# Presentation: 687598

## Another Chance: Preventing Additional Births to Teen Mothers Cindy Costello, National Campaign to Prevent Teen Pregnancyand Pat Paluzzi, Healthy Teen Network

**Notes:**
This report written by Lorraine Klerman, DrPH, summarizes what is known about additional births to teen mothers, the dimensions of the problem, the factors that seem to increase the chances of such births occurring to teen mothers, their consequences, and the potential for prevention. 

Report was jointly released by the National Campaign and the Healthy Teen Network.

The National Campaign has prepared a Science Says Issue Brief based on Another Chance.

## This Presentation Covers 4 Areas:

- About the National Campaign
- About Healthy Teen Network
- Teen pregnancy in the U.S.:  Good and bad news
- Major findings and implications from a publication on subsequent births to teen mothers produced through a CDC-funded cooperative agreement

## The National Campaign to Prevent Teen Pregnancy

- Campaign’s _*mission*_ is to improve the well-being of children, youth, and families by preventing teen pregnancy.
- Our _*goal*_* *is to reduce the rate of teen pregnancy in the United States by one-third between 1996 and 2005.
- It looks like the nation will meet this goal.

**The National Campaign to Prevent Teen Pregnancy**

##    Our Strategy...

**   ****Our Strategy...**

** ****Influence cultural **
**values and messages**

**Strengthen **
**state & local programs**

**Tolerance &**
**Bipartisanship**

**Teen Voices**

**Research**

**NCPTP**

**Unusual**
**Partners**

**Notes:**
State and Local Action
Media
Research
Religion and Public Values
Youth Leadership
Public Policy
Parents and other Adults

## Healthy Teen Network (formerly NOAPPP)

## Strategic Approaches

**Strategic Approaches**

## CDC Cooperative Agreement

- Cooperative Agreement funded by the Centers for Disease Control and Prevention (CDC).
- Goal: To enhance the ability of state and local organizations to incorporate science-based approaches into their teen pregnancy prevention efforts.

## Putting What Works To Work

- Use these materials to encourage states, communities, and national organizations to incorporate solid research into their work.
- Go beyond the traditional partners and reach out to media executives, state legislators, funders and other opinion leaders.

**Putting What Works To Work**

**Notes:**
These materials cover topics such as effective programs and strategies that have been scientifically shown to reduce pregnancy rates or sexual activity, and/or increase contraceptive use among teens.

And also teen sexual behavior trends, the role of parents, and adult/teen attitudes to help them target their programs and messaging.

## HTN’s CDC-Funded Work

## Teen Pregnancy in the United States: Good News and Bad News

## Teen Pregnancy Rates, 1972-2000

- (number of pregnancies per 1,000 girls aged 15-19)

- Henshaw, S. (2003). *U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24*. New York: The Alan Guttmacher Institute.

**After increasing 23 percent between 1972 and 1990 (including 10 percent between 1987 and 1990), the teen pregnancy rate for girls aged 15-19 decreased 28 percent between 1990 and 2000 to a record low.**

## Teen Birth Rates, 1940-2003

- Henshaw, S. (2003). *U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24*. New York: The Alan Guttmacher Institute.

**Teen Birth Rates, 1940-2003**
- (number of births per 1,000 girls aged 15-19)

- From 1940 to 1957, the teen birth rate increased 78% to a record high.  The birth rate dropped fairly steadily from the end of the 1950s through the mid-1980s, but then increased 23% between 1986 and 1991.  Between 1991 and 2003, the teen birth rate decreased 32.5% to a record low of 41.7 in 2003.

## More Good News...

- Note: changes over 1991-2003 from the YRBS, high school students in grades 9-12.
- Source: _http://www.cdc.gov/mmwr/PDF/wk/mm5138.pdf_

## A Mixed Picture...

- Teen birth rates, and rates of decline, vary substantially among the largest racial/ethnic subgroups.  Between 1991 and 2002, teen birth rates declined 42% for African-Americans, 36%, for Native Americans, 34% for non-Hispanic Whites, 33% for Asian/Pacific Islanders, and 20% for Hispanics.  The decline for all teens was 30%.

