Center for Research on Women - MemTV

Center for Research on Women

Examining Issues of Gender and Social Inequality

Shelby County Teen Pregnancy and Parenting Needs Assessment

The University of Memphis


Prepared By:

CONTENTS

Lynda M. Sagrestano, Ph.D. Ruthbeth Finerman, Ph.D. Joy Clay, Ph.D. Teresa Diener, M.A. Naketa M. Edney, M.A. Ace F. Madjlesi, M.A.

Introduction [pg. 3] Snapshot of Teen Pregnancy in Shelby County [pg. 4] Key Themes [pg. 6] Case Study : Latavia [pg. 7] Case Study : Don [pg.9]

Published by: Center for Research on Women The University of Memphis 337 Clement Hall Memphis, TN 38152 901-678-2770 [email protected] http://crow.memphis.edu

June 2012

Layout and Design by: Teresa Diener

Acknowledgements

Key Program, Service, and Policy Needs [pg. 10] Case Study : Lauren [pg. 12] Community-Level Recommendations [pg. 14] Appendices [pg. 15] A: Research Methods Summary B: Literature Review Summary C: Birth Certificate Data Analysis D: GIS Map Analysis and Maps E: Resource Inventory Analysis and Program Resource List F: Youth Risk Behavioral Surveillance Study Data Analysis G: Teen Pregnancy and Parenting Survey Data Analysis H: Parental Attitudes Toward Sex Education Data Analysis I: Provider Focus Group Summaries Reproductive Healthcare Providers MemTV and TPPS Providers J: Community Focus Group and Case Study Summaries Teen Girls Who Are Pregnant or Parenting Teen Girls Who Have Never Been Pregnant Teen Boys Parents of Teens K: Condom Access Data Analysis L: Economic Impact of Teen Pregnancy Report Summary References [pg. 94]

We wish to thank the many individuals whose help proved invaluable to our efforts. Most importantly, we wish to thank all of the teens, parents, service providers, and community leaders who participated in this study. In addition, we would like to thank those who helped facilitate data collection, listed in Appendix M. Special thanks to the Teen Pregnancy and Parenting Success Core Leadership Team and Memphis Teen Vision for their help with many aspects of this project. We would like to thank the Center for Community Building and Neighborhood Action (CBANA), including Dr. Phyllis Betts, Carol Goethe, Elizabeth Henderson, and TK Buchanan, for their assistance with the epidemiologic data and GIS mapping, and Dr. David Ciscel for conducting the economic analysis report. Additionally, we would like to thank Jennifer Gooch; Nikia Grayson; the graduate students at the University of Memphis who assisted with focus group data collection, especially August Marshall, Laura Meyer, Susanne Salehi, Courtney Robertson, Carlos Torres, Preeti Rao, Amber Sanders, Lloyd Thomas, LaKenya Smith, Richard Cash, Gayle Ozanne, and Jennifer Earheart; and graduate students in Anthropology 7511 who assisted with the resource inventory. Finally, thanks to the US Department of Health and Human Services Office of Adolescent Health, The Children’s Foundation, and the National Institute for Reproductive Health for funding this project.

2 | Shelby County Teen Pregnancy and Parenting Needs Assessment



INTRODUCTION Adolescent pregnancy significantly impacts the educational attainment, economic security, and wellbeing of both teen parents and their children as well as teens’ ability to achieve their full potential. Recently the Centers for Disease Control and Prevention (CDC) declared “Preventing Teen Pregnancy” one of six “winnable battles” because there is no cure yet to be found – we already know what works. The CDC points to four key strategies: 1) increase public awareness, 2) support evidence-based sex education programs, 3) increase access to contraception, and 4) get parents involved.1 Despite this seemingly concrete advice, teen pregnancy remains a complex challenge for communities to prioritize and systematically address. Shelby County teen birth rates are significantly higher than rates for the state. For teens 15-17, the county birthrate is 36.7/1000 women aged 15-17, as compared to 24/1000 at the state level. Similarly, for teens 18-19 the county birthrate is 107.8 per 1000 girls aged 18-19, as compared to 85.9/1000 for the state. Moreover, birth rates only tell part of the teen pregnancy story, as these numbers do not include cases of miscarriage or other termination. Furthermore, these statistics say nothing about the experiences and needs of teen parents. Therefore, a broader understanding of teen experiences in the Memphis community is essential. Ultimately, supporting the prevention of adolescent pregnancy and promoting effective teen parenting will have a significant positive impact on our community. In 2011, Tennessee was one of 17 states that received funding from the US Department of Health and Human Services, Office of Adolescent Health to design, implement, and evaluate a system of care aimed at supporting pregnant teens and improving outcomes for teen parents. Tennessee is unique in that, rather than dispersing the federal funds to several counties, the State chose to concentrate all of the federal monies on streamlining the coordination of community-based pregnancy and parenting services in Shelby County, coordinated by the Shelby County Office of Early Childhood and Youth. As part of this initiative, The University of Memphis Center for Research on Women (CROW) worked with community stakeholders to conduct a needs assessment of pregnant and parenting teens in Shelby County. An inventory of programmatic resources for pregnant and parenting teens, and a survey of condom access in select Shelby County zip codes were compiled and analyzed. In addition, the research team conducted a series of focus groups and case studies with key stakeholders, including teens, parents, program and healthcare providers, educators, and community leaders. Survey data were collected from 285 Shelby County teenagers, and epidemiologic, economic, and GIS data on teen pregnancy were examined. Detailed analyses of these data are presented in the Appendices of this report. The report that follows briefly describes the status of teen pregnancy in Shelby County. Drawing on data from all sources, key themes are identified, as well as key program, service, and policy needs. Finally, some broad based, community-level recommendations are made. This assessment informs and facilitates the implementation of a coordinated community response targeting pregnant and parenting teens in Shelby County.

1

http://www.cdc.gov/WinnableBattles/

Shelby County Teen Pregnancy and Parenting Needs Assessment | 3



SNAPSHOT OF TEEN PREGNANCY IN SHELBY COUNTY Although there is a vast range of individual experiences of teen pregnancy, some trends can be drawn from the data. The following section is excerpted from analyses of the 2009 linked birth-death records for babies born in Shelby County (see Appendix C), and key findings are highlighted below. Case studies help to illustrate the diversity of experiences of local teens impacted by teen pregnancy.

Birth Rate per 1,000 Women

Tennessee ranks in the top ten of states with the highest teen birth rates. Additionally, Shelby County rates are among the highest in the State.

107.8

18-19

85.9

Age

Shelby TN

36.7

15-17

24

0

20

40

60

80

100

120

Previous Births by Age of Mother in Shelby County 25

Age

20-24 7

18-19

0

2 or More Previous Live Births

23

1 Previous Live Birth

1

17 and under

32

10 10

20

30

40

Precentage


Teenage girls in Shelby County who give birth under the age of 17 are vulnerable to repeat pregnancies in their teen years.


High School Graduation Rates of Women Giving Birth Between Ages 20 and 24 P e r c e n t

100

83 70

80

52

60 40 20 0


Among young women giving birth between the ages of 20 and 24, the more children that they had already had as teens, the less likely they were to have graduated from high school or earned a GED.

No Previous Births

One Previous Birth Two or More Previous Births Number of Previous Births

• • •

Over 20% of teen mothers fall under the legal definition of victims of statutory rape in the state of Tennessee2. 78% of teen mothers report household incomes of less than $10,000 per year. Eighty-six percent of mothers under age 20 give birth under TennCare.

