Adolescent Pregnancy Prevention Interventions

September, 2010

What Works to Prevent Teen Pregnancy

While all adolescents are at risk, some adolescents are at increased risk for early sexual activity, poor contraceptive use, and pregnancy. Numerous protective and risk factors (individual, environmental, peer, partner, and culture) have been shown to influence adolescent sexual behavior.  Knowing what factors appear to be protective and what factors put some youth at increased risk for adolescent pregnancy allows communities to development effective interventions. Research has found that when the protective factors in an adolescent's life increase or the risk factors decrease, or both, the adolescent will be less likely to have sex, become pregnant or cause a pregnancy, and more likely to use condoms and other contraceptives correctly. Some factors can be more easily modified through programmatic interventions than others. Quality interventions focus on risk and protective factors that are the most amenable to change.

Programs to prevent adolescent pregnancy can be categorized into three broad groups: those that focus on sexual protective and risk factors, those that focus on nonsexual factors, and those that focus on both sexual and nonsexual factors. All programs discussed below are evidence-based, which means that they have been rigorously evaluated and have either demonstrated at least two positive behavior changes among program youth or showed effectiveness in reducing rates of pregnancy, sexually transmitted diseases (STIs) or HIV in intervention youth.

Programs that Focus on Sexual Factors

Programs in this group focus primarily on changing protective and risk factors that involve sexuality. Factors include an adolescent's knowledge, attitude, or beliefs about sex, perceived norms, confidence in communication and refusal skills to avoid sex, confidence in their ability to accurately use contraceptives, and their intentions regarding sexual behavior and the use of contraceptives. Programs that focus on sexual factors include curriculum-based sex and STI/HIV education programs, clinic-based and one-on-one programs and parent/child communication programs.

1. Curriculum-based Sex and STD/HIV education Programs

Curriculum-based program education programs are based on written curriculum that is implemented with groups of adolescents in schools, clinics, or community settings. Studies on curriculum-based programs included in this document have shown that these programs improve sexual protective factors by delaying sexual activity, reducing the frequency of sex, reducing the number of sexual partners, and increasing condom and contraceptive use. Overall, approximately two-thirds of curriculum-based programs evaluated have had positive effects on adolescent sexual behavior.

2. Clinic-based or One-on-One Programs

Clinic-based programs provide adolescents with reproductive health care/services and access to condoms and other forms of contraceptives. Numerous studies have measured clinic protocols within a clinic, and found that when clinics provided one-on-one counseling and information about abstinence and contraception, provided condoms and other forms of contraception, and presented clear messages about sexual behavior, consistent use of protection among sexually active adolescents increased.

3. Parent/child Communication Programs

Parent/child communication programs are educational programs designed to increase communication about sexuality between parents and their children. Programs may be solely for parents, or combine parents and adolescents together. Several parent/child communication programs show strong evidence of behavioral impact.

Programs that Focus on Non-Sexual Factors

Programs in this group focus on all protective and risk factors that may affect an adolescent's sexual behavior, not only factors related to sexuality. Examples of non-sexual factors include school performance, connectedness to family, school and community. Programs that focus on non-sexual factors are youth development programs, also known as service learning programs.

1. Service Learning Programs

Service Learning programs focus on nonsexual factors that impact the behaviors of adolescents. They can be implemented in schools, clinics, and surrounding communities. Service learning programs have two components: voluntary or required class time given to community service, and structured time for preparation and refection before, after, and during the service (e.g. group discussion, journal writing, and papers). Various studies have shown strong evidence that service learning programs have a positive impact on adolescents and are effective at either delaying the initiation of sex or reducing adolescent pregnancy.

Programs that Focus on both Sexual and Non-Sexual Factors

Programs that focus on both sexual and nonsexual factors combine programs with intensive sexuality and youth development components. Programs in this category can be quite diverse with some programs concentrating on substance abuse, violence and sexual risk-taking, and others focusing on sexual risk-taking with both sexuality and youth development components.

Figure 1: Evidence-based Programs/Interventions for Adolescent Pregnancy Prevention
Name of Program For Use With Website
Curriculum-Based Sex And STD/HIV Education Programs
Becoming a Responsible Teen: An HIV Risk Reduction Program for Adolescents African American adolescents ages 14-18, both boys and girls www.etr.org
!Cuídate! Latino youth www.selectmedia.org
Draw the Line, Respect the Line Youth in grades 6-8, found effective for boys only www.socio.com/pasha.php
Making Proud Choices: A Safer Sex Approach to HIV/STDs and Teen Pregnancy Prevention African American, Hispanic, and White adolescents, ages 11-13, who attend middle school or youth-serving community based programs www.selectmedia.org
Reducing the Risk: Building Skills to Prevent Pregnancy, STD and HIV High school students www.etr.org
Safer Choices: Preventing HIV, Other STD and Pregnancy African American, Asian, Hispanic, and White urban and suburban high school students www.etr.org
SiHLE: Sistas, Informing, Healing, Living, Empowering Sexually experienced African American adolescent females www.socio.com/pasha.php
Clinic-Based and One-on-One Programs
Reproductive Health counseling for young men Males ages 15-18 www.socio.com/pasha.php
Parent-Child Communication Programs
Keepin' it R.E.A.L. Youth in grades 7-9 www.etr.org
Service Learning Programs
Reach for Health Community Youth Service Learning Urban youth, Black and Hispanic youth, 7th and 8th grade middle school students www.socio.com/pasha.php
Teen Outreach Program (TOP) High school students, multi-ethic populations, urban, suburban, and rural youth, adolescent mothers www.wymanteens.org/index.php
Community Programs with Multiple Components
HIV Prevention for Adolescents in Low-Income Housing Developments Low-income adolescents living in housing projects, Urban youth, Multi-ethnic youth www.socio.com
Multi-Component Programs with Intensive Sexuality and Youth Development
Aban Aya African-American youth in grade 5-8 www.socio.com
Children's Aid Society Carrera Program Urban youth ages 13-15, youth at risk, Black and Hispanic adolescent females www.childrensaidsociety.org/carrera-pregnancy-prevention

