This study examines the causal associations for first time adolescent pregnancy, and evaluates the efficacy of community based interventions targeting adolescent mothers alone, or together with their male partners, and existing kinship support. The primary outcomes include improved health, educational behavioral, and social outcomes in the mother/infant dyad. The final desired outcome is preventing or delaying repeat pregnancies in these first time mothers. Furthermore the investigators will study the specific issue of violence and abuse in pregnant teens and how it relates to mental health status and their pregnancy outcomes. In addition, an intervention is proposed to target health providers caring for pregnant teens. This intervention is intended to heighten their awareness of the health and behavioral risks in pregnant teens and improve their skills in addressing these risks with their patients. The area of repeat adolescent pregnancy was selected because of the rapidly deteriorating patterns of prenatal care utilization and pregnancy outcomes associated with short interval repeated pregnancies in these mothers. The research design for this study is quasi-experimental. First time pregnant mothers will be recruited prospectively and randomized in two groups. Both groups will receive an intervention starting at 24 weeks gestationally and continuing up to 18 months corrected post-natal age. In GRP1 only the mother/infant dyads will receive the intervention, while in GRP2 the male partners and the surrounding kinship structure will also receive the intervention. Outcomes will be compared between the two groups of mother to examine the added efficacy of including the pregnant adolescents' male partners and families in this community based intervention. The impact of the intervention on fathers and kinship and how they relate to the mother/infant dyad will also be analyzed.
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