Comprehensive clinic-based programs for pregnant & parenting teens
Comprehensive clinic-based programs address the complex needs of pregnant or parenting teens. Programs include health care, contraceptive and family planning services, and help meet non-clinical needs through case management, counseling, social support, and connections to social services. Services are generally provided by medical teams in partnership with social workers. Programs are usually geared toward preventing rapid repeat pregnancy (i.e., a second pregnancy within 12-24 months)1. Teenage childbearing poses economic, social, and medical risks to mothers and their infants; risks are magnified by repeat pregnancies during adolescence2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced teen pregnancy
Reduced rapid repeat pregnancies
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased vaccination
Increased use of contraception
Increased condom use
What does the research say about effectiveness?
There is strong evidence that comprehensive clinic-based programs that support pregnant and parenting teens reduce rapid repeat pregnancies among participants3.
Comprehensive programs based in large urban hospital and clinic facilities with multi-disciplinary teams have been shown to reduce repeat pregnancies among adolescent mothers who are Black or have low incomes, through 18 months postpartum3, 4. Such programs may increase use of contraception and condoms at 12 months postpartum5, and reduce repeat pregnancy at 24 months for teen mothers who are Black and have low incomes6. Integrating a parenting and life skills intervention into existing comprehensive programs may increase maternal self-esteem and reduce repeat pregnancy through 36 months postpartum7. Such programs also appear to promote clinic attendance and increase immunizations for infants4.
Programs may more effectively reduce repeat pregnancy when they enroll teen parents earlier, during pregnancy or within 6 months of the birth, and may have greater impacts for participants who are 16 to 17 years old than for those who are 188. Participants who choose to use long-acting reversible contraception (LARCs) appear least likely to become pregnant again9.
More comprehensive programs may have stronger impacts1. Integrated clinical and social services, combined mother and infant care, contraceptive education2 and services10, non-clinical activities such mentoring and goal setting to build planning skills10, and a multi-disciplinary, youth-oriented approach all appear to increase program effectiveness. Providing easy access to services and reaching teen parents at antenatal and postnatal consultations for their first pregnancy may also increase program effectiveness2.
Experts suggest programs to prevent repeat births among teens should comprehensively address both health care and social needs, including educating providers and parenting teens on the full range of contraceptives, to increase the use of effective postpartum contraception11. Not all repeat births among teens are unintended, and experts recommend that providers and program planners must work to understand context and motivations and ensure pregnant and parenting teens are in control of decision making12.
How could this strategy advance health equity? This strategy is rated potential to increase disparities: suggested by intervention design.
Comprehensive clinic-based programs have the potential to decrease disparities in rapid repeat birth rates between teenage parents who are from systematically disadvantaged backgrounds, including those who are Black, low income, or from rural areas, and those who are from more advantaged backgrounds based on the intervention design.
Approximately 1 in 6 births to 15 to 19-year-olds are repeat births14. While the rate of repeat births among teens decreased from 2004 to 201511, rates of repeat pregnancy are higher among teens from low income or minoritized populations1, with higher rates of repeat births in rural counties than in urban ones15. Rates also vary by state1, 11, along with effective postpartum contraceptive use1. Available evidence suggests some programs may not be as effective for adolescents from lower income backgrounds as for those from higher income backgrounds3.
Pregnancy rates are also higher among teens in foster care16 and among teens with special needs17. Programs often underserve these populations, with multiple barriers to service use. A study among pregnant and parenting teens with foster experience suggests the need for navigation services, information and data sharing across systems and programs, and increased diversity in the workforce, whose members should be trained on both diverse communities and implicit bias against teen parents18, 19. Teen parents from minoritized groups may also have trouble trusting providers, due to past efforts by institutions to reduce or eliminate births in those populations, as well as perceived stigmatization and judgement based on stereotypes around teen pregnancies and births20.
Research should better address the changing context of adolescent pregnancy and births, including availability of highly effective contraceptives in the form of LARCs, Medicaid expansion and insurance changes increasing access to birth control, and shifting abortion policies. While increased availability and increased effectiveness of contraceptives have the potential to reduce repeat pregnancy and birth among teens, abortion restrictions could increase these rates8.
What is the relevant historical background?
Teenage pregnancy was not regarded as a major problem until the mid-1960s21, when early marriage rates began declining, particularly among teenagers who were Black or from other racially minoritized groups22, leading to an increase in out-of-wedlock births21. In the late 1970s, policymakers framed these teen birthrates as an “epidemic,” even though teen birth rates were in decline21. Programs for pregnant and parenting teens began emerging in the U.S. in the 1970s, to reduce taxpayer costs and improve maternal and child outcomes8, as young single mothers were viewed as a social problem, along with political concerns about rising welfare costs21.
