Adolescent girls have 11 percent of all annual births worldwide, 95 percent of which occur in low- or middle-income countries. While the profile of first-time parents (FTPs) is extremely diverse, this review focuses specifically on adolescent and young adult FTPs under the age of 25: in many countries the average age when girls and women have their first child is as young as 19 or 20. These girls and their male partners are often unprepared to begin parenthood on the most resourceful footing because of their young age, limited education, lack of vocational skills, increased likelihood of living and remaining in poverty due to limited employment opportunities. Conversely, these same factors, along with school dropout and early marriage, also predict their likelihood of becoming a young parent. Young women and men in early adulthood who become parents for the first time face similar challenges that are not well addressed by public health systems and have been overlooked in family planning and reproductive health programs. However, when equipped with the right tools, young FTPs can develop the skills and resilience to parent successfully and to create positive, healthy futures for themselves and their families, the effect of which is multiplicative and could influence how their own children will parent.
Adolescents experiencing unplanned first pregnancies, especially girls, are often pressured into child, early, or forced marriages (CEFM) as a result. Early marriages, whether wanted or unwanted, are associated with a range of adverse outcomes, including reduced likelihood of adolescent girls returning to school, receiving vocational training, restricted mobility, and access to seek employment outside the home, and increased likelihood to experience social isolation. The inability to return to school impacts girls’ access to and use of family planning in multiple ways. Lower education is correlated with lower likelihood that adolescent girls will access the family planning services that they want. Early pregnancy is linked to depression and anxiety in both young fathers and young mothers, though evidence on the lifelong impact of age at first parenthood on mental health and psychosocial support is still emerging.
In many parts of the world, first-time mothers are married or partnered to older men. Unequal power dynamics that exist in intergenerational marriages or partnerships further compound girls’ agency and their ability to make their own reproductive health decisions or advocate for their reproductive rights. This reduced agency can increase their vulnerabilities to intimate partner violence, especially during an unplanned pregnancy. Adolescent boys frequently become parents as well; however, few resources exist that target them directly.
One early pregnancy often leads to rapid, repeat pregnancies, lack of access to modern contraceptive methods, high rates of discontinuation of contraceptives, and maternal health complications. Young adult and adolescent mothers struggle the most to reach the two-to-five-year (or even one-year) pregnancy interval that predicts the best health outcomes for them and their babies, especially if their first pregnancy was unintended. This struggle is sometimes associated with social norms, cultural taboos, provider bias, or legal restrictions that focus contraceptive uptake education and outreach on older women and may even exclude young FTPs if they are not married. Programs that are designed for adolescents frequently focus on preventing first pregnancies and do not address the needs of adolescents who are already parents. FTPs may not have the resources or information on how to space pregnancies and may have never used a contraceptive method by the time of their first birth. First-time mothers and fathers alike have diverse cultural, family, and personal backgrounds and experiences that intersect to influence whether and how they engage with the right health care providers or advocates to succeed in parenting and as young adults.
Parenting self-efficacy
Beyond The Abcs Of FTPs: A Deep Dive Into Emerging Considerations For First-Time Parent Programs
Save the Children’s technical brief presents considerations from recent research and programs related to first-time parents’ reproductive and maternal health. The brief highlights emerging themes, which have potential to strengthen programs, policies, and services, and ultimately improve outcomes for FTPs. (2019)
Highlighted interventions from the past 10 years
Effect of a brief training program for primigravid adolescents on parenting self-efficacy and mother-infant bonding in the southeast of Iran
This quasi-experimental study explored the effect of a brief training program for primigravid adolescents on parenting self-efficacy and mother-infant bonding in southeast Iran. The results showed that the adolescent girls in the intervention group had higher self-efficacy during pregnancy compared to the control group. (2017)
Our First Baby Engaging First-Time Mothers and Their Partners in Mozambique
This brief discusses learnings from the USAID funded Maternal and Child Survival Program (MCSP) implemented in Mozambique which utilized a couples-based approach to increase the use of reproductive, maternal, and newborn health care and family planning among first-time parents. The Our First Baby approach consisted of small group participatory sessions with first-time mothers and their male partners to address the needs of young couples. (2019)
Access to contraception and health services
First-time parents and young married couples: a neglected window of opportunity for family planning programs
This report from Breakthrough Action describes the diverse needs of FTPs in family planning promotion, as youth in this population has been traditionally invisible in programming. The focus of the research was on the diverse needs to consider; the need for a socio-ecological approach; and the need to focus on men of all ages as fathers.
