DAY 1: Mothers too soon

 

Groundbreaking analysis exposes relationship between poverty and teenage pregnancy

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By STEVE BUIST and TERI PECOSKIE

Picture the narrow sliver of Hamilton’s inner city that runs from the foot of the escarpment to the waterfront between Sherman Avenue and Wentworth Street. It’s a gritty stretch burdened with the weight of heavy industry, cheap housing and high rates of poverty.

It’s also where one in seven babies delivered between 2006 and 2010 was born to a teen mom, one of the highest rates among all Ontario cities. During that period, nearly 100 of the 668 expectant moms living between Sherman and Wentworth who gave birth were teenage girls.

Across the bay, there’s a small chunk in the northeast corner of Burlington, an upscale neighbourhood known as The Orchard where the average home value pushes $400,000.

There were 774 women in this neighbourhood who gave birth between 2006 and 2010.

Not a single one was a teenage girl.

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The differences between the Sherman-Wentworth corridor and the Burlington neighbourhood are glaringly, almost painfully, obvious.

In the Sherman-Wentworth area, the median household income is less than $36,000, half of all children live below the poverty line, nearly 25 per cent of all income is provided by government transfers and more than one in four adults don’t have a high school diploma.

Meanwhile, in the Burlington neighbourhood, the median household income is nearly $106,000, less than 7 per cent of the neighbourhood lives below the poverty line, just 3 per cent of all income is provided by the government and nearly half of all adults have university degrees.

Nothing better illustrates the complex problem of teen moms and teen pregnancies in Ontario than these two neighbourhoods, mere miles away from each other but worlds apart.

Now, a groundbreaking Spectator examination of maternal health data from 535,000 provincial birth records clearly shows the solid connections that exist between income, education, poverty levels and the rates of teen mothers in Ontario, at both neighbourhood and community levels.

The data has been dissected into thousands of neighbourhoods that span the entire province, allowing health factors to be compared with social and economic variables.

The comprehensive analysis of four years of birth outcomes in Ontario expands on the findings of The Spectator’s landmark Code Red series, published last year.

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Code Red highlighted the strong connections that exist between poor health and poverty across Hamilton neighbourhoods. The series exposed glaring disparities in health between city neighbourhoods, including a 21-year difference in life expectancies.

The results of The Spectator’s massive new investigation of birth outcomes are just as sobering.

Across the province, in community after community and neighbourhood after neighbourhood, the patterns are disturbingly similar to those exposed in Code Red for Hamilton.

Teen mom rates in Ontario are highest in places where incomes and education achievements are low and poverty levels are high, while low rates of teen moms are tied to higher incomes, higher levels of educational achievement and lower poverty levels.

“The reality is that children born to teenage moms don’t tend to do as well, and they tend to end up being teenage moms themselves, ” said Dr. Chris Mackie, a Hamilton associate medical officer of health._GMY9545

“Often, they aren’t able to be economically successful and have the supports they need for the child to grow up and be healthy, ” Mackie added. “It’s really not a great start in life.”

The Spectator’s findings have implications for Ontario’s health ministry, public health units and social programs operated by municipalities.

“If I were taking the perspective of those people who have to allocate money for social service projects, it’s a problem – it’s a big problem, ” said Carlin Miller, a University of Windsor psychology professor who has studied the issue of teen pregnancies.

“Teen pregnancies not only change the life course of the teen mother but for generations afterwards, ” Miller added. “It’s not just one girl who’s affected, it’s generations that are affected.”

■  ■  ■

Meet Kristen.

Life was supposed to turn out differently for her. She was the one in her family expected to go to college, become a lawyer, buy a house, get married, then have a child.

Instead, by 16, Kristen had run away from her central Mountain home, doing drugs, bouncing from foster home to foster home – at least eight, she figures – all the while painfully aware her life was out of control.

There was one bit of stability, though – a steady boyfriend she’d been seeing for a year and a half.

She made sure the sex was safe. Her boyfriend had different plans.

“I found out that he decided to poke holes in the condoms we were using to get me pregnant, ” she said. “He figured it would make me stay with him.”

Just days before she gave birth, Kristen’s boyfriend put a knife to her throat and threatened to kill her and the baby if she tried to leave. He later threw their newborn son at her in the hospital.

“He was that type of guy.”

Kristen was pregnant at 16, a mother at 17, pregnant again at 17, a second-time mother at 18, then pregnant a third time at 19.

The latter pregnancies were planned, Kristen admits. She always wanted three kids, and it was important they were close in age, “so they can help each other.”

“I was an only child, so I know what it’s like to be alone and not have anyone to hang out with.”

Kristen has been with her new guy – the father of the younger two children – for three years.

At 20, she now has three children – none of whom are in her care.

She gave up her eldest for adoption when he was 18 months old.

“I’m happy with the decision there, because I was so young. It’s much better for him.”

The others – a two-year-old and an eight-month-old – were taken by Children’s Aid and now she’s fighting to get them back.

Kristen has lived on her own for more than a year, finished high school and has plans for college. Eventually, she’d like a job that allows her to help other young moms.

In spite of it all, Kristen is confident she’s straightened out her life. “I can’t complain because it made me out to be who I am today.”

“A lot of people would say ‘Why would you think about getting pregnant at such a young age?’ But if you can be a mother at that age, then you’re clearly more mature than half of the people out there.”

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From 2006 to 2010, the rate of teen mothers for the amalgamated City of Hamilton was 4.8 per cent, significantly higher than the provincial average of 3.7 per cent.

But Hamilton’s overall rate masks some glaring differences that exist within the city.

For the five suburban communities of Stoney Creek, Ancaster, Dundas, Flamborough and Glanbrook, the teen mother rate was less than 2 per cent.

For the former City of Hamilton, the rate was 6.4 per cent.

Between Queen Street and Kenilworth Avenue in the lower city, however, the rate jumps to just over 10 per cent. In fact, there are 16 neighbourhoods in the amalgamated city with teen mom rates 10 per cent or higher. Fifteen of the 16 are located in the lower part of the old city.Morgan

Conversely, there are 10 neighbourhoods in the Hamilton metropolitan area, which includes Burlington and Grimsby, where the rate of teen moms was 0 per cent.