Teen pregnancy rates have been declining in the U.S. since 1991 (CDC-Teen pregnancy) but are still higher than in other high-income countries. Racial and geographic disparities also exist within the U.S.23: pregnancy rates are three times higher among Black and Hispanic teens than whites in some states17, and birth rates remain higher for young women of color nationwide23, 24, 25, particularly in the South and Southwest25. Teen pregnancy rates among those who have been in foster care have also not declined at the same rate16.
Teen mothers today continue to experience disadvantages, often coming from backgrounds characterized by childhood adversity, including poverty, instability, violence, chronic stress, and trauma8. Adolescent mothers are more likely to suffer maternal complications26, drop out of school, have more limited job prospects, and live in poverty ((278, and repeat births can increase these disadvantages1. However, some experts suggest studies of teen parents’ poor outcomes do not account for the context of many teen parents’ lives, and that the same factors that increase the risk of teen pregnancy are largely responsible for these outcomes8.
Teen pregnancies are associated with higher rates of neonatal and infant mortality, with the highest rates among infants born to Black teens26. While the risk of infant mortality declined between 1996 and 2019 for most racialized groups and geographies, it has not changed significantly for infants born to teens who are Black or Hispanic in rural counties28. Teen pregnancies also have a higher risk of complications including preterm birth and low birthweight26. These risks are higher for infants born to teens who are already parents1, 28. Children born to teenage parents are also more likely to have academic and behavioral issues when they are older29.
Global initiatives, such as the United Nations’ Sustainable Development Goals, advocate for individuals to access their preferred contraceptive methods as part of their human rights. Such initiatives note the health and other related benefits, such as education and expanded opportunities for women, that come with access to comprehensive sexual and reproductive health services30.
Equity Considerations
- Where can adolescents in your community access the necessary knowledge and resources to prevent repeat pregnancy?
- How are existing programs trying to be culturally and linguistically appropriate, and inclusive of all gender identities and sexual orientations? Are there any systematic barriers to accessibility?
- Who can you partner with in the community to determine what type of programming may be useful and accepted?
- How do your programs address both clinical and non-clinical needs within your patient community?
Implementation Examples
The Healthy Generations program at Children’s National in Washington, D.C., integrates family-centered primary care, social work services, and regular mental health screenings13.
Implementation Resources
‡ Resources with a focus on equity.
MCH Journal-PAF - Harding JF, Zief S, Farb A, Margolis A, eds. Supporting expectant and parenting teens: The pregnancy assistance fund. Maternal and Child Health Journal. 2020;24(2 Suppl):S57-242.
Healthy Teen Network - Healthy Teen Network (HTN). Making a difference in the lives of teens and young families.
Footnotes
* Journal subscription may be required for access.
1 Frederiksen 2018 - Frederiksen BN, Rivera MI, Ahrens KA, et al. Clinic-based programs to prevent repeat teen pregnancy: A systematic review. American Journal of Preventive Medicine. 2018;55(5):736-746.
2 Rowlands 2010 - Rowlands S. Social predictors of repeat adolescent pregnancy and focused strategies. Best Practice & Research Clinical Obstetrics Gynecology. 2010;24(5):605-616.
3 Corcoran 2007 - Corcoran J, Pillai VK. Effectiveness of secondary pregnancy prevention programs: A meta-analysis. Research on Social Work Practice. 2007;17(1):5-18.
4 Akinbami 2001 - Akinbami LJ, Cheng TL, Kornfeld D. A review of teen-tot programs: Comprehensive clinical care for young parents and their children. Adolescence. 2001;36(142):381-393.
5 Lewin 2016 - Lewin A, Mitchell S, Beers L, Schmitz K, Boudreaux M. Improved contraceptive use among teen mothers in a patient-centered medical home. Journal of Adolescent Health. 2016;59(2):171-176.
6 Lewin 2019 - Lewin A, Mitchell SJ, Quinn DA, et al. A primary care intervention to prevent repeat pregnancy among teen mothers. American Journal of Preventive Medicine. 2019;56(3):404-410.
7 Cox 2019 - Cox JE, Harris SK, Conroy K, et al. A parenting and life skills intervention for teen mothers: A randomized controlled trial. Pediatrics. 2019;143(3):e20182303.
8 SmithBattle 2017 - SmithBattle L, Loman DG, Chantamit-o-pas C, Schneider JK. An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers. Journal of Adolescence. 2017;59(1):97-111.
9 Stevens-Simon 2001 - Stevens-Simon C, Kelly L, Kulick R. A village would be nice but... It takes a long-acting contraceptive to prevent repeat adolescent pregnancies. American Journal of Preventive Medicine. 2001;21(1):60-65.
