Exploring Healthcare Engagement Among Young Mothers and Their Children in Southern New Jersey: A Descriptive Survey Study

ABSTRACT

Background and Aims

Young mothers and their children are at risk for negative health outcomes, including infant and maternal mortality, and lower vaccination, breastfeeding, and medical visit attendance rates. However, little is known about young mothers' engagement and experiences with healthcare. In this exploratory quantitative study, we assessed young mothers' engagement, satisfaction, and communication experiences with healthcare providers and explored sociodemographic differences to identify ways providers and healthcare systems can improve care for young mothers and their families.

Methods

We surveyed 250 young mothers ages 15–25 in southern New Jersey from 2019 to 2022. We conducted a descriptive analysis of participant demographics, healthcare visit attendance, patient satisfaction, and communication with providers in obstetrics/gynecology (OB/GYN) and pediatrics care. We used χ ², correlation, and generalized linear model analyses to explore sociodemographic differences in healthcare engagement and experiences.

Results

Young mothers in our sample were 22 years old and had one child, on average. We found that young mothers are engaging with the healthcare system, with an average of four visits each to pediatric and OB/GYN healthcare providers in the past year. Satisfaction with care was moderately high for OB/GYN (M = 7.7; 10‐point scale) and pediatrics (M = 8.0). Young mothers also reported moderately high provider communication quality with OB/GYN (range: 63.1–70.1; 100‐point scale), and pediatric providers (range: 66.0–69.5). Exploratory analyses found that visit attendance, satisfaction, and patient‐provider communication were all associated with sociodemographic differences in race, ethnicity, education level, and health insurance type.

Conclusions

Our study provides a snapshot of young mothers' healthcare engagement and experiences in OB/GYN and pediatric care, which has been missing from the literature. We interpret our results from an intersectional, minority stress theory‐informed lens, focusing on recommendations for future research and changes that systems and providers can make to better serve young mothers and their families.

1. Young Mothers' Engagement and Experiences With Healthcare

Young mothers represent a sizable demographic in the United States, with 146,973 live births attributed to mothers aged 15–19 in 2021 [1]. Because the average age of childbearing for women in the U.S. has risen markedly in the past decade, from 25.6 in 2011 to 27.3 years of age in 2021, becoming a mother in adolescence or even emerging adulthood is less common and therefore can be a more isolating and often stigmatized experience [2]. However, we know little about the health‐related experiences of young mothers between the ages of 15 and 25.

Unfortunately, young mothers are at risk of negative sequelae of early childbearing, including sexual risk behaviors, poor physical health, illicit drug use, psychological distress, educational problems, and economic strain [3, 4, 5]. Specific to the obstetrics/gynecology (OB/GYN) context, young mothers are at increased risk for inadequate prenatal care, preterm deliveries, preeclampsia, sexually transmitted infections, and neonatal complications [6]. Furthermore, young mothers are also more likely to live in economically disadvantaged communities, which can negatively impact their mental health and affect parenting [7]. Critically, we also recognize the unique strengths and resilience displayed by young mothers who navigate complex circumstances with limited support in our society: for example, accessing prenatal healthcare [8]. It is crucial to identify how providers and healthcare systems can engage young mothers and their children in healthcare, but no data are yet available to describe their healthcare engagement and experiences.

Understanding the potential facilitators and barriers to links between young mothers and the healthcare system is important because increasing healthcare engagement and retention can improve maternal and child health outcomes, which can ultimately help mitigate inequities and enhance overall well‐being [9]. For instance, one study in India found that young mothers were less likely to use healthcare services if they came from disadvantaged backgrounds and were of younger age [10]. Young mothers have also been shown to have the highest percentage of late or missed prenatal care as compared to older mothers [8], and often feel that healthcare systems and/or providers need to shift their care focus in order to provide more respectful communication and nonjudgmental collaboration in decision‐making [11]. However, research on young mothers and their engagement with the healthcare system in the U.S. is still sparse [12]. No published research describes young mothers' healthcare engagement or experiences with OB/GYN, primary care, or pediatric services.

