Teen Pregnancy: Understanding the Social ImpactWHEC Practice Bulletin and Clinical Management Guidelines for healthcare providers. Educational grant provided by Women's Health and Education Center (WHEC). Introduction: 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: 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: 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". Health Guidance: 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: 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: Conclusion: 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: |