Thirdly, there are many differences in maternity care systems worldwide. In some countries maternity care systems are based on insurance
and the availability of these services depends on the economic circumstances of the mother, which are likely to be worse in teenage mothers than in adults. In some countries maternity care is provided free of charge and special attention is focused on mothers considered to be at greater psychosocial risk. Poor attendance by teenagers has been reported at some perinatal clinics.
Finally, the effects of chance as a (partial) source of controversy about outcomes of teenage pregnancies cannot be ruled out.