The socioecological framework can provide further context about young mothers, given that they operate within a variety of social systems [13, 14]. Multiple factors within systems (i.e., schools, families, friend groups, healthcare, etc.) influence young mothers' development and behavior, as well as their children's. Young mothers' experiences are embedded within systems, so these factors may be important to discuss in healthcare visits for their wellbeing. In addition, the minority stress theory provides a lens to better understand healthcare engagement [15]. This framework highlights the intersectional nature of young mothers' identities, including age, ethnicity, race, education, socioeconomic status, and social supports, all of which contribute to shaping their healthcare interactions [16]. In fact, young mothers inherently have intersectional identities because of their gender, age, and parenting status [17]. Minority stress theory describes how marginalized communities experience stress when their identities are stigmatized and affect how they are treated. Young mothers who also hold marginalized identities due to their race or ethnicity may experience even greater discrimination and stigma in reproductive and pediatric healthcare than their peers and be more likely to be dissatisfied with the care they receive and communication with providers. For example, there is a long history in the United States of Black women experiencing coercion and high maternal mortality during obstetric care [18, 19, 20], and parents with minoritized racial and ethnic identities report experiencing discrimination in pediatric care as well [21]. Understandably, young mothers of color may feel distrust towards medical institutions and be less likely to attend healthcare visits because of both direct experiences with discrimination and awareness of generational racial trauma in healthcare systems in their community [19, 22].

Since there is a substantial population of young mothers in the U.S., but limited understanding of who they are or their experiences with the healthcare system, the present study sought to address this gap by examining their healthcare engagement and experiences by assessing visit attendance, patient satisfaction, and communication with providers in OB/GYN and pediatrics. In addition, due to the lack of research with young mothers between ages 15–25, we provide descriptive details about the participants in our sample to provide more insight into who these young mothers are.

We included a broader age range (15–25 years) than in some previous studies which have focused exclusively on adolescent mothers for both developmental and practical reasons. First, we wanted to capture a wider range of healthcare engagement and experiences for mothers with older children. Second, young mothers in their early twenties are still several years younger than the average age at first birth in the U.S. and are still learning to enact adult roles, such as navigating healthcare systems [23].

2. Study Design and Methods

2.1. Study Design

We conducted a cross‐sectional quantitative survey with young mothers in South Jersey, United States. This project is part of a larger mixed‐methods study on barriers and facilitators to healthcare engagement among young mothers and their families. We chose this design as a first step in exploring young mothers' experiences with healthcare in this region due to the lack of existing research, and to minimize participant burden [24]. We obtained ethical approval from the institutional review boards of both the corresponding author's university and Cooper University Hospital (CUH).

2.2. Setting

Participants were recruited, and data were collected between 2019 and 2022 at pediatrics and OB/GYN clinics at Cooper University Hospital in Camden, NJ, as well as local community organizations. Participants were also recruited via social media advertisements, flyers posted in the community, and Qualtrics participant panels.

2.3. Participants

Our participants were 250 young mothers from South Jersey, United States. Inclusion criteria included: between 15 and 25 years of age, living with at least one biological child, comfortable reading English or Spanish and living in one of the seven counties defined as southern New Jersey [25]. Participants who were recruited in person were provided with a flyer describing the study, which contained a QR code linking to the Qualtrics survey. Participants recruited online saw the same information contained in the flyer and could click a link to the study description and informed consent form.

2.4. Procedure

Self‐report data were collected via a Qualtrics survey. Participants provided informed consent to participate and were given the opportunity to receive a $10 electronic gift card. Risk of bias was minimal as all data collection was anonymous, and this was an observational study.

2.5. Measures

2.5.1. Demographics

Our demographics survey included questions on gender, race, ethnicity, age of mother, highest level of education, pregnancy status, number of children, income, employment, religious service, religion importance, last health visit, age of children, upbringing location, and health insurance.

2.5.2. Medical Visit Attendance

We asked participants whether they had (1) an OB/GYN, (2) a pediatrician for their child(ren), and (3) a primary care provider. We also asked how many appointments they attended in the last year with pediatrics (How many times have your child been to an appointment with a pediatrician (children's doctor) in the past year?), OB/GYN (How many times have you been to an appointment with an obstetrician/gynecologist (OB/GYN) in the past year?), and primary care (How many times have you been to an appointment with your primary care doctor in the past year?). Finally, we asked “When was the last time you visited a doctor or health care professional for yourself, whether in a medical office, clinic, or hospital?” Response options included 30 days, 90 days, 6 months, 12 months, 2 years, and longer than 2 years.

