Editing Teenage pregnancy (section)

==Prevention==
Comprehensive [[sex education]] and access to [[birth control]] appear to reduce unplanned teenage pregnancy.<ref name=":0">{{cite journal |last1=Oringanje |first1=Chioma |last2=Meremikwu |first2=Martin M |last3=Eko |first3=Hokehe |last4=Esu |first4=Ekpereonne |last5=Meremikwu |first5=Anne |last6=Ehiri |first6=John E |title=Interventions for preventing unintended pregnancies among adolescents |journal=Cochrane Database of Systematic Reviews |date=3 February 2016 |volume=2016 |issue=2 |pages=CD005215 |doi=10.1002/14651858.CD005215.pub3 |pmid=26839116 |pmc=8730506 }}</ref> It is unclear which type of intervention is most effective.<ref name=":0" />

In the US free access to a [[Long-acting reversible contraception|long acting form of reversible birth control]] along with education decreased the rates of teen pregnancies by around 80% and the rate of abortions by more than 75%.<ref>{{cite journal|last1=Secura|first1=Gina M.|last2=Madden|first2=Tessa|last3=McNicholas|first3=Colleen|last4=Mullersman|first4=Jennifer|last5=Buckel|first5=Christina M.|last6=Zhao|first6=Qiuhong|last7=Peipert|first7=Jeffrey F.|title=Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy|journal=New England Journal of Medicine|date=2 October 2014|volume=371|issue=14|pages=1316–1323|doi=10.1056/NEJMoa1400506|pmid=25271604|pmc=4230891}}</ref> Currently there are four federal programs aimed at preventing teenage pregnancy: Teen Pregnancy Prevention (TPP), Personal Responsibility Education Program (PREP), Title V Sexual Risk Avoidance Education, and Sexual Risk Avoidance Education.<ref>{{cite book|last1=Fernandes-Alcantara|first1=Adrienne L.|title=Teen Pregnancy: Federal Prevention Programs|date=30 April 2018|publisher=Congressional Research Service|location=Washington, DC|url=https://fas.org/sgp/crs/misc/R45183.pdf|access-date=5 May 2018}}</ref>

===Education===
The Dutch approach to preventing teenage pregnancy has often been seen as a model by other countries. The curriculum focuses on values, attitudes, communication and negotiation skills, as well as biological aspects of reproduction. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach.<ref name=dutchmodel>{{cite journal|author=Valk, Guus|url=http://unesdoc.unesco.org/images/0012/001201/120152e.pdf|title= The Dutch Model|journal=The UNESCO Courier|volume=53|issue=7|page=19|date=July 2000|access-date= 3 July 2011}}</ref>

In the United States 2016, 39 states and the District of Columbia out of the 50 states required some form of sex education of HIV education.<ref name="Sex and HIV Education">{{Cite web|date=14 March 2016|title=Sex and HIV Education|url=https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education|access-date=21 October 2020|website=Guttmacher Institute|language=en}}</ref> Out of these 39 states and the District of Columbia, 17 states require that the sexual education provided be medically accurate, and 3 states prohibit a program from promoting sexual education in a religious way. These three states include California, Colorado, and Louisiana. 19 of those 39 states stress the importance of only having sex when in a committed marriage.<ref name="Sex and HIV Education"/>

From this data, 11 states currently have no requirement for sexual education for any years of schooling, meaning these 11 states may have no sexual education at all. This could mean these states are allowed to teach sexual education in any way they would like, including in medically inaccurate ways. This point is also valid for those 22 states that do not require sexual education to be medically accurate. Comprehensive sexual education has been proven to work to reduce the risk of teen pregnancies.<ref name="Sexuality Education">{{Cite web|title=Sexuality Education|url=https://advocatesforyouth.org/resources/fact-sheets/sexuality-education-2/|access-date=21 October 2020|website=Advocates for Youth|language=en}}</ref>

Without a nationwide mandate for medically accurate programs, teenagers in the United States are at risk for missing out on valuable information that can protect them. It is unfair to expect teenagers to make educated decisions about sex that can lead to teen pregnancy when they have never been properly educated about the issue. A program developed by experts in public health and sexual education titled ''National Sexuality Education Standards,'' is a valuable resource that describes what the minimum requirements of sexual education should be across the nation.<ref name="Sexuality Education"/> Giving teenagers the tools that are outlined in that roadmap would have positive effects, as it gives teenagers the resources to make educated decisions. Currently, there is not a national implementation of this program in the United States.

