Adolescent pregnancy and births are at historic lows in both Utah and the U.S. While the efforts of local and national programs that have worked to achieve this rate decrease should be celebrated, efforts to reduce unwanted pregnancies among teens and support young women cannot become complacent. Adolescent pregnancy continues to be associated with long-term difficulties for the mother, her child, and communities at large.
Adolescent pregnancy overlaps with every domain of health and results in negative risks for both mothers and their babies. “For the mothers, giving birth during adolescence is associated with limited educational attainment, which in turn can reduce future employment prospects and earning potential” (UDOH, 2016). Just 40% of adolescent mothers who have a child before the age of 18 receive their high school diploma (TNC, 2019). Adolescent mothers are also at higher risk for postpartum depression and other mental health conditions (PRAMS, 2016).
When considering the health of infants, babies born to adolescent mothers “are at higher risk of low birth weight and infant mortality” compared to babies born to older mothers (UDOH, 2019). “These babies are also more likely to grow up in homes that offer lower levels of emotional support and cognitive stimulation”, and consequently the babies themselves “are less likely to earn a high school diploma” (UDOH, 2019). Children born to adolescent mothers are also at a higher risk of becoming an adolescent parent themselves (TNC, 2019).
Nearly all adolescent pregnancies are unplanned (TNC, 2019). Because of this, many view adolescent child-bearing as only a reproductive health issue. However, since adolescent pregnancy is closely linked to a host of other critical social issues – poverty, overall child well-being, responsible fatherhood, health issues, education, and a variety of risky behaviors – communities cannot ignore the substantial public costs associated with unwanted or mistimed teen pregnancy and parenthood (TNC, 2019). Supporting adolescents’ reproductive goals of delaying first birth should be viewed not only as a reproductive health issue, but also as one that works to improve multiple domains of health for both mothers and their babies.
The Utah adolescent birth rate (per 1,000 females age 15-19) continues to be lower than the U.S. (See Figure 1). Currently, Utah ranks 13th in the nation for overall teen birth rate and fourth for teen pregnancy rate (TNC, 2017). However, Utah ranks 24th for the decline in adolescent birth rate, suggesting that improved efforts are needed to address disparities.
In Utah, there are substantial racial and ethnic disparities in the adolescent birth rate. American Indian and Black populations are almost twice as likely to have an adolescent birth compared to the White population, and Hispanic populations are nearly three times as likely to have an adolescent birth compared to non-Hispanic populations (See
Figures 2 and 3).
Geographic disparities also persist in Utah, particularly in rural areas of the state. In four local health districts (San Juan, Southeast, TriCounty, and Weber-Morgan), the adolescent birth rate is higher than both the state and national average (See Table 1). Though the adolescent birth rate continues to decline, efforts to focus on these disparities in Utah will help improve our rank when compared to the nation, as well as the overall health of all our communities.
For many years, the Utah Department of Health (UDOH) has received federal funding to address the issue of teen pregnancy through the Title V Abstinence Education grant. This funding is sub-granted to local health departments to implement nationally developed evidence-based programs for youth ages 10-16. Traditionally, these adolescent pregnancy prevention programs have focused primarily on providing sexuality education to youth in public schools. However, four noteworthy programs discussed below, including an additional federal funding opportunity—the Personal Responsibility Education Program (PREP)—illustrate a wider range of possibilities for adolescent pregnancy prevention interventions.
In October of 2016, the TriCounty Health Department received Title V Abstinence Education funding to implement the Wyman Teen Outreach Program® (TOP®), an after-school youth development program designed and evaluated by the Wyman Center in St. Louis. The program is widely used across the U.S., reaching 25,000 teens annually. Evaluation conducted by Wyman shows that 98% of youth participating in the program nationally avoid teen parenthood (Wyman, 2017). TOP® not only equips teens with the skills to avoid risky behaviors, like early sexual initiation, but also empowers them to become powerful and visionary leaders in their community. For example, TriCounty’s program participants for the 2016-2017 school year have completed nearly 50 hours of community service. Youth across the Uintah Basin now have increased skills and opportunities to engage in meaningful community service, take on leadership roles, and participate in civic engagement.
Beginning in 2010, UDOH began receiving additional teen pregnancy prevention funding for the Personal Responsibility Education Program (PREP). Like the Title V Abstinence Education Program, the funding is sub-contracted to local health departments to implement nationally developed, evidence-based programs. However, the program is intended for an older population of youth (aged 14-19) and provides a wider focus than traditional educational interventions. Four local health departments (Bear River, Tooele, Salt Lake, and Weber-Morgan), and the Urban Indian Center of Salt Lake, are currently receiving funding to implement community-based programming that provides education on a variety of adult preparation subjects, such as parent-child communication, healthy relationships, education and career success, and financial literacy, in addition to traditional sexuality-related material. The goal of the program is not only to prevent adolescent pregnancy, but also to provide all youth with the skills they need to become productive and successful adults and citizens in their community.
A third noteworthy intervention being implemented through Title V Abstinence Education and PREP funding in several Utah communities is Families Talking Together. The program was developed by the Center for Latino Adolescent and Family Health at New York University School of Social Work, and is based upon the philosophy that parents are the primary sexuality educators of their children. Evaluations of the program have shown that the intervention delays sexual initiation and promotes abstinence (HHS, 2017). Through two intensive one-on-one or small group sessions, parents learn specific skills and strategies to enable them to engage in conversations with their teens and effectively take on the role of a sexuality educator for their family.
Another unique community program focuses specifically on reducing repeat births to adolescents. The Teen Success program, one of the many programs implemented by the Education Department at Planned Parenthood Association of Utah, was established in 2011. Its primary goal is to help mothers aged 13-19 in Salt Lake County maintain their current family size until they complete their high school education and feel ready for another child. This goal is achieved through a unique, mixed method program model of providing a safe and supportive group counseling environment that also implements an educational curriculum focused on personal health and self-esteem, parenting, healthy relationships and college and career preparation. Over the past five years, this program has helped more than 100 young mothers achieve their goals and become empowered parents. The program has a 98% success rate at preventing a repeat birth during the adolescent years; and for the past three years, 100% of the high school seniors participating in the program have graduated with their high school diploma.
Effective interventions include a wide range of activities, including youth development programs, adult preparation education, and programs tailored to specific sub-populations, such as teen mothers. Regardless of the specific program or implementation setting, there are common themes for success. These include creating a safe, supportive environment for program participants; involving parents; and moving beyond a prevention focus to a more holistic adolescent development and engagement approach. Ultimately, when government and communities are willing to invest resources in programs for young people, the return in social capital is tremendous.
- U.S. Department of Health and Human Services. (2017). Teen Pregnancy Prevention Evidence Review: Families Talking Together. Retrieved from https://tppevidencereview.aspe.hhs.gov/document.aspx ?rid=3&sid=53&mid=7. Accessed April 24, 2019.
- Utah Department of Health Public Health Indicator Based Information System. (2016). Adolescent Births. Retrieved from https://ibis.health.utah.gov/indicator/view/AdoBrth.html. Accessed April 24, 2019.
- Utah Pregnancy Risk Assessment Monitoring System (PRAMS), Utah Department of Health. (2016). Percentage of Utah Women Who Reported Postpartum Depression Symptoms by Maternal Age. Retrieved from https://ibis.health.utah.gov/indicator/view/PPD.Age.html. Accessed April 24, 2019.
- Wyman Center. (2017). Results. Retrieved from http://wymancenter.org/results/.
Stokes SC, Gerke E. (2019). Data Snapshot: Adolescent Pregnancy. Utah Women’s Health Review. doi: 10.26054/0K04F501PR.