Teenage Pregnancy and the Impact of Current National and International Policies - Research Paper Example

Topic: Teenage Pregnancy and the Impact of Current National and International Policies Adults across the entire globe are busy criticizing the behavior of the young generation, yet they fail to realize that the generation they excoriated was raised in their own hands and reared in their own arms. The adults are guilty of not being able to communicate affectively to the youth about their sexual and reproductive activities. It is a duty which rests on their shoulders to guide the youth lovingly throughout their transition from teenagers to mature adults, and be a responsible part of the society. Failure to do this result in many dire consequences, and one of them is the worldwide issue of teenage pregnancy. Teenage pregnancy refers to the phenomenon of pregnancy of women under the age of twenty, usually from the ages of 13–19. Teenage pregnancy in underdeveloped countries is chiefly the outcome of the prevalence of poverty and lawlessness in the area, whereas in developed countries it is an implication of the social environment. This is a clear example of the generation gap between the adults who are widely failing in preparing the youth with information, resources, confidence, and skills, which will help them shape their life and the young people who are equally unsuccessful in grasping, and usefully availing the resources provided to them. The reason for choosing teenage pregnancy as the public health development issue to write upon is because of the fact that adolescent maternal health is being overlooked globally. Hesitance in communication between parents and the youth is the cause of hundreds of deaths, as parents fail to educate their children about reproductive health at the right time. Cultural, religious, and ethical values also stand in the way of sexual education of teenagers. Pregnancy is the leading cause of death of teenage women aged 15 to 19 (Greene, M 2002, p.7-34).  Reforms must be made to provide education, family planning services, and postnatal care to reduce maternal mortality among adolescents. The social and developmental results of the sexual activities of adolescents are more emphasized on rather than the health consequences. The youth population in the world today is greater than ever before so we are facing health concerns, which were not experienced ever before. Worldwide 10 million young people are suffering from HIV and AIDS and still the public health of teenagers is being neglected and ignored. In this essay we will discuss in detail how teenage pregnancy is a public health development issue, how can we spread awareness amongst adolescents by using health promotion techniques, national and international public health policies regarding teenage pregnancy, and ethnic principles, which affect public health activities related to this issue. Public Health: Public health is defined as “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and for the development of the social machinery to insure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity” (CEA Winslow). Unlike clinical medicine practice, which deals only with the treatment of disease, public health includes the prevention and treatments of epidemics and the improvement of the quality of life, protection of the environment of the community under consideration, development of novel insights, and innovative solutions etc. Public Health Population Based Strategies Clinical Preventive Strategies (Novick, & Morrow, 2002, p.1-34)  Population based strategies include efforts to prevent diseases, control epidemics, ensure providence of healthy food, and supply of clean drinking water. Apart from these primary goals, population based strategies deal with issues like substantial abuse, sexually transmitted diseases, and adolescent pregnancy. Awareness programs through different mediums like electronic and print media, educational institutions etc., promotion of the use of condoms, and other safe contraceptive methods etc. are all examples of public health measures taken to control adolescent pregnancy. Health Promotion: It is the science and art of enabling people to gain a control of their own health and its determinants, in order to improve their lifestyles, living standards, and physical and mental health. Health promotion is directed at both individuals and communities as a whole as it aims to acknowledge, influence, and assist people in adopting a healthier lifestyle. Most importantly, it motivates individuals and organizations to address their own health situations and take an action about them. Awareness of complications of teen pregnancy including the facts that the maternal mortality rate of teenagers is very high as compared to older women, 2 million teenagers go through unsafe abortion in developing countries, which can result in cervical tearing, hemorrhage, infertility, chronic pelvic infection, perforated uterus, and even death. All these statistics and facts can make an adolescent think twice about having unprotected sex. The International Union for Health Promotion and Education and WHO are the major organizations which are working endlessly for health promotion worldwide. Determinants