•

Among Shelby County mothers 17 and under, 21% had a sexually transmitted infection during pregnancy, and among mothers 19 and under, 18% had a sexually transmitted infection during pregnancy.

•

11% of teen girls who gave birth in Shelby County received no prenatal care, and 40% did not receive prenatal care until sometime in the second trimester.

In TN, statutory rape is defined as sex with girl aged 13-14 with man who is 4 or more years older; or sex with girl aged 15-17 with a man who is 5 or more years older. http://www.state.tn.us/tccy/tnchild/39/39-13-506.htm 2




KEY THEMES The following themes emerged from analysis of all research materials, including qualitative and quantitative data collected by CROW as well as ancillary materials compiled by research partners.

Gender Matters •

Teenage pregnancy and parenting have a more profound impact on girls than boys, in multiple ways. Girls consistently report experiencing shame, stigma, and being ostracized, leaving them socially isolated and without important sources of support. Girls also report voluntary or involuntary withdrawal from peer networks and social engagements in order to focus on parenting responsibilities. Pregnant teenage girls experience being ejected from their family home, condemned by peers, and losing friendships after being declared a “bad influence.”

•

Pregnant girls are often accused of using their pregnancy to “hold onto” a boy. Pregnant girls may also be accused of lying about who fathered their child.

•

Pregnant and parenting girls experience significant barriers to completing their education, as class attendance may conflict with prenatal care appointments and the demands of pregnancy and parenting.

•

Pregnant and parenting girls report barriers to securing and sustaining employment, due to limited education and skill training, as well as employer concerns about liability for pregnant girls and the reliability of workers who are teen parents.

•

Teenage girls report a low awareness of options, including the ability to say “no” to sexual activity or pregnancy. The result for many is a cycle of teen parenting and the expectancy of teen pregnancy across generations within a family.

•

Teenage boys report that both sexual activity and parenting can yield prestige among peers, yet boys may be denied regular involvement in the lives of their offspring.

•

Teenage boys report pressure to seek work to provide financially for children, which can lead to poor class attendance, dropping out of school, and withdrawal from social engagements, narrowing interpersonal networks and leaving them socially isolated.


“They [my parents] were both incredibly angry throughout the whole pregnancy. They worried about what the neighbors would think.” --teen mom

“He didn’t believe me and then he was like, ‘Well, it is not mine.’” --teen mom

“While pregnant, I had to deal with swollen legs, back pain and I had to stand a lot at my job and could not lift heavy things.” --teen mom

“My child is crying for food, and I’m hungry too, and school is providing no income,” --teen father



CASE STUDY: LATAVIA At the age of 18, Latavia became pregnant. Her story is unusual because she felt that she did not have any parents. As she explains, “I was a foster child from 15 and aged out at 18. Right after I aged out, I was pretty much homeless. I was very stressed about having to leave and not having anywhere to go, so I didn’t tell anyone…my therapist was the first person that I told.” Latavia says that her therapist was very supportive, but she could not visit her as often as she wished. Latavia says of the baby’s father, “Well, he denied it up until the very end. After I lost my child at three months, he was just like, ‘Oh, I would have been there’… I was only four months. I was getting ready for college when I lost my child.” Latavia feels that her pregnancy had a major impact on her life. She did not have biological family that she felt close enough with to talk to about her pregnancy. As she points out, “I was living with my mom’s aunt before I got into foster care. She would always tell me that I would be pregnant by age 13. When I turned 13, then she would say that I would be pregnant by 14, and it just went on and on. So, even though I was technically an adult when I got pregnant, I felt like I could not go back and tell my aunt because she would rub it in my face.” Her sister is 26 and has five children; she did not want to be compared to her. To some extent, the pregnancy caused her to become more of a private person: “When I became pregnant, I didn’t really have anyone to talk to at that point in time. So, now I keep a lot of things to myself.” Yet, her pregnancy also helped her to become more independent and self-reliant: “Well, I knew that if I had this baby, then I would have to do it all by myself. I don’t have parents and I don’t have a close relationship with my blood family, so it has really taught me to be self sufficient and that I just really had to take care of myself.” Although she could not talk to her biological kin, she turned to a trusted adult that she now calls “mom.” According to her, “Other than my therapist, my ‘mom’ and you lovely ladies, no one else know about my pregnancy. I am so thankful for my mom because I can talk to her and she is trustworthy.” Latavia thought that she had a number of friends, but they seemed to abandon her once she was pregnant. She comments: “That was one of the most vulnerable points in time in my life and I couldn’t find anyone to talk to that wasn’t getting paid. That made me really not trust people and so, I don’t have a lot of friends who are my age.” Latavia’s pregnancy did not directly affect her high school attendance or grades because she became pregnant two weeks prior to graduating and was preparing for college. Instead, her fears concerned attending college while pregnant. According to her, “It was really challenging for me to think about how I would go to college pregnant. I go to a private and expensive college and the majority of the students are white people. I knew that it was not only going to be difficult being pregnant…but being the pregnant black girl and I considered dropping out. It was just difficult.” Latavia felt that she would probably be kicked out of college due to her pregnancy status. Latavia thinks that it is difficult to find employment as a pregnant or parenting teen. Immediately following high school, she was hired through the Summer Youth Employment Program, but could not attend work when she was sick from the pregnancy. She did not know of any available resources. Latavia notes, “I was a part of that program and they have rules, I did not want to tell them and lose my job. Trying to find a way to work and knowing rules about being pregnant and working and that support for you while you are pregnant… I didn’t know where to start with those things.” Latavia used the internet in her employment search because many jobs require online applications. She found the internet to be a good way to get all types of information. Latavia did not receive any government assistance during her pregnancy. She lost her baby during her third month and was only able to make one doctor’s appointment during the pregnancy. She advises other teens that there are resources to help them, but they must search for them. She also recommends: “In some cases, you will not be able to go to your parents, so you really have to be a go-getter and go out and find the information on your own because once you get pregnant, that is your situation and you have to be able to take care of yourself.”




Poverty Matters •

Teen pregnancy and parenting strongly correlate with poverty. o Map B reveals that teen pregnancy clusters in areas with higher rates of poverty. o Map C indicates that nearly all teenage women giving birth in Shelby County live in poverty.

•

Although there are many resources available, none compensate for the costs and challenges of being a teen parent.

“[Some teen mothers are] under control of the baby’s father, who are probably not in high school.” --provider

“A large number of girls have children by men. They are afraid to tell because they don’t want to get him in trouble.” --provider

Age Matters •

Younger teens report less awareness of pregnancy and parenting resources, including a limited understanding of how to obtain information and reproductive health services.

•

Younger teens voice greater fear about disclosing sexual activity and pregnancy to parents or guardians.

•

Younger teens report smaller and more fragile support networks; often, the only connections they cite are to immediate family.

•

Teenage girls report age-discordant relationships,3 where sexual partners are older boys and men. This difference compromises girls’ confidence and ability to say “no” to sexual activity, and to demand that partners use condoms.

“They tried to get the people on him [father of her child] because he was 18 and it was statutory rape.” --teen mom

3 Age-discordant relationships are those in which one partner is under the age of 18 and the partners are more than 4 years apart in age.