Reaching young first-time parents for the healthy spacing of second and subsequent pregnancies
E2A’s review of the evidence base to document successful programs and programmatic elements that influence first-time parents’ use of contraceptives for the purpose of spacing their second and subsequent pregnancies in developing countries found that very few programs exist to delay or limit future births among young married women. Thus, the review emphasized the need for additional research and programming to better understand effective approaches to meet the contraceptive needs of FTPs and increase young women’s decision-making power. (2014)
Formative Research to Identify Factors that Impact the Use of Sexual and Reproductive Health Services by First-Time/Young Parents in Two Regions of Madagascar
This report presents findings from formative research conducted as part of USAID’s Maternal and Child Survival Program (MCSP) in Madagascar which sought to identify factors that influence first time young parents’ intentions to seek sexual and reproductive health (SRH) services and to use antenatal care services, maternal and newborn care, and family planning (FP), including postpartum FP, services at relevant times in their reproductive lives. (2017)
Highlighted interventions from the past 10 years
Factors Influencing Use of Health Services by First-Time Young Parents: Findings from Formative Research in Six States in Nigeria
This study aimed to provide an understanding of the dynamics around the use of SRH care utilization among first time adolescent mothers or those who were about to become mothers in Nigeria. Results from this study indicate that a holistic intervention “involving a multisectoral approach to recognize the full breadth of FTYPs’ needs will guarantee the best success in increasing care uptake and, ultimately, resulting in better health outcomes.” (2018)
Factors impacting use of health services by first-time/young parents: A formative research toolkit
This toolkit shares details about study design and sampling methodology, modifiable versions of the tools used for formative research conducted under USAID-funded Maternal and Child Survival Program in Madagascar and Nigeria. The toolkit provides lessons learned from conducting formative research to develop interventions for FT/YPs. It uses a socioecological approach and also includes guidance to simplify the process of designing research to include the perspectives of first-time mothers and fathers, their families and communities, and the health system. (2018)
Interventions To Reach Married Adolescents For Increased Contraceptive Use In Niger
This technical brief on Pathfinder International’s Reaching Married Adolescents project, which aimed to increase the modern contraceptive prevalence rate among married adolescent girls between the ages of 13 and 19 in Niger, discusses the intervention’s design and implementation plan as well as key findings. The project generated evidence around the cost effectiveness of different intervention approaches’ abilities to increase contraceptive use among married adolescents. (2019)
“Because my Husband and I Have Never Had a Baby Before…” Results and Lessons from Interventions with First-Time Parents in Madagascar, Mozambique, and Nigeria
This technical brief discusses intervention approaches, findings and implementation learnings from small-scale interventions implemented by the USAID funded Maternal and Child Survival Program (MCSP) with first-time parents in three different country contexts - Madagascar, Mozambique and Nigeria. The findings shed light on FTPs and their needs, the diverse profiles of FTPs and the FTP life course, and factors shaping health care use and non-use, including social norms and health systems factors. (2019)
Addressing the Reproductive, Maternal, and Child Health and Family Planning Needs of Young, First-Time Parents in the Eastern Region of Burkina Faso
This report presents key implementation results and learnings from E2A and Pathfinder International’s Supporting Reproductive Health Services for Young First-Time Parents in Burkina Faso project. The project sought to increase family planning uptake and the use of reproductive, maternal health, and child health care among FTPs as well as create an enabling environment by strengthening the support of influential household and community members to address health outcomes. The findings demonstrated improved knowledge around care seeking and attitudes toward family planning. (2020)
Improving Health and Gender Outcomes for First-Time Parents in Cross River State, Nigeria
This report provides an overview of the FTP component of the Saving Mothers, Giving Life (SMGL) initiative implemented in Nigeria as well as key health and gender related results achieved through the intervention. The objective of the FTP component was to improve FTPs reproductive health knowledge and behaviors while simultaneously addressing underlying gender and social norms that influence their choices and actions. The implementation learnings highlighted key considerations for future programming with FTPs. (2019)
Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys
