t r o p e R May, 2008 y c n Trends in Teen a n Pregnancies g and e r P Their Outcomes n in Montana e e T Years 1991-2005 a n a t n o M Montana Department of Public Health and Human Services Public Health and Safety Division Family and Community Health Bureau Women’s and Men’s Health Section ACKNOWLEDGEMENTS In recognition of National Teen Pregnancy Prevention Month (May), this project was inspired and initiated by the staff of the Women’s and Men’s Health Section, serving Montana’s county health departments and family planning clinics in the arena of reproductive healthcare. Special thanks to Colleen Lindsay, Donci Bardash, Dianna Frick, Liz Johnson, Kimberly Koch, and Helen McCaffrey, who guided this project to completion. Thanks to numerous stakeholders who completed surveys on the content of this report, reviewed the document before its publication, and/or contributed profiles, including: Vicki Turner, Prevention Resource Center; Susan Court, Office of Public Instruction; Trudy Mizner, Missoula County; Angel Nordquist, Planned Parenthood of Montana; Jill Baker, Planned Parenthood of Montana; Drenda Carlson; Youth Connections; Commissioner Ed Tinsley, Lewis & Clark County; Barbara Burton, Florence Crittenton; Bethany Hemlock, Montana Wyoming Tribal Leaders Council; Elizabeth Flynn, Florence Crittenton; Cindy Ballew, Bridger Clinic; Laura Mentch, Unitarian Universalist Fellowship of Bozeman; Mary Noel, MT-DPHHS; Hank Hudson, MT- DPHHS; Cathy White MD, Malmstrom Air Force Base; Elizabeth Rink PhD., Montana State University; Stephanie Knisley, Big Brothers Big Sisters; Kelly Parsley, Carroll College; and Steve Helgerson MD, MPH, MT-DPHHS. The information contained in this report represents input from several professionals in other divisions of the Montana Department of Public Health and Human Services, as well as other state and federal agencies, and private nonprofit organizations. Special thanks to Susan Court of the Office of Public Instruction; Jackie Jandt of the Addictive and Mental Disorders Division; and, Bruce Schwartz and Cody Custis of the Office of Vital Statistics. Thanks to Dr. Douglas Kirby and the National Campaign to Prevent Teen and Unplanned Pregnancy for their report Emerging Answers, 2007, which provides the basis for statewide indicators presented in this report. TABLE OF CONTENTS How to use this Report ...................................................................................................................1 Overview ........................................................................................................................................3 Pregnant Teens in Montana ............................................................................................................5 Age .....................................................................................................................................5 Prior Pregnancy ..................................................................................................................7 Marital Status .....................................................................................................................7 Patterns of Teen Sexuality ..................................................................................................8 Pregnancy Outcomes .........................................................................................................9 Health Disparities .............................................................................................................10 Community Profi les .........................................................................................................12 Fathers of Teen Pregnancy ...........................................................................................................15 Top Ten Tips from Teens to Parents .............................................................................................17 Community Profi le .......................................................................................................................18 Risk and Protective Factors ..........................................................................................................19 Risk Factors ......................................................................................................................19 Protective Factors .............................................................................................................20 Where should our community focus its efforts? ...............................................................21 Protective and Intervention Table .....................................................................21 Risk and Intervention Table ..............................................................................22 Did you know ... ................................................................................................................22 Statewide Indicators .....................................................................................................................23 General Information about the Montana 2006 PNA Survey ............................................23 General Information about the