The Health Care Issue Of Teen Pregnancy Lori Van Zoeren BS, RN Ferris State University

Objectives Describe an overview of the issue of teen pregnancy Understand the implications to health care, communities, teens and their families Learn what resources are available to address teen pregnancy Learn current and past legislative policies and practices Gain knowledge of stakeholders positions and roles in strategies to address teen pregnancy

Overview of Teen Pregnancy Teens who are sexually active and do not use birth control have a 90 % chance of pregnancy. Approximately 750,000 teens become pregnant every year (Ohio State University, [OSU], 2010). In 2011 there were 329,797 babies born to teens between the ages of 15-19 (CDC, 2012a). America’s teen birth rate is nine times higher than other developed countries (CDC, 2012a). Americans spend 10.9 million dollars annually. (CDC, 2012a). Michigan taxpayers spent 7.6 billion dollars (308 million in 2008) between 1991 and 2008 directly related to teen births(Albert, 2011)

Implications The teen’s (both mother and father) wellbeing Infant ‘s health Financial impact on pregnant teens and their families Financial impact on communities (Local, state and federal) Adolescents, who experience unplanned pregnancy may find themselves with feelings of guilt, anger, and denial (Healthy People, 2012). Feelings of regret and confusion about becoming a parent may also lead to the teen receiving inadequate medical care (Healthy People, 2012). Pressure from family members may greatly influence a teenager’s decision making process. Unstable or abusive home environments may affect the adolescent’s ability to develop healthy and loving relationships (Healthy People, 2012). Infants who are born to teenage mothers are more apt to experience lower birth weights due to poor nutritional intake and lack of surveillance throughout pregnancy (Healthy Communities, 2013). These infants are also more likely to have poor mental or physical health, and have poor performance throughout their educational experience (Healthy Communities, (2013). The infants are at greater risk for abuse and neglect, are 13% more at-risk to be incarcerated, as well as have a 22% greater chance of also experiencing teenage pregnancy (Healthy Communities, 2013). Financial Teens that experience pregnancies are less likely to graduate from high school or receive a GED by the age of 30 (Healthy People, 2012). They also are more likely to earn an average of 3,500 dollars less annually and receive financial aid for twice as long as women who wait to have their first baby until after the age of 20 (Healthy People, 2012). Teen pregnancy costs are not solely monetary. Emotional and physical strain is experienced by families, as well as the community (CDC, 2011). Approximately 50 % of pregnant teens will drop out of school, be unemployed and even incarcerated compared to teens that do not give birth (CDC, 2012a). The implications at both the state and federal levels are enormous and serve as the foundation efforts laid forth by the National Campaign to Prevent Teen Unplanned Pregnancy (Albert, 2011).

2010- 1/3 reduction in teen pregnancy Past & Present 1900’s-Immorality & STDs 1960-70’s-Immorality & STDS 1990’s-AOUM & PRAM 2010- 1/3 reduction in teen pregnancy Debates on how to address the issue of teen pregnancy, as well as on how to educate teens about sex and pregnancy prevention, have been a repetitive occurrence over the years. According to Wiley (2012), for far too long “sexuality education has been muddied with politics, morality and personal opinion” (p. 308). .   Prior to the 20th century there was no avenue in place to gain knowledge about sex other than through friends and family (Wiley, 2012). In the early 20th century, venereal diseases and overall immorality of America’s citizens gave cause for medical personnel to start discussions about educating the public about disease prevention. Wiley (2012) went on to report that as early as 1913, sex education occurred in America and was very controversial. Supporters acknowledged that education would lead to more responsible and decent behavior. Whereas opponents, worried that this would give approval of irresponsible behaviors. In the 1960’s and 1970’s promiscuity increased significantly along with sexually transmitted diseases and pregnancy (Wiley, 2012). Conversations about sex education again made a comeback and there was a reemergence of education in the classrooms. 1996 provide the timeframe when government involvement increased and the Welfare Reform Act secured monies specifically for abstinence-only until marriage (AOUM) educational funding (Wiley, 2012). This education was rarely based on science and thus several states have since abandoned applying for AOUM. In addition, the Personal Responsibility Education Program (teach abstinence and contraception) was enacted in 2010, as well as evidenced-based educational monies, for communities programs on pregnancy prevention (Wiley, 2010). There has been roughly a one-third decline in teen births since the early 1990s. Education is working but we have a long way to go. Health care providers, community organizations, educators, and parents all must contribute to the issue of teen pregnancy (CDC, 2011). While there have been fewer teen pregnancies over the past few years, the numbers still remain high and thus are a never-ending focus of discussions.

