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Preventative Pregnancy Interventions within the U.S. Foster Care System
School of Behavioral Sciences, Liberty University
Author Note
AI have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
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Abstract
Foster care youth have a copious number of issues, upon entering the foster care system,
that contributes to them being sexually active, resulting in pregnancy or a sexually transmitted
disease. Different preventative interventions have been introduced and tested with foster care
youth. In order to combat the current trend of teenage pregnancies within the foster care system,
I firmly believe that the system that exists today is in desperate need of reform. If we had more
participatory research studies, that include the majority of vulnerable youth in the entire data
collection process, then we would have a better opportunity to analyze the data and help in
developing more effective interventions within the foster care system in the United States.
Keywords: foster care, teen pregnancy, preventative programs, social media, medications
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Preventative Pregnancy Interventions within the U.S. Foster Care System
Adolescent youth entering the foster care system, within the United States, present a complex set
of psychosocial, mental health, developmental, and physical traumas. Many of these issues are
typically rooted in one’s childhood prior to entering the foster care system. These at-risk youth
face many challenges and often barriers to access programs that could benefit them and help to
identify the many reasons this population of youth engage in such high-risk sexual behaviors.
Today, social media has a huge influence on youth both in and out of foster care. There are
foster care programs, within the United States, that exist to address the specific needs of the
adolescent needing to be placed in foster care. Foster care youth have a copious number of
issues, upon entering the foster care system, that contribute to them being sexually active,
resulting in pregnancy or a sexually transmitted disease, Different preventative interventions
have been introduced and tested with foster care youth.
Teenage Pregnancy in the United States Foster Care System
Statistics
According to the National Center for Health Research, teenage youth that are in some
type of foster care, are more than twice as likely to get pregnant than their peers that live outside
of the foster care system within the United States (Brooks, 2017). The current trend within the
United States, is that we are seeing teenage pregnancy declining, however this trend is based on
teenage youth that exist outside of the foster care system. This trend has been slowly declining
since 1990, however the current trend among pregnant teenage youth within the foster care
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system has continued to show a significant rise in teenage pregnancies. The current trends show
that teenage youth in the foster care system are twice as likely to become pregnant or contract a
sexually transmitted disease, compared to their peers outside the foster care system (Brooks,
2017).
These foster care teenage youth are at a much higher risk of becoming pregnant or
contracting a sexually transmitted disease, due to many negative factors such as all forms of
childhood trauma and abuse. The teenage youth are often victims of childhood abuse, resulting in
many developmental and emotional health issues. Due to the lack of sexual education and the
many various barriers that exist that would enable these teens in getting the help that is available
to them, leave this specific population of youth to being more prone to engaging in high- risk
sexual behaviors. This leaves this vulnerable population in continual need of access to sexual
education programs, preventative health programs, and much needed counseling (Brooks, 2017).
According to the Centers for Disease Control [CDC], their National Vital Statistics
Report for 2019, the percentage rates among U.S. born ethnic groups vary greatly (Hamilton, et
al., 2021). The study looks at the historical trend of ethnic minority groups that continue to be
maltreated in the United States foster care system, specifically Black children as well as
Latino(a) children in comparison to White children. Black children have historically been
overrepresented in all forms of foster care. In 2018, 54% of Black children were reported to be
the majority population within the foster care system. Traditionally, Black children have been
disproportionately represented in foster care, due to a multitude of longstanding social issues
such as systemic racism, governmental oppression, cultural misunderstandings, and often racial
biases (Hamilton, et al., 2021).
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Traditionally, Latino(a) populations have historically been underrepresented within the
United States foster care system, however more recently trends are starting to shift to them being
overrepresented, particularly in many of the states that border Latino(a) countries (Hamilton, et
al., 2021). There are numerous reasons that put Latino(a) youth at a disadvantage within the
United States. They represent a population that is at a higher risk of domestic violence, sexual
abuse, substance abuse, lower social support, family stressors, and excessive disciplinary actions
with the intent to push Latino(a) youth to line up with American standards. Often this population
is overrepresented in neighborhoods that prove to be very unsafe and have high crime rates,
which also affect the outcome of these youth being placed into the United States foster care
system (Hamilton, et al., 2021).