CASE STUDY: DON Don was 15 years old when he found out he was going to be a father for the first time. He recalls telling his mother the news, “I was crying, she was crying, but she said we would make it through this.” And he feels he has, though it has not always been easy. The mother of his child and her family did not want Don to have much contact with the baby, and he missed out on seeing his son born. He turned to his mother for support. “My momma encouraged me to try to keep contact and try to provide, even if they weren’t calling…to still take the initiative and provide for their needs.” In order to provide for his family, Don took on a job during the summer. He worked hard and was able to go to college, but after having two more children at ages 20 and 22, Don found that he could no longer afford to stay in school and make enough money for child support. “My child is crying for food, and I’m hungry too, and school is providing no income.” Don eventually dropped out and turned to “hustling” and selling marijuana on the streets. Don realized the dangers of selling drugs, but he was OK with his choices. He refused to seek government assistance because he believed it was his duty to provide for his children. He remembered the feeling of bringing home money from drug sales: “I was able to provide for all my mommas’ needs, all my kids needs…even though I wasn’t living right and breaking laws, just to see them happy and to see them getting what they needed brought joy inside of me.” Hustling allowed Don to feel self-sufficient and provide for his family. He slowly became “engulfed by the lifestyle,” constantly using marijuana and frequently running into dangerous situations. Being a committed father led Don to re-examine his life choices: “Going to pick them [his children] up from school and spending time with them triggered a bond where I didn’t want to get locked up or be dead and not play a role in their life like I didn’t have my father in my life.” Don decided to leave hustling behind, but it came at a price. He had married the mother of his third child, but when he could no longer maintain their luxurious lifestyle, she divorced him. Many of his friends deserted him as well. But for Don, fatherhood was always an obligation beyond friends and high-end living. Moreover, fatherhood profoundly changed him: “God blessed me with something that means a lot to me, and I truly believe that’s what triggered my passion, compassion, and love for the youth of today…for kids that aren’t even mine.” At 35 Don runs his own company and volunteers with local youth. He works with many young men who are not raised by their parents, and he hopes he can offer them opportunities to create self-esteem. Having been raised by a single mother led him to realize the importance of being a father who offers time, financial support, and emotional guidance to his children. Reflecting on his own experience with his mostly absent father, Don said; “He always sent money, paid child support, I visited him during the summers, stuff like that. But it wasn’t enough. I needed him there every day, to guide me.” He said: “I’m not able to give [my children] extravagant things, but I’m able to give them what they need, and I’m able to give them the most valuable thing I possess, and that’s time.” Don thinks it is a natural instinct to want to raise your own child, though he understands that a man’s own upbringing can affect his views on fatherhood: “Psychologically in their mind, [a teen] might say ‘well, my mother wasn’t there for me, so I won’t be there for this child.” In part, this is why he is so committed to working with youth: “They are the future and many of the boys and young men I work with now may someday become fathers themselves.” He wants to instill in those young men a sense of responsibility and caring for their own future children.




KEY PROGRAM, SERVICE, AND POLICY NEEDS Memphis and Shelby County feature a number of relevant resources for pregnant and parenting teenagers, including education and information dissemination (e.g. health, family life, family planning), healthcare services (e.g., pregnancy testing, prenatal care), support services (e.g. counseling), and material goods (e.g., diapers, baby clothing). The vast majority of resources (78%) are educational. Although there are many resources, there are nevertheless unmet program needs; teens often lack immediate access to resources; and there is insufficient infrastructure for a coordinated community response. Teens and their parents consistently reveal a lack of awareness of resources, reducing the potential impact of programs. There is a need to strengthen resources and programs which address teen pregnancy in order to promote opportunities that foster the wellbeing of our youth and community. Based on our data, the research team recommends addressing the following needs and gaps in services:

Parenting Support Programs •

• • •

There is an unmet need for parental skill training and support, including the promotion of parenting across the lifespan (e.g., parenting infants, children, and teens; single parents; parenting time management; the ability to develop one’s own parenting style). Programs are needed to help parents of teens to discuss healthy sexuality. There is a demand for accessible, affordable, reliable, and high quality infant and childcare programs to help enable teenage parents to complete school or retain jobs. There are insufficient job training and youth employment programs specifically targeted at pregnant and parenting teens to promote goals of financial independence.

Teen Male Engagement •

•

There is a need for more programs that promote male awareness, education, responsibility, and engagement in reproductive health and parenting; only 5% of all resources target boys. Males are a significant but often underutilized resource for preventing sexually transmitted infections and unplanned pregnancies, as well as promoting prenatal care and positive parenting.

“[Classes] don’t really teach you what to do after you get a kid…they talk about preventative measures, not about what you do when you get a kid.” --teen mom “The community is a barrier because they are not willing to talk about sex.” --provider

“Trying to find a way to work and knowing rules about being pregnant and working and that support for you while you are pregnant… I didn’t know where to start with those things.” --teen mom

“Boys are just as afraid and uninformed about sex as girls are.” --provider

Healthy Sexuality Programs •

• •

There is an unmet need for comprehensive communitybased education about healthy sexuality, preconception health, preventing sexually transmitted infections, family planning, and reproductive health. Programs are needed to build competent and confident staff who can teach comprehensive sex education. There is a need for programs that address sexual abuse.

“Girls don’t get pregnant by themselves … [the lack of male-oriented programs] leaves little responsibility for the boys … he feels like the rest is up to her.” --provider




Program and Service Access •

•

•

•

Short-term outreach activities into targeted neighborhoods may be insufficient to build optimal community awareness, trust, and sustainability.

•

Teens without insurance or TennCare eligibility face significant barriers to accessing medical services; there is a need for early eligibility to allow teens to access prenatal care in the first trimester. All teens who visit health providers for reproductiverelated services (e.g., STI and pregnancy testing) should receive prevention information. Only one-half of all programs are open after school hours, and just 20% of all programs are open during weekends. Teens skip classes or work in order to obtain prenatal care and other programs and services. Hours need to be reconsidered. There is a need for small-scale and gender-specific programs. Teenagers report that they cannot be open or honest in large and/or mixed-gender groups.

•

•

•

•

“If you have a doctor’s appointment and an important test on the same day, you have to contemplate on which one is more important.” --teen mom

A majority of resources are housed in just two zip codes, comprising Memphis’ Medical Center and Midtown districts. Although this proximity facilitates potential collaboration among agencies, neighborhoods with high rates of teen pregnancy and parenting have the least agency presence Although an overwhelming majority of teens giving birth in Shelby County do so on TennCare, most pregnant teens live in proximity to few if any TennCare Providers; some reside as far as 20 miles away from the nearest TennCare provider. Pregnant and parenting teens lack transportation to easily access programs and providers. Transportation challenges need to be addressed. More programs need to be located in targeted areas.

Condom retailers should make products easily accessible (not locked in cabinets), and provide staff training to improve customer service, courtesy, and discretion.

“We have to make sure that we are able to talk about these things and we’re able to provide this information, and not withhold information because it makes us uncomfortable.” --educator

“Access for young women on TennCare is more complicated than for women who are not on TennCare… These are rules that don’t have to be.” --healthcare provider

“Not all information is good information.” --teenage boy

Program and Service Awareness •

•

There is a need for user-friendly websites and phone reception training. Although almost all programs inventoried have an active website and telephone number, the following trends were noted: • Staff who answer telephones are not consistently aware of their agency’s programs. • Websites do not consistently offer ready access to program information. Teens report that they instead prefer to visit popular websites (e.g., social networking and gossip sites) which unfortunately may offer unreliable information. Social marketing is needed to promote teen pregnancy prevention and parenting programs. • Teens typically seek reproductive information from their own parents or trusted relatives, or - in the absence of family - trusted peers and adults, who may be unaware of programs.




