Preventing teen pregnancy: Good news for communities

Recent polling by the National Campaign to Prevent Teen and Unplanned Pregnancy finds strong bipartisan support for implementing evidence-based teen pregnancy prevention programs.  As communities across the country seek to prevent teen pregnancy, they can reference Child Trends’ 2014 review of teen pregnancy programs, which identified more than 50 evidence-based programs, incorporating a variety of different approaches. This rich array of program approaches increases the likelihood that communities can find teen pregnancy prevention programs that are consistent with their values, responsive to the needs of their families and teens, and effective at preventing pregnancy.

Below, we review, in alphabetical order, the types of teen pregnancy prevention program models that have an established evidence base of effectiveness.

• Abstinence education programs promote abstinence above all other approaches. Though earlier reviews found few, if any, effective abstinence education programs, an expanding number of abstinence education programs have established evidence of effectiveness in recent years. These programs primarily promote abstinence beliefs and attitudes while emphasizing goals and dreams.
• Comprehensive sex education programs focus on improving reproductive health outcomes such as preventing pregnancy or increasing STI knowledge. In general these programs promote both abstinence and contraception for adolescent who become sexually active.
• Clinic-based family planning programs are specifically designed to be implemented in a health clinic or by clinic staff or physicians. Often these programs target teens who are seeking contraceptive services or diagnosis/treatment for STIs.
• Parent involvement programs focus on improving the parent-child relationship, particularly around communication about sexual behavior and healthy romantic relationships. In some instances, parents are the primary participants in these programs; in others, the program is taught to parent-child pairs.
• Youth development programs may or may not focus on reproductive health but are primarily designed to increase pro-social behavior, positive relationships, school achievement, or health outcomes broadly. Several of these programs have successfully reduced teen pregnancies or delayed sexual initiation in addition to positive impacts on other youth development outcomes.

The federal Office of Adolescent Health maintains a database of evidence-based programs and recommends that communities take into consideration the specific needs of the youth in their communities when selecting a program to implement. To ensure your program is successful, OAH has also identified some key considerations when selecting a program, including the population that the program was designed to be implemented with, the specific outcomes that the program targets (e.g., reducing sexual initiation, reducing STIs, enhancing healthy relationships, etc.), and the community’s capacity to deliver the program the way it was designed.

Communities should also consider factors that are important for effective implementation of teen pregnancy prevention programs. Evidence-based programs are designed by the developer with core elements in mind.  In order for evidence-based programs to be replicated successfully, it is important that the core curriculum elements remain intact and are delivered as designed.  A number of other factors contribute to successful implementation as well, such as well-trained implementers, community buy-in, the implementing organization’s capacity and resources, attendance and engagement among program participants, the experience of implementers in working with the target population, the adaptability and ease of use of the curriculum, and established relationships with partner or implementation sites.  Child Trends has also identified six steps an implementing organization can take to implement an evidence-based program.

The number of programs that are scientifically evaluated for effectiveness is increasing, but there is still work to be done.  Innovative programs need to be designed and tested with high-risk and hard-to-reach youth, including teens in rural areas, older teens who are out of high school, and pregnant and parenting teens. New approaches, including healthy teen relationship programs that focus in particular on establishing healthy romantic relationships, are also needed. New and innovative programs can be identified in local communities and will need rigorous evaluations to test their effectiveness. Replication studies of existing programs could confirm and expand the effectiveness of existing programs, including testing the effectiveness of programs that have been adapted for different populations and setting.

According to the Centers for Disease Control, teen pregnancy and birth rates hit a record low in 2015, while abortion rates did the same in 2014. Numerous factors are believed to have influenced these numbers, including declines in sexual activity, increases in contraceptive use, and expanding implementation of evidence-based teen pregnancy prevention programs.  As teen pregnancy and birth rates vary, so must our solutions to teen pregnancy.  Allowing and trusting communities to choose the types of evidence-based programs that work for them is critical to preventing teen pregnancy and promoting the health and long-term well-being of young people.