Our data have depicted a cohort of pregnant girls and young women in BC, Canada, who were recruited to a trial based on selected indicators of socioeconomic disadvantage (young age, low income, limited education and/or single parenting). Yet the data indicated that all participants selected using these socioeconomic and demographic indicators were also experiencing substantial additional health and social adversities. These added adversities included: housing instability, mental and physical health problems including prenatal substance use, maltreatment during childhood, and IPV exposure recently. As well, despite BC’s existing social services, less than a third had received recent income assistance entitlements. Perhaps most telling, almost all were experiencing two or more indicators of adversity while more than two thirds were experiencing four or more — suggesting considerable cumulative disadvantage.

How does this cohort compare to other British Columbians and Canadians? Beyond the eligibility criteria, while directly comparable data were not available for all variables, our cohort nevertheless reported much higher rates of associated health and social adversities including: homelessness and unstable housing, mental health problems including prenatal substance use, and serious physical health problems [43–50]. Rates of child maltreatment and IPV exposure were also twice those found for other Canadians [51, 52]. These comparisons confirm that we recruited a cohort who was experiencing marked disadvantage, the population NFP is most intended to benefit. See Table 7.

What have our data added? We have shown for the first time that high levels of disadvantage exist for some young Canadians — despite this country’s high-income status and its longstanding commitment to equity in access to universal healthcare and related social services [54]. As well, despite provincial/territorial variations in the delivery of health and social programs [53], our data nevertheless have national implications. In Canada, approximately 8000 children are born to adolescent mothers each year [43], while approximately 42,000 are born to young mothers (aged 20–24 years), with many of the latter experiencing low income (13%) and/or single parenthood (7%) [43, 46]. Reaching these populations and addressing avoidable adversities during early pregnancy — thereby also increasing children’s life chances — is a societal imperative [16, 18, 20]. Our data also suggest that public policy remedies must extend beyond public health and healthcare — encompassing social services, such as ensuring adequate housing and incomes, and preventing child maltreatment and IPV as early as possible in the lifespan. We believe that our study therefore provides new data underscoring an urgent call to action across public sectors not only in BC, but also in Canada.

Our data also have implications for children’s rights. We found less than a third of participants had recently received social service entitlements such as income assistance, while approximately half reported recent unstable housing and lifetime homelessness as well as exposure to child maltreatment and IPV. Addressing these serious avoidable adversities is a priority, especially for pregnant youth [1, 4, 7, 11, 54]. According to international child rights’ conventions, BC and other provinces/territories also have obligations to ensure that the basic needs of all minors are met, including protecting young people from harm and ensuring adequate housing, income and parental/caregiver supports [55, 56]. Our data suggest that these fundamental obligations may not be being fulfilled in BC.

Regarding age differences, we found that in this cohort, young women were facing adversities that were comparable to girls. The statistically significant differences that we did observe between the two groups may be explained by developmental stage (differences in cognitive functioning), eligibility criteria (being single was only a criteria for young women), or developmental context (lower reported income and education may be expected for the pregnant girls who may still be in school and less likely to be employed). The higher proportion of girls accessing primary healthcare and prenatal classes may be a result of better provision of services for these pregnant adolescents compared with young women, although further data are needed. Yet overall, our data suggest that the well-established risks facing children born to adolescents may also extend to children of young women who are experiencing socioeconomic disadvantage in BC.

The BCHCP RCT is embedded within BC’s health system, with NFP being delivered as an enhanced public health service — an example of delivering services proportionate to need [18]. Participants will be followed throughout pregnancy and until their children reach age 2 years (the duration of the NFP program). Additional outcome findings will be available in 2020–2022. The embedded nature of this RCT ensures that findings are shared quickly and efficiently with policy and practice partners to inform ongoing strategies to better reach populations in need.

There are nevertheless limitations to the data reported here. This cohort was not a representative sample nor did it represent all the potentially eligible girls and young women, in that many (two thirds) were not reached through BCHCP recruitment efforts. Further collaborative research-practice-policy efforts are needed to better identify and provide services and supports for this “need-to-reach” population. We also acknowledge that the data on education levels does not account for those girls who were still attending high-school (n = 182 or 25% of the total cohort). However, all girls were pregnant and preparing to parent at a young age such that their education and employment opportunities were interrupted, placing them and their children at risk for disadvantage.