1. Teen Pregnancy and Teen Families: Role of Nurses
The impact of a teen pregnancy affects the lives of the mother, baby, father, families and communities. Pregnant and parenting teens have needs that are unique to the developmental stages of adolescence, in addition to the needs common to all pregnant women, mothers, and fathers. The teenage mother is faced with many health care issues and challenges, like Low socioeconomic status, decreased education level with limited opportunities to finish high school, resulting poor job and career availability.
By Nataliya Haliyash,
MD,PhD,MSN
Ternopil State Medical University
Institute of Nursing

2. Lecture objectives Upon completing the lecture students will be able:
to understand the impact of teen childbearing on the families and communities;
to be able to recognize the special needs of pregnant and parenting teens in order to improve their health and life outcomes and those of their children;
to be able to provide services for teens that are already pregnant and/or have become parents.

3. The impact of teen childbearing
The teenage pregnancy rate declined :
in 1991 – 117 per 1,000
in 2004 – 72 per 1,000.
Similarly, the birth rate decreased by 30.5 percent :
in 1991 – 61.8 births per 1,000 females ages 15-19
in 2005 – 40.4 births per 1,000, the lowest rate in six decades.
However, preliminary data from the Centers for Disease Control and Prevention (CDC) on births in 2006 indicate that the overall birth rate for teenage girls rose 3 percent:
in 2006 – 41.9 births per 1,000 females ages
in 2009 – 39.1 births per 1,000 females ages
Teenage pregnancy and birth rates in the U.S. have seen significant declines since their most recent peak in 19911, but this trend reversed in 2006.
the first increase in the teenage birth rate since 1991, suggesting that effective efforts to reduce the occurrence of teen pregnancy continue to be needed.

4. The impact of teen childbearing
U.S. leads in number of teen pregnancies when compared Canada and Great Britain (Porter & Holness, 2011).
In 2004, the cost to federal, state and local taxpayers related to teenage childbirth was approximately $9.1billion dollars. (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2010).
A repeat pregnancy is noted to occur 500 times more often with a teen mother. (Porter & Holness, 2011).
Teenage childbearing carries large public costs, due to the medical and social complications that often accompany teenage parenthood. Recent research shows that teen childbearing costs local, state, and federal taxpayers over 9 billion dollars annually. This estimate includes various public sector costs such as healthcare, child welfare, incarceration, and lost revenue because children of teen mothers pay lower taxes over their adult lifetimes. In 2004, taxpayers saved an estimated 6.7 billion dollars from the decline in the U.S. teen birth rate, discussed above. Although many pregnancy prevention programs have not conducted formal cost-benefits analyses, these estimates are suggestive of the potential to generate tangible cost-savings through comprehensive, effective teenage pregnancy prevention programs.

5. The prevalence of adolescent pregnancy in the world
About 16 million adolescent girls aged give birth each year, roughly 11% of all births worldwide:
Almost 95% of these births occur in developing countries.
They range from about 2% in China to 18% in Latin America and the Caribbean.
Adolescent birth rates in the less developed countries are more than twice as high compared to rates in more developed countries and these range from less than 1% per year in places like Japan and the Republic of Korea, to over 20% per year in the Democratic Republic of Congo, Liberia and Niger.

6. Childbearing to mothers under 15, is a problem in certain countries
An analysis of survey data from 51 developing countries from the mid-1990s to the early 2000s showed that almost 10% of girls were mothers by age 16, with the highest rates in sub-Saharan Africa and South-Central and South-Eastern Asia.
Because the health risks of early childbearing appear to be magnified for the youngest mothers, these very early births are a major concern.

7. However, while there is a definite need for effective efforts that focus on preventing teen pregnancy in order to halt the recent increase in the teen birth rate, we can not ignore the fact that teens are still becoming parents and that these teen parents need supportive programs and services in order to reduce the risks for teen parents and their children.

8. The needs of pregnant and parenting teens
Research shows that teenage pregnancy is associated with:
medical-related risks for the teen mother and infant
and developmental risks for the growing infant.

