Health Promotion Strategies and Tactics

Running head: EFFECTIVE SEXUAL HEALTH INTERVENTIONS

Effective Sexual Health Interventions: Efforts to Prevent Teenage and Unplanned Pregnancy

Student Name

National University

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 2

Pregnancy and Teenagers

Understanding implications and severity associated with pregnancies are significant

concepts to all sexually active individuals. Puberty, or the development of secondary sexual

characteristic marked by secretions of luteinizing hormone (LH) and follicle stimulating

hormone (FSH) from the anterior pituitary gland, governs the potential for sexual reproduction

and occurs approximately after the first decade of an individual’s life. Males can reproduce

following puberty, however the female reproductive cycle is capable of reproduction from

menarche, the first menses, through menopause, the permanent cessation of menses (Tortora &

Derrickson, 2014). Teenagers, though capable of reproduction, are not fully grown adults and

face health, social, and economic burdens when becoming pregnant. Childbearing teenagers have

a higher risk than adult women of experiencing maternal illness, miscarriage, stillbirth, neonatal

death, low birth weight, and developmental and health problems among their children. Teenagers

who become pregnant are less likely to finish high school and frequently disposed to a life of

poverty and welfare reliance. Pregnancy among teenagers burdens not only the parenting

teenagers but society through annual tax revenues, public assistance, child health care, foster

care, and the criminal justice system at estimated costs of $10.9 billion dollars annually (Bridges,

2011; Planned Parenthood Federation of America (PPFA), 2013; The National Campaign to

Prevent Teen and Unplanned Pregnancy (NCPTUP), 2016).

The United States has significantly higher pregnancy and birth rates, or baby conceived

or delivered per 1,000 individuals, among teenagers than other wealthy nations. The United

States pregnancy rate is three times higher than Germany’s as well France’s and four times

higher than the Netherlands’. Birth rates are more alarming at four times that of Germany’s, five

times greater than France’s, and eight times higher than the Netherlands’ (PPFA, 2013).

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 3

Pregnancies exceeded 249, 000 in 2014 among 15 – 19 year old females across the United States.

Though this is a 9% decrease from 2013 and a 61% decrease from the peak teen pregnancy year

of 1991, a significant number of teenagers are still becoming pregnant. More than half of all

pregnancies to women aged 15 to 44 are unplanned and it is estimated that 82% of pregnancies

among 15 – 19 year old females are unintended (Bridges, 2011; NCPTUP, 2016). Though there

is still a pressing need for further interventions of teenage pregnancy prevention, the decline that

has occurred is the result of multiple effective health programs. Due to higher pregnancy and

birth rates among African American, Hispanic, and American Indian/Alaska Native youth and

youth who become acquainted with corrective and social services such as juvenile justice and

foster care, many programs have been implemented in communities around the United States to

target these populations (NCPTUP, 2015; NCPTUP, 2016). Planned Parenthood, The National

Campaign to Prevent Teen and Unplanned Pregnancy (NCPTUP), Advocates for Youth, the

American Academy of Pediatrics (AAP), the U.S. Department of Health & Human Services,

Office of Adolescent Health (USDHHS, OAH), the American College of Obstetricians and

Gynecologists (ACOG), and the Centers for Disease Control and Prevention (CDC) are among a

number of organizations that promote and advocate the prevention of teenage pregnancy.

Behavioral Interventions

Two major behavioral interventions targeted at teenage youth to prevent pregnancy are

abstinence and contraceptive use. The behavioral outcomes are often debated political topics of

opposing interests. Technological innovations have provided our population with

pharmaceuticals for a number of health issues, however preventing pregnancy by this means,

especially among teenagers, has brought a great deal of controversy to mitigation efforts. States

that strongly support abstinence-only are attributed with higher rates of pregnancies and births

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 4

than states that emphasized sexual health education encompassing abstinence, sexually

transmitted disease (STD), and contraceptive use discussions (Stanger-Hall & Hall, 2011).

Abstinence is 100% effective because it eliminates the risk of pregnancy as well as STDs

altogether, however abstinence-only campaigns often stem from belief rather than science.

Nonetheless, recent studies indicate that sexual health education covering education and

refraining from sexual intercourse as well as other options target a broader audience therefore

creating increased effectiveness in the ultimate goal: preventing teenage pregnancy (PPFA, 2013;

Stanger-Hall & Hall, 2011). Planned Parenthood, the NCPTUP, Advocates for Youth, the APA,

and the USDHHS OAH are among predominant organizations that advocate sexual health

education, which entails STI awareness, contraceptive use, and abstinence knowledge.

According to the CDC (2015), increased numbers of teenagers are practicing abstinence and 86%

of 15 – 19 year olds reported using contraception the last time they engaged in sex (Bratsis;

2015).

Planned Parenthood is a non-government organization (NGO) that began in 1916 and

offers an array of vital resources and information associated with reproductive health care. The

organization was awarded a small grant in 1948 to Gregory Pincus who began the development

of the birth control pill (Planned Parenthood, 2014b). Planned Parenthood itself is a program that

offers affordable or no cost birth control as well other methods of contraception including

condoms among other essential reproductive heath services to both female and male teenagers.

Planned Parenthood and affiliates averted 578, 681 unintended pregnancies through

contraceptive services and provided 931, 589 emergency contraceptive kits in 2014 (PPFA,

2015).

