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Unintended Teen Pregnancy: An Overview

Unintended Teen Pregnancy: An Overview. Nancy L. Stanwood, MD, MPH University of Rochester Perinatal Forum September 23, 2004. Teen Pregnancy: What, Why and How Not. Epidemiology: the size of the issue Contraception: the basics Consequences: for pregnancy, teen women and their children

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Unintended Teen Pregnancy: An Overview

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  1. Unintended Teen Pregnancy: An Overview Nancy L. Stanwood, MD, MPH University of Rochester Perinatal Forum September 23, 2004

  2. Teen Pregnancy: What, Why and How Not • Epidemiology: the size of the issue • Contraception: the basics • Consequences: for pregnancy, teen women and their children • Prevention: what works, what doesn’t

  3. A Day in the Sex Life of the World 6.3 Billion people 100 million acts of sex 910,000 conceptions 360,000 births 150,000 abortions 1,400 maternal deaths 183 deaths from unsafe abortion The World Health Organization

  4. Unintended pregnancy in the U.S. is epidemic • 6 million pregnancies each year • HALF of pregnancies are unintended =3.0 million per year • HALF of these are ended in abortion =1.4 million per year Henshaw SK. Unintended pregnancy in the United States. Family Planning Perspectives. 1998;30:24-9.

  5. Unintended pregnancy in the U.S. is common • 1 in 2 women has had an unintended pregnancy • 1 in 3 women has had one or more abortion Henshaw SK. Unintended pregnancy in the United States. Family Planning Perspectives. 1998;30:24-9.

  6. Of the annual 3 million unintended pregnancies: • Half are in women using contraception • Method failure • Imperfect use • Half are in women using no contraception but who don’t want to be pregnant Henshaw SK. Unintended pregnancy in the United States. Family Planning Perspectives. 1998;30:24-9.

  7. 95% of women are using contraception Piccinino LJ, Mosher WD. Fam Plann Perspect 1998;30:4-10, 46.

  8. Ideal vs. Typical Failure Rates • Some methods work with rare motivation Ideal = Typical • Some methods require on-going behavior Ideal <Typical

  9. Trussell J. Contraceptive failure in the United States. Contraception 2004;7:89-96. < Pregnancy rate in first year of use < < < < <

  10. What Teens Contribute to the Epidemic • 38% of the 3.0 million unintended pregnancies are in teens • 33% of the 1.4 million abortions are for teens • 80% of the 1.6 million pregnancies in teens are unintended Henshaw SK. Unintended pregnancy in the United States. Family Planning Perspectives. 1998;30:24-9.

  11. The Good News • From 1991 to 2002, the teen pregnancy rate fell by 27% • From 58/1,000 to 46/1,000 • Teen pregnancy is lower now than in 1960 (89/1000) due to contraception Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  12. Teen Sex and Pregnancy • First sex: • Average of first sex of females: 17.2 years • 70% of women have sex by age 19 • Pregnancy • 22% of these teens have been pregnant • 10% of teens become pregnant each year • 50% of teen pregnancies within 6 months of first sex

  13. Teens and Contraception • 77% use contraception at first sex • Of contracepting teen women: • 44% use Pills • 37% use Condoms • 10% use DepoProvera

  14. Teens and Contraceptive Failure • Pills • Up to 50% routinely miss >2 pills a month • Up to 30% typical pregnancy rate • Condoms • Most use inconsistently (early in relationship) • Up to 50% typical pregnancy rate • DepoProvera • Works very well, but: • Up to 50% stop using it in the 1st year • Irregular bleeding, weight gain

  15. What method works best for teens? • One with little need for on-going behavior • One she likes and will continue to use • “The most effective way for healthcare providers to help (teens) remain non-pregnant… is to encourage them to use Norplant (or the intrauterine device)…” Stevens-Simon C, Kelly L, Kulick R. A village would be nice but...it takes a long-acting contraceptive to prevent repeat adolescent pregnancies. American Journal of Preventive Medicine. 2001;21:60-5.

  16. Risk factors for teen pregnancy • Poverty • Poor educational achievement • A mother who was a teen mother • Single-parent family • Early age of first sex • Alcohol, drug abuse, violence • View of teen motherhood as positive Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  17. Protective factors • Higher socioeconomic status • Strong educational achievement • Intact family • Attending religious services • High self-esteem Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  18. Consequences of Teen Pregnancy • Abortion: 35% of teen pregnancies • On-going pregnancy, prenatal care • Late initiation of care, no preconception care • Preterm delivery, PIH, dystocia (? C-section) • Maternal mortality 2.5 x that of women age 20-24 • Neonatal mortality 2 x that of older women (adjusted for low birth weight)

  19. Consequences • Teen development • Poverty: half long term • Poor education: half do not graduate from high school • 30% of teen mothers pregnant again within 2 yrs

  20. Consequences • Infant development • Low birth weight from preterm delivery • Higher rate of infant death • Child abuse and neglect • Behavior problems into school age

  21. Prevention • Ecologic: Learn from other nations • Data: Studies of what works

  22. The United States has the highest teen pregnancy rate of any developed country

  23. Why is US rate higher than in other developed nations? • Sexual debut is the same age • US teens have more sex partners • US teens are less likely to use contraception Darroch JE, Singh S, Frost JJ. Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use. Family Planning Perspectives 2001;33:244-50, 81.

  24. Data: What works? • Types of interventions: • Comprehensive sex education • Abstinence-only education • Access to contraception • Behavior programs • Combined programs Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  25. Comprehensive Sex Education • Several programs have been rigorously evaluated • Some increase use of condoms and other contraceptives • They do not delay first sex Mauldon J, Luker K. The effects of contraceptive education on method use at first intercourse. Family Planning Perspectives 1996;28:19-24. Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  26. Abstinence-only National Campaign to Prevent Teen Pregnancy “There does not currently exist any published scientific research demonstrating that abstinence-only programs have actually delayed (or hastened) the onset of sexual intercourse or reduced any other measure of sexual activity. Thus, at the present time, it is not known whether or not abstinence-only programs delay intercourse.” http://www.teenpregnancy.org/resources/data/report_summaries/no_easy_answers Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  27. Access to contraception • Solid data show that education and access to contraception does not make teens become sexually active or take more sexual risks • Some school-based clinics may delay first sex • No evidence that condom distribution in schools decreases pregnancy rates Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  28. Behavior programs • Many and varied • Peer counseling • Role playing • Mentoring • Short-term, helps “saying no” • No long-term data • Time and labor intensive Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  29. Combined programs • Start in early adolescence • Sex education and youth development • Culturally specific • These are the most successful programs • Difficult to transplant… Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am 2003;50:781-800.

  30. Conclusions • Unintended pregnancy is not unique to teens, just more prevalent. They are part of the epidemic • Contraceptive methods that don’t take much effort work best in teens: low typical-use failure rates

  31. Conclusions • The glass is half full: teen pregnancy rates are high in the U.S., but lower than a decade ago • Abstinence-only programs are as yet unproven • Comprehensive programs increase condom and contraception use • Combined programs have the most evidence of efficacy but are intensive to implement

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