9. In what context do adolescents become pregnant?
In developing countries, about 90% of births to adolescents occur within marriage.
The proportion is close to 100% in
Western Asia/Northern Africa,
Central Asia,
and South-Central and South-Eastern Asia,
while between 70-80% in South America and in sub-Saharan Africa

10. In what context do adolescents become pregnant? (cont.)
About 75% of adolescent pregnancies are intended, ranging from 42% in Colombia to 93% in Egypt.
A small but significant percentage of adolescent pregnancies result from nonconsensual sex.
Recent studies of coerced first sex report rates between 10% and 45% of girls who first had sex before age 15.
The pregnancies may be “intended” due to social and cultural norms, or because unmarried young women see it as their only means of establishing identity. Worldwide, births to unmarried adolescent mothers are far more likely to be unintended and those outside marriage are more likely to end in abortion.
- Age at first marriage is increasing in many countries, as are rates of contraceptive use among both married and unmarried adolescents.
- Educational levels for girls, which are closely associated with early childbearing, have also risen in most countries, and job opportunities have expanded.

11. Risk factors for teen mothers and their babies
A study in Latin America found that maternal death rates for adolescents under 16 are 4 times greater than for women in their 20s.
Increased incidence of:
Low birth weight
Infection and neonatal death
SIDS
Well being of mother threatened with medical and social problems
Social issues
Low socioeconomic status
Low education for the mother
Substance abuse
Single parent families
Possibility for substandard prenatal care (Porter & Holness, 2011)
Despite the downward trend, adolescent pregnancy remains very prevalent, particularly in the poorest countries. Adolescent childbearing has a negative impact on these three dimensions: health of the adolescents and their infants; individual social and economic effects; and societal level impacts.

12. Risk factors for a child of a teen mother
Health and chronic illness problems
Increased chance of becoming a teen parent (Herrman, 2010) (as cited in Hoffman, 2006)
Greater risk of homelessness, incarceration, dropping out of high school
Increased risk of being abused (Herrman, 2010) (as cited in Healthy Teen Network, 2007).

13. Societal and socioeconomic impact of teen pregnancy
Studies have shown that delaying adolescent births could significantly lower population growth rates, potentially generating broad economic and social benefits.
Numerous studies have shown an association between adolescent pregnancy, and negative social and economic effects on both the mother and her child. However, recent reviews have found the evidence inconclusive about whether adolescent pregnancy is the cause or consequence of adverse socioeconomic factors.

14. INTERVENTIONS Theories/Teen pregnancy research
Social-Cognitive-Ecological Theories
Developmental Theories
Resilience Theory (Porter & Holness, 2011)
Home visitation
School-based programs
Community-based programs
Contraception
Abstinence
Mothers and babies need care in pregnancy, for childbirth and after birth. It must be delivered as a continuum of care that starts in the household and community and extends into the healthcare system, including care for complications.

15. INTERVENTIONS (cont.) How can adolescent pregnancy be made safer?
Mothers and babies need care in pregnancy, for childbirth and after birth. It must be delivered as a continuum of care that starts in the household and community and extends into the healthcare system, including care for complications.

16. Individual, Family, and Community Care
Programs should emphasize:
Improving the involvement of boys and men and the community at large, and including “mothers-in-law” in societies where they are the main decision-makers both at household and community level, would ensure their support and acceptance in utilization of services.
Ensuring good pregnancy outcomes start with homebased care practices that support the mother and her newborn before, during, and after the pregnancy.
Adolescent mothers should be provided with life skills (including vocational training) and sexuality education to increase their autonomy, mobility, self-esteem, and decision-making abilities.
Adolescent mothers often lack knowledge, education, experience, income, and power relative to older mothers. Thus, programs should emphasize several approaches to overcome these relative disadvantages.

17. Individual, Family, and Community Care (cont.)
Knowledge about pregnancy complications and recognizing the signs of complications should be widely disseminated to pregnant adolescents, their families and the community at large.
Programs should be put in place to retain adolescent girls in school.
Because adolescents are relatively more susceptible to violence from intimate partners than are older women, it is important to implement programs to empower adolescents to deal with domestic violence.
Programs should also find ways to reduce the cost of pregnancy care for adolescents, who tend to have fewer financial resources.
It may provide the route for ensuring that pregnant adolescents deliver with the assistance of a skilled health-care provider and have access to support and services for routine as well as emergency care throughout pregnancy, childbirth and during the postpartum period.