Four of the neighbourhoods are in Burlington, two are in Flamborough and two are in Stoney Creek.

The concentration of teen moms in Hamilton’s lower inner city is shocking.

One look at the social and economic data for the lower inner city from Queen to Kenilworth, and it’s easy to see the common factors.

The median household income for the area is around $37,000, barely half of the provincial average.

More than a third of all children between Queen and Kenilworth live in poverty, almost three times higher than the provincial average.

Nearly one in four families is headed by a single mom, and 20 per cent of all income for the area comes from the government, which is double the Ontario average.

One in every seven students between Queen and Kenilworth ends up a high-school dropout.

It all adds up to an “opportunity deficit, ” as it’s called in academic literature.

“It doesn’t make any difference if you get pregnant or not because there are no opportunities ahead of you, ” said Lea Caragata, a WilfridLaurierUniversity professor of social work who has studied the issue of teen parenting.

Her assessment is blunt.

“You’ve probably already blown it in high school, you’re out of it, you’re hanging around,” said Caragata.

“If you work … you’ve got a few hours here, a few hours there at minimum wage, you probably still live at home or you move around and couch surf with friends, and you’ve got no prospects.

“So, in a life context like that, pregnancy doesn’t matter. It’s not like you were doing anything anyway.

“For those middle-class kids in Ancaster, pregnancy will ruin their prospects and their aspirations and their parents’ aspirations for them, ” she added.

“But for these kids, it doesn’t make any difference. And that’s the heartbreak.”

■  ■  ■

Meet Dr. David Price.

He is the chair of McMaster’s Department of Family Medicine.

He’s also the founding director of the Maternity Centre on James Street South, which prides itself on helping difficult cases, such as recently arrived pregnant immigrant women and at-risk teens.

“We see a lot of the kids who have run away from home or left home for whatever reason, whether it’s economic, whether it’s violence or abuse or dysfunctional families, ” said Price.

“But also, the degree of high school completion is pretty low in this group.

“It limits what the kids themselves can do, ” he added. “They end up in low-paying jobs and it just sort of perpetuates the cycle.

“It’s a helluva lot of work looking after a child, so if you’re 15 and all of your energy goes toward raising a child, there’s not a lot of energy left to go to school, to do those other things.”Dr David Price 2571.JPG

A few months ago, he delivered the baby of a 13-year-old.

“I think there’s nobody who would disagree that’s an issue, ” said Price. “Having a child at 13 in our society, that’s a challenge.

“It’s like a baby having a baby.

“When you’re trying to describe options to a 13- or 14-year-old, it’s a real challenge because they don’t have the education and the understanding of physiology to understand when you’re presenting different medical treatment options or even ethical options, ” said Price.

“Should you have prenatal screening? What are you going to do with the results of the prenatal screening? How is that going to impact how you feel about your unborn baby?

“All of those things, which are challenging enough for a mature, well-educated 25-year-old, it must be extraordinarily difficult for a 13- or 14-year-old, ” said Price.

Between 80 to 85 women a year who pass through the Maternity Centre are teens, which is roughly one-third of the teens who give birth each year in Hamilton.

“It’s become the go-to place for the kids, ” said Price.

“I think that the word has gotten out that if you are pregnant, you come to our clinic.”

■  ■  ■

Consider this: According to provincial data, from April 2006 to March 2007, there were approximately 4,350 teens who gave birth in Ontario.

Of those, 616 – or about 14 per cent – were giving birth for the second time.

There were 554 teen girls aged 16 and under who gave birth – 26 of them for at least the second time.

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■  ■  ■

Meet Morgan. She is one of those teens who showed up at the Maternity Centre.

Morgan hadn’t planned to get pregnant at 15.  She wasn’t on birth control, but she thought – somehow – she and her boyfriend were protected.

So when she started to miss her period, she chalked it up to stress because that had happened before.

When she went to the doctor to get checked, she said the news was “like a slap in the face.”

At first, she laughed. Then she was scared.

“How the heck am I going to tell my mom?” she wondered.

She thought about having an abortion. Her boyfriend didn’t want the baby, and she knew she’d miss out on a lot if she went through with the pregnancy.

She was nowhere close to finishing high school, and besides, she’s never really liked kids.

But she decided it was meant to be.

She figured having a kid wouldn’t mess up her plans, anyway – not that she really had any.

“I didn’t know what I was going to be doing then. I don’t really know what I’m doing now,” Morgan said. “I’m not going to know for a few years. So I’m just going to have a kid with me, following me.”

It’s not unusual to see a teenager toting a baby through Morgan’s north Hamilton neighbourhood. In fact, in the blocks surrounding her home near Wentworth, north of the railway tracks, there’s almost a one-in-five chance any infant you see has a teenage mom.

Now 16, Morgan lives in a house with her six-month-old son, a handful of siblings and her mother, who also was a teen when she gave birth to the first of her seven children.

The father of Morgan’s baby doesn’t come around much anymore.

“He’s not really in the picture. He doesn’t do anything, ” she said.

It’s not anything new for her – her own dad wasn’t there for her family, either.

In spite of the circumstances, Morgan doesn’t worry much about the future. She’s getting a baby-bonus cheque and works part time at a call centre.Baby Andrew

Eventually, she says, she’ll go back to school and her sister – or someone – will be around to babysit.

She’s adamant things will work out for her and her son. And she certainly doesn’t doubt she’s old enough to shoulder the responsibility of raising him.

“I take care of him just as good as anyone else does, ” she said. “Age doesn’t really matter when it comes to having a kid. It’s about responsibility and maturity.”

■  ■  ■

Across Ontario’s vast north, there’s an epidemic of teen mothers and teen pregnancies, particularly on remote native reserves. Of the 20 communities with the highest provincial rates of teen moms, 19 of them are located in the Far North, and 17 are native reserves.

In fact, the top 30 communities with the highest rates of teen mothers are either native reserves, communities in the Far North, or both.

For those 30, the rates of teen moms are as much as 11 times higher than the provincial average of 3.7 per cent.

The five communities with the highest rates of teen moms are located in the sprawling Kenora district, the northwestern chunk of the province that extends to the shore of Hudson Bay.

