Teen Births

        This vital sign measures the rate of live births per 1,000 females aged 15-19. As an indicator of health and prosperity, teenage parents are at higher risk of experiencing premature births, negative health and socioeconomic outcomes, and increased risk of medical complications for the adolescent mother during birth.  

        In the United States the teen birth rate is 18.8 live births per 1,000 young women aged 15-19. Tennessee ranks 42nd, at 26.6 births per-1,000 young women. Teen births fell 64% between 1991 and 2015, resulting in 428,000 fewer teen births annually and $4.4 billion in public savings, considering just the cost of medical and economic supports during pregnancy and infancy. Teen births were at a modern low of 194,377 in the United States in 2017. Simultaneously, the rate of abortions in this population fell by more than half between 1990 and 2009. The decline in teen births is attributed to lower rates of sexual activity among 15-19 year olds, and increased access to and utilization of effective means of birth control. However, rates across communities and populations vary widely.  

        Teen pregnancy and births can have both short and long-term impacts on socio-economic and health outcomes for the teen parents, their children, and their communities. The vast majority of teen pregnancies are unplanned, which adds to the risk of negative outcomes including increased risk of maternal depression and physical violence during pregnancy.  Adolescent parents are at risk of lower educational income and lower lifetime income. According to the CDC, pregnancy significantly contributes to young women dropping out of high school, with just half of teen mothers receiving a high school diploma, and only 2% completing college before age 30. Additionally, teen fathers are 25-30% less likely to graduate high school than non-fathers. Between 2001 and 2009, while the teen pregnancy rate was in decline in every state and population, the graduation rate increased 3.5%.  

        Children born to teen mothers are at higher risk for death in the first year, low birth weight, decreased emotional support, decreased kindergarten readiness, behavior problems, chronic medical conditions, higher rates of foster care placement, incarceration during adolescence, lower educational achievement, becoming a teen parent themselves, and experiencing unemployment or under-employment as a young adult.  

        Young women are, for reasons beyond just carrying the pregnancy, impacted by teenage pregnancies far more than their male counterparts. Teen pregnancies are typically unplanned (82%), but often unconsented. Roughly one-in-five teenage sexual encounters involve alcohol and roughly one-in-nine high-school age women report sexual violence and forced intercourse.  

        Teen birth rates have remained higher than the national average among female populations facing greater racism and discrimination. However, while the rate remains higher in Hispanic and black populations, these populations have also experienced the most rapid improvement in teen birth rates since the early 90s. According to Pew Research, since 2007 “[t]he declines among Hispanic (50%), Asian or Pacific Islander (48%) and black (44%) teens have outpaced this national average, while the decline among white teens (36%) has been somewhat more modest. 

        Additionally, socioeconomic conditions such as family level income and low educational attainment of a teen’s family may be a risk factor for teen pregnancy. Finally, the odds of becoming pregnant as a teen more than doubled for young women living in foster care. 

Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address teen births in your community.  


1. Aban Aya Youth Poject 

The Aban Aya Youth Project (Aban Aya) is a four-year sexual health education program designed to teach students to practice abstinence, avoid drugs and alcohol, and resolve conflicts nonviolently. Curriculum focuses on culturally appropriate, Afrocentric social development curriculum for African American youth grades 5 through 8.


2. Athletes as Leaders 

The Athletes as Leaders program teaches high school female athletes about healthy relationships and avoiding sexual violence in relationships. This program is promoted in conjunction with Coaching Boys into Men.  The curriculum consists of 10 sessions that cover material related to stereotypes, oppression, self-image, dating violence, consent, and more. 


3. Campus Sexual Health Program 

Power to Decide, a reproductive health organization, created a framework for colleges to address students’ sexual health needs and avoid unintended pregnancies. This program focuses on policy and systems change, sexual health services, information and education, and equity.


4. Coaching Boys into Men 

Coaching Boys into Men (CBIM) is a comprehensive violence prevention curriculum and program that inspires athletic coaches to teach their young athletes that violence never equals strength and violence against women and girls is wrong. It’s important to recognize that change should address both adolescent girls and boys to successfully prevent teen births. The program comes with strategies, scenarios, and resources needed to talk to boys, specifically, about healthy and respectful relationships, dating violence, sexual assault, and harassment.


