Special Issue Introduction: We Can Do More: Challenges and Opportunities for Teen Pregnancy Prevention

Journal of Applied Research on Children: Informing Policy for Children at Risk, Dec 2017

Guest editors Susan Tortolero Emery and Kimberly Johnson Baker introduce Volume 8, Issue 1 of the Journal of Applied Research on Children.

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Special Issue Introduction: We Can Do More: Challenges and Opportunities for Teen Pregnancy Prevention

" Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 8 : Iss. 1 Special Issue Introduction: We Can Do More: Challenges and Opportunities for Teen Pregnancy Prevention Opportunities for Teen Pregnancy Prevention 0 1 Susan R. Tortolero 0 1 Kimberly Johnson-Baker 0 1 0 University of Texas Health Science Center , USA 1 University of Texas Health Science Center at Houston , USA Follow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatrisk Recommended Citation - The Journal of Applied Research on Children (JARC) is proud to publish this special issue “We Can Do More: Challenges and Opportunities for Teen Pregnancy Prevention” to disseminate articles on unintended pregnancy and sexual risk behavior among teens and the programs developed to reduce these adverse outcomes. Despite rates of unintended pregnancy in the United States being at a historic low, rates in some U.S. communities remain alarmingly high (as high as 54%), especially among teens and women from disadvantaged backgrounds1-6. Research shows that unintended pregnancy disproportionately affects women who are young, black or Hispanic, economically disadvantaged, unmarried, or poorly educated2-3. In terms of age, among teens and young women aged 15–19 years, the rate of unintended pregnancy is 75%3. However, among older women, the rate of unintended pregnancy is also high: 50% among those aged 20–29 years and 32% among those aged 30 years and over3. In terms of race/ethnicity, the rate of unintended pregnancy is 64% among black women and 50% among Hispanic women, compared with 38% among white women3. In terms of income level, the rate of unintended pregnancy is 60% among women with an income below the federal poverty level, compared with 37% among those with an income at or above the federal poverty level3. In terms of relationship status, the rate of unintended pregnancy is 81% among women who have never married, compared with 24% among those who are currently married3. Finally, in terms of educational attainment, the rate of unintended pregnancy is 48% among women who have less than a college degree, compared with 27% among those who have a college degree3. Unintended pregnancy places a substantial financial, physical, psychological, and social burden on teen mothers and their children as well as the U.S. public sector. Unintended pregnancy not only perpetuates the cycle of disadvantage among teens and women who are already disadvantaged, but it also potentiates many social problems including poverty, especially child poverty; child abuse and neglect; father-absence; low educational attainment; school failure; low birth weight; domestic violence; justice system involvement; and poor participation in the workforce7. In addition to exerting a devastating cost on individual women and their upward mobility, unintended pregnancy exerts a considerable cost on the public sector2, 8-9. Each year, the United States spends an estimated $21 billion on direct costs associated with unintended pregnancies9. Texas, in particular, bears a heavy financial burden, given that its teen pregnancy rate is higher than the national rate6. In 2010 alone, Texas spent an estimated $2.9 billion on births, abortions, and miscarriages resulting from unintended pregnancies6. In 2010, approximately 74% of unintended births in Texas were publicly funded, compared with 68% in the United States 6. It is important to realize that unintended pregnancy, its associated adverse outcomes, and its costs to taxpayers are all preventable. Research attributes the historic drop in the U.S. rates of unintended pregnancy to increased access to, and use of, family planning services, in general, and effective contraceptive methods, in particular6. Overall, only 5% of unintended pregnancies occur among women who use contraception consistently, whereas 54% occur among nonusers and 41% occur among inconsistent users6, 10. Similar to the rates of unintended pregnancy, the rates of incorrect, inconsistent, and nonuse of contraception are highest among women who are young, black or Hispanic, economically disadvantaged, poorly educated, or underinsured or uninsured10. Thus, increasing access to, and use of, contraception for these disadvantaged women is essential to reducing unintended pregnancy. Long-acting reversible contraceptive (LARC) methods (implants and intrauterine contraceptives [IUDs]) have shown great potential for dramatically reducing unintended pregnancy, because they require virtually no user adherence and, thus, they can increase the rates of consistent contraceptive use among teens and women11-12. In addition to increasing contraceptive use, LARC methods have many benefits, compared with traditional contraceptive