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Reproductive Health Literacy Among Adolescent Women in Utah | Categories Intellectual Health | DOI: 10.26054/0d-32cm-2k4h

by Logan Waechtler↓

Problem Statement

The adolescent brain is not fully developed until at least 25 years of age.1, 2, 3 This is especially apparent for the parts of the brain that control judgment and impulsiveness.1 As this relates to reproductive health, inadequate reproductive health literacy is a concern for female adolescents ages 12–18 in Utah. If adolescents do not have knowledge about how the reproductive health system works, then they may be unlikely to identify signs of fertility and are at greater risk of an unintended pregnancy, which leads to other adverse social and health outcomes for the mother and child.4

Reproductive health literacy is an important aspect of the status of sexual education in Utah because the state limits sexual education to abstinence-only.5 Ensuring adolescents have knowledge of reproductive health is part of all domains of health, including intellectual health. The more education a woman has, the more likely she can understand her reproductive health system, including her fertility. Curriculum changes that include more comprehensive sexual education, which incorporate fertility awareness-based methods (FABMs), are one approach to help adolescents understand hormonal fluctuations and cycle-related experiences as well as avoid unintended pregnancies. Having empowering knowledge on how the reproductive system works through charting with FABMs can help adolescents choose to engage in other activities during their fertile window that do not lead to sexual intercourse, or to choose other contraceptive measures that can prevent unintended pregnancies.

Status of the Literature

Health literacy improves health outcomes across generations.6,7 The Centers for Disease Control and Prevention (CDC) found that 40% of high school students across the U.S. engaged in sexual intercourse and 54% of those sexually active did not use a condom the previous time they had sex.8 Healthy sexuality, free of shame and stigma, paired with information to make the best decisions for themselves and their partners, is an important goal. For instance, some studies have found that many high school students rely on information about sexual and reproductive health received from peers9,10 and not what they learn from trained educators, which is insufficient. When adolescent women have low reproductive health literacy, they are at a higher risk for unintended pregnancy.4

Various studies have found that sexual and reproductive health education serves as a protective factor against adolescent pregnancies.10,11,12 Furthermore, the American Association of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American Academy of Family Physicians (AAFP) encourage pediatricians, schools, and parents to provide developmentally-appropriate and evidence-based education about human sexuality and reproduction to adolescents because it has been shown to reduce the risk of pregnancy.13,14,15 The CDC also supports this approach to reducing pregnancy risk for adolescents by providing recommendations for schools about how they can deliver quality sexual health education, such as helping students to take responsibility to improve their health outcomes.16 However, Utah’s current state of sexual education focuses on the benefits of abstinence and prohibits discussions around any form of contraception.5

In Utah, 85% of schools report abstinence as a topic in their sexual education programs.8 In contrast to the U.S. as a whole, other topics of discussion where Utah falls short include the importance of correct and consistent condom usage, the efficacy of condoms, and methods of contraception other than condoms. 8 Only 0–23% of Utah schools discuss these topics, compared to 27–45% of schools across the U.S.8 It can be argued that the topics allowed in Utah’s sexual education curriculum influence the outcomes of the pregnancy rate for female adolescents. Although Utah’s adolescent pregnancy rate for women ages 15–19 was 9.2% in 2021, this figure is lower than the U.S. average of 13.9%.17

Currently, Utah has two programs tailored to adolescent populations (ages 10-19) in the juvenile justice and foster care systems: the Sexual Risk Avoidance Education program and the Personal Responsibility Education program. Both are intended to educate adolescents on abstinence and contraception.17,18 Including FABMs in the full range of contraceptive options is warranted, as they help increase understanding about menstrual cycle parameters, fertility, and hormonal fluctuations that may influence individuals’ lived experiences. They are also an alternative for preventing pregnancy when users receive adequate training.19

Research on the inclusion of FABMs in reproductive health education for adolescents and their impact on adolescent behavior is limited. A 2005 study showed that adolescents enrolled in the Teen STAR program were about 9% less likely to initiate sexual behavior compared to those who were in the control group.20 While this study was more than 15 years ago, Teen STAR continues to offer educational programs to teenagers based in the science of the Billings Ovulation Method, an FABM that requires users of the method to track daily cervical mucus sensations to identify their window of fertility each menstrual cycle.21

Call to Action

One way to enhance adolescent knowledge of reproductive health, so that they can feel empowered, is via FABMs, which are a natural way to understand one’s own menstrual cycle, alternations in hormones, and fertile window. Adolescents can find information about these methods through organizations like FACTS About Fertility, which regularly provides a low-cost webinar for teenagers to learn the basics of charting their cycles using a FABM. However, at this time, more research on Teen STAR in addition to other FABMs targeted at adolescents such as TeenFEMM are needed regarding the effectiveness in avoiding unwanted pregnancies before rolling out in reproductive health education programs, including programs in Utah. Incorporating FABMs in school-based health education policy at the state and local level through existing programs and guiding adolescents to implement FABMs into practice has the potential to enhance reproductive health literacy of Utah’s adolescents.