5. ¡Cuídate!

¡Cuídate! is a sexual health education program that teaches Latino youth (grades 8 to 11) about risk reduction strategies, focusing on sexual abstinence and contraception. This program highlights cultural values that support “taking care of oneself” and practicing safer sexual behaviors. The Department of Health and Human Services lists ¡Cuídate! as an evidence-based teen pregnancy prevention program. 


6. Darkness to Light 

Darkness to Light is a program that aims to fight child sexual abuse through education and empowerment. Child sexual abuse has immediate impacts as well as severe long-lasting impacts on a child’s mental health. Understanding the link between child sexual abuse and teen pregnancy is important when having a conversation around teen birth rates and mental health, including confidence and self-esteem. Click on the link for educational materials, a Darkness to Light mobile app, and other resources. 


7. Family Planning Clinics Promotion to Teens 

The Tennessee Department of Health offers family planning services in every county health department clinic. The staff are specially trained to provide education; counseling; medical histories; physical assessments and treatment, if needed; and comprehensive contraceptive options. Family planning services are provided on a sliding fee scale, based on family size and income, and they are free for persons below the federal poverty level. Clinics offer services for women, men and teens, and all information is kept private. Promoting these services, especially to teen boys and girls in high school and college settings, could help to prevent unintended pregnancies. 


8. Health Improvement Project to Teens 

HIP Teens (Health Improvement Project for Teens) is an evidence-based sexual risk reduction intervention for adolescent girls (age 14 to 19) that enhances knowledge, increases motivation, and teaches behavioral skills needed to reduce pregnancy, HIV and STI risk. The Department of Health and Human Services promotes the implementation of this program in educational settings, youth development center, and youth health service centers. 


9. Positive Potential 

Positive Potential is a sexual health education program tailored for youth (grades 6 to 8) in predominately white, rural communities. Program curriculum focuses on delaying sexual initiation, reducing risky sexual behavior, and promoting positive youth development. The Department of Health and Human Services lists the Positive Potential and the Positive Potential Be The Exception programs as evidence-based teen pregnancy prevention programs. 


10. 3 Rs (Rights, Respect, Responsibility) 

Rights, Respect, Responsibility is a curriculum that is fully meets the National Sexuality Education Standards. The curriculum seeks to address both the functional knowledge related to sexuality and the specific skills necessary to adopt healthy behaviors. Rights, Respect, Responsibility reflects the tenets of social learning theory, social cognitive theory and the social ecological model of prevention.


11. Safe Dates 

Safe Dates is an educational program, created through funding from the CDC, that teaches adolescents how healthy relationships and how to recognize dating abuse and violence. During this ten-session curriculum, teens learn communication skills and how to avoid sexual violence and abuse. 


12. Seventeen Days 

Seventeen Days is listed as one of the Department of Health and Human Services’ Evidence-Based teen pregnancy prevention programs, that teaches adolescent girls (age 14 to 19) about contraception and abstinence. This video-based program allows girls to practice responding to situations so that they can make safe choices in the future.


13. Sexuality Education Outreach 

Several sexual education curricula are promoted in Tennessee’s school-based settings. These youth outreach programs teach abstinence-only family life education from the following programs: Real Essentials; Reducing the Risk; Life on Point; Promoting Health Among Teens! (Abstinence Only); Making a Difference!; Heritage Keepers Abstinence Education; and Choosing the Best.  It is important to note that the American College of Obstetricians and Gynecologists recommends that “comprehensive sexuality education should be medically accurate, evidence-based, and age-appropriate, and should include the benefits of delaying sexual intercourse, while also providing information about normal reproductive development, contraception (including long-acting reversible contraception methods) to prevent unintended pregnancies, as well as barrier protection to prevent sexually transmitted infections (STIs).” 


