can you do discussion Board post and journal

Oct 5th, 2017
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HN 370 Journal Entry

The Journal is a time for you to reflect on the content of the unit. It is an informal and viewable to yourself and your instructor.

Watch the video:

https://www.youtube.com/watch?v=9UT0Etnhl00

The video “Single Dad Builds a Future With Employment Initiative” touches on a major problem in our society; most single parent programs and services focus on single mothers. There are many young fathers who need resources as well and have nowhere to turn.

Search in your community to find resources available to young fathers. Using the Journal, list the resources you found. If there were more services to address the needs of single fathers, do you think that more single fathers would be willing to be responsible fathers as opposed to missing fathers? Explain.

HN370 Discussion Board

Read and post one primary post for each Discussion topic, addressing each of the topics clearly and correctly applying concepts from the course material to support answers. The length requirement for your post is 150 words minimum.

Be sure to make two or more responses to other students on each thread presenting original ideas, contributing to the quality of the discussion, and meets length requirement (50-100 words for each peer response).

Teenage pregnancy is a multi-faceted issue. Understanding teens as they grapple with their decisions regarding sexuality and parenthood involves understanding where they are in their development. Do they have a clear and thorough understanding of what the consequences are to being sexually active?

Based on what you have learned this week, please answer the following questions:

  • If you could design a teen pregnancy prevention program what would it look like?
  • Describe how you would involve parents, teens, schools, and community organizations.
  • Locate teen pregnancy/parenting programs available in your community and what identify services they offer.Do any of the agencies you listed offer volunteer opportunities? If so, what you would need to do to accept one? Explain how an opportunity like that would benefit your future work as a Human Service Professional.

Resources:

Read Chapter 11, "Teenage Pregnancy and Parenting," in your text, Exploring Child Welfare: A Practice Perspective.

Review the Web Resources below.