Programs for Adolescent Parents

The national organization Advocates for Youth has compiled a list of programs proven effective in preventing or reducing the incidence of second and higher order pregnancies or births among adolescent mothers in their report Science and Success: Programs that Work to Prevent Subsequent Pregnancy Among Adolescent Mothers. Figure two displays these programs. The full report can be found at http://www.advocatesforyouth.org/storage/advfy/documents/sspregnancies.pdf

Figure 2: Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers
Program For Use With Website
Health Care Program for First-Time Adolescent Mothers Urban, African American, low-income, first-time adolescent mothers

www.socio.com

Home-Based Mentoring for First-Time Adolescent Mothers Urban, low-income, African-American, first-time adolescent mothers  
Intensive School-Based Program for Teen Mothers Low-income, African American adolescent females, enrolled in high school  
Nurse Home Visiting for First-Time Adolescent Mothers Urban and rural white, Urban Latina and African American, first-time, adolescent mothers living in poverty contact: Ruth O'Brien at Obrien.ruth@tchden.org
Polly T. McCabe Center for Pregnant Adolescents In-school, pregnant and parenting, African American adolescents from low-income families

www.greatschools.net

Queens Hospital Center's Comprehensive Adolescent Program for Teenage Mothers and Their Children Economically disadvantaged, pregnant and parenting adolescents and their infants

www.socio.com

Women's Centre of Jamaica Foundation Programme for Adolescent Mothers Pregnant and parenting Caribbean teenage women

www.jamaica-kidz.com

Choosing a Program

When deciding what program to choose, always begin by looking at your community. What are the community's values and concerns regarding adolescent pregnancy? To what extent are adolescents in your community sexually active? Consider the barriers that adolescents face in making healthy sexual health choices, their access and availability to condoms, other contraceptives, and reproductive health services in your area. Also, what is the quality of already existing sex education programs in your schools and in other organizations? Do health care providers address adolescent sexual behavior in your community, and if so, how? It's also important to look at other general community characteristics: the availability of employment opportunities, and the quality of schools, the stability and strength of families and the existence programs for adolescents. Of course, any assessment of your community must also consider the resources of your own organization to implement different kinds of adolescent pregnancy prevention programs, in terms of staff, organizational, and monetary. Then, follow these best practices:

  • Replicate scientifically evaluated programs with fidelity and with the appropriate audience.
  • Incorporate the characteristics of scientifically evaluated programs.
  • Develop programs to address risk and protective factors related to adolescent pregnancy, and use logic models to show how interventions affect factors, which in turn create desired outcomes.

The following resources provide excellent information on contributing factors and on effective strategies to reduce and prevent adolescent pregnancies:

  • National Campaign to Prevent Teen and Unplanned Pregnancy, http://www.thenationalcampaign.org/
  • Child Trends, a non-profit organization that conducts research and evaluation studies in teenage pregnancy and childbearing and in issues related to parenting, family structure, and family processes, including fatherhood and male fertility at http://www.childtrends.org
  • Advocates for Youth, http://www.advocatesforyouth.org
  • Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy, http://www.thenationalcampaign.org/EA2007/default.aspx
  • Resource Center for Adolescent Pregnancy Prevention or RECAPP provides practical tools and information to effectively reduce sexual risk-taking behaviors. Up to date evaluated programming materials to help those working with teens, go to, http://www.etr.org/recapp/
  • Minnesota Organization on Adolescent Pregnancy, Prevention and Parenting (MOAPPP). MOAPPP provides factsheets on county adolescent pregnancy and birth data and state/national data and reports, including the 2010 Minnesota Adolescent Health Report. Also, the Minnesota Sexuality Education Resource Review Panel (MSERRP), found on MOAPPP's webpage, reviews curricula and provides recommendations. http://www.moappp.org.

References for this report

  • Science and Success: Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers, Advocates for Youth
  • Douglas Kirby, Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases
  • What Works: Curriculum-Based Programs that Prevent Teen Pregnancy, The National Campaign to Prevent Teen Pregnancy