**Notes:**
Progress in universal. There are declines in every state and ethnic/racial group.
However there is variation.

Latinas now have highest teen BIRTH rate.
African Americans still have highest teen PREGNANCY rate.

Note:  DHHS:  Preliminary birth data for 2003 

## A Mixed Picture...

- Note: changes over 1991-2003 from the YRBS, high school students in grades 9-12. Source: _http://www.cdc.gov/mmwr/PDF/wk/mm5138.pdf_

**Notes:**
The majority of teens have not had sexual intercourse, representing a shift from a decade ago -- down 14% 1991 – 2003; uptick in last two years.

Note: changes over 1991-2003 from the YRBS, high school students in grades 9-12.

## Some Bad News...

- Source:  National Campaign to Prevent Teen Pregnancy, Fact Sheet “How is the 34% Statistic Calculated?”, February 2004.

**Some Bad News...**

- The U.S. still has the highest rate of teen pregnancy in the industrialized world.
- 34% of teen girls become pregnant at least once before age 20.
- Recent data show an increase in the percent of high school girls who have had sex (2001 – 2003).

## Another Chance: Preventing Additional 

**Another Chance: Preventing Additional **
**Births in Teen Mothers**
**Background Information**

## Why Care about Subsequent Births?

**Notes:**
In 2001, 81 percent of first births to teenagers were non-marital, as were 72 percent of second and higher order births.   The younger the mother, the greater the likelihood that the birth will be non-marital. 

## Reasons for Additional Births

**Notes:**
Reasons for second births are less apparent than reasons for first births such as:
--un-realistic view of motherhood
--lack of knowledge of contraception
--“it can’t happen to me”

## Risk Factors

**Notes:**
Conflicting research on the risk factors for age and ethnicity.

For example, the significance of race varies by study and is not very strong when other factors are controlled in the analyses.

Various studies show contradictory results for the age of the teen mom at first birth as a risk for having a second teen birth (15 years old vs. 16 years old vs. older ages).

4th bullet:  Having 12 or more years of schooling at the time of first birth and completing at least one year of school in 2 years following, are related to a delay in second birth.

## Other Risk Factors

**Notes:**
Teen mothers who retrospectively report that they wanted their first birth are more likely to have a closely spaced 2nd birth.

As were teenage mothers living with a boyfriend, spouse, or other adult as opposed to a teen mother living with a parent or alone with her child.
Teens who are married at the time of their first birth or who marry soon thereafter are more likely to  have a closely–spaced second birth than teen mothers who remain unmarried.

Other factors NOT associated with having a subsequent birth include:
--Going on welfare after the first birth
--Attending church more than once a month

## Consequences: Teen Mothers

**Notes:**
THAN teens who have one birth.

## Consequences: Children

## Case Study: Shayla

**Notes:**
A personal story from your own neck of the woods
Shayla was born and raised by teen parents in Pittsfield, MA
--Industrial city located in Berkshire County in Western, Mass.  
--Population:  about 46,000 people.

Case study taken from Growing Up Fast by Joanna Lipper (Nov 2003)

Shayla was born to teen parents (her mother was 15 and her father 17 at birth).  
Shayla planned her first pregnancy with her boyfriend when she was 16 years old, after her best friend became pregnant.
She wanted to gain admiration of her friends
She wanted a “friend” 24 hours/day and she thought babies were really cute

While pregnant, Shayla enrolled in the Teen Parent Program. The caring staff encouraged Shayla to finish high school.
--She was one credit shy of high school graduation and completed her GED.
--Finished cosmetology school after the birth of her first child and worked at a hair salon (plus on welfare)
--She lived with her boyfriend, but he became abusive.
--After some time, Shayla and her boyfriend broke up and she lived by herself

Reflecting on her first pregnancy Shayla comments, “I thought having a baby would work out all corners of my life, but it really hasn’t.  It stressed my life out and made everything much more difficult.”

