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).

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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 5 high need high schools. Children’s Health Express is concluding its fifth year of partnership with the Austin Independent School District serving pregnant and parenting (PEP) students. This signature program is providing a campus-based medical home for PEP students and their children by sending the Dell Children’s Health Express (CHE) Mobile Health Unit to Reagan, Travis, Eastside Memorial/International, Lanier, and LBJ High Schools. The goals are two-fold: to improve health outcomes for the PEP students and their children while reducing unexcused school absences for the students. 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. Maternal depression screening is an aspect of the service model, with service referral for those in need. A total of 1015 patient visits have been provided to 336 PEP students and their children over the past five years of the program. Children’s Health Express has committed to sustaining this program.

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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 reversed slightly in SY 2014-15.

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Pregnancies among middle school students reversed a four year declining pattern in SY 2014-15.

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The performance benchmark has been that 50% of pregnant students will be identified in their first trimester, and declined slightly in SY 2014-15. This has been challenging to achieve. While the general decline in student pregnancies is an encouraging trend, an area of concern has been the multiyear increase in students whose pregnancy is not identified until the third trimester. Delays in identification may also reflect delays in access to adequate medical care to help insure a safe, healthy delivery.

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School outcomes were available for 70 pregnant students by the end of the school year, and birth outcomes were available for 84 students. It is possible that a pregnant student could have graduated before giving birth, which helps to explain the discrepancy in outcome information. In SY 2014-15, for those students whose outcomes could be identified, 77.4% of student pregnancies resulted in full term deliveries. Preterm births have been declining from the peak of 11.3% in SY 2011-12. Preterm is defined as birth prior to 38 weeks gestation. In SY 2014-15 4.8% of student births were preterm.

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School outcomes for pregnant/parenting students could be identified for 130 students in SY 2013-14, but only 70 students in SY 2014-15. Of these, 92.9% of students were known to have returned to school or graduated post-pregnancy.

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Austin and Travis high schools have seen significant reductions in student pregnancies over a three year period, while Crockett has seen a significant increase.

The AISD health education curriculum 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 federally grant-funded, evidence-based program Risk Reduction Education for Adolescent Life (REAL Talk) supplemented AISD’s comprehensive health curriculum from SY 2012-13 to SY 2013-14 as an additional key effort to prevent adolescent pregnancy 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. The grant ended in September, 2014 without continuation or expansion.