CASE STUDY: LAUREN Lauren learned she was pregnant as an 18 year old college freshman. When giving her parents the news, “I had to be blunt about it. I didn’t know about my parent’s reaction.” She explained that “This was not my first pregnancy. The first time, I was 16 and it was a statutory rape and I had to have an abortion. I didn’t know if my parents were going to have the same reaction as the first time. My dad fussed… but my mom didn’t react like I thought she would. She gave me the silent treatment.” By contrast, her boyfriend stood by her as she made the announcement to her parents. After the initial shock, her parents yielded, and her mother offered her guidance on a range of government assistance programs that would help her care for the child. Pregnancy has altered Lauren’s plans for the future: “I have a dream of owning my own business. My parents owned their own restaurant, but they don’t have it right now.” But, now she feels that she might have to wait to start her business. She explains, “My dreams might have to get put on hold because now I have a baby to raise.” Her mother has been very supportive of her finishing school, noting “One thing my mom said was that I was finishing school.” Although she has been able to remain in college thus far, her pregnancy has affected her attendance. She explains, “Sometimes it is just hard and I don’t feel like doing it.” She hopes to continue her studies, though she might take some online courses. Lauren’s pregnancy also means that she must change some of her spending habits; she loves to shop but must save for baby clothes. Lauren’s pregnancy has also caused some friction with her boyfriend’s parents. After hearing the news, his mother asked, “Well, are you sure it is yours?” This upset Lauren, who did not want to be compared to other teen moms. She reports, “They kinda hurt my feelings, you know…I am not like all of these other girls that are just getting pregnant by anybody. This time I took the time and I waited and this is the person that I am going to be with. I am not like everybody else that just sits around and jumps from bed to bed to please my needs and he wasn’t that type of person.” Lauren has not informed everyone she knows about her pregnancy because she does not wish to be judged. At the same time, she feels that her pregnancy has strengthened her relationship with her parents. Lauren reports that it is very difficult for a teen parent to find employment. She managed to hold two jobs and continue with school until the 20th week of her pregnancy but, “It was getting very hard to work two jobs. My boss wouldn’t let me sit down and eat sometimes.” She claims that her father advised her to drop one of her two jobs. In her opinion, “Sometimes teens get lazy and just want to sit at home, but I grew up working in the family business. Some teens just want things handed to them. I like to have my own money.” To improve her childcare skills, Lauren has enrolled in pregnancy and parenting classes. Currently, she attends Operation Smart Child, a four-week program that will allow her to earn “baby bucks” to purchase baby items. In a few weeks, she will begin two other programs, The Sunrise Program and First Steps. Lauren is also receiving WIC and is waiting for an update on her application for food stamps and TennCare. Lauren advises pregnant teens to keep pushing to succeed and do the research to find resources.



Public Policy •

• •

• • • •

3

There is a need to bring together a broad spectrum of stakeholders, including corporate, faith-based, and community leaders, for a coordinated community response that would have a sustainable impact on teenage pregnancy and parenting. Legislation and policies that create challenges for implementing effective teen pregnancy prevention should be revisited. There is an unmet need to raise awareness of the impact of age-discordant relationships,4 and to enforce State laws regarding statutory rape. Parental and community support needs to be engaged in neighborhoods with high rates of teen pregnancy. Schools and communities need best practices they can implement in the area of preconception health and healthy sexuality. Confidentiality in schools and healthcare settings should be promoted. There is a need to address structural barriers to teenage access to reproductive healthcare and contraception, including high cost, insurance regulations, and pharmacy policies.


“People that attend [sex ed curriculum] meetings have kids that don’t get pregnant and they are the ones making decisions.” --provider “It [abstinence-only sex education] doesn’t work for students who are already pregnant or sexually active.” --educator “Principals are worried about backlash and community perceptions about what they are doing in their schools. That’s a huge fear. They don’t want their school in the news.” --educator “I think there’s probably a direct connection between the start of prenatal care and that family support. I’ve known a lot of teens who have not received early prenatal care because they did not want to tell their family that they’re pregnant.” --provider “Some young ladies, if they know their guidance counselor has a big mouth, then they think, ‘I’m not telling them nothing!’ … But if they know you will keep it confidential they will tell you.” --educator

Age-discordant relationships are those in which one partner is under the age of 18 and the partners are more than 4 years apart in age.




COMMUNITY LEVEL RECOMMENDATIONS In addition to addressing the above gaps, we offer the following broad-based recommendations: •

To demonstrate a long-term and sustainable commitment to addressing teen pregnancy, parenting, and broader health issues, appoint a centralized official to coordinate with the mayors, business sector, faith community, and other key stakeholders.

•

Raise awareness by sponsoring community-driven, grassroots-based social marketing campaigns which engage teens to design websites and social media that are authoritative, but also popular, easy to navigate, and which speak directly to Shelby County youth.

•

Provide cultural competency training for all educators, as well as program and service providers who interact with teens and their families.

•

Support a coordinated community response by committing to sustained funding for teen pregnancy and parenting initiatives.

We would like to thank the following Community Partners for their assistance in recruiting participants for this report. Andrea Curry, North Memphis Community Development Corporation Aretha Milligan, University of Memphis Audrey May, LINC 211, Memphis Library Bridges Carol Peterson, North Side High School Cathedral of Faith Claudia Haltom, A Step Ahead Foundation Crystal Hall, Boys and Girls Club ESC Core Leadership Team Hickory Hill Community Redevelopment Corporation Kristine Strickland, Orange Mound Community Center Lashard Smith, Airways Middle School Memphis Area Gay Youth Memphis Teen Vision Orisha Henry Bowers Pearl Lee, Youth Striving for Excellence Porter-Leath Rangeline CDC Reginald Johnson, Boys Inc. Shelby County Department of Children’s Services South Memphis Alliance Toni Blankenship TPPS Core Leadership Team Women’s Foundation for Greater Memphis




APPENDIX A RESEARCH METHODS SUMMARY For the purposes of this needs assessment multiple methods were employed to collect primary information on teen pregnancy and parenting in Shelby County. These methods included: Geographical Information Systems (GIS) mapping, resource inventory, surveys, focus groups, and case studies. For all methods, the needs assessment team utilized grant partners as liaisons to participants. The local teen pregnancy collaborative, Memphis Teen Vision (MemTV), also facilitated in identifying study participants. All methodologies were reviewed and approved by the University of Memphis Institutional Review Board for the protection of confidentiality and the rights of participants. All data and recordings are securely stored in locked cabinets only accessible to the research team, and all identifying information has been removed.