Legislation Patient Protection & Affordable Care Act of 2010 (PPACA) Title X Family Planning H.R. 5810 Mentor-Mentee Teen Pregnancy Reduction Act of 2008 The National Campaign to Prevent Teen and Unplanned Pregnancy The Patent Protection and Affordable Act of 2010 was enacted by President Obama on March 23, 2010 (Landers, 2010). This enabled children to remain on their parents insurance thus covering many teen pregnancy patients. Interestingly enough this act was put into place without one Republican vote (Landers, 2010). While there is not agreement about this legislation in Washington D.C., health care in the U.S. is on an unsustainable path and drastic changes are essential for the survival of our country’s financial stability. Planned Parenthood was elated when President Obama made sure that the 2013 budget included funds for the Title X Family Planning Program (Bassett, 2012). President Obama was able to push through continuation of financial support to Planned Parenthood and other clinics that rely on these federal funds (Bassett, 2012).   In 2008 a bill was introduced to Congress by Representative Nadia Velazquez that was called H.R. 5810 (110th): Mentor-Mentee Teen Pregnancy Reduction Act of 2008 (GovTrack.us website, n.d.). This bill would provide grant monies to involve mentors in programs for at-risk teens. Mentors would receive training to then provide education to teens regarding school subjects, life skills and benefits of delaying sexual activity. The bill was again re-introduced in 2010 to unfortunately be shot down and sent to committee. There are many organizations active in Washington D.C. such as The National Campaign (2012) to prevent teen and unplanned pregnancies. Their goal is realized in the following mission statement: Three major concepts are reported as crucial in the prevention of teen pregnancy. 1)Research must be supported to increase knowledge in areas of public policy, 2)community program readily available , and 3)health care services that are readily available (The National Campaign, 2012).

Stakeholders Teens Parents Communities, Community Leaders, & Legislators Health care providers

Teens Education is crucial Giving an safe space to feel like they can talk to parents Support Helping teens understanding reasoning for decisions made may help battle this health issue. According to Weinberger, Elevag, and Giedd (2005) adolescents have a more difficult time controlling impulses. The behavioral and cognitive functions of the cortex involve a multitude of behaviors that are associated with impulse control and proper decision making abilities (Weinberger et al., 2005). While the brain is fully grown by adolescence, the circuitry, especially the parts involved with assessing risk and impulse control as well as long term planning, are not fully intact until the early 20’s (Weinberger et al., 2005). It is imperative that there is safe space created where teens are able to have open and honest conversations with parents or older adults about choosing to become sexually active

Parents: 10 tips to help prevent pregnancy in your teen Make sure that there is clarity about one’s own values and beliefs Talk to children frequently and as soon as possible about specifics regarding sexual activity Establish rules, curfews and expectations of behavior Know your youth’s friends and their families Encourage group activities and limit one-on-one dating at an early age Set limits of two or three year age differences while child is a teenager Talk about goals for the future Encourage high and achievable expectations for school performance Know what your teen is watching, reading, listening to Strive for a positive relationship with your teen

Communities & Legislators Be willing to openly discuss concerns regarding teen pregnancy Engage community members into volunteering time to support local programs Community leaders must also seek partnerships with local legislators to secure funding and legislations that support teen pregnancy prevention programs Supporting sex education in your schools Community members must be willing to openly discuss concerns regarding teen pregnancy and impacts to their community. Having community hearings, educating community members about programs that are effective at delaying sexual activity will supply knowledge to a greater number of people. Community leaders must also seek partnerships with local legislators to communicate issues at the state level. There will forever be discussions about budget issues. Discussing financial hurdles and providing fact based suggestions would be invaluable ammunition in gaining support. The National Campaign (2011) gives many great ideas for communities to gain recognition by policymakers. The media is a great resource in getting information to the public. If possible, contact reporters that specialize in health and/or children’s issues to write up a story for mass disseminate. A blog can be another valuable tool to disseminate information to a greater number or community members. Also leaders can create their own press release that focuses on the issues that are specific to their community. The organization can then produce materials that highlight the cost data which builds the case and gains support of senators and representatives (The National Campaign, 2011). The Future of Sex Education (FOSE) project is a collaborative endeavor to advance sex education in schools (Wiley, 2005). Their goal is to ensure that all teens enrolled in public school “receive developmentally appropriate, culturally and age appropriate, comprehensive sexuality education at school” (p. 309). Collaborative efforts with organizations such as FOSE will enable leaders with the resources needed to battle teen pregnancy in their communities.