2.5.3. Patient Satisfaction

We measured patient satisfaction with one question for each specialty: overall, how satisfied are you with your appointments with your OB/GYN (or pediatrician) during the past 12 months? Participants rated satisfaction on a scale from 0 to 10 (0 = the worst, 10 = the best).

2.5.4. Ambulatory Care Experiences

The Ambulatory Care Experiences Survey–Short Form [26] includes 34 questions covering two broad dimensions of patient experiences (clinical interactions and organizational features), which are broken down into seven subscales (doctor/patient communication, clinical team interactions, health promotion support, integration of care, office staff, visit‐based continuity, and organizational access). For this analysis, we only looked at the doctor/patient communication subscale and patient satisfaction (for both OB/GYN and pediatric settings, respectively). We repeated the survey for OB/GYN and pediatrics, replacing the phrase “personal doctor” with “OB/GYN” and “pediatrician”, respectively. Participants only answered questions about an OB/GYN or pediatrician if they reported they or their child had ever seen that specialist. Communication items were rated on a scale of 1 (“never”) to 6 (“always”). Each item score was converted to a 100‐point scale following Sequist and colleagues' recommendations [26], with higher scores indicating more positive impressions. Finally, we computed a mean score for communication in each specialty. Scores of 7 (“not applicable”) were coded as missing. Satisfaction with care (“Overall, how satisfied are you with your child's appointments with their pediatrician during the past 12 months?” was rated on a scale from 0 to 10.

2.6. Data Analysis Plan

We examined young mothers' sociodemographic characteristics, healthcare engagement, and experiences using a descriptive data analysis. The number of participants in each analysis varied due to missing data on some measures. We examined the pattern of responses for each participant and excluded participants suspected to be bots based on the inclusion criteria. We calculated means, standard deviations, and frequencies for all primary variables and used chi‐square and correlation analyses to examine demographic differences in whether patients had primary care, OB/GYN, and pediatric providers. Finally, we use generalized linear models (GLMs) to explore demographic differences in (1) the number of visits to healthcare provider in the last year, (2) patient satisfaction ratings, and (3) doctor‐patient communication for each specialty. All exploratory statistical tests were two‐sided, and the significance level was set at p < 0.05.

2.7. Study Size

To determine whether our sample size was adequate for our exploratory inferential statistics, we performed a post‐hoc power analysis for linear regression with 14 predictors (the number of groups across four categorical demographic variables). Using G*Power [27], we determined that with a sample size of 250, we would have >99% power to detect a medium effect of 0.25 at α = 0.05.

3. Results

The average age of young mothers was 22.2 years (SD = 2.3). The percentage of young mothers living with their significant other and not married was 31.7%, while 29.8% were single, 18.3% were married, 14.3% were in a serious relationship and not living together, 5.6% were casually dating/in a non‐serious relationship, and <1.0% were separated. Young mothers had been pregnant 1.4 times (SD = 0.7) had 1.2 live births (SD = 0.5), on average, and had children with an average age of 17.9 months (SD = 22.0 months). Table 1 shows additional demographic information.

Table 1.

Sociodemographic characteristics.

Sociodemographic characteristic	Categories	N (%)
Gender (n = 250)	Female	246 (98.4)
	Non‐binary/third gender	4 (1.6)
Sexual orientation (n = 246)	Heterosexual	184 (74.8)
	Homosexual	5 (2.0)
	Bisexual	40 (16.3)
	Pansexual	8 (3.3)
	Asexual	2 (0.8)
	Demisexual	2 (0.8)
	Other	5 (2.0)
Race (n = 252)	American Indian or Native Alaskan	4 (1.6)
	Asian	8 (3.2)
	Black or African American	67 (26.6)
	Native Hawaiian or other Pacific Islander	6 (2.4)
	White	149 (59.1)
	Other	18 (7.1)
Ethnicity (n = 225)	Hispanic or Latino/Latina	78 (30.8)
	Not Hispanic or Latino/Latina	175 (69.2)
Highest level of education (n = 253)	Some high school	26 (10.3)
	High school diploma or GED	78 (30.8)
	Some university	71 (28.1)
	Associate's degree	37 (14.6)
	Bachelor's degree	33 (13.0)
	Master's degree	8 (3.2)
Currently pregnant (n = 248)	Yes	37 (14.9)
	No	211 (85.1)
Income (n = 251)	Less than 15 K	57 (22.7)
	15–29K	65 (25.9)
	30–45K	58 (23.1)
	45–60K	42 (16.7)
	Over 60 K	29 (11.6)
Employment (n = 253)	Full time	97 (38.3)
	Part time	82 (32.4)
	Not employed	74 (29.2)
Religious service (n = 233)	Once a week	24 (10.3)
	2–3 Times per month	29 (12.4)
	Once a month	17 (7.3)
	Few times a year	72 (30.9)
	Never	91 (39.1)
Religion importance (n = 234)	Very important	53 (22.6)
	Somewhat important	94 (40.2)
	Not really important	47 (20.1)
	Not at all important	40 (17.1)
Upbringing location (n = 233)	Rural	77 (33.0)
	Suburban	91 (39.1)
	Urban	59 (25.3)
	Megalopolis	6 (2.6)
Health insurance (n = 252)	Private	95 (37.7)
	Medicaid	142 (56.3)
	Tricare	2 (0.8)
	None	11 (4.4)
	Other	2 (0.8)

