Teen Pregnancy and Teen Families: Role of Nurses

1. Teen Pregnancy and Teen Families: Role of Nurses By Nataliya Haliyash, MD,PhD,MSN Ternopil State Medical University Institute of Nursing

2. Lecture objectives Upon completing the lecture students will be able: • to understand the impact of teen childbearing on the families and communities; • to be able to recognize the special needs of pregnant and parenting teens in order to improve their health and life outcomes and those of their children; • to be able to provide services for teens that are already pregnant and/or have become parents.

3. The impact of teen childbearing • The teenage pregnancy rate declined : • in 1991 –117 per 1,000 • in 2004 –72 per 1,000. • Similarly, the birth rate decreased by 30.5 percent : • in 1991 –61.8 births per 1,000 females ages 15-19 • in 2005 –40.4 births per 1,000, the lowest rate in six decades. • However, preliminary data from the Centers for Disease Control and Prevention (CDC) on births in 2006 indicate that the overall birth rate for teenage girls rose 3 percent: • in 2006 –41.9 births per 1,000 females ages 15-19. • in 2009 –39.1 births per 1,000 females ages 15-19.

4. The impact of teen childbearing • U.S. leads in number of teen pregnancies when compared Canada and Great Britain (Porter & Holness, 2011). • In 2004, the cost to federal, state and local taxpayers related to teenage childbirth was approximately $9.1billion dollars. (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2010). • A repeat pregnancy is noted to occur 500 times more often with a teen mother. (Porter & Holness, 2011).

5. The prevalence of adolescentpregnancy in the world • About 16 million adolescent girls aged 15-19 give birth eachyear, roughly 11% of all births worldwide: • Almost 95% of these births occur in developing countries. • They range from about 2% in China to 18% in LatinAmerica and the Caribbean. • Adolescent birth rates in the less developed countriesare more than twice as high compared to rates in moredeveloped countries and these range from less than 1%per year in places like Japan and the Republic of Korea,to over 20% per year in the Democratic Republic ofCongo, Liberia and Niger.

6. Childbearing to mothers under 15, is a problem in certaincountries • An analysis of survey data from 51 developingcountries from the mid-1990s to the early 2000sshowed that almost 10% of girls were mothers by age16, with the highest rates in sub-Saharan Africa andSouth-Central and South-Eastern Asia. • Because the health risks of early childbearing appearto be magnified for the youngest mothers, these veryearly births are a major concern.

7. However, while there is a definite need for effective efforts that focus on preventing teen pregnancy in order to halt the recent increase in the teen birth rate, we can not ignore the fact that teens are still becoming parents and that these teen parents need supportive programs and services in order to reduce the risks for teen parents and their children.

8. The needs of pregnant and parenting teens • Research shows that teenage pregnancy is associated with: • medical-related risks for the teen mother and infant • and developmental risks for the growing infant.

9. In what context do adolescentsbecome pregnant? • In developing countries, about 90% of births to adolescentsoccur within marriage. • The proportion is close to 100%in • Western Asia/Northern Africa, • Central Asia, • and South-Central and South-Eastern Asia, • while between 70-80% inSouth America and in sub-Saharan Africa

10. In what context do adolescentsbecome pregnant? (cont.) • About 75% of adolescent pregnancies are intended, rangingfrom 42% in Colombia to 93% in Egypt. • A small but significant percentage of adolescentpregnancies result from nonconsensual sex. • Recentstudies of coerced first sex report rates between 10%and 45% of girls who first had sex before age 15.

11. Risk factors for teen mothers and their babies • A study in Latin America found that maternal death rates for adolescents under 16 are 4 times greater than for women in their 20s. • Increased incidence of: • Low birth weight • Infection and neonatal death • SIDS • Well being of mother threatened with medical and social problems • Social issues • Low socioeconomic status • Low education for the mother • Substance abuse • Single parent families • Possibility for substandard prenatal care (Porter & Holness, 2011)

12. Risk factors for a child of a teen mother • Health and chronic illness problems • Increased chance of becoming a teen parent (Herrman, 2010) (as cited in Hoffman, 2006) • Greater risk of homelessness, incarceration, dropping out of high school • Increased risk of being abused (Herrman, 2010) (as cited in Healthy Teen Network, 2007).

13. Societal and socioeconomic impact of teen pregnancy • Studies have shown that delaying adolescent births couldsignificantly lower population growth rates, potentiallygenerating broad economic and social benefits. • Numerous studies have shown an association betweenadolescent pregnancy, and negative social and economiceffects on both the mother and her child. However, recentreviews have found the evidence inconclusive about whetheradolescent pregnancy is the cause or consequence ofadverse socioeconomic factors.

