'Second chances': Lessons from Jamaica’s remarkably successful Programme for Adolescent Mothers

In the 1970s, adolescents giving birth in Caribbean countries was commonplace. At the time, girls below the age of 19 were having well more than one of every 10 babies in the region and accounted for about 60 percent of all first births.

At the time, the situation was not recognized as detrimental, given the large number of students, both girls and boys, who never finished school and had scarce job opportunities. Many even viewed early marriage and motherhood as part of everyday life. As the decade wore on, however, and more women started finishing school and joining the workforce, it quickly became obvious that not finishing school meant losing out on new economic opportunities that hadn't been available to their parents.

Countries across the Caribbean and Latin America responded with programs aimed mostly at preventing early pregnancy, with mixed success.

In Jamaica, however, the Women’s Centre of Jamaica Foundation decided to take a radically different approach. In 1978, it launched the Programme for Adolescent Mothers (PAM) to help pregnant girls and adolescent mothers continue their education and return to school after giving birth, by offering academic instructions, counseling in self-esteem, sexual and reproductive health issues, and vocational training.

While the non-residential program has had its challenges over the years, it has achieved something remarkable: among some 46,000 adolescent mothers who have participated over the past four decades, repeat pregnancy has remained under two percent. The organization currently serves almost half of all the adolescent mothers in Jamaica.

We spoke with the foundation's executive director, Zoe Simpson, and University of Cape Coast's Joshua Amo-Adjei, who has researched the program, about how it became successful and what other countries could potentially learn from it.

What was the situation in 1970s Jamaica that led to the creation of the Programmme for Adolescent Mothers, and how did it get started?

Simpson: In the 1970s, the situation in Jamaica was a little grim with respect to the stories of adolescent mothers. At the time, the teen pregnancy rate was about 30 percent, which was really not good for nation-building. The girls would drop out of school on account of pregnancies, and we would not see or hear from them until many years later when they showed up with a third or fourth pregnancy. Girls were not able to continue their education having had an early pregnancy.

The government said, "We have to address that. We must respond to that need." The government recognized that it was very important for girls to continue their education, so the program was established to speak to the educational needs of those girls. The cultural norms [at the time] were such that if a girl got pregnant, that was the end of her educational journey; she was shoved off in oblivion, pretty much. We recognized that for girls' education to be salvaged, it would take a national approach.

When the program was established, the government decided to provide funding if it proved to be successful. I think we had 17 girls at the end of the first year, then we got up to about 100 girls and were on a good path. With that, the government said, "Yes, this is something we can support. We will commit to this program," which was very positive and contributed towards nation-building.

Among women and girls who have taken part in the program since it was created in 1978, repeat pregnancy has remained under two percent. Why has the program been so successful?

Simpson: First and foremost, government support. Whatever political administration we've had, there has been a wide- scale embrace of this program. It wasn't about our political affiliation. It was about nation-building. The success of the program can also be attributed to the intersectoral approach that was taken in its implementation. There has also been wide-scale international and national donor funding as persons have come to recognize the efficacy of the program.

Several policies have also propelled the work that we do. Chief of these has been the National Policy for the Reintegration of School-age Mothers into the Formal School System, which says the place for the girl remains in school. Prior to 2013, when the policy was adopted, we had to beg and beseech principals to take back the girls. The decision was made at their discretion. Now, at the end of the year, when the girls have completed the program and have had their babies, we simply send their names to the Ministry of Education and it's the ministry that secures the [school] space for the girls. Even the girls now know they have this policy [supporting them]. Even if they don't come to the Women's Center, they can return to school and say, "I'm back."

I also want to point to the strategies we've used to extend the reach of the program across the island. Whereas we started with one center in Kingston and 17 girls, we've now extended across the island, so we have a presence in every parish. The program is accessible and available to every girl.

We've also conducted aggressive advocacy. Because of discrimination and stigmatization of these girls, there were persons who refused to embrace [the program] initially. As we advocated for the rights of girls, persons eventually bought in, and the level of discrimination dissipated over time.