Using Demographic and Health Surveys from 13 West African countries, this paper compares the use, timing, source, and components of antenatal care between adolescent and older first-time mothers. The results demonstrated that adolescent first-time mothers included in the study start receiving antenatal care later, make fewer visits and receive fewer prescribed components of care compared to older first-time mothers. (2017)
Expanding Method Choice, and Access to Contraceptive Information and Services for First-Time Mothers in Shinyanga District, Tanzania
This report details key findings and lessons learned from an intervention which utilized a three-pronged approach (structural level, community level and individual level) to increase uptake of family planning information and services by young women and first time mothers in Tanzania. The intervention yielded positive outcomes such as increased uptake of family planning methods and services by young women as well as increased satisfaction among service providers and community health workers on how to effectively offer family planning services to young women and first-time mothers. (2017)
Relationship quality
REAL Fathers Implementation Guidelines and Core Materials
The Responsible, Engaged, and Loving (REAL) implementation guidelines and core materials are intended to guide practitioners in implementing the REAL initiative—an intervention targeting young men (aged 16-25 years) to build positive partnerships and parenting practices as they enter into partnership and fatherhood. REAL aims to reduce intimate partner violence, prevent physical punishment of children, improve parenting practices, and enhance partner communication. The package includes a mentor training curriculum, mentor discussion guide, mentor resource sheets, and women’s group sessions. (2019)
Engaging family and community members
Adolescent Mothers Against All Odds (AMAL): Facilitator Guide, Curriculum, and Toolkit
CARE’s Adolescent Mothers against All Odds (AMAL) Initiative seeks to address the needs of pregnant adolescents and first-time mothers in crisis-affected settings, while simultaneously addressing community consciousness and engagement around gender, power, and social norms. The AMAL initiative includes three main components (i.e., adolescent-centered components, community- centered components and provider-centered components). This toolkit provides program implementers with guidance, session-based curricula, complementary resources, and monitoring, evaluation, and learning tools for the aforementioned three components. (2020)
Our First Baby Health Education for Adolescents Who Are Pregnant or First-Time Parents Facilitator’s Guide
Save the Children’s Our First Baby Facilitators Guide provides important instructions to facilitate nine participatory sessions on sexual, reproductive, and child health for first-time young parents, including adolescents who are pregnant and their male partners. More specifically, topics covered in the sessions include fertility, antenatal care, care of the mother during pregnancy, first-time fatherhood, birth planning/delivery, newborn and postpartum care, exclusive breastfeeding, healthy timing and spacing of pregnancy, family planning, sexually transmitted infections, HIV, and gender-based violence. (2019)
Providing Reproductive Health Services to Young Married Women and First-time Parents in West Africa: A Supplemental Training Module for Community Workers Conducting Home Visits
This training module aims to help community health workers improve their knowledge on contraception and reproductive health as well as improve their client counseling skills when conducting home visits to young married women and first-time parents. The training is also designed to aid community health workers in counseling husbands, mothers-in-law, and other key influencers on young women’s fertility decisions. (2016)
Providing Reproductive Health Services to Young Married Women and First-time Parents in West Africa: A Supplemental Training Module for Facility-based Health Care Providers
This supplemental training module aims to improve health care providers’ ability to offer comprehensive, high-quality, nonjudgmental services to young married women and first-time parents by increasing their knowledge, awareness and understanding of the needs of these unique populations. Topics covered in the sessions include healthy timing and spacing of pregnancy, contraception, fertility and decision making among young married women and their partners and first-time parents. (2016)
The lived experiences and social support needs of first-time mothers at health care facilities in the City of Tshwane, South Africa
This qualitative research study explored the lived experiences and social support needs of the first-time mothers following discharge from health care facilities in Tshwane, South Africa. The findings indicate that the first-time mothers in the study had limited knowledge and skills related to caring for their newborn babies, lacked confidence thus underscoring the need for social structures to support them during the postpartum period. (2017)