## Case Study: Shayla

**Notes:**
Quote

After her first child was 3 years old, Shayla missed having a baby in the house. She felt she matured and was able to live on her own and raise her son.
She felt she missed out on caring for her first child since she was either at school or working. She longed for the mother-child bonding time.
She wanted to have a second child and spend more time with him/her.

After dating her new boyfriend for 3 months, Shayla became pregnant with her 2nd child at 19 years old. 
It is unclear whether or not she planned her second pregnancy. 
At times, she made it sound like she and her boyfriend planned it and other times referred to contraception failing.

Shayla gave birth to a premature boy.  She spent 6 months not working and taking care of her new son, Caleb.
When her son turned 7 months old, she got a part-time telemarketing and later a full-time job at Dunkin Donuts.
Her grandmother got certified as a home day care instructor and took care of her two great-grandchildren.

## MCH Impact of Teen Births

- Teen mothers less likely to have adequate PNC—initiate even later with 2nd and 3rd pregnancies.
- Teen mothers more likely to have LBW infants—with greater risk for infant mortality—findings less clear for subsequent births among teens
- Teen mothers more likely to smoke during pregnancy, have inadequate diet and weight gain.

## MCH Impact of Teen Births –cont’d

- More emergency medical visits among children of teen parents.
- More developmental delays among children of teen parents.
- Pregnant teens at great risk for intimate partner violence and even death—two studies of autopsy reports show increase in pregnancy among murdered teens.

## Another Chance: Preventing Additional Births in Teen Mothers

**Another Chance: Preventing Additional Births in Teen Mothers**
**Program Findings**

## Inclusion Criteria for Klerman Study

- Program focused on pregnant or parenting teens;
- Was conducted in the US;
- Used an experimental or quasi-experimental design for evaluation;
- Had a sample size of at least 50 in each group; and
- Teen mothers were followed for at least 12 months post partum.

## Results Caveats

- Many differences occurred leaving comparison difficult:
- Participant differences such as age or pregnancy number;
- Program differences such as length of stay; length of follow-up; care for teens with first or _>_2nd pregnancy;
- Evaluation differences such as outcomes measured; quasi-experimental design; loss to follow-up
- Inadequate description of many programs

## Findings

- 19 programs of 6 different types included
- Multi-site (6)-emphasis on education and employment-self sufficiency
- Project Redirection
- Parents Too Soon (2)
- Teenage Parent Welfare Demonstration
- New Chance
- Early Head Start
- Conclusion: Marginal differences in repeat pregnancy rates-most successful program had more emphasis on CSE and family planning

## Findings-cont’d

- Medical Settings (4)-emphasis on prenatal, postpartum and child care with family planning education and/or services
- Comprehensive Adolescent Program in Queens Hospital
- Teen Mother and Child Program
- Teen Baby Clinic
- West Dallas Youth Clinic
- Conclusions: Two marginally successful, one clearly statistically better and one without difference.  One with clear differences had heavy emphasis on family planning.

## Findings-cont’d

- School-based (3)-two were alternative schools and one a program within a school-emphasis on education plus medical and support needs
- Polly T. McCabe Center
- Special School Program
- Second Chance Club
- Conclusions: two out of three had statistically significant differences in repeat pregnancy rates.

## Findings-cont’d

- Home Visiting (3)-Combined education and support—followed curricula
- Nurse-Family Partnership (Olds Model)
- Nurse Visiting Program in Memphis
- Teenage Parent Home Visitor Services Demonstration
- Conclusions: Nurse-based program successful at 24, 36 and 45 months but not 12.  Demonstration project not successful.

## Findings-cont’d

## Findings-cont’d

## Other Example not in Klerman

## The Bottom Line

## Issues to Resolve

## Next Steps

## For more information: 

- Visit _www.teenpregnancy.org _
- _www.healthyteennetwork.org_

**Thank You!**