Web Resources


11 Teenage Pregnancy and Parenting Lynne Kellner Competencies Applied with Practice Behavior Examples—in This Chapter • • • • • • • • • • Professional Identity Ethical Practice Critical Thinking Diversity in Practice Human Rights & Justice Research Based Practice Human Behavior Policy Practice Practice Contexts Engage, Assess, Intervene, Evaluate Case Example Shannon, a sixteen-year-old high school junior, and her one-year-old son live with her twenty-two-year-old boyfriend and her mother. Her mother looks after the baby while Shannon attends school. Immediately on returning home, Shannon assumes full responsibility for the baby because her mother and boyfriend both work evenings. Shannon arranged with her guidance counselor to enter a half-day job-training program while condensing her academics into the other half; however, she has not attended the program in nine of the past ten days. “Why would Shannon pass up this opportunity to improve her income potential?” the counselor asks in frustration. Raising a child to adulthood has become increasingly complicated and expensive in our technologically advanced world. Children tend to remain at home longer as they complete their educations before entering an ever-more-competitive work world. Inflation makes it harder for young adults to become self-supporting. No wonder Shannon’s guidance counselor thinks that acquiring job skills would give Shannon the “best chance” at self-sufficiency. Shannon, however, is struggling with the adolescent developmental issues compounded by early parenthood. Peer contact, with its frivolous concerns and moments of forgetting her responsibilities, satisfies needs separate from those of her child. With the emergence of adolescent pregnancy as a national social problem in the 1960s, attention focused on the following: the psychological and financial inability of teen parents to care for their children; the negative impact on adolescent development, including decreased career and economic options for parenting teens; the economic consequences for the country of supporting children of unwed mothers; and the absence of fathers in children’s lives. This chapter will review and analyze these concerns and assumptions, place adolescent pregnancy in historical context, review current research to enhance our understanding, identify risk factors, and highlight key intervention strategies. DEFINITION OF TERMS Children having children is a phrase popularly used to describe adolescent pregnancy. Although catchy, it simplifies a very complicated phenomenon. Determining when adolescence ends is no simple feat in today’s society. Using traditional responsibilities of adulthood as guideposts—such as establishing a career, buying a home, and marrying and raising a family—many psychologists now extend adolescence into the midtwenties. When teen parents are viewed as children, intervention strategies appear patronizing. If the intention is to empower teens to assume responsible parenting, the “children having children” perspective is counterproductive. For the purposes of this chapter, age groupings established by the Department of Health and Human Services (Hamilton et al, 2010) will be used to distinguish between three sets of teenagers: young teens (ages ten to fourteen), middle teens (ages fifteen to seventeen), and older teens (ages eighteen and nineteen). HISTORICAL PERSPECTIVE Teen pregnancy is construed differently today than when our country was first settled. Many have preconceptions of the early Americans as moralistic and repressive. Think of Nathaniel Hawthorne’s The Scarlet Letter, in which Hester Prynne, bearing the minister’s love-child, is publicly humiliated and sentenced to wear a scarlet A (for adultery) on her bosom. Although the colonists disapproved of premarital sexual relations, they tolerated them if the mother married before thirty-two weeks of giving birth (Hambleton, 2004). As many as one-third of early eighteenth century brides were pregnant at the time they married. Abortions, herbally induced, were considered an acceptable treatment for “blocked menstruation” as long as there was no quickening, or movement of the baby (Mays, 2004). Both societal and technological changes accompanying the Industrial Revolution impacted childbearing patterns. As Americans moved from farms to factories, young men delayed marriage in order to save enough money to provide for a family rather than relying on the fruits of the land (Furstenburg, 2007). Medical advances lead to more reliable birth control; advances in rubber processing resulted in a new kind of condom, replacing those made from linen or animal intestines, and the newly developed IUD (intrauterine device) provided a long-term birth control method (Tone, 2002). Wealthier women had access to birth control, but poorer women did not. Consequently, childbearing rates among the poor remained high, and some in the upper classes feared that our country would be swamped with those of “low grade stock” (Males, 2010, 40). President Theodore Roosevelt referred to the declining rates of childbirth among white women as “race suicide” (Males, 2010, 40). The public emphasis on pregnancy prevention as desirable for the lower socioeconomic class still continues. Whereas previous generations resolved the problem of out-of-wedlock pregnancies with “shotgun weddings,” by the late nineteenth century, homes for unwed mothers provided shelter, medical care, and a moral education (Hulsey, 2004). As the number of young pregnant women living in group homes increased, researchers began to study the effects of illegitimacy. In 1919 the newly established Children’s Bureau concluded that the mortality rate among babies born to unmarried mothers was three times higher than those born to married couples; many were concerned that teen mothers were “too young” physically to bear healthy babies (Lundberg and Lenrott, 1919). As the twentieth century began, teenage and premarital pregnancy became the domain of the professional social worker. After World War II, many young men returned from the war and young women left their military-supporting jobs to marry and start families. Post–World War II “baby boom” teen birthrates peaked at 96.3 per 1,000 women in 1957 (Ventura et al., 2001, 1). In the 1950s, half of all teens who married were pregnant, but this did not pose a problem in the national consciousness because most were married. Until the 1960s, marriage and childbearing remained tightly linked; for many couples, engaged or pre-engaged, getting pregnant simply meant moving up the wedding date (Furstenburg, 2007). However, when the National Fertility Survey of 1965 revealed that 34% of poor women reported unwanted pregnancies, compared to 15% of more financially stable women (Campbell, 1968), politicians argued that those least able to provide for families were having the most children. The rising rates of federal assistance, coupled with higher birthrates among unmarried poor women, created a climate in which teen mothers were blamed for taxing the national economy. The 1960s was a time of social turmoil, and a number of societal factors contributed to Americans questioning traditional values. After publication of the groundbreaking Kinsey reports on both men’s (1948) and women’s (1953) sexual practices revealed that Americans had been engaging in premarital sex for some time, many people revisited their assumptions about sexual attitudes and their images of a moralistic national past, and consequently the stigma of illegitimacy lessened (Furstenburg, 2007). When the birth-control pill was introduced in 1960, contraception became less intrusive. Concurrently, leaders in the women’s movement affirmed women as sexual beings, thus making it easier for teen women to say yes to sex or, perhaps more realistically, making it harder to say no to their partners. In 1973 Roe v. Wade legalized abortion and made terminating unwanted pregnancies safe and legal, thus reducing fears that an unwanted pregnancy would inevitably lead to early parenthood and marriage. Feeling that they had more options, many women found marriage less attractive than those of previous generations and became less willing to enter unsatisfying unions simply because they were pregnant. As manufacturing jobs declined, men delayed marriage so that they could complete more education (Furstenburg, 2007). The confluence of more relaxed sexual attitude and, delayed marriage helped set the stage for increased rates of teen sexual activity and pregnancy. Expectations that early pregnancy reduced a woman’s options were also challenged by adolescents. Through the 1960s, pregnant students were forced to withdraw from high school, but in the environment of increasing tolerance of teen sexuality, this too changed. In 1971, a pregnant honor student, frustrated by the lack of challenge of home tutoring, sued her Massachusetts school district on the grounds that her right to attend regular classes had been violated (Ordway v. Hargraves). The school argued that the school environment was too dangerous for a pregnant teen. This perspective was typical of policies that ostracized pregnant teens for fear that they would negatively influence peers. The court ruled that the school had discriminated and acted illegally by expelling a student due to pregnancy. This case drew national attention to the rights of young pregnant women and shifted the focus from a moralistic one to a practical one on educational equality (Kiester, 1972). In 1972, Title IX mandated that public schools educate pregnant teens (California Department of Education, 2010). Starting in the 1960s, teen mothers received economic support, education, job training, and developmental opportunities for their young children through ventures such as Head Start. Such services were intended to help stop the “cycle of poverty.” During the 1980s, a new belief emerged that teen pregnancy could be reduced if economic supports were withdrawn so that mothers would have to join the work force to support their children (Raley, 2008). This attitude culminated in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which targeted prevention of teen pregnancy as a way of reducing entitlement benefits (Furstenburg, 2007). Consequently, mothers younger than eighteen were required to live with a parent or under other adult supervision, such as in group homes, and remain in school in order to receive benefits. Teen fathers are included in our society’s increasing focus on personal responsibility. Minor fathers were subjected to the same support obligations as older men, and were held accountable for payments. Recognizing the difficulty many teen fathers have providing financial support to their children, some states are looking to paternal grandparents. Wisconsin has enacted “grandparent liability” statutes that allow the courts to order grandparents to help support the offspring of their minor sons (Rozie-Battle, 2003). During the 1960s and 1970s, most children growing up in female-headed homes were children of divorced parents, but a growing acceptance of out-of-wedlock child-bearing became the major cause in the 1980s. The number of babies born out of wedlock has steadily risen since the 1990s, with record highs for the sixty-five years during which data has been collected: 38.5% of all babies born in the United States in 2006 were born to unmarried mothers. Of mothers under twenty, 84.4% remain single. Younger teen mothers are least likely to be married: 98.3% of mothers under fifteen are single compared to 57.9% of mothers age twenty to twenty-four (Hamilton et al., 2007, 14). Even teen mothers in relationships or cohabitating with the child’s father face the stresses of young relationships and are likely to wind up single-parenting within a few years. THROUGH THE EYES OF SOCIETY: MYTHS REVISITED Human Rights and Justice Practice Behavior Example: Understand the forms and mechanisms of oppression and discrimination Critical Thinking Question: How have pregnant teens been victims of oppression in the past? Are they still? Teens Acting Badly Popular opinion holds that teen females become pregnant because they and their teenage boyfriends cannot control their sexual impulses or do not know enough to use contraception. While this may be true in many cases, it does not acknowledge the number of teens who are either subjected to, or “willingly” participate in, teen/adult sexual relations. Seventy percent of females seventeen and younger who get pregnant do so by adult males over age twenty; and a quarter of teen fathers have children with adult women. Decades of marriage and birth records indicate that a quarter of the fathers of children born to teen mothers are twenty-five years of age or older. For the young teen trying to escape a troubled home, an older partner may provide increased resources, independence, and mobility (Males, 2010, 32–33). The movie