PREGNANCY AND PARENTING: PREVENTION AND SERVICES

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Chapter 10PREGNANCY AND PARENTING:PREVENTION AND SERVICESContentsPageIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323.Background on Adolescent Pregnancy and Parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323Sources and Limitations of Data on Adolescent Sexual Activity, Pregnancy, Childbearing,and Abortion . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .323Trends in the Incidence and Prevalence of Adolescent Sexual Activity, Pregnancy,Childbearing, and Abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .326Sexual Activity and Contraceptive Use Among Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326Pregnancies Among Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . 326Births Among Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328Abortions Among Adolescents . . . . . . . . ., , . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . 329Out-of-Wedlock Childbearing Among Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331Adolescent Fatherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .332Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332Consequences of Adolescent Sexual Activity, Pregnancy, Abortion, and Parenthood . . . . . . . . . . . . . . . . . 334Consequences for Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336Consequences for Children of Adolescent Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339Risk and Protective Factors in Adolescent Pregnancy and Parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340Risk and Protective Factors Related to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340Risk and Protective Factors Related to Pregnancy Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345Demographic Differences Related to Adolescent Pregnancy and Pregnancy Outcomes . . . . . . . . . . . . . . 348Prevention of Adolescent Pregnancy and Associated Negative Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356programs That May Help Prevent Adolescent Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356Programs That Emphasize Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357Programs That Provide Contraceptives to Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .372programs That Seek To Enhance Adolescents’ Life Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389Economic Incentive Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394Conclusions About the Effectiveness of programs To Prevent Adolescent Pregnancy . . . . . . . . . . . . . . . 394programs Designed To Prevent Negative Outcomes of Adolescent Pregnancy and Parenthood . . . . . . . . . 397Programs That Offer Alternatives to Parenthood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .397Programs That Offer Maternity Care or Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399Programs That Offer Specific Types of Services to Pregnant Adolescents and Adolescent Mothers . . . 400Programs That Offer Comprehensive Services to Pregnant Adolescents and Adolescent Mothers . . . . . 403Programs for Adolescent Fathers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405Conclusions About the Effectiveness of Programs To Prevent Negative Outcomes ofAdolescent Pregnancy and Parenthood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406Major Federal programs and Policies Pertaining to Adolescent Pregnancy and Parenting . . . . . . . . . . . . . . . . 408The Title X Family Planning Services and Research Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408The Title XX Adolescent Family Life Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411Other Federal Programs Pertaining to Adolescent Pregnancy and Parenting . . . . . . . . . . . . . . . . . . . . . . . . . 412Conclusions and Policy Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417Chapter 10 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418

BoxesBoxPage1O-A. The True Story of Keesha: An Unwed Teenage Mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3241O-B. Examples of New and Emerging Contraceptive Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3761O-C. The Six General Conclusions of the National Academy of Sciences’ Panel onAdolescent Pregnancy and Childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3%1O-D. Roadblocks to the Provision and Coordination of Care for Pregnant and Parenting Womenand Children: Findings of the National Commission To Prevent Infant Mortality . . . . . . . . . . . . . . . . . 407Figures.FigurePage10-1. Number of U.S. Females Ages 15 to 19, Number of Sexually Experienced U.S. FemalesAges 15 to 19, and Number of pregnancies Among U.S. Females Ages 15 to 19Pregnancies Among U.S. Females Ages 15 to 19,1970-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32710-2. Trends in Pregnancy Rates, Birth Rates, Abortion Rates, Miscarriage Rates, andOut-of-Wedlock Birth Rates Among U.S. Females Ages 15 to 19,1970-87 . . . . . . . . . . . . . . 32710-3. Trends in Sexual Experience Rates Among U.S. Adolescent Females Ages 15 to 19 and PregnancyRates for Sexually Experienced U.S. Females U.S. Females Ages 15 to 19, 1970-85 . . . . . . . . . . . . . 32810-4. Birth Rates, Abortion Rates, Miscarriage Rates, and Pregnancy Rates Among FemalesAges 15 to 19 in 11 Countries, 1983 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32910-5. Trends in Birth Rates Among U.S. Females Ages 10 to 19, 1970-88 . . . . . . . . . . . . . . . . . . . . . . . . . . . 33010-6. Trends in the Percentage of Pregnancies Ending in Abortion Among U.S. FemalesUnder Age 20,1970-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 3010-7. Trends in Pregnancy Rates, Birth Rates, and Abortion Rates Among U.S. FemalesAges 15 to 19,1973-85 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33110-8. Trends in Out-of-Wedlock Childbearing Among U.S. Females Under Age 20, 1960-88 . . . . . . . . . . . 33110-9. Overview of U.S. Adolescent Pregnancy and Parenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33510-10. A Conceptual Model for Pregnant/Parenting Teens and Their Male Partners:Pregnancy Resolution Decisions, Life Style Adaptations, and Well-Being . . . . . . . . . . . . . . . . . . . . . . . 34110-11. Trends in Out-of-Wedlock Childbearing Among U.S. Females Under Age 20 by Race, 1%9-87 . 35410-12. Percentage of U.S. Female Contraceptive Users Experiencing Contraceptive FailureDuring the First 12 Months of Use, by Age and Method of Contraception. . . . . . . . . . . . . . . . . . . . . . 373TablesTablePage10-1. U.S. Mothers and the Reported Age of the Fathers of Their Children, by Child’s Race, 1988 . . . . . . . 33310-2. Adolescent Fathers: Distribution of Male Participants in the 1984 NLSY Who ReportedHaving Fathered a Child Before the Age of 20, by Father’s Age at Child’s Birth andMarital Status at Conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33410-3. Adolescent Fathers: Distribution of Male Participants in the 1984 NLSY Who ReportedHaving Fathered a Child Before the Age of 20, by, Race/Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33410-4. State Education Agencies and Large School Districts’ Position on the Teaching ofSelected Topics in Sex Education, 1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35910-5. Evaluations of School-or Community-Based Sex Education, Life Skills Training, andOther Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36010-6. Evaluation of a Multimodal Pregnancy Prevention Program That Included Schooland Community-Based Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36910-7. Overview of Contraceptive Methods Most Commonly Used by U.S. Adolescents . . . . . . . . . . . . . . . . 37410-8. Evaluations of Contraceptive Provision Policies and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37910-9. Evaluations of Youth Employment Demonstration Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39210-10. Overview of Title X and Title XX of the Public Health Service Act . . . . . . . . . . . . . . . . . . . . . . . . . . . 409