At-risk foster care teenagers influences & barriers
It’s hard to believe that one of the wealthiest countries in the world as well as one most
industrialized countries in the world, the United States of America, represents the highest rates of
teenage pregnancy despite there being a downward trend. This is especially true within the
United States foster care system where marginalized & ethnic minority populations are very
disproportionately represented in comparison to White populations. There are a range of factors
that play into the disproportion of ethnic minority populations in comparison to White
populations, within the United States foster care system, often due to many economic &
environmental disadvantages that they face. Many at-risk youth often have multiple barriers to
access of programs that could benefit them and help to identify the many reasons as to why these
minority populations of youth engage in such high-risk sexual behaviors. Some of the more
recent programs have taken a more holistic approach by developing different culturally sensitive
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empowerment approaches that show a positive shift from focusing primarily on pregnancy
prevention methods to focusing on personal empowerment. This approach aids in more self-
awareness and self confidence that attributes to healthier sexual choices (Martin, 2022).
This study looked at the impact that social media outlets have on foster care youth.
Online dating and intimate & sexual relationships affect all youth. However, youth in foster care
tend to have much higher rates of unintended pregnancies, sexual abuse, STI’s, HIV, and a
tendency to abuse the social media platforms by participating in unhealthy online intimate
relationships. This can potentially allow them to participate in high-risk sexual behavior with an
online person. Social media can foster positive outcomes such as presenting the opportunity for
foster care youth to connect with friends & family which aid in increased self-confidence,
emotional support, and help them to become more socially active as opposed to being isolated
and depressed. Many of this vulnerable youth population often cultivate negative online
behaviors & interactions, due to many having had previous controlling intimate relationships,
past traumas, lack of coping skills, sexual coercion, sexting, and sexual harassment (Kachingwe,
et al., 2020).
This study looked at different caretakers' approaches to educating youth in foster care
regarding sexual health topics with the goal of looking into how social media exposure affects
foster care youth. They aspired to find any results to aid in future research & investigate all
aspects of effects that the foster care youth experienced. The study looked at three child welfare
jurisdictions & compared & contrasted different approaches to sexual health education, within
each foster care home. Their approach was to analyze the data they collected and compare &
contrast themes that were related to the foster care youths experience with social media.
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According to Albertson, et al., (2017) “Youth caregivers described four main themes: (a) impacts
of media on youth norms and attitudes, (b) impacts of media on youth behavior, (c)
impacts of youth on exposure to pornography, and (d) caregiver monitoring and mediation of
media”. In conclusion to this approach of studying the effects of social media use on foster care
youth, although they found common themes among the groups, much more studying & research
is needed to effectively work with this population of youth and create affective intervention
strategies that end with positive outcomes (Albertson, et al., 2017).
Interventions tested to safe-guard teenagers in foster care against teenage pregnancy
Sexual Health Education
This study looks at sexual education, specifically the preventative use of condoms, and the
effects & results of this form of birth control. Foster care youth experience extremely poor
outcomes, compared to their peers that are not in the system, specifically with early unplanned
pregnancies and contracting STI’s. The findings were positive in that teaching preventative
sexual health, specifically regarding the use of condoms, could improve their use in this high-risk
youth population. According to Finigan-Carr et al., (2021), “Youth in foster care are at a higher
risk for being pregnant and parenting. While teen pregnancy rates nationally are decreasing,
pregnancy rates among girls in foster care remain high at almost two and a half times that of their
peers, with rapid repeat pregnancies being a problem”. He goes on to say, “Consistent condom
use is the primary prevention method for minimizing the risks of many negative consequences
from unprotected sex, especially the risks of STIs and HIV/AIDS” (Finigan-Carr, et al., (2021).
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Clearly there is a dire need for more effective sexual education not only for the teenager
that resides in foster care, but for the family involved as well as in the social and educational
environment with caretakers, social workers, and human services professionals. These high-risk
youth should have access to sexual education that includes preventative measures like
contraceptives.
An additional study, according to McKibben et al., (2021), suggests a unique, yet effective,
approach to case workers having one-on-one “brave conversations”, with youth in foster care
homes throughout the day, where they have trauma-and evidence- informed conversations about
sexual health & safety. The way it works, which is beneficial to both the caseworker and the
foster care youth, is that social workers train the caseworkers on how to initiate these
conversations by teaching them capacity-building skills. Practicing the “brave conversations”
between the caseworker & the foster care youth, revealed that caseworkers perceived this type of
approach as strengthening protective factors that they teach the youth. These youth are very
vulnerable to sexual abuse. This approach is also referred to as the ‘LINC’ model which helps to
link the foster care youth and the caseworker on a more personal level increasing the connection
between the caseworker and the foster care youth creating stronger & safer relationships
(McKibben, et al., (2021).