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 5

The CDC, AAP, and ACOG recommended the use of long-acting reversible

contraceptives (LARCs) such as subdermal implants and intrauterine devices (IUDs) for teenage

use because pregnancy can be prevented for three to ten years (Bratsis, 2015). The Contraceptive

CHOICE Project in Saint Louis, Missouri enrolled participants from 2007 to 2011 to promote the

most effective methods of birth control at affordable costs and prevent unintended pregnancy

(Kempner, 2012). More than 40 percent of teenagers in the CHOICE program chose LARCs,

which proved to have higher satisfaction rates and continued use than other forms of birth

control (Washington University School of Medicine St. Louis, 2016).

Environmental Interventions

Environmental strategies that have influenced change in pregnancy prevention promotion

include creating access to affordable health care and contraceptives, increasing social and peer

support, providing incentives and disincentives, campaigning to alter negative perceptions of

sexual health education, and increasing awareness and equity.

The media can be a strong promoter for sexual engagement as well as a strong deterrent.

With widespread technological innovations, the media is literally everywhere from television,

radio, and print to social media applications such as Facebook, Twitter, and Snapchat. The media

influences a number of health issues including teenage pregnancy due to subjective norms that

are disseminated and idolized. MTV, a music television network, aired a show called “16 and

Pregnant”. Studies reveal that the show had a positive impact on teen birth rates with a 5.7%

decline in birth rates over a 1.5 year time period. The underlying influence is that the media

intervention discussed sex, contraception and abortion and also highlighted parenting as a

teenager as a difficult, unglamorous, abnormal occurrence (Ahern & Bramlett, 2016).

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 6

Sexual health education is an important environmental influence and component of

education on teenagers. More than 90% of parents reported proactive implementation of sexual

education in both middle and high school along with a positive attitude to discussion of birth

control, STDs, healthy versus unhealthy relationships, abstinence, and sexual orientation

(Planned Parenthood, 2014c). Let’s Talk is a program designed to engage conversation between

parents or guardians and there children. A survey conducted by Planned Parenthood and New

York University’s Center for Latino Adolescent and Family Health indicated that in 2014, 8 out

10 young people aged 9 to 21 have talked with their parents about STDs, peer pressure, healthy

relationships, and birth control (Planned Parenthood, 2014c). Sexual health education programs

in public schools provide teenagers with the ability and self-efficacy to make informed decisions

as well as influence social norms.

Policy Interventions

Enacting policies that promote teenage pregnancy prevention include birth control and

family planning availability through insurance plans, education policies that require sexual health

education in curriculums, policies that require affordability, and federal funding initiatives, to

name a few.

The Teen Pregnancy Prevention (TPP) program, lead by the USDHHS OAH, provides

support for replication of evidence-based TPP programs and funding for the development and

evaluation of innovative approaches to prevent teenage pregnancies (USDHHS OAH, 2016). The

TPP program enrolled more than 122,000 youth of multiple ethnicities from September 2012

through August 2013. The majority of participants were Hispanic at 36.6%, followed by non-

Hispanic blacks at 30.4%, non-Hispanic whites at 23.3%, and the remaining 9.7% comprised of

American Indian/Alaska Native and Asian/Pacific Islander (USDHHS OAH, 2014).

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 7

In 1960, the US Food and Drug Administration (FDA) approved the sale of oral pills for

contraception (Planned Parenthood, 2014b). Unless using state funds form Utah or Texas,

teenagers do not need parental permission to obtain birth control from Planned Parenthood and

condoms are nearly always available at no cost (Teen Pregnancy Statistics, 2016). Planned

Parenthood accepts most insurance providers and also provides free and low-cost services to

those who are unable to pay for needed resources (Planned Parenthood, 2014a). Birth control is

not currently obtainable over-the-counter (OTC) and though organizations such as Guttmacher

Institute are advocating to the US FDA for this policy change, it will likely not be available to

teenagers under the age of 18 (Sonfield & Barot, 2014).

In 2010, the Affordable Care Act (ACA) was signed into federal law to make

preventative health efforts affordable and accessible by eliminating cost sharing and requiring

that health plans cover preventative services including sexual health counseling and

contraceptive methods (unless religiously affiliated) (USDHHS HRSA, 2016). Prior to the ACA

implementation, 55% of young women reported experiencing inability to consistently afford

birth control. More than 48.5 million women have been covered by the ACA since 2012 to

receive birth control with no out-of-pocket costs (Jaimes, Hayes, & Marr, 2015).

Colorado serves as an exemplary example of policy change influence when the state

made significant efforts to advocate for funding and improve access to effective contraceptives

for teenagers. Upon securing funding for LARCs, intrauterine devices and hormonal implants,

for teens and poor women, Colorado experienced a teen birth rate decline of 40% from 2009 to

2013 (Ahern & Bramlett, 2016).

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 8

Conclusion

Teenage pregnancy is an issue that affects individuals on intrapersonal, interpersonal,

communal, and societal levels due to health, social, and economic burdens. Diverse

organizations and programs have been developed to lessen the burden and have proven effective

based on the steady decline of teen pregnancies and births evidenced in the Unites States. There

are still an alarming numbers of teenage females and males becoming parents. Therefore,

multidisciplinary programs that target unified change in behavioral, environmental, and political

components are necessary to create greater impact on teenage pregnancy prevention.

EFFECTIVE SEXUAL HEALTH INTERVENTIONS 9

References

Ahern, N. R., & Bramlett, T. (2016). An update on teen pregnancy. Journal of Psychosocial

Nursing & Mental Health Services, 54(2), 25-28.

doi:http://dx.doi.org/10.3928/02793695-20160119-03

Bratsis, M. E. (2015). Reducing teen pregnancy. The Science Teacher, 82(6), 12. Retrieved from

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Bridges, E. (2011). Unintended pregnancy among young people in the united states: Dismantling

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f

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