10 Norton 2017 - Norton M, Chandra-Mouli V, Lane C. Interventions for preventing unintended, rapid repeat pregnancy among adolescents: A review of the evidence and lessons from high-quality evaluations. Global Health: Science and Practice. 2017;5(4):547-570.
11 CDC MMWR-Dee 2017 - Dee DL, Pazol K, Cox S, et al. Trends in repeat births and use of postpartum contraception among teens — United States, 2004–2015. Morbidity and Mortality Weekly Report (MMWR). 2017;66(16):422-426.
12 Whitaker 2016 - Whitaker R, Hendry M, Aslam R, et al. Intervention now to eliminate repeat unintended pregnancy in teenagers (INTERUPT): A systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement. Health Technology Assessment. 2016;20(16).
13 Healthy Generations - Healthy Generations Program. Children's National Hospital, Washington, D.C.
14 Margolis 2020 - Margolis A, Rice T, Banikya-Leaseburg M, et al. Meeting the multifaceted needs of expectant and parenting young families through the Pregnancy Assistance Fund. Maternal and Child Health Journal. 2020;24(Suppl 2):S76-S83.
15 CDC MMWR-Hamilton 2018 - Hamilton BE, Ely DM. Repeat birth rates for teens, by urbanization level of county — National Vital Statistics System, 2007–2016. Morbidity and Mortality Weekly Report (MMWR). 2018;67(35):998.
16 King 2022 - King B, Shpiegel S, Grinnell-Davis C, Smith R. The importance of resources and relationships: An introduction to the special issue on expectant and parenting youth in foster care. Child and Adolescent Social Work Journal. 2022;39(6):651-656.
17 Mathematica-Goesling 2020 - Goesling B, Wood RG. Promoting lasting, equitable change by reaching youth in need. Princeton: Mathematica Policy Research (MPR); 2020.
18 Villagrana 2023 - Villagrana KM, Carver AT, Holley LC, et al. 'You have to go hunting for information': Barriers to service utilization among expectant and parenting youth with experience in foster care. Child and Family Social Work. 2023;29(2):571-583.
19 Villagrana 2022 - Villagrana KM, Carver AT, Holley LC, et al. ‘You have to go hunting for information’: Barriers to service utilization among expectant and parenting youth with experience in foster care. Child and Family Social Work. 2023;29:571-583.
20 Hubel 2020 - Hubel GS, Moreland AD. What do adolescent parents need to prevent repeat pregnancy? A qualitative investigation. Vulnerable Children and Youth Studies. 2020;15(1):21-31.
21 Vinovskis 2003 - Vinovskis MA. Historical perspectives on adolescent pregnancy and education in the United States. The History of the Family. 2003;8(3):399-421
22 Furstenberg 2007 - Furstenberg FF. Chapter 1: The history of teenage childbearing as a social problem. In: Destinies of the Disadvantaged: The Politics of Teen Childbearing. New York: Russell Sage Foundation; 2007.
23 CDC-About teen pregnancy - Centers for Disease Control and Prevention (CDC). About teen pregnancy.
24 KFF-Hill 2022 - Hill L, Artiga S, Ranji U. Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. 2022.
25 Fuller 2018 - Fuller TR, White CP, Chu J, et al. Social determinants and teen pregnancy prevention: Exploring the role of nontraditional partnerships. Health Promotion Practice. 2018;19(1):23-30.
26 CDC-Woodall 2020 - Woodall AM, Driscoll AK. Racial and ethnic differences in mortality rate of infants born to teen mothers: United States, 2017-2018. Data Brief no. 3761. Centers of Disease Control and Prevention (CDC), National Center for Health Statistics. 2020.
27 Harding 2020 - Harding JF, Knab J, Zief S, Kelly K, McCallum D. A systematic review of programs to promote aspects of teen parents’ self-sufficiency: Supporting educational outcomes and healthy birth spacing. Maternal and Child Health Journal. 2020;24(Suppl 2):S84-S104.
28 Woodall 2023 - Woodall AM, Driscoll AK, Mirzazadeh A, Branum AM. Disparities in mortality trends for infants of teenagers: 1996 to 2019. Pediatrics. 2023;151(5):e2022060512.
29 Klerman 2004 - Klerman LV. Another chance: Preventing additional births to teen mothers. Washington, D.C.: The National Campaign to Prevent Teen Pregnancy. 2004:1-58.
30 WHO-SDG 3.7 - World Health Organization (WHO). The Global Health Observatory: SDG Target 3.7 Sexual and Reproductive Health.
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