14. INTERVENTIONS • Theories/Teen pregnancy research • Social-Cognitive-Ecological Theories • Developmental Theories • Resilience Theory (Porter & Holness, 2011) • Home visitation • School-based programs • Community-based programs • Contraception • Abstinence

15. INTERVENTIONS (cont.) • How can adolescent pregnancy be made safer? • Mothers and babies need care in pregnancy, for childbirthand after birth. It must be delivered as a continuum of carethat starts in the household and community and extends intothe healthcare system, including care for complications.

16. Individual, Family, and Community Care • Programs should emphasize: • Improving the involvement of boys and men and thecommunity at large, and including “mothers-in-law”in societies where they are the main decision-makersboth at household and community level, would ensuretheir support and acceptance in utilization of services. • Ensuring good pregnancy outcomes start withhomebasedcare practices that support the mother and hernewborn before, during, and after the pregnancy. • Adolescent mothers should be provided with life skills(including vocational training) and sexuality educationto increase their autonomy, mobility, self-esteem, anddecision-making abilities.

17. Individual, Family, and Community Care (cont.) • Knowledge about pregnancy complications andrecognizing the signs of complications should be widelydisseminated to pregnant adolescents, their familiesand the community at large. • Programs should be put in place to retain adolescent girls in school. • Because adolescents are relatively more susceptible to violence from intimate partners than are older women, it is important to implement programs to empower adolescents to deal with domestic violence. • Programs should also find ways to reduce the cost of pregnancy care for adolescents, who tend to have fewer financial resources.

18. Types of Community Programs for Pregnant Teens School-based program • Valley High Teen Mom Program Faith-based program • LDS Family Services • Catholic Community Services • Additional Services available Community-based program • Utah Parents as Teachers • Teen Mother program

19. Resilience-Recoil-Rebound Theory of Teen Pregnancy Prevention • Resilience • The ability to "bounce back" when faced with a challenging experience in life (Porter & Holness, 2011) (as cited in American Psychological Association [APA], 2011; Luthar & Cicchetti, 2000). • Reflected in coping skills when faced with pregnancy • Recoil-Rebound • Refers to recovery when faced with a setback in life with optimism and hope for the future • Strong support systems are needed to reinforce resilience in teen mothers at risk for repeat pregnancy • Family • Peer groups • School • Church • Community

20. Home Visitation Programs • Begin as early in the pregnancy as possible • Continue after birth of baby and through two years of age • Follow Olds Model • Establish a trust relationship • Visit weekly for the first month • Every other week until delivery (Robert Wood Johnson Foundation, 2008) • After delivery, resume home visits at eight weeks, every other week through the child's second birthday • Certified Nurse Midwives visit for the first eight weeks

21. Outpatient and Clinical Care • Thecontent of such clinical and outreachinterventions should be the same for adolescent mothers asfor other women: • It is important to provide adolescents with an earlystart to antenatal care and to options for continuingor terminating pregnancy, particularly becauseadolescents tend to delay seeking abortion, resort tothe use of less skilled providers, use more dangerousmethods, and delay seeking care for complications. • They are, therefore, more likely to suffer seriouscomplications and even death. • Since adolescents are especially susceptible to anemiain pregnancy, it is important for programs to make aspecial effort to diagnose and treat for anemia.

22. Outpatient and Clinical Care (cont.) • Adverse outcomes such as low birth weight canbe reduced by improving the nutritional status ofadolescents before pregnancy and preventing sexuallytransmitted infections before and during pregnancy. • Pregnant adolescents especially first time mothersare particularly susceptible to malaria, a major factorin maternal deaths in some countries. Priority shouldbe given in treatment and management of malaria inpregnancy. • Special attention should be given to adolescents under16 during obstetric care because they and their infantsare at especially high risk of complications and death.

23. Outpatient and Clinical Care (cont.) • Discussion of the “Plan for Birth and Complications,”including the place of birth, availability oftransportation, companion of choice, and costsinvolved, is essential, particularly for adolescents inlight of the higher incidence of complications both forthe mother and her newborn. • Health workers should prioritize adolescents’ access toservices to prevent mother-to-child transmission of HIV,given the high concentration of infection rates in youngwomen. • It is important that adolescent mothers be counseledand provided with post partum family planning methodsof their choice to avoid future adolescent pregnancy.

