The below is written by Shelagh Larson, DNP, WHNP-BC, NCMP. Dr. Larson is Secretary of the NPWH Board of Directors.
The month of May might be the time of flowers, butterflies and Mother’s Day. It is also the month we recognize Teen Pregnancy. Teen pregnancy is a healthcare issue that all providers, parents, teachers, politicians and religious leaders need to come together for.
Rates of adolescent pregnancy, birth and abortion in the United States continued to decline and reached historic lows. The teen pregnancy rate is the summation of all live births, abortions, and miscarriages per 1,000 adolescent females in a given year.
- The rate declined 7% from 2016 to 2017, to 18.8 births per 1,000 females aged 15–19.
- Birth rates fell 10% for women aged 15–17 years and 6% for women aged 18–19 years.
- The largest decline in the teen birth rate from 2016 to 2017 was for non-Hispanic Asian females, down 15% to 3.3 births per 1,000.
Although reasons for the declines are not totally clearly understood, evidence suggests these declines are due to teens abstaining from sexual activity, and those that are sexually active, are using more birth control, especially long acting reversible contraceptive (LARCs), than in previous years. Kathryn Kost, lead author of the Guttmacher Institute says, “The available evidence suggests that improved contraceptive use continues to be the primary driver of these declines.” Before you throw a party, let’s see the other side to the story.
Still, the teen birth rate in the U.S. remains significantly higher than in other developed countries, according to the CDC. The U.S. teen pregnancy rate is substantially higher than in other western industrialized nations, and racial/ethnic and geographic disparities in teen birth rates persist.
- About 77 percent of teen pregnancies are unintended, undesired, or occurred “too soon”.
- Not all teen births are first births, either. In 2017, one in six (16.3 percent) births to 15- to 19-year-olds were to females who already had one or more births.
- Moreover, teen childbearing costs U.S. taxpayers between $9.4 and $28 billion a year through public assistance payments, lost tax revenue, and greater expenditures for public health care, foster care, and criminal justice services.
- On a positive note, between 1991 and 2015, the teen birth rate dropped 64%, which resulted in $4.4 billion in public savings in 2015 alone.
The Social Cycle
Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school. While adolescents that are enrolled in school and engaged in learning (including participating in after-school curriculum/programs, having positive attitudes toward school, and performing well educationally) are less likely than are other adolescents to have or to father a baby. The adolescents with mothers who gave birth as teens and/or whose mothers have only a high school degree are more likely to have a baby before age 20 than are teens whose mothers were older at their birth or who attended at least some college. Having lived with both biological parents at age 14 is associated with a lower risk of a teen birth. At the community level, adolescents who live in wealthier neighborhoods with strong levels of employment are less likely to have or to father a baby than are adolescents in neighborhoods in which income and employment opportunities are more limited. Teenage girls who are pregnant — especially if they don’t have support from their parents — are at risk of not getting adequate prenatal care.
The stigma of out-of-wedlock pregnancy may have diminished; however, the risks of serious health consequences remain for babies born to teen mothers. The infants are more likely to have born preterm, lower birth weights, and to suffer the associated health problems. Children born to adolescents realize particular challenges— more likely to have inferior educational, behavioral, and health outcomes throughout their lives, compared with children born to older parents. These children are also more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult. This is a perpetuating cycle.
The Providers Role
As a health care provider, you play a critical role in further reducing teen pregnancy rates through the care you provide to your adolescent patients.
- Ask both male and female adolescent patients about their past and current sexual and reproductive history.
- Provide confidential, respectful, and culturally appropriate services that meet the needs of teen clients.
- Discuss not only pregnancy as a risk, but also acquiring STDs.
- Support those who are not sexually active to continue to wait.
- Present sexually active teens the importance of always using dual methods—such as an IUD or hormonal method, and a condom—to prevent pregnancy, and STDs including human immunodeficiency virus (HIV).
- Discuss the full range of contraceptive methods after birth, especially LARCs. Research indicates that effective contraception helps prevent poor birth spacing, thereby reducing the risk of low-weight and/or premature birth. Most states’ Medicaid program cover the cost of contraceptives, especially the LARCs.
Abstinence-only programs are a classic case of “information manipulation”—an attempt to misuse information to influence individual choice. This is why leading medical organizations have taken strong stances against abstinence-only programs. These programs often promote harmful gender stereotypes, and they marginalize and systematically ignore the needs of marginalized groups, including LGBTQ young people. Ultimately, young people have a need and right to complete and accurate information to support their healthy sexual development as adolescents, and throughout their lives.
We Can Make a Difference
We are making a difference in teen pregnancy rates, but our job is not over. Having the power to decide if, when, and under what circumstances to get pregnant and have a child increases young people’s opportunities to be healthy, to complete their education, and to pursue the future they want. But they can’t make that decision if they lack information and access to contraception. It is our calling to make that difference.