All five are remote native reserves accessible only by airplane for most of the year.

About one in three births on those five reserves between 2006 and 2010 was to a teen mom.

At Sandy Lake First Nation, for example, 40 per cent of the mothers giving birth were teens.

Contrast this to the rates of teen moms in the wealthy suburbs of the Greater Toronto Area.

In Vaughan, for instance, the rate of teen moms between 2006 and 2010 was well below 1 per cent. During that span, more than 12,300 women living in Vaughan gave birth. Just 76 of them were teens.

Or consider this comparison.

There were nearly as many teen mothers on the small remote native reserve of Pikangikum – population 2,400 – as there were in the entire Town of Oakville – population 172,000.

In Pikangikum, 47 of 144 mothers were teens. In Oakville, 48 of 7,151 mothers were teens.

At Six Nations, southwest of Hamilton, Canada’s most heavily populated native reserve, the rate of teen mothers was nearly 17 per cent – the 27th highest of Ontario’s 420 communities.

Boredom, isolation, substance use, lack of opportunities and education – particularly in the Far North – contribute to the elevated rates of teen mothers on reserves.

But cultural differences also play a role, according to native leaders.

“We certainly don’t encourage (teen pregnancy), ” said Julie Wilson, supervisor of Six Nations’ Maternal and Child Centre, “but I think it’s viewed differently when it happens because there is a huge respect in this culture for life, for babies, for children.

“That’s what you leave – that’s your family, that’s your blood, ” said Wilson.

“It’s not that anyone really wants their daughter to have a teen pregnancy, but there is a lot more understanding in that it is a gift from the Creator and it is a special life.”

While teen motherhood is an epidemic in Ontario’s Far North, it’s almost non-existent in the bedroom communities surrounding Toronto.

In Vaughan and Markham, the rate of teen moms is 0.6 per cent – in other words, just six of every 1,000 mothers is a teen.

In Oakville, Caledon and Richmond Hill, the rate is 0.7 per cent.

In Burlington, the teen mom rate is 1.4 per cent. In Milton, it’s 1.1 per cent.

“Kids who have a certain level of privilege use birth control because not getting pregnant matters, ” said Caragata, the Laurier professor.

Teen pregnancy statistics support her claim.

In the Far North, teen pregnancy rates, like those of teen moms, are hugely elevated.

In the Kenora district, there were 53 pregnancies for every 1,000 girls between the ages of 15 and 19 in 2009, compared to the Ontario average of just under 29 per 1,000.

In the Timmins-Cochrane district, the rate was 64 per 1,000 and in Thunder Bay, it was nearly 48 per 1,000.

Hamilton’s teen pregnancy rate was 35.6 for every thousand girls 15 to 19, which is 25 per cent higher than the provincial average.

In fact, the rate actually rose slightly from 2001 to 2009.

By contrast, the teen pregnancy rate for Halton and York regions was 15 per 1,000 girls ages 15 to 19 in 2009.

Girls in wealthier regions are also more likely to terminate their pregnancies, according to provincial data. In York, 80 per cent of pregnancies to girls ages 15 to 19 ended in abortion in 2009. In Halton, the figure was 75 per cent.

Meanwhile, in the Kenora district, just 21 per cent of pregnancies in girls 15 to 19 ended in abortion. For the Timmins-Cochrane district, the rate was 24 per cent.

In Hamilton, about 61 per cent of those pregnancies were aborted, close to the provincial rate of 59 per cent.

■  ■  ■

Meet Nina.

Things are different where she’s from.

In her home country – the Czech Republic – it’s not unusual for a teenager to have a baby. Her mom was 17 when she had her.

When she met a good Czech guy, Nina didn’t think it was out of the norm to get pregnant – even if they’d been together only a few months.

She was 15.

“I just got really close to him and his family, ” she said.

“I used to go there all the time and even slept over a couple of times. I felt like I wanted to be with this guy forever, so we just planned to have a baby.

“I think it’s better to be young than older, ” she added. “I still have young parents and I like it that way. It’s better that way because I want to spend my whole life with my child.”

Nina’s son, Nicolas, is a year old and his dad is long gone.

He left in Nina’s third trimester, returning to England to serve time in jail for a crime she didn’t know about at the time – and won’t disclose.

It was a blow – but she said her son helped her get through it.

“It’s him that I need to be taking care of and living for. It gets my mind off other things. Without him, it would be way harder.”

Nina lives with her dad and his new wife on the Mountain. She’s got a new boyfriend, too – a guy she said she met on the dance floor of a club last summer.

For Nina, it’s their different religious backgrounds, rather than the baby, that complicates the relationship.

“He knows I’m a good girl. And his parents do, too, so they’re not really stopping anything.”

Nina said her child motivates her to stay out of trouble, and it was he who drove her to go back to school at Grace Haven – a local centre for pregnant teens and young moms.

She’s almost done Grade 9 now and thinks she’d like to become a cosmetician one day.

“This is making me stronger, pushing me more to school and I’m just not doing stupid things, ” she said. “I think having a child makes everything better for me.”

■  ■  ■

Not far from the rail yards near the old downtown of what was once FortWilliam, there’s a piece of Thunder Bay known as Victoriaville.

The neighbourhood is home to a near-vacant mall, a methadone clinic and a homeless shelter with a soup kitchen that serves 500 meals a day.

Of the province’s 2,100 municipal neighbourhoods, it had the highest rate of teen mothers.

One in four babies in Victoriaville was born to a teen mom between 2006 and 2010.

Based on Statistics Canada census data, it appears about one of every three teen girls living in the neighbourhood had a baby at some point between 2006 and 2010.

The stories of Hamilton and Thunder Bay are similar in some important ways, at least when it comes to their local economies.

Both have watched their traditional industrial bases gradually erode.

Once a major shipping hub, many of Thunder Bay’s grain elevators stand abandoned along the waterfront.

“There were lumber mills and pulp and paper mills, and all that’s really declined, ” said Lee Sieswerda, an epidemiologist with the Thunder Bay District Health Unit. “In the same way as Hamilton has seen that hit in terms of employment, we’ve seen the same kind of thing.