Teen pregnancy can be reduced by sex education, as a 2022 study in 55 US [[County (United States)|counties]] showed. The study used federal funded sex education programs as a proxy for sex education, but provided no details about funding levels, the number of students reached, or the amount of time spent on sex education. The reduction of teenage births, not pregnancy, was significant, with a 3% reduction, indicating that an increase in funding, education, or reach could decrease teenage pregnancy even further.<ref>{{Cite journal|last1=Mark|first1=Nicholas D. E.|last2=Wu|first2=Lawrence L.|date=22 February 2022|title=More comprehensive sex education reduced teen births: Quasi-experimental evidence|journal=Proceedings of the National Academy of Sciences|language=en|volume=119|issue=8|pages=e2113144119|doi=10.1073/pnas.2113144119|doi-access=free |issn=0027-8424|pmid=35165192|pmc=8872707|bibcode=2022PNAS..11913144M }}</ref> Although 3% sounds like a small number, given a teenage girl population of 10 million females aged 15–19 in 2020,<ref name=":2">{{Cite web|title=U.S. population by age and gender 2019|url=https://www.statista.com/statistics/241488/population-of-the-us-by-sex-and-age/|access-date=22 February 2022|website=Statista|language=en}}</ref> and ~190,000 teenage births per year, a 3% reduction would translate to about 6,000 prevented teenage births per year when extrapolated to the whole nation.

===Abstinence only education===
[[File:No Sex Signage in Ghana.jpg|thumb|A notice in [[Ghana]], promoting abstinence for the prevention of unplanned pregnancy and [[HIV/AIDS]], 2005]]

Some schools provide [[abstinence-only sex education]]. Evidence does not support the effectiveness of abstinence-only sex education.<ref name=Obs07>{{cite journal |last1=Ott |first1=Mary A |last2=Santelli |first2=John S |title=Abstinence and abstinence-only education |journal=Current Opinion in Obstetrics and Gynecology |date=October 2007 |volume=19 |issue=5 |pages=446–452 |doi=10.1097/GCO.0b013e3282efdc0b |pmid=17885460 |pmc=5913747 }}</ref> It has been found to be ineffective in decreasing [[HIV]] risk in the developed world,<ref name="Underhill2007">{{cite journal|last=Underhill|first=K|author2=Operario, D |author3=Montgomery, P |title=Abstinence-only programs for HIV infection prevention in high-income countries|journal=Cochrane Database of Systematic Reviews|date=17 October 2007|issue=4|pages=CD005421|pmid=17943855|doi=10.1002/14651858.CD005421.pub2|editor1-last=Operario|editor1-first=Don}}</ref> and does not decrease rates of [[unplanned pregnancy]] when compared to comprehensive sex education.<ref name="Obs07"/> It does not decrease the sexual activity rates of students, when compared to students who undertake comprehensive sexual education classes.<ref name=Kohler08>{{cite journal|last=Kohler|first=Pamela|author3=Manhart, Lisa|author2=Lafferty, William |title=Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy|journal=Journal of Adolescent Health|date=April 2008|volume=42|issue=4|pages=344–351|doi=10.1016/j.jadohealth.2007.08.026|pmid=18346659|s2cid=16986622 }}</ref>

===Assistance===
[[Nurse-Family Partnership]] (NFP) is a non-profit organization operating in the United States and the UK designed to serve the needs of young mothers who may have special needs in their first pregnancy.
Each mother served is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child's second birthday. NFP intervention has been associated with improvements in maternal health, child health, and economic security.<ref>{{cite web |title=Nurse-Family Partnership |url=https://evidencebasedprograms.org/programs/nurse-family-partnership/ |website=Social Programs that Work |access-date=4 December 2022}}</ref>

===Public policy===
====Canada====
In 2018, [[Quebec|Québec]]'s Institut national de santé publique (INSPQ) began implementing adjustments to the Protocole de contraception du Québec (Québec Contraception Protocol). The new protocol allows [[registered nurse]]s to prescribe hormonal birth control, an IUD or emergency birth control to women, as long as they comply with prescribed standards in the Prescription infirmière: Guide explicatif conjoint, and are properly trained in providing contraceptives. In 2020, Québec will offer online training to registered nurses, provided by the Ordre des infirmières et infirmiers du Québec (OIIQ). Nurses that do not have training in the areas of sexually transmitted and blood borne infections may have to take additional online courses provided by the INSPQ.<ref>Institut national de santé publique du Québec. 2018. [https://www.inspq.qc.ca/sites/default/files/publications/2409_protocole-contraception_quebec_fnl.pdf Protocole de contraception du Québec Mise à jour 2018].</ref>

