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Jane is a 16-year-old high-school sophomore from an upper-middle class family. In many ways, she's a typical teenager. She enjoys texting on her cell phone, while listening to hip-hop on her MP3 player. Her bedroom wall sports posters of the latest teen idols. She has a MySpace page, spends hours in the afternoon surfing Facebook, and also enjoys hanging out at the mall with her friends.
Jane will soon trade in her size 4 jeans for those that offer a stretch waist; her MP3 player will likely contain lullabies in addition to hip-hop music; and Parents magazine will replace Facebook and MySpace.
Jane is one of several high-school girls who are about to become teenage mothers.
Teen pregnancy raises many questions. Did her sex education class miss the mark; is she a victim of defective protection; or is Jane just looking for someone to love her?
One Approach Doesn't Fit
The acuity of health issues in the school setting both medical and psychological have increased dramatically in recent years requiring the school nurse to do more with less - less time and fewer resources.
Pregnancy prevention cannot be wrapped up in the time it takes to apply an ACE bandage, and one size doesn't fit all. There are several approaches to preventing unplanned teen pregnancy ranging from high schools that subscribe to abstinence-only program (which receive about $176 million a year in federal funding)1 to those that provide sexual education, including those that teach about contraception, as well as a small number of maverick schools that administer condoms either through the health office or via dispenser.
According to the CDC, birth statistics rose in 2006 by 3 percent in teen girls ages 15-19 after a 14-year downward trend.2 In 2007, the rate jumped another 1.4 percent, according to the CDC. An increase in the use of contraceptives at first and at most recent intercourse, and a decreased desire to become teenage mothers may be factors in the decline over the preceding years.
However, since this data has been published, a new phenomena has been identified, a segment of teens who desire and intentionally try to become pregnant. The release of this new data renews the debate of what is the best approach to sex education and teen pregnancy prevention.
What's to Blame?
The school nurse impacts many facets of an adolescents' life from health education and first aid to counseling individuals with complex psychological disorders and medication management (which often includes polypharmacy).
Teen pregnancy prevention/family planning is one area the school nurse has the potential to influence the next 20 years - particularly if the teen spends it pregnant, supporting and raising her child.
If knowledge deficit is not the catalyst for teen pregnancy, then sexual attitudes and high-risk behavior certainly may be antecedents of teen pregnancy. A current review of the literature suggests the problem does not lie with the teaching of sex education classes, but rather it begins with the attitudes and perceptions of adolescent girls.
In a study presented in The Canadian Journal of Human Sexuality, teenage girls were administered a questionnaire testing their knowledge about sexuality and contraception.3 Results overwhelmingly indicated knowledge of subject matter was good; therefore, the problem of teenage pregnancy must have another cause.
Adolescent depression may be a factor in the increase in today's teen pregnancy rate.4 School nurses, according to an informal survey, have identified depression, lack of social connections and the absence of extra-curricular activities as common denominators linking teens and the desire to become teenage mothers.
The combination of adolescent depression and lack of parental involvement appear to be paramount as motivating factors in teenage girls' desire to transition into parenthood. In the Canadian Journal of Human Sexuality study, teenage girls self-reportedly cited "family adversity" as the leading cause of and predictor for teen pregnancy.3
Growing Up Directionless
The nuclear family is a distant concept that is all but extinct. Children are being raised or more appropriately housed and fed while the adult in their charge is out making ends meet, climbing the corporate ladder or developing themselves personally, professionally or a combination of the two. Whatever the reason, the end results in a social problem that includes a directionless soon-to-be teen parent in search for her own voice and someone to love and care for.
This phenomenon was illustrated in the media this past June in Gloucester, MA, where 17 high-school girls allegedly forged a pregnancy pact. School superintendent Christopher Farmer has said, "Many of our young people are growing up directionless."
The problem of teen pregnancy is non-discriminatory; it crosses county lines and reaches across socioeconomic class. Income, race, religion or political affiliation affords immunity from this social problem. While the situation in Massachusetts occurred in a mostly white, working class, predominantly Catholic town, feelings of emptiness are echoed in the hearts of teens of varying demographic makeup across the U.S.
Not My Child
Gov. Sarah Palin of Alaska and her family were not beyond reproach. The announcement of 17-year-old daughter Bristol Palin's giving birth to a son in December serves to exemplify no family is impervious to an issue, which at least is at the center of controversy regarding funding and educational approach in our public schools. Notably, Palin opposes programs that teach teenagers anything about contraception.
Reviews of abstinence-only programs have not found consistent and significant effects on delaying the initiation of intercourse.5 Conversely; family involvement, family structure, parental values, parental monitoring, and parent-child communication are important factors influencing critical life choices and are a crucial part of teen pregnancy prevention. The closeness of family ties, parental preteen support, and especially mother-daughter relationships is associated with teens not having sex.6
The Nursing Process
Assessing and evaluating the root cause of this social situation is the first step in planning and implementing an appropriate strategy for prevention efforts.
Though teens, when questioned regarding the demands of parenthood, believed there were positives aspects of teen births, early childbearing was considered "hard" in many aspects.7
Educational efforts need to continue to promote abstinence, while reinforcing the impact and consequences of unprotected intercourse. Additionally, the proper use of contraception should be explained.
Designing a program that includes parent-teen communication, while promoting abstinence and the proper use of contraception should have better combined results.
School nurses and educators should build and expand on these perceptions to guide programs, messages and curricula with the intent to reverse the current climate and trends and reduce the number of teen pregnancies.
References
1. Contraceptive Technology Update. (2008, March). Teen birth rate rises for first time in 14 years - what lies behind the change? Retrieved Sept. 14, 2008 from the World Wide Web: www.cinahl.com
2. Centers for Disease Control and Prevention. (2007, Dec. 5). Teen birth rate rises first time in 15 years. Retrieved March 18, 2009 from the World Wide Web: http://www.cdc.gov/nchs/pressroom/07newsreleases/teenbirth.htm
3. Sanie, S., Gantt, A., & Rosenthal, M. (2004, Oct. 15). Pregnancy prevention in adolescents. American Family Physician, 70(8), 1517-1524.
4. Cohen, D., et al. (2007, February). Availability of high school extracurricular sports programs and high-risk behaviors. Journal of School Health, 77(2), 80-86.
5. Herrman, J. (2008, 2008 Jan-Feb). Adolescent perceptions of teen births. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(1), 42-50.
6. Lederman, R., & Mian, T. (2003, March). The parent-adolescent relationship education (PARE) program: a curriculum for prevention of STDs and pregnancy in middle school youth. Behavioral Medicine, 29(1), 33-41.
7. Stein, Rob. (2007, Dec. 6). Teen birth rate rises in U.S., reversing a 14-year decline. Washington Post. Retrieved Sept. 11, 2008 from the World Wide Web: http://www.washingtonpost.com/wp-dyn/content/article/2007/12/05/AR2007120501208.html?nav=emailpage
Melissa Cardinal is a school nurse at Hopatcong High School, Hopatcong, NJ.
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