Krista Brooks, BS
The United States has one of the highest teen pregnancy and birth rates in the industrialized world. 1 Although teen pregnancy rates in the U.S. have been declining since 1990, when rates peaked at 12% of adolescent girls, it still has an extremely high rate compared to other countries with comparable wealth and educational levels.2 Pregnancy and birth rates for teens are based on averages but the rates are much higher or lower for some teens. For example, some of the highest teen birth rates are found in the Southern part of the country.2 In 2008, nearly 60% of teen births in the U.S. were to African American and Hispanic girls.3 It is important to note that although some pregnant teens are married, that has been a small minority in recent years.
Teenage girls in the foster care system are twice as likely to get pregnant before turning nineteen as teenage girls who are not in foster care. Why are these teens at such high risk for pregnancy? The Guttmacher Institute speculates that the circumstances that led them to be placed in foster care in the first place, along with the experience of being in foster care, seem to make these teens especially vulnerable. For example, teens in foster care are more likely to have suffered from some sort of child abuse, which can lead to physical and emotional health problems.
The foster care setting also creates a unique situation where many adolescent youth do not have close family connections. A parent-adolescent bond has been shown to decrease the risk of teen pregnancy and encourages contraceptive use and delaying risky sexual activities.”4 Additionally, a teenage girl in foster care may want start her own family as a way of creating the relationships she is missing.
Foster youth that age out of the system (after age 18) are often left to fend for themselves and end up in difficult situations that put them at risk for pregnancy, as well as health problems. These youth can end up homeless, increasing the likelihood that their own children will be placed into the foster care system.5 They desperately need help to break the cycle.
Targeting foster youth for pregnancy prevention interventions can be difficult. Many switch schools frequently or attend school infrequently, which keeps them from participating in school-based sex education programs. Frequent changes in caseworkers can create a lack of monitoring of routine health check ups for foster adolescents. This, in addition to changes in living arrangements, lowers the chances of the adolescents establishing a connection with a clinic or organization that provides reproductive health care and contraceptives. Moving from one foster home to another also prevents girls from getting the sexual health information they need; a girl may develop a relationship with an adult that might be conducive to frank talk but then have to move again. Sometimes the religious beliefs and practices of caseworkers and foster parents limit their ability to address sexual health issues.
In September 2010, the Department of Health and Human Services announced that it would give $155 million in grants to states, non-profit organizations, school districts, universities, and others for the implementation of evidence-based teen pregnancy interventions.6 While this is good news, there are no scientifically proven programs specifically designed to prevent pregnancy among foster youth. A California focus group found that foster care adolescents perceived the sexual education they received in school “as irrelevant to their living and social situations and more suited to youths who were residing in stable, single-family homes, with clearly identifiable and accessible parent figures with whom they could discuss the material.”5
Based on what is known about preventing teen pregnancy generally, child welfare centers, case workers, and foster parents should work together to ensure that foster youth are receiving comprehensive sexual health care and information. Trainings for foster parents and case workers could help facilitate conversations with foster youth about sexual health. These trainings could be covered through federal funding, specifically the Fostering Connections Act, which has provisions to “delay pregnancy and childbearing and help adolescents develop a transition plan for themselves as they age out of foster care.” Additionally, since many foster youth qualify for Medicaid up to the age of 21 (under Health Care Reform, the age will increase to 26 in 2014), case workers could link adolescents to local clinics to improve access and increase the number of youth receiving care.
New data that could be helpful for the design of such programs will soon be reported to the Administration for Children and Families by state welfare programs, which are trying to learn more about adolescents in the foster care system, including their behavior and activities. Additionally, one program developed specifically for foster youth living in group homes—Power Through Choices—has already been used in several states and is in the process of being evaluated. It is an interactive educational program of ten sessions that aims to empower kids and give them decision-making skills to prevent sexually-transmitted diseases and pregnancy. It uses group discussion, demonstrations, and role-playing to teach kids how to make healthy life choices. If it is found to be effective, this program could serve as a potential model for organizations across the country that work with foster youth.5
In summary, teenage girls in foster care urgently need access to educational programs, counseling, and health services targeted to prevent teen pregnancy. Likewise, foster parents, caseworkers, and others who come into contact with these teens need special training. New information about the attitudes and behaviors of girls in foster care will help in the development of pregnancy prevention programs and services, but what is urgently needed are evaluations of existing programs to determine what works and what doesn’t.
1 Kost K, Henshaw S, Carlin L. U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity: Guttmacher Institute; 2010
2 Hoffman S. By the Numbers—The Public Costs of Teen Childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2006
3 Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2009.National Vital Statistics Reports 2010;59(3):Table 2.
4 Boonstra, HD. (2011). Teen pregnancy among young women in foster care: a primer.Guttmacher Policy Review, 14(2), Retrieved from http://www.guttmacher.org/pubs/gpr/14/2/gpr140208.html
5 Becker, MG, & Barth, RP. (2000). Power through choices: the development of a sexuality education curriculum for youths in out-of-home care. Child Welfare, 79(3), Retrieved from http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ635691&ERICExtSearch_SearchType_0=no&accno=EJ635691
6 U.S. Department of Health and Human Servce, (2010).HHS awards evidence-based teen pregnancy prevention grants. News Release. Retrieved from http://www.hhs.gov/news/press/2010pres/09/20100930a.html