Given this dramatic difference, it is time to examine the root causes of teen pregnancy. The evidence shows that the social condition in which a person is born, lives, works, and ages, is the single most important determinant of one’s health status. To create change, we must examine social determinants that impact people’s lives. I believe that reducing teen pregnancy in diverse populations requires that we examine the social context in which pregnancy among youth occurs.
In the United States, the most common approach to reducing teen births has been through individual behavior-change interventions, such as curricula offered in schools and through community programs and other settings. These programs generally include sex education, basic anatomy, and role-playing around relationship skills and skills such as negotiating condom use. But unfamiliarity with contraceptives does not adequately explain the disparity in teen birth rates between white and minority communities. So providing condoms and training won’t necessarily lead to a behavior change when there are deeper causes that result in ambivalence about avoiding pregnancy. Root causes vary from community to community, but there are some frequent themes: poverty, lack of education, lack of opportunity. My view is that, if you focus on individual behavior change alone, but then send a youth back to an environment that is not supportive or that offers few opportunities, permanent behavior change is not likely.
My team here at JSI is passionate about improving health outcomes through a broad examination of factors from the individual level through the interpersonal, the organizational, and the community levels, all the way to policy at a society-wide level. In public health, we call this the socio-ecological model. [see graphic] We are not alone in this viewpoint. The World Health Organization recognizes “growing health disparities in the U.S. and around the world and the need for strategies that address context.” (http://www.oecd.org/dataoecd/38/6/40278615.pdf)
Through a project funded by the CDC, we’ve been given the opportunity to demonstrate that the socio-ecologic model works to bridge the disparities that exist around teen pregnancy. Through this project, JSI is providing training and technical assistance to organizations in nine states. The organizations include non-profits and government agencies. JSI will be integrating into all components of this work an emphasis on addressing social determinants. We expect the initiative to demonstrate the effectiveness of innovative, multi-component, community-wide approaches in reducing teen pregnancies and births in communities with the highest rates, with a priority on reaching African-American and Latino and Latina youth aged 15 to 19. This is the first nationwide CDC initiative to focus on the social determinants of teen pregnancy.
We have visited each of the nine partner organizations to learn their perspectives on the social determinants behind the high teen-pregnancy rate. Some of the contributing factors these communities have identified are the high number of high school drop-outs, youth unemployment, gang activity, lack of sex education, lack of parenting skills, a cycle of the children of teen parents having babies, high rates of sexual abuse, and poverty. Many of these factors are, of course, interrelated.
Some social determinants are much too big for small community groups to tackle alone. While our partner organizations are generally supportive of the socio-ecological model, they may say to us: “We are not in the work of poverty prevention.” So the question becomes, “What is it that we can do that is realistic?” Our next step is to help our partners identify feasible steps they can take within their own communities.
Often we advise them to start by expanding their professional networks — to seek partnerships with local government agencies, schools, businesses, and non-profits. In this way, when an organization identifies an opportunity, it can work with a partner so they each contribute within their area of strength. For example, a community-based pregnancy-prevention program might work with a clinic and with the local transportation agency to ensure that youth who learn about the benefits of reproductive health services have a way to get to the clinic for these services. The pregnancy-prevention program would then continue to make connections in the community, and in this way build up capacity to address more complex issues.
This work is not for the faint of heart; it can be frustrating. We have to create political will. But we can’t turn our backs on communities that are struggling with this burden. Questions of the morality of such an approach aside, we cannot ignore the effect on the overall economy. As noted by the Organization for Economic Co-operation and Development: “Teenage births, along with other factors, are an important indicator of future opportunities for women to pursue education and of career prospects. Young mothers are more likely to drop out of education and work in low-paid jobs with long-term consequences on family welfare.”
It is clear that we must empower communities to find solutions to the root causes of high rates of teen pregnancy. We’ve been given a chance to prove it and we are moving ahead.
Myriam Hernandez-Jennings is the project director of the CDC-funded Teenage Pregnancy Prevention: Integrating Services, Programs and Strategies through Community-Wide Initiatives program and is coordinating and providing training and technical assistance to all national, state, and community partners under the program.