Feature

Eating badly for two

The UK has one of the highest teenage pregnancy rates in Europe – but many pregnant teenagers have a diet that is unhealthy for them and their babies.
Helen Burchett and Annie Seeley explain why nutrition for pregnant teenagers should be a public health priority

Most pregnant teenagers are not eating an adequate diet – and for many it is because they cannot afford the healthy diet needed for themselves and their growing babies.

The Maternity Alliance and the Food Commission interviewed 46 pregnant young women under 18 about their diet and how various factors affected their food choices. The interviews reveal pregnant teenagers, particularly those living away from their parents, face huge obstacles to eating an adequate diet.

In the 24-hour period examined, commonly consumed foods included milk, breakfast cereals (usually sweetened), squashes/fizzy drinks, white bread and crisps/bagged snacks. Hardly any of the teenagers ate enough fruit and vegetables. A nutritional analysis of a sample of participants showed their diets did not meet their energy requirements, despite frequent consumption of high sugar/fat foods.

Most ate too much fat (particularly saturated fat), too much sugar and not enough fibre. Insufficient intake of vitamin A, magnesium, zinc and vitamin C were common. The 24-hour food diary of one 15 year old living at home contained 11 portions of high fat/salt/sugar foods – such as biscuits and cereal – no fruit and one portion of vegetables.

Almost all those interviewed had made changes to their diet since becoming pregnant, and over half were healthy improvements. Changes were due to changes in taste, such as cravings or nausea, or because they wanted to eat more healthily because of their pregnancy. ‘I’m making an effort to eat them [fruit and vegetables] because I want my baby to be healthy,’ said one interviewee.

Most were aware of the basic components of a healthy diet. Taste preferences were the most common reason given for not eating the foods they thought they should. Everyone remembered receiving some form of dietary advice, most commonly from midwives. But negative advice (which foods to reduce or avoid) was remembered better than positive advice (which foods to increase). The majority said they tried to follow the advice given but, of those who did not, or did so intermittently, almost all said this was because it was too expensive. ‘I love veg and all that, I just can’t afford it,’ was one comment.

Family circumstances had a considerable impact on the food the young women ate. Family often had a positive impact on their diet, encouraging them to eat healthily or providing meals for those not living at home. But for some, dependence on the family meant eating the same food as the rest of the family – which was often less healthy than they would have liked.

Two-thirds of the pregnant teenagers living away from home had a food budget of less than £20.25 a week – the estimated cost of a ‘modest but adequate’ diet. The same number said their diet worsened as their money ran out. One pregnant 16-year-old said: ‘I normally fill myself up on bread, crisps or chocolate because it’s cheap.’

While financial constraints had a negative impact on the diets of many teenagers living with parents or boyfriend’s parents, these problems were particularly common among those living away from family.

State benefit for teenagers is less than for 25 year olds: 16-17 year olds who are living away from family may be entitled to £43.25 a week, £11.40 less than a 25 year old. Those who cannot prove they are ‘estranged’ from their parents receive even less, £32.90 a week.

With £6 or less a day to live on, it is not surprising that, typically, they could afford less than £3 for food. To eat healthily on less than £3 is both difficult and time-consuming, but cheaper, less healthy ways to fill up can be managed by buying calorie-dense, often processed foods such as chips or biscuits.

Many of the young women living away from family survived by continuing to depend heavily on their own or their partner’s parents. This put additional stresses on family relationships at a time when they were already likely to be under strain.

Given that the UK has the highest rate of teenage pregnancy in Western Europe,¹ and that babies born to teenagers are more likely to suffer ill health than those born to older women,² the issue of nutrition for pregnant teenagers should be a major public health priority.

Nutrition during pregnancy is important for the health of both mother and child, and this is particularly true for teenagers, whose own bodies are still developing. Inadequate nutrition during pregnancy will affect the mother’s long-term health as the growing fetus draws on her nutrient reserves, and it will affect the fetus which, deprived of an adequate range of nutrients, will be at risk of stunted growth and possibly later heart disease and diabetes.

Improving the diet of any group is not a simple or easy task and pregnant teenagers are no exception. The first step in helping these young women eat a healthy diet is to provide them with the means to shop for and cook the food they need, by ensuring they have sufficient money and adequate cooking facilities.

There are examples of projects working with pregnant teenagers that incorporate food-related activities, and these should be encouraged. But more evidence is required into what is effective in improving diets. For example, several studies have found that while nutrition interventions can improve knowledge, this does not necessarily translate into behavioural change.

Working to improve the diets of pregnant teenagers will provide a sound foundation for the health of the next generation. The recommendations here offer a starting point in the process of helping pregnant teenagers to eat well.

This article is based on the report Good Enough to Eat: The Diet of Pregnant Teenagers published by The Maternity Alliance and The Food Commission. The report can be downloaded free of charge from www.maternityalliance.org.uk or www.foodcomm.org.uk

More information from Helen Burchett: hburchett@maternityalliance.org.uk or 020 7490 7639 ext 132.