Teen Pregnancy: A 'Winnable' Public Health Battle?

This is the third in a six-part MyHealthNewsDaily series examining the problems and solutions related to six "winnable battles" in public health, as recently announced by the U.S. Centers for Disease Control and Prevention.

Teenagers sporting baby bumps aren't hard to find, with three of every 10 American girls becoming pregnant by the age of 20. But national health experts are optimistic that a 20-year downward trend in teen pregnancies can be continued with consistent legislative and parental support.

CDC director Thomas Frieden's choice of teen pregnancy as one of six public health issues that are "winnable battles" seems particularly appropriate to teen pregnancy experts, who hope this new push to prominence will save the issue from what they see as apathy on the part of the public.

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"The CDC pick is not only a good thing, but particularly timely," said Bill Albert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy. "We've seen truly extraordinary success on an issue that many once considered intractable... but I don't think anyone would consider three in 10 girls getting pregnant a victory." [Related: Teen Pregnancy Rates Dip Slightly, But Concerns Remain]

Pregnant teens miss out on typical adolescent experiences. A 2006 report from researchers at Rhode Island Hospital and Brown Medical School found teens who'd had a child reported feeling they had to put their lives on hold and revise their life goals, and expressed concern about the difficulties of juggling school and motherhood.

The teen birth rate has plummeted 37 percent since 1990, with a slight increase in the mid-2000s before returning to the downward trend in 2008, according to the National Abstinence Education Association (NAEA).

What needs to be done to win

For the battle to be won, teen pregnancy needs to be de-glamorized, the same way smoking has been over the past generation, said NAEA executive director Valerie Huber.

Young people also need a stronger "risk-avoidance message," which comes from abstinence programs and parents, she said.

"We need to look at teen pregnancy as one consequence of a deeper health issue — teen sexual activity," Huber said. "One in four girls has at least one (sexually transmitted disease) and the rate in African-American girls is one in two."

Albert said a "kitchen sink" strategy is needed to further lower the teen birth rate, which should include government investment in proven sex education programs and parents openly broaching the subject with their kids.

"No one strategy or intervention is going to do it," he said.

Huber is dismayed that 169 abstinence programs lost funding on Sept. 30 as part of President Barack Obama's request to phase out funds for this type of education.

But a report released in January by the non-profit organization the Guttmacher Institute attributed the mid-2000 rise in teen pregnancy to "the growth of abstinence-only sex education programs at the expense of comprehensive programs."

A 2006 report from Columbia University's Mailman School of Public Health found U.S. teenage pregnancy rates declined by 24 percent between 1995 and 2002. The researchers attributed 86 percent of that decline to improved contraceptive use  — teens were using more effective methods and using multiple methods (e.g., the pill together with condoms). They also attributed 14 percent of the decline to teens waiting longer to start having sex.

Other research reveals another way to curb teen pregnancy: give kids a sense of self-confidence and high expectations for their futures. Teen girls with low confidence in themselves and their educational future are most likely to become pregnant, according to research published in 2004 in the American Journal of Health Behavior.

Is this battle winnable?

Albert and Huber differ on how they define victory.

"I doubt we will ever get to zero" pregnancies, Albert said. "Maybe the first goal is for the U.S. to no longer have the highest rate of teen births among (industrialized) countries."

According to United Nations' statistics, the teen birth rate is one and a half times higher than in Great Britain, which has the highest rate in Europe. Countries such as Canada, Japan, Denmark and Sweden have much lower rates.

Before winning is possible, Huber said, the battlefield should be widened to include teen sexual activity rather than only the resulting pregnancies.

"The premise is too narrow," she said. "I agree that this needs to be a health priority... but there needs to be some policy course corrections."