How can we help prevent pregnancy for youth in care?
While teenage pregnancy and birth rates have hit historic lows, the number of pregnant and parenting youth in foster care continues to remain at disproportionately high rates. Research reveals that 33 percent of young women in foster care have been pregnant by age 17 or 18, compared to just 14 percent of their peers in the general population.1 Repeat pregnancies are also common, with 62 percent of this population being pregnant more than once within that time frame. For young men, an important study reported that 50 percent had gotten a young woman pregnant, compared with 19 percent of their non-foster peers.2
Youth in foster care are at a higher risk for teenage pregnancy for a number of reasons. Many don’t have a consistent and trusted adult in their lives in whom they can confide about personal issues and who can educate them about reproductive health issues. Without a person in their lives who can mentor them, they are more susceptible to peer pressure to become sexually active. Youth in foster care often don’t have access to accurate information about reproductive health in the way that their non-foster peers do. In addition, many young women in foster care see benefits to having a baby, perceiving the child as a means of achieving unconditional love and having the stable family and sense of belonging they never experienced themselves. Furthermore, many youth in foster care may come from family cultures where teenage pregnancy is accepted.
Unplanned teenage pregnancies have serious health and educational effects on both mother and child. Teenage parenting in foster care also has financial consequences for child welfare systems, as they need to provide housing and appropriate services. Teenage mothers in foster care are twice as likely as older mothers to be reported for abuse and neglect and have their children removed from their care.3 For new young mothers, securing housing and finding employment when transitioning out of care is much more challenging with a baby or young child. The children of teen mothers are also more likely to drop out of school, become incarcerated at some point during adolescence, and have babies at young ages.3
As an agency leader, I came to realize that I could find my way to effective solutions to pressing problems by leading from a set of core values. These foundational commitments helped me set the tone for my agency’s response to any issue, large or small. One value I consistently articulated was that every child matters. We recently received an inquiry from the first lady in a Midwestern state about preventing pregnancy for youth in foster care, and I was reminded of the importance of values when considering new strategies, be they policy, program, or practice. We have a responsibility to keep children – all children – safe. And if children are placed in our care, we owe it to them and to the public to ensure we give them the information and supports they need to make informed choices for themselves. We can’t do it alone. Together, all three branches of government can be instrumental in addressing the needs of the teenagers we jointly serve.
– David Sanders, PH.D., EVP of Systems Improvement, Casey Family Programs
Strategies for consideration
The child welfare agency plays an important role in addressing the well-being of all the children in its care, which includes services to support reproductive health and unplanned pregnancy prevention. Child welfare agencies can make progress in reducing unplanned teenage pregnancy among youth in foster care by implementing the following strategies:
- Give youth the information they need to make good decisions: Both young men and women in foster care need accurate information and good decision-making skills to protect them from unintended pregnancy if they choose to be sexually active. Child welfare agencies can focus on sexual and reproductive health as an integral part of the youth’s case plan and ensure that all youth receive the support, knowledge, and tools needed to make healthy long-term decisions regarding sex and pregnancy planning. Child welfare agencies can offer sexual education programs for youth in foster care and make this a component of existing programs within child welfare agencies. For example, many states have integrated these programs into their Independent Living Programs (ILPs). Currently, there is one evidence-based pregnancy prevention program that has been adapted for youth in foster care: Making Proud Choices for Youth in Out of Home Care.4
- Collaborate with other systems: Child welfare cannot prevent teenage pregnancy on its own; agencies need to partner and collaborate with other entities, such as public health, education, judicial, and private sector organizations, to help ensure youth have access to reproductive health services and education. In particular, child welfare agencies can partner with public health departments to ensure access to reproductive and sexual health care services as well as evidence-based prevention programs.
- Develop agency policies and procedures: Agencies can develop and implement specific policies and procedures to help prevent unplanned pregnancies and promote sexual health among youth in foster care. These should include clarifying the roles and responsibilities of all the adults who care for these youth, including caseworkers, foster parents, and other supportive adults. For example, it might be necessary to clarify who is responsible for ensuring that the youth have access to regular reproductive health care screenings once they become adolescents.
- Provide training for foster parents and caseworkers: Many caseworkers and caregivers may feel unprepared to talk with foster youth directly about personal issues. Training should be provided for foster parents and caseworkers on how to talk with youth in nonjudgmental and supportive ways about sexual and reproductive health, contraception and pregnancy prevention, and healthy relationships. Training should also be provided on the psychological reasons that both young men and young women in foster care are more likely to become teenage parents.
- Provide access to health care: All foster youth are entitled to health screenings, yet due to frequent changes in placement and other issues, they may not have a regular health care provider or know where to find a clinic. Caseworkers should ensure that all youth, starting at puberty, receive regular screenings that provide age-appropriate information about reproductive health and pregnancy prevention, including methods of contraception and how to access them.
