Confronting the impact of teen pregnancy in Mississippi: the need for after-school programs

Introduction

Teen pregnancy remains a public health and social problem that poses a substantial threat to the educational and economic future of affected teens and their families nationally, statewide, and locally. The teen pregnancy rate for the US in 2013 was 43% and Mississippi ranking third-highest (46th) with 58% along with Oklahoma and Texas, behind Arkansas (49) and New Mexico (50) affecting Hispanics and African Americans compared to other races and ethnicities [1]. Although, Mississippi’s teen pregnancy rates declined 45% between 1988 and 2013, racial/ethnic and geographic disparities still exist [1]. In 2013, non-Hispanic Black females ages 15–19 years accounted for 57.1% of all pregnancies in this age group, followed by Hispanic females (40.9%), and non-Hispanic White females (36%) [2]. According to geographic variation, Mississippi Public Health Districts, III, VI and, VII have the highest teen pregnancy rates which encompass the Delta Hills (68%), East Central (52.6%), and Southwest (55%) regions of the state [2]. It is important to note that while rates vary across the state, teen pregnancy rates in eight public health districts were higher than the national average.

According to the National Campaign to Prevent Teen and Unplanned Pregnancy (2015), the US teen birth rate (age 15–19 years) was 22%, while that of Mississippi was 34.8% (Table 1), ranking second-highest (48th) in the country along with Oklahoma and behind Arkansas (50) [1]. In Mississippi, Hispanic females ages 15–19 years had the highest birth rate (43.8%), followed by non-Hispanic Black females (41.9%), and non-Hispanic White females (28.5%) for the state in 2015 [1]. However, most teen births in Mississippi (71%) are to older teens (ages 18–19 years) [1]. In addition, 18% of all teen births were to teens who already had a child, with a cost of $137 million for teen childbearing accounting for increased public health care, child welfare, and lost tax revenue in 2010 [1].

Unintended pregnancies account for 62% of all pregnancies to teens, resulting in costs of $267 million [1], which include incarceration, food stamps, child care, and healthcare expenses. The latter include: Medicaid expenditures for prenatal care; women, infant, and children programs; temporary assistance for needy families; and children’s health insurance programs. In the absence of publicly funded family planning services, teen pregnancies would have been 73% higher than that at present [1]. It is apparent that there are many challenges in reducing teen pregnancy in Mississippi; such as, the lack of resources (time and public funding), administrative support, services for reproductive and sexual health, ineffective communication with decreased parental involvement and stigma, and poor evaluations of programs. Therefore, we propose that the introduction of after-school programs would have many beneficial effects in addition to lowering rates of teen pregnancy and sexually transmitted diseases (STDs). They could enhance educational attainment and the likelihood of high school and college completion, thereby raising employment prospects and rates. Teens who aspire to a promising educational future and career tend to delay sexual involvement, use contraceptives more consistently, and avoid unintended pregnancies or birth.

Previous studies have shown that after-school programs are associated with lower rates of exposure to violence, lower rates of teen pregnancy, and improved academic performance among youth [9], [10], [11]. Data from the National Longitudinal Study of Adolescent Health (Add Health), suggests that teens who delayed sexual intercourse tend to graduate from high school and perform better academically than their counterparts who were sexually active [12]. In addition, the dropout rate among teens who delayed sex before 18 was significantly lower (8.6%) when compared to 21% dropout rate among teens who engaged in sexual intercourse. In general, teens that are sexually active have a higher dropout rate than teens that were sexually inactive [12]. Add Health data estimated 15.8% of teens who delayed sexual activity would graduate from college when compared to 7.4% sexually active teens. Furthermore, the data revealed that 42.5% of teens who were not sexually active through high school would likely attend college as compared to 22.6% of teens who became sexually active before 18 were attending or had graduated from college [12].

Background

Trends in teen pregnancy rates reflect shifts in sexual behaviors and public policies that drive high teen birth rates among minority populations. Table 2 compares the percentages and distribution of adolescent sexual behavior among high school students in the US, in Mississippi and in New Hampshire. Mississippi had a substantially increased risk for teen pregnancy and STDs, with 33.8% of high school students reporting being currently sexually active compared to 11.5% nationwide [13]. In addition, 48.0% of Mississippi high school students reported ever having sex, 8.3% having sex before the age of 13 years, and 15.5% having sex with four or more sexual partners during their lifetime (Table 2) [13].

Due to the social and economic burden of teen pregnancy, the Mississippi State Legislature passed House Bill (HB) 999 in 2011, requiring public schools in the state and local districts to implement age-appropriate sex education curricula for middle and high school students. HB 999 requires schools to develop medically accurate “abstinence only” programs (i.e. teaching that abstaining from sexual activity is the only truly effective way to prevent unintended pregnancy) and “abstinence plus” (which focuses on delaying the initiation of sexual activity and recommends the use of contraceptives if a teen is sexually active), which are curriculum-based sex education programs [3].

Implications and recommendations

Given the factors of high “stimulus-seeking” activity in the teenage years, and the typical absence of adult supervision in the after-school hours, advocacy for teen pregnancy prevention should focus less on abstinence and sexual health-related programs and more on reducing opportunities for sexual activity via after-school programs. Such programs could serve to reduce risks of STDs, juvenile delinquency, and involvement in the criminal justice system as well as enhance school attainment and career opportunities [17]. The literature suggests that conservative policies on health and social problems in the US have not improved the general well-being of minority populations, but rather have obstructed the health of minority youth [16]. Certainly, there are limitations to the effectiveness of health education modalities that concentrate on promoting abstinence from sex among adolescents [18]. In conclusion, our review suggests that to reduce rates of teen pregnancy, the focus of public policy should be on developing well-supervised and high-quality after-school and summer programs for low-income children rather than on sex education alone. Such programs can be expected to have the effect of simultaneously addressing and reducing rates of teen pregnancy and STDs as well as increasing classroom success and educational attainment, and ultimately reducing social and health inequities in Mississippi and beyond [17].