Teen pregnancy and early childbearing are complex issues which have attracted a great deal of attention from service providers, educators, and policy makers in recent years.1 Experience and research clearly indicate that adolescent pregnancy is associated with a variety of factors—it is not simply a problem of teens having unprotected sexual intercourse at an early age. For many young people, the issues related to early pregnancy and childbearing include much broader social, economic, cultural, and psychological factors, including poverty, school failure, and sexual abuse. A further complicating factor is that adult men are frequently the fathers of children born to teenage women.2,3
These complexities pose particular challenges to pregnancy prevention program planners. It must be recognized that there is no "magic solution" to teen pregnancy nor will a single intervention work for all teens. Communities should not look for immediately lower pregnancy or birth rates over a short period because the process is time-consuming, requires affirmation from young people, and a serious commitment of financial resources. To reach a broad teen audience, programmers need to implement a combination of strategies and involve all key members of the community.
While there is still much to learn about the causes and consequences of early pregnancy, program planners can benefit greatly from the research and the "lessons learned" from the numerous programs already in place across the country. This document summarizes key ingredients of successful teen pregnancy prevention programs and may be used as a guide for developing new strategies and strengthening existing interventions.
The following principles are important for program implementation:
- Set clearly defined and realistic program goals and objectives. They may relate to delayed initiation of sexual intercourse, increased and more effective contraceptive use, reduced rates of pregnancy and childbearing among participants, and/or increased rates of school completion.
- Encourage community collaboration. Parents, neighborhood organizations, schools, health providers, and youth agencies can provide critical support during all phases of program design and implementation. The media, business sector, religious organizations, and policy makers also play an important role in the prevention partnership.
- Involve youth in needs assessment, program design, implementation, and evaluation. Teens can be involved in a variety of activities including agency advisory boards, community outreach efforts, and program planning and review.
- Create activities that are both age and developmentally appropriate. Interventions should be tailored for younger, middle, and older adolescents and should account for varying levels of cognitive development.
- Provide culturally appropriate program activities. Activities should be relevant to young people and should reflect an understanding of and sensitivity to the racial and ethnic backgrounds of participants.
- Coordinate messages to target both young women men. It is important to emphasize joint responsibility, sexual communication, assertiveness, and refusal skills. Either gender-specific or coed programs can reach both young women and men.
- Offer long-term and consistent support. Programs should be tailored to individual participants. While some young people need little support to prevent a pregnancy, others will require more comprehensive interventions over a sustained period of time.
- Provide information on both abstinence and contraception and ensure access to contraceptive services. Messages on abstinence and postponement of sexual activity are important for those who have not yet initiated sexual intercourse and should be presented as viable options for those who are already sexually active. Sexually active teens also require accessible and affordable contraceptive and reproductive health services. Still other adolescents may need additional interventions to strengthen their motivation to prevent or delay too-early childbearing.
Pregnancy prevention programs must account for the varying levels of risk among teens. When developing specific interventions, the following issues are important to consider:
All young people need comprehensive sexuality education to prepare them for healthy adult relationships. Sexuality education programs should increase adolescents' knowledge and help them to explore attitudes, feelings, and values about human development, relationships, dating, gender roles, sexual orientation, sexual behavior, and healthy sexual decision-making. Educational programs are most effective when they
- Provide accurate information on both abstinence and contraception,4
- Are developmentally appropriate,5
- Encourage skill development, including decision-making, assertiveness and negotiation skills as well as life skills, training and goal setting.6,7
A sensitive, well-trained, and non-judgmental staff person plays an important role by helping teens learn about and decide to use contraception effectively and consistently. The first contact with a family planning service provider is critical in setting the stage for future visits. Family planning staff should utilize a guided counseling process to help a teen decide which method of contraception is most appropriate. This type of counseling is particularly useful for teens who receive a negative pregnancy test during a "pregnancy scare."8 In addition, the role of males should be addressed in family planning settings. Although men are influential in contraceptive use and acceptance among young women, they are seldom specifically engaged in prevention efforts.
Comprehensive sexual and reproductive health services for adolescents should include gynecological exams, contraceptive methods, pregnancy testing, and screening, treatment, and/or referral for sexually transmitted diseases including HIV/AIDS.
