Teen Pregnancy Research Paper Samples

Nursing Problem

In the year 2012 alone, upwards of 305,388 were born to mothers aged between 15 and 19 years, representing a birth rate of 29.4/1000 women. While teen birth rates have been declining over the last few years, the rates remain high and represent a major nursing problem for a number of reasons. Firstly, teen pregnancy (along with the associated sexually transmitted diseases and teen parenthood), is higher in the US relative to other industrialized countries (Kohler, Manhart, & Lafferty, 2008; Center for Disease Control and Prevention, 2014). While it appears that there’s little difference in the rate of sexual activity among teenagers in the US, UK, Russia, Romania, Sweden, Canada and France, the US has the highest prevalence rate of teen births, abortions and pregnancies. According to Kohler, Manhart, & Lafferty (2008) and Mueller, Gavin, & Kulkarni (2008), the majority of teen pregnancies are unplanned and thus mothers struggle with ill preparation, emotional stress, peer rejection, financial problems and lack of parental/partner support, which means that without close attention from the health care system the mother and baby’s health may be adversely affected.
Unlike older women, teen mothers require additional nursing care, including intensive emotional support, prenatal education and postpartum. Due to the relatively low life experiences and committed sexual partners, which renders them ill-equipped to cope with life changes occasioned by pregnancy and parenthood, effectively needing greater nursing care and support. Even worse, is the fact that few clinical and reproductive health programs are targeted at teens, with some of the already existent programs such as sex education proving to be largely ineffective. It is urgent to determine the underlying reasons for the high rates of teen pregnancies, effectiveness of existent strategies to reduce the problem and the need to provide effective nursing care and support to the mothers. This is squarely a nursing and public health issue, not least because pregnancies at such an early age affects the mothers’ reproductive health, education, personal development and the new born children’s development.

