Teen Pregnancy

1. Teen Pregnancy Misty Thompson DO August 19, 2011

2. Financial Disclosures • I do not have any financial or beneficial relationship to disclose that may pose a conflict of interest

3. Objectives • Review statistics regarding teen pregnancy trends • Discuss available options for pregnant teens • Discuss maternal and neonatal morbidities as they relate to teenage pregnancy • Review how the media can affect teen pregnancy • Discuss the physician’s role in pregnancy prevention, discussion of options, and prenatal care.

4. Teen Pregnancy Statistics • The US has the highest rates of teen pregnancy and births in the western industrialized world • Teen pregnancy costs the world approx. $10 billion annually • 34% of young women become pregnant before the age of 20 (approx. 820,000/yr)

5. State Levels & Trends • Between 2000-2005, teen pregnancy rates declined in every state except North Dakota • States with the highest teenage birth rates are MS, TX, NM, AR, AZ • The states with the lowest teenage birth rates are NH, VT, MA, CT, NJ.

7. Facts on Teen Pregnancy • Very few teens who become mothers plan on doing so; 82% are unintended, and teens account for 20% of unintended pregnancies annually • Two-thirds of teen pregnancies occur among 18-19 year olds • Accounts for 11% of all US births

8. Facts on Teen Pregnancy • Out of all teen pregnancies, 57% end in birth • 14% result in miscarriage • 29% are terminated by abortion • US teen pregnancy rates are higher than those of other developed countries

9. Teen Pregnancy Risk Factors • Teens becoming sexually active earlier-pregnancy rates in among those under 15 years of age are on the rise. A large portion of these girls had an unwanted or non-voluntary experience their first time, but were more likely to go on to have more intercourse

10. Teen Pregnancy Risk Factors • Among ethnic groups, African Americans and Hispanic teens are more likely to become sexually active earlier • Socioeconomic factors-Risky sexual behaviors in teens are more likely to occur in poor families, and among those with single parents. A study found that teens girls whose fathers were not present in the home were more likely to become pregnant than those who had regular contact and good relationships with their fathers .

11. Teen Pregnancy Risk Factors • Parents’ education levels-Those teenagers whose parents have lower levels of education are more likely to engage in risky sexual behavior, and more likely to become pregnant.

12. Teen Pregnancy Risk Factors • Teen religious involvement-Teenagers who have a low occurrence involvement in religious activities are more likely to experience teen pregnancy. Involvement in religious activities is one of the strongest factors related to delayed sexual activity.

13. Teen Pregnancy Risk Factors • Educational involvement-Teens that focus on school activity are less likely to engage in intercourse, and are more likely to use birth control when they do. • Drug & alcohol use-Inhibition reducing drugs & alcohol may encourage unintended sexual activity (cannabis & amphetamines)

14. Teen Pregnancy Risk Factors • Age discrepancy in relationships-studies in the US indicate that age discrepancy between the teenage girls and the men who impregnate them is an important contributing factor. Teenage girls in relationships with older boys, and in particular with adult men, are more likely to become pregnant than teenage girls in relationships with boys their own age.

15. Teen Pregnancy Risk Factors • Sexual abuse-between 11 and 20 percent of pregnancies in teenagers are a result of rape, while 60% of teenage mothers had unwanted sexual experiences preceding their pregnancy. Studies have found a strong link between childhood sexual abuse and teen pregnancy. Up to 70% of women who gave birth as a teen report being molested as young girls.

16. Teen Pregnancy Risk Factors • Dating violence-Studies show teens are often in abusive relationships at the time of conception, and the knowledge of their pregnancy intensifies controlling or violent behaviors of their boyfriends. 51% of teenage mothers have experienced birth control sabotage, 21% experienced school or work sabotage

17. Teen Pregnancy Prevention • In the US, the topic of sex education is the subject of much debate. “Abstinence-only” education & virginity pledges are becoming more popular in some schools. However, 88% of those who pledge abstinence have premarital sex anyway. Most public schools offer abstinence education along with advice about contraception.

