Hispanic Sex Education

Policy Paper: Perception of Teachers and Parents towards Hispanic
Pregnancies & Birth Control Distribution
In Public Schools
Tangela Norman-Sheppard
SOWK 7360/ Policy and Practice in Human Services
Our Lady of the Lake University
Professor: Dr. Brian Christenson

I. Executive Summary
Teenage parenthood is by no means a new social phenomenon. Historically, women have tended to childbearing during their teens and early twenties. During the past two decades the United States teenage birthrate has actually declined (Polit,et al., 1982). Of the 29 million young people between the ages 12 and 18, approximately 12 million have had sexual intercourse (Guttmacher Institute,
1984). Furthermore, 78% of births to teenagers are first births. However, 19% are second births, and 4% are third or higher order births. About 5% of the United States teenagers give birth each year (Guttmacher Institute, 1984).
The use of contraception is an integral part in preventing teen pregnancy (Goodyear & Newcomb, 2002). Examples of contraception include condoms, oral birth control, as well as birth control injections (Russle& Lee, 2004). Teens who are Hispanic use less contraception compared to teens from other races (Ryan, Franzetta, &Manlove, 2005). According to Ryan, “between 1991 and 2003, 43% of Hispanic teens did not use a condom during their most recent sexual experience (Ryan, Franzetta, &Manlove, 2005, p. 4).” In a study published in the Journal of Nursing Research and Health, Deborah Griffin states that contraception use is directly related to a teen’s attitudes regarding contraception (Griffin, Lesser, Uman, &Nyamathi, 2003). A positive attitude towards contraception and the perceived risk of pregnancy allows teens to openly communicate with their partners about contraception (Griffin, Lesser, Uman, &Nyamathi, 2003). The majorities of Hispanic teens do not have positive attitudes regarding contraception, and do not openly communicate with their partners (Griffin, Lesser, Uman, &Nyamathi, 2003). One of the reasons that potentially explain the lack of communication between Hispanic teen partners is that girls choose partners that are on average three years older (Goodyear & Newcomb, 2002 ). This age difference creates a communication barrier because the girls do not want to jeopardize the trust of their partners by asking to use contraception (Goodyear & Newcomb, 2002). Additionally, the girls have a fear of abuse or retaliation from their partner if trust is jeopardized (Griffin, Lesser, Uman, &Nyamathi, 2003). The girls also want to build a closer relationship and have a sense of belonging related to their partners (Griffin, Lesser, Uman, &Nyamathi, 2003).
As researchers, parents, teachers, and school officials are trying to eliminate the steadily growing amount of youth who are impregnate each year. Many raised the question whether birth control should be administered at school to teenage girls. The age of these girls can be given at early as age eleven years old, which indicates middle school six-grade levels. Are their health barriers and side effects of giving these girls the pill? The pill can perhaps solve one problem if done correctly as well as created several other problems later in life, for these young adolescent girls. At age eleven many girls have not even reach the stage of puberty where they began a monthly cycle flow. And yet the suggestion is made to offer birth control pill that have several health issues on adults not considering the health issue that it may cause on adolescent girls (Hamilton &Ventrua, 2012).
II. Problem History
a. Background
Teen pregnancy is a major problem in the United States that has economic, educational, and health implications all across society. The prevalence of teen pregnancy, or adolescent pregnancy can be stated using teen birth rate. This is defined as “the number of live births to women ages 13-19 per 1000 women.” (Hamilton & Ventrua, 2012,). The teen birthrate for all races in 1991 was 61.8 per 1000 women. If this rate were to stay constant, then there would be approximately 3.4 million births to teenage mothers throughout 2010 (Hamilton & Ventrua, 2012). The rate of teenage births varies across the nation depending on the race and ethnicity of the teen mother (Waddell, Orr, Sackoff, & Santelli, 2010). According to a study conducted by Christine Dehlendorf published in the Journal of Maternal and Child Health, Hispanics have the highest prevalence of teen births among all races and ethnicities in the U.S. (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009).
However, perceptions of parental support for broadly-based sexual health education in the schools can be influenced, particularly at the local level, by a number of factors. For example, in a particular community, those who oppose the provision of sexual health education in the schools or who argue that sexual health education should only embody a particular ideological vision of sexual health may be highly vocal and persistent in promoting their point of view, thereby giving the impression that they represent a large proportion of community opinion. Letters to the editor in local newspapers, presentations to boards of health and/or education, demonstrations, and media reports on these events can all potentially create a false impression of parental opinions and attitudes related to sexual health education in the schools
(Langille et al., 1996; McKay, 1996).
Nevertheless, In an analysis of the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative survey of 1027 U.S. students who were in grades 7 through 12 in 1995, it was reported that 36.2% of Hispanic teenagers stated they never used contraception during their sexual relationships (Manlove, Ryan, &Franzetta, 2003). In comparison, 23.3% of Black teens and 17.0% of White teens reported no contraceptive use. Moreover, the authors found that Hispanic teenagers reported the lowest levels of consistent contraceptive use (54%) compared with White and Black teens (each 66%) (Manlove, et al.). According to the CDC’s Youth Risk Behavior Surveillance, in 2005, 65.3% of Latino male adolescents and 49.8%of Latina female adolescents reported using a condom during their last sexual encounter compared with 62.8% of sexually active teenagers in general (CDC, 2006b).
