Teen Pregnancy -- Boston, MA

Teen Pregnancy -- Boston, MA

Teenage pregnancy is medically defined as a pregnancy in a woman who has not yet reached her 20th birthday. Legally, it has numerous definitions, depending upon the country and culture of origin. . This definition does not assume marriage, nor if the woman is legally an adult (depending on the country). Certainly over the years, the idea of pregnancy at an early age has undergone significant changes -- there were times when it was necessary for women to begin their childbearing years earlier due to demographics, lifespan, and other psychographical issues. In the modern, developed world, however, teenage pregnancy is associated with not only social issues, but of dramatic political, economic, and medical issues surrounding the mother, child, and family members. Teenage pregnancy in the United States, for instance, usually results in lower educational levels for the mother and child, poverty, and often social stigma in many communities to the level where it becomes a public health issue (Wong, 1999). . In contemporary U.S. culture, however, the amount of information and professional data that is needed to become a well-rounded citizen is so high that we usually gauge 18 as the very minimum age to begin to have the resources and/or acumen to raise a family. Like many other contemporary issues, though, the impact of diet and artificial hormones in the food supply, combined with advertising and entertainment's push towards sexuality, often pressures younger people to experiment with sex far earlier, regardless of the health or psychological consequences (Linking Teen Pregnancy Prevention to Other Critical Social Issues, 2010).

In the United States, if more children were born to parents who are ready and able to care for them, who have the fiscal resources not to tax the system, there would be a significant reduction in a host of social problems that afflict children -- from failure in school to crime and child abuse and neglect. The problem is not new, and despite an approximate 30% decline since the 1990s, the United States remains one of countries with the highest rates of teen pregnancy in the developed world -- over 750,000 annual pregnancies, or 3 in 10 girls become pregnant before age 20 (Singh and Darroch, 2000).

Assessment -- for the purposes of this review, our assessment will focus on the greater metropolitan area of Boston, Massachusetts. Boston is the largest city in Massachusetts, and one of the oldest cities in the United States as well as the largest in New England, considered by some to be the central hub of economics, culture, and politics for the entire New England region. It is the anchor of a large metropolitan area called Greater Boston, with approximately 5 million inhabitants and the 10th largest metropolitan area in the United States, with the city comprising about 90 square miles (Bureau, 2008). Population wise, about 12,000 people live per square mile, and the data shows an increase of approximately 10% between 2000 and 2009. About 20% of the population is under the age of 18 and 16% between 18-24; with an average household size of 2.31 and family size of 3.17; making it in some ways less typical than some other major metropolitan areas. The median income for the area is approximately $40,000 with about 20% of the population falling under the poverty level. One of the issues with Boston is that since the 1950s, the proportion of the city's ethnic make-up changed as many Caucasians left the area, to a new gentrification trend in which Whites now make up a slight majority (Bureau, Census Summary - Boston, MA, 2000).

Economically, Boston is quite varied. There are a number of colleges and universities in the area that contribute significantly to the city (almost $5 billion/annum). Boston is also a center for high technology, biotechnology, and life sciences. Tourism contributes about $8 billion to the economy, and it is also a major seaport. There are a number of printing, publishing, and major corporations headquartered in the area. Boston, in fact, is considered a global city and has the sixth-largest economy in the United States with a robust $400 billion/annum contribution to the total U.S. economy (Boston:Economy, 2009). Boston has the reputation of being the intellectual center of the Eastern Seaboard, the "Athens of America," and has over 100 colleges and universities. In a similar manner, many of Boston's medical facilities are associated with universities and research institutions. This often results in the Boston area being on the cutting edge of research and development in any number of sociological and medical research projects, and one of the nation's primary areas for intervention research in public health (Medical Research in Boston, 2010).

As with any major metropolitan area, the Greater Boston area has a number of complex social and health concerns. Within the area, health problems involve medical, social, and cultural issues. "Premature mortality and morbidity, once mostly an issue of infectious disease rates, now include chronic and preventable noncommunicable diseases, as well as urban problems and public health issues of poverty. Disparities exist in health outcomes for most of these health problems. Here we define disparities as differences among subgroups in health outcomes that have in part putative social justice rationales" (Health and Social Disparities, 2010).

Teen Pregnancy and Sex Education -- the greater Boston area has had a consistently lower teen pregnancy and birth rate than the overall United States over the last few decades, although the abortion rate is higher than the national rate. However positive some of these statistics might seem, Boston and the United States have rates nearly 10-12 times higher than that of the Netherlands, and 5 times higher than France. Most research points to a variety of rather complex explanations for these differences, but typically focus on the level of education and sexual respect given to teens in other countries -- access to information, family planning, and birth control without adult intervention (Teen Pregnancy and Birth Rates, 2010).

Sex and portrayal of sexual activity is extremely prevalent in contemporary society. Sexual activity is not only condoned, but glorified within the overall media paradigm in the United States. In fact, it is impossible for America's children to ignore these media images, explicit though they may be (Lagorio, 2006). Yet one third of school districts in the U.S. teaches abstinence-only-until-marriage, and not only espouses "just waiting," but fails to generate information about contraception and human sexuality. (Rollins, 2002). Many argue that teaching adolescents about safe sex is sending them too many mixed messages. This belief says that the message says sexual activity is fine, as long as protection is used. But what about all the explicit imagery and actions that the media portrays as being normal "cool," and acceptable - is this not also sending a message?