Montana 2007 YRBS .....................................................23 Addressing Risk and Protective Factors using an Ecological Model ..............................24 Community Domain .........................................................................................................25 Family Domain .................................................................................................................26 Peer and Individual Domains ...........................................................................................27 Community Profi les .........................................................................................................30 Best Practices ...............................................................................................................................31 What can I do to prevent teen pregnancy? .......................................................................31 Elected Leaders & Policy-makers ....................................................................................32 Healthcare Providers ........................................................................................................33 Educators ..........................................................................................................................34 Parents ..............................................................................................................................35 Teens ................................................................................................................................36 Ten Tips for Parents .....................................................................................................................37 Resources .....................................................................................................................................38 Defi nition of Terms ......................................................................................................................39 Endnotes .......................................................................................................................................41 Community Profi les .....................................................................................................................43 Methodology ................................................................................................................................46 Appendices ...................................................................................................................................47 Tables: Number of Pregnancies among Montana Females ..............................................47 Tables: Pregnancy Rate among Montana Females ..........................................................49 Graphs: Montana County Health Trends .........................................................................51 HOW TO USE THIS REPORT The Trends in Teen Pregnancies and Their Outcomes in Montana report is published by the Montana Department of Public Health and Human Services, Women’s and Men’s Health Section. The report is intended to highlight trends related to statewide teen pregnancy rates, health disparities, protective and risk factors over a fifteen year period, and encourages local communities to build capacity toward teen pregnancy prevention efforts. Please reference the Definition of Terms found at the end of this report. Pregnancies are estimated by counting live births, fetal deaths (weighing 350 grams or more or greater than 20 weeks gestation, if the weight is unknown) and induced abortions reported to the Montana Office of Vital Statistics. This number is most likely an underestimation of the actual number of pregnancies, as it does not include unreported pregnancies, or miscarriages that occur early in pregnancy. Pregnancies and live births are reported for Montana residents only. Live births, miscarriages, and abortions that occurred to Montana residents outside of Montana may not be included in this number. Not all states record the same statistics or consistently report such vital events to other states. The denominator data for all rates and tables is based on population estimates from The National Center for Health Statistics.28 Pregnancy rates are calculated by dividing the number of pregnancies to females ages 15-19 by the estimated midyear population of 15-19 year old females (produced by the Census Bureau), and multiplying the result by 1,000. Rates are reported as the number of pregnancies per 1,000 population of females ages 15-19. Families and communities are the most influential factors in a teen’s life, and can make the most progress in teen pregnancy prevention. Many communities and individuals throughout Montana are currently mobilized to prevent teen pregnancy. In honor of their work, we have included profiles of such efforts throughout this report. Numerous teen pregnancy prevention stakeholders rely on this report including: state program staff, decision-makers (such as county commissioners, tribal leaders, and legislators), non- governmental organizations (such as Big Brother Big Sisters), youth-service organizations, schools, AmeriCorps*VISTA members, doctors, nurses, public health staff, teachers, administrators, and community members. Information from this report is most commonly used to: 1. Compare with other risk behavior data 2. Generate public awareness 3. Locate resources on teen pregnancy prevention 4. Influence decision-makers 5. Apply for program funding 6. Create a community-specific needs assessment. 