b. Current Context
The U.S. Census Bureau states that the Hispanic population is the largest and fastest growing minority population in the country (CDC, 2012). It is estimated that there are 52 million Hispanics as of 2011, which make up 16.7% of the U.S. population. The CDC estimates that by 2050, the Hispanic population will reach 132.8 million and make up 30% of the U.S. population (CDC, 2012). The population of Hispanic teens is projected to increase 50% by the 2025, and make up 25% of the entire U.S. teen population (Ryan, Franzetta, & Manlove, 2005). One fourth of the Hispanic teens in the U.S. will give birth before age 20 (Ryan, Franzetta, & Manlove, 2005). In 2009 the teenage birthrate for Hispanics was 81 per 1000 women, while the teen birthrate was 26 per 1000 women for whites (Ryan, Franzetta, & Manlove, 2005). Although overall teen pregnancy rates have been dropping for all ethnicities, the Hispanic teen pregnancy rates have been decreasing at a much slower rate (Ryan, Franzetta, & Manlove, 2005). From 1991 to 2005, Dehlendorf states that teen birthrates in whites and African Americans decreased by 50% and 48% respectively, but only 22% among Hispanics (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009).
Sex education is an issue of debate because of the implications the influence this education has on children as young as twelve years old resulting in the participation of sexual activity. The question revolving around this issue is should taxpayers have to pay for an education program that students should be getting from their parents or legal guardians. The simple answer is no. These programs place teachers in an awkward situation because parents are the ones that should be teaching their children about sex. The distribution of condoms with sex education should not happen for it allows students to be one step closer to having sex because they are told that it is safe and very unlikely for the girl to get pregnant. Supplying the students with condoms, yes, allows for safer sex but it also plants the idea in the students head that they are expected to engage in sexual activity (Kaiser Family Foundation, 1999).
c. Importance of the Problem
The high risks being experienced by the Hispanic teen population warrant attention because teen pregnancy and childbearing can have negative consequences for both teen mothers and their children. Young mothers are less likely to ever marry, while those who do marry as teens face a greater risk of unstable unions than those have lower educational attainment, lower income, and a greater chance of needing public assistance than older mothers (Moore, 1995). Compared with children born to older mothers, those born to teenage mothers are more likely to face disadvantages throughout life, including lower educational attainment, a greater risk of poverty and of growing up with a single parent, and an increased likelihood of engaging in problem behaviors and in early sexual activity (McLanahan, & Sandefur, 1994).
It is important to address individual, cultural, and social determinants when looking at Hispanic teen pregnancy. Teens are getting mixed messages from cultural determinants, which affect individual determinants. Coupled with mixed messages are societal barriers placed by social determinants. Hispanic culture is telling teens to get married and have children while U.S. culture is placing an emphasis on education and delaying pregnancy. Russell states that Hispanic teens in the U.S. face the problem of “a shift in thinking about what it means to be Hispanic. A shift from interdependent and family based identity to one based on economic and individual independence from both family and intimate partners (Russle & Lee, 2004, p. 148).” Addressing individual, cultural, and social determinants will help to reduce teen pregnancy in the United States Hispanic population. Our research suggests one of the following approaches maybe effective:
• Emphasize the importance of contraception.
Teach teens that, if they decide to have sex, they must use contraception consistently for it to be effective. Also, encourage the use of long-lasting methods of contraception, such as injectable or the contraceptive patch, for pregnancy prevention, and stress the value of condoms for preventing both pregnancy and sexual transmitted infections (Haveman, Wolfe, & Peterson 1997).
III. Theoretical Perspective
Critical Race Theory place a big role in teen pregnancy among Latinos. Fifty-three percent of Latina teens get pregnant at least once before the age of twenty (National Campaign to Stop Teen Pregnancy). Thirty-one percent of the births in 2002 were to Latina teen moms, and 43 percent were to white teen moms. Latina girls are more likely to get treated differently than non-Hispanic mothers. This is because they are most likely to have a lower education level and income level, and because they live in poor neighborhoods (East & Jacobson, 2001).
In this Theory, Many Latina teens get treated differently whether or not they are pregnant. There’s this stereotype of Latina girls being “easy” to boys. Not every Latina girl gets pregnant at a young age, nor do they let boys take advantage of them. Latina teen moms should not get treated differently than any other teen mom, and Latina girls shouldn’t have that stereotype put on them (East & Jacobson, 2001).