Precious provides an example of how commonly it is assumed that a pregnant teen has made a bad decision with a fellow teen. Only after her second child is born, a social worker discovers that Precious’ two children were the product of rape by her father. Cycle of Poverty • Many believe that young mothers, and others receiving federal benefits, do so in disregard of middle-class values and suggest that “cutting off” supports will force welfare recipients to tow the line. While popular opinion supports this belief, many social policy analysts do not. The real value of welfare benefits, given inflation, declined significantly from the 1960s to the 1980s, thus decreasing the incentive young mothers would have for collecting benefits, or as many believe, having another child to get more money. While the European countries offer much more generous welfare benefits, they have lower rates of teen pregnancy. To argue that subsisting on welfare benefits encourages teens into early parenthood does not acknowledge the impact of the larger social context in which they weigh their options concerning the relative benefits of early parenthood in relation to perceived educational and occupational opportunities. Feeling unable to achieve middle-class goals, a teen may turn to achieving adult status by becoming a parent; this may not represent a good choice, but it is often an understandable one, given the lack of better options. (Raley, 2008, 339) Growing evidence suggests that pre-existing academic and economic hardships play a role in the continuing struggles of teen mothers. While 85% of young women who delay having their first child until at least twenty or twenty-one obtain a high school diploma or GED, only 63% of mothers who give birth by age seventeen do so. Teen mothers are also less likely to complete higher education: less than 2% of women who have babies by seventeen, and only 3% who give birth at eighteen or nineteen, complete a four-year college degree by age thirty, compared to 9% of women who delay parenting until age twenty or twenty-one. Given the emphasis on education in the workforce, it is not surprising that a young mother’s earning potential is impacted; in fact, women who had babies by age seventeen earned about $84,000 less during the first fifteen years of motherhood than those who waited until age twenty or twenty-one (Hoffman, 2006, 19–21). Teenage mothers rely on public assistance, such as Temporary Assistance to Needy Families (TANF), food stamps, and housing assistance, more than older mothers do; those seventeen and younger receive more than twice as much assistance ($37,000, compared to $17,000), and for almost twice as long, as mothers who first have a child at twenty or twenty-one (Hoffman, 2006, 22–24). The National Campaign to Prevent Teen and Unplanned Pregnancy (2011) conservatively estimates that teen childbearing cost taxpayers $10.9 billion in 2008, mostly on costs associated with publicly funded health care for the children, child welfare service, and later lost tax revenues of their adult children as a result of lower educational levels and earnings. However, a closer look at the mother’s pre-pregnancy socioeconomic status reveals that many teen mothers experienced systemic disadvantage prior to their pregnancies and not as a result of their early childbearing. Poor women who have children as teens have life-courses similar to peers who wait until their twenties to start their families: they find employment, but typically not in jobs that help them enter the middle-class; wed and usually divorce; and typically do not substantially further their education. The timing may be a bit different, but the end result tends not to vary much. Mothers who wait until their twenties may have better parenting skills, in part of a result of exposure to educational opportunities beforehand, and tend to place less of a burden on their families to help support them and their children (Furstenberg, 2007). Medical Concerns Because teens have more complications in pregnancy than older women, many argue that teens are not physiologically ready to bear children. Poverty, lack of education, and poor health care decisions contribute to the poor outcomes of teen pregnancies. Many teens delay or avoid prenatal care because they deny their pregnancies, fear or do not know of resources, or are unable to pay for services. From 2000 to 2003, only 47.1% of the youngest teen mothers received first trimester prenatal care, in contrast to 69.5% of mothers aged fifteen to nineteen, 78.2% of mothers aged twenty to twenty-four, and 86.2% of mothers aged twenty-five to twenty-nine. Disturbingly, 7.0% of mothers aged fifteen to nineteen and 16.1% of mothers under fifteen received prenatal care only during the third trimester, if at all (Menacker et al., 2004, 13). Many young mothers do not make healthy choices; almost a quarter of pregnant adolescents gain excessive weight (Martin et al., 2007, 13). Older teens (18.9%) and mothers in their early twenties (18.6%) have the highest rates of smoking, which correlates with low birth weight, miscarriage, infant mortality, and compromised postnatal development (Martin et al., 2007, 16). Ten percent of babies born to teen mothers are of low birth weight (defined as less than 2,500 grams or 5.5 pounds), compared to 8% born to mothers over twenty. Low birth weight places an infant at increased risk of illness, infection, and death shortly after birth, as well as later delayed motor and social development and/or learning disabilities (Child Trends, 2011b). Gilbert et al. (2004) compared 300,000 births to Californian first-time mothers aged eleven to fifteen, sixteen to nineteen, or twenty to twenty-nine to determine if teen mothers suffer more birth complications than older women of the same ethnicity. Compared to older women, teens in all four racial groups (Asian, white, Hispanic, and African American) collectively were one-and-a-half to three times more likely to have adverse birth outcomes, including infant and neonatal death, prematurity, and low birth weight. However, they did not have higher rates of preeclampsia or eclampsia, as in previous studies. Like older Asian women, teen Asian mothers had the best overall outcomes, except for increased prematurity and low birth weight. African American teens had the worst outcomes, but these outcomes did not significantly differ from those of older African American women; perhaps lower socioeconomic status (SES) and limited access to health care accounts for their poor pregnancy outcomes. White teenagers had the best outcomes of all adolescents. However, compared to older white women, they were also at the highest risk for negative outcomes. All teens except Asians were at increased risk of complications during delivery, mostly caused by urinary tract infections. Although younger teens had more complications, their babies were least likely to be delivered by Cesarean section, which may account for the higher rates of infant and neonatal death. Although attention has focused on teenage mothers, babies born to teenage fathers have a 15% increased risk of premature birth, a 13% increased risk of low birth weight, a 17% increased risk of being small for gestational age, and a 22% increased risk of death within the first month. Although it is not clear why the children of teen fathers are at higher risk, risky social behaviors, such as smoking and alcohol and drug use, are known to negatively impact the quality of sperm (Reinberg, 2008). Development of the Children Do children of teen parents suffer developmentally? Educators cite the approximately 50% of children of teen mothers who repeat a grade in school as evidence that young parenting negatively impacts child development. Since about half of all teenage mothers drop out of school before they are pregnant, perhaps the effects of both inherited dispositions to learning problems and the lack of modeling of solid academic skills are factors here (National Campaign to Prevent Teen Pregnancy, 2006). Teen parenting has been associated with gender-specific social impacts on the offspring. Sons of teenage mothers are more likely to be incarcerated before age forty than sons born to women aged twenty or twenty-one (2.2 times more likely than sons born to mothers seventeen and younger, and 40% more likely than sons born to mothers aged eighteen or nineteen). Daughters of teenage mothers are at increased risk of having children early in life, even after academic factors and family background are taken into account. The daughters of mothers who gave birth at age twenty or twenty-one are 33% less likely to become pregnant as teenagers than the daughters of mothers who gave birth at age eighteen or nineteen, and 60% less likely to become pregnant as teenagers than the daughters of mothers who gave birth at age seventeen or younger (Hoffman, 2006, 16– 18). Pogarsky et al.’s 2006 study of male children (73% African American, 15% white, and 17% Hispanic) found higher rates of externalizing behaviors, drug use, gang membership, and unemployment in early adulthood among sons of teen mothers compared to sons of older mothers. They argue that their study counters assertions that when minority groups welcome early parenting as a normative life event, the offspring are not adversely affected. The impact of a teen’s emotional immaturity as a parent is harder to assess. Some teens welcome the challenge of parenthood; others feel overwhelmed and are impatient with their children. One consequence of parental frustration and lack of parenting skills is increased child abuse and neglect (see Chapter 9). Compared to mothers who gave birth at age twenty or twenty-one, mothers who gave birth at age eighteen or nineteen were one-third more likely to have their children placed in foster care before they reached age five, and mothers who gave birth at age seventeen or younger were more than twice as likely. Although children born to mothers seventeen or younger had more chronic medical conditions, they were less likely to receive medical care and twice as likely to be reported for suspected child abuse or neglect than peers born to mothers aged twenty or twenty-one (Hoffman, 2006, 13–14). DEMOGRAPHICS In 2009, teen pregnancy rates fell to the lowest since 1946; mothers aged fifteen to nineteen gave birth to 409,840 babies, a 36% decrease from the all-time high of 644,708 births in 1970 (Ventura and Hamilton, 2011, 1–2) (See Figure 11.1). The number of babies born to the youngest mothers, aged ten to fourteen, also fell to the lowest in nearly sixty years to 5,030 (Ventura and Hamilton, 2011, 2). These drops resume a trend in decreasing teen pregnancy rates by approximately one-third that occurred from 1991–2005, but was interrupted for two years before rates began to fall again in 2008 (Ventura and Hamilton, 2011, 1). After increases of almost 5% in 2006–2007, rates began to fall again in 2008 by about 2% and with bigger declines in 2009 for all teen women (Hamilton et al., 2010, 2) (See Table 11.1). Figure 11.1 Number of births and birth rate of teenagers aged 15–19: United States, 1940–2009 Source: Ventura S. J., Hamilton B. E. (2011). U.S. Teenage Birth Rate Resumes decline. NCHS data brief, no 58, p. 1. Hyattsville, MD: National Center for Health Statistics. 2011. Retrieved May 27, 2011, from http://www.cdc.gov/nchs/data/databriefs/db58.htm. Teen birth rates for all ethnic groups, except Asian and Pacific Islanders, increased in 2006–2007 and then fell again beginning in 2008. Native American and Alaskan Natives showed the steepest increase (12%) from 2005–2007, followed by non-Hispanic blacks (6%) and non-Hispanic whites (5%). When teen pregnancy rates began to decline again from 2007–2008, Asian and Pacific Islanders had the steepest level of decline (6%) as well as the lowest rate of pregnancies (16.2 per 1,000 females compared to the average of 41.5 for all ethic groups). Pregnancy rates for Hispanic teens decreased by 5% during this time compared to 1–2% for all other ethic groups (Hamilton et al., 2010, 11) (See Table 11.2). Table 11.1 Birth Rates for Teenagers by Age: United States, 1991, 2008, and 2009 Age 10–14 15–17 18–19 2009 .5 20.1 66.2 2008 .6 21.7 70.7 1991 1.4 −17 38.6 −7 94.0 −6 *Rates reported per 1,000 females Percent Change 2008-2009 Percent Change 1991–2009 −64 −48 −30 Sources: Synthesized from Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Preliminary data for 2008. National vital statistics reports; vol 58, no 16. Hyattsville, MD: National Center for Health Statistics, and Ventura S.J., Hamilton BE. (2011). U.S. teenage birth rate resumes decline. NCHS data brief, no 58., p. 1. Hyattsville, MD: National Center for Health Statistics. 