“If teen pregnancy is more common around disadvantaged people and we’ve seen a real hit to our economy, it kind of follows that teen pregnancy would follow along with that decline.”

One critical difference in Thunder Bay is the much higher concentration of aboriginals, many of them young people.

About one in eight people in Victoriaville is native, the same proportion as Thunder Bay itself.

Statistics also show the Canada-wide fertility rate for aboriginal teen girls is seven times higher than the national average.

“You have a group that has high fertility among teen moms and a larger proportion of that particular subpopulation in the city, so it’s not too surprising that you end up with a higher teen pregnancy rate, ” said Sieswerda.

Six of the 12 neighbourhoods in Ontario with the highest rates of teen moms are located in Thunder Bay, Hamilton and Sault Ste. Marie, another steelmaking hub that has suffered from substantial job losses over the past three decades.

Drill down to the level of Ontario’s neighbourhoods and the disparities in teen mom rates between rich and poor are obvious.

Take Victoriaville, for instance.

The median household income there, according to the last census, was $16,200 – below the poverty line and far behind the Ontario average of $60,500.

In Victoriaville, two of every three children live in poverty, more than 40 per cent of all income comes from government transfers and nearly one in three families is headed by a single mom.

In fact, take the five Ontario neighbourhoods with the highest rates of teen mothers and look at their average characteristics.

All five have teen mom rates that range between 21 and 25 per cent. Together, their median household income is just over half of the provincial average, and both their poverty rate and the proportion of income that comes from government transfers are more than twice the provincial norm.

Compare that with the five neighbourhoods at the other end of the scale – in Burlington, Oakville, Vaughan, Markham and Toronto.

Of the 4,461 women who gave birth in those five neighbourhoods, not one was a teenager. The median household income is nearly 50 per cent higher than the provincial average, the rate of government transfer income is half the Ontario rate and less than one in 10 families is headed by a single mom.

■  ■  ■

Meet Jane Howard.

She is a nurse with Health Initiatives for Youth Hamilton, known formerly as the Planned Parenthood Society.

It’s a nonprofit charitable organization aimed primarily at teens that provides testing for pregnancy and sexually transmitted diseases, as well as pregnancy-options counselling.

“It distresses me that I’m seeing younger and younger teenagers who want to get pregnant, ” Howard said.

“They come in for a pregnancy test and it’s negative and I’ll say ‘Have you thought about some birth control?’ and they’ll say ‘No, I want to get pregnant.’

“When I ask why, they say ‘I’d like to have a baby, my boyfriend and I would like to have a baby.’

“Do you have a place to live? How are you going to support them?” Howard will ask. “‘Well, my mom said we can stay with her.'”

She remembers the time three young girls were sitting together in the waiting room.

“I overheard them and one said ‘I’m coming in for a pregnancy test, ‘ and the others said ‘So are we – wouldn’t it be fun if we were all pregnant together?’

“I thought ‘Oh my goodness, is that the social community network now? That we’re all going to be pregnant?’ And I don’t think any of them were – that week.”

Or there was the time Howard’s daughter and two-month-old granddaughter visited the office while a young teen girl was present.

“She said ‘Isn’t she cute, can I hold her?’ and I said sure.”

The baby began to cry and the teen immediately handed her back, as if the baby had caught fire.

“My daughter and I were laughing, thinking hopefully that’s a form of birth control, ” said Howard. “No, a few months later, she walked in and she was pregnant.

“Obviously, it wasn’t a deterrent. It didn’t occur to her that she could be in that boat if she didn’t get on some birth control. She didn’t and now she has two kids. And she’s 18.”

While Howard deals with teen pregnancies – and near misses – every working day, she can only make a best guess at the underlying psychology.

“Young women, who maybe don’t have the family life they would like to have, think that they can make their own family and have somebody to love, ” said Howard.

■  ■  ■

Across Ontario, the connections between teen motherhood rates and socio-economic circumstances are clear.

Understanding why these connections exist is much murkier.

There is growing interest worldwide in trying to understand the social determinants of health – the notion that a person’s physical health is intimately tied to a number of factors that don’t appear to have anything to do with health at first glance.

Early-childhood development, housing, employment and working conditions, race, gender, income – and more importantly, income inequity – they’re some of the dozen or so social determinants that can have an effect on health.

“Is teen pregnancy the outcome or is it a symptom of this larger constellation of things we call the social determinants of health?” asked Sieswerda, the Thunder Bay epidemiologist.

“It’s a good question. Has anybody figured out how to address the social determinants of health?”

Several of these social determinants pop up in the teen mom discussion.

For starters, there is a multi-generational component linked to the issue.

Teen moms are more likely to have been the product of teen moms themselves, and they’re more likely to watch their own children become teen parents.

Mackie, a Hamilton associate medical officer of health, pointed out education also plays a role. So does poverty, which is another problem that crosses generations.

“And there aren’t a lot of interventions to break the cycle of poverty, ” Mackie added.

Sometimes, it’s just a nasty collision of a variety of problems.

“A lot of adolescent moms … come from a very disadvantaged background, ” said Debbie Sheehan, director of the family health division for City of Hamilton Public Health Services.

“And by disadvantaged, I’m not just talking about finances.

“Many of them come with past histories of being physically abused, sexually abused, neglected, those types of things.

“From environments, ” she added, “where there’s a lot of physical violence, not necessarily directed at themselves, but with intimate-partner violence, perhaps against their mother.”

These are the types of teens who become part of Hamilton’s nurse-family partnership program.

It’s an intensive home-visiting model that matches a public health nurse with a low-income, first-time mother – and Hamilton is the only location in Ontario to offer the program.

“What we find is that many of them have this life-changing event of having their first kid and it’s pretty easy for that to go badly because kids are so complicated and challenging,” said Mackie.

The nurses begin following the expectant mother midway through the pregnancy, then continue working with mother and baby until the child turns two.

The goal is to improve the health of the child, help increase the young parents’ self-sufficiency and provide education and counselling support on health and parenting issues.

“Many of the graduates from our nurse-family partnership program are going on to go back to school, to get jobs, ” said Mackie. “Some of them are aiming to be nurses, because they’re inspired by these mentors.

