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All states and territories are eligible to apply for formula PREP grants to provide evidence-based teen pregnancy prevention programs. States may use funds for abstinence education, mentoring, counseling or adult-supervised activities to promote abstinence from sexual activity. Programs must be medically accurate and focus on youth with a higher risk of teen pregnancy, including homeless teens, teens of certain racial and ethnic backgrounds, those in foster care, or teens living in geographic areas with high teen birth rates. Program funding extends through Fiscal Year Grantees use a Positive Youth Development framework to promote risk avoidance among teens and teach how to voluntarily refrain from sexual activity before marriage.
Teen Pregnancy Prevention. Ensure access to information and services. Lack of relevant knowledge about how to prevent pregnancy, as well as lack of access to effective prevention services, may be barriers to preventing teen and unplanned pregnancy.
Lisa Drakeford's top 10 YA books about teen pregnancy | Children's books | The Guardian
Mississippi and Arkansas recently enacted innovative policies to address these challenges by requiring community colleges and public universities to develop a plan to address unplanned pregnancy among students on their campuses. The plans must address eight different areas, such as incorporating information on unplanned pregnancy into student orientation and courses, conducting public awareness campaigns and increasing student access to health services.
Most of the details of how to address these areas are left up to the individual schools, and content may include information on both abstinence and contraception. Louisiana passed a similar law in Integrate pregnancy planning and prevention into human services, education, workforce and other initiatives that support youth and youth families. For example, ensure that programs focused on supporting young parents, including home visiting programs, also focus on helping delay or space a subsequent pregnancy.
In addition, ensure that young people transitioning out of foster care receive relevant information and health care to help them avoid an unplanned pregnancy. All states are somehow involved in sex education for public school children. State policies vary, however, in particular requirements, such as around curriculum and parental involvement. Twenty-four states and the District of Columbia, for example, require public schools teach sex education.
Eighteen states and D. State leaders may examine these and other elements of sex education policy with the aim of developing programs to most effectively help students avoid teen pregnancy and sexually transmitted infections. Invest in evidence-based programs. State leaders may look to the evidence-based policies and program models supported by the two initiatives as examples of effective interventions to address teen pregnancy in their communities. In addition, the U. Focus efforts on groups with the greatest need. State leaders may wish to identify the disparities in teen pregnancy rates in their communities, in order to maximize scarce resources and ensure that efforts address groups most in need of services.
For example, states may choose to focus programs or other efforts in rural regions , which often have higher teen birth rates than urban and suburban areas, or where there may be unique health care access challenges. States may also wish to focus on reducing racial and ethnic teen birth disparities. Despite recent declines, the birth rate for black and Hispanic teens is still more than twice the rate for white teens nationally, and more than four times greater in some states. Press: New Haven, The essays present differing views of whether and if so, why adolescent pregnancy is problematic:" the perspective of the United Kingdom versus the United States.
Under the Welfare Reform Act of states must submit plans that explain how they will reduce out-of-wedlock births and encourage enforcement of statutory rape laws. This report charts the states' responses. The article discusses the Welfare Reform Act's provisions on teens and state responses. Harvard Univ. Press: Cambridge, MA, The author regrets the strong tendency to blame teen mothers for social ills that may not be causally related. Madara, F. This report on case law shows a much greater judicial deference then than now to penalties imposed on pregnant and parenting students.
Even then, a number of courts had refused to uphold such penalties. The book describes the Latino population of the state including its health issues and advises health providers how to work with these patients. It contains Spanish translation of parts of health interviews and a resource list. Manson, Andrea Bazan, et al. OMH No. Single copies are available from the Office, The book explains the purposes of the laws on reporting possible child maltreatment, legal terms, the reporting process, the reporter's rights and potential liabilities and offers helpful advice.
Appendices contain the reporting laws and related criminal laws. Moore, Kristin A. Teens with family, school or behavior problems, in poverty or with low incomes are more likely to bear children. The authors urge rigorous evaluation of abstinence programs, combining sex education and skills building, supporting families and helping teens set goals. Musick, Judith S. Yale U. Press: New York and London, The author states, "One of the major tenets of this book is that in order to avoid teenage motherhood, girls growing up in poverty need to possess not just average but above-average psychological resources and strengths, self-concepts, and competencies.
