Adolescent Pregnancy and Parenting

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Adolescent Pregnancy and Parenting Policy Hearing Panel Second Round Revision BACKGROUND The social work profession is in a distinctive position to respond to the issues of adolescent pregnancy and parenting. Because social workers assess problems and needs from an ecological perspective considering individual, family, and community factors, and utilize comprehensive approaches to resolving problems, the profession can have a broad impact on issues regarding adolescent pregnancy and parenting. The issues of adolescent pregnancy and parenting are multifaceted and do not have a single root cause. As such, no single methodology exists for impacting adolescent pregnancy prevention, for supporting adolescent parents in parenting their children, or for overcoming the challenges adolescent parents face. 16 17 18 19 20 21 22 23 24 25 26 In looking at the issues of adolescent pregnancy and parenting, social work takes into account the medical, social, economic, familial, racial, ethnic, cultural and all other ecological factors impacting and influencing the adolescent. To better understand the issue, it is valuable to look at where the United States ranks in comparison to other developed, industrialized countries. In spite of a large decline over the course of the last 12 years, the United States continues to have the highest adolescent pregnancy rate of industrialized and developed countries (National Campaign to Prevent Teen Pregnancy, 2004b). In fact, recent decreases have only moved the U.S. rates to where similar countries were in the 1990s (Darroch, Singh, Frost, & Study Team, 2001). As a point of comparison, the adolescent pregnancy rate of the United States is nearly twice that of 1

27 Canada and Great Britain (Boonstra, 2002). 28 29 30 31 32 33 34 35 36 Although the rate of adolescent pregnancy in the United States has been declining over the past 15 years, each year almost 750,000 adolescent women become pregnant. Almost eight in 10 of these pregnancies are unintended (Alan Guttmacher Institute, 2006a; Boonstra, 2002). In the United States, about 57 percent of adolescent pregnancies result in a birth (Alan Guttmacher Institute, 2006a). The percentage of adolescent males who are involved in pregnancies is small with only 3 percent of 15 year to 19 year olds being fathers and only 7 percent of the births each year involving adolescent males (Alan Guttmacher Institute, 2002). 37 38 39 40 41 42 43 44 45 46 47 48 49 Many teenage women reported that their early sexual experiences resulted from peer pressures, including efforts to sustain a relationship, and were not as pleasurable as had been anticipated (Dodson, n.d.; Luker, 1996). Pregnancies of adolescents aged 15 years and under (approximately 3 percent per year) account for the smallest number of adolescent pregnancies and these pregnancies are frequently related to sexual exploitation or sexual assault of the adolescent by the present partner, or to sexual abuse of the adolescent by other adults in or outside of the family. Seven in 10 girls who had sexual intercourse before age 13 reported the experience was involuntary. The younger the adolescent mother, the more likely that her male partner was 10 or more years older than she (Alan Guttmacher Institute, 1999a). There is also a strong link between adolescent pregnancy and sexual abuse for not only females but males as well (Saewyc, Magee, & Pettingell, 2004). 2

50 51 52 53 54 55 56 57 58 59 60 Like many social issues, adolescent pregnancy and parenting impact minority populations disproportionately. The decline in adolescent pregnancy has been sharpest in the African American population with the pregnancy rate for 15 year to 19 year olds declining 40 percent between 1990 and 2002 (Alan Guttmacher Institute, 2006b), although adolescent pregnancy rates are still highest among African Americans. In births to adolescent mothers, Latinas have the highest rate (83 births per 1,000 girls) compared to African Americans (63 per 1,000) and Caucasians (27 per 1,000) (Kaiser Family Foundation, 2006). Although adolescent Latinas had a slight increase in pregnancy rates from 1991 to 1992, by 2002, the rate was 19 percent lower than in 1990 (Alan Guttmacher Institute, 2006b). 61 62 63 64 65 66 67 68 69 70 71 72 Many factors account for the difference in the adolescent pregnancy rates among Western industrialized countries. Much attention has been paid to the success of countries such as France, Sweden, and Great Britain in preventing and lowering their rates of adolescent pregnancy. The United States could gain valuable knowledge about preventing and addressing the issue of adolescent pregnancy by examining the resources and methods that other industrialized countries use. A common misperception is that other countries have lower rates of sexual activity among their adolescents; however, an examination of rates of sexual activity among adolescents in the United States and other industrialized countries show little difference in the rates of sexual activity. Indeed, abortion rates are lower in countries such as Great Britain, France, Canada, and Sweden despite having similar sexual activity as the United States. Since rates of sexual activity 3