18. Teen Pregnancy Prevention • Relationships with inequalities tend to be associated with lower contraceptive use & consistency • Condom use is more frequent with casual sexual partners • Consistent birth control use occurs in relationships where partners have discussed birth control prior to first having sex

19. Teen Pregnancy Prevention • Discussions between sexual partners about condoms and sexual histories are consistently linked with improved condom use • The younger teenagers are at the time of sexual encounters with their partners, the less likely they are to use birth control.

20. Teen Pregnancy Prevention • Family and individual characteristics such as higher family socioeconomic status, living with both biological parents, and receiving sex education are associated with improved contraceptive use and consistency.

21. Teens and Birth Control • There are many reasons teens may not use birth control, even if they do not want to have a baby. They may: • Think they will not get pregnant • Be afraid to go to a health care provider or clinic to ask for birth control • Not know how to get birth control or think they cannot afford it

22. Teens and Birth Control • Worry about their parents finding out • Be afraid of what their partner thinks about birth control • Think that birth control might hurt their ability to get pregnant in the future • Have sex that was not planned • Think they will not get pregnant the first time they have sex

23. Teens and Birth Control • In most states, minors (people younger than 18 years) have the right to make choices about birth control without their parents’ permission. • Inform patients that if they use their parents’ health insurance to pay for birth control or a provider’s visit, it may appear on a bill that the parents receive

24. Teens and Birth Control • Education about how pregnancy occurs will help teens understand how the different methods of birth control work • Discuss emergency birth control

25. Options for Pregnant Teens • When a teen pregnancy occurs, the young woman is faced with a decision as how to proceed with the pregnancy and/or birth. • There are three choices available: adoption, abortion, and teen parenting.

26. Adoption • Adoption is the least prevalent option among pregnant teens. • Only 1-2% of women place their children up for adoption, and the number of teens who place their babies for adoption has declined sharply over recent decades. • There are 3 adoption types: closed, semi-open, open

27. Closed Adoption • A confidential adoption in which the adoptive family and birth mother remain confidential, with no contact prior to or after the placement of the child. For many generations, it was common practice to keep all adoptions closed. Some people believe closed adoptions to be safer, mainly out of a fear that if the birth parents know where the adoptive family lives, that they will take back the adopted child.

28. Semi-Open Adoption • The adoptive family and birth parents usually will know basic information about each other, such as their first names and state of residence. Complete contact information, such as phone numbers and addresses, are not shared. While adoptive families and birth parents may speak to one another prior to the birth of the child, some confidentiality is maintained.

29. Semi-Open Adoption • Once the child has been placed with the adoptive family, the birth parents may still stay in contact with the family via letters and pictures, however this correspondence is handled by a third party, such as the adoption agency.

30. Open Adoption • Open adoption typically means that the birth parents and the adoptive family speak prior to and even after the child is born. This may include phone calls and face-to-face visits.

31. Open Adoption • Some adoptions of this nature are very open, with the adoptive family and birth parents exchanging contact information and agreeing to periodic visits by the birth parents as the child grows. It is also common in open adoptions for the adoptive family to mail pictures and letters to the birth parents.

32. Abortion • Of teenagers who become pregnant, 29% choose to have an abortion rather than bear a child. • Many states have enacted laws that restrict teenagers' access to abortion by requiring parental involvement in the abortion decision.

33. Abortion • Parental notification laws-require medical personnel to notify a minor's parent(s) of her intention to obtain an abortion • Parental consent laws-require medical personnel to obtain written permission from the parents before providing an abortion • Almost all of the parental notification and consent laws have judicial bypass options that allow a teen who feels she cannot involve her parents to get a judge's permission to proceed with her abortion.

34. Abortion • Abortion providers encourage teenagers to tell a parent or another important family member about their plans. Even without state laws, one or both parents of 61% of minors know about their daughters' abortions. The younger the teen, the higher the likelihood that she has told her mother about the situation.