24. Health Systems Features • In addition to the special interventions that would enhancethe continuum of care for adolescents and their babies,countries can incorporate features into their health systemsthat can improve adolescents’ access to quality careincluding that forcontraception and, ultimately, healthoutcomes. • A crucial area of focus is in human resources, whereevidence shows the importance of developing healthworker competencies in dealing with the specialinformation and psychosocial needs of adolescentmothers. • A more conducive legal and policy environment thatenhances access to care for adolescents includingcontraceptive services is needed.

25. Planned Parenthood Programs • Planned Parenthood believes that it is important tohelp teens delay having sexual intercourse, • but italso believes that policy makers mustaccept the factthat teens engage in sexual behavior, • and they mustinitiate and provide funding for various programs andinterventions that will facilitate responsible sexualbehavior.

26. Sex Education Can Help Prevent Teenage Pregnancy • Sex education programs that are balanced andrealistic: • encourage students to postpone sex untilthey are older, • and promote safer-sex practicesamong those who choose to be sexually active, • have been proven effective at delaying firstintercourse and increasing use of contraceptionamong sexually active youth. • These programs havenot been shown to initiate early sexual activity or toincrease levels of sexual activity or numbers ofsexual partners among sexually active youth (Kirby,2007; Kohler et al., 2008).

27. Sex Education Can Help Prevent Teenage Pregnancy (cont.) • Sex education that is responsible and medicallyaccurate, begins in kindergarten, and continues inan age-appropriate manner through the 12th grade,is necessary given the early ages at which youngpeople are initiating intercourse — 6.2 percent ofstudents nationwide report having sex before theage of 13, 43.8 percent by grade 10, and 63.1percent by grade 12 (CDC, 2012). • In fact, the mostsuccessful programs aimed at reducing teenagepregnancy are those targeting younger adolescentswho are not yet sexually experienced (Frost &Forrest, 1995).

28. Sex Education is a Success in Other Developed Nations • The Netherlands, where sex educationbegins in preschool and is integrated into alllevels and subjects of schooling, boasts oneof the lowest teen birthrates in the world —5.3 per 1,000 women aged 15–19 — a ratesix and a half times lower than that of theU.S. (Berne & Huberman, 1999; UnitedNations, 2011). • In Germany, where sex education iscomprehensive and targeted to meet thereading and developmental needs of thestudents, the teenage birthrate is three anda half times times lower than that of theU.S.; its teenage abortion rate is about fivetimes lower.

29. The Media Has an Important Role in PregnancyPrevention • Another source of teen information about sex is themedia: • In the U.S., one in three television programscontains a scene devoting primary emphasisto sexual behavior, and one in 10 contains ascene in which intercourse is depicted orstrongly implied, yet sexual precautions andthe consequences of sexual behavior arerarely depicted (Kunkel et al., 2005). • Research clearly shows that televisionportrayals contribute to sexual socialization— watching programs high in sexual contenthas been correlated with the early initiationof adolescent sexual intercourse(Collins et al., 2004).

30. The Media Has an Important Role in PregnancyPrevention(cont.) • The U.S. needs a long-term teenage pregnancyprevention media campaign that addresses theconsequences of sexual behavior. • At present, mostmajor networks do not air commercials or publicinformation campaigns about sexual health. • Developed countries such as the Netherlands, Germany, and France, in which teenage birthrates are three to six and a half times lower than that of the U.S., promote healthy, lowerrisk sexual behavior through national media campaigns that have a high degree of influence with young women and men (Berne & Huberman, 1999).

31. Conclusion • Making pregnancy safer for the youngest mothers andtheir babies is a priority for countries as they strive tomeet targets for improving basic health care. • Maternaland newborn health programs have a clear role in betterserving the needs of the youngest mothers.

32. References American Psychological Association. (2011). The road to resilience. Washington DC: Author. Retrieved from http://www.apa.org/helpcenter/road-resilience.aspx Herrman, J.W. (2010). Assessing the teen parent family. The role for nurses. Nursing for Women's Health, 114(3), 214-221. doi: 10.111/j.1751- 486X.2010.01542x Luthar, S. S., & Cicchetti, D. (2000). The construct of resilience: Implications for interventions and social policies. Development & Psychopathology, 12(4), 357-885. Porter, L.S. & Holness, N.A. (2011). Breaking the repeat teen pregnancy cycle. How nurses can nurture resilience in at-risk teens. Nursing for Women's Health, 15(5), 370-381. doi: 10.1111/j.1751-486X.2011.01661.x Robert Wood Johnson Foundation. (2008). A closer look at the olds model. Retrieved from http://www.rwjf.org/pr/product.jsp?id=51653

33. Thank you for attention! Q & A ?