Teen Pregnancy: Understanding the Social Impact
WHEC Practice Bulletin and Clinical Management Guidelines for healthcare providers. Educational grant provided by Women's Health and Education Center (WHEC).
Better information helps us to make better decisions. Although in USA, teen pregnancy and birthrates are declining, they still remain highest among the Industrialized countries. The birth rate for U.S. teenagers in 1998 was 51.1% live births per 1,000 women aged 15 - 19 years, 2% lower than 1997 and 18% lower than in 1991. The most dramatic reduction in birth rates between 1991 and 1997 were a 23% decline in black teenage births and a 16% decline among non-Hispanic white teens.
The impact of teenage pregnancy and subsequent childbirth on parents, child and society reaches far and wide and has negative consequences to all involved. Too many teenagers become parents either they cannot envision another positive future direction to their lives, or because they lack concrete educational or employment goals and opportunities that would convince them to delay parenthood.
Consequences of Adolescent Pregnancy:
- To Mother: It lowers family income (80% will eventually go on welfare). Lower educational levels, increased dropout rate, and less likely to be married are the main problems a teenage mother faces.
- To Child: More likely to be low birth weight and have childhood health problems and be hospitalized. It increases infant mortality and less likely to receive proper nutrition, healthcare, cognitive and social stimulation. Possibility of abuse, neglect, lower intellect and academic achievement are very high. They are more likely to be teen parents as their peers and more likely to be unemployed and poor. They have increased risk of social and behavioral problems.
- To Father: It increases the rate of delinquent behaviors, such as alcohol and substance abuse, lower educational levels and lower earning potential.
- To Society: It is estimated that annually in lost tax revenues, public assistance, child healthcare, foster care, and involvement with the criminal justice system, the cost is about $7 Billion, about $1,400 per year per family.
Abstinence versus Contraception:
Current literature suggests that 20% decline in Teen Pregnancy since the early 1990s is due to decreased sexual activity while 80% of the decrease is associated with more effective contraceptive practice. Of the 69% of U.S. School districts that teach sex education 86% promote abstinence as the preferred option for adolescents.
Contraception use appears to be on rise. The Youth Risk Behavior Surveillance, United States, 1997 reported the use of condoms to be increasing. Teenagers are yet not informed about the availability, efficiency and a variety of contraceptive techniques available to them. There is no magic solution to reduce teen pregnancy; childbearing and sexually transmitted diseases. Aggressive efforts on both families and communities are required. Young people need accurate, age-appropriate information about sexual behavior and its consequences.
Reversible Contraception for Teenagers:
- Depo-Provera: It is given as injection every 3 months, requires 4 visits per year for administration. It also reduces menstrual cramps, iron deficiency anemia, and risk for endometrial cancer.
- Norplant: Implants (6) are inserted under the skin and effective for 5 years. It needs to be inserted and removed by the health care provider. NORPLANT II, which has 2 implants, will be available in USA soon.
- Birth Control Pills, Patch and Vaginal ring: There are a variety of Low Dose Birth Control Pills, Patch and Vaginal ring, available and are fairly safe to use. They can reduce the menstrual cramps, menstrual flow, regulate the menstrual cycles and some of BCP's can reduce acne.
- Condoms and Contraceptive Jelly: These Barrier Methods can also reduce the incidence of sexually transmitted diseases.
- "Emergency'' contraceptive Pills or "Morning -after pill'': It is effective if taken within 72 hours after unprotected sex. It is available and most of the health insurances cover it. Your healthcare provider has to prescribe it.
- The Patch: For the convenience Contraception Patch is available in the market, to be changed once a week for 3 weeks and one week off. This option is gaining popularity among teens, who do not remember to take pills every day and like to have menstruation monthly. Please consult your Healthcare Provider to find out which one is the right option for you.