1 HOW TO USE THIS REPORT Though an overview of various statewide teen pregnancy indicators from the Montana Prevention Needs Assessment (PNA) and the Youth Risk Behavior Survey (YRBS) are presented in this report, we encourage readers to review the PNA and YRBS for more detailed data on any specific indicator for their community. In addition to this report, supplemental materials, as well as links to further resources, are published on the Women’s and Men’s Health Section Website. These materials include data tables for Montana counties, tools for conducting local needs assessments, resources for families and educators, capacity-building tools, and supplemental reports. For an electronic copy of this report or an alternate format, contact: Montana Department of Public Health & Human Services Public Health & Safety Division Family & Community Health Bureau Women’s and Men’s Health Section PO Box 202951 Helena, MT 59620 (406) 444-3609 http://www.dphhs.mt.gov/PHSD/Women-Health/famplan-index.shtml 2 OVERVIEW Teen pregnancy rates in Montana and the nation have declined between 1991 and 2005. However, the decline in Montana teen pregnancy rates occurred primarily between 1991 (69 per 1,000) and 1999 (52 per 1,000) when the rate decreased 33%. National teen pregnancy rates after 2002 are not yet available. Preliminary state and national birth data from 2006 indicates an increase in teen pregnancy and birth rates from the previous year.1 Figure 1: Teen pregnancy rates, females, ages 15-19, Montana and US, 1991-2005 160 0 120 0 0 1, 80 Montana r pe 40 US 0 1991 1993 1995 1997 1999 2001 2003 2005 The Montana teen pregnancy rate remained relatively stable between 2000 (51 per 1,000) and 2005 (49 per 1,000), with a 5-year rate (2001-2005) of 50 pregnancies per 1,000. Most teen pregnancies in Montana occurred to teens 18 and 19 years of age. Figure 2: Teen pregnancy rates, females, Montana teen pregnancy rates are by age group, Montana, 2001-2005 lower than national rates, but the 160 United States still ranks among the 15-17 120 highest in the developed world for teen 0 0 0 pregnancies. 1, 80 18-19 r e p 40 Total 15-19 0 Figure 3: Average teen birth rates, females, ages 15-19, 2001-2005 2001 2002 2003 2004 2005 The teen pregnancy rate in the United States is 50 estimated to be more than twice as high as that in 40 0 neighboring Canada.2,3 However, methods of 00 30 United States calculating teen pregnancy rates differ between er 1, 20 Montana p 10 Canada countries and the same timeframes are not always 0 available. A more standard comparison is teen birth Birth Rate rates, which still indicate that both the US and Montana have much higher rates than Canada.1,4 Teen pregnancy rates among American Indians, Montana’s largest minority group, are significantly higher than the statewide rate. While one in five Montana females will become pregnant before the age of 20, two in three American Indian females will become pregnant before age 20. In 2005, the teen pregnancy rate for Montana American Indians was 127 per 1,000, compared with 49 per 1,000 for the state as a whole. 3 OVERVIEW Glacier, Big Horn, Roosevelt, Blaine, Rosebud, Hill, Mineral, Cascade, Lake, and Yellowstone counties have the top ten highest five-year rates (2001-2005) of teen pregnancy in the state. More than forty years of research has been dedicated to teen pregnancy prevention, with the National Campaign to Prevent Teen and Unwanted Pregnancy emerging as the leader in research in this area. Using risk and protective factors from their recent publication, Emerging Answers 2007, this report provides insight into the statewide influencers of teen pregnancy. These factors are broken down into various “domains” including community, family, peer and individual. Two state- sponsored surveys, the Youth Risk Behavior Survey and the Prevention Needs Assessment, use similar domains (with some variation in definition) to poll Montana students on their exposure to certain risk and protective factors for teen pregnancy. Although each pregnant teen experiences a unique situation, factors such as family disruption, being economically disadvantaged, peers who engage in rebellious and high-risk behavior, using alcohol and/or drugs, and having multiple sex partners may contribute to an increased risk of teen pregnancy. Factors such as high family connectedness, parent-child communication, condom/contraceptive use, and greater connectedness to school are more likely to protect teens from pregnancy. Families and parents continue to be the most influential people in a teen’s life, in large part; parents must initiate conversations with teens on sexuality. Younger teens are more likely than older teens to cite parents as being most influential. Research from the National Campaign to Prevent Teen and Unplanned Pregnancy