Preventing Teen Pregnancies

A Decade of Progress, with Challenges Ahead

When teens have a baby, the impact is serious and long-lasting for the teen parents, their child, their families and the community. Teenage mothers are less likely to graduate from high school and continue to higher education. And they have a higher risk of living in poverty than girls who delay parenthood.The consequences also extend to the children of teen mothers, who are more likely to be premature and more likely to drop out of high school than children of older parents¹.

Both nationally and locally, teen birth rates have fallen significantly in the past 60 years. But persistent disparities along racial and ethnic demographic lines demonstrate the need for continued and improved access to education, guidance, and health care.

The Numbers

• Nationally, pregnancy rates for teen girls (15-19) have fallen from 111 pregnancies per 1,000 teen girls in 1988 to 57 per 1,000 in 2010².
• In Connecticut the teen pregnancy rate has fallen from 107 pregnancies per teen girls in 1988 to 44 per 1,000 in 2010³.
• The national teen birth rate has dropped from 53 births per-1,000 teen girls in 1988 to 34.3 per 1,000 in 2010⁴.
• The teen birth-rate in Connecticut has dropped from 36 births per-1000 teen girls in 1988 to 19 per 1,000 in 2010⁵.
• The birth rate in the City of New Haven was 46 births per 1000 teen girls in 2010, more than twice the state average⁶.
• Black and Hispanic mothers comprised 94% of the teen births in New Haven in 2008⁷.
• 50% of teen mothers graduate from high school, compared to 90% of young women overall⁸.

Declining rates, persistent disparities

National studies have attributed the overall drop in teen birth rates to a wide range of factors, including improved sexuality education, better access to birth control, and fewer teens choosing to have sex⁹. Between 2006 and 2010, the percentage of sexually active teens using highly effective birth control methods like the birth control pill or IUD, or combining two methods (like the pill and condom) increased by more than 30%¹⁰.

As in other cities, teen-birth rates in New Haven are significantly higher than in the state or country, particularly among minorities. The reasons for these disparities are unclear, but social determinants of health – like access to care, opportunities for youth involvement, and income and educational inequality – likely play a role¹¹.

Eliminating racial and ethnic disparities and continuing the downward trend in teen pregnancies requires coordinated efforts from government agencies, community-based organizations and local citizens. According to the Centers for Disease Control and Prevention, the most effective way to reduce rates of teen pregnancy and birth is through a combination of education and preventive care. Access to either, despite recent improvements, remains a challenge for many Greater New Haven youth.

Misconceptions and Magical Thinking: Education and Teen Pregnancy

Healthy relationships and sexuality education are essential to effectively preventing teen pregnancy. Unfortunately, many young people never receive the information they need to make healthy choices. Some parents are uncomfortable talking with their children about sex and pregnancy. And because sexuality education is not a required part of the public school curriculum in Connecticut, most schools do not offer it. Left to inform themselves, many youth frequently turn to friends or the internet for advice that is often incomplete or incorrect.

The limited availability of sexuality education leads to widespread myths about pregnancy and sex – myths that contribute to risky behavior and the cycle of teen pregnancy. Significant numbers of young adults, for example, believe that a woman cannot get pregnant even if she misses several birth control pills, or that a couple cannot conceive if they have sex standing up¹². The fatalistic view that pregnancy will happen "if it's my time," regardless of birth control, is a form of magical thinking held by many young people. The persistence of such myths can hamper young people's ability to use contraception correctly, and may discourage them from using it at all.

Toward Better Education

Improving the availability of sexuality education requires a community-wide commitment. But not all education programs are created equal. Some are too brief to delve into the complexities of relationships and sexuality, and others rely on fear and shame. Numerous health leaders, including the Sexuality Information and Education Council of the United States (SIECUS), have extensively researched different approaches to sexuality education, and identified certain elements that are effective at reducing risky behavior and teen pregnancy. These include¹³:

• Helping teens become effective decision makers
• Information on the benefits of abstinence, along with information on how to effectively prevent pregnancy if teens do choose to have sex
• Medically accurate information on anatomy, pregnancy, contraception, and sexually transmitted infections (STIs)
• An emphasis on family (including parent-child) communication
• Information on the characteristics of healthy and unhealthy relationships

Making Strides in Greater New Haven

The New Haven Board of Education took a significant step toward improving education in 2013, when it adopted a nationally recognized research-based sexuality health curriculum known as "The Michigan Model for Health." Starting in elementary school, the curriculum delivers health information sequentially, working up to topics such as healthy decision making in middle school grades. Much of the program's success will depend on the skill level of the teachers delivering the material and facilitating discussions. To help this effort, the district has committed to hiring certified health instructors for grades 7 -12.

