1. Division of Reproductive Health Office of the Director CDC’s Winnable Battle CDC Health Officer Orientation May 13, 2015 Lisa M. Romero, DrPH, MPH Health Scientist

2. 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

3. Teen pregnancy

4. 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.

5. 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)

6. Progress in teen pregnancy

7. “ 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, MPH Director, Centers for Disease Control and Prevention Administrator, Agency for Toxic Substances and Disease Registry

8. 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

9. 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

10. 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

11. 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.html http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_w;

12. 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)

13. 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.

14. 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/http://www.cdc.gov/psr/teenpregnancy/

15. 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…

16. Summary How 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

17. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-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