Teen pregnancy rates and prevention effectiveness in the United States

Teen Pregnancy

YOUNG LIVES at STAKE

Teenage Pregnancy

The United States has the highest rate of teen pregnancy in the developed world with 750,000 every year and the accompanying negative social and economic impact on the teenagers, their children, their families, the community and the nation. Measures have been instituted, such as the 10 best practices, three-policy strategies and sex education programs. Most private and public schools teach abstinence as primary solution to the problem at 87%. The policy has proved ineffective, especially among older teenagers. Field practitioners make their recommendations for more effective prevention, which comprise the features of a recommended initiative.

Introduction

This study seeks out the magnitude and impact of teenage pregnancy in a multicultural society like the United States. Statistics say that teen pregnancy rates went down from 1990-2005 but went up again from 2006 at 3%. How can current programs address the problem more adequately?

Literature Review

Incidence and Prevalence

Teen pregnancy rates in the developed world remain highest in the United States (Guttmacher Institute, 2011). These are more than twice higher than in Canada at 27.9 per 1,000 women aged 15-19 and 31.4 in Sweden as of 2006. Approximately 750,000 teen pregnancies occur every year, and 82% are unintended. Of this number, 59% end in birth and the rest, in abortion. Abortion rate in 2006 was 19.3 per 1,000 women or 56% lower than in 1988 and 1% higher than in 2005. The 86% decline in teen pregnancy decline between 1995 and 2002 was attributed to the significant increase and improvement in the use of contraceptive methods. A decrease in sexual activity accounts for only 14% of the decline. American teens are likelier than teens in Canada, England, France and Sweden to have shorter and less consistent sexual relationships. They are also less likely to use artificial contraceptives, like the pill, or dual methods. About 46% of many sexually experienced male teens and 33% of female teens did not receive formal instruction about contraception before their first sexual experience (Guttmacher).

The majority of public and private high schools at 87% taught abstinence as the most effective method of preventing pregnancy, HIV and STD in a required health education course, according to 2006 reports (Guttmacher, 2011). That required health education course taught about condom efficacy at 65% and its correct use at 39%. It also taught about the risks of pregnancy at 76% and the risks with having multiple sex partners at 81% (Guttmacher).

Social and Economic Impact and Costs

Teenage pregnancy costs more than $9 billion per year of taxpayers' money (CDC, 2011; Hermes, 2011). These costs cover increased health care and foster care, increased incarceration rates, and lost tax revenue for lower educational attainment and income for teen mothers. Both pregnancy and birth significantly contribute to high school dropout rates among girls who receive a high school diploma at age 22 at 50%. This compares with almost 90% of those who graduate from high school without getting pregnant at that age. Their children are also likelier to become low achievers in school, drop out of high school, develop more health problems than other children, get imprisoned in their teen years, get pregnant as teenagers, or encounter difficulties in getting employment. These disadvantages remain even when the risks are adjusted for. These risks include poverty, low levels of education, single-family structure, and low school performance (CDC, Hermes).

Factors

The highest rates of teen pregnancy and children are found among non-Hispanic black youth, Hispanic or Latino youth, American Indian or Alaska Native youth and other socio-economically disadvantaged youth of any race or ethnicity (CDC, 2011). Black and Hispanic female 15-19 years old comprise only 35% of the total population yet account for almost 60% of all teen births in 2009. Greater public health efforts are aimed at these populations in addressing overall U.S. teen birth rates. Other sectors, which invite attention, are youth in foster care and juvenile justice system and those living in risk conditions. Teenage pregnancy is one of the six top priorities of CDC, which sees a "winnable battle" against it. Its prevention programs address specific protective factors. These are knowledge of sexual issues, HIV, other STDs and pregnancy' perception of HIV risk; personal values about sex and abstinence; perception of, and attitude towards, condom use; perception of peer norms and behavior towards sex; capacity to refuse sex and use condom; resolve to refrain from sex or limit the number of sexual partners; communication with parents and other adults about sex, condoms, and contraception; avoidance of places and situations leading to sex; and intent to use condoms (CDC).

Community-Based Doulas for Disadvantaged Pregnant Teens

A recent descriptive study conducted with 24 pregnant and disadvantaged teens revealed that the adjunctive role of community-based doulas provides vital and primary support during their difficult time (Breedlove, 2005). Doulas are women in the community who provide support and positive presence during labor, childbirth and immediately after childbirth. They also provide maternal and psychosocial support to the teen mothers. Surveyed teens said they received enhanced knowledge about childbearing, support during childbirth, self-care, and early attachment to their newborn. They also reported that the doulas were a positive addition to their supportive networks. Doulas who extend comprehensive relationship-based caring are a valuable supplement to perinatal programs in the community. Overall, the study found that pregnant teenagers perceived doulas as increasing their ability to cope with the stresses of pregnancy. They also viewed doulas as friends who support them through pregnancy, labor and childbirth, early parenting and provided them with increased knowledge about motherhood in their unique social condition (Breedlove).

Prevention Programs: 10 Best Practices

The Office of Adolescent Health began implementing a $75-million grant program for teenage prevention program in support of proven effective models (HHS, 2010). There are 72 grantees in 32 States, in addition to Washington DC, which receive grants for up to five years. The OAH oversees the implementation and evaluation of the grants (HHS). Evaluation studies of earlier programs show that many are not effective or not too well evaluated (Johns, 2000). Research identifies the 10 best practices for the programs, three of which are a youth development component, family involvement, and culturally relevant practices. Emphasis is placed on the role of cooperative extension in improving outcomes for teen parents and their children, especially those living in urban communities. These best practices are particularly useful in the communities in San Francisco, San Mateo and Santa Clara Counties where teen pregnancy rates are highest, especially among Hispanic adolescents. It is, thus, important to address the unique characteristics and needs of this minority group. The identified best practices have been incorporated into the programs in partnership with six local sites. At the same time, technical assistance in adopting and implementing these best practices and in program evaluation has been extended (Johns).

