Teen mothers need tangible support to help them with their contraceptive decisions and to prevent unintended rapid-repeat births, according to recent research.1
The AIM (Adult Identity Mentoring) 4 Teen Moms (AIM4TM) program is a future-oriented behavioral intervention that can help influence teen mothers’ attitudes, intentions, and contraceptive use and behaviors.
“There’s a strong history and a lot of evidence behind the intervention,” says Julie A. Cederbaum, PhD, MSW, MPH, associate professor at the University of Southern California Suzanne Dworak-Peck School of Social Work.
The first-time teen mothers enrolled in the intervention group received seven individual sessions every 10-14 days and lasting 45 to 60 minutes each. They also attended two 90-minute group sessions.
“There is a trained facilitator, who is like an advisor,” Cederbaum explains.
AIM4TM’s philosophy is focused on personal legacy, future goals, and aspirations. The teens are encouraged to think about who they want to be and what their future goals are.
“Say someone wanted to be a nurse,” Cederbaum says. “She may think, ‘What would it take to get me to that goal, and what barriers could get in my way?’”
For instance, a second birth could be a barrier. A teen mother might think that a rapid-repeat pregnancy could slow her down.
“It’s helping young people project what their goals are for the future and identify roadblocks that get in their way,” Cederbaum says. “Contraceptive planning, in terms of intervention, comes about from safeguarding one’s future and creating a reproductive life plan.”
AIM4TM uses these five main content elements:
• Thinking about a positive possible future. The intervention helps young people envision a positive future and set goals through discussion and activities.2
“They think about themselves and what they want,” Cederbaum says. “Until that’s established, it’s hard to have a reason to not engage in risky behaviors.”
A person should think through what he or she wants before thinking through a way to achieve their goals, she adds. For instance, if a program participant wants to attend college, she may want to think about whether another pregnancy and child would help with that goal. If not, she may think about what type of contraception makes the most sense.
“Look at what the end goal is and work back to go through the steps,” Cederbaum says.
• Actions to achieve future success. This element teaches communication skills and how people can identify their own strengths. It helps them find resources and experience success through engagement in personal and group activities.
“As providers, we go to step one — contraception, but they need to think through why,” Cederbaum explains. “They think, ‘If I just had a child, what’s the motivation for me to not have another one? I need something for my future.’”
Each person needs to think about what would slow her plan and what would help achieve it. Once a participant realizes actions that prevent a pregnancy may help her achieve the next steps of the plan, she is motivated to use contraception. Participants also are motivated to prevent unplanned pregnancy because it would impede their goal.
As youth focus on actions, they begin to understand how to access and use support systems. “Social support was not a specific element of this intervention,” Cederbaum notes. “However, we do talk about how there are intervention activities to support moms in thinking about these resources, the formal support they have, and the relationships with others to help them meet their aspirations.”
Actions also require positive habits, such as taking a birth control pill each day at the same time. “We tell people to put the pill next to their toothbrush, because if you brush your teeth every day, you’ll take your pill every day,” she says. “As providers, we think there are easy solutions, but we forget to ask what would get in the way of someone doing that. An implant or long-acting reversible contraceptive might be a better choice than oral contraception or condoms for some people.”
Condoms require negotiation, and oral contraception requires a consistent habit and planning. “We need to think realistically that if a young person’s goal is to not be pregnant, which contraception choice is best for them within the parameters of their life, the context of their life,” Cederbaum adds.
• Safeguarding one’s future; encouragement to make less risky choices. Young mothers learn how to reduce risk and safeguard their future. This element focuses on intent, followed by actions to support the intent.
“For me to perform a behavior, I have to intend to do it, and for me to intend to do a behavior, I need to have a positive attitude about it,” Cederbaum explains. “If I’m going to use a condom, I need to intend to use it the next time I have sex.”
If a person does not intend to do it, they are unlikely to take the action. “For me to intend to use a condom, I have to believe condoms work and won’t reduce pleasure, and so I have to believe positive things about condoms,” she says. “Often, we target interventions to that attitude, talking through the barrier.”
Talking with patients about different contraceptive methods and the barriers to each can help the provider and patient mutually decide on the best contraceptive choice for the patient.
• Creating a reproductive life plan. The curriculum covers different methods of contraception and helps young mothers conceptualize family planning as part of a larger holistic reproductive health agenda. They create personalized reproductive life plans.
The program helps young mothers identify their higher birth control attitudes. For example, one attitude statement is, “I will not have sex if I do not have a reliable method of birth control,” Cederbaum says.
Social support may influence attitudes about contraceptives and use of contraceptives. Tangible support, which includes actions that help a person meet their goals, is important to helping teen mothers realize their reproductive health goals.1
“This is someone taking you to the doctor if you need it, or helping you with daily chores, if you’re sick,” Cederbaum explains. “It’s someone watching the child so the person can go to an appointment. It’s not just someone in my corner telling me that contraception is a good thing, but having someone in my corner who can help me do it.”
• Motherhood as an identity strength. There is a focus on how motherhood is a driving force that motivates many young mothers to succeed in life. Youths are encouraged to consider parenting as something that adds to their strengths and experiences. It is useful to their success, rather than just a limiting factor in their lives.
“It’s not that medical providers are not doing the right thing, but if there is some time built in to think about a young person’s whole self and not just their reproductive self, then this integrates these different facets of their being,” Cederbaum explains. “For young people, it’s particularly hard. In a medical setting, you say, ‘Focus on these goals,’ but no one is bringing an umbrella of how all of these goals are working together.”
It is easier for adults to plan their goals. Young people need this to be laid out for them.
“One thing we found with the intervention as a whole was that it was much more effective for younger moms, ages 15 to 17, than it was for older teens, 18 to 19, and that makes sense,” Cederbaum says. “Younger moms just may be less equipped to enter motherhood and are in more need of some of these supports.”
Older teen mothers may have more established networks or have partners who can support some of their goals.
REFERENCES
- Cederbaum JA, Yoon Y, Lee JO, et al. AIM for Teen Moms: Social support’s role in contraceptive use among young mothers. J Adolesc Health 2022;S1054-139X(22)00285-3.
- AIM 4 Teen Moms. Program overview.
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