GIS Mapping. GIS is a system for mapping, visualizing, and analyzing geographic data. For this project, CROW partnered with the Center for Community Building and Neighborhood Action (CBANA) to develop maps that visually depict the relationships among poverty, teen births, and related health outcomes for teen mothers in Shelby County. Additionally, GIS was used to map community assets in relation to the neighborhoods where teen mothers live. These maps help to explain some of the barriers teens face in accessing healthcare services as well as pregnancy and parenting resources. Maps have been included as an appendix to this report [Appendix D]. All maps depict the most recent linked birth-death data available (2009). Resource Inventory. The CROW research team compiled a resource inventory of programs and services for pregnant or parenting teenagers in Shelby County. Data were collected from April through December of 2011, and compiled from a range of sources, including an online database of nonprofit agencies in Memphis, MemTV partners, the Memphis and Shelby County Health Department Fetal and Infant Mortality Review (FIMR) Committee, and other community collaborators. Resources were checked by calling agencies and services to confirm information obtained from available sources. Survey. An 8‐page, self‐administered survey was developed to elicit a broad range of information from local teens, including demographic and background information, sexual history and behavior, pregnancy and parenting history, family dynamics, and mental health factors. Survey data collection was completed in Spring 2012 through various community partners who serve teens. In addition, data were collected from first year students at Southwest Community College and the University of Memphis. A total of 285 surveys were completed. Parental Consent was obtained for all participants under the age of 18. Participants who completed the survey received a $10 gift card immediately upon completing the survey. Focus Groups and Case Study Interviews. Eleven focus groups, ranging from 5-35 participants per group, and 8 case studies were undertaken between April 2011 and March 2012 to better understand the context of adolescent sexuality, pregnancy, risk prevention, sex education, and programs and services related to pregnancy and parenting available to adolescents. The research team developed protocols that focused on the challenges of being a teen parent; key resources available for family planning, STD prevention, pregnancy and prenatal care, and parenting; barriers to pregnancy prevention; and impediments to finishing school and obtaining employment as a pregnant or parenting teen. Questions were tailored to the different target populations: 1) teen girls who were pregnant and/ or parenting; 2) teen girls who had never been pregnant; 3) teen boys; 4) parents of teens; and 5) service providers recruited through MemTV membership and the Teen Pregnancy and Parenting Success (TPPS) Initiative funded partners. Community partners helped the research team identify focus group and case study participants by distributing recruitment flyers. Interested individuals provided their names and contact information, and potential participants were contacted by telephone by a trained member of the research team. Focus groups were held at various locations throughout areas targeted by the TPPS project. Interviews with volunteer participants were scheduled at a mutually acceptable time. Interviews took place in private settings either at a place convenient to the interviewee, or in a research room at the University of Memphis, depending on the interviewee’s preferences. The focus groups and interviews each lasted approximately sixty to ninety minutes. Upon completion, participants were offered a $25 gift card. Cases of rape and statutory rape were reported according to legal requirements.




APPENDIX B LITERATURE REVIEW Researchers are increasingly finding that health disparities such as teen pregnancy or infant mortality involve a complex set of factors that are biological, psychosocial, and structural or institutional in nature (Bronfenbrenner, 1979; Kelly, Ryan, Altman, & Stelzner, 2000; Ryerson Espino & Trickett, 2008; Sallis, Owen, & Fisher et al., 2008; Hall, Moreau, & Trussell, 2012). As summarized in the literature review that follows, adolescent sexual behavior is shaped by a broad range of variables, including family structure and context, family processes and relationships, and biologic or hereditary factors. Community variables also impact adolescent intentions, actions, and risk behaviors. Health and transportation systems directly affect adolescents’ access to reproductive health services and medically reliable information. Neighborhood resources and needs, opportunities for teen employment, and cultural norms about appropriate relationships also play important roles in influencing teens’ reproductive behaviors. Public health interventions designed to address health disparities operate within complex social systems and their social and historical contexts consequently shape community perceptions of health and sexuality (Asthana & Halliday, 2006). Consequently, the most effective interventions should purposefully target multiple levels in the system to have the greatest impact (Sagrestano & Paikoff, 1997; Sallis et al., 2008), while seeking to accommodate conflicting values and other community needs competing for policy makers’ attention.

All American teenagers should have the opportunity to make choices that allow them to live a long, healthy life regardless of their income, education, or ethnic background. Teens are not just young adults; they have yet to fully develop their decision-making capacity. As a result, judgment missteps can have long term consequences on their potential to have productive lives. Unfortunately, many teens are engaging in sexual behaviors that make them and their offspring vulnerable to poor health and negative life outcomes. Pregnant adolescents experience higher rates of certain medical complications during pregnancy (Martin et al., 2005) which place their infants at risk for adverse birth outcomes and at higher risk for cognitive, behavioral, and emotional impairment (Gilbert, Jandial, Filed, Bigelow, & Danielson, 2004). Nationally more than 80% of teen mothers live in poverty during their children’s important developmental years (Hoffman & Maynard, 2008), and many will not graduate from high school (Hoffman, 2006). Thus, postponing parenting until they have achieved other key milestones such as completing their education will result in a greater likelihood of achieving their full potential.

Risk/Protective Factors and Teen Pregnancy Prevention: The Impact of Quality Relationships and Communication The opportunity for positive life outcomes begins in our families, neighborhoods, and schools. Understanding risk factors that are associated with a higher likelihood of negative life outcomes such as teenage pregnancy and dropping out of school (Coie et al., 1993) can help the community better design adolescent pregnancy prevention interventions. The challenge is that risk factors tend to cross domains as adolescents interact with families, peers, schools, and the community (Synder & Patterson, 1987) and operate cumulatively and interactively (Oldentettel & Wordes, 2000). Fortunately, protective (resilience) factors, that is, variables that directly or indirectly buffer against such risks (Coie et al., 1993), can also be enhanced or enriched to help teens make better and more responsible choices and have the skills to counter pressures to act otherwise. The challenge for program designers is that research has identified more than 500 diverse risk and protective factors. Kirby, however, notes that among the many factors “teens’ own, sexual beliefs, values, attitudes, and intentions are the most strongly related to sexual behavior” (2007, p. 14). The following key conclusions emerge from the literature:

1. Parents Matter. • Parent-child connectedness, defined as parental closeness, supervision, and behavioral monitoring, is associated with reduced adolescent pregnancy risk (e.g., delayed onset of sexual behavior) and transmission of parental



• • •


values regarding appropriate sexual behavior (Commendador, 2010; Huang, Murphy, & Hser, 2011; Miller, 2002; Oman, Vesely, & Aspy, 2005; Short, Yates, Biro, & Rosenthal, 2005). Teens living in one-parent households are more likely to engage in sexual activity and related risk behaviors at a younger age than are those in two-parent households (Abma, Martinez, Mosher, & Dawson, 2002; Bonell et al., 2006; Miller, 2002; Oman et al., 2005). Researchers hypothesize that parental supervision of teens may be connected with lower teen pregnancy risk, and that single parent households might have more trouble supervising their teens than do two parent households (Miller, 2002; Oman et al., 2005). Positive relationships and communications with parents and health care providers/case managers can enhance teens’ decision making skills and understanding of contraceptive issues (Akers, Schwarz, Borrero, & Corbie-Smith, 2010; Lemay, Cashman, Elfenbein, & Felice, 2007; Garwick, Nerdahl, Banken, Muenzenberger, & Sieving, 2004; Hacker, Amare, Strunk, & Horst, 2000).

