Special Health Conditions: Adolescent Pregnancy

Recent data (2011, 2008) reflects that Texas ranks 3rd of 51 (50 states and the District of Columbia) in pregnancies among women aged 15-19, and 5th of 51 in births to teens aged 15-19. At 46.9 births per 1000, the Texas birth rate to women aged 15-19 exceeds the U.S. rate of 31.3. Similarly, the Texas birth rate to teens 15-17 exceeds the U.S. rate (25.6 compared to 15.4) (http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/states/tx.html).

For identified pregnant students, the goal of school-based nursing case management services is to support a healthy pregnancy to full term delivery, followed by the continuation of the teen mother in school.  Pregnancy-related case management services include regularly scheduled contacts with the student to provide pregnancy education and support, linkage to a primary provider, public health insurance and social service referrals as needed, school attendance monitoring, communication with the provider as needed, infant care education and infant immunization support.

A Program of Children’s Health Express

A Health Resources and Services Administration (HRSA) grant has allowed the Children’s Health Express mobile health clinic (CHE) to provide medical and social work services to pregnant/parenting students at 3 high need high schools. Students and their children were assisted in obtaining well child, pediatric, WIC, Medicaid and related care without needing to travel, reducing out of school time. Goals for the program have been to increase the graduation rate among pregnant/parenting students and to increase immunization rates for their infants. The CHE program provided 223 well care and acute care visits to 30 pregnant/parenting students and 66 of their children during SY 2011-12. 76% of the visits were for the children of AISD students. Of the child visits, 78% were for an ill child. Maternal depression screening is an aspect of the service model, with service referral for those in need. Having access to CHE reduced the lost school time for parenting students, increasing the likelihood that they will complete high school. The CHE mobile clinic is the primary provider for 63% of those served in this program. Resources to sustain the program are being sought with the expiration of the HRSA grant.

2012-2013-chart-26

A previously identified pregnant student is one who is identified in one school year and returns to school the following term, continuing pregnancy related services. A newly identified pregnant student is one who is identified during the current school year. The number of reported student pregnancies increased steadily from SY 2005-06 through SY 2010-11. The decline in reported pregnancies begun in SY 2011-12 continued in SY 2012-13, with 343 newly diagnosed student pregnancies.

2012-2013-chart-27

While the decline in student pregnancies is an encouraging trend, an area of concern is the multiyear increase in students whose pregnancy is not identified until the third trimester, and declining identification in the first trimester. Delays in identification may also reflect delays in access to adequate medical care to help insure a safe, healthy delivery.

2012-2013-chart-28

There were 22 confirmed Middle School pregnancies in SY 2012-13. Pregnancies among middle school students were identified on 13 campuses, indicating that middle school pregnancy is an infrequent, but wide spread phenomenon in AISD.

2012-2013-chart-29

Pregnancy outcomes were available for 145 students by the end of the school year. In SY 2012-13, for those students whose outcomes could be identified, 80.7% of student pregnancies resulted in full term deliveries, an increase from 67.2% in the prior year. Still, 9.7% of student births were preterm, an area of concern.

2012-2013-chart-30

School outcomes for pregnant/parenting students could be identified for 175 students in SY 2012-13. Of these, 116 (66.3%) of students were known to have returned to school or graduated post-pregnancy. An additional 50 students withdrew from school; fewer than 6 did not return to school.

2012-2013-chart-31

Two Programs of AISD: Human Sexuality Curriculum and REAL Talk

The AISD health education curriculum which is comprehensive, taught K-12, is aligned with best practices and age appropriate. The District’s human sexuality curriculum teaches abstinence as the preferred method to prevent unintended pregnancy and sexually transmitted diseases. In addition to promoting abstinence, the curriculum educates students on goal setting, emotional supports, risk reduction, and addressing peer pressure in an effort to prevent pregnancy and sexually transmitted infections/diseases (STDs). The AISD high school human sexuality curriculum can be found athttp://www.austinschools.org/curriculum/pe_health/hs/health/big_decisions.html.

In addition to the comprehensive health curriculum, the grant-funded evidence-based program Risk Reduction Education for Adolescent Life (REAL Talk) constitutes an additional key effort to prevent adolescent pregnancy in AISD schools. There is a significant need within Austin ISD and Travis County to address the high rates of teen pregnancies and rates of sexually transmitted infections among our adolescent population through increased sexual health education for adolescents and their parents. Middle school and high school campuses with the highest rates of teen pregnancies are targeted, and parental consent is required for participation in REAL Talk. Parent involvement activities, service learning projects, and individual mentoring are provided to participants. The outcome goals of the AISD REAL Talk program include increased knowledge of issues relevant to sexual health and decision-making. Additional areas that could be assessed, with district approval, include changes in sexual behavior, changes in high risk behavior, and changes in intention (e.g. to delay initiation of sexual activity).