“The thing that’s remarkable for me is that you haven’t changed that person’s income, ” he added. “You’ve just given them what they might not have had and that’s a good friend, almost so close as to become family, but somebody who can give them hope and give them mentorship and a little bit of guidance.”

■  ■  ■

Meet Kathleen.

She’s a bright, well-spoken young woman who’s not afraid to speak candidly about her life.

“I’m 20 and I have two kids under the age of two, ” she said. “It’s a very busy household. There’s a lot of temper tantrums – by everybody – but there’s also a lot of laughter.”

She was 17 when she got pregnant for the first time. “We just weren’t being smart about it.”

Her boyfriend was 20 and he had a good job with an automotive company, so they got a place of their own.

“My first big dilemma was what am I going to do about school?” she said. “I decided my best option was to stop going to school at that point.

“I figured if I was going to work so hard and just end up missing classes anyway, then I’m just exerting energy into something that’s not going to be productive for me in the end.”

But the stress of life as a young family was too much, so they separated. Kathleen then dated another man, became pregnant and had a second child.

“He was a different story, he just couldn’t get it together, ” she said. “He couldn’t get a job, he just couldn’t get used to the idea of being a dad.”

Kathleen and the father of her first child have since reconciled. They’re taking small steps toward living together as a family.

“With my first child, I felt the tremendous weight of being a statistic on my shoulders, ” said Kathleen. “All the time, people were judging you or telling you that you shouldn’t be a parent. It was really frustrating for us because we had so much more than a lot of young parents.”

“Yes, I understood that there are some young parents who aren’t prepared, ” she added, “but we worked really hard to separate ourselves from being like that young family with a newborn living at home with their parents.”

Talk to any group of pregnant teens or teen moms and you’ll quickly notice they share one common characteristic – a relentless, almost blinding optimism for the future that can seem oddly out of place with their current circumstances.

“The No. 1 thing a teen mom will say to you is that their goal is to be the best mother possible, ” said Sheehan.

“Always. It’s so important to them.

“And often, people don’t even think to ask that question. Assumptions get made.

“They’ll say that often – ‘People judged me, ‘” Sheehan added. “‘Yes, I’m an adolescent, and yes, I’m young to be a mother, but I am a mom now or a mom-to-be, and I want to be a good mom.'”

It raises the question: Is teen motherhood a problem?

“That really comes to the heart of the question here, and you’re going to get a lot of different perspectives on that, ” said Mackie.

Certainly, there are health risks for young mothers. Teen moms have higher rates of postpartum depression.

They also have a higher risk of delivering premature or low birth weight babies, and low birth weight babies are at greater risk for developing lifelong health problems.

Studies that have followed the children of teenage mothers for decades have also shown that they have an increased risk of becoming high school dropouts, suffer higher levels of unemployment and violent offending.

From a community standpoint, it takes financial resources and staff to provide support for teen families, and that support might need to extend beyond one generation.

It explains why municipalities across the province, including Hamilton, have put a lot of time, effort and money into programs designed to keep teenagers from becoming pregnant.

Is teen motherhood a problem? It sure sounds like it.

“But once they are pregnant, ” said Sieswerda, the Thunder Bay epidemiologist, “there’s not a lot of point in continuing to call it a problem.”

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The great divide

 In northern Ontario, aboriginal communities are struggling with high rates of drug addiction and teenage pregnancy

For nearly two hours, the tiny single-prop eight-seat plane has been buzzing north from Thunder Bay through a cloudless sky.

To the edges of the horizon stretches an unending carpet of green, spotted with countless lakes and streams, untouched, it seems, by humanity.

Finally, a small settlement hugging the edge of a lake comes into focus.

The plane glides onto the gravel runway and taxis to the small building that serves as the airport for BigTroutLake, a First Nations community of about 1,400 people that lies about 300 kilometres south of the Hudson Bay shore.BORN-Day1-Photo5

For 10 months of the year, the daily flights on tiny Wasaya Airlines are BigTroutLake’s only connection to the outside world. In the dead of winter, for two months, maybe three depending on the weather, there’s an ice road – but that’s a nine-hour journey south just to reach the main highway at PickleLake.

Two band members hired to provide security at the airstrip begin combing through the luggage that’s just been unloaded.

At BigTroutLake, bags are inspected on arrival, not departure.

They’re looking for alcohol, yes, because BigTroutLake is supposed to be a dry community.

But more importantly, bags are being searched for smuggled pills, primarily the powerful painkillers OxyContin and Percocet.

In the band office, Chief Donny Morris points to a soft drink can on the table. “What’s that?” he asks.

He takes the can and carefully begins to unscrew the silver top from the base. He tilts it and inside is a compartment that could hold dozens of pills.

“We were starting to wonder why so many people all of a sudden were coming back with cans” of the citrus beverage, Morris says.

Substance abuse, particularly OxyContin, is a big problem here.

It’s one of the symptoms of the crushing boredom and isolation that accompanies life at a fly-in native reserve, along with high rates of unemployment and low rates of formal education.

And like other remote native communities in Ontario’s Far North, there’s also an epidemic of teen moms.

Between 2006 and 2010, BigTroutLake had the fifth-highest rate of teen moms in all of Ontario. Nearly 30 per cent of the mothers who gave birth over that time were teenagers, about eight times higher than the Ontario average.

The four communities with higher rates are also remote fly-in native reserves located, like BigTroutLake, in the sprawling Kenora district that covers the province’s northwest. Together, about one baby in three at these five reserves is born to a teen mom.

“A lot of our young moms and young boys are together at an early age, so that’s (an) issue, ” said Morris.

“Right now, common-law is a major thing, where a lot of kids are brought into that (type of) relationship and the sincerity of belonging to a family trend is not there, ” he added. “We have to go back to our roots, use our elders to start explaining what it was in the old days.

“Even though, I have to admit, will we ever go back? I don’t know.”

■  ■  ■

Meet Joy Quequish.

She’s 30 now but was a teen mom earlier in life.

She sits at the dining room table in the Mamow Against Drugs Healing Centre, a log cabin-style home overlooking BigTroutLake with room for six women at a time.