Considering the many forces drawing poor females toward early unprotected sex and early parenthood, the scarcity of viable alternatives steering them toward school and work, and the responses of family and peers, which validate pregnancies once they have occurred, it is remarkable that rates of adolescent childbearing are not even higher. As it is, these ever-present forces interact with developmental need and psychological vulnerability to draw many poor young women-even those with considerable promise-into early parenthood.
The authors ask why so few teens choose adoption. Nash, Margaret A. Equality Center: Washington, D. A survey of twelve schools on their treatment of pregnant and parenting students reveals that few have clear policies and most violate federal law Title IX. The memorandum reviews clinical social workers' obligation to keep clients' confidences. National Association of Social Workers, Standards for the practice of social work with adolescents. The pamphlet contains 10 standards, followed by interpretations, for social workers as counselors and advocates for adolescents.
It identifies these needs as essential: "a safe environment, adequate health care,.
The document identifies these factors as affecting dropout: schools' lack of data on pregnant and parenting students; lack of concern; programs for pregnant but not parenting students; programs' isolation from other dropout prevention efforts; districts' failure to change policy or practices system wide; and schools' lack of regular contact and cooperation with other agencies. Changes and strategies are suggested. The report, based on focus groups of preteens, teens, youth workers and parents, chronicles the severe problems facing Hispanic teens in the U.
The authors ask, however, that Hispanic girls be considered "at promise" instead of 'at risk. These threats are more prevalent among Hispanic girls than among their non-Hispanic white or African American peers. Hispanic girls have the highest national rates of teenage pregnancy, suicide attempts, alcohol and drug abuse, and self-reported gun possession. It is chilling that about one in three Hispanic girls report seriously considering suicide, the highest rate of any racial or ethnic group.
Raleigh, North Carolina, Spring The book consists of questions and answers about young North Carolinians' legal rights in these areas: school, work, money, transportation, health, controlled substances, abuse and neglect, the criminal justice system, parenting, emancipation, marriage, and citizenship. Raleigh, The book describes several categories of children with disabilities and the help and process each is entitled to under state law. The department recognizes that pregnancy can be disabling, but pregnant students do not have the rights and remedies of those with other disabilities.
The most significant difference is the absence of a requirement for an individualized education program. Instead, the state Board of Education directs that, "Local education agencies shall develop a written program to meet the special educational needs of pregnant students. O'Leary, Kathleen M. The authors describe the difficulty of providing services to this group and the long-term investment required. Despite the adolescents' absenteeism and apparent apathy, the authors think they benefited significantly, forming close bonds with caseworkers and taking what they needed of the services offered.
Orloff, Leslye E. Although partially outdated, the article offers practical advice for those working with battered immigrant women. Parker, Barbara, et al. The authors find a significantly higher percentage of pregnant teens Plotnick, Robert D. This study of non-Hispanic white adolescents, based on data from the National Longitudinal Survey of Youth, sought factors that influenced both the likelihood of teen pregnancy for an individual and its resolution.
The author concludes that "the likelihood of resolving a premarital pregnancy by abortion is positively related to high self-esteem and high educational expectations. Presti, Susan M.
Lisa Drakeford's top 10 YA books about teen pregnancy
Insight , vol. The authors recount the ambivalent history of North Carolina's treatment of pregnant and parenting students. In the General Assembly recognized them as students with special needs, but without state or federal funding for the group state education officials failed to address its problems. Reddy, Diane, et al. Reeg, Bob, et al. This document reports on interviews of homeless young parents about their own welfare eligibility, knowledge of and access to benefits, and the effect on them of the requirement that minor parents receiving welfare must live with a parent.