2011. Retrieved March 14, 2011 from, http://www.cdc.gov/nchs/data/databriefs/db58.pdf. In 2007, the United States had the highest teen birth rate for women of any developed country; followed by the United Kingdom with rates about two-thirds of those of the United States (Abma et al., 2010, 3). Teen pregnancy rates vary widely by geographic region; the intermountain West states heralded the largest declines for teens aged fifteen to nineteen, while the southeastern states had the largest declines for middle teens, fifteen to seventeen, and New England showed the sharpest declines for pregnant eighteen- to nineteen-year-olds (27% for both New Hampshire and Vermont) between 2007 and 2009. All but four states (Kansas, Montana, North Dakota, and West Virginia) and the District of Columbia showed at least a 5% decline in pregnancy rates among older teens. West Virginia showed the highest increase among middle teens at 17% (Ventura and Hamilton, 2011, 5–6). Given different rates of pregnancy, it appears that cultural factors impact how teens and their parents view premarital sexuality and pregnancy. Studies looking at ethnic differences in contraceptive use have not been definitive, but some indicate that Hispanic teens are less likely to use birth control than whites or African Americans; these differences diminish but do not disappear when parental education, employment, and income are taken into consideration (Marsiglio et al., 2006). Acculturation plays a role in subtle ways. Lack of integration into the dominant culture somewhat protects against teenage motherhood (Afable-Munsuz and Brindis, 2006). Zehr (2005) found that Hispanic students in grades seven to twelve with low levels of acculturation are significantly less likely to have sexual relations, and more-acculturated Hispanic teens are more likely to initiate sex earlier but are more likely to use condoms and consider having smaller families than less acculturated teens. The issue of acculturation and its impact on teen pregnancy warrants further research. Table 11.2 Comparison of Birth Rates * for Women Fifteen to Nineteen Years, by Race/Ethnicity: United States, 1991, 2005, 2007, and 2008 Race/Ethnicity Percent Change 2007–2008 41.5 42.5 40.5 61.8 −2 26.7 27.2 25.9 43.4 −2 62.9 64.3 60.9 118.2−2 200820072005 1991 Total Non-Hispanic White Non-Hispanic Black American Indian Or Alaska 58.4 69.0 52.7 84.1 −1 Native Asian or Pacific Islander 16.2 17.3 17.0 27.3 −6 Hispanic 77.4 81.7 81.7 104.6−5 Percent Change 2005–2007 +5 +5 +6 Percent Change 1991–2005 −34 −40 −48 +12 −37 +2 0 −38 −22 *Rates reported per 1,000 women Source: From Hamilton, B. E., Martin, J. A., & Ventura, S. J. “Births: Preliminary Data for 2008” (p. 11) National Vital Statistics Reports (Vol. 58, no. 16), Hyattsville, MD: National Center for Health Statistics, 2010. Although it is difficult to get definitive numbers, because the age of the father is not reported on all birth certificates, in 2005 births to teen fathers apparently hit an all-time high: 16.8 per 1,000 men aged fifteen to nineteen (Martin, 2007, 12). According to selfreports in 2002, 13% of sexually experienced teenage males have impregnated a partner, and about 4% are fathers (Marsiglio, 2006, 12). Moore (2008) suggests multiple factors may contribute to the various cycles in teen births, but that our understanding of these is compromised by the limited attention that was paid to studying why teen pregnancy declined between 1991 and 2005. Moore suggests a closer look at changing social and economic environments, fluctuations in the composition of the adolescent population, and factors related directly to teen childbearing as contributing factors to these fluctuations. She notes that since teen pregnancy data is based on comparisons to the number of teens accounted for through the U.S. Census, it does not reflect the actual number of adolescents in the country, some of whom are here illegally; this underestimation of teens may artificially inflate the teen pregnancy rates. Additionally, the higher birth rates of 2006–2007 may reflect a modest increase in immigrants from countries that practice early childbearing, such as Mexico, and some European and African nations. Since teen’s perceptions of the pros and cons of early parenthood reflect their views of their futures, and are influenced by their educational experiences, the post-1991 declines may partially be a function of increased Title IX funding that allowed more girls to participate in sports, possibly providing structure and means of fulfilment that made teen parenting less attractive. Although well-intentioned, one negative consequence of the 2002 No Child Left Behind Law may be that marginalized students, often cut off from supportive services or non-academic opportunities such as art, music, and gym, may have felt more discouraged at the prospect of graduating and dropped out (Moore, 2008). Decreased sexual activity and increased use of contraceptives most likely contributed to the decline beginning in 1991. Abortion has steadily declined among teens, with one exception of a slight increase among eighteen- to nineteen-year-old Hispanics in 2005– 2006, so its impact on the teen birth rate is difficult to discern. At the turn of the century, the movement toward abstinence-only sex education resulted in a decrease in teens learning accurate information about contraception, but the roles of these variables in the last few years are not yet well understood (Moore, 2008). When people decide to start their families has been historically linked to the perceived availability of economic resources, as evidenced by curtailed fertility rates during the Great Depression (Furstenburg, 2007). Perhaps today’s economic difficulties are playing a part in the recent decline in teen birth rates as well. TEENS AT RISK Many correlations exist between teenage pregnancy and SES, parents’ educational level, family structure, previous history of sexual abuse, age, and cognitive and developmental levels. In their review of over 400 studies, Kirby and LePore (2007) found that the risk factors most amenable to change include poor parent–child communication and peerrelated factors such as peers’ failure to use condoms and contraceptives and peers’ permissive values about sex and early childbearing. Family Function Many teens experience changing, perhaps unstable, family living situations. Supervision often becomes more relaxed during times of change, perhaps due to limited parental time or to children’s “playing parents off against each other,” particularly when there is discord. Adolescents’ behaviors often embody implicit family messages, and parents in flux often convey confusing messages. Parents dealing with marital and/or other issues may turn to alcohol to help them numb their pain. Parental substance abuse is associated with teens having sex more frequently and with more partners; parents struggling with their own alcohol or drug problems may not provide appropriate supervision, or they may model substance abusing behaviors that make teens more likely to engage in sex (Kirby and LePore, 2007). Teens implicitly acknowledge roles that they see their parents embody. Female teens whose mothers work outside the home are less likely to get pregnant than teens whose mothers do not (Zavodny, 2001), perhaps because they see their mothers in other roles besides that of caretaker. Adolescents who experience significant family disruption, such as Child Protective Services investigations and out-of-home placements, are more likely to initiate sex before age sixteen, and have lower rates of condom use and higher rates of teen births (Perper and Manlove, 2009). Teens that live with two parents are significantly less likely to engage in sexual relations. In a national study, 19% of female teens aged fifteen to nineteen who lived in two-parent homes (either biological or adoptive) reported having sex within the past three months compared to 31% living with a stepparent and 35% in single-parent homes. Adolescent males followed a similar pattern: 20% in two-parent homes, 25% in stepparent families, and 34% living with a single-parent had sex within the last three months (Abma et al., 2010, 7). Not surprisingly, higher rates of sexual activity among teens from singleparent homes results in higher teen birth rates. Teens who live with two parents, either biological or adoptive, are less likely to become parents; 39% of all teen parents stem from two-parent homes while teens who live with two parents comprise 57% of the general population (Sloup et al., 2009, 2). Policy Practice Practice Behavior Example: Know the history and current structures of social policies and services; the role of policy in service delivery; and the role of practice in policy development Critical Thinking Question: What has been done for teen fathers? What more might be done? If you were working with Mark, what might you say or do to help him recognize the possible consequences of his behavior? Case Example Mark Mark, age sixteen, has had to make many decisions on his own since his parents separated ten years ago. He lives with his father and three older siblings, but his mother maintains regular contact. Now his older brother is getting married. Mark knows that his father disapproves of the early marriage and feels anger and sorrow over his failed marriage. Mark tells his dad that he will not go to the engagement party because he has “a hot date.” Given his ambivalence over the party, his dad finds it hard to convince Mark that he needs to attend. Mark stays home with Bethany, his fifteen-year-old girlfriend. As they get closer to sexual intercourse, she asks if his dad is coming home. Mark assures her that his dad will not “find them” and adds, “My dad practically knows what we’re doing anyway. He’s cool.” Kirby and LePore (2007) have found that when parents are supportive and maintain warm, close relationships with their teens, the teens are less likely to have unprotected sex and therefore less likely to get pregnant or impregnate someone. Generally, consistent parental supervision correlates with lower rates of teen pregnancy; however, overly strict supervision or intrusive parenting appears to have the opposite effect. For teens rebelling against tyrannical parents, pregnancy may be a way to establish independence, assert adult identity, or spite parents. Socioeconomic Status Reflecting on the lack of opportunities in her area, one seventeen-year-old mother commented: “What can you do when you grow up round here anyway? There’s too many kids going to school and then nothing for them to do. There’s no decent jobs, and then they wonder why girls get pregnant. For me it was because I wanted to do something—I wasn’t gonna do nothing, like, so that’s like, that’s like my job—being a mum to K (baby son)” (Cater and Coleman, 2006, 31). Fernández-Villaverde et al. (2010) suggest that adolescents decide whether or not to engage in sexual relations based on their understanding of what is in their best interest. They weigh the pleasures of sexuality against the possibility of an unintended pregnancy; teens from families that do not view an unintended pregnancy as interfering with educational or financial opportunities for their children are less likely to socialize their children to avoid early parenthood. Teens from families with higher parental education levels and SES are more likely than other teens to delay sexual intercourse and use contraception (Kirby and LePore, 2007). More highly educated parents have higher expectations for their children and foster greater internal control. In general, their children expect to graduate from high school. Teens of all economic strata conceive, but those from families whose income is below 200% of federal poverty guidelines are disproportionably more likely to either get pregnant or impregnate (Sloup et al., 2009). When middle-class teens conceive, anticipating greater opportunities, they are more likely to abort than teens from less-educated, poorer families (Bulow and Meller, 1998). Having a child can motivate a young woman from a disadvantaged family to “get her life together,” or have a goal. Previous Sexual Abuse and Date Rape In the United States, female teens are at significant risk of sexual victimization. Two studies of pregnant and parenting teens found that about six out of ten had been sexually assaulted, and that an overwhelming number of the assailants (46% in one study) were at least ten years older than the teen (Males, 2010, 33). Fifty-four percent of female rape victims report they are eighteen or younger (National Institute of Justice, 2010). Seven percent of women whose first sexual encounter was in their teen years reported that it was involuntary. As the age difference between the young girl and her older male partner increased, so did the rates of coercion: 13% of women who considered the intercourse involuntary reported that their male partners were three or more years older than them (Abma et al., 2010, 9). Once victimized, teens often lack the skills to protect themselves. Those who have been victimized engage