3.1. Healthcare Engagement

Most (79.7%) young mothers reported that they have a primary care provider, while 20.3% did not. χ ² tests revealed that the type of insurance was associated with having a primary care provider (χ ² ₄ = 10.16; N = 221; p = 0.038); post‐hoc adjusted residuals showed that young mothers without insurance were overrepresented in the “no” category (adjusted residual = 3.1). The percentage of young mothers who said they have an OB/GYN provider was 81.1%, while 18.9% said they do not. Young mothers with Hispanic/Latina ethnicity were overrepresented in the “no OB/GYN provider” category (χ ² ₁ = 8.914; N = 222; p = 0.003; adjusted residual = 3.0). Finally, 95.0% of participants said they have a pediatrician for their child, while 5.0% said they do not. Due to small cell sizes (only 11 participants did not have a pediatrician), χ ² results could not be interpreted.

Regarding how recently they last visited a healthcare provider, 41.1% of young mothers said their last visit was in the past 30 days, 20.6% said their last visit was within the past 90 days, 19.8% within the past 6 months, and 11.9% within the past 12 months. A small percentage, 4.3%, reported visits within the past 2 years, while 2.4% indicated that their last visit was more than 2 years ago.

In terms of medical specialty visits, most young mothers (83.5%) saw their OB/GYN in the past year, while 16.5% did not. Most young mothers (93.1%) saw their child's pediatrician in the past year; 6.9% did not. The mean number of primary care appointments attended in the past year was 3.1 (SD = 7.3), whereas for OB/GYN it was 4.3 visits (SD = 5.5), and for pediatrics it was 4.6 visits (SD = 3.6). We also conducted Spearman's rho bivariate correlation analyses to explore associations between types of provider visits. There were small, positive associations between the number of primary care and OB/GYN visits (r = 0.21, p = 0.002, N = 208), primary care and pediatrics visits (r = 0.17, p = 0.014, N = 213), and OB/GYN visits (r = 0.17, p = 0.017, N = 207).

To evaluate whether visits to one type of provider were significantly higher than the others, we used a Friedman test: there was a significant difference between provider type for visit attendance in the past year (χ ² ₂ = 49.36; N = 204; p < 0.001), with pediatrics visits as the most frequent (mean rank = 2.36), followed by OB/GYN (mean rank = 1.88), and primary care (mean rank = 1.76). However, post‐hoc Wilcoxon signed‐rank tests comparing these means were not significant at a Bonferroni‐corrected alpha level of 0.0167.

Finally, to explore possible demographic differences in the number of appointments attended in the past year for each specialty, we used GLMs with negative binomial distribution and log link with race, ethnicity, highest level of education, and type of insurance as predictors of appointments attended for each of the three specialties (primary care, OB/GYN, and pediatrics). We recoded education into three categories: less than high school diploma, high school graduate/some college, and college graduate or higher. We found that race (χ ²(5) = 17.80, p = 0.003) was significantly associated with number of primary care visits, in that Black/African American (incidence rate ratio [IRR], 2.11; 95% CI, 1.42–3.13; p = 0.003) and Native Hawaiian/Pacific Islander young mothers (IRR, 3.45; 95% CI, 1.13–10.48; p = 0.029) reported more primary care visits than white participants. For OB/GYN visits in the past year, race (χ ²(5) = 11.71, p = 0.039) and ethnicity (χ ²(1) = 6.67, p = 0.01) were significant predictors. Participants who identified as another race not specified had more OB/GYN visits in the past year than white young mothers (IRR, 2.63; 95% CI, 1.41–4.91; p = 0.002), and Hispanic/Latina young mothers reported more OB/GYN visits than non‐Hispanic/Latina participants in the past year, (IRR, 0.60; 95% CI, 0.41–0.88; p = 0.01). There were no significant sociodemographic predictors of pediatric visits.