2. Age Matters. • Younger teens report low levels of knowledge about safe sex/contraceptive options (Phipps et al., 2008; Iuliano, Speizer, Santelli, & Kendall, 2006; Kalmuss, Davidson, Coball, laraque, & Cassell, 2003) and high levels of “unplanned” sexual activity (Phipps et al., 2008). • Older teens (15 years or older) are more likely to report having a higher knowledge of contraception and slightly higher rates of contraceptive use than younger teens (Phipps et al., 2008). • Physical maturity may also be a factor in sexual activity (Kirby, 2007). Of note, older teens (who show higher rates of consistent contraceptive use) also report experiencing more side effects from birth control, which teens report as a potential variable for nonuse (Phipps et al., 2008; Iuliano et al., 2006). • Teen attitudes about contraception generally become more positive as they age. Researchers suggest that the variance in teen attitudes about contraception use by age groups [12-14, 15-17, 18-21] may relate to increased sexual experiences (Phipps et al., 2008), greater exposure to contraceptive options, and reduced fear surrounding their parents finding out (Iuliano et al., 2006). • Research suggests the need to tailor pregnancy prevention and teen parenting programs to specific age subgroups (Phipps et al., 2008; Kalmuss et al., 2003). 3. Intentions Matter. • The pregnancy intentions of teen girls (measured by their beliefs about pregnancy likelihood and their plans to become pregnant), along with their perceptions of pregnancy consequences, influence their contraceptive use (Rosengard, Phipps, Adler, & Ellen, 2004; Bruckner, Martin, & Bearman, 2004; Stevens-Simon, Sheeder, Beach, & Harter, 2005; Spear, 2004). • One key factor related to teens’ desire to avoid pregnancy was the importance of “achieving future goals and maintaining positive self-esteem” (Stevens-Simon et al., 2005, p. 243e20). • Teenagers who are ambivalent about becoming pregnant have lower rates of contraception use and higher rates of unintended pregnancy (Bruckner et al., 2004; Spear, 2004). • Higher “unplanned” pregnancy rates are seen in teens who see no serious, negative consequences associated with teen pregnancies, or who see both positive and negative consequences (consequences discussed include: embarrassment, future education goals, finances, stress, relationship with family/friends/boyfriend) (StevensSimon et al., 2005; Jaccard, Dodge, & Dittus, 2003; Bruckne et al., 2004). 4. Reproductive Health Knowledge Matters, for Both Parents and Teens. • One factor affecting the form of contraceptive methods teens choose to use is knowledge of perceived risks, defined as the level of ambivalence surrounding possibly getting pregnant, and how likely they believe pregnancy is with their current contraceptive behavior (Ott et al., 2002; Manning, Longmore, & Giordano, 2000). • US teen girls have reported the mistaken belief that their behavior could not result in pregnancy or was a very low risk, for example, not considering having intercourse only once or twice as being sexually active (Lemay, Cashman, Elfenbein, & Felice, 2007; Iuliano et al., 2006). • Teens report that some of the most common barriers to obtaining and using contraceptives are embarrassment, confidentiality concerns, and inability to obtain contraception without parental knowledge (Lemay et al., 2007, p. 233). • Lack of access to confidential care is a barrier to obtaining STI prevention and treatment services (Lemay et al., 2007).



• • • • • •

•


Disparities in health provider access by young women, especially those uninsured, underinsured, and immigrants, result in barriers to reproductive health services utilization (Hall, Moreau, & Trussell, 2012). Perceived negative side effects from using the pill, such as weight gain, are a barrier to its use (Garwick et al., 2004) and such side effects appear to be the reason for selecting or changing to a different method of contraception (Lemay et al., 2007). Parental values and knowledge affect teen use of contraceptives. The majority of parents with teenage children report “low levels of contraceptive knowledge…as well as negative attitudes toward some long-acting methods” (Akers et al., 2010, p. 165). Very conservative parents tend to hold very negative, yet medically inaccurate, views about condoms and oral contraceptives (Eisenberg et al., 2004). To reduce the incidence of STIs, researchers suggest that formal sex education may improve condom consistency, thus reinforcing the need to target teens and parents about sexual health prior to the initiation of sexual activity (Manlove, Ikramullah, & Terry-Humen, 2008). Adolescents who are offered education about safe sex and birth control (including medically accurate information about the pill, condom use, and other safe sex options), show higher rates of contraceptive use (Longmore, Manning, Giordano, & Rudolph, 2003; Klein, 2005; Bruckner & Bearman, 2005). Research suggests that exposure to sexuality education that includes contraception does not lead to increased sexual activity (Klein, 2005). Students in school-based risk reduction programs where they engage in activities that improve their belief in their ability to use condoms were more likely to have protected sex (Longmore et al., 2003, p. 56).

5. Relationships with Peers and Partners Matter. • Researchers have documented the effects of peer pressure on teen sexual behaviors. Consistent with Kirby’s findings (2007), Garwick found that teens who have “friendships with older peers who were engaged in risky behaviors” (2004, p. 346) engage in similar risk behaviors. • The research on how the degree of intimacy and commitment in a relationship may affect a couple’s use of contraception is mixed. Teen boys in romantic relationships who consistently engage in “couple-like activities” are more likely to use contraception; however, teens may become less careful when they believe they are in a committed relationship (Manlove, Ryan, & Franzetta, 2004). • Both teen girls and boys reported higher rates of overall contraceptive use (Manning et al., 2000), less condom use, and more hormonal contraceptive use (Ott et al., 2002) with serious/close partners than casual partners. • Because there is significant variation in contraceptive use across relationships, length and degree of commitment (Manlove et al., 2004; Lemay et al., 2007), Manlove and her colleagues conclude: “program providers should address the possibility that decisions on contraceptive use are compromised by teenagers’ needs for intimacy” (2004, p. 272). • Research suggests that successful sex education curricula should stress developing skills to help teens navigate relationship communication related to risk reduction (Wight et al., 2002).

Educate, Involve the Community, and Invest in Our Teens: Provide Clear, Consistent and Appropriate Messages Kirby, a recognized expert in the field of adolescent pregnancy prevention, convincingly argues that communitybased programs aimed at reducing teen pregnancy and sexually transmitted infections should clearly establish goals, be straightforward, and set specific outcomes expected from the effort. Further, program designers should implement programs that have demonstrated their effectiveness for similar teen populations, base the curriculum on an assessment of needs of the target population, and assure that the program is implemented with fidelity and consistent with community values (Kirby, 2007). Adolescents have suggested that sex education programs should frame the issues more positively, emphasizing fewer scare tactics and focusing more on anatomy; on negotiation and communication skills; and on providing information on health clinics in areas that teens frequent (DiCenso, Guyatt, Willan, & Griffith, 2002). Over 80% of U. S. adults support comprehensive sex education programs that emphasize abstinence but also inform youth about contraception (Kirby, 2007, p. 14). Part of the challenge facing communities in countering teen risk behaviors is an increasingly sexualized society. A recent American Psychological Task Force argues that sexualization is especially problematic for adolescents who are developing into sexual beings and learning how




to engage in intimate relationships (APA, 2007). Consequently, teen pregnancy prevention programs need to integrate an understanding of child development, socialization influences, and relational skills in order to collaborate with parents, schools, the faith community, and policy makers to develop a community-based comprehensive/coordinated approach to adolescent pregnancy prevention. Adopted by many states, comprehensive sex education programs are designed to be age appropriate and medically accurate. Available curricula include various topics, such as reproductive anatomy, relationships, and decision-making. Curricula should be approved by school systems, and be available for review by parents. Existing curricula may or may not include information about contraception. Comprehensive sex education programs can reduce sexual risk behaviors (Kirby, 2007; Kohler, Manhart, & Lafferty, 2008). Outcomes from abstinenceonly programs, however, present a mixed picture as such programs may improve teen values or intentions about abstinence, but improvements have not been demonstrated to endure (Kirby, 2007, pp. 14-15). Pledging abstinence also has been a strategy for delaying sexual initiation. Rosenbaum (2009), however, found that those pledging abstinence had equal STI rates as nonpledgers, were less likely to use contraception, and held more negative and fearful attitudes about sex and birth control. The challenge for demonstrated effective programs is the difficult issue of learning the lessons from implemented programs and then replicating what works with fidelity. The research suggests that sex education curricula need to be medically accurate, comprehensive, age-appropriate, and culturally sensitive; incorporate community values; yet maintain legitimacy and effectively influence youth behaviors. Without a national standard of medical accuracy, however, individual states and school systems define the accuracy of their curriculum. Added to this is the challenge of having a teacher’s personal perspectives potentially impede information dissemination, such as withholding information or promoting stereotypes (Santelli, 2008). Communities embarking on the process of changing teen sexual behavior face a daunting challenge. Fortunately, the research evidence has identified through rigorous evaluation (experimental design) 25 programs and an additional seven effective programs (quasi-experimental design) to select from when launching a teen pregnancy prevention program (Suellentrop , 2011). Convincingly, the experts advise that before launching a program communities should take the proactive steps of defining outcomes expected and the targeted behaviors sought to be affected, reflecting the commitment of the broader community to youth development, and involving parents and adolescents (Suellentrop, 2011).