Efforts to Reduce Teen Pregnancy:
Decline in teen pregnancy are achievable via 2 paths: changing sexual behavior and changing contraceptive use. Basic information about abstinence, contraception, condoms, and other options for protection, as well as their reproductive health is very important. We should talk to teenagers more openly, about the consequences of having more than one child- before age 20. Whether or not teenagers choose to have sex, they need to develop skills in communication and sexual decision making so that sex does not just "happen".
Periodic health guidance for parents and adolescents is a critical component of primary and preventive health care. It provides an opportunity for physicians, adolescent patients, and their parents to address current and potential health care needs. This is different from obtaining the past medical history because it involves the counseling and discussion component of the health care visit. To help adolescents navigate the transition from childhood to adulthood, these recommendations are helpful: 1) health guidance for both parents and adolescents, 2) screening, and 3) immunization. Physicians should tailor the content of their health guidance, screening and level of parental involvement to the unique requirements of each patient. A physical examination is not required at every visit, but should be performed at least once during early adolescent (ages 12-14 years), middle adolescence (ages 15-17 years), and late adolescence (ages 18-21 years). A pelvic examination should be performed when indicated by the medical history (e.g., pubertal aberrancy, abnormal bleeding, or abdominal or pelvic pain). If the patient has had sexual intercourse, screening for sexually transmitted diseases (STDs) is appropriate and the patient should have her first Pap test no later than 3 years after first intercourse.
For the parents and other adult caregivers: at least once during child's early adolescence, once during middle adolescence, and preferably once during late adolescence parents and adult caregiver should receive health guidance. Such guidance can be provided either concurrent to the adolescent's visit or as a separate visit. Health guidance should include:
- Normal adolescent development, including information about physical, sexual, and emotional development. Signs and symptoms of common diseases and morbidities in adolescents including depression and emotional distress to alert parents to the potential health risks facing their children.
- Physical and psychosocial benefits gained from participation in sports and other supervised extracurricular activities.
- Promote healthy adolescent adjustment; minimizing criticism, respecting privacy and spending quality time with the adolescents.
- Ways to monitor the adolescent's social and recreational activities, including tobacco, alcohol, and drug use and sexual behavior, particularly in early and middle adolescence.
- Remaining involved in the adolescent's use of her free time, including television and Internet usage, particularly in early and middle adolescence. Monitoring peer relationships. It is important for parents and guardians to recognize the influential role of the media, particularly as a source of sexual information for adolescents.
For the adolescent: annual health guidance to promote a better understanding of their physical, psychosocial, and psychosexual development. Such guidance should emphasize health promotion and risk reduction strategies. The importance of becoming actively involved in decisions regarding their own health care also should be stressed:
- Dietary habits, including ways to achieve a healthy diet and safe weight management.
- Benefits of physical activity and encouragement to engage regularly in safe physical activities.
- Responsible and consensual sexual behavior including counseling on abstinence, STDs and HIV should be part of health guidance.
- Prevention of injuries, avoiding the use of alcohol and illegal drugs, avoiding the use of weapons or promoting weapon safety and using non-violent conflict resolution should be encouraged.
No single or simple approach has successfully reduced the teen pregnancy rate; much more study and efforts are required. Other industrialized countries have much lower teen pregnancy and abortion rates than USA. There is few, if any other social problem that has a greater impact on us as a nation. It will take the involvement and efforts on the part of families, society and government to negotiate a change in the right direction. As physicians, we are in a unique position to take a leadership role in the decision making process, at all levels.
Resources on Adolescent Pregnancy:
- National Organization on Adolescent Pregnancy, Parenting, and Prevention. (NOAPPP)
2401 Pennsylvania Ave, NW, Suite 350
Washington DC 20037
- Planned Parenthood Federation of America (PPFA)
810 7th. Ave
New York, NY 10019
- The National Campaign To Prevent Teen Pregnancy:
1776 Massachusetts Ave, NW, Suite 200
Washington DC 20036
- The American College of Obstetricians and Gynecologist (ACOG):
Department of Adolescent Health Care
409 12th Street, SW
PO Box 96920
Washington DC 20090-6920
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