3.2. Patient Satisfaction

On a 10‐point scale, the overall mean satisfaction with OB/GYN providers in the past 12 months was 7.7 (SD = 2.5), and the overall mean satisfaction with pediatricians in the past 12 months was 8.0 (SD = 2.2). Using GLMs with a normal distribution and identity link, we tested whether race, ethnicity, highest level of education, and insurance type were associated with overall satisfaction with each specialty. Race (χ ²(5) = 37.09, p < 0.001), education (χ ²(2) = 16.48, p < 0.001), and insurance type (χ ²(3) = 22.99, p < 0.001) were all significant predictors for OB/GYN satisfaction. Specifically, young mothers who identified as Asian (b = 2.00, SE = 0.59; 95% CI, 0.83–3.16, p < 0.001) and other race (b = 1.00, SE = 0.39; 95% CI, 0.24–1.76, p = 0.01) were more satisfied with their care compared with white participants, while Native Hawaiian/Pacific Islander young mothers were less satisfied (b = −2.23, SE = 0.61; 95% CI, −3.41 to −1.04, p < 0.001). Young mothers who had less than a high school diploma were significant less satisfied with OB/GYN care than participants with a college degree or higher (b = −1.27, SE = 0.32; 95% CI, −1.90 to −0.65, p < 0.001). Both participants with private insurance (b = 1.95, SE = 0.53; 95% CI, 0.90–2.99, p < 0.001) and public insurance (b = 1.23, SE = 0.52; 95% CI, 0.21–2.26, p = 0.018) were more satisfied with their OB/GYN provider than those with no insurance.

For overall satisfaction with pediatric care, all four sociodemographic predictors were significant: race (χ ²(5) = 26.51, p < 0.001), ethnicity (χ ²(1) = 15.32, p < 0.001), education (χ ²(2) = 18.22, p < 0.001), and health insurance (χ ²(3) = 21.67, p < 0.001). Specifically, Black/African American (b = −0.77, SE = 0.20; 95% CI, −1.17 to −0.37, p < 0.001) and Hispanic/Latina (b = −0.77, SE = 0.20; 95% CI, −1.12 to −0.38, p < 0.001) young mothers were less satisfied with pediatric care than white young mothers, respectively. Young mothers with less than a high school diploma (b = −1.24, SE = 0.29; 95% CI, −1.81 to −0.67, p < 0.001) and high school/some college (b = −0.39, SE = 0.19; 95% CI, −0.76 to −0.03, p = 0.035) were less satisfied with pediatric care then participants with a college degree or higher. Finally, young mothers with private insurance were more satisfied with pediatric care (b = 1.08, SE = 0.47; 95% CI, 0.17–2.00, p = 0.021), while young mothers with military insurance were less satisfied (b = −1.75, SE = 0.85; 95% CI, −3.41 to −0.85, p = 0.039), in comparison with participants without insurance.

