TEENAGE PREGNANCY PREVENTION

TEENAGE PREGNANCY CARRIES HIGH COSTS in terms of both the social and economic health of mothers and their children. Teenage mothers are less likely to receive prenatal care, and their children are more likely to be born before term, to have low birth weights, and to have developmental delays. Teenage mothers are also less likely to complete their education than moms over twenty years of age.

Teenage pregnancy and birth rates both dropped in the 1990s among all racial and ethnic groups. Increased use of contraceptives and increased abstinence among teens could explain the decrease (Moss*). However, the U.S. still has the highest rate of teenage pregnancy among western industrialized nations, 42.9 births per 1,000 females aged 15-19. In 2002, there were 431,988 births to females under twenty (Child Trends*). Four out of ten girls become pregnant by the age of twenty. Eighty percent of these teenage pregnancies are unintended, and 79 percent of pregnant teens are unmarried. The birth rate remains high in low-income, minority neighborhoods, where the birth rate still remains at 153 and 138 births per 1,000 for black and Hispanic teenage girls respectively (Annie E. Casey Foundation [AECF]*). Sixty percent of all teenage mothers are in poverty at the time of birth (Moss*).

Teenage pregnancy is linked to several risk factors. Being poor, living in a single-parent household, child abuse, and risky behaviors such as drug abuse and early or unprotected sex are all predictors of whether a teenager will become pregnant (Kirby 1997*; Dillard*). The three general strategies to reduce teenage pregnancy all try to increase the factors that protect teens against these risky behaviors. The first is an abstinence-only approach, which has not been shown to be effective (Kirby 2001*; Manlove et al.*). The second is comprehensive health education or sexuality education that includes information on contraception; this may delay sexual initiation and increase contraceptive use (Kirby 2001*). Finally, youth development programs that include sex education along with other activities (such as volunteering, mentoring, and job training) (Manlove et al.*) are associated with delayed first sex and lower teenage pregnancy rates (Kirby 2001*). Overall, there are no simple approaches; a strategy to reduce teenage pregnancy must include sexuality education, strategies for teen pregnancy prevention, and changing teenage behavior in relationships (Kirby 1997*). Programs that seek to affect the teenage pregnancy rate should focus on increasing teens’ assets, such as knowledge about sex and sexuality and communication skills, that allow them to approach sexuality responsibly.

Teenage Pregnancy Prevention Program Planning

	First, survey community resources (number and location of walk-in health clinics, access to contraceptives, after school youth programs, etc.) (AECF*). Determine the history of teenage pregnancy prevention services in the community and who has been involved in the issue. Document gaps in resources and identify potential partners (Brindis and Davis*).
	Carefully define specific short- and long-term program goals. Some common short-term goals include improving adult-youth communication, improving knowledge of where to get birth control, and increasing use of birth control and reproductive health services (Advocates For Youth*). Long-term goals include delaying sexual initiation, decreasing the frequency of sex, lowering the number of sexual partners, and reducing teenage pregnancy and rates of sexually transmitted diseases (Brindis and Davis*; Grossman et al.*). Avoid narrow goals such as changing attitudes or values alone; these strategies are not effective in reducing teenage pregnancy (U.S. General Accounting Office *).
	Involve all stakeholders in designing the program. Often this is a difficult process, especially if community norms preclude teen sexual activity (Grossman et al.*). Although schools and churches are the most difficult actors to include, it is crucial to get a range of ideas that include all cultures in a community (Walker and Kotloff*; Walker, Watson and Jucovy *; AECF*; Grossman et al.*). Recognize that while there will rarely be a consensus, it is possible to agree on a common good, such as lower pregnancy rates (Brindis and Davis*).
	Plan a role for parents. While some programs are specifically aimed at improving parent-child communication, research shows that even improving parent-child “connectedness” is effective in reducing teenage risky sexual behavior (Kirby 2001*).
	Plan from the outset to involve men and boys. Both are often overlooked in teenage pregnancy prevention programs (Sonenstein et al.*).
	Design outreach efforts to recruit teens via radio spots and flyers placed in malls and other places where teens gather. Make sure to find boys through sports teams, the YMCA, etc. (Sonenstein et al.*).

Health/Sexuality Education Programs

	Teen education programs should last for more than two or three sessions (Advocates For Youth*). Effective programs often run for more than 14 hours total, or use small group settings for instruction and discussion. Provide basic, accurate information, and don’t talk down to teenagers (Kirby 1997*).
	Involve parents and work on improving parent-child communication (Manlove et al.*). Talking about sex doesn’t encourage kids to have sex; in fact, teens often rely on their parents to address the issue (AECF*; Grossman et al.*).
	Use specific strategies for teenage boys. For example:
	Train men to teach teenage boys, and choose trainers who will be role models—e.g., athletic team coaches (Sonenstein et al.*). Avoid locating classes based at clinics or other sources of health care because boys rarely visit doctors. Don’t reinforce negative views of males, such as men using girls for sex or failing to pay child support. Focus on preventing STDs rather than pregnancy, because STDs are perceived as a more immediate and tangible threat. Redefine ideas of manhood to include responsibility for sexual behavior (Advocates For Youth*).
	Tailored strategies are needed for teenagers in different age groups. Written materials and behavioral strategies should be geared to specific levels of literacy, physical and emotional development (Brindis and Davis*). All teens should learn behavioral skills such as decision-making, refusing to have sex, and how to bring up contraception in a relationship (Brindis and Davis 1998*; Manlove et al.*).
	For children in elementary and middle school, programs should stress unambiguously that they are too young for sexual activity and that abstinence is the norm (Brindis and Davis*).
	For adolescents in high school, peers are the most important influence of whether to have sex; if they perceive that other teens their age are sexually active, they are more likely to be as well (Dillard*). Although peer education programs are a popular way to address other adolescent issues, peer sexual education programs have not been rigorously evaluated (Brindis and Davis*; Manlove et al.*). Programs should instead address peer influence through teaching behavioral skills and changing perceptions (Manlove et al.*). Virginity pledges are a popular strategy to utilize peer influence to responsible ends; indeed, students taking pledges delayed their first sexual experience by about eighteen months. However, when they finally did have sex they were one third less likely to use contraceptives (Alford*).
	Programs for teen mothers should differ from those for teens without children (Brindis and Davis*; Manlove et al.*; Kirby 2001*).
	Clinics can be a valuable partner in educating teens. Clinics that use one-on-one counseling, provide accurate information about abstinence and contraception, and provide contraception, have been shown to increase contraceptive use without increasing sexual activity (Kirby 2001*). Be sure the clinic can provide or refer to mental health and other health services (Advocates For Youth*). Clinics should provide one-on-one counseling to teens as well (Kirby*).

Maintaining Progress

	Follow up on teenagers who visit clinics for health and contraception services. Continue outreach; a sustained effort is necessary to maintain results, because every year brings a new cohort of adolescents (Kirby 2001*).
	Develop performance measures based on your goals and previously mapped community resources. For example, are community clinics open longer hours? Are teens delaying when they first have sex, and using contraception when they do? (AECF*).