Although many child welfare agencies have programs to address the needs of pregnant or parenting youth in foster care, few programs or policies have been specifically designed to prevent pregnancy for youth in care. However, a number of states are beginning to develop approaches and programs to address the high rates of pregnancy among youth in foster care. The following section provides examples of programs and policies that have been implemented in jurisdictions around the country.
Orange County, California5: In 2013, California passed SB 528, which requires child welfare agencies to inform youth in foster care about their reproductive and sexual health care rights. As a result, Orange County Social Services Agency developed a Reproductive Health and Parenting Policy that clarifies the roles and responsibilities of caseworkers, caregivers, and the child welfare agency about providing information to youth in foster care on reproductive and sexual health services, youth rights, and how to access services. Every six months, child welfare staff must inform youth of their rights to access services and provide information about reproductive and sexual health. Child welfare staff and caregivers must attend trainings that support the implementation of this policy.
Hawaii, Alameda County (California), Minnesota, North Carolina, and Rhode Island: Making Proud Choices! is an evidence-informed sexual health curriculum, designed to help teens understand behaviors that put them at risk for pregnancy and sexually transmitted infections (STIs), and to empower them to reduce this risk through healthy decision-making. In 2011, the National Campaign to Prevent Teen and Unwanted Pregnancy began a three-year project in partnership with the American Public Human Services Association (APHSA) with a focus on reducing teen pregnancy rates among youth involved in the child welfare system. They adapted Making Proud Choices! for youth in foster care and provided technical assistance and support to five teams of state and local child welfare professionals as they implemented the program. The main message incorporated throughout the adapted curriculum is: “Youth can make proud and responsible choices in spite of what has happened to them in the past.”6
Throughout the project, the five teams — located in Alameda County (California), Minnesota, North Carolina, Rhode Island, and Hawaii — established critical partnerships between public health and child welfare organizations that enabled them to implement the programs at a larger scale and with a heightened focus on sustainability. Since February 2013, the teams have been delivering the program to youth in care and participating in an ongoing process evaluation, which is beginning to provide valuable insight about the types of partnerships and support systems that need to be in place to incorporate teen pregnancy prevention into daily child welfare practice. Hawaii, for example, has made the curriculum part of its ongoing Life Skills program, which helps youth develop independent living skills. Hawaii implemented the training into three out of the four statewide ILPs and provides trainings for foster parents and caseworkers about how to talk to youth about sexual heath.
Maryland, California, and Oklahoma: Power Through Choices (PTC) is a sexual education and skill-building curriculum designed for youth living in foster care and other out-of-home settings, with the goal of reducing risks related to teen pregnancy and STIs. PTC is intentionally designed with and for youth in foster care and other out-of-home placements. With a focus on self-empowerment and the impact of choices, PTC uses interactive learning to provide information and skills that help youth in out-of-home settings avoid risk-taking sexual behaviors. The PTC curriculum challenges youth to set goals for their future and helps them recognize the importance of making healthy choices to accomplish those goals. In Maryland, California, and Oklahoma, PTC was implemented in group care settings.
Connecticut: Connecticut used its Personal Responsibility Education Program (PREP) federal grant to build a cross-systems collaborative focused on reducing unwanted teenage pregnancy and included child welfare, education, public health, and mental health systems, along with community partners. Connecticut implemented Teen Talk, an intervention program developed by Planned Parenthood of Southern New England, with a goal of decreasing rates of teen pregnancy and STIs among teens aged 13–19. It is a comprehensive program designed to provide reproductive health education to youth and facilitate access to reproductive health care in order to delay sexual activity, prevent unplanned pregnancy, and prevent STIs. Teen Talk is a 10-hour program comprising four 2.5-hour sessions and was delivered to youth in child welfare congregate care settings. The core design uses the Health Belief Model’s behavior change theory.
The following table provides tools, research, and recommendations related to the prevention of unplanned pregnancy for youth in foster care:
Below are tools, research, and recommendations related to the prevention of unplanned pregnancy for youth in foster care:
Guttmacher Institute, Teen Pregnancy Among Young Women In Foster Care: A Primer (2011)
This article explores the reasons why youth in foster care have high rates of teenage pregnancy. It suggests that the basic policy framework needed to support interventions to reduce teen pregnancy among young women in foster care is already in place at the federal level and that child welfare agencies and program planners should be thinking about ways to maximize these levers to help adolescents in foster care delay pregnancy.
National Campaign to Prevent Teen and Unplanned Pregnancy, A Call to Action: 10 Ways to Address Teen Pregnancy Prevention Among Youth in Foster Care (2016)
In October 2015, the National Campaign engaged more than 100 professionals in a national conversation about how to address teen pregnancy among youth in foster care. Based on this gathering, 10 key ways have been identified in which funders, decision-makers, child welfare leaders, and others who are interested in improving the health and well-being of youth in foster care can begin to make progress on reducing teen pregnancy among youth in foster care.
