Study: Canadian teen mothers face increased risk of premature death, concerns raised in Saskatchewan

The leading cause of premature death for pregnant teens fell into the category of non-injury related, or natural causes. The second cause was injury-related of an unintentional nature, which could include car accidents, or accidental overdoses. The third cause of premature deaths were injury-related of an intentional nature, such as self-harm or harm caused by someone else. Teens with pregnancies that ended in a live birth, miscarriage, still birth or ectopic pregnancy had the highest risk of premature death when compared to those who terminated their pregnancies.

The study’s lead researcher, Dr. Joel Ray, said the data integrated his two areas of clinical and research focus interest: premature mortality among young adults, particularly in the wake of increased mental health crises, the opioid crisis and the health insight pregnancy can offer on a woman’s life trajectory.

A pregnancy, Ray said, is a “canary in the coal mine” that provides a snapshot of the teen’s past life experiences and forecasts future wellbeing.

“It’s both a good sort of rearview mirror… and it’s also a good horizon indicator,” he said.

Dr. Joanne Sivertson, the head obstetrician and gynecologist for the Saskatchewan Health Authority and a practicing doctor in Prince Albert, said Ray and his colleagues’ study is “statistically and clinically significant.”

“It’s a scary outcome,” she said, noting the death rate was “much higher” than the number she expected.

In considering the implications this new information has for her patient population in Prince Albert and the North, Sivertson highlighted a limit to provincial vital statistics — one she’s advocating to change: Saskatchewan restricts postpartum mortality data to occurrences within six weeks after delivery, instead of the one-year period a majority of provinces have adopted.

“The women in northern Saskatchewan in particular have disparity in their health outcomes and I strongly suspect in their survival rates. We just don’t have those numbers the way that we’d like to have to support that statement,” she said.

Ray agreed extending the monitoring period to one year enhances healthcare providers’ understanding of a new mother’s social and psychological wellness.

“Maternal mortality statistics extending to one year will tell you more about young mothers who are in the early phase of motherhood,” he said. “How they do, how they fare, because some of the deaths that occurred after 42 days are no longer really connected to the labour and birth episode or really connected to pregnancy. It’s much more centered in the phenomenon of motherhood.”

Despite a lack of accessible data for provincial health care providers, Ray suggested the study could likely be replicated in Saskatchewan with national mortality statistics.

(Original Graphic, CB)

The investigation also noted teen pregnancy on its own is unlikely to kill a young mother. Other markers or “adverse life experiences” such as sexual and emotional abuse, divorce, or income decline are connected to unprotected sex but also to premature mortality. The opioid crisis “played very heavily” into cause of death in the study, Ray said.

Sivertson says because of these correlations, it’s about intervening before the pregnancy occurs.

“It’s about trying to fix our social systems to lift people up out of poverty and correct some of those disparities that exist, especially in [northern Saskatchewan],” she said. “If we wait until a patient shows up with a pregnancy as a teenager we can try to intervene then, but a lot of the initial damage has been done to their psyche and their social wellbeing if we’re looking at the adverse childhood effects.”

Speaking anecdotally, Sivertson said overcoming hardship has greater affect on her patients than stigma.

“I don’t see the young mothers feeling or expressing shame or regret. In fact, some of them are coming to me at very young ages at like 19 because they haven’t been able to get pregnant. I think for some of these patients, motherhood is actually a change in their life status that some actually seek. I think they may be seeking it because they’re in a challenging environment and they want something different. They’re seeking motherhood,” she said. “From my limited perspective… I actually feel like the stigma isn’t necessarily a big piece of it. I feel like it’s more a reflection of the lives they’ve been living, or may even be trying to escape.”

Regarding public policy, Ray and his colleagues’ study offers insights in preventing these pregnancies and potentially associated deaths.

“Premature mortality is an excellent indicator of things that can be prevented and solutions that can be sought to do that,” he said, adding those solutions could be ensuring young women have peer supports, access to contraception and the “maximum agency” to avoid pregnancy on their own terms.

“Adverse childhood experiences are a component of what enables that preadolescent girl to develop the skills and capacity for self efficacy, for believing that she has agency. So that once she hits her reproductive years she has some of those tools available to her. It’s an absolutely difficult time in any young woman’s life to make those transitions into adolescence. It doesn’t matter where they live or who they are; it’s a trialing time. It really requires a lot of skills whose foundation period is in childhood. The ability to say no, the ability to see harm from good. And the opportunity to differentiate decisions that can go wrong.”

Julian Wotherspoon, the director of Planned Parenthood Regina, said the doubled risk of premature mortality for teen mothers is a ‘shocking number’ but one that reveals more about the needs in Saskatchewan.

The province’s recent legislative change, effectively banning third party educators to provide sexual health education, creates a barrier in connecting with vulnerable teens, she said.

Sex education “wasn’t necessarily adequate before it became a contentious issue more recently,” Wotherspoon said. “It was really heavily dependent on how comfortable the teacher was with that material. What we frequently hear from teachers is that they don’t feel equipped to teach this which is why there was such a high demand for Planned Parenthood to go into schools to begin with.”

In addition to teen pregnancy mortality rates, Wotherspoon seeks further indicators on the sexual health of the province. Routinely other organizations submit requests to her for any data she may have that is not available from Vital Statistics. But the information Planned Parenthood holds is limited to who has accessed their services.

“I think this is an interesting symptom of the kind of government that we have right now. I think that control over that kind of information sort of limits people on the ground from leveraging that kind of data in order to create change in the areas where they work. I don’t think that is only our sector,” Wotherspoon said, adding she’s heard similar concerns from workers in other areas. “There’s population information that we just don’t have in Saskatchewan that is often available in other provinces.”

Another barrier for the Prairies is a shortage of health care professionals, she said. Ensuring services are available when needed is complicated by current staffing levels. The factor of teenage autonomy stressed by both Sivertson and Ray was again echoed by Wotherspoon.

“We also live in a province with really high levels of domestic and sexualized violence which leads to a culture that is, I think, more difficult to negotiate these things with in a sexual encounter. When we combine that with youth that just aren’t getting the education that they need in order to negotiate those terms, whether or not they know about condoms doesn’t really help if they don’t have the tools to negotiate condom use in a sexual situation.”

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glynn.brothen@pattisonmedia.com

by Glynn Brothen

Study: Canadian teen mothers face increased risk of premature death, concerns raised in Saskatchewan

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