“Mamow” means “together” in the Oji-Cree language. The home, which opened more than a year ago, acts as a detox centre for young women.

For eight years, Joy has been battling her addiction, with varying degrees of success. She started with cocaine and crack and then became hooked on OxyContin.

She’s told about the soft drink can in the band office, and she laughs.BORN-Day1-Photo6

“That’s nothing, ” Joy said. “There’s air fresheners like that, two-litre bottles of pop, body sprays, everything. “It’s a huge problem, ” she added. “It’s not just here, it’s everywhere. All the reserves are into it.”

Joy ended up at the detox centre because she says she wants to stop once and for all.

“I lost everything, ” she said. “My kids, my house, my schooling, just everything.

“I’m just tired, ” she added. “I want to be back the way I used to be before I moved here.

“I was clean, I never did drugs, I barely even drank, maybe a couple of times a year. I was always there for my son, I always worked.

“I lost all my jobs in the past six years because of my addiction.”

Joy spent part of her youth living in Cambridge with her father, a native, and his non-native girlfriend.

She returned to BigTroutLake to live with her mother and became pregnant at 19. Her own mom had her first child at 18, and now has eight children and 23 grandchildren.

“I was raised by a white family and nobody ever had a kid in their teens down south, ” said Joy. “I didn’t know any teen who had a kid until I came here.”

At BigTroutLake, she said “it’s almost like everybody’s so used to it that it’s not even noticed. It’s nothing anymore for a teenager to have a kid.”

With Joy at the table are two other women who were also teen moms.

Janice Barkman and Ruby Gliddy are both 28 and they, too, are trying to kick their addictions to OxyContin.

It’s the withdrawals that are the worst part, they say. Achy bones, cold sweats, bad headaches. Tired and sluggish yet restless and unable to sleep.

“You feel dead, ” said Janice. “You sit there and just want to end it.”

OxyContin not only robbed the women of their physical and emotional health, it also robbed them of their money and belongings.

“I’ve sold everything I could, my clothes, anything, to get it, ” said Janice.

“I’m slowly getting all my stuff back.”

OxyContin pills are often cut into pieces and sold in quarters or halves.

At BigTroutLake, a quarter of an OxyContin pill will sell for the staggering sum of between $160 and $180.

Even young kids have become familiar with the terminology and the culture, Joy said.

“They know what quarters are, or halves, they know what the clamps are that we use to shave them, they know not to touch their parents’ needles, ” she said.

“Some people have a little tool bag with their rakes and spoons and our kids know not to touch any of our stuff, ” she added. “That’s just how bad it is.”

■  ■  ■

Meet Ruby.

She was 19 when she had her first child. “I was drunk, ” Ruby explained.

She now has five children, including twins, but none of them are in her care. Only two are living at BigTroutLake.

“I stopped using for awhile when the twins were born, ” she said. “One of them went into Oxy withdrawals.”

The twins were taken from her at the hospital right after they were born and they now live in Sioux Lookout. Ruby has seen them twice in the past three years.

Janice became pregnant at 15. She, too, was drunk at the time. “And I liked the guy.”

She eventually had three kids with the same man. “They just kept popping out, ” she said.

She and the children’s father are no longer together. He’s taking care of one of them, his grandmother is taking care of another and Janice has one.

It’s a common theme at the reserve – children being raised by extended family members, sometimes on other reserves or farther south in Sioux Lookout or Thunder Bay.

“It’s almost expected from every family, ” said Joy, whose own two kids live with their father. “There are a lot of kids being raised by their grandparents.”

Inadequate housing compounds the problem. Morris, the band chief, flips through one of his financial documents and says the band has only enough money to build four new homes in the next three years.

Meanwhile, he said, “we see these young moms living with their parents or grandparents, raising their kids in one bedroom, sometimes three or four kids in one bedroom.”

■  ■  ■

At the end of Highway 671, about a 90-minute drive north of Kenora, you’ll find Grassy Narrows First Nation.

Visitors are greeted with a large, ominous hand-painted sign warning that trespassers face possible imprisonment.

Here and there, fields are littered with the metal carcasses of automobiles. At times, it’s hard to tell which homes are occupied and which are abandoned.

But GrassyNarrows does have one thing that BigTroutLake lacks – a year-round road, in this case to Kenora, that provides 24-hour-a-day access to doctors, a hospital, shopping, even potential jobs.BORN-Day1-Photo7

Yet even with this direct connection, the rate of teen moms remains as stubbornly high as those of the remote fly-in native communities to the north.

GrassyNarrows had the ninth-highest rate of teen moms in Ontario between 2006 and 2010. Just over a quarter of all babies were born to a teenager.

Wayne Hyacinthe is the health director at GrassyNarrows. He cites a familiar laundry list of potential reasons for the high rate of teen moms – low income, lack of employment, higher dropout rates from school.

“With the lack of opportunity comes low self-esteem, which, I would think, translates to them dabbling in more adult-oriented activities, such as sexual activities and addictions,” said Hyacinthe.

He speaks bluntly about some of the issues that plague GrassyNarrows, which has a population of 800.

“Parenting skills are low, as opposed to mainstream society, where they’re all given values, told that that’s wrong, this is right, ” said Hyacinthe.

“Maybe it’s the loss of identity and livelihood and just no sense of direction.

“The native culture at one time was self-sufficient, before first contact, ” he said.

“When the monetary system came in, we became a culture of welfare.

“You’re waiting for that next handout.”

Hyacinthe is a band member, but grew up in the mining town of RedLake, then came to live on the reserve.

“So I’m maybe not subject to that mindset, ” Hyacinthe said. “I was told by my dad, ‘Get off your ass, go get a job, it’s not going to come to you.’

“Those values are instilled, and I’m trying to instil that in my son. But I don’t see that going on in other households.”

GrassyNarrows has been in the national news before.

Back in the 1960s, it was discovered a paper mill in Dryden had dumped massive amounts of mercury into the river system that served GrassyNarrows.

In 1970, the federal government shut down the local fishing industry, and within a year, according to one report, unemployment on the reserve rose to 95 per cent from 5 per cent.

Alcohol abuse and solvent sniffing, which band members claim were nonexistent before the waters were contaminated, subsequently became serious problems at Grassy Narrows.