Racial disparities are often Understudied or overlooked. While many factors explain general patterns of teen reproductive and sexual health behavior, few studies shed light on what contributes to greater risk-taking among youth of color as compared with white youth. Studies find a link between knowledge, attitudes and beliefs and sexual behavior, but racial differences in individual factors do not account fully for greater sexual risk-taking among minority teens. Similarly, studies focusing on social, economic and cultural issues have not shown conclusively that factors such as living in single-parent household, family poverty, parental education, access to services, and cultural norms disproportionately influence the sexual risk-taking of minority teens separate and apart from race/ethnicity. That is, even when each of these factors is considered (separately or in combination), race/ethnicity often continues to demonstrate a significant and independent effect on teen sexual behavior (East & Jacobson, 2001). Most Americans take pride in how far this country has come in achieving racial equality. The removal of overt racism and discrimination in the language of American laws has led many to believe that our laws and policies function in a race-neutral manner. Contemporary racism, however, is much more insidious. Racism remains inscribed in our social values, institutions, and social interactions so that laws and policies still work to perpetuate disadvantages and disparities for people of color. Understanding and disentangling this process cannot be captured solely through measures of socioeconomic status or context. Any true understanding of the impact of race, race relations, and social outcomes, including disparities in teen sexual and reproductive, requires a structural theory of racism (East & Jacobson, 2001). There are many individual, social, and cultural determinants that affect teen pregnancy in the rapidly growing U.S. Hispanic population. Some of these determinants such as personal attitudes towards the use of contraception, and choosing a good partner are under a teen’s control. Hispanic teens that have high self-esteems along with positive attitudes towards the use to contraception have lower risks of pregnancy. The partners of Hispanic teens who support the use of contraception and openly communicate about sex within the relationships also reduce the risk of pregnancy. Other determinants such as culture, and socioeconomics are not under individual control. (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009) (Goodyear & Newcomb, 2002). Aspects of Hispanic culture such as getting married early and starting a family without progressing education, lead to higher risk of pregnancy (Russle & Lee, 2004). Having parents who are educated and communicate with teens about the use of contraception and the risk of pregnancy, helps to combat some of the cultural expectations (Madan, Palaniappan, Urizar, Fortmann, & Gould, 2006). Conversely to cultural determinants that increase the risk of pregnancy are those that serve as protective determinants and reduce the risk. Having strong religious values and being able to speak English reduces the risk of pregnancy (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). Teens who grow up in poor communities that lack access to healthcare and education have an increased risk of pregnancy (Waddell, Orr, Sackoff, & Santelli, 2010). Parents play a very important role in the Hispanic culture (Zsembik& Fennell, 2005). Teens claim that parents are their primary source of information when it comes to dealing with sex and pregnancy (Ryan, Franzetta, & Manlove, 2005). Though the Hispanic culture places a taboo on the topic of sex, parents who have a higher level of education tend to discuss sex more openly with their teenage children compared to parents who have less education (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). This allows parents the opportunity to communicate the risks of teen pregnancy and the use of contraception in its prevention. Many parents of Hispanic teens work multiple jobs and do not have the time to talk about sex and pregnancy prevention (Zsembik & Fennell, 2005). In addition to communication with parents, the time a teen spends in the United States also plays an important role in pregnancy risk. The term acculturation can be used to describe the “exposure and adaptation to the U.S. culture such as birthplace, number or years in the U.S. and the use of the English language spoken at home (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009, p. 195).” Dhelendorf states that teens, who have entered the U.S. at an earlier age and have resided longer, tend to have increased levels of sexual activity compared to teens that come at a later age (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). This may be due to the exposure of the high frequency of sex being portrayed in U.S. media and culture (Dehlendorf, Marchi, Vittinghoff, &Braveman, 2009). In addition to time spent in the U.S., language spoken at home affects the risk of teen pregnancy for Hispanics (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). Those who spoke only Spanish at home were more likely to engage in early sexual activity compared to those who spoke English at home (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). Teens who spoke a combination of English and Spanish at home had the lowest levels of sexual activity (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). The ability to speak English acts as a protective determinant on teen pregnancy, and may open up more opportunities to obtain education about the topic (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). For example, by being able to speak English, Hispanic teens are able to communicate with healthcare professionals who design teen pregnancy prevention programs (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009). This would allow teens to have resources such as contraception along with the education to use them (Dehlendorf, Marchi, Vittinghoff, & Braveman, 2009).

IV. Problem Definition
a. Statement of the Problem
While teen pregnancy rates around the country are dropping, they remain frustratingly stable in the Hispanic community. The birth rate among teenagers in the U.S. ranks highest, compared to other industrialized nations. Living in poverty increases a teen’s risk of becoming pregnant before the age of 19. States with the highest economic inequality have the highest incidence of teen pregnancy, as do states with abstinence-only sexual education programs. While teen pregnancy rates have been steadily declining since the 1990s, birth rates among African American and Latina teens have remained stable. In fact, 44 percent of Latina teens become pregnant before reaching the age of 20, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. Young Hispanic women are more than twice as likely to have a baby as teenagers, when compared to the entire U.S. population (Hoffman, 2006).
Teen pregnancy has large economic impacts on society. It is estimated the children born to teenage mothers cost U.S. federal, state, and local taxpayers approximately $10.9 billion in 2008 (Lavin & Cox, 2012). “Between 1991 and 2004, there were 6,776,230 births to teenage mothers which cost tax payers $161 billion (p. 7) (Hoffman, 2006).” The majority of these costs were paid through welfare, Medicaid, and foster care for the infants (Azar, 2012). This has led to increased costs of healthcare and other public services. In 2004, the U. S. spent $11.6 billion putting approximately 532,000 children of teen mothers in foster care and adoption services (Hoffman, 2006). Teens who get pregnant and the children who are born to teenage mothers have many educational problems. Only half of the teens that get pregnant obtain a high school diploma or GED (Azar, 2012). Out of the teens that do complete a high school education, only 30% are likely to get a college level education (Basch, 2011). The children who are born to teen mothers have many learning problems. They are more likely to be placed in special education classes and have far greater learning disabilities than children born to older mothers (Gueorguieva, Carter, Ariet, Roth, Mahan, & Resnick, 2001). In addition to learning disabilities, children born to teens also have a more difficult time making friends at school and participating in after school activities (Waddell, Orr, Sackoff, & Santelli, 2010). Teenage mothers also give birth to children who have a larger risk for health problems such as lower birth weights, and reach developmental milestones slower (Gueorguieva, Carter, Ariet, Roth, Mahan, & Resnick, 2001). These children are also less likely to see the doctor to be treated for health problems (Hoffman, 2006).
The problem of teen pregnancy is cyclic in nature because children born to teen mothers are 66% more likely to become teen mothers themselves (Basch, 2011). Working towards reducing teen pregnancy rates will lead to a more educated workforce, less tax burden on payers, and healthier lives for teens and children.
According to, The National Center for Health Statistics, Centers for Disease Control and Prevention, Race and socioeconomic issues play a role in the wide variation between racial groups in adolescent pregnancy rates. Latina teens have experienced the smallest decline in teen pregnancy and birth rates during the past few decades; they currently have the highest teen birth rate of any racial/ethnic group. When the teen pregnancy rate of women ages 15 to 19 plummeted across the nation between 1990 and 2002, there was a 40 percent decrease for African-American teenagers and a 34 percent decrease for white teenagers, but only a 19 percent dip for Hispanic teenagers (NCHS, 2008).
