Family Planning

Healthy Kansans 2010

Steering Committee Meeting

April 1, 2005

Sharp Declines in Teen Pregnancy Rates

U.S. overall 30% decrease in last 10 years

Kansas 1994-2003

Age 10-19, all races – 24.1% decrease

Age 10-17, all races – 34.0% decrease

Age 10-19, A-A - 42.5% decrease

Teen Pregnancy Rates by Race/EthnicityKansas, 1994-2003

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Rate

White 37.2 36.5 35.2 32.9 30.5 28.6 29.1 28.0 26.2 23.9

A-A 108.3 99.8 85.2 90.5 71.1 73.8 62.8 63.0 53.0 56.0

Hispanic 75.0 78.4 82.4 77.0 73.1 77.7 74.3 70.3 67.9 65.9

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Per 1000 age-specific population

Teen = ages 15-17Pregnancy = livebirths, fetal deaths, abortions

Data Sources: Center for Health & Environmental Statistics, Kansas Department of Health & Environment

Teen Pregnancy

• 1998 cross over effect for A-A and Hispanic TP rates has continued

• African-American TPR still 2.34 x white TPR and Hispanic TPR 2.75 x white TPR

• HP 2010 Goal – 43.0 / 1000 LB; Kansas 2003 26.6

Activities/Best Practices

• Communities with high TP rates

• Prevention projects – community/school education; peer education; case management

• A-A TP in Sedgwick; HTP in SW Kansas

• Comprehensive School Health Education

• Youth development focus

National Campaign to Prevent TP

• No Easy Answers 1997; Emerging Answers 2001; Another Chance 2004

• Switch focus to 2nd births to teen mothers

• 25% of teen mothers - 2nd birth before age 20

• Goal: reduce % of 2nd teen births to <20%

Best Practices

• Close, sustained relationship with teen• Initiate in PG, continue to age 2 for child & age 18 for

mother• Personnel with training and authority to address

complexities of FP, domestic violence, etc• Avoid group ed and counseling; indiv. attention

– Emphasis on contraceptive education• Encourage education & economic self-sufficiency• Provide child care• Encourage living with parents and not boyfriend

Unintended Pregnancy

• 50-60% of pregnancies (mistimed, unwanted)• Occur in all segments of society• Less likely to seek early PNC, to BF• More likely to expose fetus to noxious subst.• High risk of LBW & complications• ½ end in abortion

E s t . U n in t e n d e d P r e g n a n c y in W o m e n A g e s 1 8 - 4 4 , K a n s a s

U n w a n t e d = s e l f - r e p o r t s s h e d id n o t w a n t t o e v e r b e p r e g n a n tM is t im e d p r e g n a n c y = s e l f - r e p o r t s s h e w a n te d t o b e p r e g n a n t la t e rU n in te n d e d = u n w a n te d + m is t im e d

D a t a S o u r c e s : 1 9 9 8 - B e h a v io r a l R is k F a c t o r S u r v e i l la n c e S y s t e m , K a n s a s D e p a r t m e n t o f H e a lt h a n d E n v i r o n m e n t2 0 0 3 , 2 0 0 4 – W o m e n ’s H e a lt h S u r v e y , K a n s a s D e p a r t m e n t o f H e a lt h & E n v i r o n m e n t

1 1 .11 3 .6

1 5 .3

1 9 .2

2 6 .4

3 2 .8

0

5

1 0

1 5

2 0

2 5

3 0

3 5

1 9 9 8 2 0 0 3 - 2 0 0 4

Ra

te U n w a n te d P r e g n a n c y

M i s t i m e d P r e g n a n c y

U n i n te n d e d P r e g n a n c y

P e r 1 0 0 w o m e n a g e s 1 8 - 4 4

Unintended Pregnancy

• HP 2010 Goal:

• decrease unintended preg. to 30%

• 9:10 women at risk not using contraception

Best Practices

• Initiate PRAMS or similar surveillance

• Improve access to health care in reproductive years

• Increase knowledge about reproductive health & contraceptive use

• Improve access to more highly effective methods (also more expensive)

PPOR Approach/Best Practice

• Used in developing countries to target resources• Simple approach • Strong conceptual basis • ID gaps (excess mortality)• Mobilize community to action • Target resources - prioritize prevention efforts• Establish on-going surveillance

Perinatal Periods of Risk AnalysisKansas, 1999 through 2003

Numerator = Number of fetal and infant deathsDenominator = Number of live births + fetal deaths Excludes: fetal deaths before 24 weeks, under 500 g; LB less than 500 g; abortionsMethod of Analysis Source: CityMatchData Sources: Center for Health & Environmental Statistics, Kansas Department of Health & Environment

3.2*

2.0* 1.5* 2.0*

*rate per 1,000 population

August 2003

From Data to Potential Action

Maternal Maternal Health/ Health/

PrematurityPrematurity

Maternal Maternal CareCare

Newborn Newborn CareCare

Infant Infant HealthHealth

Preconceptional Health Health Behaviors Perinatal Care

Prenatal Care High Risk Referral Obstetric Care

Perinatal Management Neonatal Care Pediatric Surgery

Sleep Position Breast Feeding Injury Prevention

Recommendations

• Initiate state perinatal surveillance (PRAMS, PPOR)– partnership Kansas Perinatal Council

• Support local perinatal surveillance (PPOR, FIMR)– Sedgwick federal Healthy Start Program– Wyandotte – Dr. Jim Guillory

• Focus efforts on area of excess mortality – preconceptional health (women’s health care,

family planning, smoking cessation)– health behaviors prior to pregnancy

Linda KenneyBureau for Children, Youth and Families785-296-1310Lkenney@kdhe.state.ks.us

Ref: PPOR www.CityMatCH.org