in voluntary sexual activity at a younger age, have unprotected sex more often, have more and older partners, and are more vulnerable to revictimization than non-abused teens (Logan et al., 2007). Teens, particularly males, who have experienced more severe forms of abuse—such as rape or incest—are at increased risk of teen conception. Fatherhood may be a way for a boy molested by an adult male to assert his masculinity. The relative lack of family support that some boys receive may also contribute to maladaptive behaviors. Previous sexual abuse increases a teen’s likelihood of using alcohol and drugs, which in turn increases susceptibility to sexually risky behaviors (Logan et al., 2007). Males twenty or older father most of the babies born to teenage mothers. The Minnesota Organization on Adolescent Pregnancy found that within the state, men aged eighteen to twenty-nine fathered 43% of the babies born to females fourteen or younger and 73% of those born to females aged fifteen to seventeen in 2005 (Kandakai and Smith, 2007). The American Bar Association (ABA) conducted focus groups with teen mothers whose children had been fathered by adults; in most cases, the relationship began when the females were about fourteen and the males were in their twenties. Older men offered the young women more maturity than peers, security, money, and sometimes a home environment better than the ones the women came from. However, most of the men were controlling and turned emotionally abusive and left soon after the women gave birth. Some did provide stable, caring relationships, but this was the exception. The ABA recommends that protection under statutory rape laws be extended to all females aged ten to fifteen when the male is twenty or older, even if the sex was “consensual,” and that states prosecute more aggressively and remove the “mistake-of-age” clause that many perpetrators currently use as a defense (Elstein and Davis, 1997). Nevertheless, statutory rape laws have not changed much over the last decade or so. Case Example Maritza Maritza’s stepfather sexually abused her when she was nine and ten years old. When Martiza’s mother learned of the abuse, she had her husband leave immediately and brought Maritza to a counselor. Maritza responded well to treatment. As an adolescent she did well in school and had a circle of friends she could trust. When she was fifteen, the leader of a church youth group sexually assaulted her younger brother, Pedro. This new family crisis revived old issues of trust for Maritza. Much to her mother’s horror, Maritza began to put herself in vulnerable situations. For instance, when Juan, a neighbor in his early twenties, dropped by, she entered the living room to talk to him wearing only her underwear. Uncomfortable with the situation, Juan immediately left the house. Maritza began making provocative comments to older boys on the streets. When her mother confronted her, Maritza said that she knew the boys and they wouldn’t “do anything.” Maritza’s placing herself in risky situations seemed inconsistent with her good judgment of the last few years. Her therapist wondered if Maritza was “testing the waters,” placing herself in risky situations in the hope that she would not be further victimized and therefore would be reassured that the world was safe. Unfortunately, the neighborhood boys began to think of her as “loose,” and one night at a party she was raped. Educational and Behavioral Difficulties Many studies show that teens who have poor academic skills and low educational expectations are significantly more likely to have a child than those who have high grades and standardized test scores and feel connected and participate in school organizations, and plan to attend college have sex later and postpone childrearing (Kirby and LePore, 2007; Raley, 2008). In addition to educational problems, female teens often exhibit numerous behavioral problems before conception; those who dated earlier and experimented with alcohol were at high risk of conception (Talashek et al., 2006). Like adolescent mothers, teen fathers often are disadvantaged; they commonly do poorly in school and drop out, come from homes with low to moderate incomes, have a mother who gave birth as a teen, belong to a gang, and exhibit aggression and other problem behaviors (Guttmacher Institute, 2002). Antisocial behavior is a risk factor for teenage paternity; those who are persistently aggressive in school are at highest risk. Two-thirds of 335 boys whose peers described them as aggressive in at least two different grades fathered children as teens (on average, at age seventeen), and those aggressive males who enjoyed peer approval were more likely to father children than those who were rejected by peers (Miller-Johnson et al., 2004). Schools are social environments that convey a sense of available opportunities to their students and an understanding of their options in the larger social structure. Although statistics may suggest that academic difficulties are a causal factor in teen parenting, it must be looked at as part of the larger social fabric. Differential funding among school districts impacts their ability to fund academic and other programs, offer competitive salaries to teachers, provide extra help to struggling students, and continue to acquire resources. Those with limited academic programs and high teacher turnover or “burnout” are less likely to inspire students to believe that they have many options in their future. High school dropouts are six times more likely to become teen parents than their peers, perhaps this reflects not only their educational difficulties but also their limited expectations for success other than parenthood (Raley, 2008, 343). HOW TEENS MAKE DECISIONS ABOUT FERTILITY AND CHILDREARING There has been a slow and steady decline in the number of teens having sex; the percentage of females aged fifteen to nineteeen who had sexual intercourse at least once dropped from 51% in 1988 to 42% in the 2006–2008 time period, with a similar decrease in males from 60% to 43% (Abma et al., 2010, 6–7). Older teens (aged eighteen to nineteen) are more than twice as likely to be “sexually active,” defined as having had sex within the last three months, than younger ones (Abma et al., 2010, 7, 16). While the majority of teens had their first sexual encounter with a “steady” partner (72% of females and 56% of males), 14% of females and a quarter of males had their first encounter with someone they had just met or with “just of a friend” (Abma et al., 2010, 8). Roughly a quarter of teens (25% for females and 22% for males) reported only one sexual partner within the last year, while 3% of females and 4% of males reported four or more partners. Teens that have intercourse earlier are more likely to have multiple partners, thus increasing the risk of pregnancy (Abma et al., 2010, 8–9). Sexually active teens often feel ambivalent over their choices. In a retrospective study in which young adults aged eighteen to twenty-four reflected on their early sexual experiences, many (47% of females and 34% of males) recalled having had mixed feelings about first becoming sexually active. Younger females who had relations with much older partners reported the most dissatisfaction (Abma et al., 2010, 9–10). Therefore, it is not surprising that in a national representative survey, 65% of sexually active females and 57% of males aged twelve to nineteen said that they wished they had waited until they were older before having intercourse (Albert, 2010, 5), and 60% said they believed teens should be given a strong message to delay sex until they have at least graduated high school (Albert, 2010, 15). Many teenagers report that they did not consciously decide to have sexual relations; it “just happened.” Planning for intercourse implies that one is a willing partner, which goes against societal messages that “good girls” do not seek out sex. Effective contraceptive use requires a comfort with one’s body. Younger adolescents have not had time to adjust to raging hormones and changing body images. At first intercourse, 79% of females and 87% of males reported using contraceptives. As they continued to be sexually active, 84% of teen females and 93% of teen males did so, perhaps with increased intimacy and improved communication, they are able to discuss their intentions and contraceptive choices more (Zavodny, 2001). While condoms are the preferred method for first intercourse, teens who remain sexually active often use a hormonal method instead of or in addition to a condom. However, teens relying on periodic abstinence, or the calendar method, rose dramatically from 11% in 1988 to 17% (Abma et al., 2010, 10–11). Seventy percent of teens who reported that they were currently using birth control said that they would not continue to do so if their parents had to be notified (Guttmacher Institute, 2006, 3). Older teens, and those with more resources, may feel more comfortable interacting with health care providers to obtain prescription contraceptives. Despite increased use of contraception, an estimated 750,000 U.S. teens become pregnant each year; 82% of the pregnancies are unplanned. Of all teen pregnancies, 59% go to full term, and more than a quarter are terminated through abortion (Guttmacher Institute, 2011, 1). Studies have shown that teens who use alcohol or other substances are more likely to have sex, have sex more frequently and with more partners, and are more likely to get pregnant or impregnate someone (Talashek et al., 2006). Perhaps those under the influence are not making informed choices to engage in sexual activity. Early dating may lead to experimenting with alcohol; in turn, drinking may lead to sexual experimentation. Zimmer-Gembeck et al. (2006) found that teens who initiated sex earlier and had more partners were more likely to use alcohol. In a 2010 study, youths aged twelve to nineteen reported the influences that most affected their decisions about sex: 46% said parents, 20% said friends, 7% said religious leaders, 5% said siblings, 4% said teachers and sex educators, and 4% said the media. The vast majority of both teens (80%) and parents (91%) believe that more open conversations among them would help teens to postpone sexual activity, and teens wish that their parents would be able to talk to them about relationship issues as well as birth control and sex. Both adults (73%) and teens (71%) supported messages of abstinence and contraception; they did not consider these two messages to be in conflict or believe that discussing contraception encourages teens to have sex (Albert, 2010, 8, 11, 16). Parents worry about the impact of peers’ attitudes on teens. Teens are more likely to have sex if their close friends are older, are sexually active, use alcohol or drugs, or view early childbearing and sexual intercourse positively. They are more likely to use condoms or contraceptives when their peers, especially their romantic partners, favor doing so or use them (Kirby and LePore, 2007). Over two-thirds of teens report that they would find parenthood a “real challenge” and would be “very upset” and were not sure how they would handle it (Albert, 2010, 22). Teen males who have a male relative who is forced to pay child support or who perceive the likelihood that they will have to pay child support if they impregnate their partners are more likely to use contraception and limit the number of female partners (Huang, 2005). Case Example Alicia Alicia, age fourteen, lives with her thirty-year-old mother, Sharon; four younger siblings; and her mother’s partner (father of the youngest two children). Alicia has been intermittently running away from home for the last year and is failing eighth grade despite her above-average intelligence. Sharon often expresses intolerance at Alicia’s normal adolescent frustrations. She feels, “After all, I never had to worry about going out or clothes or schoolwork. I had Alicia to worry about.” Alicia is sexually active with her eighteen-year-old boyfriend, Brent. They plan to marry when Alicia graduates from high school. One night, after another screaming argument with her mother, Alicia is grounded “for the rest of her life.” Alicia and Brent had planned to go out. Atypically, instead of leaving, Alicia sits at the kitchen table with the three condoms she had stored away, blows each up like a balloon, draws faces on them, and shows them to her mother. As Alicia “bumps up” against her mother developmentally, they are more and more angry at each other. Her mother has little patience for the “normal” crisis of adolescence; her own development was foreshortened when she had to care for a baby. Alicia has not experienced her mother as protective or nurturing, and many of her behavioral problems serve to draw her mother into a more involved role. Although she seldom admits it, Alicia would like her mother to take a more