3.3. Patient‐Provider Communication

Mean scores for doctor‐patient communication with OB/GYN providers are presented in Table 2. We explored whether race, ethnicity, highest level of education, and type of insurance were associated with overall patient‐provider communication scores in OB/GYN, again using GLMs with normal distribution and identity link. We found that all four sociodemographic predictors were significant: race (χ ²(5) = 1933.75, p < 0.001), ethnicity (χ ²(1) = 8.88, p = 0.003), education (χ ²(2) = 845.34, p < 0.001), and health insurance (χ ²(3) = 2967.12, p < 0.001). Specifically, participants who identified as American Indian/Alaska Native (b = 9.82, SE = 0.75; 95% CI, 8.36–11.28, p < 0.001), Asian (b = 7.95, SE = 0.59; 95% CI, 6.79–9.12, p < 0.001), Black/African American (b = 0.58, SE = 0.21; 95% CI, 0.17–0.98, p = 0.005), and another race (b = 1.23, SE = 0.36; 95% CI, 0.52–1.94, p < 0.001) provided higher scores, while Native Hawaiian/Pacific Islander patients gave lower scores (b = −22.79, SE = 0.60; 95% CI, −23.97 to −21.60, p < 0.001) in comparison with white participants. Hispanic/Latina young mothers reported better communication than non‐Hispanic/Latina participants (b = 0.62, SE = 0.21; 95% CI, 0.21–1.03, p = 0.003), while both participants with less than a high school diploma (b = −9.03, SE = 0.31; 95% CI, −9.65 to −8.42, p < 0.001) and high school/some college (b = −1.88, SE = 0.20; 95% CI, −2.26 to −1.49, p < 0.001) gave lower communication scores than young mothers with a college degree or higher. Finally, participants with private (b = 19.32, SE = 0.53; 95% CI, 18.28–20.36, p < 0.001), public (b = 11.07, SE = 0.52; 95% CI, 10.05–12.09, p < 0.001), and military insurance (b = 2.39, SE = 0.88; 95% CI, 0.66–4.11, p = 0.007) all reported better communication than young mothers with no insurance.

Table 2.

Patient‐provider communication, past 12 months: Obstetrics/gynecology.

Item	Mean (SD)
How often did your OB/GYN explain things in a way that was easy to understand?	70.1 (18.8)
How often did your OB/GYN listen carefully to you?	68.7 (19.9)
How often did your OB/GYN give you clear instructions about what to do to take care of the health problems or symptoms that were bothering you?	66.4 (21.5)
How often did your OB/GYN give you clear instructions about what to do if your symptoms got worse or came back?	67.3 (21.2)
How often did your OB/GYN show respect for what you had to say?	67.0 (21.2)
How often did your OB/GYN spend enough time with you?	63.1 (22.0)
How often did your OB/GYN seem to know all the important information about your medical history?	67.2 (22.0)
Overall mean	67.1 (17.2)

Abbreviations: OB/GYN, obstetrician/gynecologist; SD, standard deviation.

Mean scores for pediatric provider communication are presented in Table 3. We again found that all four sociodemographic predictors were significant: race (χ ²(5) = 1706.81, p < 0.001), ethnicity (χ ²(1) = 717.77, p < 0.001), education (χ ²(2) = 329.58, p < 0.001), and health insurance (χ ²(3) = 4226.39, p < 0.001). The following parameter estimates for all predictor categories were significant at the p < 0.001 level. In comparison with white young mothers, participants who identified as Native American/Alaska Native (b = 20.95, SE = 0.76; 95% CI, 19.46–22.44) and other race (b = 5.97, SE = 0.38; 95% CI, 5.24–6.71) reported better communication, while Asian (b = −6.13, SE = 0.52; 95% CI, −7.15 to −5.10), Black/African American (b = −1.01, SE = 0.20; 95% CI, −1.41 to −0.62), and Native Hawaiian/Pacific Islander participants (b = −11.14, SE = 0.52; 95% CI, −12.17 to −10.12) gave lower scores. Hispanic/Latina young mothers rated pediatric providers lower on communication in comparison with non‐Hispanic/Latina participants (b = −5.28, SE = 0.20; 95% CI, −5.66 to −4.89). Young mothers with less than a high school education (b = −5.08, SE = 0.28; 95% CI, −5.64 to −4.52) and high school/some college (b = −2.00, SE = 0.19; 95% CI, −2.37 to −1.63) both had lower communication scores for pediatric providers compared to participants with a college degree or higher. Finally, participants with private (b = 15.11, SE = 0.47; 95% CI, 14.20–16.03) and public insurance (b = 9.79, SE = 0.46; 95% CI, 8.89–10.70) gave higher communication scores, while young mothers with military insurance gave lower scores (b = −24.58, SE = 0.85; 95% CI, −26.24 to −22.91).

Table 3.

Patient‐provider communication, past 12 months: Pediatrics.