suggests that teens want their parents to bring up these topics to them; they do not want to be the ones to bring them up to their parents.5 Figure 4: Responses to "When it comes to descisions about sex, who is the most influential?" , females and males, by age group 60% 50% Teens 15-19 40% 30% Teens 12-14 20% 10% 0% s s s s a s e f Parent Friend eacher eligiou Leader Medi Sibling omeon Else Yoursel T R S 4 PREGNANT TEENS IN MONTANA Age. Most pregnant teens in Montana are 18 or 19 Teen pregnancy rates per 1,000, by age group years of age. Over the past 15 years, the pregnancy 15-17 18-19 15-19 rate for all age categories has declined. However, MT (2005) 25.9 88.6 49.3 as Figure 5 shows, the decline in Montana teen pregnancy rates occurred primarily between 1991 US (2002)* 42.3 125.6 75.4 and 1999. *most recent year for which data is available Figure 5: Teen pregnancy rates, females ages 15-19, Montana, 1991 - 2005 140 120 100 0 0 0 80 15-17 1, r 60 18-19 e p 40 All 15-19 20 0 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 Year State and national teen pregnancy statistics are broken Figure 6: Distribution of teen pregnancy, into three age categories: 18-19 by age group, Montana, 2001- 2005 year olds; 15 -17 year olds; and teens under the age of 15. Teens in each category differ 32% markedly from one another in biological and social maturity, 15-17 years in educational level, and in 18-19 years legal status. Please Note: because of the low number of 68% pregnancies of teens under the age of 15, the charts and tables focus on teens between 15 and 19 years of age. 5 PREGNANT TEENS IN MONTANA Eighteen and nineteen year old teens are still considered adolescents although they may have limited adult rights and responsibilities (i.e., voting). Older pregnant teens in Montana are characterized by the following:6 (cid:120) Education. Slightly more than half of older teens who give birth are high school graduates (52%); another 7% have completed one or more years of college. However, more than one-third (40%) have not completed high school by the time their babies are born. (cid:120) Prenatal care. Older teens that carry their pregnancies to term are more likely than younger teens to seek prenatal care within the first trimester (70%) and make nine or more prenatal visits (72.1%). Fifteen to seventeen year old teens are considered minors in the eyes of the law. They are characterized by the following:7 (cid:120) Education: Most teens in this age group who give The younger the birth are still in high school (89%) while 10% are pregnant teen, the less high school graduates. likely she was to seek (cid:120) Prenatal care. For those young teens whose prenatal care in the pregnancies resulted in a live birth, only 62% first trimester of began prenatal care within the first trimester; pregnancy. 66.5% had 9 or more prenatal visits to a health care professional. Teens under age 15 are referred to as “very young teens” and are characterized by the following:8 (cid:120) Education. A little over half of very young teens who give birth under age 15 have an eighth grade In 2005, there were 22 education (55%) while 21% have completed the 9th pregnancies reported grade. One in five (20%) teens younger than 15 among Montana teens have less than an 8th grade education. ages 14 years and (cid:120) Prenatal care. For those very young teens whose younger. pregnancies resulted in a live birth, less than half (45%) begin prenatal care within the first trimester. Only 3 of 5 (59.4%) make 9 or more prenatal visits. 6 PREGNANT TEENS IN MONTANA Figure 7: Trimester prenatal care began, by age group, Montana, 1991-2005 100 80 t 12-44 n 60 e c 18-19 r 40 e P 15-17 20 12-14 0 1st 2nd 3rd No Care Prior Pregnancies. Approximately one in four pregnant teens (26%) in Montana has had a previous pregnancy.9 This percentage has decreased slightly since 1991 when 29% of pregnant teens reported being pregnant before. Older pregnant teens are more likely to have had a previous pregnancy. Of pregnant 18 and 19 year old teens in Montana in 2005, one in three (29%) reported a previous pregnancy. During the same time period, 15% of 15 to 17 year old teens had reported a previous pregnancy. Marital Status. Since 1991, premarital childbearing has increased not only among teens, but also among women of all ages. Being unmarried and having a baby has a growing level of acceptance in American society.10 The US Census reports that in the 1930’s, 82% of first births occurred to married women compared to 59% of first births in the 1990’s.11 Among all Montana teens ages 15 to 19, 86% of births were to unmarried females. Patterns of marriage and childbearing among Montana teens differ according to the mother’s race. Children born to unmarried mothers represented 82% of all births to White teens in 2005; in 1991they accounted for 68% of births. Among American Indian teens, 95% of children were born to unmarried mothers in 2005; this proportion has increased from 85% in 1991. Figure 8: Percent of live births to unmarried teens ages 15-19, Montana, 2001-2005 100% 80% 60% All Montana Teens 40% All American Indian Teens 20% 0% 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 Year 7