Teen pregnancy is an issue that affects thousands of Americans each year. Understanding the causes of this health issue can help drive research into new solutions to lower the teen pregnancy rate. One way to understand why and how teen pregnancy exists is to look at an ecological model (also called the Human Ecology Theory). According to Urie Brofenbrenner, there are five environmental systems that one can encounter throughout the lifespan that may influence behavior (refer to appendix A for representation). These systems start small (like the microsystem, which is the direct environment) all the way up to the Chronosytem, which includes socio-historical contexts and major cultural shifts (Brofenbrenner, 1994).
In the context of teen pregnancy, young girls are influenced by a variety of sources, many of which fall under the social determinants of health, making teen pregnancy a public health concern. Statistics show this is a public health concern as well. In 2012, there were 274,641 babies born to adolescent females ages 15-19, which equates to almost 27 births per 1,000 females in this age group. The rate of teen pregnancy has dramatically declined in the United States since the early 1990s. The teen pregnancy rate declined from 67.8 pregnancies per 1,000 is 2008 to 57.4 pregnancies per 1,000 females in 2010 alone (Wind, 2014). While these statistics are promising, work still needs to be done in the field of Public Health to continue this downward trend. This post will seek to evaluate teen pregnancy in the context of the ecological model, with respect to the social determinants of health. How are teens influenced in our society, and what can we do in the realm of public health to make an impact on teen pregnancy?
Although teen pregnancy rates have fallen in the past several decades, the problem still creates havoc on the lives of teens. One factor that leads teen girls to become pregnant is peer pressure. “During adolescence, teenagers often feel pressure to make friends and fit in with their peers. Many times these teens let their friends influence their decision to have sex, even when they do not fully understand the consequences associated with the act. Teenagers have sex as a way to appear cool and sophisticated, but in some cases the end result is an unplanned teen pregnancy” (Langham, 2013). Peer pressure is a significant problem that can lead to unwanted pregnancies. Teenagers, both male and female, may feel pressured to become sexually active in order to impress their peers. Some may engage in sexual behaviors before they are ready and before they have the resources available to prevent unwanted pregnancies.
Who’s at the highest risk for teen pregnancy? Unfortunately, adolescence raised in lower socioeconomic families, with fewer resources available to them. One study found girls between the ages of 15-17 and living in areas with greater income inequality experienced higher rates of pregnancy, regardless of race or ethnicity. Education and employment affect a person’s likelihood for teen pregnancy; high school dropouts and unemployed teens are at greater risk than those with higher education and jobs. (Penman-Aguilar, Carter, Snead, & Kourtis, 2013). Employment prospects are often dependent on education and the higher the education, the better the pay and access to resources.
One of the main issues in teen pregnancy is the availability and affordability of health care resources. Most teens that are sexually active, who come from low-income families, do not have insurance that covers contraceptives such as condoms, pills, injections, implants and IUDs and are not able to afford them on their own. Planned Parenthood has suggested that an increase in insurance coverage for contraceptives will help reduce teen pregnancy (Planned Parenthood, 2013). In other countries where they have low pregnancy rates, contraceptive services and devices are provided to teens free of charge. Fortunately in 2012 the Affordable Care Act (ACA) started making contraceptives available to most women without co-pay (Planned Parenthood, 2013).
Another solution that Planned Parenthood proposed is to use public funding and starting prevention programs. Women who are low-income are more likely to have an unintended pregnancy than higher-income women. Public funding will help reduce pregnancy rates among the poor by giving them access to affordable health care and contraceptives. Not only is public funding effective in preventing pregnancies, it is also cost-effective. "Every dollar spent on publicly subsidized family planning services saves $3.74 on costs that would otherwise be spent on medical care, welfare benefits, and other social services to women who became pregnant and gave birth" (Planned Parenthood, 2013).
Most communities provide youth development programs for teens in low-incomes family. These programs can help lower pregnancy rates. However, they do not actually target or address the real problem, which is poverty. There also needs to be specialized programs for teens that identify as lesbian or bisexual, are involved in abusive relationships or have older partners. These teens are more likely to become pregnant, therefore, they need programs that can address their needs and help them find services (Planned Parenthood, 2013). Organizations such as the Center for Disease Control and Prevention and The National Campaign to Prevent Teen and Unintended Pregnancy are constantly working on and creating programs for low-income and at risk teens to lower teen pregnancy rates.