methods12-13. For example, LARC methods have a lower failure rate: a recent study reported that the failure rate was 0.3% for IUDs, compared with 9% for birth control pills13. Other benefits of LARC methods include a quick return to fertility after the IUD is removed and a reduction in heavy menstrual bleeding among those using the hormonal IUD12-13. Moreover, side effects associated with IUDs are typically minor, and serious complications are rare, which may help to overcome perceived patient barriers to contraception use and adherence12-13. Despite the great promise of LARC and other effective contraceptive methods, teens and women who live in disadvantaged communities face systematic barriers to accessing them. These barriers include ( 1 ) lack of implementation of evidence-based clinical guidelines by the health provider community; ( 2 ) lack of training on and knowledge of LARC methods; ( 3 ) low confidence of providers in discussing contraception with patients; ( 4 ) lack of patient-centered counseling and education; ( 5 ) financial barriers to prescribing LARC methods; ( 6 ) consent requirements for teens; ( 7 ) limited outreach to patients in disadvantaged communities; ( 8 ) lack of buy-in from clinic leadership and staff; ( 9 ) health system factors affecting timely LARC provision; and ( 10 ) patient misperceptions of safety, mistrust of health providers, and expectations about side effects. Clearly, we are facing an uphill battle, but it is a winnable battle that we must continue to fight to ensure the health and wellbeing of future generations. The articles in this special issue of the JARC describe the problems of teen pregnancy, as well as how researchers and practitioners are partnering with community stakeholders to design, develop, and disseminate technological interventions to reduce unintended pregnancy in disproportionately affected communities. Independently, each article makes an important contribution to the literature by focusing on a vulnerable population, describing novel theoretical frameworks and technological applications, and/or developing and evaluating theory-based inventions to reduce unintended pregnancy. Collectively, these articles help to inform a winning strategy in the ongoing battle against unintended pregnancy and its associated adverse outcomes. 1. Dee , D. L. , Pazol , K. , Cox , S. , Smith , R. A. , Bower , K. , Kapaya , M. Warner , L. ( 2017 ). Trends in repeat births and use of postpartum contraception among teens - united states, 2004 - 2015 . MMWR. Morbidity and Mortality Weekly Report , 66 ( 16 ), 422 . 2. Finer , L. B. , & Zolna , M. R. ( 2014 ). Shifts in intended and unintended pregnancies in the united states, 2001 - 2008 . American Journal of Public Health, 104 Suppl 1 ( S1 ), S43 - S48 . doi: 10 .2105/AJPH. 2013 .301416 3. Finer , L. B. , & Zolna , M. R. ( 2016 ). Declines in unintended pregnancy in the united states, 2008 - 2011 . Obstetrical & Gynecological Survey, 71 ( 7 ), 408 - 409 . doi: 10 .1097/OGX.0000000000000340 4. Martin , J. A. , Hamilton , B. E. , & Osterman , M. J. K. ( 2016 ). Births in the united states , 2015 . NCHS Data Brief , ( 258 ), 1 . 5. Nelson , A. L. , & Kakaiya , R. ( 2016 ). Prevention of unintended pregnancy among sexually active adolescents in the united states . Primary Prevention Insights , 6 , 1 . 6. State Facts About Unintended Pregnancy : Texas. ( 2017 , September 07). Retrieved October 08 , 2017 , from https://www.guttmacher.org/fact-sheet/ state-facts-aboutunintended-pregnancy-texas 7. Brown , S. S. , Eisenberg , L. , & Institute of Medicine (U.S.). Committee on Unintended Pregnancy . ( 1995 ). The best intentions: Unintended pregnancy and the well-being of children and families . Washington, D.C: National Academy Press. 8. Frost , J. J. , Sonfield , A. , Zolna , M. R. , & Finer , L. B. ( 2014 ). Return on investment: A fuller assessment of the benefits and cost savings of the US publicly funded family planning program . The Milbank Quarterly , 92 ( 4 ), 667 - 720 . doi: 10 .1111/ 1468 - 0009 . 12080 9. Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010 . (2016, April 06) . Retrieved October 08 , 2017 , from https://www.guttmacher.org/report/publiccosts-unintended -pregnancies-and-role-public-insurance-programspaying-pregnancy 10. Contraceptive Use in the United States . ( 2017 , September 21). Retrieved October 08 , 2017 , from https://www.guttmacher.org/factsheet/contraceptive-use -united-states 11. Boonstra , H. D. ( 2014 ). What Is Behind the Declines in Teen Pregnancy Rates? Guttmacher Policy Review , 17 ( 3 ), 15 - 21 . 12. Daniele , M. A. , Cleland , J. , Benova , L. , & Ali , M. ( 2017 ). Provider and lay perspectives on intra-uterine contraception: a global review . Reproductive Health , 14 ( 1 ), 119 . Reproductive Health. ( 2017 , February 09). Retrieved October 08 , 2017 , from https://www.cdc.gov/reproductivehealth/contraception/index.htm

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Susan R. Tortolero, Kimberly Johnson-Baker. Special Issue Introduction: We Can Do More: Challenges and Opportunities for Teen Pregnancy Prevention, Journal of Applied Research on Children: Informing Policy for Children at Risk, 2017,