14. Teen Outreach Program 

Teen Outreach Program (TOP) is a program promoted by the Department of Health and Human Services. This program promotes the positive development of adolescents through curriculum-guided, interactive group discussions; positive adult guidance and support; and community service learning. TOP curriculum is focused on key topics related to adolescent health and development, including building social, emotional, and life skills; developing a positive sense of self; and connecting with others. Child Trends found this program to effectively impact teen pregnancy and contraceptive use. 


1. Administration for Children and Families, Sexual Risk Avoidance Education Program (SRAE) 

Purpose: The SRAE Program provides funding for projects to educate youth on how to voluntarily refrain from non-marital sexual activity and prevent other youth risk behaviors. Programs should target high risk youth populations, such as foster care children, LGBTQ youth, African American youth, Hispanic youth, runaway youth, and American Indian youth. There are currently 13 sub-awardees funded through the Tennessee Department of Health’s SRAE grant. This grant is a two-year program. Please contact the TAPPP Program Director (at 615-532-0274) for more information. 

Duration: Three years 

Amount: Varies 


2. Community Foundations

Purpose: Community Foundations offer small grants that focus on community-driven change in Tennessee. The Community Foundations in Tennessee include Appalachian Community Fund, The Community Foundation of Greater Chattanooga, Community Foundation of Greater Memphis, Community Foundation of Middle Tennessee, Knox County Community Foundation, and East Tennessee Foundation. Most of these foundations consider healthy youth development as a focus area of grant funding.

Duration: Varies 

Amount: Varies 


3. Robert Wood Johnson Foundation 

Purpose: The Robert Wood Johnson Foundation funds public institutions and nonprofit organizations, with the goal of addressing health equity across four program areas: Health Systems, Healthy Children Health Weight, Health Communities, and Health Leadership. Specifically, RWJF provides grants for programs that aim to enable all children to attain their optimal physical, social and emotional well-being, including growing up at a healthy weight, an important determinant of this being teen pregnancy. Strong grant applications place a strong focus on policy change working toward better health outcomes for the community. 

Duration: One to three years 

Amount: $100,000- $300,000 


4. Tennessee Department of Children's Services 

Purpose: The Tennessee Department of Children’s Services has announced a funding opportunity for programs, project, and activities related to Tennessee’s Building Strong Brains initiative. This initiative aims to address Adverse Childhood Experiences (ACEs) by promoting safe, stable and nurturing relationships between infants/children and their care takers. ACEs are a strong predictor of adult health and prosperity later in life, affecting many of the socioeconomic drivers of teen pregnancy. 

Duration: One year, with opportunity to renew

Amount: Up to $200,000 


5. The Department of Justice 

Purpose: The Department of Justice offers funding to support law enforcement and public safety activities in state, local, and tribal jurisdictions; to assist victims of crime; to provide training and technical assistance; to conduct research; and to implement programs that improve the criminal, civil, and juvenile justice systems. Communities focusing on teen pregnancy prevention through reducing domestic violence and sexual abuse may consider applying for a grant through the Office on Violence Against Women.

Duration: Varies 

Amount: Up to $1,000,000 (average) 


6. U.S. Department of Health and Human Services 

Purpose: The Department of Health and Human Services, Office of Adolescent Health, offers grant funding to programs that are medically accurate and age appropriate with the aim of reducing teen pregnancy. Funding is awarded for replicating effective programs and new, innovative strategies to promote healthy adolescence. 

Duration: One to two years 

Amount: $200,000- $500,000 per year 


1. HPV Awareness Day 

HPV Awareness Day is observed each year on March 4. This campaign seeks to educate youth and families about the prevalence of HPV, the risk factors of contracting it, and the dangers of the STI. See the campaign link below for shareable resources. 


2. "Let's Talk" Month 

Let's Talk Month is a national public education campaign celebrated in October and coordinated by Advocates for Youth. Let's Talk Month is an opportunity for community agencies, religious institutions, businesses, schools, media, parent groups and health providers to plan programs and activities which encourage parent/child communication about sexuality.


3. National Teen Pregnancy Prevention Month 

National Teen Pregnancy Prevention Month (NTPPM) occurs every May. The Department of Health and Human Services provides materials that communities can use to join the NTPPM conversation.


