Teen Pregnancy

Introduction

  • The US has one of the highest rates of teen pregnancy among developed countries. However, the rate is dropping.
  • In 1991, 61.8 per 1,000 teens gave birth compared to 26.5 per 1,000 in 2013.
  •  73% of teen births in 2013 involved teens between the ages of 18-19.
  • In 2013, 273,105 babies were born to teenagers between the ages of 15-19. However, more then 750,000 teens became pregnant.
  • 77% of teen pregnancies were unplanned or occurred before the parents were ready
    • 60% resulted in live birth, 15% in miscarriage, and 30% in abortion
  • Women <21 years old were twice as likely to have unintended pregnancy on short acting contraception methods
  • 93% of male and 86% of female teens ages 15-19 used contraception the last time they had sex in the previous 3 months.
    • However, 85 % of male and 78 % of female teens age 15-19 used contraception the first time they had sex.
  • In a CDC study from 2004-2008, teens reported they were not using contraception because:
    • They didn’t think they would become pregnant (31%)
    • They weren’t concerned about becoming pregnant (22%)
    • Their partner didn’t want to use contraception (24%).
  • In only 18% to 35% of teen pregnancies was the father also under the age of 20
  • Poor outcomes of teen pregnancy are associated with maternal adverse childhood experiences:
    • Physical, sexual, and emotional abuse
    • Divorced parents
    • Living with someone with substance abuse or mental illness
  • Men who have experienced adverse childhood experiences are more likely to have a child with a teen mother
  • Teen pregnancy in the US results in a cost of approximately $11 billion annually once you consider foster care, health care, increased incarceration rates and lost tax revenue.

Repeat Pregnancies

  • A second pregnancy is seen in 35% of teen mothers within 2 years of their first child’s birth. 
  • Repeat pregnancy is more likely to be intentional than a teen’s first pregnancy.
  • Factors associated with increased rates of repeat pregnancy:
    • Being married or living with her partner
    • Receiving major child care support from the teen’s mother
    • Not returning to school within 6 months of delivery
    • Not using long acting contraception method within 3 months of delivery

Teen birth rates vary by age group, race, and geographic location

TP_1.pngSource: http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf 

TP_2.pngSource: http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/...

TP_3.pngSource: http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/...

 

Factors associated with increase rates of teen pregnancy

  • Intimate partner violence
  • Having friends who are also teen parents
  • Mood disorders
  • Being the child of a teen parent
  • Having a parent who did not attend college
  • Having limited access to employment or resources
  • Partner of an older age with lower education

Factors associated with decreased rates of teen pregnancy

  • Being enrolled in school
  • Good academic performance
  • Involved in extra-curricular activities
  • Open communication with adults and/or parents about proper contraception use
  • Having accurate information about STIs, HIV, abstinence, pregnancy, and sexual health
  • Having peers who use condoms
  • Becoming sexually active at a later age
  • Limiting the number of sexual partners
  • Living with biological parents at age 14
  • Having parental support and healthy family dynamics

Effects of teen pregnancy on teen parents

  • Limited or late prenatal care (often due to lack of resources, family support and/or education)
  • Increased rates of anemia during pregnancy
  • Increased rates of substance use during pregnancy
  • Increased rates of gestational hypertension and pre-eclampsia
  • Low maternal weight gain
  • Poverty
  • Increased rates of intimate partner violence (can lead to 1st or 2nd trimester bleeding or substance abuse)
  • Teens are less likely to complete school, which often effects household income
  • Teen fathers have increased rates of depressive symptoms than older fathers.
  • Teen fathers living separately from their children have higher rates of depressive symptoms than those who live with their children.

Effects of teen pregnancy on children

  • Increased risk of prematurity, low birth weight, and infant mortality
  • Fetal effects of increased maternal substance use and limited prenatal care
  • Increased placement into foster care
  • Increased rates of depression in teen parents can negatively impact their children’s development and behavior.
  • Children of mothers who report low-self esteem or poor interpersonal relationships are more likely to be abused or neglected.
  • Teen parents are less likely to smile, vocalize, and have stimulating interactions with their child.
  • Teen parents are more likely to have unrealistic expectations of behavior which can lead to harsh discipline of their children.
  • Increased risk of becoming teen parents themselves
  • Increased risk for incarceration

 

  • Protective factors against poor outcomes include:
    • Strong connection to family, school, and community
    • Feelings of self-worth and achievement
    • Positive interactions with their fathers

Addressing the needs of pregnant teens and their children

 

Ask

  • Take a thorough social history including sexual history, relationships, STIs, and contraceptive methods
  • Remind teens of the confidentiality of the physician patient relationship
  • Provide a safe space for teens to discuss how they feel about their pregnancy and the options available to them.
  • Ask teens about their support systems
  • Encourage teens to seek prenatal care early in the pregnancy
  • Screen for depression using tools like the Edinburgh Postnatal Depression Scale, as teen parents are at increased risk for depression in comparison to older parents.
    • Keep in mind that men are more likely to report irritability, anhedonia, sleep disturbances and fatigue rather than sadness or worthlessness
  • Screen for past and present physical, emotional, and sexual abuse and/or exploitation and incorporate social workers and mental health professionals into the patient’s care as needed
  • Pay close attention to the child’s development and provide parents with information about programs like Head Start that aim to increase school readiness

Inform

  • Provide accurate information about contraception
  • Provide anticipatory guidance and stress coping mechanisms and address the importance of positive nurturing relationships in their child’s development
  • Teach basic parenting skills at a developmentally appropriate level for the parents.
  • Utilize a multidisciplinary approach in providing the best care for teen parents and their children.
    • Help connect parents to community resources, nurse visitation programs, social services, and the Special Supplemental Nutrition Program for Women, Infants, and Children.
  • Use programs like Title XXI and Early and Periodic Screening, Diagnosis, and Treatment to provide developmental and medical services to low income teen parents and their children

Support

  • Discuss the importance of teen parents being involved in the parenting of their child even if they receive childcare help from family members.
  • If a pediatrician questions a teen’s decision-making ability, they can suggest having a co-decision maker who assists the teens in decisions regarding their child.
  • Encourage fathers to be involved in their child’s life from an early age
  • Encourage breastfeeding and help teens navigate barriers to breastfeeding at school or work
  • Advocate for the development of evidence-based programs in the community that work to reduce unintended teen pregnancies
  • Facilitate discussions about teens’ academic and professional goals.
  • Encourage teens to finish high school and pursue vocational school or higher education.
    • Help them to find educational programs, like the GRADS program, that focus on helping teen parents complete their education
  • Encourage continuation of healthy lifestyles started during pregnancy.
    • Even though teens have higher rates of substance use during pregnancy, most teens do stop or decrease their smoking or substance use during pregnancy

Additional Resources

 

References  

  1. Office of Adolescent Health (last updated 12/18/15) “Teen Pregnancy and Childbearing.”   U. S Department of Health  & Human Services.
  2. Garfield,  CF et al. (2014). “A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults.” Pediatrics, 133(5): 836-843.
  3. Magill, MK et al. (2007). “Adolescent Pregnancy and Associated Risks: Not Just a Result of Maternal Age.” Am Fam Physician, 75(9):1310-1311.
  4. Committee on Adolescence and Committee on Early Childhood, Adoption, and Dependent Care (2001). “Care of Adolescent Parents and Their Children”
  5. Pediatrics, 107(2): 429-434.
  6. Youth.gov “Pregnancy Prevention”
  7. Committee on Adolescence. (2014). “Addendum—Adolescent Pregnancy: Current Trends and Issues.” Pediatrics, 133(5): 954-957.

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