APPENDIX C ANALYSIS OF BIRTH CERTIFICATE DATA FOR INFANTS BORN TO TEEN MOTHERS LIVING IN SHELBY COUNTY, TENNESSEE The following section is based on analyses of the 2009 linked birth-death records for babies born in Shelby County, conducted by the Center for Community Building and Neighborhood Action. In 2009, 14,407 infants were born to mothers living in Shelby County, Tennessee. This was down from 15,045 in 2008, a 4% decrease. Of all the babies born in Shelby County in 2009, 15%, or 2,181 were born to women under the age of 20. Out of 14,407 infants born in 2009, 171 died, giving us a county wide infant mortality rate of almost 12 per 1,000 births, about the same as in 2008 and almost double the national rate for 20091, reinforcing the perception of Shelby County as a location with unusually high incidences of infant mortality.

Births to Teen Mothers in 2009

In 2008, Tennessee ranked in the top ten of states with the highest teen birth rates. The rates were even higher in Shelby County both then and in 2009. For 2009, Shelby County reported 36.7 births per 1,000 women aged 15-17, and 107.8 births per 1,000 women aged 18 and 19 This compares with state rates of 24.0 for women aged 15 to 17 and 85.9 for women aged 18 and 19.2 Nationally, there was a decrease in the number of teen births from 2008 to 2009. Shelby County also experienced decreasing numbers of teen births, with births to mothers 17 and under decreasing by 8%, and births to all mothers 19 and under decreasing by 6% between 2008 and 2009.

Birth Rate per 1,000 Women 107.8

18-19

85.9

Age

Shelby TN

36.7

15-17

24

0

20

40

60

80

100

120

1HEALTH2 Infant mortality: Death rates among infants by detailed race and Hispanic origin of mother, 1983–1991 and 1995–2009, http://www. childstats.gov/americaschildren/tables/health2.asp?popup=true#b, accessed 1/2/2012. 2Selected Data on Teenage Pregnancies, Resident Data, Tennessee Division of Health Statistics, http://health.state.tn.us/statistics/PdfFiles/VS_ Rate_Sheets_2009/Births15-1709.pdf, http://health.state.tn.us/statistics/PdfFiles/VS_Rate_Sheets_2009/Births18-1909.pdf.




Births by Age Category, Shelby County, Comparing 2008 and 2009 Age Category

2008 Total Births

2009 Total Births

% Difference

Under 15

50

34

-32%

15 to 17

800

744

-7%

17 and under

850

778

-8%

18 and 19

1,476

1,403

-5%

19 and under

2,326

2,181

-6%

20 to 24

4,373

4,243

-3%

25 to 29

4,006

3,817

-5%

30 to 34

2,741

2,646

-3%

35 to 39

1,269

1,245

-2%

40 and over

235

275

17%

Total all ages

14,950

14,407

-4%

History of Previous Births. The number of teen births to mothers who have previously given birth

was 11% of mothers under 17. This percentage jumps to 30% for the mothers between the ages of 18 and 19. This compares to 9% of mothers under 17, and 23% for mothers between the ages of 18 and 19 in the state of Tennessee.

Previous Births by Age of Mother in Shelby County 25

Age

20-24 7

18-19

0

2 or More Previous Live Births

23


1

17 and under

32

10 10

20

30

40

Precentage




Previous Births by Age of Mother, Shelby County, 2009 Age Category Under 15*

No Previous Live Births


More Than 1 Previous Live Birth

Total Births

33

1

0

34

15 to 17

88%

10%

1%

744

17 and under

89%

10%

1%

778

18 and 19

70%

23%

7%

1,403

19 and under

77%

19

5%

2,181

20 to 24

43%

32%

25%

4,243

Total all ages

39%

29%

32%

14,407

*Raw numbers are reported for this age group due to the small total.

Demographic Characteristics of Teen Mothers

Race/Ethnicity. Eighty-one percent of mothers under the age of 20 in Shelby County in 2009 were African American, 10% were Hispanic, 8% were white, and about 1% were Asian or Pacific Islander. Less than one percent would fall into the category of ‘other’. Thirty-six percent of those infants born to mothers under the age of 20 were born to very young mothers 17 or under.

Race and Ethnicity of Teen Mothers 8%

1%

10% Black/AA Hispanic White Asian/PI 81%




Race and Ethnicity of Mother by Age Categories, Shelby County, 2009 Age Category Under 15*

Black or AA

White

Hispanic

Asian/PI

Total Births

27

1

6

0

34

15 to 17

82%

6%

11%

1%

744

17 and under

82%

6%

12%

1%

778

18 and 19

81%

10%

8%

1%

1,403

19 and under

81%

8%

10%

1%

2,181

Total all ages

60%

26%

11%

3%

14,407


Age of Baby’s Father. When available, birth certificate data includes the age of the father. For the 776

unmarried Shelby County women under the age of 18, only 238, or 31% reported the age of the father. Of these 238 women, 21% would fall under the legal definition of victims of statutory rape (sex with girl aged 13-14 with man who is 4 or more years older; sex with girl aged 15-17 with a man who is 5 or more years older) in the state of Tennessee.3 Income Level. Teen mothers report very low incomes: 78% with household incomes less than

$10,000 per year. Eighty-six percent of mothers under age 20 give birth under TennCare. Teens are also more likely to be receiving WIC benefits, although the percent enrolled in WIC is about 10% less than those reporting TennCare as the method of payment. Income Status Indicators by Age Categories, Shelby County, 2009 Age Category Under 15*

Less Than 10,000

Less Than 25,000

Medicaid/ Teen Care

Private Insurance

Self-Pay

WIC

Total Births

15

20

27

4

2

24

34

15 to 17

78%

92%

85%

10%

5%

73%

744

17 and under

78%

92%

84%

10%

5%

73%

778

18 and 19

78%

94%

87%

8%

4%

67%

1,403

19 and under

78%

93%

86%

9%

4%

69%

2,181

Total all ages

48%

63%

60%

34%

6%

48%

14,407

*Raw numbers are reported for this age group due to the small total

Educational Level. Teen mothers are highly unlikely to have completed high school. Of more concern

are the challenges these young women will face in completing their education after having a child. If we look at the cohort of Shelby County women giving birth between the ages of 20 and 24 in 2009, we find that 83% who did not report any previous births had at least finished high school. For those with one previous birth, 70% had at least a high school diploma or GED. For those women with two or more previous births in this age range, only 52% had achieved that level of education.