Chapter 10PREGNANCY AND PARENTING: PREVENTION AND SERVICESIntroductionIn 1988, roughlyone million U.S. adolescentsbecame pregnant, and nearly half a million gavebirth. In recent decades, sexual activity rates amongU.S. adolescents have been increasing, but birthrates among U.S. adolescents have generally beendeclining .2 Since 1960, however, births to unmarried U.S. adolescents have increased dramatically(195c). About two-thirds of the almost 488,941 U.S.females under age 20 who gave birth in this countryin 1988 (as compared to about one-fifth in 1960)were single mothers (195c). Some of the immediatedifficulties encountered by unmarried adolescentswho become pregnant and bear children out ofwedlock are illustrated by one mother’s story in box1O-A.Early out-of-wedlock childbearing increases dramatically the chance that a mother and her child (orchildren) will live in poverty. Because of their needfor economic and other support, adolescents whobecome mothers and their children cost U.S. taxpayers a substantial amount of money. Families startedby adolescents account for the majority of familiesreceiving benefits under Aid to Families WithDependent Children (AFDC) program; and in 1985,AFDC, Medicaid, and Food Stamp Program costsfor families begun by a birth to a teenager wereestimated to be 16,65 billion (149). 3 In 1988,Federal, State, and local governments spent anestimated 20 billion on AFDC, Medicaid, and foodstamps to support families started by women whenthey were under age 20 (33).4 These estimates do notinclude other public costs commonly associatedwith family support such as housing subsidies, fostercare, or day care (33).Adolescent pregnancy and parenthood are notnew phenomena in this country. In recent decades,however, numerous societal and other transforma-tions have changed the context in which thesephenomena occur and heightened perceptions thatpregnancy and childbearing among U.S. adolescentsare serious problems (13,148,149,235). Among theconcerns are recent increases in births to adolescentsas a proportion of all births and the rising number ofthese that are out of wedlock (51a,89a). Blackadolescents have much higher rates of premaritalpregnancy and out-of-wedlock births than whiteadolescents, but in recent decades, a large increasein out-of-wedlock childbearing rates has taken placeamong whites (51a,196).This chapter examines the problems of adolescentpregnancy and parenting. The first section of thechapter presents background information on sexualactivity, pregnancies, births, and abortions amongU.S. adolescents. Subsequent sections review programs that may help prevent adolescent pregnancy,programs that may help prevent negative outcomesassociated with adolescent pregnancy and parenting,and major Federal policies and programs pertainingto adolescent pregnancy and parenting. The chapterends with conclusions and policy implications.Background on Adolescent Pregnancyand ParentingSources and Limitations of Data on AdolescentSexual Activity, Pregnancy, Childbearing,and AbortionData on U.S. adolescents’ sexual activity, contraceptive use, pregnancy, childbearing, and abortionare available from a variety of sources describedbelow. Data on births among adolescents, as notedbelow, are considerably more accurate than data onsexual activity, pregnancies, or abortions,Data on U.S. adolescents’ sexual activity havebeen collected in several surveys, although the typeIAlthough & focus of OTA’S adole nt he th repofl ;s on adolescents ages

associated with adolescent pregnancy and parenting, and major Federal policies and programs pertaining to adolescent pregnancy and parenting. The chapter ends with conclusions and policy implications. Background on Adolescent Pregnancy and Parenting Sources and Limitations of Data on Adolescent Sexual Activity, Pregnancy, Childbearing, and Abortion

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