73 74 75 do not explain higher adolescent pregnancy rates in the United States, other factors must be considered and examined, particularly the significance of contraceptive use among adolescents (Darroch et al., 2001). 76 77 78 79 80 81 82 Other factors that contribute to the higher rates in the United States include a higher proportion of adolescents growing up in socially and economically disadvantaged situations; lower tolerance of adolescent sexual activity coupled with limited comprehensive sexuality education for many youth; and challenges to accessing contraceptives and other reproductive health care services (Alan Guttmacher Institute, 2001). 83 84 85 86 87 88 89 90 91 92 93 94 95 ISSUE STATEMENT The social work profession has long been concerned about the issues of unintended adolescent pregnancy and adolescent parenting. The implications of adolescent pregnancy and parenting are far reaching and affect not only adolescent parents but also their families and communities. Although there have been dramatic decreases in adolescent pregnancy across the country over the last 12 years, those adolescents and their families affected by an unintended pregnancy continue to face educational, economic, and health challenges. Even though declines in the rates of adolescent pregnancy include all races and ethnicities, adolescent pregnancy impacts minority communities in a different and significant way. At times, changes in the political and cultural environment of the country may erode the support necessary to overcome the challenges surrounding adolescent pregnancy and solutions become controversial, 4

96 97 hindering professionals from having access to resources to prevent and address adolescent pregnancy. 98 99 100 101 102 103 104 105 106 107 108 109 Reproductive Technology Advances in reproductive technology have had a major impact on the decline in adolescent pregnancy over the last 12 years. Methods of contraception, including delivery systems that last longer and encourage compliance with the administration of the contraceptive, are responsible for approximately 86 percent of the decline in adolescent pregnancy. This pattern of decline has been observed in other industrialized countries as well (Santelli, Lindberg, Finer, & Singh, 2007). Access to this technology is not without difficulty as more states are considering expanding required parental notification and consent to include birth control methods. Even with the advances in reproductive technology, many communities still lack access to affordable, confidential, publicly funded reproductive health care (Frost, Frohwirth, & Purcell, 2004). 110 111 112 113 114 115 116 117 118 Emergency contraception is an option for reducing adolescent pregnancy, and because it is taken after the act of sexual intercourse, it is viable for those adolescents who did not plan to have sex. Although it is available over the counter for women 18 years of age and older, younger females must still access formal medical services to use this method. Male Involvement Programming and research on adolescent parents has traditionally focused on the adolescent mothers. The stereotypes that adolescent fathers are not involved with their 5

119 120 121 122 123 124 125 children, are irresponsible and only care about sexual fulfillment often drive prevention and intervention programming which may cause negative impacts on adolescent fathers who want to access resources. The limited data available about adolescent fathers indicate that adolescent fathers want to be involved in the lives of their children, and are involved even if the involvement does not include financial support (Kimball, 2004). This data suggests that programs must be more inclusive of fathers, and that different methods of outreach and engagement are needed to involve them in services and programming 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 Maternal and Child Health We know that adolescents access prenatal care later in the pregnancy or sometimes not at all (Child Trends DataBank, 2007). Often this is related to the fear and secrecy that might surround the pregnancy. The impact of the lack of prenatal care results in adolescents having negative birth outcomes with a higher number of their babies born early, with low birth weights, or to die before age one (Reichman & Pagnini, 1997). All of these factors have a potential negative impact on the well-being of the baby as well as the mother s health. The ability of adolescents to engage confidential contraceptive, abortion, and prenatal services without parental consent is critical to the overall health of not only the adolescent, but also the pregnancy and, if she chooses to maintain the pregnancy, the baby. When appropriate and acceptable to the adolescent, involvement of a supportive adult may be helpful. Thirty-four states now require some sort of parental involvement in a minor s decision to have an abortion, up from 18 states in 1991 (Kaiser Family Foundation, 2006). Some states are also exploring consent or notification laws for minors use of 6

