Unifem July 11, 2009 Melissa Gilliam MD, MPH Chief, Section of Family Planning and Contraceptive Research Head, Program in Gynecology for Girls, Adolescents and Young Adult Women The University of Chicago Planning Families: A Road to Health for Women and Girls

The Section of Family Planning at the University of Chicago Research Clinical Community based Policy Program Fellowship Program Program in Gynecology for girls, adolescents and young adult women The Ryan Center

Life course perspective: women’s health is essential to the health of the individual, family and society over time Multifaceted role for women: childbearing, childrearing, providing for family, role in society, workforce and community Goal: women’s lifelong health and wellbeing Family planning is part of the continuum of lifelong health A life course approach to women’s health

Overview Adolescent Health Repeat pregnancy

Adolescent health

Adolescence is a time of growing independence from family. This challenging but essential period enables youth to lead healthy adult lives

Discover by engaging with youth Understand by conducting qualitative, quantitative and clinical research Change through policy and advocacy

Program in gynecology for girls, adolescents and young adult women Comprehensive reproductive healthcare for girls and young women with chronic or acute illness affecting their reproductive health

Teen Pregnancy Each year 750,000 teens become pregnant. One third are 17 and under. Half of these pregnancies result in birth. One third end in abortion. Guttmacher Institute, U.S. teenage pregnancy statistics: national and state trends and trends by race and ethnicity, New York: Guttmacher Institute, September 2006, accessed September 12, 2006; and Finer LB et al., Disparities in unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.

Sexually Transmitted Infections Teens and young adults (aged 15–24) account for an estimated one-half of all new STIs Nine million teenagers and young adults acquire an STI each year Two young people every hour become infected with HIV Recent CDC data show ¼ teens has an STI (Chlamydia, HPV, Trichomonas, HSV) Weinstock H., Perspectives on Sexual and Reproductive Health, 2004, 36(1):6–10. Forhan, S Oral abstract, 2008 National STD Prevention Conference

Teen Pregnancy

Teen birth rates up in 26 states --USA Today January /3 of families begun by young unmarried women are poor Over half of women receiving welfare had first child has a teen Teen moms and moms-to-be take a class in the Bronx, N.Y., to help them have healthy pregnancies and healthy babies.

Repeat Teen Pregnancy

Repeat Teen Pregnancy 28% to 63% of adolescent mothers become pregnant again within 18 months 20–37% experience a repeat birth within 24 months Meade CS and Ickovics JR, Social Science and Medicine, 2005, 60(4):661– 678.

Shifting paradigms: Bronfenbrenner’s Ecological Theory of Human Development Human development placed in context of social entities: “like a set of Russian dolls” Family Neighborhood Community Society Behavior is a function of the person and the environment

Limitation of Comparative Research Racial comparisons Comparisons across socioeconomic strata “at risk” or “deviant” Heterogeneity of ethnic minority populations What is race? McLoyd V., “The Imperative of Research on Minority Adolescents”. In Studying Minority Adolescents. London, 1998

Postpartum-ABCs Contraceptive use behaviors Focus groups with first time adolescent mothers Teens with repeat pregnancies Determined domains of influence for adolescent mothers’ contraceptive behaviors: Biology Psychology Social (family, partner, community, school) Neighborhoods

Longitudinal study of first time postpartum adolescent mothers youth interviewed 5 times in the first postpartum year Qualitative and quantitative techniques Post Partum Adolescent Birth Control Study (PP-ABCs)

Research with Adolescent of Color “The challenge then is not to create databases on minority children that necessarily parallel those that exist on non-Latino white, middle class children. Rather, it is to formulate culturally relevant constructs, and systematically document the precursors and consequences of developmental outcomes in the context of a culturally sensitive framework. Research of this kind is more arduous and slower-paced” McLoyd, 1998

“Judgments of untimeliness should be tentative. Their purpose is not primarily to diagnose and certainly not to blame but rather to prevent or alleviate unnecessary suffering for young women and their children.” Sara Ruddick Ruddick in Procreative choice for adolescent women. The Politics of Pregnancy. Lawson and Rhode eds. Yale New Haven Press 1993

Section Letitia Bennett Sabrina Holmquist Mishka Terplan Stephanie Mistretta Sandra Tilmon Bri Tristan Amy Whitaker Amy Neustadt Asha Quansah Erica Smith Debbie Stulberg Jim Puricelli Robert Webster

Thank you