Annotated Bibliography

Allen, E., Bonell, C., Strange, V., Copas, A., Stephenson, J., Johnson, A. M., et al. (2007). Does the UK government's teenage pregnancy strategy deal with the correct risk factors? Findings from a secondary analysis of data from a randomised trial of sex education and their implications for policy. J Epidemiol Community Health. Jan 2007; 61(1), 20–27.
Allen et al. (2007), which assessed the link between risk factors identified by a UK government report and teen pregnancy, using much more recent data. The study confirms the influence of factors such as sex knowledge, parental relationship, sex education and communication in mitigating teen pregnancy risk. This study ignored other risk factors in the report such as education/training expectation. It also relied on observational data, which is subjective. It however, serves to offer a confirmation for my personal assumptions about teen pregnancy risk factors, and even if its does not prove them, I think highlighting them helps me and other researchers in future give these issues the priority that they deserve.
Bonell, C., Allen, E., Strang, V., Copas, A., Oakley, A., Stephenson, J., et al. (2005). The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education. Journal of Epidemiology and Community Health, 59(3), 223-230.
Bonell et al. (2005) looks outside the box. It established that while attitudes to school were linked to protected sex, unprotected sex and the risk of pregnancy, dislike to school was more strongly correlated with negative outcomes compared to ambivalence towards school. Even after adjustments for demographic characteristics (socioeconomic statuds, knowledge indicators, sexual health confidence and lack of education expectation), the results remained the same. The study highlights the importance of keeping children in school and a systemic approach to combatting teen pregnancy. It reminds of the the systems theory of nursing. Society is a system and in order to understand the causal factors behind teen pregnancy, nurses need to understand the entire system, which should also be used to address the problem. While I think a more direct study to determine the link between school dropout rates and teen pregnancy/birth rates would be more revealing, I feel this study addresses the psychosocial issues that cause children to drop out or fail to do well in school. This is important, because while children may not drop out, they lose the motivation and willingness to pursue education and end up prioritizing wrong things.
Chang, Y., Hayter, M., & Lin, M. (2012). Pubescent male students' attitudes towards menstruation in Taiwan: implications for reproductive health education and school nursing practice. Journal Of Clinical Nursing, 21(3/4), 513-521. doi:10.1111/j.1365-2702.
This study wanted to establish the attitudes of pubescent boys towards menstruation, which is an important part of reproductive health. It is a pointer to the nature and effectiveness of sex education, teen pregnancy and the associated social stigma. The approach used in this study move away from the effectiveness of sex education and give an indirect pointer to actual effectiveness. The results show that boys think that menstruation is an unimportant and a silent issue or had erroneous knowledge about it. Evidence of stereotypical knowledge was also established. This study is important because menstrual education among teens forms an important part of reproductive health education, and boys need to give girls the social support to understand their bodies as against stigmatizing them. The small sample size and exploratory nature of this study is a limitation, but is nonetheless important in stimulating debate and further research.
Henderson, M., Wight, D., Raab, G. M., Abraham, C., Parkes, A., Scott, S., et al. (2007). Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster rafinal results of cluster randomised trial. bmj, 334(7585), 133.
Henderson, et al. (2007) explored the impact of theoretically-founded sex education and conventional sex educational programs on pregnancies and abortions among a cohort of women that had attended 25 Eastern Scotland schools. A controlled randomized trial using 4196 women showed no difference between the conventional sex education programs and the theoretically based programs. Effectively special sex education programs are ineffective in reducing the number of abortions and teen pregnancies and that this was not due to poor quality delivery. This study’s may limitation is its inability to pick out the sociocultural factors that may have rendered the program ineffective, besides the fact that it does not make clear whether theoretically-based programs are the same as evidence-based programs. If theoretically-based is the same as evidence-based programs, then this study is hugely significant, but only because further research may have to be conducted. Personally, I think special programs are impractical and resource-consuming, but whether or not they are effective requires more studies.
Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344-351.
This is an epidemiological evaluation of the role and effect of sex education programs on sexual activity initiation, teen pregnancy and STDs. The results show that conservative sex education programs emphasizing abstinence that are common in the US could be the problem. Abstinence only education was not only ineffective, but comprehensive sex education reduced teen pregnancy risk. Even most importantly, education about contraception did not lead to greater sexual activity. Having grown up in a deeply Christian community that was too keen on no-sex-before-marriage message and completely ignoring the fact that this was largely ignored, I realize the importance of this study. As health workers and researchers, it is our responsibility to separate between factual health information and culturally-dressed information that currently characterizes what our teens know about sex. We need to ensure that they learn that abstinence, contraception, safe abortion and other aspects have a role to play in their lives so that they can make informed choices. This study is limited by the fact its measurement of abstinence-only programs may be abstinence-only programs may also be affected by social desirability biases because respondents who have been thought to abstain are unlikely to reveal their involvement in sex. The study’s suitability and relevance of its finding that comprehensive sex education reduces teen pregnancy without increasing sexual activity is, however, extremely relevant to nursing practice.