The band received a settlement of $8.6 million in 1986, but the money couldn’t make up for 16 years of lost opportunities.

Unemployment remains a persistent problem.

Hyacinthe is proud to point out, however, solvent sniffing has been virtually eradicated, thanks to what he calls “the iron fist concept.”

“It was tough love, right, but it worked, ” said Hyacinthe. “There’s one solvent user in this community to this day and he’s actually getting treatment.”

It was the same tough-love approach that was used with drug dealers.

A number of years ago, Hyacinthe said, a group of people confronted a band member who was dealing cocaine and OxyContin on the reserve.

“They went to that house and kicked the crap out of him, ” said Hyacinthe. “So he had a choice.

“He left. He didn’t come back to this day. He lives in Winnipeg.

“He’s been told that if you come back, we’ll split your head open, ” he added.

■  ■  ■

Back at BigTroutLake, Joy is frustrated with being cooped up at the detox centre.

“It’s like jail, ” she says, glumly. “You can’t even use the phone.

“There’s lots of people out there who are trying to get us in trouble or try to get us kicked out, ” she adds.

“I don’t know what I’m going to do when we’re done here.”

The closed nature of the reserve makes it difficult for people like Joy, Janice and Ruby to escape their problems.

Behind the band office, on a hill overlooking the lake, is the community cemetery.

The graves are surrounded by white-picket fences.

Scattered across the cemetery are rows of tiny white rectangles, marking the gravesites of babies, many of them born and dead on the same day.

In the middle of one site is the grave of Joyce Muckuck, born Sept. 21, 1952, died May 9, 2005, at the age of 52.

Muckuck had flown down to Sioux Lookout to have a checkup, had a heart attack there and died.

Surrounding her grave are seven little plots, each with a small wooden enclosure, representing seven of her grandchildren who died as babies.

Why is the cemetery filled with so many babies?

Chief Donny Morris can’t say for sure, but he hints at the underlying problem.

“You take that chance, I guess, when you experiment with drugs, ” said Morris.

“I don’t think they deliberately lose their child just because they don’t want it.”

The chief and the three women at the detox centre all say the same thing.

Boredom, isolation and the lack of activities, particularly for young people, contribute to the high rates of teen moms and the substance abuse problem.

The isolation also results in other, more practical problems.

Something as simple as eating a healthy diet is a challenge at BigTroutLake, where it costs almost $15 for a four-litre jug of milk and $10 for a five-pound bag of potatoes. Yet a can of Coca-Cola sells for $1.25.

There is a bowling alley and an arena, which operates with a natural ice surface once the weather is cold enough.

But it’s not enough, Joy said, and some of the problems are filtering down to kids who are younger and younger.

“There’s absolutely nothing they can do, ” said Joy. “There’s nothing for them to do except hang around and get into trouble and find their own ways to have fun.

“What can you do when there’s nothing there for you to do?”

 

Breaking the cycle

There weren’t any of the usual signs. No morning sickness or breast tenderness. No hint of a swollen belly.

So naturally, Racheal was shocked when a Hamilton doctor told her she was seven months pregnant.

It was the summer she graduated from Grade 8. She was 14 years old.

“I didn’t know what to do, ” she recalls.

At that stage, it was too late for an abortion and Racheal didn’t feel comfortable with the notion of putting her newborn up for adoption.

Her mom, while disappointed, supported Racheal’s decision to keep the baby. In a sense, she had to — she was also a teenager when she had her first child.

“She tried not to be hypocritical because she had us young, ” explains Racheal, now 16.

There was one condition, though.

“My mom said if I didn’t go to school, she’d kick me out.”

But for Racheal and others like her, many regular schools have difficulty accommodating the evolving needs of pregnant and parenting teens.

Enter the Young Parent Network, established about seven years ago by Grace Haven, St. Martin’s Manor and Good Shepherd Services to offer support and identify barriers and gaps in the services available to pregnant teen and young moms.

Racheal, who had her son Jerimiah in October, is one of about 600 young women from Hamilton and surrounding area who access the network’s services each year. With high school classes, day care, counselling and support, Grace Haven was a good fit for her.

It was also a good fit for her mother, who turned to Grace Haven when she was a pregnant teen 15 years earlier. In all, the agency has reached out to Hamilton’s young moms and pregnant teens for more than a century.

Most girls in need hear about the Young Parent Network from a friend or neighbour, former residents or graduates. Others are referred by child welfare or public health.

Though they’re in a similar situation, their personal circumstances vary.

Racheal and her son, for instance, still live with her mom and stepdad in a home in east Hamilton. She travels to Grace Haven daily for classes and workshops on such things as nutrition or breastfeeding.

For Julia Dolan, Grace Haven’s residence was a better fit. The 17-year-old was about four months pregnant when she moved in last July.

“I’d rather be in a less stressful environment, ” Julia said. “It just seemed like a good idea at the time to get away from my regular routine and living at my house.

“I was kind of drinking and stuff like that a lot. I thought, if I move out of the house and out of this habit, I could start fresh and do it over again.”

Funded by the Salvation Army, Grace Haven can accommodate 10 residents and four babies. Young women can apply to reside at the home — free of cost — the moment they find out they’re pregnant. They’re eligible to stay until their baby is 18 months old.

At any given time, about 30 young women use Grace Haven’s programs, including high school classes taught by Hamilton-Wentworth District School Board teachers, day care and prenatal classes. They can also receive counselling for addictions and abuse, meet with a chaplain — though Grace Haven is nondenominational — attend peer support groups and get tips on such life skills as bathing a baby or budgeting.

Few understand the need for an integrated approach to teen motherhood as well as Grace Haven’s program manager, Jo-Anne Rochon. She’s been with the agency for 23 years.

“They need education, they need jobs, they need to feel good about themselves, they need to feel empowered, they need to be accepted, they need not to be judged — like anyone — and they need to be people who make good decisions, ” Rochon says.

“Teen pregnancy isn’t just about being pregnant and having a baby.”

■  ■  ■

Meet Carolynn Green. For a decade, she’s taught everything from geography to career studies at Grace Haven.