18. Types of Community Programs for Pregnant Teens
School-based program
Valley High Teen Mom Program
Faith-based program
LDS Family Services
Catholic Community Services
Additional Services available
Community-based program
Utah Parents as Teachers
Teen Mother program

19. Resilience-Recoil-Rebound Theory of Teen Pregnancy Prevention
The ability to "bounce back" when faced with a challenging experience in life (Porter & Holness, 2011) (as cited in American Psychological Association [APA], 2011; Luthar & Cicchetti, 2000).
Reflected in coping skills when faced with pregnancy
Recoil-Rebound
Refers to recovery when faced with a setback in life with optimism and hope for the future
Strong support systems are needed to reinforce resilience in teen mothers at risk for repeat pregnancy
Family
Peer groups
School
Church
Community
Community programs can be based on Resilience-Recoil-Rebound Theory of Teen Pregnancy Prevention

20. Home Visitation Programs
Begin as early in the pregnancy as possible
Continue after birth of baby and through two years of age
Follow Olds Model
Establish a trust relationship
Visit weekly for the first month
Every other week until delivery (Robert Wood Johnson Foundation, 2008)
After delivery, resume home visits at eight weeks, every other week through the child's second birthday
Certified Nurse Midwives visit for the first eight weeks

21. Outpatient and Clinical Care
The content of such clinical and outreach interventions should be the same for adolescent mothers as for other women:
It is important to provide adolescents with an early start to antenatal care and to options for continuing or terminating pregnancy, particularly because adolescents tend to delay seeking abortion, resort to the use of less skilled providers, use more dangerous methods, and delay seeking care for complications.
They are, therefore, more likely to suffer serious complications and even death.
Since adolescents are especially susceptible to anemia in pregnancy, it is important for programs to make a special effort to diagnose and treat for anemia.
Skilled health workers provide a range of services in outpatient or clinical settings that help save the lives of pregnant mothers and their newborns. With a few important exceptions,

22. Outpatient and Clinical Care (cont.)
Adverse outcomes such as low birth weight can be reduced by improving the nutritional status of adolescents before pregnancy and preventing sexually transmitted infections before and during pregnancy.
Pregnant adolescents especially first time mothers are particularly susceptible to malaria, a major factor in maternal deaths in some countries. Priority should be given in treatment and management of malaria in pregnancy.
Special attention should be given to adolescents under 16 during obstetric care because they and their infants are at especially high risk of complications and death.

23. Outpatient and Clinical Care (cont.)
Discussion of the “Plan for Birth and Complications,” including the place of birth, availability of transportation, companion of choice, and costs involved, is essential, particularly for adolescents in light of the higher incidence of complications both for the mother and her newborn.
Health workers should prioritize adolescents’ access to services to prevent mother-to-child transmission of HIV, given the high concentration of infection rates in young women.
It is important that adolescent mothers be counseled and provided with post partum family planning methods of their choice to avoid future adolescent pregnancy.

24. Health Systems Features
In addition to the special interventions that would enhance the continuum of care for adolescents and their babies, countries can incorporate features into their health systems that can improve adolescents’ access to quality care including that for contraception and, ultimately, health outcomes.
A crucial area of focus is in human resources, where evidence shows the importance of developing health worker competencies in dealing with the special information and psychosocial needs of adolescent mothers.
A more conducive legal and policy environment that enhances access to care for adolescents including contraceptive services is needed.

25. Planned Parenthood Programs
Planned Parenthood believes that it is important to help teens delay having sexual intercourse,
but it also believes that policy makers must accept the fact that teens engage in sexual behavior,
and they must initiate and provide funding for various programs and interventions that will facilitate responsible sexual behavior.