Providers of Health Care Comprehensive sex education must be delivered to affect all populations of teens which includes abstinence as a viable option Education about nutrition, substance abuse, STDs, drugs that are harmful to the growing baby , importance of proper prenatal care Support prevention programs by staffing clinics and services to schools Health care providers have the opportunity to fill a role as educators in health issues such as teen pregnancy. Teens must have information that is presented to them about pregnancy prevention and resources that are readily available. Health educators play an important role in making sure that necessary information is disseminated in a way that can be assimilated by at- risk teens. This must be done in a nonthreatening way and be comprehensive enough but be at a level that can be thoroughly understood by the population of interest. Comprehensive sex education must be delivered to affect all populations of teens. The CDC (2012a) highlighted that education should include personal values about sex and abstinence as a viable option. Education should also include what situations or functions put teens at greater risk and the role peer pressure plays in decision-making. There also must be comprehensive discussions about the risks of sexually transmitted diseases and unwanted pregnancy. Education about nutrition, substance abuse, drugs that are harmful to the growing baby and many other aspects of care during pregnancy must occur (CDC, 2012a). The importance of early pregnancy care and accurate health care knowledge is essential for the health of both and mother and the infant.

Strategies President’s Teen Pregnancy Initiative (TPPI) Educational websites (Advocates for Youth, National Governor’s Association) Research (ETR Associates) Teen male involvement (Project Alpha) Social media The President's Teen Pregnancy Prevention Initiative (TPPI) is partnering with the federal Office of the Assistant Secretary for Health (OASH) to reduce teenage pregnancy and address disparities in teen pregnancy and birth rates (CDC, 2013, para. 1). This program has five key elements laid out to address teen pregnancy prevention. They are: Community mobilization and sustainability. Evidenced-based programs. Increasing youth access to contraceptive and reproductive health care services. Stakeholder education. Working with diverse communities (CDC, 2013, para. 4). Advocates for Youth (2008) is another strategy in which to decreased unplanned pregnancies. The main goal of this organization is to educate legislators on the issues of sexual and reproductive health. Advocates for Youth (2008) believe that the abstinence only approach has failed miserably and efforts must be made to make available confidential birth control methods to those in need. ETR Associates (2012) is a leading research center. ETR’s research staff is nationally recognized for their research contributions in efforts to improve education in public health across the country for varied populations. Although there are educational workshops for teen males available such as Project Alpha (March of Dimes, 2013). College males serve as mentors to younger males on sexual health and responsible sexual activities. While social media can be a powerful educational medium, many times teen pregnancy is glamorized in movies, television, magazines and other forms of the entertainment industry.

Summary While there are enormous amounts of other resources and strategies that could not possibly be all presented here, I hope I have provided you with a good mix of ideas on how to combat teen pregnancy. Teen pregnancy will always be a health care issue. Strategies supporting programs for sexual health education, as well as, activism of health care providers at the local and state levels is imperative to make an impact on the teen pregnancy rate as we move through the 21st Century

Available Resources Albert, B. (2011, June 9). Teen childbearing in Michigan costs taxpayers $308 million annually [Press release]. Retrieved from The national campaign to prevent teen and unplanned pregnancy: http://www.thenationalcampaign.org/costs/pdf/counting- it-up/press-release-michigan.pdf Center for Disease Control and Prevention. (2007). Preconception and interconception health status of women who recently gave birth to a live-born infant —Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004 (Vol. 56 / SS-10). Washington, DC: Government Printing Office. Center for Disease Control and Prevention. (2011). Preventing teen pregnancy in the U S. Retrieved from http://www.cdc.gov/VitalSigns/TeenPregnancy/

References Center for Disease Control and Prevention. (2012a). Reducing teen pregnancy: Engaging communities. Retrieved from http://www.cdc.gov/Features/TeenPregnancy/ Center for Disease Control and Prevention. (2012b). Teen pregnancy and Social Media. Retrieved from http://www.cdc.gov/teenpregnancy/socialmedia/