==== United States ====
[[File:CDC Teenager Sex Stats 2015.png|thumb|upright=1.5|US statistics in April 2015]]
In the US, one policy initiative that has been used to increase rates of contraceptive use is [[Title X]]. Title X of the [[Family Planning Services and Population Research Act of 1970]] ({{USPL|91|572}}) provides family planning services for those who do not qualify for [[Medicaid]] by distributing "funding to a network of public, private, and nonprofit entities [to provide] services on a sliding scale based on income."<ref>{{cite web|last=The National Campaign to Prevent Teen and Unplanned Pregnancy|title=Policy Brief: Title X Plays a Critical Role in Preventing Unplanned Pregnancy|url=http://www.thenationalcampaign.org/resources/pdf/Briefly_PolicyBrief_TitleX.pdf|access-date=15 February 2011|url-status=dead|archive-url=https://web.archive.org/web/20110807191610/http://www.thenationalcampaign.org/resources/pdf/Briefly_PolicyBrief_TitleX.pdf|archive-date=7 August 2011}}</ref> Studies indicate that, internationally, success in reducing teen pregnancy rates is directly correlated with the kind of access that Title X provides: "What appears crucial to success is that adolescents know where they can go to obtain information and services, can get there easily and are assured of receiving confidential, nonjudgmental care, and that these services and contraceptive supplies are free or cost very little."<ref name="DJE" /> In addressing high rates of unplanned teen pregnancies, scholars agree that the problem must be confronted from both the biological and cultural contexts.

In September 2010, the [[United States Department of Health and Human Services|US Department of Health and Human Services]] approved $155 million in new funding for comprehensive sex education programs designed to prevent teenage pregnancy. The money is being awarded "to states, non-profit organizations, school districts, universities and others. These grants will support the replication of teen pregnancy prevention programs that have been shown to be effective through rigorous research as well as the testing of new, innovative approaches to combating teen pregnancy."<ref>{{cite web|last=U.S. Department of Health & Human Services|title=HHS Awards Evidence-based Teen Pregnancy Prevention Grants|url=https://www.hhs.gov/news/press/2010pres/09/20100930a.html|access-date=15 February 2011|url-status=dead|archive-url=https://web.archive.org/web/20110110070257/http://www.hhs.gov/news/press/2010pres/09/20100930a.html|archive-date=10 January 2011}}</ref> Of the total of $150 million, $55 million is funded by [[Patient Protection and Affordable Care Act|Affordable Care Act]] through the Personal Responsibility Education Program, which requires states receiving funding to incorporate lessons about both abstinence and contraception.

==== Developing countries ====
In the developing world, programs of reproductive health aimed at teenagers are often small scale and not centrally coordinated, although some countries such as [[Sri Lanka]] have a systematic policy framework for teaching about sex within schools.<ref name="escap" /> Non-governmental agencies such as the [[International Planned Parenthood Federation]] and [[Marie Stopes International]] provide contraceptive advice for young women worldwide. Laws against [[child marriage]] have reduced but not eliminated the practice. Improved female [[literacy]] and educational prospects have led to an increase in the age at first birth in areas such as [[Iran]], [[Indonesia]], and the Indian state of [[Kerala]].

===Other===
A team of researchers and educators in California have published a list of "best practices" in the prevention of teen pregnancy, which includes, in addition to the previously mentioned concepts, working to "instill a belief in a successful future", male involvement in the prevention process, and designing interventions that are culturally relevant.<ref name=joe>{{cite journal |author1=Fe Moncloa |author2=Marilyn Johns |author3=Elizabeth J. Gong |author4=Stephen Russell |author5=Faye Lee |author6=Estella West |year=2003 |url=http://www.joe.org/joe/2003april/tt1.php |title=Best Practices in Teen Pregnancy Prevention Practitioner Handbook |journal=Journal of Extension |volume=41 |issue=2 |access-date=3 December 2011 |archive-date=8 August 2020 |archive-url=https://web.archive.org/web/20200808044201/https://www.joe.org/joe/2003april/tt1.php |url-status=dead }}</ref>