Teen Pregnancy: We ARE Failing our Children

What is wrong with these scenarios?!?....

Last Thursday night while I was in the hospital on call for our Residency Program, we had 8 patients on our Labor and Delivery unit. The mean maternal age was 17...

The next day, I was covering our ultrasound unit and three of the last patients I saw were age 14 (2) and age 15. I had seen a couple of 16 year olds earlier in the day. None knew when they had gotten pregnant, how many weeks gestation they might be, or even what that meant. All were “late entries to prenatal care” with estimates of gestational age between 25 and 33 weeks, thus missing any benefit of early counseling, screening, and medical care...

Within the past year, I saw an 11 and a half year old who also presented at 28 weeks gestation. Her mother was excited that her daughter was having a girl – all I could think about (while tactfully suppressing my blind rage) was finding the criminal who had gotten her pregnant...

Recently, I saw a 16 year old who presented for her initial visit and ultrasound at 33 weeks gestation. The baby had an abdominal wall defect called gastroschisis in which the intestines are outside the abdomen exiting through a small defect next to the umbilicus. When I tried to explain what the condition was all about to the patient and her family, she became angry at me, demanded to know what she could “do about it” (in the context of terminating the pregnancy) and then told me that she was going to go outside and smoke before she would “talk about it anymore.” Her mother handed her a cigarette as she was heading toward the door...

In almost every instance above, the father of the baby was significantly older than the mother...

While I was discussing these observations with one of our nurses on L&D, I was told that “60 girls in her daughter’s high school are currently pregnant...”

The children are not to blame. We have failed hem. We have all failed them – parents, social services, schools, counselors, religious leaders, government leaders, the criminal justice system, and health care providers. The annual summary from the National Center for Health Statistics and the Centers for Disease Prevention and Control for 2006 (most recent data) support my simple observations in the trenches that began a few years back. Teen pregnancy rose 3% in 2006, to 41.9 per 1000 females aged 15 to 19 years, the first increase after 14 years of steady decline (Martin, et al., Pediatrics 2008;121:788-801). From what we have seen recently in our own practice, I anticipate now that the rates for 2007 and 2008 will be even worse. It goes without saying that the rates among Blacks and Hispanics will probably be nearly twice those seen in the White populations.

We live in times when there has never in the history of humans been a greater disparity between the age of puberty and the social and economic demands that allow us to survive productively in this world. That also means that children are now reaching the age of ‘reproductive maturity’ when they are least likely to be in a position to control impulses, to understand the consequences of, and to make sensible decisions (or to resist sexual overtures of older and more experienced males) related to, sexual activity. The consequences are not only pregnancies and sexually transmitted disease but, in most cases, as has been shown repeatedly in the past, a loss of lifetime opportunities for success, a life spent in poverty, poor health, a long history of dependency on social welfare, limited access to an adequate health care system, and the high likelihood that their inheritance to their children will be a life similar to theirs.

It is much too simplistic after decades of neglect and inadequate education – denial and repression are not education – and actively withholding information to state simplistically that “it is the parents’ responsibility.” Parents have failed, but most ‘parents’ do not themselves have the necessary skill sets to deal with this problem. Two wage earner households, high divorce rates, and times of a poor economy have left many parents struggling to cope themselves and too easily tempted to turn their children over to the internet as a poor substitute for distraction, nurturing, attention, and sustenance.

Abstinence-alone efforts have also failed as a widespread approach and are practically meaningless anyway to children at the age at which they are now reaching puberty. There is growing data to support that teaching about contraception is “not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education (Kohler, et al., J Adolesc Health 2008;42:344-51).” But, all this needs to be presented in a program of ongoing education and practical incentivization. “The most expedient way to strengthen the impact of pregnancy prevention programs on adolescent childbearing is to shift the focus of intervention …to helping young women develop goals that make adolescent childbearing a threat to what they want in life. This means intervening actively enough to ensure that goal setting translates into an internal desire to postpone childbearing beyond adolescence (Sheeder, et al., Matern Child Health J 2008: epub May 16).”

Responsible living, grade-appropriate sex education, nutritional counseling, and physical education need to be a part of every school curriculum starting in early grades. These need to be integrated into programs that address responsibility by teaching not only the consequences of shirking responsibility but also the meaning of the word itself in terms of what is necessary to survive. Group support systems conducted by trained and objective educators may be the way of reducing first-time pregnancies as well as recidivism among adolescents (Key, et al., J Adolesc Health 2008;42:394-400). Perhaps it may even be time to reconsider going back to a system of separate education for girls and boys! These programs are going to require a mandate and funding from the governments at the federal, state, and local levels, but what could be more important than the legacy that could provide. It is a small investment to make. The future not only of our children, but the country as a whole is at stake here...

Labels: teen pregnancy

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