A Moment of Reflection along the Journey to Reducing Unwanted Pregnancies among Adolescents

May is National Teen Pregnancy Prevention Month. This year we mark the incredible gains achieved in lowering teen birth rates and recognize the relentless commitment of all those involved in prevention, outreach, and education.

A recent CDC MMWR report released in April 2015 listed the following accomplishments:

• From 2006-2014, the birth rate for U.S. teens aged 15-19 declined 41% from 41.1 to 24.2 per 1000 females
• The greatest decline was seen in Hispanics (51%), than non-Hispanic blacks (44%), and non-Hispanic whites (35%)
• Every state in the nation has seen declines in teen birth rates

Much of this success can be attributed to resources and efforts directed into educational efforts, social marketing, and the availability of reproductive health services and access to contraception for adolescents.

Despite these record declines in the birth rates among teens, racial/ethnic and geographic disparities persist. U.S. county-level data shows that teen birth rates are highest in areas where unemployment is high, and educational attainment and family income are low. Also, compared with other developed nations in 2011, the U.S. had the highest teen birth rate (31.3 per 1000),  more than twice as high as the teen birth rate of our northern neighbor, Canada (14 per 1,000) and nearly ten times higher than Switzerland (3.4 per 1000)*.

Like many public health issues with persistent disparities, individual behavior change can only go so far. A multi-component approach to teen pregnancy begs the question:

What are the underlying social conditions that drive disparate outcomes and impact teen pregnancy?

In an attempt to address this question, the CDC funded a five-year project supporting state- and community-based organizations in high-need communities with the goal of reducing teen birth rates by 10%, specifically with adolescents 15-19 years old, and African American and Hispanic youth. The Teen Pregnancy Prevention: Integrating Services, Programs, and Strategies Through Community-wide Initiatives (CWI), launched in 2010 comprised of five distinct but related components:

• Evidence-based programs
• Youth access to contraception/reproductive health care
• Community mobilization and sustainability
• Stakeholder education
• Working with diverse communities

JSI was one of five national organizations funded to provide training and technical assistance (T/TA) to grantees in the Working with diverse communities (WDC) component. This component centered on building grantee’s capacity to integrate a social determinants of health (SDH) approach to teen pregnancy prevention programs; raising awareness of the root causes related to teen pregnancy and facilitating discussions to identify feasible action steps to begin addressing the identified root causes.

Deconstructing the concept of “social determinants of health” as factors that impact where youth “live, learn, work, and play,” and mapping these factors on a socio-ecological framework allowed grantees and their partners to see that teen pregnancy prevention programming can encompass other efforts, including:

• Addressing sexual violence and past trauma;
• Improving parent-child communication;
• Providing job training opportunities;
• Linking teens to services using a community health worker model;
• Mobilizing youth and other community stakeholders in promoting adolescent health and well being.

All of these efforts cannot be sustained without strong cross-sector partnerships. As the project evolved, the WDC component focused on equipping grantees to assess the social and emotional needs of youth, and the development of a strong referral network needed to be able to meet those needs.

Although the CDC project ended, the work of addressing the social conditions impacting the healthy development of adolescents in communities is far from over. Teen pregnancy prevention efforts need to be dually focused — ensuring that environments where youth live, learn, work and play are supportive of individual behavior change.

Written by Jocelyn Chu

* https://thenationalcampaign.org/resource/fast-facts-how-does-united-states-compare