Different Approaches to Adolescent and Teenage Pregnancy in the United States

Introduction

When one thinks of adolescent and teenage pregnancy, the first image that often comes to mind is the stereotypical depiction that appears in movies. The girl is often called a slut or a whore, and she gets berated as she walks down the school hallways, head down, counting the minutes until she can escape the continuous ridicule.

According to the United Nations Children's Fund (UNICEF), the term teenage pregnancy encompasses all births to women ages 13-19 and the World Health Organization (WHO) even includes ages 10-12 as well (Adolescent[WHO]; World). Though some may deny the prevalence of adolescent and teenage pregnancy in today's society, the Centers for Disease Control and Prevention (CDC) affirm that over 229,700 babies were born to 15-19-year-old women in 2015 alone (Reproductive). Though this number constitutes a low amount for the United States (U.S.), the developed country with the highest rate of teenage pregnancy, it is still extremely high; fortunately, rates have been decreasing steadily since 1990 (Reproductive; Teen; Trends).

It is imperative to address this problem because adolescent and teenage pregnancy is known to have a tremendously large impact on the social, emotional, and physical health of the mother, which can also affect her child. For example, UNICEF certifies that the likelihood of teenage mothers to seek prenatal care is not nearly as high as women who are in their twenties or beyond, and this fact combined with the underdevelopment of younger girls' bodies can result in a multitude of various complications, including premature or underweight babies (World). There are a variety of other implications to keep in mind as well. For instance, teenage pregnancy often leads to a dependence on alcohol or other substances, depression or other mental illness with potentially fatal results, home environments without a father figure for the child, and an assortment of social repercussions (Adolescent[WHO]; Reproductive; Swierzewski; World). On a similar note, multiple sources discussed the decreased likelihood of the mother to finish her education, and Stanley J. Swierzewski, III, M.D., confirms that approximately one-third of young women who become pregnant do not graduate from high school. Additionally, Lisa Shuger, former Director of Public Policy at the National Campaign to Prevent Teen and Unplanned Pregnancy, notes that two percent of teenage moms complete their college degree by the age of 30. This greatly reduces a young mother's ability to support not only herself, but her child as well, as her potential to earn money significantly declines (Brace).

On that note, it is important to consider a teen mom's reliance on government assistance programs and the economic impact of adolescent and teenage pregnancies in general. For example, researchers for the Journal of the Georgia Public Health Association found a difference of almost $10,000 between the average salary of a high school dropout and a high school graduate (Brace). This often results in heavy dependence on health care services and government aid in general, contributing to monumental costs for taxpayers. For instance, associated costs amounted to more than $9.4 billion in 2010 for things such as lost tax revenue due to diminished levels of high school graduates, imprisonment increases regarding teenage mothers and fathers, and an increased reliance on foster care and health care services (Reproductive). Due to the impact of teenage pregnancy on said economic costs and other aspects of society, it can very clearly be deemed as a community health problem.

Analysis

As time has passed, researchers and scientists have developed multiple strategies to combat the prevalence of adolescent and teenage pregnancy. Since society has changed, claiming that abstinence is key is no longer realistic. The CDC confirms that 40 percent of high school students in 2017 engaged in sexual intercourse at least once, an extreme difference from time periods such as the 1950s (Sexual). That percentage is lower than previous years, and it is the lowest in the history of the survey, but it is still much greater than zero. Rather than condemning sexual relations as a concept, professionals have instead advocated for increased and expanded access to contraceptives. This idea is present in the Affordable Care Act (ACA) of 2010 with the emphasis on preventive measures. Under the ACA, insurance companies are required to provide coverage for a multitude of contraceptive methods without out-of-pocket costs for women (Taylor). According to a survey from the Guttmacher Institute, 50-63% of women's reasons for using contraceptive methods focused on family care, financial means, finishing education, or establishing themselves in the work force (Sonfield). With this reasoning in mind, expanding access to contraceptives is a responsible way to prevent unplanned events.

If we look at this on a larger scale, there have been multiple studies that linked increased access to contraceptive methods and changing social attitudes to lower rates of adolescent and teenage pregnancies across different countries around the world. For example, the Netherlands is known for its widespread acceptance of contraceptives, open communication about family planning, low abortion and teen pregnancy rates, and overall nondiscriminatory environment relating to these matters, which is different from the approach used by a large portion of other countries in the world, including the U.S. (Adolescent[Guttmacher]; Ketting). To put this into perspective, for every 1,000 adolescents, the U.S. had 57 pregnancies, while the Netherlands only had 14 per 1000 adolescents in 2010 (Sedgh). If the U.S. adopted a similar system and implemented it over a period of time, one could conclude that the stigma behind these measures might finally be overcome, leading to safer, smarter decisions and lower rates of adolescent and teenage pregnancy.

Another approach that has been suggested is improving the curriculum of health classes in middle schools, junior high schools, and high schools across the country. Since every child is required by law to attend school, it is only logical that these classes present accurate information in a cohesive manner so students understand the true consequences of unprotected sex. According to the CDC, teaching younger children about contraceptive use and their purposes, such as STI and STD prevention, tends to be more effective than waiting to educate them about it when they are older (Why). Additionally, according to a study conducted by the Guttmacher Institute, the number of high schools that teach a variety of sex education topics, including the correct use of a condom, contraceptive methods, reproductive anatomy, abstinence, and more, declined between the years of 2000 and 2014 from around 55-96 percent to less than 40-80 percent (Programs). If schools bolster their curriculum and utilize resources from accredited organizations that fit the specific youth population present in their community, the effects could include a lower rate of not only adolescent and teenage pregnancy but of STI and STD transmission as well.