Item	Mean (SD)
How often did your pediatrician explain things in a way that was easy to understand?	69.5 (19.2)
How often did your pediatrician listen carefully to you?	68.1 (20.5)
How often did your pediatrician give you clear instructions about what to do to take care of the health problems or symptoms that were bothering your child(ren)?	67.4 (22.3)
How often did your pediatrician give you clear instructions about what to do if your child(ren)'s symptoms got worse or came back?	69.1 (19.0)
How often did your pediatrician show respect for what you had to say?	66.3 (22.0)
How often did your pediatrician spend enough time with you?	66.0 (21.1)
How often did your pediatrician seem to know all the important information about your medical history?	67.8 (20.4)
Overall mean	67.9 (17.3)

Abbreviation: SD, standard deviation.

4. Discussion

This provides a window into the healthcare engagement and experiences of young mothers, an understudied population who experience health inequities and have significant healthcare needs for themselves and their children. We recognize that sampling, methods, and age ranges are different, but we contrast our findings with a 2016 national dataset stating that teen mothers had the highest late or total lack of prenatal care compared with mothers of other ages [8]. The previous data about young mothers' medical appointment attendance suggests they are relatively low compared with older mothers; however, our data suggest that most young mothers do regularly attend healthcare visits, particularly with their children's pediatrician. We found that 79.7% of our young mothers had a primary care provider, which compares favorably with a national survey of youth ages 14–24, which found that only 75.8% had a primary care provider [28]. Similarly, 10% of children in the U.S. did not have a pediatrician as of 2024 [29], whereas only 5% of our mothers said their child does not; this could be due to New Jersey having a relatively high number of pediatricians: 93.6 per 100,000 children, which is 14th in the nation [30]. In terms of reproductive healthcare, a 2025 survey found that 24% had never had a well‐woman screening exam [31]. By definition, it should not be surprising that most of our young mothers indicated having an OB/GYN provider, but 19% still do not.

We also looked at patient satisfaction and communication with healthcare providers. Although these scores were moderately high, there is room for improvement in terms of longer visits and respectful communication between providers and young mothers in pediatrics and OB/GYN. For both specialties, the lowest communication scores were for provider time with patients, and the highest scores were for explaining information in an understandable way. Data from a large national sample suggests that patients spend an average of 9.5 min with OB/GYN providers and 8.8 min with providers from other specialties; reproductive health care providers also received higher satisfaction ratings [32]. While extending physician time with patients can be challenging given the managed care environment in the U.S., the American Medical Association has resources available to manage practice workflows and optimize time with patients [33].

Our appointment attendance data suggest that young mothers in South Jersey are committed to their children's health, regardless of the barriers they may face, as nearly all of them have a pediatrician and attend these appointments more often than they do for their own healthcare. Moreover, we did not find any significant sociodemographic predictors of pediatric visits. The young mothers in our sample, regardless of background, are following American Academy of Pediatrics recommendations for regular visits based on developmental age to address critical prevention issues like vaccination and developmental milestones [34]. From a socioecological perspective [13], there are numerous individual, relational, and systemic issues that impact young mothers' health that warrant more in‐depth discussion. Young mothers are embedded within social networks and relationships (e.g., family of origin; current and previous romantic partners) where they also navigate stigma and power dynamics. Many juggle daily conflicting responsibilities across multiple systems (childcare, school, work, social services), limiting the time they have available to access healthcare services. Telehealth, home visits, extended clinic hours, and walk‐in/virtual drop‐in times are all flexible options recommended by the American Academy of Pediatrics [35, 36, 37].

OB/GYN and primary care clinics would particularly benefit from increasing access to care. For example, concerns about cost, insurance coverage, transportation, and issues with provider communication are all barriers to preventive reproductive healthcare for emerging adult women in the U.S [31]. Integrating system‐level specialists such as nurse navigators and social workers and ensuring all staff and providers have evidence‐based training in culturally competent care for the local community are all steps providers can take to increase access to care [38, 39]. Positive evaluations of integrated services with young mothers such as teen‐tot clinics [40] show there may be benefits of receiving care from multidisciplinary teams. Coordinating care across the transition between prenatal/postnatal care using huddles is effective within interdisciplinary settings [41, 42, 43] and may help increase attendance for mothers.