The recent increase in teen pregnancy and birth rates in 2006 indicated that African-American teens were 2.4 times more likely and Hispanics were 3.3 times more likely than their white peers to become teen parents. Research suggests that current teen pregnancy prevention programming generally is not culturally sensitive, and that Latina teens are over-represented in the recent increase in the teen birth rate because they are not benefiting from current prevention programs (Wilkinson, Lee & Russell, 2006).
b. Key Stakeholders We are mindful of the fact that addressing teenage pregnancy is not a challenge facing only one department. Addressing teenage pregnancy is a battle that requires the active involvement of all stakeholders, if it is to be well fought. These stakeholders include other government departments, key organizations in the non-governmental sector; the research community, the religious sector, community leaders and more importantly, parents and the learner’s themselves. It is for this reason that we invite all stakeholders to engage with the presentations today, and draw from it that which can assist them to respond better to the challenges in their respective schools and sectors (Constantine, 2007).
According to National Sexuality Education Standards, in December 2008, a group of nearly 40 stakeholders—including health education experts, medical and public health professionals, teachers, advocates, sex educators and young people—gathered to discuss the future of sex education. At that time, social conservatives were on the defensive against a wealth of evidence that the abstinence-only educational approach is not effective in preventing teen sexual activity, and Congress was beginning to question federal funding for programs embodying this rigid approach. With the election of President Obama, sex education experts were hopeful that the end of federal funding for abstinence-only programs was near, and they began to envision a time when schools would be willing and able to implement more comprehensive sex education. At the end of a two-day meeting, the group concluded that parents, teachers and schools needed guidance on the minimum, core elements for sex education in schools. Subsequently, a partnership of the nation’s leading school health education organizations was formed to provide a framework for instruction and student assessment (NSES, 2012).
One justification they have frequently heard for the omission of key aspects of the mandated comprehensive sex education is fear of community opposition, together with the belief that state and national surveys showing high levels of support are not applicable to a district’s unique community. This justification is consistent with concerns and beliefs reported by community stakeholders, including parents and health and education professionals. In a series of focus group interviews, these stakeholders overwhelmingly supported comprehensive sex education, yet most participants reported feeling intimidated by actual or anticipated challenges involved in bringing such education to their school districts (Constantine, 2007).
c. Impact of the Problem Teen pregnancy has effects that can differ widely depending on a teen’s situation. The effects for a married teen with a wanted pregnancy will be dramatically different than for an unmarried teen with an unexpected pregnancy. Other factors, such as family support, health issues, and economic circumstances can all make the effects of a difficult teen pregnancy worse or mitigate them. The most immediate effects of teen pregnancy are the physical changes to the teen’s body, which begin to take place even before she is aware she is pregnant, and in the case of an unplanned pregnancy, possibly many months before she realizes or acknowledges that she is pregnant. Once the pregnancy is identified, the teen may be overjoyed, on the one hand, or depressed, bitter, angry, scared, or suicidal, on the other hand. She may fear people’s reactions—including those of the baby’s father and her parents—fear childbirth itself, and fear for her future. In some cases, she may not even know who the baby’s father is, creating a situation that would be complicated and distressing for anyone, let alone a teen. If the teen did not mean to get pregnant, she may face challenging decisions about abortion, adoption, raising a child, and her education. Even a girl whose family and religious community is anti-abortion is likely to face the question of abortion from the school nurse or other health care providers, friends, neighbors, etc. She may also face pressure in various directions from those with differing opinions, about which they feel enormously strongly. For a young teen, this is likely to be the most complicated, loaded decision that she has ever dealt with, and she may feel completely overwhelmed with responsibility (http://www.pregnantteenhelp.org/).
Other difficult questions that may present themselves to the pregnant teen concern continuing (or not) her relationship with the baby’s father, and if so how: marriage? Friends? Co-parents with little else in common? What kind of support there might be if she did keep the baby both economically and childcare for her to finish high school is another consideration, and if she planned to continue her education after college, that looms as well. Of all pregnant women, teens are the most likely to receive inadequate prenatal care. In some cases, this may occur because the teen doesn’t realize she’s pregnant, but it can also result from trying to hide the pregnancy. By missing prenatal care, a teen not only misses the vitamins that contribute to her health as well as the unborn child’s, but also the screenings, nutritional advice, and information about mitigating morning sickness and other side effects of pregnancy that might be very welcome as well as contribute to better health for both mother and baby (http://www.pregnantteenhelp.org/).
Pregnant teens are more at risk for pregnancy-induced hypertension (elevated blood pressure) and preeclampsia (high blood pressure accompanied by fluid retention: a potentially dangerous condition) than older women who are pregnant. Anemia and depression are also common side effects. Pregnant teens are more likely to have premature babies, born at less than 37 weeks gestation, and this in itself means their babies have an increased risk for a variety of health-related problems. All babies of pregnant teens are more likely to have a low birth weight, and preemies are additionally more likely to have developmental problems with their respiratory and digestive systems, as well as issues in the areas of vision and cognition. Following the birth of the baby, teens are at greater risk for post-partum depression than older women (http://www.pregnantteenhelp.org/). The effects of teen pregnancy can carry into the future as the teen settles into motherhood and finds fulfillment in raising her child and her other activities and relationships. It can also carry into the future in less happy ways. Teen pregnancy statistics provide the following information:
• two-thirds of teen mothers fail to complete a high school diploma
• teen fathers generally end up with less total schooling that men who become fathers later in life
• children of teens are at greater risk for poor school performance and
• girls born to teen parents are at increased risk for becoming teen mothers. (http://www.pregnantteenhelp.org/).
