weight gain and perinatal outcomes in adolescent mothers: A retrospective cohort studyMacSween, K., Whelan, E., & Woolcott, C.G. [53]Journal of Obstetrics and Gynaecology Canada2016Quantitative–retrospective cohort studyManuscript Examination of associations between Gestational weight gain and perinatal outcomes among adolescents compared to adult womenAll live born, singleton deliveries to adolescents and a comparison group of women in Nova Scotia between 1 January 2003 and 31 December 2014General PregnancyNoneHealth JournalYesDemographics: Health OutcomesDiscredit
Teenage pregnancy: the impact of maternal adolescent childbearing and older sister’s teenage pregnancy on a younger sisterWall-Wieler, E., Roos, L.L., & Nickel, N.C. [54]BMC Pregnancy and Childbirth2016Quantitative–retrospective Cohort StudyManuscriptExamination of mother or older sister’s teenage childbearing and teen pregnancy predictionWomen born in Manitoba between 1 April 1979, and 31 March 1994, meeting inclusion criteriaGeneral PregnancyYesHealth JournalYesDemographics; Risk factorsIlluminate
Teen clinics: missing the mark? Comparing pregnancy and sexually transmitted infections rates among enrolled and non-enrolled adolescentsShaw, S.Y. et al. [55]International Journal for Equity in Health2016Quantitative–population-based studyManuscriptComparison of pregnancy and STI rates between adolescents enrolled in schools with school-based clinics, those in schools without clinics, and those not enrolled in school.All adolescents 14 to 19 years of age with continuous health coverage between fiscal years (1 April to 31 March) 2003 to 2010General PregnancyNoneHealth JournalYesTeen Pregnancy Prevention; Risk factors; Program EvaluationAcknowledge
Teenage pregnancy and long-term mental health outcomes among Indigenous women in CanadaXavier, C., Brown, H., & Benoit, A. [56]Women’s Mental Health2018Quantitative–cross sectional study ManuscriptComparison of risks for poor long-term mental health outcomes among Indigenous women with and without teenage pregnancySurvey respondents who were Indigenous women who, at the time of the interview, were 25–49 years of age and had at least one childGeneral PregnancyYesHealth Journal YeeSocial Determinants of Health; Health OutcomesAcknowledge
Adolescent pregnancy outcomes among sisters and mothers: A population-based retrospective cohort study using linkable administrative dataWall-Wieler, E., Roos, L.L., & Nickel, N.C. [57]Public Health Reports2018Quantitative–retrospective cohort studyManuscriptExamination of older sister’s adolescent reproductive outcomes effect on younger sister’s reproductive behavior Women born between 1 April 1984, and 31 March 1996, meeting inclusion criteriaGeneral PregnancyNonePublic Health JournalYesDemographics; Risk factors; Social Determinants of HealthAcknowledge
Characteristics and outcomes of adolescent births in Nova Scotia: A retrospective cohort studyJain, L. H. et al. [58]Journal of Obstetrics and Gynaecology Canada2018Quantitative–retrospective Cohort StudyManuscriptExamination of maternal characteristics and outcomes of adolescent births in Nova ScotiaSingleton live births between 1 January 2006 and 31 December 2015, using Nova Scotia Atlee Perinatal DatabaseGeneral PregnancyNoneHealth JournalUnknown credentialsDemographics; Risk factors; Social Determinants of Health; Health OutcomesDistract
Maternal area of residence, socioeconomic status, and risk of adverse maternal and birth outcomes in adolescent mothersAmjad, S. et al. [59]Journal of Obstetrics and Gynaecology Canada2019Quantitative–retrospective cohort studyManuscriptEvaluation of joint association between residence, socioeconomic status, and adverse adolescent pregnancy outcomesAll singleton live births in Alberta between 1 April 2010 and 31 March 2015 among women aged 15 to 19 registered in the Alberta Perinatal Health ProgramGeneral PregnancyYesHealth JournalYesRisk factors; Social Determinants of Health; Health OutcomesAcknowledge
The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancyCatherine, N. et al. [60]BMC Public Health2019Quantitative–randomized controlled trial studyManuscriptDescription of health and social adversities experienced by a cohort of girls and young women in early pregnancy in BCParticipants enrolled in the BCHCP trial meeting eligibility criteriaGeneral PregnancyNonePublic Health JournalYesDemographics; Risk factors; Social Determinants of HealthIlluminate
Risk factors and birth outcomes associated with teenage pregnancy: A Canadian sampleWong, S. et al. [61]Journal of Pediatric and Adolescent Gynecology2020Quantitative–retrospective cohort studyManuscriptExamination of extent to which socioeconomic status, mental health, and substance use are associated with teenage pregnancies in Southwestern Ontario and risk of adverse birth outcomesAll births at London Health Sciences Center, Ontario between February 2009 and February 2014General PregnancyNoneHealth JournalNoDemographics; Risk factors; Social Determinants of Health; Health OutcomesDisregard
Trends in adolescent rapid repeat pregnancy in CanadaRamage, K et al. [62]Journal of Obstetrics and Gynecology Canada2021Quantitative–descriptive analysis ManuscriptExamination of trends in and outcomes of adolescent rapid repeat pregnancy in CanadaWomen aged 20 or younger at index birth event and delivered an infant during the study period (2004/2005 to 2014/2015) in CanadaGeneral PregnancyYesHealth JournalYesDemographics; Surveillance and Monitoring; Health OutcomesDisregard

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