Teenage Pregnancy Policy Brief

To: New York City Mayor Bill de Blasio

From:  Farhana C.

Date:  January 22, 2019

Re:  Actions to lower the plague of teen pregnancy in the U.S.

Problem statement:

What actions should be taken to lower teenage pregnancy in the United States of America?

Background:

Teen pregnancy plague in the community:

U.S. teen pregnancy rate is decreasing yet it remains the highest compared to other industrialized nations. In 1991, the teen birth rate was 67% and as of 2016, the rate has dropped to 20.3% (7). For example, teenage pregnancy in the USA is three times more than Canada, four times more than France and Germany and eight times more than Japan (6). Adolescent pregnancy puts a social, financial and health strain on teen parents, families and states (6).

Health restrains on teen parents:

Teen pregnancy is not only a health issue, but it impacts other aspects of life. Having a child at a young age put a lot of mental pressure, which can lead to mental health conditions including depression, anxiety, and bipolar disorder (6). First, raising a child is challenging but with a dangerous mental condition, it becomes almost impossible that can lead to child abuse, self-harm and suicidal thoughts.

Teen pregnancy is a Public cost:

Many people think teen pregnancy is a private crisis of the family and teen parents but, it impacts every human being as it is a public cost. Teen pregnancy is a major contributor to increase high school dropout rate among girls. This leads to lower school achievement, more health problems, increase incarceration rate, and face unemployment. Also, the child is more likely to be born prematurely, have low birth weight, which causes healthcare attention from the Medicaid program. Also, teen parents are more likely to get access to AFDC, food stamps and other public financial support and assistance. In 2008, foster care & increased health care, increased incarceration rate cost the U.S $11 billion dollars which all were associated with teen pregnancy and childbirth. In 2010, the U.S. spent at least 9.4 billion associated with teen pregnancy and childbirth (6). The spending is increasing, and all the dollars came from every U.S. taxpayer check which could have been used for other purposes.

Landscape: Few stakeholders

Teen parents: Teens make the decision to be sexually active or not, so they are an important stakeholder in this scenario. Also, the teens can talk to the health care providers and parents before making the big decision.

Parents of sexually active teenagers: Parents play an essential role in child life and can talk with their teens about safety, manners, and future. Parents can encourage teens not to involve in sexual activity before an appropriate age. Also, parents can take their teens to the health care provider to learn about the effective preventative and safe method of birth control. Additionally, parents can inform their child about sexually transmitted diseases and teach ways to stay safe.

Public City Schools of New York: Children spend a good portion of their life in school and they are surrounded by people who they admire and respect. Teachers can teach teens about safe and effective sex practice.

Policy Options:

There should be a legal mandate in all states to teach formal sex education in school. Currently, only 24 states school has a legal mandate for schools to teach sex education and 34 mandate HIV education (1). That means still lot of American adolescence do not have access to appropriate knowledge to prevent pregnancy or dangerous disease.

Advantages: Sex education in school can inform adolescents about sex, sexual practice, child abuse, and sexually transmitted disease as adolescence likely to experiment with “sex” (1). Sex education can help children understand the physical changes in their body, desire to explore and impact of sex on their life. Also, school is a safe and better place to learn compare to pornographic materials that are often misleading. Furthermore, education can clarify myths about sex, teach ways to prevent unwanted pregnancy and help to transform into adults (2).

Disadvantage: Sometimes the teacher who is offering sex education are not expert on the topic, so they can share incorrect information that can be lethal. Children are like sponge, so incorrect information can transform them into becoming an ignorant adult (2). Also, the class is most often treated as extracurricular, which can prevent the student from paying attention and understanding the importance of knowledge in real life.

 

There should be a clinical guideline that is used by a health care provider to inform adolescents about a safe and effective choice of birth control.  Most teens use some form of birth control including pills, condoms, etc., which are a less effective preventive method.

Advantage:  Long-Acting Reversible contraceptive (LARC) is an effective method to prevent unplanned pregnancy, which can help to curtail teen pregnancy statistics (4). If the Healthcare providers inform the adolescents about safe method or abstinence, then it can work more effectively then extracurricular sex education class. Furthermore, these LARC can prevent pregnancy for 3-10 years based on the method (4 ).

Disadvantage: Long-Acting Reversible contraceptive (LARC) is expensive for most adolescence as it requires an upfront cost for supplies (4). Also, there is some risk associated with it if the provider lacks appropriated training on insertion and removal of LARC. Also, it does not provide protection from the Sexually transmitted disease

Allocate funds to support confidential family planning and preventive service such as low-cost LARC, training the healthcare providers on LARC insertion and removal, and resign the pregnancy prevention program.

Advantage: these funds can be used to develop the clinical guidelines that can train providers on a safe and effective way to insert and remove LARC products, which can prevent unplanned teenage pregnancy. Additionally, the LARC is an expensive option for a low-income family, so the fund can be used to pay a portion of the cost or make it no-cost options for LARC. Currently, one fund called “Title X” of planned parenthood exists which prevented one million unintended pregnancy in 2014. However, this program is the verge of losing funds because of political reasons (3). Additionally, the funding can be used to redesign the pregnancy prevention program because these programs need to be specifically designed to serve adolescent respective to their culture, religion and socioeconomic background.

Disadvantage: These funds will have to come from the federal government, which means the political environment can impact the amount and duration of the funds. For example, one of the funds “Title X” is under threat to lose money, which can cause many teenagers to lose access to effective birth control and give rise the unwanted pregnancy (3).

Policy Recommendation: 

Abstinence is the best way to prevent teenage pregnancy but 43% of teens between the age of 15-19 are currently sexually active (4). So, abstinence is not convenient and does not fit the adolescence need. However, 90% of these sexually active teens use some form of birth control. Unfortunately, these teens are using less effective methods, condoms & birth control pills, which could be the reason for having still a high teen pregnancy rate. Therefore, I recommend the health care providers inform the adolescence about effective birth control methods such as intrauterine devices and implants to prevent becoming parents at a young age. However, the healthcare provider should also inform the teens about sexually transmitted diseases as effective birth control does not provide protection. Since, healthcare providers are credible, respected and admired in the society, adolescence will be more willing to adhere to health care provider’s advice compare to other people.

Sources:

1. https://www.onlymyhealth.com/sex-education-in-schools-pros-cons-1310535352
2. https://www.plannedparenthood.org/learn/for-educators/whats-state-sex-education-us
3. https://www.romper.com/p/defunding-planned-parenthood-the-pros-cons-prove-a-danger-to-women-28401
4. https://www.cdc.gov/vitalsigns/larc/index.html
5. https://www.purdue.edu/hhs/hdfs/fii/wp-content/uploads/2015/06/pf_fis15report.pdf
6. https://medcraveonline.com/MOJPH/MOJPH-03-00054.pdf
7. http://www.ncsl.org/research/health/teen-pregnancy-prevention.aspx
8. https://www.cdc.gov/teenpregnancy/about/index.htm