V. Alternatives Solutions/Policies
a. List Alternatives
The first Alternative is to teach abstinence. Abstinence is the only 100 percent effective method of birth control. It is also important that teens understand the importance of using birth control if they choose to become sexually active. Teens are often more embarrassed to talk to their parents about birth control than they are afraid of having unprotected sex. School health programs can provide teens with general information on birth control methods but parents need to educate teens on the importance of waiting to have sex until they are ready and being responsible enough to use protection. Abstinence from sex (oral, anal or vaginal) is the only behavior that is 100 percent effective at preventing teenage pregnancy. In fact, the National Campaign stresses that abstinence from sex is the best choice for teens as it avoids early pregnancy, parenthood and sexually transmitted infections (STI’s). Planned Parenthood reminds teens that remaining abstinent is a behavior choice and it can be difficult for some people (Khouzam, 2005).
Congress should send a strong abstinence message coupled with education about contraception. Surveys of both adults and teens reveal strong support for abstinence as the preferred standard of behavior for school-age youth, and they want teens to hear this message. At the same time, a majority is in favor of making birth control services and information available to teens who are sexually active. In addition, few expect all unmarried adults in their twenties to abstain from sex until marriage. And since a large proportion of non-marital births occurs in this age group, and a significant number of teens continue to be sexually active, education about and access to reproductive health services remains important through Title X of the Public Health Service Act, the Medicaid program, and other federal and state programs (Khouzam, 2005).
The Second Alternative, Encourage parent-child relationships. Parents can help prevent teen pregnancy by being involved in their teens ' lives and maintaining a close and open relationship. Teenagers who have close relationships with their parents are less likely to become sexually active in their early teenage years. As a parent, be open with your teenagers about your own personal morals and values about sex. The National Campaign to Prevent Teen and Unplanned Pregnancy encourages parents to know where their teens are and what they are doing, to get to know their teens ' friends and their families, and to talk to their teens often about sex. Teens should be encouraged to value their education and personal hobbies and should be taught to recognize future possibilities. Enroll your teen in a sexual education class and talk to her about what was learned. Be open about contraceptives. Communicate about consequences of sex including pregnancy, parenthood and sexually transmitted diseases. Talk confidently, but avoid lecturing (Snyder 2000).
The third alternative besides abstinence, using contraception during sexual intercourse can also prevent teenage pregnancy. Whether using barrier or hormonal methods, contraception can help to avoid pregnancy. StayTeen.org reports that one-third of teenage girls did not use any form of contraception the last time they had sex and 52 percent of sexually active teens reported a primary reason for not using contraceptives is because their partners did not want to. Educating teens about contraceptive methods may help to change attitudes and behaviors toward safer sex practices (Lippman, 2005).
Contraception means prevention. The purpose is to prevent pregnancy, so it is important to know the specific method security. Also, because an important part of a good sex life is to use contraception so that sexual diseases and unwanted pregnancies are avoided. Several of the most widely used contraceptives are very safe, adjacent to 100 percent safe. The pill is the most widely used contraceptive in Europe and the vaginal contraceptive ring the latest offering in contraception. Condoms for men, the only form of contraception that protects against both pregnancy and sexually transmitted diseases, STD’s (Lippman, 2005).
b. Comparison of Alternatives Teen pregnancy is a concerning issue for all members of society. According to the The Guttmacher Institute, and the data published in 2010, 750,000 women younger than 20 became pregnant in 2006, the year with the most-recently released statistics. This translates to 71.5 pregnancies per 1,000 women aged 15 to 19, meaning approximately 7 percent of teens that age became pregnant. When a teen pregnancy occurs, the young woman is faced with a decision as how to proceed with the pregnancy and after the birth. The three choices available to a pregnant teen are to have an abortion and terminate the pregnancy, carry the baby to term and place the child for adoption or parent the child as a teen mother (Guttmacher Institute, 2009). Abortion is legal in the United States, although not all areas have an abortion provider available. As of 2010, 34 states have parental consent laws, meaning that a minor seeking an abortion must notify her parents. Parent consent laws, availability and cost are the greatest barriers a teen faces to obtaining an abortion (Singh, Prada & Kestler, 2006). Abortion is an issue in which many people don’t agree with based on the fact that many people as if it is like killing a human life, which technically it is. Nevertheless, it is an available option for teens who feel that that is the way they would like to deal with the situation. The process for abortion is heart-breaking but many girls still go through with it despite all of this. There are two possible ways for this, the abortion pill and the in-clinic abortion (Singh, Prada&Kestler, 2006).
Abortion is much more common than people think. 1 in 3 women in the U.S. get an abortion before the age of 45 according to Planned Parenthood. Abortion serves as a way to get rid of the baby before it develops more into full growth inside the mother’s womb. Women of all ages chose this procedure for different reasons but being a teen mom isn’t something that teens look for so they go with abortion. This happens all over the U.S. even though in some states there needs to be parental consent for those younger than 18 years old(Singh, Prada & Kestler, 2006).
The Centers for Disease Control and Prevention reports that in 2006, 27 percent of pregnancies among girls aged 15 to 19 ended in abortion. In the case of Roe v. Wade, 1973, the Supreme Court confirmed women 's right to choose to terminate an unwanted pregnancy. Since then, courts have upheld this decision. However, the decision to have an abortion is extremely personal (CODC, 2007).