of Health and Population: Determinants of health are those factors which are responsible for the quality of health in an individual or a community. The key determinants of health are education and literacy rate, social status, physical and social environment, biologic, perinatal, behavioral conditions, genetics endowment, gender, culture etc. (Novick, L. and Morrow, C. 2002, p.1-34)  The changes in the population of a specific area over a period of time are called population growth. Factors which contribute to this change are: 1. Fertility rate 2. Infant mortality rate 3. Education and literacy rate 4. Standards of living and employment rate 5. Life expectancy Maternal mortality rate can also affect the population greatly. The fertility rate in the US is higher than any other developed country but the population is decreased too by the number of deaths of teenage mothers every day. In Nigeria 72% of all deaths of teenage girls are resulted due to unsafe abortion. HIV and STDs take many lives every year; all these factors influence the population of an area immensely. Adolescent pregnancy also affects the literacy and employment rate, because only 50% teenage mothers graduate from high school, thus never getting employed at good positions as well. The children of adolescents are also most likely to face unemployment as adults. Public Health Surveillance and Profiling: Public health surveillance provides warning information to decision makers about health concerns, which need to be addressed to in a particular community or population. This data not only facilitates in the timely action and control of a disease by analysis and dissemination, but also helps in the evaluation of the impacts of intervention. Better methods of public health surveillance result in better disease detection, management, and control. Health profiling is the process of collecting and recording an overview of data using key health indicators to provide information to local health councils or international health organization so that they can determine where to focus and target their resources in tackling with health inequalities (Novick, L. and Morrow, C. 2002, p.1-34). Public health surveillance and profiling help in the prevention of teenage pregnancy by creating the conceptual framework for the prevention programs, target group selection and segmentation, checking resource availability, replicating, scaling up, and determining long and short term goals. Youth Risk Behavior Surveillance System Steering Committee is a federal agency set up for the surveillance of morbid deaths in teenagers, by profiling and gathering information on sexual behavior of adolescents it had further divided into Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. Health Policy: It can be defined as the set of instructions, information, decisions, plans, and actions which are undertaken in order to achieve specific health care goals in a targeted area or population. Health policy addresses the future visions and measures to be taken regarding the health concern under consideration (National Research Council, 1993, p. 4-5). Public Health Steps for Teenage Pregnancy Prevention: In 2008, Teenage mothers between the ages of 15-19 gave 435,000 live births, making it a birth rate of 41.5 per 1,000 women of this age. More than 80% of these pregnancies and births were unintended. Adolescent reproductive health is a major health concern as it is not just related to sexual activities but also to the complications of unsafe abortion, escalating level of STDs, the adverse impacts of non-marital child bearing, and the HIV pandemic etc. Access to accurate reproductive and sexual information is a right of every young person and they should be granted that right for the sake of their own wellbeing. Though this task is challenging as the sexual education of adolescents is woefully inadequate, it is not an impossible task to implement. It can be accomplished by spreading awareness through different campaigns and sources, like: School based sexual education programs Community/NGO based programs Youth development projects Peer programs Mass media Linkages with employment programs Many societies and organizations are working today for this cause and it is because of their efforts that the teenage pregnancy and birth rate has been declining in the recent years. Amongst the organizations endeavoring to prevent teenage pregnancy and its consequences are Robert Wood Johnson Foundation, Youth Serving Organization (YSO), CEDPA, Health of Adolescent Refugees Project (HARP), Sexual Health and Development for Youth, Teen Outreach Program (TOP) and AIDSCAP etc. Moreover by the collaboration of Ministry of Health and Ministry of Education, a sexual and reproductive health curriculum has been devised in order to create sexual health awareness by school based programs. A two year course called Safer Choices has been included in the curriculum to raise awareness against HIV and STDs. The Ministry of Education has asked IMIFAP to help in devising a suitable curriculum for secondary school students. Many organizations are based online providing the youth essential reproductive health information; MEXFAM, INPPARES, Advocates for Youth, and APROFA are all organizations