Unfortunately, most media depictions of sexual activity do not provide the information of safely protecting oneself from diseases or pregnancy. In the majority of movies and television it is rare to see one stop to use a condom; or the girl talking about birth control. So, too, after effects are rarely even mentioned; potential for STDs, pregnancy, etc. In fact, in most contemporary television shows and movies, very few of the participants in sexual activity are even married. Television, and movies are showing children and adolescents that it is tacitly permissible to be sexually active without marriage -- yet in school they are being told it is better to abstain from sex until after marriage, causing even more psychological confusion and mistrust (Marcotte, 2008). Who's sending the mixed message now and what should our educational system do to be more proactive about sex education?

Diagnosis and Issues - Educating youth efficiently about sexuality is not only wise, it is vital with the public school system, and it is not too early to begin in elementary school with some basic facts, and enhance those facts in Junior and Senior High. Not talking about the subject will not make it less real, and giving students at least a chance for good information may, in fact, be the wisest course in preventing disease and unwanted pregnancy. Proselytizing abstinence in the contemporary world may seem quite moral, but it is not only unrealistic, it is unhealthy in not preparing teens for safe sex (Hedgepath, 2000).

The abstinence only programs teach teens to engage only in monogamous relationships after marriage. They not only teach that the effects of sexual activity are physically harmful but may also have detrimental psychological effects well beyond adolescence. This view tends to emphasize the failure rates and side effects of many contraceptives. Also rarely mentioned is that individuals are waiting longer to marry, sometimes into their late 20s -- it is hard to be realistic about teaching a 14-year-old that they are not to engage in sexual activity for 15 more years ("Abstinence," 2002).

In fact, to many researchers in the Human Sexuality field, this form of "education" is deceitful. For instance, according to the Centers for Disease Control, less than 50% of American schools provide students with the information about condoms and how to use them (Lite, 2002). According to Tamara Kreinin, president of the Sexuality Information and Education Council of the U.S., "Manipulating facts about condoms is using a scare tactic to try and get kids not to be sexually active" (Morse, 2002).

One of the consequences of a lack of full and complete information to youth actually causes self-imposed ignorance of their own safety. If adolescents do not get the proper education on protecting themselves from STDs, it is unlikely they will get much beyond playground rumor. In several reviews conducted by the U.S. Surgeon General and by the Committee of HIV Prevention, abstinence only programs have little to no effect on the sexual behavior of adolescents ("Abstinence"). Further, denying young people full and accurate information about sex, contraception, and prevention of sexually transmitted diseases puts them at needless health risks. The reality is that teens will talk about sex, will experiment, and will likely have a sexual experience prior to age 15 -- in light of that reality, is it not better to promote abstinence but teach facts? The more sexual behavior and information are hidden from teens, in fact, results in a greater likelihood of them engaging in behavior without enough information to be responsible. Abstinence only programs, without information on STDs, HIV, and sexual activity are simply headed in the wrong direction for the reality of contemporary adolescent culture (Basso, 2003).

In addition, most scholars agree that by informing youth about the dangers of unprotected sexual activity will result in fewer teenage pregnancies and sexually transmitted diseases (Braithwaite, 2008). and, these same scholars point out that the programs of the past have not worked. Unfortunately, for example, America has one of the highest teenage pregnancy rates among all industrialized nations (Philliber, 2002). Similarly, countries with more open attitudes about human sexuality, and more factual and informative programs within their public schools have fewer teen pregnancies, fewer incidents of STDs, and a lower incidence of HIV among non-drug using teens (Valk, 2000).

Planning and Nursing Actions - Such programs are encouraging teens to ask for help and make the right decision with all the information provided. Holland for instance has the lowest teen pregnancy rate in Europe (only 8.4/1,000). Concepts as frank as condom use, sexual experimentation, and explicit answers about sexual activity are seen as the reason for this success in family planning. Sexuality is taught as part of biology, and since 1993, textbooks have been rewritten to reflect more modern views. The school system sees its role as "helping to make good decisions," but the Dutch healthcare system, non-judgmental and completely private, is also a part of the mix. Finally, scholars who have studied the Dutch model say, "parents in the Netherlands take a very pragmatic approach. They know their children are going to have sex, and they are ready to prepare them and to speak with them about their responsibility. This is the key word" (Ibid). In the 21st century, though, it is not enough to just talk about condom usage -- there are numerous STDs and the threat of HIV that may have lifelong effects, and clearly it is up to the Public School system to inform and develop program standards to reflect the reality of life, rather than the morals of individual teachers (Kapp, 1980).

The nursing profession is in a unique position to mitigate some of the stringent issues surrounding the prevention of teen pregnancy, reduction of disease, and general health considerations. Within the national environment, there are programs available to help teens through these trials that nurses can actively participate in. For instance, the campaign Fight for Your Rights: Protect Yourself, which informs and empowers youth on the issues surrounding their sexual health (Rollins). According to the Global HIV Prevention Working Group 45 million more people will become infected with HIV by 2010 (Lite). Thus, HIV is a pandemic and part of medical culture for younger people, and, like any other disease, must be part of the curriculum at an understandable and appropriate level for each age group (Weinstein, 2005).