Adoption is the least-prevalent option among pregnant teens. Research shows that only 1 to 2 percent of women place their children for adoption, and that the number of teens who place their babies for adoption has declined sharply over recent decades. A decreased social stigma regarding teen pregnancy leads fewer women to place their child for adoption and, instead, to keep the baby. For those mothers who choose to place their child for adoption, several options are available, including open adoption, closed adoption and being able to select and meet the adoptive parents. Some girls dealing with teen pregnancy choose to place their baby up for adoption. There are a number of reasons for which a pregnant teen may choose adoption. She may want to continue her education. She may not be financially stable or she may be lacking support. In addition to these reasons, some teens who are pregnant simply feel that adoption is a better option for their baby in the long term (Ibid, & Resnick, 2003).
When it comes to adoption, there are many options to consider. You can choose between an open and closed adoption. What this means is choosing between having contact with a baby 's adoptive parents, or not having contact. Contact means that someone can have regular updates on their baby as he or she grows. In addition to this, a woman can choose to work with an adoption agency that finds and screens couples and seek couples to adopt babies independently (Ibid, & Resnick 2003).
Over half of teen pregnancies end with the woman choosing to deliver and rear the child. Teen mothers are less likely to complete high school or college than women who delayed having children, and less than one-third of teen mothers compete high school. The Gladney Center for Adoption reports that 80 perfect of teen mothers receive welfare at some point. Approximately 25 percent of teen mothers have another child within two years of their first birth (Redelmeier, Rozin & Kahneman, 2004). Being raised by a teen parent has consequences for the child as well.
Research shows that babies born to teen mothers are more likely to be born underweight than babies born to mothers over age 20; 7 percent of pregnant teens receive no prenatal care. Teen pregnancy often creates a cycle of poverty, crime and further teen pregnancy. Research has shown that sons of teen mothers are 2.7 times more likely to go to prison than sons of women that had children after the age of 20, as well as children of teenage mothers are twice as likely to be abused and neglected as children born to women over the age of 20(Redelmeier, Rozin & Kahneman,
2004).

c. Constraints
Hundreds of not-for-profit teenage pregnancy prevention and comprehensive sex education programs across the U.S.
are facing budgetary constraints as a result of the economic downturn and reductions in public and private funding, which could threaten the ability of many centers to continue operations, the Wall Street Journal reports. According to the Journal, recessionary pressures are taking a toll on many centers despite prospects for government funding for comprehensive sex education that could be "the best in years." President Obama has indicated that he will likely make a "sharp break" with the policies of former President George W. Bush, under whom $1.3 billion in federal funds were appropriated for abstinence-only education programs. A blueprint for Obama 's proposed fiscal year 2010 budget suggests that teen pregnancy prevention funding will target programs that "stress the importance of abstinence while providing medically accurate and age-appropriate information to youth who have already become sexually active." White House spokesperson Reid Cherlin declined to comment on the administration 's specific budget proposals but said that Obama "is committed to reducing the number of unintended pregnancies in this country, and we are reviewing this issue as part of the budget process." Meanwhile, Congress is expected to consider legislation (S. 611, H.R. 1551), introduced in March by Sen. Frank Lautenberg (D-N.J.) and Rep. Barbara Lee (D-Calif.), that would provide
federal funds for comprehensive sex education in schools. However, even if Congress approves new funding, the money might take until late fall or next year to start reaching programs, the Journal reports. According to the Guttmacher Institute, comprehensive sex education programs, which provide information about both abstinence and contraception, currently do not have a dedicated federal funding stream (The National Partnership for Children & Families 2009). The Journal reports that many teen sex education programs are facing cuts from public and private funding sources all at the same time. The financial strains come at a time when teen birth rates are increasing and the number of HIV cases remains high, the Journal reports. In a recent report, the Centers for Disease Control and Prevention found that teen birth rates increased for the second year in a row in 2007, after a 14-year decline. Forrest Alton, executive director of the South Carolina Campaign to Prevent Teen Pregnancy, said "This is no time for an interruption in services." According to some advocates, the rise in teen birth rates could be attributed to a lack of funding for comprehensive sex education and family planning services, sexual content in the media or complacency resulting from earlier birth rate declines. Marcia Egbert -- senior program officer with the George Gund Foundation and chair of a group of public and private organizations operating sex education programs in public schools in Cleveland, Ohio -- said, "I 've never seen such a juxtaposition of opportunity and pain." According to the Journal, the Cleveland program 's budget was reduced by more than half this school year as a result of reductions in a state welfare block grant (The National Partnership for children &Families, 2009). The Journal also profiled the Denmark-Olar Teen Life Center in South Carolina, which provides sex education classes, "life skills" sessions and guidance on contraceptive use, mostly to black teens. The center recently lost a significant funding source when state budget cuts compelled South Carolina 's Department of Health and Human Services to narrow Medicaid reimbursement criteria. According to the Journal, the center now can bill Medicaid only for services provided to young people who are parents, sexually active or fit other medical criteria. Coretta Jamison, who has worked at the center for 17 years, said the Medicaid changes reduced the number of billings to the point that the center cannot sustain itself, despite its other grants. She added that although the local school board will provide some funds for the center during the school year, future funding sources remain unclear (The National Partnership for children & Families, 2009).
Public health insurance programs in 2008 spent $12.5 billion on births resulting from unintended pregnancies, but that figure would have doubled -- exceeding $25 billion -- without publicly funded programs that provide family planning services, according to a new study from the Guttmacher Institute (National Partnership for children & Families, 2009).