which are using interactive computer technology to spread awareness amongst the youth (Senderowitz, J. 2000, p. 6-46). These organizations are spread worldwide from Peru to African countries like Kenya and Zambia, but their mission statement is one. The gist of the initiatives remains the same. Initiatives: 1. Fostering/Creating a Suitable Environment: The community or environment plays a crucial role in the successful implementation of reproductive health programs. If a community is supportive, the task can be achieved with more ease and vice versa. The first initiative of any organization is to gain the support of the community in order to further continue the sexual education guide. Community collaboration can be achieved by mobilizing and interacting with the community. Participatory and publicizing approaches will lead to greater receptivity and support from the public which in turn will result in better reception of the awareness campaign. 2. Improving Attitudes, Knowledge, Self-efficacy: Adolescents are in a transition between childhood and adulthood, so they are in the process of discovering themselves. They are sexually active and possess the right of knowing about their reproductive health. Right education at the appropriate time can save many lives, but the question remains what should be included in the curriculum of sexual education and what should be omitted. Due to the physical, social, economic, and cultural differences between different countries, it is impossible to achieve similar results worldwide by using the same curriculum, but the main point must remain the same in all courses taught throughout the world – These courses are planned for the education of the youth; it must be ensured that the teenagers are comfortable with the teaching environment and the course being taught. If they fail to grasp the concept because of any disparity in the mentioned factors, then it will not prove beneficial for their mental and physical health. An indication of success is an educational environment which is interactive and experiential where teenagers can learn skills required for safe sexual behavior. Peer programs, youth groups, computer based activities, and media activities are all different methods of educating adolescents about their reproductive health and behavior. 3. Improving Health-Seeking and Safer Sex Practices: The final initiative is about providing guidance in utilizing the skills which teenagers have learnt in the education process. Encouragement of the use of condoms and other safe contraceptive methods, limiting the number of sexual partners, availability of legalized and safe abortion options, providence of professional guidance, and counseling if required. Negative provider attitudes can be discouraged by social marketing tools which can also aid in promoting the availability of safe contraceptives and condoms (World Health Organization 2007, p. 32-73). Current Programs and Debates about Teenage Pregnancy as Public Health and Health Promotion Development Issue: According to the World Health Organization, there is an urgent need for organizations and programs that are concerned with the health and safety of pregnant adolescents, and especially those which will inculcate skills to build a successful future for these young women. The U. S. Agency for International Development (USAID) identifies critical factors for the improvement of adolescent maternal health: encouraging teenage mothers to use prenatal care in identification and treatment of malaria, anemia, providing obstetric care for ensuring the safe delivery of teenage mothers and their babies; and postnatal care to identify post - par tum health concerns, providence of newborn care, and offering of contraception to accomplish family planning management and birth spacing (World Health Organization 2007, p. 32-73). An effective, influential and comprehensive program provided knowledge of contraception and reproductive health to Chilean school teenagers aged 12 to 17. The program was successful and decreased pregnancy rates among students by giving out information about both abstinence and contraception, by being flexible and cooperative, providing reference for counseling and reproductive health care, and by promoting open interaction between youth, parents, teachers, and health care professionals. The Adolescent Girls Initiate for Reproductive Health in Nepal focused on the improvement of availability of reproductive health information and direct access to services. Data indicated that 99% of girls aged 10 to 14 were aware of family planning methods at the end of the project compared to the 63% at the beginning. Profamilia, which is a Columbian based family planning association encouraged teenage girls to facilitate from reproductive health care services and noted 37 percent escalation in adolescent clinic visits. Reproductive Health of Young Adults in India (RHEYA) is an Indian association which emphasized on the education of adolescents about the use of contraception and delaying pregnancy. 