Division of Reproductive HealthOffice of the Director

CDC’s Winnable Battle

CDC Health Officer OrientationMay 13, 2015

Lisa M. Romero, DrPH, MPHHealth Scientist

Objectives

Describe the burden of teen pregnancy in the United States

Describe why teen pregnancy is a Winnable Battle

Describe the Teen Pregnancy Winnable Battle priority areas

Illustrate selected activities for each of the 5 priority areas

Teen pregnancy

200020012002200320042005200620072008200920102011201220130

10

20

30

40

50

60

70

80

90

100

Ra

te p

er

1,0

00

wo

me

n a

ge

d 1

5-1

9 y

ea

rs

16.3

26.5

Teen pregnancy, induced abortion, and birth rates, United States, 2000–2013

65.3

Teen pregnancy rate

Teen birth rate

Teen abortion rate

1. Pregnancy, abortion and birth rates 2000-2008: Ventura SJ, Curtin SC, Abma JC. Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008. National Vital Statistics Reports, 2012;60(7). Table 2.

2. Pregnancy and abortion rates 2009:Curtin SC, Abma JC, Ventura SJ, Henshaw SK. Pregnancy rates for U.S. women continue to drop. NCHS data brief, no 136. Hyattsville, MD: National Center for Health Statistics. 2013.

3. Birth rates 2009: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National Vital Statistics Reports, 2011;60(2). Table S-2.4. Birth rates 2010–2011: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2011. National Vital Statistics Reports, 2012;61(5). Table 2.5. Birth rates 2013: Hamilton, B., Martin, J., Osterman, M., Curtin, S. Births: Preliminary Data for 2013. National Vital Statistics Reports. Vol. 63, No. 2. May 29, 2014.

Teen birth rates lowest in Northeast, upper Midwest, upper Northwest, and highest in

South, 2013

www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf (page 37)

Progress in teen pregnancy

“Teen pregnancy and childbirth continue existing cycles of social, economic and educational disadvantages in our nation’s communities. This is why CDC has identified Teen Pregnancy Prevention as a Winnable Battle for public health programs. Together with our partners, we can reduce teen pregnancy and childbirth rates in this country.”

– Thomas R. Frieden, MD, MPHDirector, Centers for Disease Control and Prevention

Administrator, Agency for Toxic Substances and Disease Registry

What CDC is Doing To Prevent Teen

Pregnancy?Five Priority Actions:

1. Support community-wide, multi-component approaches to teen pregnancy prevention

2. Strengthen effective clinical interventions and promote the use of highly effective contraceptive methods

3. Support the teen pregnancy prevention efforts of state and local MCH governments and agencies

4. Support systems change

5. Expand the analytic agenda

Support the integration of services, programs, and strategies through community-wide teen pregnancy

prevention initiatives Mobilize communities to support and sustain teen pregnancy

prevention efforts Educate key stakeholders about the need for evidence-based

teen pregnancy prevention efforts Implement evidence-based teen pregnancy prevention

programs Increase youth access to reproductive health services Assure the reproductive health needs of diverse youth are met

http://www.cdc.gov/teenpregnancy/preventteenpreg.htm

Increase access to and use of the most effective contraceptive methods by sexually active teens

Educate providers on the recommendations for Providing Quality Family Planning Services (QFP) • Define what services should be offered in a family planning visit and

describe how to do so

Provide quality contraceptive counseling to teens• Use a tiered approach, describing the most effective methods first

Long acting reversible contraceptives (LARC) [i.e., hormonal implant and intrauterine device (IUD)

• Work with the teen client to help them choose the most effective and appropriate contraceptive method that best meets their individual needs• Educate providers that LARC methods are safe and effective for all women, including teens

http://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf

Increase access to and use of the most effective contraceptive methods by sexually active teens

Educate providers on the U.S. Medical Eligibility Criteria (MEC) for Contraceptive Use• Guidance for which contraceptive methods can be used safely by women with

certain characteristics and medical conditions Most teens can safely use all methods of contraception, including IUDs & implants

Educate providers on the U.S. Selected Practice Recommendations (SPR) for Contraceptive Use• Guidance for health care providers on common, yet complex issues in

management of contraception Quick Start - starting a woman on contraception on the same day as her visit Few exams or tests needed before starting contraception

http://www.who.int/reproductivehealth/publications/family_planning/9241562846index/en/index.htmlhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_w;

12

Few teens use the most effective types of birth control

Barriers to use of LARC• Teens

Know very little about LARC Mistakenly think they cannot use because of age

• Health Providers High upfront costs for supplies often not fully reimbursed Misplaced concerns about safety/ appropriateness of IUDs Lack training on insertion and removal

Address barriers to LARC• Educate providers LARC is medically safe for teens• Train providers• Provide contraception at no or reduced cost to the client

Increase access to and use of Long Acting Reversible Contraceptives (LARC)

Support other state and local Teen Pregnancy Prevention

Efforts

Needs assessment of states:• Teen Pregnancy Prevention funding• Teen Pregnancy Prevention as a state priority• Future needs

Disseminate evidence-based guidance and best practices

Partner with MCH departments, schools, other youth-serving agencies

Activities – webinars, direct training and TA, maintain website with key resources, etc.

Support Systems Change

Expand eligibility for Medicaid family planning services to the income eligibility level for pregnancy-related services and to include women < 18 years• Increase access to contraceptive services to low and no-income

women• Decrease pregnancy and births among teens• Save money for state and federal governments

A good investment: For every public dollar spent on family planning services, nearly $4 in public expenditures is saved

Source: Prevention Status Report on Teen Pregnancy http://www.cdc.gov/psr/teenpregnancy/

Expand the analytic agenda

• Vital Signs on Teen Pregnancy

• PRAMS data as unique source of data on teen childbearing

• Health consequences of short inter-pregnancy intervals in teens

• Systematic review of the consequences of teen pregnancy

• Cost-effectiveness of providing LARC immediately postpartum

• Intervention research (dual protection, contraceptive counseling in HIV+ teens)

• Many other important questions…

SummaryHow states can support the TPWB Priority Actions:

Integrate services, programs, and strategies through community-wide efforts

Use evidence-based guidance to improve teens’ access to contraception and the quality of services provided

Educate providers LARC is safe and effective for teens Increase access to contraceptive services to low and no-income

women by systems change Continue to ask “why” and “how” questions to improve teen

pregnancy prevention efforts

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Chronic Disease Prevention and Health Promotion

Division of Reproductive Health, Office of the Director

www.cdc.gov/teenpregnancy