National Campaign to Prevent Teen and Unplanned Pregnancy, Help Me to Succeed: A Guide to Support Youth in Foster Care to Prevent Teen Pregnancy (2013)
Understanding a youth’s feelings and opinions regarding the risks of early pregnancy and prevention strategies can help child welfare professionals provide more effective support for the young people they support in foster care. This report combines messages directly from youth in foster care in Georgia with national research to provide insight and advice to adults working in the child welfare sector. The report includes suggestions on how to find the balance between helping youth in care have a “normal” adolescent experience while providing them with the support they need to overcome barriers they face as a result of being in the child welfare system.
National Campaign to Prevent Teen and Unplanned Pregnancy, Tips and Tools for Trusted Adults (2017)
These evidence-informed tip sheets were produced after interviews and focus groups with stakeholders and youth in care. Each tip sheet is equipped with scripts, data, and tips for beginning and continuing conversations with youth. These can be utilized with any youth by any trusted adult figure, but were shaped by the unique narratives and data collected from those involved in the child welfare system. These tip sheets are organized by three age ranges, along with the topics and conversations appropriate to each.
National Campaign to Prevent Teen and Unplanned Pregnancy, Tips for Working with Foster Care and Juvenile Justice: Preventing Teen Pregnancy Through Outreach and Engagement (2013)
This tip sheet offers practical tips for engaging the foster care and juvenile justice communities in teen pregnancy prevention efforts, with a focus on helping these providers understand how teen pregnancy prevention relates to their mission and the concrete steps they can take to reduce teen pregnancy.
National Center for Child Welfare Excellence at the Silberman School of Social Work, Information Packet: Pregnancy Prevention for Youth in Foster Care (2015)
This information packet provides best practice tips, and models of pregnancy prevention programs for youth in foster care.
National Center for Youth Law, Cause for Concern: Unwanted Pregnancy and Childbirth Among Adolescents in Foster Care (2014)
This article presents an overview of recent research on the poor outcomes experienced by teen mothers, including lower levels of educational attainment, higher rates of single parenthood, and less stable employment.
National Conference of State Legislatures, Legisbrief: Teen Pregnancy Among Youth in Foster Care (2013)
This two-page brief gives examples of states’ approaches to addressing high rates of pregnancy. It describes federal funding sources for pregnancy prevention.
Public Health Institute, Sex Education and Reproductive Health Needs of Foster and Transitioning Youth in Three California Counties (2009)
In this study, the authors conducted a sex education and reproductive health needs assessment for foster and transitioning youth aged 14–21 years in three California counties. They investigated youths’ sexual and reproductive health needs and challenges; barriers to addressing those needs and challenges; staff and former foster youth’s suggestions regarding needs, challenges, and barriers; and actions needed to promote sexual and reproductive health and to address the issues and challenges that these youth face.
U.S. Department of Health & Human Services, Office of Adolescent Health, Evaluation of Adolescent Pregnancy Prevention Approaches, Addressing Teen Pregnancy Risks for Youth Living in Out-of-Home Care: Implementing POWER Through Choices 2010 (2014)
This report provides an overview of the Oklahoma Institute for Child Advocacy’s comprehensive sexual health education curriculum for high-risk youth. The summary includes the implementation study findings.
1 Finer, L. B., & Henshaw, S. K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38(2), 90–96.
2 Finer, L. B., & Zolna, M. R. (2014). Shifts in intended and unintended pregnancies in the United States, 2001–2008. American Journal of Public Health, 104(S1), S44–S48.
3 Hoffman, S. D. (2006). By the numbers: The public costs of teen childbearing. Retrieved from The National Campaign to Prevent Teen Pregnancy website: https://www.healthymarriageandfamilies.org/library-resource/numbers-public-costs-teen-childbearing?backtolib=0&f%5B0%5D=field_ressource_keywords%3A3937&page=1
4 ETR Program Success Center for Sexual and Reproductive Health. (n.d.) Making proud choices. Retrieved from http://www.etr.org/ebi/programs/making-proud-choices/
5 The National Campaign To Prevent Teen and Unplanned Pregnancy (2013). Engaging Youth in Care on Teen Pregnancy. Retrieved from https://www.hhs.gov/ash/oah/sites/default/files/ash/oah/oah-initiatives/teen_pregnancy/training/Assests/vulnerableyouth_fostercare.pdf
6 National Campaign to Prevent Teen and Unplanned Pregnancy. (2016). A call to action: 10 ways to address teen pregnancy prevention among youth in foster care. Retrieved from https://powertodecide.org/what-we-do/information/resource-library/call-to-action