142 143 contraceptive services. These efforts would have a negative impact on the prevention of adolescent pregnancy and create an increase in negative maternal and child outcomes. 144 145 146 147 148 149 Another factor in maternal health is repeat pregnancies. Second pregnancies are an issue for adolescent mothers, with 42 percent becoming pregnant within 24 months of birth of the first child (Raneri & Wiemann, 2007). The implications of additional children stretch not only to the health of the adolescent mother, but to the potential impact on her ability to parent multiple children and on her economic well-being. 150 151 152 153 154 155 156 157 158 159 160 161 162 163 Educational Attainment and Poverty The negative impact of an adolescent pregnancy on educational attainment and future employment and earning power is well documented. Adolescent mothers complete high school at much lower rates and go on to college less often than their contemporaries (Hofferth, Reid, & Mott, 2001). Clearly, there is a link between the ability to complete high school and going to college and income stability. Adolescent parenting disproportionately has an impact on those already in poverty and can serve as a tie to that income status over the longer term. Adolescents in the United States who give birth are much more likely to come from poor or low-income families (83 percent) than those who have abortions (61 percent) or teens in general (Alan Guttmacher Institute, 1999b, p. 4). Adolescent mothers have an increased likelihood of ending up on welfare, with almost one-half receiving welfare benefits within five years of the birth of their first child (National Campaign to Prevent Teen Pregnancy, 2002). 164 7

165 166 167 168 169 170 Generational Impact Adolescent pregnancy has long had a generational impact, with daughters of adolescent mothers being more likely to go on to become adolescent parents themselves some estimate by 22 percent. The sons of adolescent mothers are also disadvantaged, with 13 percent more likely to end up in prison (National Campaign to Prevent Teen Pregnancy, 2002). 171 172 173 174 POLICY STATEMENT Within the context of culturally appropriate and sensitive practice, and based in the NASW values and ethical principles, it is the policy of NASW to support and further: 175 176 177 178 179 180 181 182 183 184 185 186 187 Services that are responsive to the needs and desires (including developmental, ecological, familial, bio-psycho-social, mental health, etc.,) of the client or clients (individual, families, groups, organizations, and/or communities) being served; Services and supports that are safe, legal, affordable, and confidential; Comprehensive health education and services for all adolescents; A comprehensive approach to sexuality education for all adolescents, including but not limited to, physiology of sexuality and sexual relations, emotional aspects of romantic relationships, pregnancy prevention (including abstinence and contraception), realistic mock parenting activities, etc.; Comprehensive family planning services for all adolescents; Comprehensive services to adolescents who become pregnant, including but not limited to, health care, education (mainstream and alternative programs to meet 8

188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 all young parents needs), parenting education and support, social and emotional well-being support (including infant mental health and other mental health services), legal services, etc.; Adherence to Title IX of the National Education Act that protects pregnant and parenting adolescents from discrimination in the public schools, denial of access to education, and exclusion from participation in school activities because of pregnancy or parenting; Comprehensive services to young males who father babies of adolescent mothers, including but not limited to, education (mainstream and alternative programs to meet all young parents needs), parenting education and support, social and emotional well-being support (including infant mental health and other mental health services), legal services, etc.; Responsible and nurturing involvement of young fathers in their children s lives from the prenatal period all throughout their lives, when appropriate and possible; Comprehensive services to the children of adolescent parents, including but not limited to health care, education, services to promote social and emotional well being, etc.; Financial support that enables rather than hinders adolescent parents engagement in their primary responsibilities of parenting and completing an education. 207 208 209 210 References Alan Guttmacher Institute. (1999a). Teenage pregnancy: Overall trends and state-by- state information. Washington, DC: Author. 9