The study underscores the importance of Medicaid, the Children 's Health Insurance Program and Indian Health Service in ensuring that women can access maternity care, according to the study 's authors. The findings also demonstrate the contrast between public expenditures on births from unintended pregnancies and intended pregnancies. In total, 1.1 million of the two million publicly funded births in 2008 resulted from unintended pregnancies. By comparison, among the general population nationwide, about 1.7 million of 4.2 million births resulted from unintended pregnancies. Examining data from states and Washington, D.C., the researchers found that in 15 jurisdictions, public programs covered at least 70% of all births resulting from unintended pregnancies. Almost all of these states were in the South, where poverty levels are higher than other areas (National Partnership for children & Families, 2009).
VI. Recommendations
a. Description “Cuidate!” is a teen sexual risk reduction program designed by Dr. Antonia M. Villarruel from the University Of Michigan School Of Nursing. The program is designed to reduce the risk of teen pregnancy, HIV, and STIs among Hispanic teens. “Cuidate!” features an interactive format, which includes group discussions about sexual health, videos about teen pregnancy, and role-playing possible real life scenarios. The program is administered through six one-hour sessions in consecutive days over the course of a year in either Spanish or English (Villarruel, Jemmott,& Jemmot, 2005). “Cuidate!” was specifically designed for Spanish speaking Hispanic adolescents ages 13-19. The program is designed for teens that attend urban high schools across the United States. “Cuidate!” was first implemented across high schools in northern Philadelphia (Villarruel, Jemmott,& Jemmot, 2005). “Cuidate!” uses components of Social Learning Theory and Theory of Planned Behavior to change attitudes, beliefs, and self-efficacy in order to increase abstinence and condom use among Hispanic teens. In addition it targets Hispanic cultural components such as role of family, and gender expectations to reduce cultural barriers to safe sex. Lastly it seeks to emphasize cultural values that reinforce safe sex practices (Villarruel, Jemmott,& Jemmot, 2005). “Safer Choices” is a school wide sex education and teen pregnancy prevention program designed by ETR Associates, a non-profit organization in California. The program was administered in high schools in the southwest United States, predominantly Texas and California. It is given in 20 sessions, each consisting of a single class period administered during 2 years. Each of the sessions uses activities that build communication skills and improve attitudes and expectations about abstinence and condom use. In addition, sessions help teens learn how to say no to unprotected sex or any other unwanted sexual experience. This program also involves the parents of teens by giving parent/student homework assignments. Lastly, the program provides information about community resources regarding sexual health to both teens and parents (Advocates for Youth, 2005).
The “Safer Choices” program is designed for students in the 9th and 10th grades who attend school in urban and suburban communities. The program is also targeted towards many racial groups such as Hispanic, Black, and Asian teens. Lastly, the program targets teens that are both sexually experienced or not experienced (Advocates for Youth, 2005).
The “Safer Choices” program uses components of Social Cognitive Theory, Theory of Social Influences, and Models of Social Change, to add positive views and expectations regarding abstinence, condom use, and potential obstacles to contraception use (Advocates for Youth, 2005).
The Children’s Aid Society Carrera Program is a community based holistic youth teen pregnancy prevention program that was created by Dr. Michael A. Carrera. The “Carrera Program” consists of everyday after school activities 5 days a week that last 3-5 hours. These activities consist of comprehensive abstinence and contraceptive sex education, career exploration, and academic tutoring. Participants also attend art workshops and sports activities. These students were broken up into groups and rotated through the various activities throughout the week. The program also provides free access to mental, dental, and reproductive healthcare along with family involvement. The program consists of 6 major components which include staff treating participants like family, reinforcing positive skills of each participant, providing individual case management, continued long term contact with participants, parent and family involvement, while administering everything from a single facility. Participants also learn how to be responsible adults by obtaining personal financial management skills, positive career awareness, and employment experience. The academic tutoring component consists of SAT preparation, and assistance with college applications. The “Carrera Program” targets socio economically disadvantaged youth in New York City. These youth primarily consist of Hispanic women ages 13-15 (The Children 's Aid Society, 2006). The “Carrera Program” does not use a direct theoretical model to prevent teen pregnancy, but instead utilizes a holistic approach by empowering teens with real life physical, social, and financial skills to become functioning members of society. Along with sex education and access to comprehensive healthcare, these teens are shown that they can obtain a higher education while maintaining a healthy lifestyle (The Children 's Aid Society, 2006).
b. Rationale According to Sara Elkins of Newsweek, though teen pregnancy rates are declining generally, they remain stubbornly high for Latinas and blacks. According to the National Campaign to Prevent Teen Pregnancy, 51 percent of Latina teens become pregnant at least once before reaching 20—a full 20 points higher than the national average. While that figure is still lower than the 58-percent rate for African-Americans, it 's declining at a considerably slower pace: teen pregnancy rates decreased 29 percent for blacks and whites in the 1990s, compared to just 19 percent for Latinas. Part of the reason: current educational programs aimed at the Hispanic community are failing to connect culturally, say Bill Albert and Ruthie Flores of the National Campaign 's Latino Initiative (Elkins p.3). The appropriate type of sex education that should be taught in U.S. public schools continues to be a major topic of debate, which is motivated by the high teen pregnancy and birth rates in the U.S., compared to other developed countries. Much of this debate has centered on whether abstinence-only versus comprehensive sex education should be taught in public schools. Some argue that sex education that covers safe sexual practices, such as condom use, sends a mixed message to students and promotes sexual activity. This view has been supported by the US government, which promotes abstinence-only initiatives through the Adolescent Family Life Act (AFLA), Community-Based Abstinence Education (CBAE) and Title V, Section 510 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (welfare reform), among others (Advocates for Youth, 2007). Funding for abstinence-only programs in 2006 and 2007 was $176 million annually (before matching state funds). The central message of these programs is to delay sexual activity until marriage, and under the federal funding regulations most of these programs cannot include information about contraception or safer-sex practices
(Santelli , Ott , Lyons, Rogers, & Summers, 2006) . The federal funding for abstinence-only education expired on June 30, 2009, and no funds were allocated for the FY 2010 budget. Instead, a “Labor-Health and Human Services, Education and Other Agencies” appropriations bill including a total of $114 million for a new evidence-based Teen Pregnancy Prevention Initiative for FY 2010 was signed into law in December 2009. This constitutes the first large-scale federal investment dedicated to preventing teen pregnancy through research- and evidence-based efforts. However, despite accumulating evidence that abstinence-only programs are ineffective (Trenholm, Devaney, Fortson, Quay, & Wheeler, 2007). The abstinence-only funding (including Title V funding) was restored on September 29, 2009, for 2010 and beyond, by including $250 million of mandatory abstinence-only funding over 5 years as part of an amendment to the Senate Finance Committee 's health-reform legislation (HR 3590, Amendment #2786, section 2954). This was authorized by the legislature on March 23, 2010 (Kirby, 2007).