4. National Women and Girls HIV/AIDS Awareness Day 

The National Women and Girls HIV/AIDS Awareness Day is held on March 10 each year. This campaign aims to spread awareness about protecting women and girls from HIV/AIDS. See the source for more campaign materials. 


5. National Youth HIV/AIDS Awareness Day 

National Youth HIV/AIDS Awareness Day is held on April 10 each year. This awareness day serves to increase knowledge about youth HIV/AIDS rates, risk factors, and prevention resources. Protecting against youth HIV/AIDS also protects against teen pregnancy rates. 


6. STD Prevention/Awareness Month

The Centers for Disease Control promotes STD Prevention/Awareness Month each year during April. This month is a great opportunity to promote not only safe sex and healthy relationships, but also teen friendly clinics and health department services to adolescent teens. 


7. Teen Dating/Violence Awareness Month 

Teen Dating Violence Awareness Month occurs each year during February. This campaign seeks to educate teens on healthy relationships and how to recognize abuse in their own relationships and others’. 


8. Teen Health Fair/Clinic 

Health fairs are one day events that engage teens and community partners in order to spread messages about healthy practices and decision making. At these events, local health professionals can help teens and parents better understand available resources, answer questions about reproductive health services, and other programming relevant to teens.  Click on the link for general tips on how to host an effective health fair. 


9. "Thanks, Birth Control!" 

“Thanks, birth control!” is an educational campaign managed by Power to Decide that focuses on access to birth control and preventing unintended and teen pregnancies. See the source below for social media messages and opportunities for action. 


1. Teen Parent Counseling in Evidence-Based Home Visiting Programs 

Current Evidence-Based Home Visiting programs should implement policy to encourage counselors to be trained in teen pregnancy prevention, particularly preventing repeat births for adolescent mothers. The CDC states, “Promoting home visiting and other programs shown to prevent repeat teen pregnancy and reduce sexual risk behavior.”


2. Training on Child Sexual Abuse 

According to the Children’s Advocacy Centers of Tennessee, girls who are victims of childhood sexual abuse are 2.2 times more likely to become teen mothers than girls who have not experienced sexual abuse. One way to combat this cycle of harmful health outcomes is to enact policies that encourage or require community members who work directly with children (educators, sports facilitators, etc.) to regularly take trainings on how to recognize and stop child sexual abuse. There are over 50 Children’s Advocacy Centers in Tennessee that provide trainings and community education.


1.  Assess reproductive goals through use of PATH Framework in primary care provider settings 

PATH (Pregnancy/Parenthood, Attitude, Timing, and How important is pregnancy prevention) questions are designed to empower clients and help them understand their reproductive goals and how best to achieve them. The program is designed to reduce unintended pregnancies, which are shown to produce worse health outcomes for infants and mothers.


2. Comprehensive Contraceptive Counseling with same day access for all methods including LARCs

Contraception, including Long Acting Reversible Contraception (LARC), is supported by the American Academy of Pediatrics as a method to reduce the number of unintended pregnancies. Teen births often stem from unintended pregnancies and lead to increased risk of health problems for the mother and the baby. Further, the CDC states that 1 in 5 teen births are repeat births.  Policies in primary care settings should encourage a discussion between care providers and adolescents about their reproductive health and need for contraception. To minimize barriers, same-day access for all contraceptive methods including LARCs should be available. If the client is already pregnant, then access to immediate postpartum LARC can also help remove barriers for clients. Training and technical assistance is available from the Family Planning program at TDH (mch.health@tn.gov). 


3. Teen-Friendly Primary Care Settings 

In order to best serve teens, primary care settings should be youth-friendly by striving to provide confidentiality, privacy, information regarding consent to medical care, cultural appropriateness, and comprehensive services. Physical aspects, such as posters and decorations targeting youth, reassures teens and encourages them to visit their primary care provider. In addition, hours that account for after-school programs and sports increase a teen’s access to a primary care provider. By promoting these policies in primary care settings, teens are more likely to approach care providers for information on how best to avoid unintended pregnancies. It’s recommended that a short survey is collected from teens to evaluate the effectiveness of a teen-friendly setting. 


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