Over the years, Green has watched hundreds of teens work toward high school diplomas. Despite her best efforts, however, it doesn’t always work out for these girls.

Some don’t stay long enough to earn the credits they need — Julia Dolan, for instance, withdrew from the program in October. For others, attendance is the problem.

As a mom herself, Green understands it’s easy to be overwhelmed by such obstacles as a long commute to the quiet, three-storey Herkimer Street facility. Sometimes it’s simply the absence of a good night’s sleep — having to get up in the middle of the night to tend to a crying baby — that gets in the way.

Yet, Green maintains a sunny optimism.

“We have a lot of success stories, ” she says. “There have definitely been a number of them who have gone on to college and finished.”

Rochon, too, revels in the girls’ accomplishments.

“We have young women that take three buses to come here, ” she says. “That’s a pretty big challenge — getting up at seven in the morning, getting on the bus with a buggy, with all the things they need.

“They come here and go to school every day and then they go home and do whatever they need to do the rest of their evening. And that, to me, is hard work.”

Both women understand there’s more to it to than just getting these girls into the classroom, though. At Grace Haven, it’s about changing attitudes toward education.

It’s an essential part of breaking the teen mom cycle and improving prospects for the next generation.

“We’re giving a more positive experience and they’re feeling more successful and they can pass that on to their children, ” Green says. “Because, again, that’s the whole cycle.

“If they hate school, they’re going to pass that on to their kids. They’re not going to meet-the-teacher night, they’re not going to be involved in that stuff.”

Meanwhile, St. Martin’s Manor, established in 1954 by Catholic Family Services, can house 12 pregnant teens or young moms and their babies on an ability-to-pay basis. Hundreds more access high school classes and other programs at the Mohawk Road West agency each year, and participation is only expected to climb now that a day-care centre recently opened at the site.

“These programs are really stellar because teens can come and actually live there if, for whatever reason, their home situation is not going to meet their needs, ” says Debbie Sheehan, director of family services in Hamilton’s public health department.

And with extensive programming and in-house educational opportunities, “It’s really a one-stop shopping approach.”

Angela’s Place became a lifeline for Carly Crease and others taking classes at St. Martin’s Manor and Grace Haven.

The 18-year-old was just five weeks from her due date when she found out she was pregnant. Not surprisingly, her first reaction was panic.

“‘I have no clothes, I have no diapers, I have no bed. Oh my God, I need to get all this stuff, ’” Carly recalled. “Am I ready if it happens anytime? Because at 35 weeks, it really can happen anytime. I could have had him two days after that.

“It was really difficult — the unknown.”

She was also up against personal pressures.

“Me and my boyfriend were having some issues, ” she recalls. “We’ve been together for a long time — almost four years — and we lived together for a lot of it, so we just needed some space.”

As a solution, a staff member at St. Martin’s Manor directed Carly to Angela’s Place — Good Shepherd Services’ subsidized housing complex for young moms — where she and her son Carter could live on their own as she tried to work through her problems.

Established in 2008 in a boxy, three-floor walk-up at the corner of Tragina Avenue North and Barton Street East, Angela’s Place has 15 furnished apartments where women and their babies can stay for up to two years.

A community room in the basement hosts programs such as cooking and nutrition classes and educational sessions about infant development and parental bonding.

Similar to Grace Haven and St. Martin’s Manor, there is staff on hand to guide the girls back into the community once their stay at the complex is up.

The residents at Angela’s Place are often not ready to be independent.

They all receive government assistance cheques, says program manager Chris Maleta, and many have turned to prostitution at some point as a means of supporting themselves.

There are rules at Angela’s Place. The building has a secure entrance, there’s no alcohol allowed and participation in some programs, such as holistic nutrition, is mandatory.

“We try to help them get back to school or find employment, to try to break that cycle of poverty, ” Maleta says.

“It’s in demand. I have a waiting list all the time.”

One of the more unique programs at Angela’s Place caters to young dads — an often overlooked or neglected aspect of teen parenthood.

“Being a dad is very different than being a mom, ” Maleta explains. “They do feel misplaced. They feel they don’t have the same choices or role with their children.”

One of these soon-to-be dads is Dylan, who just turned 20.

When Dylan learned his girlfriend Brandy, 17, was pregnant, he urged her to get an abortion.

He was “pissed off, ” and so were his parents — as a well-to-do family, they’d wanted better for their son.

But he’s come a long way to accepting their situation. Though he makes good money in construction, he sold his car and bought a house for the couple to live together in the east end, near the former Centre Mall.

Dylan has also started attending prenatal classes with Brandy at Angela’s Place on Tuesday nights.

“I’ve got it all under control, ” he says.

 

HOW WE DID IT:

An application was made to BORN (Better Outcomes Registry & Network) Ontario for access to all Ontario birth outcomes and maternal health data for the four fiscal years spanning 2006-07 to 2009-10.

BORN Ontario maintains newborn and maternal information for each birth in Ontario through the Niday Perinatal Database.

Data for approximately 535,000 births over the four-year period for the entire province were turned over to Neil Johnston, a faculty member in McMasterUniversity’s Department of Medicine, who is also associated with the Firestone Institute for Respiratory Health and St. Joseph’s Healthcare. He also runs the Ontario Physician Human Resources Data Centre for the province’s health ministry.

Johnston also collaborated on The Spectator’s Code Red series. He assisted on a pro bono basis and maintained exclusive control of the raw data.

Patrick DeLuca, another Code Red collaborator, once again provided statistical analysis and mapping expertise for the new project. DeLuca is a member of McMaster’s Centre for Spatial Analysis and he, too, agreed to assist on a pro bono basis.

The BORN data was assembled into spreadsheets for analysis at two levels.

The data was aggregated up to the level of municipalities and small communities, including native reserves. There are 420 municipalities and communities represented in the data.

The information was also broken down to the level of neighbourhoods — or census tracts, as defined by Statistics Canada — for each of Ontario’s 19 census metropolitan areas.

There are more than 2,100 neighbourhoods represented across the province and they account for more than 80 per cent of all Ontario births.

Birth and maternal health outcomes could then be compared to StatsCan social and economic data at both the municipal and neighbourhood levels.

 

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