15% of young couples used contraception to delay their first child because they were a part of RHEYA counseling, compared to just 1% of adolescent couples in the control group (Senderowitz, J. 2000, p.6-46). Public Health Programs influenced by Ethical Principles: In our society, ethical and cultural influence is still very strong and prevalent. In many communities pre-marital sex and child bearing is not readily accepted. RHEYA promotes the concept of contraception as in India; it is against ethical values and principles to bear a child while being single. Similarly HHS sexual education training program is the Abstinence Education Program; the welfare reform law enacted this program in 1996 and it grants funds for the educational activities relating to programs and presentations on the abstinence of per-marital sexual activity. It also grants funds for activities on programs related to teen pregnancy prevention. Other programs include Adolescent Family Life Program, a chapter of Centers for Disease Control and Prevention. All these public health development groups are based on ethical principles of abstinence from sexual activity before marriage, and are operating throughout the world with this agenda (Cornerstone Consulting Group, Inc. 2003, p.1-4). In many countries, like Northern Ireland, due to ethical reasons, abortion is illegal because of which, many pregnant teenagers who do not desire to keep their babies consider options like self-induced abortion, back street abortion, and infanticide etc. which cannot have deleterious effects on young women (Dennison, C. 2004, p.2-8). Major Public Health Concerned to Adolescent Pregnancy: The main target group for the implementation of initiatives is of teenagers from the ages of 15 to 19. Recent estimates show that one half of all new HIV infections occur among adolescents, and one out of every four teenagers engaged in sexual activity acquires an STD per year. These shows how much more prone to sexually transmitted diseases young people are, as compared to adults. 10 to 15% of teenage girls who have sexual intercourse end up pregnant (Grunseit, A. 1997, p.8-23). According to an estimate made by WHO, 14 to 15 million young women from the ages of 15 – 19 give birth every year. A large number of abnormalities are reported in children born of teenage mothers .15% of the worldwide burden of disability for maternal conditions comprises of adolescents, and they also account for 13% of all maternal deaths globally. Due to these health concerns, public health organizations have introduced programs to reduce the high rate of adolescent pregnancy and delay early debut sexual rate (Greene, M 2002, p.7-34). Statistics suggest that teenagers from low income families which are more inclined to have financial problems are more at the risk of becoming pregnant at a young age. The people who are more vulnerable of teenage pregnancy are: Homeless teenagers School dropouts or adolescents who do not perform well at school Adolescents from broken homes Certain ethnic minorities Children of teenage mothers Teenagers with criminal records (Dennison, C. 2004, p.2-8)  Teenage parents and their newborn babies are at great physical and economic risks as the teenagers are not capable of standing on their own feet and becoming totally independent. They put themselves at high emotional and physical risky by engaging in unprotected sex. It should be made aware to the teenagers that abstinence from sex at a young age is the best prevention of teenage pregnancy. Statistics show that 58% of teenagers believe that they cannot be provided with birth control measures and their actions result in unplanned pregnancy (The USAID Health Policy Initiative 2009, p.1-5). It is the responsibility of public health organizations to make sure that adolescents should have the awareness and access to birth control measures. Parents and teachers should also play a tremendous role in the social awareness of teenagers; they should not distance themselves from them and guide them in every possible way through their sexually challenging years (Cornerstone Consulting Group, Inc. 2003, p.1-4). References: Cornerstone Consulting Group, Inc. (2003) Three Policy Strategies Central to Preventing Teen Pregnancy. Houston: Center for Health Improvement, p.1-4. Dennison, C. (2004) Teenage pregnancy: An overview of the research Evidence. Health Development Agency, p.2-8. Greene, M (2002). Sexual & Reproductive Health Policies for a Youthful World. Washington D.C: Population Action, p.7-34. Grunseit, A. (1997) Impact of HIV and sexual health education on the sexual behavior of young people: A review Update. Joint United Nations Programme on HIV/AIDS, p.8-23. National Research Council (1993) Population Summit of the World's Scientific Academies. Washington D.C: The National Academies Press, p.4-5 Novick, L. and Morrow, C. (2002) Defining Public Health: Historical and contemporary Developments. Jones and Bartlett Publishers, p.1-34. Senderowitz, J. (2000) A Review of Program Approaches to Adolescent Reproductive Health. U.S. Agency for International Development Population Technical Assistance Project Bureau for Global Programs, (176), p.6-46. The USAID Health Policy Initiative (2009) Poverty and Youth Reproductive Health. Washington D.C: CEDPA, p.1-5. World Health Organization (2007) Adolescent pregnancy: unmet needs and undone deeds. Maternal, newborn, child and adolescent health, (19), p.32-73. Read More