authoritative role and “be a mother.” How a teen integrates parental expectations, peer pressure, personal ambitions, and beliefs about his or her future to arrive at a decision about having sex is a complex process that is difficult for researchers looking at individual factors to adequately describe. In addition to familial, peer, and cultural factors, individual factors play a role. Teens with higher cognitive skills and greater internal control have less frequent sex, use condoms more regularly, and are less likely to become parents (Kirby and LePore, 2007). FATHERS Case Example Bruce Bruce, age seventeen, is the father of Korinna, eighteen months old, and Rickie, a newborn. Last year Bruce dropped out of school to apprentice at his uncle’s automotive repair shop. Having never had much patience, Bruce did not take directions well. Three months later his uncle asked him to leave. When Bruce’s girlfriend, Hannah, became pregnant the first time, her parents unsuccessfully tried to convince her to end the relationship. Hannah planned to place the baby for adoption. But once Korinna was born and her parents held their first grandchild, she and her family decided to raise the child. Bruce visited Hannah and the baby every day, but relations with Hannah’s parents were strained. Bruce resented that Hannah’s mother thought she knew more about the baby than he did. He boasted of the work that he could get, the income he could make to support Hannah and the baby, but he remained unemployed except for occasional work through Day-Temps. Hannah dreamed of sharing an apartment with Bruce and the baby, but there was no way. On two occasions, to prove to Hannah’s family that they were “worthy” parents, Bruce and Hannah took off with the baby for a few days. Hannah’s parents were worried sick. The young couple had little money and had not said where they were going. Bruce and Hannah continued to want to spend time with their friends, who sometimes enjoyed the baby and sometimes felt constrained by her presence. When Korinna was nine months old, Hannah became pregnant again. She and Bruce decided to marry. Hannah’s parents hoped that the engagement meant that Hannah and Bruce were maturing. Bruce looked harder for work this time, but there were few jobs for those with his low level of skills and low tolerance of frustration. When Rickie was born, Bruce was proud to have fathered a son. He spoke of his intentions to “be there” for his son and provide for his family, but day by day he became less confident that he could do so. As it became harder to maintain that he could support his children, he began to have one-night stands. Children whose young fathers remain involved in their lives benefit socially, emotionally, and academically (Lundahl et al, 2008). Whether adolescent fathers remain involved in their children’s lives tends to be tied to their relationship with the child’s mother. Those who were emotionally involved during the pregnancy and maintained a romantic relationship after the birth, were employed, and had male peers who were fathers tended to remain more involved (Fagan et al., 2003; Robbers, 2008). Young fathers who had antagonistic relationships with the maternal grandmother tend to be less involved with their children (Bunting and McAuley, 2004). Early parenthood can be particularly difficult for young fathers struggling for economic independence and identity formation. Paschal et al. (2010) interviewed thirty African American fathers, ages fourteen to nineteen, about how they defined and performed their roles as fathers. Three major themes emerged: provider (53%), nurturer (27%), and autonomous behavior (20%). The providers defined a “good father” as one who provides financially or materially; most helped provide tangible goods, such as diapers, and sporadic financial assistance, often with the assistance of their parents. Those romantically involved with the young mothers were most likely to assume this role. The nurturers believed that “helping out” or “being there” made them good fathers, and often did so with the help of their families. Older fathers were more likely to view themselves as nurturers and the younger fathers were more likely to view themselves autonomously, expressing their opposition to the idea of their fatherhood by deliberately detaching themselves from the role both conceptually and practically. Adult males father most of the babies born to adolescents mothers, and 20% of the fathers are at least five years their senior. Older partners increase the chance of a young woman becoming pregnant; 69% of teen females with partners six or more years older become pregnant compared to 17% of those with partners only two years older (Solomon-Fears, 2008). A TEEN’S VIEW Case Example Trinh Darany and I were going out almost a year. I thought we were in love. So when he asked to make love, I said okay, except for trying to hide it from my parents. Then I got pregnant. He pulled out, so I didn’t think it could happen, especially so soon. I told Darany, and he tried to avoid me. Always had something to do, somewhere to go. I told him we had to talk; finally we did. And he wanted me to have an abortion. But I couldn’t. No. It’s wrong. I couldn’t do that to my family. I didn’t plan to have Mony, but I really love him. But it sure has changed things. I go to group [expressive arts group], and I have to leave early so I can get home for Mony. My mom helps watch him, but she has to go to bed early to get up for work. My dad works two jobs, so he has no time. Then I have to watch Mony and my three younger brothers and sisters. I used to hate school, used to say I hated school anyway. … But I sure miss it now. Funny thing is, now that I’m not really in school [she attends GED classes], I want to be there. I want to do good and get a job. Now that I’m around a baby all day, I want to be a pediatric nurse. But it’s hard to find time to study. I’m tired at the end of the day. I’m glad I have the playgroup at the Y[MCA] to see other moms. Sometimes it’s hard for them, too. But I do love Mony. I just wish Darany would come over more. Last Saturday I did my hair and had a new dress and waited and waited for him. I was so angry; he didn’t call. He finally came, but it was too late to go out. … I have to be up at six with the baby. When Trinh learned she was pregnant, she went to the school health counselor, who informed her that she would need to live with her mother or another adult relative in order to receive welfare benefits. Trinh had hoped to live with nineteen-year-old Darany, but he would not marry her. When Trinh gave birth, her mother was with her. They named the baby Mony, meaning “precious stone” in Cambodian. Darany came to the hospital the next day but did not visit for another month. Trinh’s mother taught her how to care for an infant. The counselor helped her find a Saturday GED class while her mother cared for the baby. During the week, Trinh was so tired that it was hard for her to study. One day, desperately wanting to be around peers, she dropped by the Teen Center and was invited to join an expressive arts program. Delighted with the idea, she joined despite feeling self-conscious about being the only parent, and the only Cambodian, in the program. Trinh’s mother provides child care and emotional support. Trinh longs for a commitment from Darany but knows that’s a dream. Every few weeks he visits but doesn’t show much interest in the baby. Although mandated to pay child support, Darany works “off the books” and gets around it. Fortunately, Trinh receives assistance through Women, Infants, and Children. As the baby sleeps through the night, Trinh is able to study for her GED. She plans to attend a nursing school at the community college. SERVICES: PRIMARY PREVENTION Primary prevention programs, aimed at preventing sexual activity and pregnancy, vary in format, philosophy, and success rates (Kirby, 2007). The Obama Administration has expanded its strategy to prevent teen pregnancy from the previous administration’s policy to fund only abstinence-only sex education programs to include a variety of interventions. Programs Focusing on Sexual Antecedents Sexual antecedents include decisions about abstinence, sexual activity, and contraception. Twenty states and the District of Columbia mandate sex and HIV education in their public schools; states are twice as likely to require that abstinence be stressed than to require that information on contraception be included (Guttmacher Institute, 2011). Abstinence (Just Say No) versus Comprehensive Programs Practice Contexts Practice Behavior Example: Provide leadership in promoting sustainable changes in service delivery and practice to improve the quality of social services Critical Thinking Question: How effective do you feel services are to teen parents? As a practitioner, how might you provide leadership in improving such services? Decisions as to whether sex education should focus only on abstinence often have political and moral underpinnings. Although many parents would like to encourage their children to delay sexual initiation, 80% want them to have information on contraception so they can make informed decisions about their sexual health (Kirby, 2007, 4). Likewise, 73% of teens state that they would like more information on abstinence, birth control, or both (Albert, 2010, 17). Kirby notes that the most effective programs present clear messages and goals to teens. Educational programs that promote avoidance of alcohol use, drug use, and violent behavior but do not directly address sexual issues have generally been found to have little impact on teen sexual behavior (Kirby, 2007, 19). Roughly two-thirds of the comprehensive programs have been shown to delay sexual initiation and increase condom and/or other contraceptive use. However, it is not clear if they reduce childrearing (Kirby, 2007, 14). While abstinence-only programs contributed to teens’ intentions to remain abstinent, these intentions do not endure, and teens do not translate them into behavior (Kirby, 2007). As many of one in eight American teens may take “virginity pledges” to remain celibate until marriage; given that adolescents from more conservative or religious backgrounds are more likely to do so, it seems that any delay in sexual initiation may reflect their preexisting values and not be a function of the pledge itself (Tamkins, 2008). One of the most popular abstinence programs is the Silver Ring Thing, which offers a “concert-style show incorporating music, laser lights, fast-paced video, drama and comedy performances” geared to convincing middle and high school students that abstinence until marriage is “God’s plan” (History of the Silver Ring Thing, 2008). Upon pledging, teens receive a silver ring, inscribed with a phrase from the Bible, that they are not to remove until their wedding nights. Teens who have had intercourse are offered a chance for “secondary virginity,” or no further intercourse until marriage. A study comparing pledgers to peers found that 82% of pledgers denied ever having taken the pledge five years later and that pledgers did not differ from non-pledging peers in rates of premarital sex, sexually transmitted disease, and initiated sex and had the same number of lifetime sexual partners. The pledgers, however, were less likely to report using birth control or condoms in the past year or any form of birth control the last time they had sex (Rosenbaum, 2009). Educational Programs for Teens and Their Families Sex education programs vary considerably in length (from less than ten hours to more than forty) and curriculum. Programs provide information and emphasize the building of skills and clarification of values (Kirby 2007). “Safer Choices” is a two year multicomponent program for ninth and tenth graders that combines classroom curriculum, school-wide activities and attempts to change the school’s normative culture by creating a School Health Promotion Council and a Safer Choices Peer Team. It promotes the message that unprotected sex, or intercourse before one feels ready is an unsafe choice, using protection against pregnancy and STDs is a safer choice, and abstinence is the safest choice. Activities for parents help them learn how to talk to their teens about the Safer Choices message. In a comparison of twenty participant sites to a group of control sites, the program was found not effective in delaying sexual initiation, reducing the frequency of sex or the number of sexual partners. However, participants had fewer instances of unprotected sex, and reported increased knowledge of sexual information, greater self-efficacy to refuse sex and communicate with a partner, and more positive beliefs about condom use. The program also had a positive impact on parent–child communication (Child Trends, 2011b). Programs Providing Contraceptive Access Two types of programs provide access to contraceptive