35. Abortion • Those young women who do not or cannot tell their parents often have important reasons such as a family history of alcoholism, abuse, or incest. To involve such parents could invite further abuse of the teenager. • Rather than tell their parents, some teenagers resort to unsafe, illegal abortions or try to perform the abortion themselves. In doing so, they risk serious injury, death, or criminal charges.

36. States Ranked by Rates of Teen Abortion • New Jersey (47) • New York (46) • Maryland (38) • Nevada (36) • California (36) • Hawaii (34) • Florida (33) • Delaware (31) • Connecticut (30) • Illinois (27)

37. Teen Parenting • Over half of teen pregnancies end with the woman choosing to deliver and rear the child. • Teen mothers are less likely to complete high school or college than women who delayed having children, and fewer than 1/3 of teen mothers complete high school.

38. Teen Parenting • 80% of teen mothers receive welfare at some point. • 25% of teen mothers have another child within two years of their first birth. • Teen pregnancy often creates a cycle of poverty, crime, and further teen pregnancy.

39. Teen Parenting • Sons of teen mothers are 2.7 times more likely to go to prison than sons of women that had children after the age of 20 • Children of teenage mothers are twice as likely to be abused and neglected than children born to women over the age of 20.

40. Pregnancy Complications • There are special risks to a baby when the mother is not fully mature. Because most teenagers are not physically, emotionally, or financially ready to carry and care for a child, their babies tend to have LBW & are predisposed to a variety of illnesses. A teen mother will need the full support of her family to live a healthy lifestyle for her and her baby.

41. Pregnancy Complications • Compared with older age groups, teen mothers are at greater risk of having medical complications. • Because the teenage mother is more likely to receive little or no prenatal care, she often becomes anemic • Teens are more likely to develop preeclampsia & have preterm labor

42. Pregnancy Complications • Vitamin deficiencies are more common • A teenage mother’s weight gain is likely to be inadequate-since the mother is still growing herself, she needs to eat properly not only for her own growth but for normal growth of the fetus.

43. Pregnancy Complications • Pelvic bones do not reach their maximum size until about the age of 18; therefore, the pelvis of the teenage mother may not have grown enough to allow vaginal delivery of a normal-size baby. For this reason, the incidence of cesarean section is higher in teenage mothers

44. Pregnancy Complications • Babies born to teenage mothers are more likely to die in the first year of life compared with babies born to mothers older than 20 years of age. • Since the teenage mother is less likely to eat correctly during pregnancy, her baby often has a low birth weight, making it more likely the baby will become ill. • Teens are more likely to smoke, drink, or take drugs during pregnancy

45. Pregnancy Complications • The teenage mother should be encouraged to seek prenatal care early in pregnancy, eat a nutritious diet, take prenatal vitamins, and engage in healthy physical activity. A supportive family can help the teenage mother cope with her new responsibilities, and social service agencies may be needed to help find ways to finish school and seek employment.

46. Children Born to Teen Mothers • Children born to teenage mothers are less likely to receive proper nutrition, health care, and cognitive and social stimulation. As a result, they are at risk for lower academic achievement. • Children born to teenage mothers are at increased risk for abuse and neglect.

47. Children Born to Teen Mothers • Babies born to women who do not have regular prenatal care are 4 times more likely to die before the age of 1 year. • Girls born to teenage mothers are 22% more likely to become teenage mothers themselves.

48. Is the Media Glamorizing Teen Pregnancy?

49. Teen Pregnancy and the Media • Teen pregnancy has gained significant attention in the media in recent years (from MTV’s popular shows 16 & Pregnant and Teen Mom to recent cover stories in major magazines). • Some have criticized these efforts for glamorizing teen pregnancy. New research suggests that teens do not share that view.

50. Teen Pregnancy and the Media • According to a poll by The National Campaign to Prevent Teen and Unplanned Pregnancy, most teens (79% of girls & 67% of boys) agree that when a TV show or character they like deals with teen pregnancy, it makes them think more about their own risk of getting pregnant or causing a pregnancy and how to avoid it.