McKay, A., Byers, E. S., Voyer, S. D., Humphreys, T. P., & Markham, C. (2014). Ontario parents' opinions and attitudes towards sexual health education in the schools. Canadian Journal Of Human Sexuality, 23(3) , 159-166. doi:10.3138/cjhs.23.3-A1.
Researchers sought to understand parental attitudes towards sexual health education (SHE) among parents with children attending public, elementary secondary schools in Canada/Ontario. It is a qualitative study that uses slightly different outcome measurements compared to other studies included in this review, and brings to light a very important perspective. The results show that the vast majority not only support these programs, but also think that they should be started in middle schools and the curricula needed to be up-to-date. They rated 13 sex education topics that included abstinence and contraception as extremely important and identified themselves, doctors, nurses and schools as the most competent sources of information. The study results are limited by the fact that the sampled parents were disproportionately well educated, rich and mostly women. It is curious that parents overwhelmingly support these programs, which means that the opposition to liberal sex education comes from governments and culture as against parents and schools.
Mueller, T. E., Gavin, L. E., & Kulkarni, A. (2008). The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. Journal of adolescent health, 42(1), 89-96.
This is personally interesting because it speaks to the mediating factors surrounding the first sexual intercourse and use of contraceptives. Using data from the National Survey of Family Growth, this work examined whether sex education resulted in delayed age of first intercourse and encouraged the use of contraceptives. The results are partially encouraging. They show that formal sex education resulted in delayed/postponed first sexual intercourse among both boys and girls, but it had no effect on the use of birth control among girls. Also, unlike Bonell et al. (2005), this study shows that these patterns were influenced by social and economic factors. I think, the longer children can wait before having sex, the more the knowledge and maturity they will use, which is why, this study’s results are important. This paper is, however, silent on the possible reasons for the failure in using contraceptives among girls, but I think if this is addressed more actively in the curricula, then it can be changed.
Santelli, J. S., Lindberg, L. D., Finer, L. B., & Singh, S. (2007). Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. American Journal of Public Health, 97(1), 150.
This is more direct in examining the impact of contraception on the reducing teen pregnancy rates in the US. The tools used includes the pregnancy and the contraceptive risk indices. Results pointed to a 34% and 46% reductions in contraceptive risk index among all people and adolescents (aged 15 to 17) respectively, with the subsequent risk of pregnancy falling by 34%. The reduced risk of pregnancy was attributed to contraception. Once again, this study highlights the importance of contraception over abstinence and the need for nurses such as ourselves to make this known to our patients. This study’s limitations included the fact that it relied on self-reporting that is difficult to ascertain the accuracy and that the NSFG data used was unstable for Hispanic adolescents. Further, the researchers also assumed that there had been no changes in contraception use and that contraceptives were used correctly, which may not have been the case. I, however think that it makes it easy for use to set priorities for sex education and reproductive health promotions.
Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the US. PloS one, 6(10), e24658.
Using a sample of 45 sex education policies/laws and drawing on recent national data, this study’s conclusions are personally the most shocking to me, but also confirms what I have long suspected. Firstly, it shows that abstinence-only sex education programs are positively associated teenage birth rates and pregnancies, which proves that they are ineffective. The results also confirm that our teens are having sex anyway, and as nurses, health care, and education practitioners, we need to reconcile with this reality. I cannot understand why we continue to insist on sex education programs that have no basis in evidence-based research, but I believe institutional and cultural barriers may be contributing to this. Subjective coding of state laws/policies may affect the reliability of this study, but it nonetheless adds evidence to the need for comprehensive sex education to ensure effectiveness.
Thato, R., Jenkins, R. A., & Dusitsin, N. (2008). Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students. Journal Of Advanced Nursing, 62(4), 457-469. doi:10.1111/j.1365-2648.2008.04609.
This study raises the issue of cultural sensitivity of sex education programs and comprehensiveness of the same. The researchers used a quasi-experimental research design which is close to randomized controlled trial used by Santelli, Lindberg, Finer, & Singh (2007) and other studies. The tools used i.e. Sexual behaviour and condom use; Intention to refuse sex; STI and HIV/AIDS knowledge; intention to use condoms; and pregnancy knowledge are closely identical to those used in Henderson, et al. (2007) and Santelli, Lindberg, Finer, & Singh (2007). Some aspects of these tools are, however, subjective. The results show that culturally seinsive, comprensive sex education leads to better knowledge on the risks of pregnancies, increased intention to reject sex and reduced sexual activity. However, there was no consequence on contraception use. It is interesting to determine whether the lack of influence on sex education on contraception use was due to flaws in the curricula, delivery or cultural barriers, as well as find out how cultural barriers such as religion may affect sex education. I however, think the fact that there is a measure of effectiveness is a step forward in using culture to foster better reproductive health among teens. This study is limited because it used self-reporting methods that are difficult to verify, besides the fact that proportion of sexually experienced youth in the sample was low making it possible that the sample was unrepresentative.