services: reproductive health clinics and school-based or school-linked clinics. Many worry that providing contraceptive services to teens increases their sexual activity, but studies have not confirmed this. When clinics, whether publicly funded such as Planned Parenthood or school-based, provide one-on-one counseling on abstinence and contraception, give clear messages about the inherent risks of sex, and provide contraceptives, teens consistently increase their use of protection. When California increased funding for lowcost family planning clinics, the number of teens acquiring contraceptives greatly increased (Kirby, 2007). School-based clinics that also provide prenatal care may help pregnant teens remain in school (Barnet, 2004). Communitywide Initiatives Many communities are finding that developing broad-based intervention models that include communication strategies and media campaigns tailored to their target audience increases their success (Centers for Disease Control and Prevention, 2011). One such program, the Community Level HIV Prevention Intervention for Adolescents in LowIncome Developments, includes curricula on communicating with a potential partner, how to refuse sex, and condom negotiation. Teens participate in follow-up sessions, a Teen Health Project Leadership Council, media projects, social events, talent and musical shows, and festivals. Parents attend workshops on HIV/AIDS. Program participants delayed sexual initiation and those who were already sexually active increased their condom use (Alford, 2008). Despite concerns about media influences on teen sexuality, teens claim this influence is far less destructive than adults fear. The Parents Television Council (2005) notes that only 15% of TV shows with sexual content illustrate risks of sexual behavior, such as pregnancy or STDs; the remaining 85% portray sex as without consequences. The media has occasionally addressed teen sexuality in an informed, serious manner. The National Campaign to Prevent Teen and Unplanned Pregnancy (2010) funded a study to analyze the impact of the popular reality show, 16 and Pregnant, that premiered in 2009. Each hour-long episode chronicles a teen’s journey through her pregnancy and early parenthood, including the challenges of tumultuous relationships, lack of supports and financial resources, school and work stresses, and the impact of gossip. Six out of ten teens have watched at least one episode; and 82% of those stated that the show helps teens better understand the challenges of early parenthood while only 15% felt it glamorized teen pregnancy. More than a third talked to a parent after watching the show (3). Three-fourths of teen respondents stated that when a teen TV character becomes pregnant, they think more about the negative consequences of teen pregnancy (Albert, 2010, 6). When celebrities, such as Bristol Palin, have children in their teens, parents have an opportunity to ask their children how they feel about the celebrity’s decision and discuss the possible outcomes for parent and child. Each May since 2002, the National Campaign to Prevent Teen and Unplanned Pregnancy has sponsored a National Day to Prevent Teen Pregnancy. Teens are invited to take a short online quiz, available in English or Spanish, that asks how they would respond to a number of risky sexual situations (www.thenationalcampaign.org/national/default.aspx). In addition to the online quiz on the National Day to Prevent Teen Pregnancy, the extensive website of the National Campaign provides teens with a wealth of information and a chance to communicate online with other teens. Although a vast amount of Internet information is questionable at best, some solid websites provide information on these issues. Columbia University hosts a website called “Go Ask Alice!” (http://www.goaskalice.columbia.edu/) where teens can access information on alcohol and drugs, various health issues, sexuality and sexual health, and relationships. Programs Focusing on Nonsexual Antecedents Programs focusing on nonsexual antecedents target risk factors, such as school failure and societal disadvantages, and help young people develop skills and confidence, and broaden their horizons. Early Childhood Programs Preschool programs such as Head Start provide structured learning experiences to help young children overcome the disadvantages of poverty that are linked to teen pregnancy. Some programs intervene at younger ages. The Abecedarian Project, sponsored by the University of North Carolina, provides low-income families with fulltime, high-quality care for their children from infancy to age five. When compared to a control group at ages twelve, fifteen, and twenty-one, the Abecedarian Project graduates had higher reading and math scores in the primary grades, had their first children later, completed more education, and were more likely to attend four-year colleges. Young mothers who participated in the program achieved higher educational and employment status than those in the control group (“Carolina Abecedarian Project,” 2007). Youth Development Programs Youth Development Programs involving national, state, and local organizations; schools; social service agencies; community-based groups; businesses; religious organizations; and tribes provide supportive, nurturing environments that make it less likely that teens will choose behaviors leading to teen pregnancy. Some programs are gender-specific. Girls Incorporated developed several programs that target girls aged nine to fourteen with the intention to promote girls’ health and well-being by giving them information, fostering connections between the girls and their communities, and developing the girls’ leadership skills; programs for older youth also directly address teen sexuality issues. The Wise Guys program provides reproductive information and health care to male teens either in schools or through local health centers (see www.wiseguysnc.org). A 2006 evaluation of multiple programs for young males highlighted the importance of establishing a male-friendly environment and focusing on issues important to males (Troccoli and Whitehead, 2006). Because intervention efforts have traditionally focused on girls, it is important to create gender-neutral pamphlets on contraception; reflect male interests in waiting rooms and meeting rooms (e.g., with sports magazines and videos and posters of prominent men such as Barack Obama); and reach out to young men on their own turf, such as at sporting events or in the locker room. Programs that address other health needs, such as school or job physicals, can create a comfort zone in which teen men can discuss sexuality. Male staff and “maleonly” hours can increase a program’s friendliness, provide a forum for increasing academic and job skills, and provide a place to discuss relationship and sexuality issues. Effective intervention programs for males deliver messages about teen pregnancy that are authentic and present real-life stories. They are credible, not preachy, funny, ageand gender-specific, original, and positive. The recent focus on service learning, in which community volunteer work is combined with a reflective component, has been found to have a positive impact on teen pregnancy. Several studies have found that service-learning programs that require extensive commitments keep teens busy after school and consequently reduce the teen conception rate, particularly during the academic year (Kirby, 2007). Programs Focusing on Sexual and Nonsexual Antecedents Comprehensive programs are based on two premises: (1) adolescents with hopes for the future delay parenthood, and (2) intervening in more than one realm of the teen’s life is more effective than intervening in only one. In 1984 Dr. Michael Carrera started the Adolescent Pregnancy Prevention Program, sponsored by the Children’s Aid Society, for girls ages thirteen to fifteen in Harlem, which was later extended to males. The program entails a job club, career guidance, academic assessment, tutoring, college admissions assistance, performing arts workshops, a family life and sex education curriculum, and sports instruction. Reproductive health services and mental health counseling are also available. Teens meet daily after school and on Saturdays. In the summer they work while maintaining contact with the program. A three-year evaluation across twelve sites in seven states indicated that female participants had significantly lower rates of pregnancies and births; both genders scored higher on knowledge-based tests on health habits and sexual and contraceptive knowledge, as well as on the PSAT than a control group, and were more likely to have life and technical skills, hold bank accounts, and have skills necessary for employment (Child Trends, 2009). Kirby (2007) found that girls in the program delayed first sex, used contraceptives more, and had fewer pregnancies compared to peers who did not participate, but that the program had no impact when implemented with boys. SERVICES: SECONDARY PREVENTION From 1991 to 2008, repeat teen births decreased from 25% to 19% nationally (Child Trends, 2011a). Not surprisingly, states with high initial teen pregnancy rates had higher rates of repeat pregnancies. Mississippi has the highest rate at 23%, while New Hampshire has the lowest at 12%. Teen mothers with multiple children tend to have the poorest socioeconomic outcomes of young parents. Secondary prevention targets successive unwanted pregnancies and provides supportive services to parenting teens and their children. Adolescent parents, particularly those in poverty, often need multiple services to ensure the financial and emotional stability of their families. School-based programs, vocational-skills training, life-skills training, health care, child care, counseling, case management, and GED classes address the many needs of adolescent parents. Teen Parents and Their Families Over 6 million children in the United States live with at least one grandparent; 2.5 million of whom live in three-generation households with a single mother and grandparent(s). Children born to teen mothers who live with grandparents are 80% less likely to live in poverty than those of teen mothers who live by themselves (University of Southern California, 2009). Teen parents who continue to live with their parents are more likely to complete high school than those who co-habituate; financial pressures to support a household negatively affect both teen fathers and mothers’ ability to complete secondary education (Mollborn, 2010). Parenting Programs Programs for teen mothers and their children, sometimes called “teen-tot programs,” have three goals: (1) preventing repeat pregnancies while teen mothers complete their educations, (2) improving the health of mother and child, and (3) improving parenting skills (Akinbami et al., 2001). Studies on the effectiveness of parenting programs indicate mixed results. Although Akinbami and colleagues found that participants in four programs did not report increased care-giving skills compared to control groups, these participants were less likely to have repeat pregnancies. Barnet et al. (2007) found the opposite and noted that depressed adolescents have a 44% increased risk of a subsequent pregnancy within two years. When Rowen et al. (2005) asked pregnant and parenting teens what services they wanted, the teens requested mentoring by women who had given birth as teens, involvement of their parents in childcare and life decisions, spiritual guidance, parenting classes, personal growth and development classes, and peer support groups. The young mothers said they wanted to be role models for their children and wanted mentors who had given birth early in life to guide them and nurture their developing self-confidence. Keeping Fathers Involved One study of over 700 adolescent mothers reported that about one-third had been with the babies’ fathers for a year or less. That amount of time is not adequate for a young couple to establish itself as a couple, decide on commitment, or develop communication skills before dealing with the pregnancy (Wiemann et al., 2006). Young mothers involve fathers more in parenting if the father contributes financially. To send a message that fathers are important to their children, the Obama Administration has shifted emphasis away from promoting marriage, as established by the Clinton Administration and continued through the Bush Administration, to promoting fatherhood (Marsh, 2010). While the President’s Fatherhood Initiatives do encourage marriage, they also acknowledge that families are created through many different circumstances and urge all parents to stay involved with their children. The Fatherhood Initiative attempts to meet the needs of fathers in various situations through three entities: a new Fatherhood, Marriage and Families Innovation Fund designed to expand on local fatherhood and family-strengthening