26. Sex Education Can Help Prevent Teenage Pregnancy
Sex education programs that are balanced and realistic:
encourage students to postpone sex until they are older,
and promote safer-sex practices among those who choose to be sexually active,
have been proven effective at delaying first intercourse and increasing use of contraception among sexually active youth.
These programs have not been shown to initiate early sexual activity or to increase levels of sexual activity or numbers of sexual partners among sexually active youth (Kirby, 2007; Kohler et al., 2008).

27. Sex Education Can Help Prevent Teenage Pregnancy (cont.)
Sex education that is responsible and medically accurate, begins in kindergarten, and continues in an age-appropriate manner through the 12th grade, is necessary given the early ages at which young people are initiating intercourse — 6.2 percent of students nationwide report having sex before the age of 13, 43.8 percent by grade 10, and 63.1 percent by grade 12 (CDC, 2012).
In fact, the most successful programs aimed at reducing teenage pregnancy are those targeting younger adolescents who are not yet sexually experienced (Frost & Forrest, 1995).

28. Sex Education is a Success in Other Developed Nations
The Netherlands, where sex education begins in preschool and is integrated into all levels and subjects of schooling, boasts one of the lowest teen birthrates in the world — 5.3 per 1,000 women aged 15–19 — a rate six and a half times lower than that of the U.S. (Berne & Huberman, 1999; United Nations, 2011).
In Germany, where sex education is comprehensive and targeted to meet the reading and developmental needs of the students, the teenage birthrate is three and a half times times lower than that of the U.S.; its teenage abortion rate is about five times lower.

29. The Media Has an Important Role in Pregnancy Prevention
Another source of teen information about sex is the media:
In the U.S., one in three television programs contains a scene devoting primary emphasis to sexual behavior, and one in 10 contains a scene in which intercourse is depicted or strongly implied, yet sexual precautions and the consequences of sexual behavior are rarely depicted (Kunkel et al., 2005).
Research clearly shows that television portrayals contribute to sexual socialization — watching programs high in sexual content has been correlated with the early initiation of adolescent sexual intercourse (Collins et al., 2004).

30. The Media Has an Important Role in Pregnancy Prevention (cont.)
The U.S. needs a long-term teenage pregnancy prevention media campaign that addresses the consequences of sexual behavior.
At present, most major networks do not air commercials or public information campaigns about sexual health.
Developed countries such as the Netherlands, Germany, and France, in which teenage birthrates are three to six and a half times lower than that of the U.S., promote healthy, lowerrisk sexual behavior through national media campaigns that have a high degree of influence with young women and men (Berne & Huberman, 1999).
An analysis of the sexual content in television, magazines, music, and movies popular among young teens found very rare depictions of sexually healthy behavior: 12 percent of all popular media content was sexual in nature, but less than one-half of one percent discussed or portrayed sexual health (Hust et al., 2008).

31. Conclusion
Making pregnancy safer for the youngest mothers and their babies is a priority for countries as they strive to meet targets for improving basic health care.
Maternal and newborn health programs have a clear role in better serving the needs of the youngest mothers.
However, more and better research is needed to expand the evidence base on effective interventions for pregnant adolescents and to translate knowledge into action at the country level. As part of a broader effort being undertaken by various WHO Departments, WHO’s MPS Department hopes to contribute to this effort by publishing a Position Paper on Adolescent Pregnancy later in The position paper will lay out an action plan for WHO and partners to address adolescent pregnancy using the framework of the Making Pregnancy Safer Approach to Improving Maternal and Newborn Survival.

32. References
American Psychological Association. (2011). The road to resilience Washington DC: Author. Retrieved from
Herrman, J.W. (2010). Assessing the teen parent family. The role for nurses. Nursing for Women's Health, 114(3), doi: /j X x
Luthar, S. S., & Cicchetti, D. (2000). The construct of resilience: Implications for interventions and social policies. Development & Psychopathology, 12(4),
Porter, L.S. & Holness, N.A. (2011). Breaking the repeat teen pregnancy cycle. How nurses can nurture resilience in at-risk teens. Nursing for Women's Health, 15(5), doi: /j X x
Robert Wood Johnson Foundation. (2008). A closer look at the olds model. Retrieved from

33. Thank you
for attention!
Q & A ?