The year 2009 marked the beginning of new ways of thinking about sex education in the United States when federal funds previously allocated for abstinence education expired (Stanger-Hall & Hall, 2011). The overarching purpose of sex education is noted as reducing the occurrence of teen pregnancy. A multiplicity of government agencies with health focuses negotiated a bill that annexed over 100 million dollars to the funding of comprehensive sex education for the 2010 fiscal year. Although the research community was in outstanding agreement about the failure of abstinence education to reduce teen pregnancy, the finance committee still sequestered 250 million dollars to abstinence education. States were then given the option to choose between abstinence-only education and comprehensive sex education (Stranger-Hall & Hall, 2011).
Stranger-Hall and Hall (2011) recognize the presence of certain social-ecological influences on teen pregnancy rates as well. In order to include these factors as possible mediators between the reduction of teen pregnancy cases and comprehensive sex education, they are operationalized as individual educational attainment, socio-economics like household income, and ethnic background. Access to family planning was also measured as a possible mediator. Researchers found that the level of implementation of comprehensive sex education determined the level of adherence, in other words, lower levels of teen pregnancy. Demographic and ecological factors reflected some difference; however, overall, states that implemented sex education programs that initiated some kind of deviation from traditional abstinence education forms had lower levels of occurring teen pregnancy.
Another major study suggested that the level of implementation in many states is contingent on the level of religiosity of communities (Cavazos-Rehg, Krauss, Spitznagel, Iguchi, Schootman, Cottler, & Beirut, 2012). States with higher levels of religiosity were strongly associated with fewer family planning and sexual education resources and higher rates of teen pregnancy in girls, ages fifteen to seventeen. This study does not look at comprehensive sex education specifically; however, it does posit that states that welcome at least teaching condom use had fewer occurrences of teen pregnancy.
Teen pregnancy is an ongoing public health concern that we have the power to reduce in this nation. Unfortunately, the solution is not a simple, one step process because the issue itself is complex and stems from a number of social determinants. However, teaching comprehensive sex education has shown to be successful, the state of California was able to cut their teen pregnancy rate in half over the course of a decade (Boonstra, 2010). In communicating about teenage pregnancy we’re raising awareness to the issue, instead of sweeping it under the rug. Websites, resources, and even television shows offer teens a safe place to have open dialogue or view outcomes of teen pregnancy, before it’s too late (Wellesley College, 2014). All of these resources work as prevention.
Why do we think we can change the future of teen pregnancy? Because all the data tells us we can. Funding of comprehensive sex education programs, communication, and access to resources has proven to help lower the teen pregnancy rate. By providing adolescence the knowledge and tools, we are empowering them to take control of their bodies and make more informed decisions that will impact their lives. Studies show teens are going to have sex regardless, so we might as well talk to them about it.
Appendix A (Bronfenbrenner, 1994)
References
Boonstra, H. D. (2010). Winning campaign: California’s concerted effort to reduce its teen pregnancy rate. Guttmacher Policy Review, 13(2), 18-24.
Bronfenbrenner, U. (1994). Ecological Models of Human Development. Oxford: Elsevier Sciences, 3(2), 36-42.
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Iguchi, M., Schootman, M., Cottler, L., Grucza, R.A., & Bierut, L. J. (2012, February). Associations between sexuality education in schools and adolescent birthrates: a state-level longitudinal model. Archives of pediatrics & adolescent medicine,166(2), 134-140.
Langham, R.Y. (2013). “What Are the Causes of Teenage Pregnancy?” Livestrong. Retrieved from http://www.livestrong.com/article/146681-what-are-the-causes-of-teenage-pregnancy/
Penman-Aguilar, A., Carter, M., Snead, M. C., & Kourtis, A. P. (2013). Socioeconomic disadvantage as a social determinant of teen childbearing in the US. Public Health Reports, 128(Suppl 1), 5.
Planned Parenthood. (2013, July). Reducing Teenage Pregnancy. Retrieved from http://www.plannedparenthood.org/files/6813/9611/7632/Reducing_Teen_Pregnancy.pdf
Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: Why we need comprehensive sex education in the US. PloS one, 6(10), e24658.
Wellesley College. (2014). New study finds MTV’s '16 and Pregnant,' 'Teen Mom' contributed to record decline in U.S. teen childbearing rate. Science Daily. Retrieved from http://www.sciencedaily.com/releases/2014/01/140113095145.htm
Wind, R. (2014). U.S. Teen Pregnancy, Birth and Abortion Rates Reach Historic Lows. Retrieved from https://guttmacher.org/media/nr/2014/05/05/index.html
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