programs; transitional jobs programs through the Department of Labor to help noncustodial parents develop job skills and find work; and newly-created “fathering reentry courts” through the Justice Department to assist fathers as they leave the criminal justice system in finding employment, allowing them to make child-support payments and reconnect with their families (Feldman, 2010). The President’s website, www.fatherhood.gov, has much information for teen parents along with links to other resources and videos by teens. The U.S. Department of Health and Human Services’ Fatherhood Initiative supports a number of programs across multiple sites, to help low-income fathers obtain skills to support their children financially and emotionally. Young fathers are more likely to engage in services when they are invited to participate as part of a program that serves the young mother, but in separate groups with male leaders to allow them to feel safe and willing to open up about their doubts, fears, and other feelings that they might not want to express in a co-ed group. Engaging both the father and mother in complementary group activities simultaneously helps the young father to maintain a good relationship with the child’s mother. Allowing young fathers to identify their own needs and activities helps empower them; some may engage more with curriculum teaching parenting skills, while others may want to have a fathers nights out or engage in sports. Programs should be culturally relevant rather than “mainstream,” and recognize important elements of the ethnic, religious, and socioeconomic composition of the group (Rosenberg and Wilcox, 2006). One project for teen and disenfranchised fathers is the Men in Relationships Group (MIRG), an open-ended group led by mental health counselors that helps them learn to interact with their children and gain job seeking skills. The fathers bring their children along to participate in play activities while they attend their groups. There is a Job Club, for those who are unemployed or underemployed, which teaches job seeking skills. Fathers who have progressed through the program may pair up with the professional staff to begin another MIRG group or complete a five-day training in the MIRG model, leading to a certificate and the ability to lead MIRG groups (Rosenberg and Wilcox, 2006). Initiatives under Responsible Fatherhood grants have shown promising results. In eight states participants have increased their employment rates 8 to 33% and their incomes 25 to 250%. Consequently they have increased their child support compliance. Also, 27% of the fathers reported seeing their children more after the program (U.S. Department of Health and Human Services, 2005; U.S. Department of Health and Human Services, 2011,). Residential Programs “Second Chance Homes” allow pregnant and parenting teen women, unable to live with their families due to maltreatment or other extenuating circumstances, to learn parenting skills, earn educational credentials, and develop skills to earn a livable wage. These programs vary considerably across the country from short-term ones servicing young mothers only until shortly after delivery to longer-term, more comprehensive programs that may also provide parenting and job-finding skills services to adolescent fathers. Programs may be housed within group houses, a cluster of apartments, or a network of houses; some programs move young mothers from more structured, restrictive, rule-governed group homes to their own apartments as they progress. Regardless of format, all programs hope to counter the negative impacts of poverty, unhealthy relationships and unsafe living situations, educational barriers, and lack of support for the young parents within the context of a supportive, adult-supervised living arrangement. Although early descriptive outcome data of Second Chance Homes is encouraging, more rigorous evaluations are needed (Andrews and Moore, 2011). One study of all twentytwo programs in Massachusetts found mixed results. Although outcomes related to educational goals, health and safety of mothers and their babies, and decreased reliance on public assistance were favorable, employment and improved housing after discharge were not. About one-fourth of the teens were pregnant again within two years. Employed teens did only marginally better financially than those on public assistance. Particularly disturbing, 16% reported homelessness after discharge from the programs, and 14% reported that they were in violent relationships (Collins et al., 2000). The researchers suggest that stronger case management upon discharge is necessary to solidify gains made by teens while they are in the program. SHAPING THE FUTURE OF TEEN PREGNANCY PREVENTION Focus on Research There has been a growing acknowledgement that programs need to be carefully studied and evaluated to enable wise decisions about future funding. Kirby (2007) found that effective prevention programs involve people with differing expertise in their design and implementation, have clear goals based on needs assessments that consider community values and resources, create a safe learning environment, include multiple activities that help teens to personalize information, solicit support from appropriate community or school authorities, and are carried out in full. Legislative Initiatives The goals of the President’s Teen Pregnancy Prevention Initiative 2010–2015 include reducing teen pregnancy and birth rates in targeted communities by 10%; increasing the percentage of youth who abstain from or delay intercourse; and increasing correct condom and other effective contraceptive use among sexually active youth (Centers for Disease Control and Prevention, 2011). To this end, in December 2009 Congress awarded $114.5 million to replicate successful evidence-based programs and fund innovative teen pregnancy efforts across the country, and many incorporate lessons about both abstinence and contraception (Guttmacher, 2011). A number of programs also incorporate other adult responsibility subjects, such as maintaining healthy relationships, improving communication with parents, and financial literacy. Philosophical Shifts Research Based Practice Practice Behavior Example: Use practice experience to inform scientific inquiry Critical Thinking Question: After reading the vignettes in this chapter, in what areas do you feel more research must be done to aid teens who face premature pregnancy? How might this shape the future? Decades after the sexual revolution and shifts in family structure, many parents are again willing to set stricter expectations. Public policy has also become more conservative. In the 1960s and 1970s, intervention focused on preventing second or third generations of pregnant teens. Today’s efforts focus on providing opportunities for teens and changing their attitudes about the future before they have children. Many interventions are broad-based and include educational, social, and vocational opportunities to help at-risk teens develop goals and hopes for their futures. Despite fiscal realities, there is a growing consensus that interventions spread over longer periods are more effective. SUMMARY Teenage pregnancy and parenthood is a multi-faceted issue. Understanding teens as they grapple with their decisions regarding sexuality and parenthood involves understanding their self-perceptions and their assessments of the opportunities that await them. The more opportunities a teen perceives as available in the future, the more likely she or he is to delay parenthood. Teenagers, particularly younger ones, are not accustomed to thinking of themselves as sexual beings. Taking responsibility for the consequences of sexual activity means acknowledging a host of new and conflicting feelings, negotiating with a sexual partner, and determining one’s values regarding premarital intercourse and parenting in light of family beliefs. Teen pregnancy prevention programs have many foci. Sex education and abstinence programs teach teens the risks of sexual activity and provide factual information. More effective ones integrate skill building and value clarification. More comprehensive programs address individual or family disadvantages and societal dysfunctions such as poor academic achievement, growing up in poverty and/or single-parent homes, lack of health care services, and lack of vocational opportunities. Many poor teens do not see themselves as “giving up much” by beginning parenthood. Teen mothers, now required to live with a parent or in an adult-supervised situation to be eligible for welfare payments, receive the benefits of having their mother or another adult help care for their children. Those who cannot live with their families can move into residential programs in which they receive housing, child care instruction, support, case management, and other needed services. Young mothers receiving welfare need to complete high school as well. Various programs exist to help young parents develop a variety of skills. Increasingly these programs also help young fathers. CHAPTER 11 PRACTICE TEST The following questions will test your application and analysis of the content found within this chapter. For additional assessment, including licensing-exam type questions on applying chapter content to practice behaviors, visit MySearchLab. 1. The attention to meeting the needs of pregnant teens in the 1960s probably came out of • • • • a.the war on poverty movement b.people’s guilt over the earlier treatment of teen pregnancy c.a moralistic view that preferred to ignore the plight of pregnant teens d.the child protection movement 2. Sarah is fifteen and pregnant. She was never a good student and is considering dropping out of school until she has her baby. Afterward, she may decide to return to high school or get a GED. Statistically, Sarah is among the _______ pregnant teens who may get a high school degree or a GED. • • • • a.40% b.15% c.63% d.85% 3. In 2007, the highest teen birth rate of any developed country was in • • • • a.Great Britain b.the United States c.France d.Germany 4. What factor puts teens at the most risk for pregnancy to occur? • • • • a.their socio-economic status b.the influence of the media c.their belief that sex “just happens” while birth control requires planning d.their parents had a child before marriage 5. Celeste, 14, and David, 15, have been sexually active for several months. Each lives with both parents and is the oldest in their families. Both have mothers who work outside the home, Celeste’s mother as a lawyer and David’s mother as a bookkeeper. Both teens do well in school and hope to go to college. Statistically, what factors within their lives make it less likely for Celeste to become pregnant if the couple is using responsible birth control? 6. Peter wants Gail to have sex with him. She tells him that she has taken a “virginity pledge.” The impasse has caused a problem in their relationship. If you were counseling the couple what might you want to know? MYSEARCHLAB CONNECTIONS Reinforce what you learned in this chapter by studying videos, cases, documents, and more available at www.MySearchLab.com. Watch and Review Watch These Videos • Abortion Wars Internet Dating Read and Review Read These Cases/Documents • Δ Adolescents Explore and Assess Explore These Assets • Teen Pregnancy—http://aspe.hhs.gov/hsp/teenp/intro.htm Center for Adolescent Studies—http://www.indiana.edu/~cafs/ Coalition for Positive Sexuality—http://www.positive.org/Youth and Children Resources Net— www.child.net/ Children’s Welfare League of America—http://www.cwla.org/ Assess Your Knowledge Assess your knowledge with a variety of topical and chapter assessment. Conclude your assessment by completing the chapter exam. ★ = CSWE Core Competency Asset Δ = Case Study

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Teenage pregnancy has been seen as an issue that as open-ended and may be viewed in
two perspectives (Chen, et al, 2007). In designing an effective teen pregnancy prevention
program, the best way would be to ensure that each and every party involved such as the kids,
parents and the health department have been brought together. It would be only effective if the
teens themselves have been educated on the consequences that come with teen pregnancy. This
program would be used to install a responsibility among the teens and in the process reduce
chances of teen pregnancy (Somers & Fahlman, 2001).
In the attempt to involve parties such as the teens, the schools, the parents as well as the
community at large, sensitization campaigns on the issue of teen pregnancy needs to be put in
place. this would be used to attract the teens and the community. Holding such campaigns even
in the schools would help in incorporating the schooling community in the campaign and in the
program at large (C...

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