c. Implementation
Though each of the programs mentioned about shows evidence in preventing teen pregnancy, an ideal teen pregnancy prevention program for the Hispanic population in the United States would use components of the “Carrera Program” and the “Cuidate!” program. Although the “Safer Choices” program targets multi ethnic youth, it is not designed specifically for the Hispanic population, nor does it address Hispanic cultural components like the “Cuidate!” program does. Furthermore, “Safer Choices” only teaches sex education and communication skills and does not look at other factors that may lead to teen pregnancy. On the other hand, the “Carrera Program” looks to address multiple factors that may lead to teen pregnancy besides lack of sex education. These factors include lack of financial resources and inadequate access to healthcare. With a combination of the “Cuidate!” and “Carrera” programs, Hispanic teens would be able to obtain sex education designed specifically for their culture, access to healthcare, access to employment, and financial management skills. These two programs focus on addressing the major cultural and social determinants of teen pregnancy in the U.S. Hispanic population (Advocates for Youth, 2005).
d. Evaluation
A randomized control/ treatment evaluation of 553 Hispanic teens was conducted to show results of the program. The treatment group consisted of 263 teens that participated in “Cuidate!”, while the control group consisted of 287 teens that did not participate. These teens were evaluated using surveys at 3 months, 6 months, and 12 months after the program was administered. The program reduced the frequency of sexual intercourse among its participants. In the treatment group, 26%, 28%, and 36% of teens reported they had sexual intercourse after 3, 6, and 12-month evaluations respectively. In the control group, 31%, 33%, and 41% reported they had sexual intercourse after 3, 6, and 12-month evaluations respectively. The program also led to an increase in condom use among its participants. In the treatment group 43%, 45%, and 42% of Hispanic teens reported that they used a condom during the last time they had sex in 3, 6, and 12-month evaluations respectively. In the control group 26%, 29%, and 28% reported using a condom during the last time they had sex in the 3, 6, and 12-month evaluations respectively. Lastly, the program showed a reduction in the number of sexual partners within Hispanic teens. After the 6-month evaluation, 9% of the treatment group teens and 10% of control group teens reported having multiple partners. At the 12-month evaluation, 8% of treatment group teens and 17% of control group teens reported having multiple partners (Villarruel, Jemmott,& Jemmot, 2005).
The “Safer Choices” program was evaluated by administering surveys across 20 high schools in California and Texas. In each state respectively, 5 high schools used the “Safer Choices” program while 5 used a normal state sex education curriculum. The surveys were administered after a 31-month period of receiving either program. The treatment group consisted of the teens that received the “Safer Choices” program, while the control group consisted of teens that received the state sex education curriculum. There were 3,869 9th and 10th grade students who completed the survey. Out of these students, 50% were male. The races of the students included 29% White, 29% Hispanic, 20% Black, and 14% Asian. After the 31-month follow up, those who participated in the “Safer Choices” program reported an increase of knowledge regarding sex compared to those who participated in the state curriculum. In addition, those who participated in “Safer Choices” reported an increase in positive attitudes and greater self-efficacy towards condoms. The participants also reported having few barriers to condom use and a higher perceived risk of unprotected sex. These participants were also 1.76 times more likely to use an effective form of contraception and delay the initiation of sex compared to the control group (Advocates for Youth, 2005). The “Carrera Program” was evaluated by using surveys administered to students who participated in the “Carrera Program” and those who did not participate after a 3-year follow-up. The surveys were given to 600 students of which 484 responded. Of those who responded, 50% were male. The respondents were 54% black and 46% Hispanic. There was a 22% increase in knowledge regarding sex among the participants of the “Carrera Program” compared to an 11% increase in the control group. In addition, 75% of the participants reported that they had an increased resistance to sex compared to 36% of the control group. Lastly, 36% of the participants reported an increased use of contraception during their last sexual experience compared to 26% in the control group (The Children 's Aid Society, 2006).

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VIII. Appendices
Teen Pregnancy Graphics Data Descriptions
About Teen Pregnancy 2011: Data Points Line chart of birth rates (live births) per 1,000 females aged 15–19 years for all races and Hispanic ethnicity in the United States, 2000–2011.

Source: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National Vital Statistics Reports. 2011; 60 (2): Table S-2.
*Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2011. National Vital Statistics Reports. 2012; 61 (5). Table 2.

Teenage birth rates for 15 – 19 year olds by state, 2011

Source: Martin, J. A., Hamilton, B. E., Ventura, S. J., & Osterman, M. J. K. (2013). Births: Final data for 2011. Hyattsville, MD: National Center for Health Statistics.