Monitoring and evaluation have helped as well. We've had a number of research projects that showed exactly how the girls have managed beyond the Women's Center. The research has shown that they have done extremely well for themselves academically. You can find a girl in just about any discipline, any profession that you can think of, who has been a past student of the Women’s Center. The research also shows that the offspring of the girls themselves are in a better position than the offspring of girls who do not access this kind of program or intervention.

Amo-Adjei: If I may add – the program was not [working] in isolation. There were other complementary elements or interventions that were implemented concurrently. The project has also successfully targeted school placement – when adolescent mothers returned from childbirth, they were supported in getting admission into schools through one-on-one advocacy with head teachers because, at the time, there was fear about a "contagion" effect. What I mean by that is that [teachers] feared that adolescent mothers returning to school could serve as a negative influence on others. But thanks to the program and its leadership, such adolescents were able to get back into school.

Could you walk us through your program? How does it work?

Simpson: We do recruitment in hospitals and health centers, the spaces where the girls show up for antenatal and postnatal care, and we introduce them to the program. We do a home visit and introduce the program to the parents, and we allow the parents to come to terms with the extent of the support they need to give their daughter, if she's going to be successful. We seek to get the support from the families, whether it's an extended family or whomever.

She then registers in the center that's nearest to her home. Then she starts her program of continuing education, which includes regular academic instruction. We partner with the Ministry of Education so we get our part-time teachers from schools and they give the girls their lessons. During that time, we offer counseling about the use of various contraceptive methods, the correct use of a method. We do not force it on the girls, but with their parents' consent, we encourage the use of a method of choice.

We prepare her to have the baby, and ensure she has support. We ensure she's going to the hospital and health centers for her antenatal care. Once she's had her baby, we prepare her for reintegration. We expose her to the reality that it's not going to be the same. She can go back to school and do well, but it's going to be a little more challenging. We prepare her for those challenges. This is when her life skills, decision-making, and time management skills are honed, so that she can return to school comfortably and complete her secondary education. We facilitate the process of reintegration. It's not enough to send her back to school and say, "Hey, that's good." We also provide the girls with psychosocial support, which includes mentorship. Because there's another mouth to be fed, the [household] budget now is reduced; we provide financial support when necessary. As research has shown, the girls are at risk of a second-time drop-out unless they're monitored sufficiently and provided with extensive support. All eyes are on that goal of [school] completion.

Could you speak about how fathers are involved in the program?

Simpson: Yes, that's very important. We identify the young fathers, and we provide them with counseling services. They are also encouraged to continue and complete their education and are provided with the support they need, whether it be financial or the psychosocial support they need to continue in school. The boys also sometimes drop out.

Nobody should be left behind where their education is concerned. A Young Fathers Initiative has been instituted in collaboration with the Bureau of Gender Affairs. The young fathers are counseled and are helped to come to terms with their paternity rights and responsibilities. It is not that we are encouraging the relationship with the girl, but we want the fathers to have a positive relationship with their children. You can understand the psychological worth of a connection between father and child.

That's going to be a very big part of our next steps in scaling up the Young Father's Initiative; the fathers are right there with their roles and responsibilities and their personal development to be a better person, to be a better father, and to change the landscape in the Caribbean, where we have this missing father syndrome, and we see the effect of that on our youngsters. The fathers are integral to the process.

What are the lessons for other countries?

Amo-Adjei: Political commitment is critical and has a cascading effect on such interventions. More specifically, one of the challenges with global health innovations and interventions in developing countries is the issue of sustainability. That is because mainly, or most times, programs are funded by external donors, which is very good, but local government or national government commitment tends to be lacking in many instances.

If you look carefully at the Jamaican case, the role of the national government in committing resources, prioritizing the issue of adolescent mothers and their return to school, and other life skills programs has been crucial in sustaining the program for the past 40 years. To the best of our knowledge, this is the longest-running program for getting adolescent mothers back to school. That tells you that with local commitment a lot can be achieved in global health innovations and interventions.