In 2010, the CDC added teenage pregnancy to a list of what they considered to be “winnable battles” in the United States. This term refers to a set of problems in public health that impact a large number of people throughout the US, but have approaches in place which are known to be effective in addressing them. While teenage pregnancy would technically be defined as women from the ages of 13-19 who become pregnant, no matter the outcome of the pregnancy, the CDC has limited the definition to refer to women aged 15-19 who birth a living child.
Across the globe, morbidity rate for teenage pregnancy is 47 per 1,000 women, and mortality rate is about 250 deaths per 100,000 live births. With targeted funding and prevention programs, the CDC was able to help decrease the birth rate in the United States. However, the Trump administration is threatening to undo that work by defunding teen pregnancy prevention programs, and pushing abstinence-only, rather than scientifically based and comprehensive, sexual education.
In 1999, the birth rate per 1,000 females aged 15-19 was 48.8; this number had been decreasing over the 2000’s, and in 2009, the birth rate was 37.9 per 1,000. The CDC made a goal to make the birth rate 30.3 per 1,000 by 2015. There were several concerns that needed to be addressed when implementing the plan to decrease these. First, there were considerable gaps in the rate of teen pregnancies among different races. African Americans accounted for 57% of teenage births, despite only representing 35% of the total US population of females aged 15-19.
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Teens most at risk for pregnancy include those who lack knowledge about sex, contraception, and healthy relationships; have poor performance at school; come from single parent households; have poor parental supervision; were victims of sexual abuse; and use drugs and alcohol, among many other things. This means that when providing resources to teenagers to prevent pregnancy, these resources must be accessible by teenagers who fit these descriptions.
Teenage pregnancy creates substantial economic costs, costing about $9.4 billion dollars annually. Additionally, teenagers who become pregnant are at greater risk of premature delivery; delivering babies with low birth rates; develop pregnancy induced hypertension; and develop pre-eclampsia. They are also at greater risk of dropping out of high school, as well as developing post-partum depression.
The CDC paired with the Office of Population Affairs to release the Quality Family Guidelines, which was given to providers as a resource for evidence based family planning with recommendations for adolescents. They worked with the American Academy of Pediatrics to teach providers how best to work with sexually active adolescents, and they worked with the Office of Adolescent Health to provide adolescents with evidence based sexual education, provide reproductive health services, and provide long acting contraception such as intrauterine devices (IUD, like hormonal Mirena and non-hormonal Paraguard) and contraceptive implants (like Nexplanon). Using these processes, in 2015 the birth rate for women aged 15-19 dropped to 22.3 per 1,000, surpassing the CDC’s original goal. In 2017, the birth rate dropped even further, to 18.8 per 1,000 women.
Though providing comprehensive, evidence based sexual education and access to free or cheap long acting contraceptives has proven to be successful in decreasing the rates of teenage pregnancy, the Trump administration is pushing for abstinence only sexual education, and is removing funding for programs that aim to prevent teen pregnancies. Many conservatives feel that providing comprehensive sexual education and access to contraceptives will encourage young people to begin having sexual intercourse earlier and more frequently, and therefore should be avoided. Unfortunately, abstinence only sexual education and lack of knowledge about safe sexual encounters have been shown to have no effect on decreasing teenage sexual behavior.
In June 2018, the Trump administration cut over $200 million of funding for the Teenage Pregnancy Prevention Program, a federal program whose efforts were focused on African American and Hispanic teenagers, and those from low income households and rural areas. These programs were contracted to receive federal money until 2020, but the funding was cut two years early. Instead, funding is being diverted to abstinence only programs. Additionally, the Trump administration has been attempting to change the Affordable Care Act to not only deny more people affordable health insurance, but also to prevent it from guaranteeing women access to free birth control through their insurance plan. Given this, the rate of teen pregnancy is expected to begin to rise again.