Half of the remainder did not know of the program. Fourteen service organizations of 20 surveyed said homeless parenting youth had difficulties with access. Thirty-one per cent of youth subject to the living-with-parent rule said it had placed them in an unsafe setting. The author explains child-support collection, emphasizing the needs of low-income single parents. Quinn, Pammela S. The author argues "that statutes that would hold abortion providers liable for failing to ensure that their minor patients have actually obtained legal consent are generally unconstitutional. Ruch-Ross, Holly S.
Sandven, Kari and Michael D.
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The study consisted of 54 mothers who chose "shared parenting" with a family member, made a "gift" of their child to another, or became "exclusive" parents by moving out on their own. The researchers say why the mothers rejected legal adoption. The reasons included a very high expectation of negative reaction from partner, friends, and family.
Office of the Surgeon General: Washington, D. The report recommends frank discussion with teens about sexuality and health problems related to it. The Surgeon-General also urges "thorough and medically accurate sex education. Sawhill, Isabel V. The author, who is president of the National Campaign to Prevent Teen Pregnancy, reviews statistics about teen pregnancy in the United States and considers the problems it poses for welfare reform.
She describes how states have used federal abstinence education funds and concludes by urging states to work "in partnership with civic and faith-based institutions" to align the culture's values against sexual activity for teens. These articles begin a series on confidentiality, describing what is confidential and why; common exceptions to confidentiality; and what rules govern DSS' acquisition, use, protection and disclosure of confidential information. Scott, Elizabeth S. The article tells how the law sees adolescents as medical decision makers. The author objects to researchers' observations that adolescents "do not think or act like children" and that the cognitive abilities of teens 14 and over are the same as adults'.
Instead, she urges recognition that judgment increases with age. The author finds a negative relationship between marriage and educational attainment for African-American, white and Hispanic teen mothers; lower educational status for Hispanic mothers; "significantly higher educational levels" for black second child-bearers than white or Hispanic; older male partners, especially for Latinas.
Most significantly, early adolescent mothers, even mothers of two, were barely below the national median in educational attainment and black mothers exceeded it. She concludes that early adolescents in general have school problems, but also that schools should concentrate their efforts to prevent school failure on the youngest mothers. The book explains "more than 30 publicly-funded social services, public health or mental health programs available to serve young children and their families," as well as some programs for older children.
The Society considers confidentiality an essential element in adolescent health care and advises providers to inform adolescents and their parents of confidentiality requirements. The paper estimates the international magnitude of youth homelessness U. It lists the major reasons for leaving home, the dangers youth encounter living on their own, their survival mechanisms, and health threats including unintended pregnancy.
Typically, however, unmarried female adolescents relied on their partner to purchase and make decisions about contraceptive use as the following interview excerpts help to illustrate:. When I bought condoms, I felt shy. I went to the drug store and asked for condoms, the seller gave me and I was in hurry up to walk out from the drugstore because I was afraid to be seen by others and I felt shy. However, I have to use condoms. If I did not have condoms, my boyfriend will not come to see me, so, I decided to buy condoms. For the small grocery, I just did like I wanted to buy some soap and shampoo, then, I also got condoms and I paid and I did not look at the face of seller because I felt shy.
I did not buy at my village and I went to buy in other villages. It is not hard to ask for because it is a place to sell and buy. If you go to health center, you will be asked many detailed questions such as why you want to get it.. If you are an unmarried adolescent, the providers are more likely to speak not nicely and get angry and they look at adolescents as a stranger, so we do not dare to go to use health services at the health facilities as we are shy and we are afraid that the health provider will scold us. There was general agreement that the costs of services, medicines and transport, as well as opportunity costs, were barriers for many adolescents.
The district hospital is more comfortable because this is near our community. The HC is far from our community about 20 km. If the provider are not skillful in technical areas, so they prefer to go to the provincial hospital which is far and we did not have transportation and budget to go. Thus they decided not to use the health services. Unlike many of the unmarried adolescent girls, who mainly relied on their partner to make decisions about their sexual and reproductive healthcare needs, most of the married adolescents explained that accessing services and making decisions about contraception was something they discussed and decided together with their husbands.
They also recognized that parents and parents-in-law could be partners in the decision-making process because of their experience. For the decision on whether a pregnant unmarried girl would be able to go full term and where she could deliver the husbands and mothers-in-law felt this would depend on her parents and elders in the community:.