Another type of sexual education study was conducted by Albertson, et al., (2020), where they
tested different strategies for monitoring and communicating sexual health topics to foster care
youth with the goal of developing different creative communication strategies that they could
teach to caseworkers. This study looked at different caretakers approaches to educating youth in
foster care regarding sexual health topics. They focused on three child welfare jurisdictions &
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compared & contrasted different approaches to sexual health education, within each foster care
home. They concluded that three major themes stood out: (1) using creative conversation
starters, open/direct communication, trust-building, self-education, and specifically orienting the
information to each individual youth, (2) using different strategies by clearly communicating
rules, spending time with the youth/their friends & family, using a social support system, as well
as using technology, and (3) using different approaches to promote positive youth development
by advocating for them and engaging youth in setting goals. They furthered the study by also
training caregivers by: (1) introducing more information on normal adolescent behaviors &
sexual health education, and (2) teaching caregivers ways to effectively communicate with each
youth by openly engaging with them by providing evidence-informed communication & monitor
the youth in a developmentally-informed way that respectively helped them to improve their
knowledge on reproductive health (Albertson, et al., (2020).
According to Davis, et al., (2021), there has been a necessary increase in the use of antipsychotic
& psychotropic medication techniques, especially for foster care youth & youth from low-
income families. The use of these medication techniques has rapidly increased over the past two
decades. This study aims to compare both youth in & out of the foster care system that are
specifically on Medicaid. Their goal was to identify factors that could contribute to the duration
and frequency of psychotropic medications used on both youth populations. The results showed a
slight increase in use for youth in foster care compared to their peers that were living outside of
foster care. There is still a lack of evidence in regards to the use and prescribing methods of
psychotropics to youth. It was noted that there is a definite need for better monitoring of these
types of medications being prescribed to ensure that the youth are not just receiving medication
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but also receiving appropriate behavioral health and primary care & prevention services (Davis,
et al., (2021).
Oman, et al., (2016) used a randomized-controlled trial (RCT) intervention technique that
studied the effectiveness of a teen-pregnancy prevention program for foster care youth by using
an intervention called Power Through Choices (PTC). The PTC intervention technique is a ten-
session, age appropriate, and medically accurate sexual health education program. The design
used was an RCT involving over one thousand youth from forty-four residential group homes
and from three states to collect data. Half of the group homes were randomly assigned to the
intervention group and half were randomly assigned to control groups that offered “usual care”.
The results indicated that the youth in the PTC intervention program showed significantly greater
improvements in comparison to those who were not in the PTC intervention program. This study
is the first randomized controlled trial of a teen pregnancy-prevention program designed for
youth in foster care settings to be published. This program has proven to be a positive medically
accurate sexual health education intervention method for youth living in the United States Foster
Care system (Oman, et al., 2016).
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Conclusion
The trends and common themes among the articles that I reviewed, share many
commonalities when looking at the many hardships and barriers that young adolescent girls face
within the U.S. foster care system. The lack of access to sexual health education, prenatal care,
healthy diets, support systems, and the basic daily needs are all at the forefront of this systemic
problem that exists in the United States. Teen pregnancy is all too real for those that are placed
into the foster care system due to many pre-existing issues, sexual health education being of the
utmost importance. Although it is documented that there are helpful “systems” in place to aid the
high number of teenage pregnancies within the foster care system, the complexities of each
individual case, poses a greater need for a vast variety of interventions for this youth population.
These intervention techniques and programs are needed in order to combat the current rates of
teenage pregnancies, particularly with minority ethnic populations, within the foster care system.
Human service professionals adhere to a code of ethics that embodies the fundamental values
due to every living human being, especially when it comes to honoring cultural diversity and
advocating for these underprivileged individuals. I believe that with like-minded hearts, coming
together in unity, can facilitate the necessary change of the current narrative, that is taking place
for the youth in the United States as a whole, and particularly for those who have faced some
form of crisis or trauma that lands them into the foster care system.
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References
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