The social and economic factors that are intimately tied to rates of teen motherhood also contribute to other poor maternal health outcomes, such as low birth weight and scant or no prenatal care in the crucial early months of pregnancy.
A massive Metroland investigation of 535,000 provincial birth records shows the distribution of low birth weight babies is often highest where incomes and educational achievements are low and poverty is heavily concentrated.
In fact, Metroland uncovered one community in the northern Ontario where close to 23 per cent of babies born between 2006 and 2010 weighed less than 2,500 grams or 5.5 pounds — the cut-off for low birth weight.
The average rate of low birth weight babies in Ontario is 6.5 per cent. In Waterloo Region it is 5.9 per cent.
“It might be that many of these people do not have access to a family physician,” said Neil Johnston, a health research faculty member in McMaster University's department of medicine and a collaborator in Metroland's analysis of data from Ontario's Better Outcomes Registry and Network (BORN).
“It might be they can't afford or aren't motivated to attend prenatal care sessions,” he added. “They might be less adequately nourished, or have behaviours that are unhealthy.
“It's not a single smoking gun. It's almost a conspiracy of things that preclude them from ensuring the child they're carrying will be as healthy as possible.”
Poor maternal outcomes such as low birth weight have important short- and long-term implications.
For one, hospital costs for caring for low birth weight babies are enormously high.
Low birth weight babies are also more likely to have lifelong health problems, such as learning disorders, visual impairment, respiratory illnesses and cerebral palsy.
In the initial instalment of the BORN series, Metroland uncovered a clear link between poor socio-economic outcomes and high rates of teen pregnancy in neighbourhoods and communities provincewide.
When it comes to low birth weights, the connection between maternal outcomes and socio-economic factors is not as clear-cut.
Consider two of Metroland's findings from the analysis of data:
There are high rates of low birth weight babies in neighbourhoods and communities that have low incomes, low educational achievement and high rates of poverty.
Conversely, there are also high rates of low birth weight babies in Ontario's more affluent neighbourhoods and communities.
It's important to distinguish between two categories of low birth weight babies — those who are born at full term and have low birth weight because they don't grow and develop to the appropriate level, and those who have a low birth weight because they are born prematurely.
It's also important to distinguish between the various factors that contribute to low birth weight, including maternal age and fertility treatments.
It isn't always poverty or low education.
Perhaps a third of low weight births can be attributed to socio-economic factors, such as smoking.
Since smoking rates are inversely related to income — the lower the income, the higher the rate of smoking — it's not surprising there's a connection between smoking, poverty and increased rates of low birth weight babies in Ontario's poorer neighbourhoods and communities.
Take Brantford, for instance.
Smack dab in the middle of the city is a gritty neighbourhood where poor socio-economic factors and high rates of low birth weight meet.
In that part of downtown, nearly 40 per cent of adults over 25 years old don't have a high school diploma, according to the 2006 census.
Three-quarters of children under 18 live in poverty, and the median household income is $21,700, about a third of the provincial average of $60,455.
The unemployment rate is almost double the provincial norm of 6.4 per cent and the rate of teen mothers between 2006 and 2010 was 17 per cent — vastly higher than the Ontario average of 3.7 per cent.
In those four years, 15.7 per cent of babies in that area had low birth weights.
In the case of this Brantford neighbourhood, it's clear social and economic factors play a role in the rate of low birth weight babies.
But that still leaves two-thirds of cases that have a physiological basis and cut across socio-economic strata.
Maternal age, for one, can contribute.
Young first-time moms, such as teens, are more prone to having low birth weight babies.
So are women on the opposite end of the spectrum — first-time moms beyond the age of 35.
This expanding segment of society — the live birth rate among Ontario mothers between the ages of 35 and 39 grew by 32.5 per cent between 1995 and 2004 — helps to explain why the province's low birth weight rate has actually risen slightly in past decades. This was in spite of a 1997 Ministry of Health objective to lower the rate to 4 per cent by 2010.
The growth of in vitro fertilization and other fertility treatments could also be factors.
According to a provincial report, women undergoing IVF treatments are nearly 14 times as likely to have multiple births — twins, triplets, or otherwise — which are closely linked to higher rates of low birth weight and premature deliveries.
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