Efficacy

The studies included in this review employed a variety of methods (including randomized controlled trials, quasi-experimental design, cluster randomised trial and descriptive designs) to achieve their ends, which I think makes their collective findings robust. The fact that the varied methods, data, research contexts and subjects have not affected the basic finding against abstinence, abstinence-only sex education and abstinence-plus strategies, provides an irrefutable proof that comprehensive sex education is the best possible strategy to reduce teen pregnancy (Bonell, et al., 2005; McKay, Byers, Voyer, Humphreys, & Markham, 2014; Santelli, Lindberg, Finer, & Singh, 2007; Stanger-Hall & Hall, 2011). The unity in findings in favor of comprehensive sex education also means that the evidence gathered in this review is sufficient to facilitate the drawing of recommendations and a conclusion. There is only limited evidence that such education did not have effects on contraception, but it cannot on its own be the basis to reject comprehensive sex education in schools (Santelli, Lindberg, Finer, & Singh, 2007; Thato, Jenkins, & Dusitsin, 2008).

Evidence Summary

All the studies, that I included, had the common purpose of assessing nature and/or effectiveness of sex education programs on reducing the risk of teen pregnancy, STD, contraception, birth rates and abortions. The studies show evidence for the effectiveness of comprehensive sex education, liberal sex education and other forms of sex education that do not dwell on abstinence alone. Allen, et al. (2007), Henderson, et al (2007), Kohler, Manhart, & Lafferty (2008), Mueller, Gavin, & Kulkarni (2008) and Thato, Jenkins, & Dusitsin (2008) show that comprehensive sex education or variation of it are associated with reduced risky sexual bebahiour and teen pregnacy. Further, it is evident that liberal sex education did not lead to greater sexual activity, rather, it equipped teens with skills and knowledge. Mueller, Gavin, & Kulkarni (2008) shows that formal sex education resulted in delayed/postponed first sexual intercourse among both boys and girls. Also, unlike Bonell et al. (2005), this study shows that these patterns were influenced by social and economic factors.Even most tellingly Stanger-Hall & Hall (2011) shows that abstinence-only sex education programs are positively associated teenage birth rates and pregnancies, which proves that they are ineffective.
However, it is curious that sex education seems not to have an influence on contraception use. Thato, Jenkins, & Dusitsin (2008) found no effect on contraception usage, while Mueller, Gavin, & Kulkarni (2008) established that sex education had no effect on the use of birth control among girls. Mediating issues may include socioeconomic factors, attitudes towards school, pubescent boys’ knowledge about reproductive health and even the age of the children (Chang, Hayter, & Lin, 2012; Bonell, et al., 2005; Allen, et al., 2007).

Nursing Strategy Recommendation

The strategy to improve nursing care to teens will include the provision of the comprehensive sex education as against abstinence-only education and abstinence-plus strategies, which will include (Henderson, et al., 2007; Santelli, Lindberg, Finer, & Singh, 2007):

Reproductive health knowledge

Decision-making and self-care in order for teens to avoid situations and places that may lead to sex, reject sex (Mueller, Gavin, & Kulkarni, 2008; Thato, Jenkins, & Dusitsin, 2008)
Foster knowledge and positive attitudes towards sexual health education among children, by building on the support from parents and other health care practitioners.
As practitioners, we must focus more on evidence-based strategies and move away from the culture. This is not easy. It is necessary to actively fight institutional, social and cultural factors that hinder the provision of evidence-based sex education including the federal funding, cultural, religious and personal beliefs. It may also be helpful to provide culturally sensitive sexual health education to foster acceptance, as long as it comprehensive on key issues.

References

Allen, E., Bonell, C., Strange, V., Copas, A., Stephenson, J., Johnson, A. M., et al. (2007). Does the UK government's teenage pregnancy strategy deal with the correct risk factors? Findings from a secondary analysis of data from a randomised trial of sex education and their implications for policy. J Epidemiol Community Health. Jan 2007; 61(1), 20–27.
Bonell, C., Allen, E., Strang, V., Copas, A., Oakley, A., Stephenson, J., et al. (2005). The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education. Journal of Epidemiology and Community Health, 59(3), 223-230.
Center for Disease Control and Prevention. (2014, Dec). Teen Pregnancy in the United States. Retrieved Nov 2014, from http://www.cdc.gov/teenpregnancy/aboutteenpreg.htm
Chang, Y., Hayter, M., & Lin, M. (2012). Pubescent male students' attitudes towards menstruation in Taiwan: implications for reproductive health education and school nursing practice. Journal Of Clinical Nursing, 21(3/4), 513-521. doi:10.1111/j.1365-2702.
Henderson, M., Wight, D., Raab, G. M., Abraham, C., Parkes, A., Scott, S., et al. (2007). Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster rafinal results of cluster randomised trial. bmj, 334(7585), 133.
Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. . Journal of Adolescent Health, 40(3), 206-217.
Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344-351.
McKay, A., Byers, E. S., Voyer, S. D., Humphreys, T. P., & Markham, C. (2014). Ontario parents' opinions and attitudes towards sexual health education in the schools. Canadian Journal Of Human Sexuality, 23(3) , 159-166. doi:10.3138/cjhs.23.3-A1.
Mueller, T. E., Gavin, L. E., & Kulkarni, A. (2008). The association between sex education and youth’s engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. Journal of adolescent health, 42(1), 89-96.
Santelli, J. S., Lindberg, L. D., Finer, L. B., & Singh, S. (2007). Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. American Journal of Public Health, 97(1), 150.
Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: a review of US policies and programs. Journal of Adolescent Health, 38(1), 72-81.
Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the US. PloS one, 6(10), e24658.
Thato, R., Jenkins, R. A., & Dusitsin, N. (2008). Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students. Journal Of Advanced Nursing, 62(4), 457-469. doi:10.1111/j.1365-2648.2008.04609.
Weaver, H., Smith, G., & Kippax, S. (2005). School‐based sex education policies and indicators of sexual health among young people: a comparison of the Netherlands, France, Australia and the United States. Sex Education, 5(2), 171-188.