Teen-friendly services are most effective when they
- Guarantee confidentiality,9
- Offer accessible hours,9 including walk-in appointments and flexible and extended hours during evenings and weekends,
- Offer a convenient setting where teens naturally congregate,9
- Provide free-of-charge or affordable services (on a sliding fee scale),9
- Offer directive contraceptive education and counseling,10
- Offer to delay the pelvic exam at the initial visit.11
Motivational Opportunities and Related Services
For those teens at highest risk of pregnancy, effective prevention strategies include improving educational and economic opportunities and/or intervening in the numerous social and psychological factors associated with sexual risk-taking. Strategies should be designed for the individual young people and need to include access to
- Psychosocial counseling, including treatment for sexual abuse, drug and alcohol use, and/ or family distress,12,l3,l4
- Mentoring programs for youth to develop a close relationship with an adult,15
- Educational opportunities, including tutoring and access to higher education,16
- Recreational activities such as sports, drama, and social clubs,16
- Vocational and job skills, including job placement,16
- Community service opportunities.17
Call to Action
Based upon these program strategies and principles, communities may want to assess adolescent needs, review service availability, identify gaps and resources, and develop a comprehensive plan of action for adolescent pregnancy prevention. This plan should address ways to develop new programs, strengthen existing efforts, or better coordinate activities and referral networks so that all teens have access to a wide array of prevention services. To be most effective, community-wide program efforts must be supported by expanded financial resources, increased public awareness, and the implementation of favorable policies at the national, state, and local levels.
Written by: Laura Davis, 1996
Please contact Advocates for Youth's National Teen Pregnancy Prevention Clearinghouse at 202.419.3420to receive additional information, technical assistance, or training on pregnancy prevention programs or related issues.
The Components of Promising Teen Pregnancy Prevention Programs were developed by Advocates for Youth's National Teen Pregnancy Prevention Initiative Advisory Committee. The following members of the committee have endorsed The Components:
Claire Brindis, Dr.P.H.
Center for Reproductive Health Policy & Research
San Francisco, California
Plain Talk Initiative
San Diego, California
Patricia Canessa, M.A.
Lee Arts of Living Institute
Lorraine Williams Greene
" I Have a Future"
Meharry Medical College
Robert H. Duckett
First Things First
Planned Parenthood Federation of America
Healthy Girls Initiative
Margaret Pruitt Clark
Advocates for Youth
Activism 2000 Project
- Committee on Unintended Pregnancy, Institute of Medicine, National Academy of Sciences; Brown SS, Eisenberg L, editors. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC: National Academy Press, 1995.
- Landry DJ, Forrest JD. How old are U.S. fathers? Fam Plann Perspect 1995;27:159-161.
- Males M. School-age pregnancy: why hasn't prevention worked? J Sch Health 1993;63:429-432.
- Frost JJ, Forrest JD. Understanding the impact of effective teenage pregnancy prevention programs. Fam Plann Perspect 1995;27: 188-195.
- Girls Incorporated. Truth, Trust and Technology: New Research on Preventing Adolescent Pregnancy. Indianapolis IN: Girls Inc. 1991.
- Howard M, McCabe JB. Helping teenagers postpone sexual involvement. Fam Plann Perspect 1990;22:21-26.
- Kirby D, Barth RP, Leland N. Fetro JV. Reducing the Risk: impact of a new curriculum on sexual risk-taking. Fam Plann Perspect 1991;23:253-263.
- Zahin LS, Emerson MR, Ringers PA, Sedivy V. Adolescents with negative pregnancy test results. JAMB 1996;275:113-117.
- Brindis C. Adolescent Pregnancy Prevention: A Guidebook for Communities. Palo Alto Calif: Health Promotion Resource Center, Stanford Center for Research in Disease Prevention, 1991.
- Nathanson C, Becker MH. The influence of client-provider relationships on teenage women's subsequent use of contraception. Amer J Pub Health 1985;75: 33-38.
- Armstrong KA, Stover MA. SMART START: an option for adolescents to delay the pelvic examination and blood work in family planning clinics. J Adolesc Health 1994;15:389-395.
- Moore KA, [et al]. Adolescent Pregnancy Prevention Programs: Interventions and Evaluations. Washington, DC: Child Trends 1995.
- Berenson AB, San Miguel, VV. Wilkinson GS. Violence and its relationship to substance use in adolescent pregnancy. J Adolesc Health 1992;13:470-74.
- Boyer D, Fine D. Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Fam Plann Perspect 1992;24:4-11+.
- Tiemey JP, Grossman JB, Resch NL. Making a Difference: An Impact Study of Big Brother/Big Sisters. Philadelphia PA: Public/Private Ventures, 1995.
- Carrera MA, Dempsey P. Philliber W. Philliber S. Evaluating a comprehensive pregnancy prevention program. Fam Life Ed 1992;11(1):4-9.
- Philliber S. Allen JP. Life Options and Community Service: Teen Outreach Program. In Miller BC, Card JJ, Paikoff RL, Peterson JL. Preventing Adolescent Pregnancy: Model Programs and Evaluations. Newbury Park, CA: Sage Publications, 1992.