Sex Education Programs -- These include group discussion and emphasize the importance of peer influence (Orecchia, 2009). Research has shown that psycho-educational groups are especially effective in reducing risk behavior among teenage females. Statistics show that young Latina, Native American and African-American girls have higher teen birth rates than whites. First sexual experiences also occur to black females earlier than their white counterparts. The younger they become sexually active, the less likely they use protective means. Practitioners recommend community-based and culturally specific adolescent pregnancy prevention programs for African-American girls younger than 11 or 12. On the other hand, Latina youth need help from staff members who understand Latino culture and speak Spanish. These staff members must emphasize the importance of education to future financial stability among these young girls. Staff members must also be responsive to generational differences and gender roles among Latino families. Intervention with young Native American girls involves trusted family, school and community leaders and greater access to contraceptives (Orecchia).

Practitioners' Perceptions

Qualitative interviews with 58 teenage pregnancy prevention practitioners elicited insights into the realities in implementing culturally sensitive programs (Russell et al., 2004). They work primarily with Mexican-American female teenagers in two regions in California. They consider the knowledge and awareness of Hispanic culture and commitment to the teenagers and their needs essential. They also regard educational and career achievement activities as critical program components. The involvement of the girls' partners and family members are equally important while challenging. At the same time, they observe that implicit program goals of continued education and female self-sufficiency as clashing with traditional Hispanic cultural values. On the whole, respondent-practitioners see the need to balance prevention programs' competing values and goals with those Hispanic culture and experiences (Russell et al.).

Focus on Older Female Teens

Eight out of 10 teen pregnancies and births belong to older teens or those aged 18-19 (Suellentrop, 2010). Pregnancy rates are thrice higher in them than for younger teens. Reported declines were smaller and recent increases are larger in their category. Most of these pregnancies are unplanned and belong to unmarried women. Almost 250,000 births to unmarried older teen women or 83% of all births among 18-19-year-olds were recorded in 2008 alone. Social and economic risks to this age group appear more significant than in those aged 20-21. Children of teen mothers in the 18-19 age group are more likely to be placed in foster care or subjected to abuse or neglect in their first five years. They are also more likely to develop problem conditions in cognition and knowledge, language and communications, social skill and emotional well-being, and physical and motor development. Research furthermore shows that sons of teen mothers in this older teen bracket are more likely to be arrested, imprisoned and stay imprisoned longer than sons of mothers aged 20-21 (Suellentrop).

Teen mothers in this older age bracket are less likely to finish high school and get a diploma than those in the 20-21 age bracket (Suellentrop, 2010). They are also less likely to finish post-secondary education when compared with others who delay childbearing for a few more years. Summarily, children of teen mothers appear to do better if their mothers are slightly older. The chances also appear even better if the pregnancy is wanted and welcomed (Suellentrop).

Findings and Conclusion

The U.S. has the highest teen pregnancy rates in the developed world with approximately 750,000 pregnancies every year, 82% of which are un-intended. A significant decline was recorded from 1995-2002 at 86% due to a correspondingly significant increase in the use of contraceptives. The dominant policy in 87% of public and private schools concerning teen pregnancy is abstinence, which has been noted to be ineffective. Teen pregnancy costs more than $9 billion of taxpayers' money in addition to a range of social and economic burdens on the women, their families, communities and the public. Teen pregnancy rates are highest among non-Hispanic black, Hispanic or Latino, American Indian or Alaska Native and other socially and economically disadvantaged women. According to 2009 figures, 60% of them are 15-19 years old, the majority being in the older 18-19 age group.

A $75 million grant has been made available to prevention programs of 33 States. Ten best practices have been identified. Sex education programs have been conducted. Practitioners have expressed their perceptions and experiences with female teenagers, their characteristics and unique needs. Increased teen pregnancy rates after 2006 indicate that these programs have not been adequate.

Recommendations

A responsive and effective teen pregnancy prevention initiative for professional practice should incorporate the recommendations of practitioners. Culturally specific programs for African-American girls younger than 11 or 12; field workers who are familiar with the Latino culture and can speak Spanish for Latina young women; and trusted family, school and community leaders for young Native American women and greater access to contraceptives for the women should form part of the initiative. Commitment to the young women; their needs; their educational and career achievement activities, the involvement of their partners and their families; and implicit goals of continued education and personal self-sufficiency are also recommended.

The focus should be on older teens in the 18-19 age group, where pregnancy rates are three times higher than younger teens at 250,000 yearly or 83%, according to 2008 figures alone.

Then current policies and strategies may be added, especially those, which have shown positive outcomes. The three-policy strategies -- comprehensive sexuality education, access to contraceptives and reproductive health care, and youth development -- will make valuable contribution. The 10 best practices may be introduced as well, particularly youth development, family involvement, culturally relevant practices, and cooperative extension. The assistance of community-based doulas in the young women's own communities will prove advantageous. And where abstinence may be practiced, it should also be recommended. A comprehensive initiative with all these recommended features should be implemented by all the 33 States under the $75 million grant and then evaluated after a year. A re-adjustment of the features should follow. #