3Tennessee Compilation of Selected Laws on Children, Youth and Families, 2011 Edition, Tennessee Code Annotated, Title 39 Criminal Offenses, Chapter 13 Offenses Against Person, Part 5 Sexual Offenses, 39-13-506. Statutory rape. http://www.state.tn.us/tccy/tnchild/39/39-13-506.htm, accessed 2/2/2012.




Education Status of Mother by Age Categories, Shelby County, 2009 Age Category

No HS Diploma

Under 15*

HS Grad or GED

Post HS Ed

Total Births

34

0

0

34

15 to 17

94%

6%

0%

744

17 and under

94%

6%

0%

778

18 and 19

45%

40%

14%

1,403

19 and under

94%

6%

9%

2,181

20 to 24

29%

36%

35%

4,243

25 to 29

21%

23%

56%

3,817

30 to 34

15%

17%

68%

2,646

35 to 39

15%

14%

70%

1,245

40 and over

18%

16%

66%

275

Total all ages

28%

25%

46%

14,407

*Raw numbers are reported for this age group due to the small total

Medical Risk Factors

Infant Mortality. In 2009, infant mortality rates were slightly higher for mothers ages 18 and 19 (13

per 1,000 births) than for mothers between the ages 15 to 17 (11 per 1,000). The small number of births to mothers aged 15 and under make comparisons in this group difficult and invalidate the robustness of calculated rates and percentages for this subset of births. In 2009, there was only 1 infant death to the 34 young women in this age group.

Infant Mortality per 1000 births

Infant Mortality Rate by Age 16 14 12

11.6

13.6

12.8 10.6

14.5

14.5

35-39

40 and over

9.4

10 8 6 4 2 0 17 and under

18-19

20-24

25-29

30-34

Age of Mother




Infant Mortality by Age Category, Shelby County, Comparing 2008 and 2009 Age Category

2008 Total Births

2009 Total Births

% Difference

2008 Infant Deaths

2009 Infant Deaths

2008 IM Rate

2009 IM Rate

Under 15

50

34

-32%

0

1

--

--

15 to 17

80

744

-7%

20

8

25

11

17 and under

850

778

-8%

20

9

24

12

18 and 19

1,476

1,403

-5%

24

18

16

13

19 and under

2,326

2,181

-6%

44

27

19

12

20 to 24

4,373

4,243

-3%

50

45

11

11

25 to 29

4,006

3,817

-3%

42

52

10

14

30 to 34

2,741

2,646

-4%

21

25

8

9

35 to 39

1,269

1,245

-2%

16

18

13

14

40 and over

235

275

17%

7

4

30

15

Total all ages

14,950

14,407

-4%

180

171

12

12

Prematurity and Low Birth Weight. Births to teen mothers were only slightly more likely to be

premature or of low birth weight than infants born to mothers aged twenty or above. Fetal Maturity and Birth Weight by Age of Mother, Shelby County, 2009 Age Category

Under 15*

Mature

PreMature

Very PreMature

Extremely Premature

High Birth Weight

Normal Birth Weight

Low Birth Weight

30

3

1

0

1

29

4

15 to 17

88%

8%

3%

1%

3%

86%

11%

17 and under

88%

8%

3%

1%

3%

86%

11%

18 and 19

88%

8%

3%

1%

2%

86%

12%

19 and under

88%

8%

3%

1%

3%

86%

12%

20 to 24

86%

10%

3%

1%

4%

84%

12%

25 to 29

87%

8%

3%

2%

6%

84%

10%

30 to 34

87%

8%

3%

1%

8%

81%

11%

35 to 39

85%

10%

4%

1%

8%

80%

12%

40 and over

81%

16%

2%

0%

11%

79%

10%

Total all ages

87%

10%

3%

1%

5%

83%

11%


Obesity. Obesity is a variable related to age in Shelby County. The older the mother is, the more

likely she is to be overweight. Although teens were less likely than their older counterparts to be overweight or obese, one third were overweight or obese according to pre-pregnancy BMIs measurements. This compares to almost 50% for young women aged 20 to 24. Obesity is of particular concern as it has been identified as a risk factor for infant mortality in Shelby County.




Obesity by Age of Mother 70

64

60

57

Percentage

50

45

46

44

43

40 30 20 10

9

17 10

25 24

21 15 7

6

25

28 24

27

26

40 30 26

29

Underweight Normal Overweight

3

4

4

2

Obese

0 17 and 18-19 20-24 25-29 30-34 35-39 40 and under over Age

Pre-Pregnancy BMI Groupings by Age Categories, Shelby County, 2009 Age Category

Underweight

Normal

1

21

9

11

15 to 17

9%

64%

16%

11%

17 and under

9%

64%

17%

10%

18 and 19

7%

57%

21%

15%

19 and under

8%

59%

19%

14%

20 to 24

6%

45%

24%

5%

25 to 29

4%

44%

25%

27%

30 to 34

3%

46%

24%

28%

35 to 39

2%

43%

26%

29%

40 and over

4%

40%

26%

30%

Total all ages

5%

47%

24%

25%

Under 15*

Overweight

Obese


Being overweight is also related to race, with 25% of white mothers, 35% of African American mothers, and 26% of Hispanic mothers 19 and under being obese or overweight.




Percentage

Obesity of Teen Mothers by Race 45 40 35 30 25 20 15 10 5 0

39 28

32

30 23 18

Black/AA White Hispanic

17 and under

18-19 Age

Overweight and Obese Mothers by Race/Ethnicity, Shelby County, 2009 Age Category

Percent Overweight or Obese African American

White

Hispanic

Asian

17 and under

28%

30%

18%

*

18 and 19

39%

23%

32%

*

19 and under

35%

25%

26%

*

20 to 24

52%

42%

39%

*

25 to 29

63%

37%

50%

*

30 to 34

70%

34%

58%

*

35 to 39

75%

40%

53%

*

40 and over

76%

40%

*

*

Total all ages

55%

37%

67%

23%

Sexually Transmitted Infections. Teen mothers stand out in having high rates of sexually transmitted

infections.4 In Shelby County, the younger the mother, the higher the percentage of births to infected mothers. Among mothers 17 and under, 21% had a sexually transmitted infection during pregnancy, and among mothers 19 and under, 18% had a sexually transmitted infection during pregnancy.

4In our data, we coded a positive for STD infection if the data indicated the mother had Gonorrhea, syphilis, herpes simplex, Chlamydia, hepatitis B, or hepatitis C. Hepatitis C is often, but not always contacted sexually and may be considered by some to not be a “STD”.




The most common infection in 2009 was Chlamydia, with a total of 799 or 6% of all births affected. The rates for teen mothers were much higher than for mothers over 20. Herpes simplex, the next most common sexually transmitted disease, affected older mothers at a higher rate than teens. Only 2% of births to teen mothers were affected by herpes. For Shelby County mothers 20 to 24, 2% of births were affected, 3% for births to mothers 25-34, and 4% for mothers 35 and above.

Chlamydia by Age 35 and over

1

30-34

1

Age

25-29

3

20-24

7

18-19

15

17 and under

18 0

5

10

15

20

Percentage

Births to Mothers with Chlamydia by Age of Mother, Shelby County, 2009 Age Category

Number of Births Affected

Number of Births Affected

15 to 17

136

18%

17 and under

141

18%

18 and 19

207

15%

19 and under

348

16%

20 to 24

306

7%

25 to 29

106

3%

30 to 34

25

1%

35 to 39

13

1%

40 and over

1