The adolescents in this study demonstrated some knowledge of SRH and maternal health and were aware of contraceptive methods mainly condoms and the oral contraceptive pill. While they had some ideas about the types of SRH and maternal health services provided in the health services, they were often unsure about the exact nature of the services and, due to a general lack of interaction with the services, were concerned about what would happen at the clinic and what kind of questions they might be asked.
Furthermore, when they did attend services, they were often too shy to ask questions when they did not understand or worried that they would be scolded, resulting in them sometimes not understanding what medication they had been given, for what purpose, or when and how to take it. Many people gave birth at home, and nothing happens and the new born can get healthy as children who were born at hospital. Most old people parent ask their daughters to give birth at home first and they will come to hospital only when there is problem.
There were no any problems of delivery at home with the assistance of my parent in law in our community. None of the married adolescents had attended PNC, and very few knew about it or felt there was a need. Typically, the mothers-in-law had very little understanding of the need for PNC. While the husbands seemed to have more awareness of PNC, they also felt there was no need to attend PNC if there were no obvious problems.
Addressing adolescent SRH is essential in reducing maternal and new born mortality and morbidity, as well as the often negative socio-economic consequences of early sexual debut and childbearing [ 8 , 26 , 27 , 28 , 29 ]. This study has identified key determinants of early marriage and childbearing, as well as demand- and supply-side barriers facing adolescents in northern Lao PDR, with a particular focus on adolescents from different ethno-linguistic groups to the majority Lao-Tai group.
This is important because these adolescents experience significant disparities in health and socio-economic outcomes. Without interventions informed by the needs and perceptions of these adolescents, these disparities are likely to continue to grow at a time when the Lao PDR is going through rapid socio-economic change, greater interaction with markets, and changing aspirations [ 20 , 30 , 31 ]. While the broader socio-economic context is rapidly changing, the distinctive cultural practices and understanding of what it is to be an adolescent are changing more slowly and are deeply embedded in the social norms of previously remote communities, such as those included in this study.
In this context, adolescent marriage and pregnancy is the norm, with marriage after the age of twenty considered undesirable and indeed, many were concerned that if they were not married by twenty they would not be attractive to men. From this perspective, early initiation of sexual intercourse, marriage and childbearing need to be understood within the cultural logic of the sexual practice of what it is to be an adolescent in these communities and the taken for granted reality [ 32 ]. There was substantial agreement between the accounts of the different participant groups included in this study, with participants identifying a range of supply- and demand-side barriers to adolescents accessing sexual, reproductive and maternal health services.
Many of these related to the well documented supply- and demand-side barriers of affordability, acceptability, availability and accessibility that interact in complex ways with power imbalances, perceived need and the capacity of the girls to make, or act on, their own decisions about service use, as well as language barriers. In addition to these barriers, unmarried female adolescents, however, experienced specific barriers related to their young age and, more specifically, their marital status.
Shyness, lack of experience and confidence in interacting with healthcare facilities, staffed primarily by people of Lao-Tai ethnicity, reputational concerns, limited autonomous decision-making capacity, and knowledge gaps were particularly acute for unmarried adolescents and limited their capacity to control their reproduction, protect themselves from STIs and utilize healthcare services.
As has been observed elsewhere, [ 33 , 34 , 35 , 36 , 37 , 38 ], the real or perceived lack of confidentiality and judgmental attitudes of service providers were also strong disincentives for unmarried female adolescents to seek care. The skills and attitudes of providers were also identified as barriers to access for both married and unmarried adolescents.
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The healthcare providers in this study also recognised the need for them to be provided specific training in relation to the SRH needs of adolescents. Inadequate training has been associated with negative attitudes towards adolescent SRH [ 37 , 39 ]. Training that addresses knowledge, attitudes and communication and counselling skills including confidentiality may enhance provider skills, and assist in shifting attitudes to those that are more understanding of adolescents [ 39 , 40 ].