References

  1. Strasburger, VC, Zimmerman, H, Temple, JR, Madigan, S. Teenagers, sexting, and law. 2019 May 1; Pediatrics, 143(5). https://doi.org/10.1542/peds.2018-3183
  2. Vijayakumar, N, Op de Macks, Z, Shirtcliff, EA, Pfeifer, JH. Puberty and the human brain: Insights into adolescent development. 2018 July 1; Neuroscience & Biobehavioral Reviews, 92: 417-436. https://doi.org/10.1016%2Fj.neubiorev.2018.06.004
  3. Arain, M, Haque, M, Johal, L, Mathur, P, Wynand, N, Rais, A, Sandhu, R, Sharma, S. Maturation of the adolescent brain. 2022 December 7; Neuropsychiatric Disease and Treatment, 9: 449-461. http://dx.doi.org/10.2147/NDT.S39776
  4. França, AS, Pirkle, CM, Sentell, T, Velez, MP, Domingues, MR, Bassani, DG, Câmara, SMA. Evaluating health literacy among adolescent and young adult pregnant women from a low-income area of northeast Brazil. 2020 December; International Journal of Environmental Research and Public Health, 17(23): 8806. http://dx.doi.org/10.3390/ijerph17238806
  5. Centers for Disease Control and Prevention (CDC). Analysis of state health education laws: Utah summary report. Centers for Disease Control and Prevention. 2017 December. https://www.cdc.gov/healthyyouth/policy/pdf/summary_report_factsheets/Utah.pdf. Accessed November 30, 2022.
  6. Corrarino, JE. Health literacy and women’s health: challenges and opportunities. 2013 April 30; Journal of Midwifery & Women’s Health, 58(3): 257-264. https://doi.org/10.1111/jmwh.12018
  7. Fleary, SA, Joseph, P, Pappagianopoulos, JE. Adolescent health literacy and health behaviors: a systematic review. 2017 November 25; Journal of Adolescence, 62:116-127. https://doi.org/10.1016/j.adolescence.2017.11.010
  8. Centers for Disease Control and Prevention (CDC). School health profiles 2018: Characteristics of health programs among secondary schools. 2019; Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/data/profiles/pdf/2018/CDC-Profiles-2018.pdf. Accessed November 30, 2022.
  9. Kyielleh, JM, Tabong, PT, Konlaan, BB. Adolescents’ reproductive knowledge, choices, and factors affecting reproductive health choices: A qualitative study in the West Gonja District in Northern region, Ghana. 2018 January 24; BMC International Health and Human Rights, 18(6). https://doi.org/10.1186/s12914-018-0147-5
  10. Vongxay, V, Albers, F, Thongmixay, S, Thongsombath, M, Broerse, JE, Sychareun, V, Essink DR. Sexual and reproductive health literacy of school adolescence in Lao PDR. 2019 January 16; PLOS One, 14(1). https://doi.org/10.1371/journal.pone.0209675
  11. Fonner, VA, Armstrong, KS, Kennedy, CE, O’Reilly, KR, Sweat, MD. School based sex education and HIV prevention in low- and middle-income countries: A systematic review and meta-analysis. 2014 March 4; PLOS One, 9(3). https://doi.org/10.1371/journal.pone.0089692
  12. Wangamati, CK. Comprehensive sexuality education in sub-Saharan Africa: adaptation and implementation challenges in universal access for children and adolescents. 2020 December 9; Sexual and Reproductive Health Matters, 28(2). https://doi.org/10.1080/26410397.2020.1851346
  13. Breuner, CC, Mattson, G, American Academy of Pediatrics (AAP) Committee on Adolescence, AAP Committee on Psychosocial Aspects of Child and Family Health. Sexuality education for children and adolescents. 2016 August 1; Pediatrics, 138(2). https://doi.org/10.1542/peds.2016-1348
  14. American College of Obstetricians and Gynecologists (ACOG) Committee on Adolescence, AAP Committee on Psychosocial Aspects of Child and Family Health. Comprehensive sexuality education. Committee Opinion No. 678. 2016 November; Obstetrics and Gynecology, 128: 227-230. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/11/comprehensive-sexuality-education
  15. American Academy of Family Physicians (AAFP). Adolescent health care, sexuality, and contraception. 2020. https://www.aafp.org/about/policies/all/adolescent-sexuality.html. Accessed April 10, 2023.
  16. Centers for Disease Control and Prevention (CDC). What Works in Schools: Sexual health education. 2023 March 13; Centers for Disease Control and Prevention. https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm. Accessed April 10, 2023.
  17. Utah Department of Health and Human Services. Complete health indicator report of adolescent births. Public Health Indicator Based Information System (IBIS): Utah’s Public Health Data Resource. https://ibis.health.utah.gov/ibisph-view/indicator/complete_profile/AdoBrth.html. November 14, 2022. October 22, 2021. Accessed November 30, 2022.
  18. Utah Department of Health and Human Services. How we are addressing the problem. n.d. https://mihp.utah.gov/uncategorized/how-we-are-addressing-the-problem. Accessed June 23, 2023.
  19. Duane, M, Stanford, J, Porucznik, C, Vigil, P. Fertility awareness-based methods for women’s health and family planning. 2022 May 24; Frontiers in Medicine, 9(858977). https://doi.org/10.3389/fmed.2022.858977
  20. Vigil, P, Riquelme, R, Rivadeneira, R, Aranda, W. Effects of Teenstar, an abstinence only sexual education program, on adolescent sexual behavior. 2005 October; Revista Médica de Chile, 133(10): 1173-1182. http://dx.doi.org/10.4067/S0034-98872005001000006
  21. Teen STAR. Our history. n.d. https://www.teenstar.org/history.html. Accessed April 10, 2023.

Citation

Waechtler L. (2023). Reproductive Health Literacy Among Adolescent Women in Utah. Utah Women’s Health Review. doi: 10.26054/0d-32cm-2k4h

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Reproductive Health Literacy Among Adolescent Women in Utah by Logan Waechtler