Preventing teen pregnancy in underserved communities

Preventing teen pregnancy in underserved communities
Preventing teen pregnancy in underserved communities
I am a Family Nurse Practitioner working at a women's shelter in the Bronx, and I cannot get over the number of pregnant teenagers -- some younger than 15 -- who walk into the shelter seeking our services. 

In 2011, American girls aged 15 to 19 years gave birth to almost 330,000 babies, according to the CDC.

Nationwide teen pregnancy rates are the lowest they've been in 70 years, and New York City recently reported an almost 30% decline in teen births.

But before we pat ourselves on the back, let us consider the facts. The United States still has the highest rate of teen pregnancy and childbearing among industrial nations -- six to nine times those in developed countries with the lowest birth rates -- and significant racial, ethnic and socioeconomic disparities exist. Last week, the CDC reported that 20% of all babies born to teen moms are repeat births. This is not surprising to me. 

Declines are happening but not fast enough, especially within underserved communities. Although teen birth rates declined for all races in 2011, socioeconomically disadvantaged youth of any race or ethnicity experience the highest rates of teen pregnancy and childbirth.

I witness the realities of teen pregnancy daily. One recent patient, a 16-year-old Hispanic woman, was a B+ student and planned to be the first in her family to go to college. When she got pregnant, her family threw her out and she turned to the system for help. In addition to the economic toll teen pregnancy takes, babies born to teen moms are often low birth weight and experience disproportionately high mortality.

One of the reasons the U.S. lags behind other Western nations when it comes to teen pregnancy is comparatively low contraception use among sexually active teens. Providing better access to contraception is a necessary step in the right direction. It would certainly be cheaper than the billions of dollars we currently spend to continue social welfare programs for teen moms, who are unable to provide for themselves and their children. 

The National Campaign to Prevent Teen and Unplanned Pregnancy estimates that for every $1 U.S. dollar we spend on contraceptives for teens, we save almost $6 on medical care alone for unplanned pregnancies. In 2008, the cost of unplanned pregnancies in the U.S. was almost $11 billion. Even after all that money is spent, we still fall short of adequately providing for these families. 

Teen pregnancy is one of the primary causes of increasing U.S. child poverty rates. Research shows many teen mothers remain on public assistance their entire lives. About 60% of all teenage mothers and their children are likely to live in lifelong poverty, and children of teen parents are more likely to become teen parents themselves, according to the CDC.

President Obama recently launched a national teen prevention program. Its main focus is to help bring down teen pregnancy rates using “multicomponent, community-wide initiatives.” The program calls for churches, schools, community centers and public leaders need to implement cultural and linguistically suitable pregnancy prevention programs aimed at teenagers. 

American teens that become pregnant either have no access to contraceptives or they do not use the services available, according to the CDC. Many adults are uncomfortable with the idea of teenagers having sex, and therefore endorse abstinence as the primary method of contraception. 

This one-sided approach does not reflect the reality of the fact that teens are sexually active. We must continuously update teen pregnancy prevention programs, and keep the conversation about sex open with teens.

Ask what teens think about sex, and what they think about how it is portrayed in school by their friends, families and the media. Encourage parents to become more involved in their children's lives. Sex education should begin in the home. When parents know that their children are sexually active, they should encourage them to use contraceptives. Teen pregnancy is not only a teenagers' problem. It affects the entire country.

Millicent Alfred, FNP, MSN, RN, is a certified Family Nurse Practitioner who works in a women's shelter in the Bronx.


References

  1. CDC. Teen Pregnancy. November 21, 2012. Available at: http://www.cdc.gov/teenpregnancy/aboutteenpreg.htm
  2. CDC. Vital Signs: Teen Pregnancy – United States – 1991-2009. MMWR. 60(13);414-420.
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