211 212 213 214 215 Alan Guttmacher Institute. (1999b). U.S. teenage pregnancy rate drops another 4% between 1995 and 1996 [Press release]. Washington, DC: Author. Retrieved June 15, 1999, from http//www.agi-usa.org/pubs/archives/newsrelease_teenpreg.html 216 217 218 Alan Guttmacher Institute. (2001). Can more progress be made? Teenage sexual and reproductive behavior in developed countries. Washington, DC and New York: Author. 219 220 221 Alan Guttmacher Institute. (2002). Their own right: Addressing the sexual and reproductive health of American men. Washington, DC and New York: Author. 222 223 224 Alan Guttmacher Institute. (2006a). Facts on American teens sexual and reproductive health. Washington, DC and New York: Author. 225 226 227 Alan Guttmacher Institute. (2006b). U.S. teenage pregnancy statistics national and state trends and trends by race and ethnicity. New York: Author. 228 229 230 Boonstra, H. (2002). Teen pregnancy: Trends and lessons learned. Guttmacher Report on Public Policy, 5(1), 7-10. 231 232 Child Trends DataBank. (2007). Late or no prenatal care. Washington, DC: Author. 233 10

234 235 236 Darroch, J. E., Singh, S., Frost, J. J., & Study Team. (2001). Differences in teenage pregnancy rates among five developed countries: The roles of sexual activity and contraceptive use. Family Planning Perspectives, 33(6), 244-250 & 281. 237 238 239 Dodson, L. (n.d.). We could be your daughters: Girls, sexuality and pregnancy in low- income America. Cambridge, MA: Radcliffe Public Policy Institute. 240 241 242 243 Frost, J. J., Frohwirth, L., & Purcell, A. (2004). The availability and use of publicly funded family planning clinics: U.S. trends, 1994 2001. Perspectives on Sexual and Reproductive Health, 36(5), 206 215. 244 245 246 Hofferth, S. L., Reid, L., & Mott, F. L. (2001). The effects of early childbearing on schooling over time. Family Planning Perspectives, 33(5), 259-267. 247 248 249 Kaiser Family Foundation. (2006). Sexual health statistics for teenagers and young adults in the United States. Washington, DC: Author. 250 251 Kimball, C. (2004). Teen fathers: An introduction. Prevention Researcher, 11(4), 3-5. 252 253 254 Luker, K. (1996). Dubious conceptions: The politics of teenage pregnancy. Cambridge, MA: Harvard University Press. 255 11

256 257 258 National Campaign to Prevent Teen Pregnancy. (2002). Not just another single issue: Teen pregnancy prevention s link to other critical social issues. Washington, DC: Author. 259 260 261 National Campaign to Prevent Teen Pregnancy. (2004b). Teen birth rates: How does the United States compare? Washington, DC: Author. 262 263 264 Raneri, L. G., & Wiemann, C. M. (2007). Social ecological predictors of repeat adolescent pregnancy. Perspectives on Sexual and Reproductive Health, 39, 39 47. 265 266 267 Reichman, N. E., & Pagnini, D. L. (1997). Maternal age and birth outcomes: Data from New Jersey. Family Planning Perspectives, 29(6), 268-272 & 295. 268 269 270 271 Saewyc, E. M., Magee, L. L., & Pettingell, S. E. (2004). Teenage pregnancy and associated risk behaviors among sexually abused adolescents. Perspectives on Sexual and Reproductive Health, 36(3), 98-105. 272 273 274 275 Santelli, J. S., Lindberg, L. D., Finer, L. B., & Singh, S. (2007). Explaining recent declines in adolescent pregnancy in the United States: The contribution of abstinence and improved contraceptive use. American Journal of Public Health, 97, 150-156. 12