<p>Perspectives on Adolescent Pregnancy Prevention Strategies in the United States: Looking Back, Looking Forward</p>

Abstract

Attempts to solve the "problem of adolescent pregnancy" have long been a focus of national, state, and local efforts in the United States. This review article summarizes trends and strategies around adolescent pregnancy prevention, provides lessons learned and best practices, and presents ideas for future directions. Over the past decades, a wide variety of policy and programmatic interventions have been implemented-including educational efforts, clinical health services, and community-wide coalitions-accompanied by a growing consensus regarding viable solutions. While notable reductions in adolescent pregnancy and childbearing have occurred across all sociodemographic groups, racial/ethnic, geographic, and socioeconomic disparities persist. Many adolescents who most need sexual health information and services are underserved by current programs and policies. A growing understanding of the role of social determinants of health, the impacts of structural racism, and the need for equity and inclusion must inform the next set of interventions and societal commitments to not only ameliorate the occurrence of unintended adolescent pregnancy but also foster healthy adolescent development. Recommendations for future efforts include improving the content, quality, and sustainability of education programs; actively engaging youth in the design of policies, programs, and clinical services; using technology thoughtfully to improve health literacy; expanding access to services through telehealth and other delivery options; and designing programs and policies that recognize and address structural racism, health equity, and inclusion.

Why are pediatricians uncomfortable with prescribing emergency contraception for adolescents?

“… 21 The public health system and medical professional associations should also promote continuing education for health professionals and the community since knowledge and access to EC prevent unplanned pregnancies. 22 , 25 Moreover, contraceptive counseling for adolescents is an essential skill for pediatricians. 13 Therefore, regional and national medical residency programs in pediatrics should emphasize this subject in the program.…”

“…Previous studies and systematic reviews did not find associations between EC and risky sexual behavior, such as increased frequency of unprotected sex or sexually transmitted infections. [24][25][26] One-third of participants avoided EC prescription due to fear of teratogenic effects, although this association was not observed in cohort studies. 10,27 Some respondents reported religious and moral reasons for not recommending EC.…”

Early Sexual Debut and Neighborhood Social Environment in Latinx Youth

“…Most sexual health research and prevention approaches address individual level risk factors, yet widespread recognition of social determinants, the structural and social influences on health, is needed. 30 – 32 The relative salience of social determinants on sexual health in an agricultural community shaped by immigration is largely unexamined. This study, therefore, addresses gaps in understanding aspects of social environments that appear influential to sexual health during the transition between early and middle adolescence.…”

Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach

“…10 11 High unemployment and poor educational opportunities shape teenagers' sense of hope for the future which influences both sexual risk behaviors and mental health. 12 Poverty also creates cost-barriers to supervised out-of-school time and fewer opportunities for structured recreational/after-school activities, creating greater opportunity for adolescents to engage in risky behaviors (i.e., sexual activity, substance use 13 ), further contributing to social isolation and depression. 14 Relatedly, there are several policy-level and contextual factors at the macro-level that shape the mental health of adolescents, risk of pregnancy and their subsequent adjustment to pregnancy and parenting.…”