There is still room for improvement when it comes to communication with pediatric care and OB/GYN providers, particularly spending sufficient appointment time and showing respect to young mothers through communication. For example, young mothers are vulnerable to sexual risk behaviors, and disclosure is critical for prevention and treatment‐ but young mothers have to feel comfortable [3]. Minority stress theory [44] makes sense of this since young mothers' identities can be stigmatized by providers, affecting communication by both parties and leaving young mothers feeling unsafe [19, 22]. Our exploratory analyses suggest that young mothers' engagement, satisfaction, and communication with providers in healthcare settings may vary depending on their identities and life circumstances. The associations between social determinants of health and patients' experiences are nuanced and not always in the direction we might expect: for example, members of some minoritized racial and ethnic groups provided higher patient‐provider communication scores for OB/GYN, but lower scores for pediatrics, in comparison with white young mothers. In contrast, young mothers with more education and health insurance reported better communication with providers in both specialties. Sociodemographic factors were also associated with healthcare visits in the past year and patient satisfaction, but this varied by specialty, with young mothers from some minoritized racial and ethnic groups reporting more visits than white young mothers, and lower satisfaction in pediatrics, but not as consistently in OB/GYN. These findings highlight the importance of using an intersectional approach to examining how young mothers' healthcare is impacted by structural racism and social determinants of health. For example, young mothers from minoritized racial and ethnic groups may attend more OB/GYN appointments because they are at greater risk for pregnancy complications [18].

Patient satisfaction may be affected by discrimination from healthcare providers, which contributes to social distance, poor healthcare, and diminishes respect and dignity [45]. From a minority stress theory perspective, young mothers are often left to constantly re‐adjust and adapt to situations because of discriminatory or hostile social environments (e.g., microaggressions like being judged by staff based on gender, race/ethnicity, and being a young mother). There are often power dynamics at play when providers, particularly those with visibly different identities from those of their patients, are discussing sexual behaviors [46]. Structural and systemic racism affect all aspects of healthcare, from transportation, housing, and insurance barriers to interactions with providers and staff. Clinicians working with young mothers must be aware of these dynamics as well as the generational history and trauma associated with medical mistrust [19, 20, 47]. We recommend giving young mothers a safe space to voice their concerns and needs during visits: they are the experts on their own lives, so providers need to practice cultural humility and trauma‐informed care, and listen to these patients' lived experiences—particularly birth experiences, which are more likely to have been traumatic for young women of color [20]. These approaches are rooted in understanding the lived experience of the individual from a bottom‐up perspective and prioritize safety, respect, and dignity, which can likely enhance healthcare engagement [48, 49]. Trauma‐informed care can help providers and staff learn to adopt a curious and nonjudgmental stance to help patients feel heard [50].

Our study has several limitations. First, we used cross‐sectional self‐report data from a specific geographic area, which limits our ability to generalize our results. Second, there may be a self‐selection bias that may be influencing our findings, whereby participants who are most engaged or interested in the topic of healthcare voluntarily participated in the study. Third, we did not collect data on whether the healthcare visits we asked about were sick or well visits—that is, for preventative care or treatment of a specific condition—and we did not evaluate satisfaction or communication in primary care.

For future research, we recommend using qualitative and longitudinal methods to provide a more comprehensive understanding young mothers' healthcare engagement and experiences over time, particularly over the transition from prenatal to postnatal care and pediatrics. Additionally, we recommend conducting intersectional identity‐based analyses to further explore the heterogeneity within this population, which will help us understand unique challenges like stigma and barriers for young mothers and their families to inform prevention and intervention efforts to support healthcare engagement.

Author Contributions

Jonathan Jin: conceptualization (equal), formal analysis (lead), writing – original draft preparation (lead), writing – review and editing (equal). Meredith C. Jones: conceptualization (equal), supervision (equal), writing – review and editing (equal). Nicole A. Vaughn: conceptualization (equal), supervision (equal). D.J. Angelone: conceptualization (equal), supervision (equal), writing – review and editing (equal). Lauren C. Wallace: conceptualization (equal), writing – review and editing (equal). Danika Charles: conceptualization (equal), writing – review and editing (equal). Ebru Yucel: conceptualization (equal), writing – review and editing equal).

Ethics Statement

Ethical approval for the study was obtained from the Institutional Review Board of both the corresponding author's university (Pro2018000312) and Cooper University Hospital (CUH) (Protocol #22‐044). All study procedures involving human participants were conducted in accordance with the ethical standards of the respective Institutional Review Board and the principles of the Declaration of Helsinki.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The corresponding and senior authors (J.J., M.J.) affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

The authors confirm that the deidentified data supporting the findings of this study are available from the senior author, M.J. (jonesme@rowan.edu) upon reasonable request via email.