This is important as forming trusting relationships between adolescents and healthcare practitioners is likely to be essential in contributing to sexually healthy development of adolescents as they transition to adulthood. Few of the adolescent mothers reported attending the recommended number of ANC or PNC visits or delivering in a healthcare facility. This was mainly due to the aforementioned demand- and supply-side barriers and, in particular, perceived need, lack of knowledge about the potential benefits, and the high cost.
Even where facility based birthing is free of charge, there may still be unpredictable informal charges, as well as the costs of transport and potential loss of income for at least one person who needs to accompany the adolescent female to the facility. A similar finding was observed in ethnic communities in Vietnam [ 41 ]. The study suggests the need for greater emphasis in health promotion activities which empower individuals to be active agents of change.
Specific strategies should be developed at the policy, service provider and community level and should include adolescents, families, and community leaders.
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Strategies should be designed with adolescents and take into account the normative contexts surrounding teen pregnancy, in both mainstream and minority cultures. As social norms are a group-level phenomenon [ 43 ], strategies need to target different levels of the systems as illustrated in Table 2. The triangulation of multiple viewpoints is a strength of this study, although care must be taken to separate the opinions of each type of key informant.
Although this research provides data for understanding the experiences of teenage pregnancy and barriers in accessing health services by teen mothers, it is a qualitative study with potential biases resulting from selection issues, so its results are not representative and, therefore, not generalizable for all unmarried adolescent girls and teenage mothers in Lao PDR.
The use of local interpreters might have biased the information and disturbed the natural flow of the FGDs, however, we tried to minimize this by using an experienced female moderator and a female translator. Interviews were translated and it is possible that meaning could have been lost or distorted in the interpretation process. Despite a recognition globally that ensuring adolescents have accessible, affordable and appropriate access to SRH services, in many setting access remains poor [ 16 , 17 , 23 ].
Context-specific research and policy focus is required to identify opportunities for filling this critical gap in service provision [ 24 , 25 ]. Policy-makers and healthcare providers also need to recognise that adolescents are sexual beings, and that we need to give adolescents the knowledge, tools and support to be able to keep themselves sexually safe and, ideally, delay pregnancy at least until after age At the same time, it is important that interventions remain culturally respectful, while embracing contemporary aspirations and allow non-Lao-Tai ethnic groups to continue to live and flourish in the Lao PDR.
Finally, while there is some descriptive research on outcomes for non-Lao-Tai adolescents, in Lao-Tai populations more evidence is needed for effective interventions that promote health and social justice. The management of teenage pregnancy. Br Med J. WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. J Adolesc Health. Pregnancy in adolescence: is it an obstetrical risk? J Pediatr Adolesc Gynecol. Braine T. Adolescent pregnancy: a culturally complex issue.
Bull World Health Organ. Adverse effects of teenage pregnancy. Ceylon Med J. A quantitative exploration of the sociocultural context of teenage pregnancy in Sri Lanka. BMC Pregnancy and Childbirth. Are teenage pregnancies at high risk? A comparison study in a developing country.
Arch Gynecol Obstet. Teenage pregnancy: a socially inflicted health hazard. Dutta I, Joshi P. Maternal and perinatal outcome in teenage vs. Vicenarian primigravidae - a clinical study. Journal of clinical and diagnostic research : JCDR. Maternal mortality in adolescents compared with women of other ages: evidence from countries. Lancet Glob Health. Einstein Sao Paulo, Brazil , 13 4 Adolescent pregnancy. The Pediatric Clinics of North America. Public health nursing care for adolescent mothers: impact on infant health and selected maternal outcomes at 1 year postbirth.
Never-pregnant African American adolescent girls perceptions of adolescent pregnancy. J Pediatr Nurs. Smithbattle L. Reducing the stigmatization of teen mothers. Am J Matern Child Nurs. Perceptions of adolescent pregnancy among teenage girls in Rakai, Uganda. Global Qualitative Nursing Research. Adv Life Course Res. Vientiane The United Nations; Lyttleton C, Sayanouso D. Cultural reproduction and "minority" sexuality: intimate changes among ethnic Akha in the upper Mekong. Asian Studies Review.