The study also mentioned an interesting side perspective: some adolescents who want to prepare and educate themselves turn to the internet rather than broaching the conversation with their parents or asking their health teachers. However, the Guttmacher Institute found that almost 50 percent of the websites that contained information about contraceptives were erroneous and unreliable (Programs). Because it is nearly impossible to monitor all the websites that deal with these and related subjects, it becomes imperative for parents to take an active role in addition to the regulated school curriculum. The CDC confirms the importance of the role parents play in their child's sexual education, and their role has been linked to increased contraception use and abstinence (Martinez). Since 70 percent of teenage males and 79 percent of teenage females engaged in a conversation with their parents about a sex-related topic between 2006 and 2008, one can easily grasp the importance of parents' roles in sex education (Martinez).

It is important to note the idea of abstinence-only education programs and how they are largely ineffective despite the large amount of federal funding provided to them. An organization based in Washington, D.C. that works with over 28,000 health care providers called Advocates for Youth conducted a study that showed not only the abstinence-only programs' lack of long-term impact, let alone success, but also accounted for the decreased likelihood of adolescents to use a variety of contraceptive methods (Programs; Truth). A more effective method would be to educate the youth on all the different options when it comes to their sexual health. By providing them with all the facts, increased abstinence can occur, not necessarily from scaring them into STI/STD and teen pregnancy avoidance, but rather by keeping them informed to make their own mature decisions.

As teenage pregnancy is known to be one of the CDC's highest priority issues, evidence-based prevention programs have been heavily endorsed by the agency in the efforts to combat the problem (Reproductive). There are almost 50 programs that passed the rigorous examination known as the Teen Pregnancy Prevention (TPP) Evidence Review. The programs are run through the Office of Adolescent Health which is based within the U.S. Department of Health and Human Services (Frequently). Some initiatives focus on five components to fully reach all members of a community. According to the CDC, those five components are community mobilization and sustainability, evidence-based programs, increasing youth access to contraceptive and reproductive health care services, stakeholder education, and working with diverse communities (Communitywide). These have been established as the most important elements to keep in mind in addressing adolescent and teenage pregnancy. An example of an evidence-based program is one known as Get Real, which focuses on the middle school curriculum with the ultimate purpose of helping to delay sexual relations until after eighth grade. It is comprised of both in-school lessons that are implemented in sixth, seventh, and eighth grade, and activities that are completed at home with their parents. It was reviewed to be of moderate quality and is distributed by a program success center for sexual and reproductive health known as ETR (Goesling). Grants are also provided to organizations so they can have the flexibility to choose the program that best fits the needs of their community, and over 200 have been granted at this point in time (Blackman; It's). Though there have been some attempts to dismantle the TPP Program, it is important to note that teenage pregnancy and birth rates have greatly decreased by more than 40 percent since the enactment of TPP in 2010 through 2016. Additionally, the program has been unprecedented in its use of research and findings to continually work towards better, more effective solutions, and is supported by 85 percent of adults, an amount comprised of both political parties (It's).

Conclusion

Overall, there have been a variety of approaches to the important community health problem that is adolescent and teenage pregnancy as scientists, researchers, and doctors alike have realized the impact that young moms can have on their surrounding communities, especially economically. If the importance of teen pregnancy continues to be emphasized, this problem can potentially reach eradication in the United States. Moving forward, it is important for a variety of things to occur. For example, doctors should make sure parents are adequately prepared to address sex-related concepts with their children, as they play extremely important roles in their development, including establishing precedents for their sexual health. Similarly, school health curriculum must continue to strive to be as informative as possible, as the CDC affirms that 83 percent of teenagers had not received any form of sex education before they first engaged in sexual relations (Preventing). Some changes might need to be made in different schools involving the grades at which the students are first educated on the topics, and these should all be evaluated on a regular or school-by-school basis.

It has been scientifically proven that teen birth rates have continuously fallen since 1990-91. For U.S. teenagers in the age group of 15 to 19, the rate has declined 64 percent since 1991, and when specifically focusing on 15- to 17-year-olds, their rate has decreased 74 percent (Hamilton). These declines could be attributed to individual factors or a combination of multiple. Because of the increased importance that has been placed on contraceptive availability, the passing of the ACA in 2010 and the enactment of the TPP program, the revitalized emphasis on the importance of sex education and parental involvement, and the overall evolving atmosphere of teenage sexual relations, many things have contributed to the continuous decline of teen birth rates for the past two decades.

After analyzing the plethora of available options to combat this pressing issue, I believe the continued implementation of evidence-based programs would be the best way to continue progress. These evidence-based programs reference the importance of contraceptive availability, health education, and family involvement, all of which I mentioned earlier as separate approaches. By utilizing the whole impact of the programs and by focusing on the emphasis on evidence to support all claims at every step of the process, this approach is likely to be well-received by communities around the country. There will still be stubborn, ignorant people who only believe in abstinence and will prevent their children from receiving sexual education, but as time progresses, people may continue to become more and more open-minded. In conclusion, there is much that can be done regarding adolescent and teenage pregnancy. If these actions are continually taken, the country will be improved, not just for young mothers and their children, but entire communities as well.

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