The Neuroscience of Social Exclusion: Developmental and Public Health Implications Across the Life-Course

Puerto Rico is a United States’ territory with an estimated population of 3.2 million. In Puerto Rico, 38.9% of all live births occur to young mothers (10–24 years), and 7.8% of live births were to mothers of 15–19 years of age, as reported for 2020.^[1] Teen mothers, teen fathers, and their families are impacted by social exclusion mechanisms that involve socioeconomic position, life-course protective factors, and nurturing family environment conditions.^[2] Proyecto Nacer, in Puerto Rico, is a non-profit organization that developed and implements a service model based on the complex systems theory, which is a social inclusion model aligned and uses a family-centered approach, known as the Family Incubator Model, as illustrated in Figure 1, where the social inclusion model was adapted to demonstrate the ecological interactions upon the organization’s wrap-around services.^[3]

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Figure 1:

Adaptation of the social inclusion model: Proyecto Nacer’s interventions and outcomes.

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The Family Incubator Model was developed in the year 2000 and has been used to serve thousands of teen parents’ families using a three-generation approach.^[2] In June 2024, Proyecto Nacer’s teen parents had the following sociodemographic profile: 90% were single mothers, 10% single fathers, with an average age of 17.4 years, 74% reported having extremely low annual household income ($9,999 or less), and where 68% of their parents had a high school diploma as their highest academic achievement; 72% had one child, 14% were pregnant, and 74% of these teen parents reported to have dropped out of school because of an unplanned pregnancy, with 45% doing so in 9th grade or before. It is essential to observe this sociodemographic profile since poverty, teen parenting, school dropouts, and other conditions are socially sanctioned through stigma and marginalization and are an intrinsic source of social stress in teen mothers, children born to adolescents, and their families. Adolescent parents’ families, such as the ones served by Proyecto Nacer’s comprehensive model of service, reflect disparities in social determinants of health, which in turn act as social exclusion mechanisms.

In postindustrial Puerto Rico, general social expectations for teenagers are to complete a professional or academic degree, obtain a job, establish a formal relationship with a partner, and then have children. Thus, when teenagers become parents, multiple social stressors arise which act in addition to previous exclusion precursors fueled by stigma, inadequacy perception, and a deficit-based perception of positive parenting, goal achievements, and expected contribution to social capital. Due to age and legal capacity, teen parents in Puerto Rico are not legally able to undergo contracting for housing, have a full-time job, or register their child in the Demographic Registry without their parent’s signature, which subjugates them to their parents’ will. Thus, teen parents are perceived as lacking and unable to make good decisions, as well as unable to provide for and protect their children, while their parents are socially perceived as deficient since their children became pregnant due to their inability to guard them, and their children born to teenagers are immediately identified as at risk of maltreatment or worthy of pity, in general.

On the one hand, social exclusion mechanisms and pathways are recognized in the social inclusion model as a systemic and socioecological issue.^[4] On the other hand, neuroscience meta-analysis research has demonstrated that social exclusion activates brain regions related to social pain processing, such as the dorsal and ventral anterior cingulate cortex. Social pain is a distressing emotional response associated with a perceived or actual sense of social connectedness or value due to social exclusion, rejection, or fear of being negatively perceived.^[1,5] We argue that public policies, regulations, social stigma, socioeconomic barriers, and intrinsic factors related to mental, emotional, and underdeveloped skills, to name a few, promote exclusion mechanisms that entail measurable social pain, stress, and trauma with potentially negative results in neurocognitive outcomes for teen parents’ families living in Puerto Rico. If harsh societal conditions persist in teen mothers when they are pregnant, they can generate negative health outcomes throughout the life course, including heart disease, diabetes, and asthma for their children.^[6] Furthermore, the results of social pain through social exclusion hurt society, as potential resources and positive interpersonal interactions are lost or removed to rehabilitate negative societal and health outcomes in the future.