The New Haven Public Schools have also worked with community partner Yale University Community Health Educators since 1999. Each year, more than 150 Yale volunteers lead workshops in New Haven classrooms, teaching 2,000 middle and high school students about topics like birth control and substance abuse.

Planned Parenthood of Southern New England (PPSNE) also helps fill the gap in sexuality education through a wide range of evidence-based programs, including their nationally-recognized Teen Talk series. Teen Talk covers anatomy, birth control (including abstinence), sexually transmitted infections, pregnancy, healthy relationships and effective communication. The four-session program has a tangible impact on youth participants, including several young people who completed one series, then eagerly returned for a second with several friends in tow. In addition to their classroom-based programs, PPSNE also coordinates a group of 20 teen peer educators in Greater New Haven public schools, offers a parent-child communication program called "Real Life. Real Talk," and trains professionals to deliver comprehensive sexuality education to the youth they serve.

Family Centered Services of Connecticut is providing Wyman's Teen Outreach Program (TOP) at New Haven's Barnard Environmental Studies Magnet. The TOP program emphasizes volunteering in the community, and its curriculum includes classroom discussions that help teenage boys and girls build communication skills, set values in their relationships, and improve their decision making.

New Haven Healthy Start's Teen Baby Buddies is a program that raises the awareness around infant mortality, social determinants of health, promotes healthy life choices and provides training to arm teens with the information needed for them to share what they have learned and to make healthier decisions.

Teens are educated through a series of 6 week sessions that include: the importance of pre conception health, how the environment influences health, ways to negotiate peer pressure, the importance of good nutrition and how to develop a reproductive life plan.

The New Haven Family Alliance operates a Male Involvement Network, where they help young non-custodial fathers learn to be more engaged parents. Their curriculum tackles issues from child development to healthy relationships, and covers healthy sexuality and family planning. The goal is more stable, supportive families for New Haven's next generation.

Improving Access to Healthcare

Following a brief increase in National Teen pregnancy rates in 2005, the City of New Haven took action by creating a mayor's task force. In 2007, the task force released the report, "A Call to Action: Helping New Haven Teens Avoid Unintended Pregnancy," which led to the establishment of the Teen Pregnancy Prevention Council. The council, which disbanded in 2013, achieved a significant success in 2010, when the School Based Health Centers were approved to provide hormonal contraception directly to students whose parents have already given them permission to receive care from the health centers.

Operated by Fair Haven Community Health Center, Cornell Scott Hill Health Center, and Yale-New Haven Hospital, the School Based Health Centers enable many students to access preventive care where they already are, eliminating major barriers to consistent and correct contraceptive use.

New Haven youth are also able to turn to Planned Parenthood of Southern New England (PPSNE) for access to preventive care. PPSNE's New Haven health center offers birth control on a sliding fee scale, along with counseling sessions to help young people find the best contraceptive fit for their lifestyle. They also operate monthly Teen Clinics, where youth can seek free preventive services, including birth control, well woman exams, and testing and treatment for sexually transmitted infections. PPSNE's high school peer educators lead educational activities in a youth-only waiting room and teens are welcome to bring friends for pizza, games and education.

Barriers To Access

New Haven's youth continue to face barriers, however. Many teens are unwilling to go to the School Based Health Centers for reproductive health services out of a concern of being seen and judged by their peers, or aren't able to since they lack parental consent to use the school-based health center, according to Pierrette Silverman, Vice President of Education and Training for Planned Parenthood of Southern New England and a member of the former Mayor's Teen Pregnancy Prevention Council.

Young people also struggle to access preventive care outside of school. While most New Haven youth do have insurance coverage, some remain uninsured due to residency or citizenship status, and are unable to afford family planning services. Moreover, many teens are uncomfortable talking to the policyholder in their family – usually a parent – about their sexuality, and may forgo reproductive health care because the explanation of benefits sent home could compromise their privacy¹⁴. Still others have never gone to a medical appointment without a parent and are nervous about scheduling the visit and communicating with the provider, according to Planned Parenthood of Southern New England.

The Centers for Disease Control and Prevention (CDC) has outlined several characteristics of adolescent-friendly family planning care. In order to improve youth access to preventive care and decrease rates of teen pregnancy, providers can alter their models of care to meet the developmental needs of young people. A teen-friendly health center can include¹⁵:

• Evening and weekend hours, because teens are usually in school or participating in extracurricular activities for much of the workday.
• Free or low-fee services
• An environment that accommodates the physical, emotional and social needs of adolescents, including the desire for privacy and peer support
• Education about safer sex and healthy relationships. Providers should also encourage teens to involve a parent or other adult in their decision to be sexually active.?

What the Community Foundation is Doing

Planned Parenthood of Southern New England has received grants from both unrestricted and donor advised funds from The Community Foundation and The Community Fund for Women and Girls. Recently funded projects include:

• New Haven Healthy Tweens Program (NHHTP), which combines in-school programs with workshops that empower parents to become the primary sex educators of their children.
• Teen Engagement New Haven Initiative, a comprehensive program aimed at improving teenagers' understanding of, comfort with and access to reproductive health services.
• Teen Talk, a teen pregnancy prevention program for New Haven teens.

Young Parents Program of Milford has received support for classes targeting women 22 years of age and under in order to promote healthy choices, responsible decision-making, healthy birth outcomes and prevention of future unwanted pregnancies.

New Haven Healthy Start, a program at The Community Foundation, was recently awarded a fifth round of federal funding in the amount of $5.7 million over five years, 2014 to 2019. The main purpose of this funding is to:improve women's health; promote quality services; strengthen family resilience; achieve collective impact; and increase accountability through quality improvement, performance monitoring and evaluation.

Student Parenting and Family Services provides unwanted pregnancy prevention counseling, support for child care, parenting education and support services to teenage parents attending middle or high school in New Haven.

Works Cited

1. Answering the Call to Action: Helping New Haven Teens Avoid Unintended Pregnancy, Five Year Progress Report (2007-2012). The Mayor's Teen Pregnancy Prevention Council, City of New Haven, 2012: 14.
2-5. Kost, Kathryn and Henshaw, Stanley. U.S. Teenage Pregnancies, Births and Abortions, 2010:
National and State Trends by Age, Race and Ethnicity. Guttmacher Institute, May, 2014.
6. Cohen, Robert K. Teen Pregnancy. CT General Assembly Office of Legislative Research, 2013.
7. Hess, Cynthia et al., The Status of Women and Girls in New Haven Connecticut. Institute for Women's Policy Research, July, 2012.
8. Answering the Call to Action: Helping New Haven Teens Avoid Unintended Pregnancy, Five Year Progress Report (2007-2012). The Mayor's Teen Pregnancy Prevention Council, City of New Haven, 2012: 4.
9. Sifferlin, Alexandra, "What's behind the Drop in in U.S. Teen Birth Rates," Time Healthland, May 24, 2013.
10. Guttmacher Institute, 2012.
11. Centers for Disease Control and Prevention, 2014.
12. Kaye, K., Suellentrop, K., and Sloup, C. The Fog Zone: How Misperceptions, Magical Thinking, and Ambivalence Put Young Adults at Risk for Unplanned Pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy, 2009.
13. Sexuality Information and Education Council of the United States Fact Sheet.
14. Cromer, Barbara A. and McCarthy, Maureen, Family Planning Services in Adolescent Pregnancy Prevention: The Views of Key Informants In Four Countries. Guttmacher Institute, 1999.

15.A Teen-Friendly Reproductive Health Visit. Centers for Disease Control and Prevention. Accessed March 1, 2015.

A special thanks to Planned Parenthood of Southern New England for contributing to this issue brief.