Intervention Report on Teenage Pregnancy

Executive Summary

This study is divided into five key sections. The first section focuses on the introduction where it explains the chosen intervention for reducing teenage pregnancy. The main intervention is the family planning services program. The main finding of the study is that the idea behind providing these services is to offer teenagers with enough time to ensure familiarity and comfortability with the clinical procedures. The second section focuses on background and context of the study. In this section, key characteristics of the prevalence of pregnancy among teenagers is examined with an objective of providing context. Most of the programs that have been adopted to impact childbearing among teenagers have been unsystematic, poorly designed and small projects that do not have any useful evaluation strategy. This explains why the family planning services program was implemented because it provides remedies to the issues faced by policymakers. The third section discusses the family-based intervention and its impacts on reducing teenage pregnancy. This section involves analyzing the reasons why it has been adopted and the measures that it has helped to achieve. The fourth section involves the evaluation strategies used to monitor the impacts of the family planning services program. The fifth section discusses the implementation stages of the program. The final stage summarizes the main findings from the study.

Introduction

The intervention for reducing teenage pregnancy that this paper focuses on is the family planning services program. The main goal of the providers of family planning services is offering access to reproductive health services and contraception, reducing specific barriers to contraceptive care and offering teenagers wit skills required for effective and consistent use of contraception. Notably, family planning services are provided in various settings by different providers such as hospital outpatient departments, family planning clinics, private physician practices and health maintenance companies. The idea behind providing these services is to offer teenagers with enough time to ensure familiarity and comfortability with the clinical procedures. The family planning initiative incorporates a community and school-based element and a media campaign. the teenagers within the targeted societies have showed zero improvements in the childbearing or pregnancy rates. This study continues to identify other methods for increasing the use of contraceptives among teenagers in the clinic-based systems which have proven useful and important as well.

Some of the strategies discussed in the study involve the family members of the teenagers towards increasing communications related to contraception and supporting contraceptive services. Undeniably, all types of settings of service delivery have varied funding streams or mixtures of sources of funding, and not all the funds allocated for family planning services are utilized to provide initiatives to the teenager clients. The variability in service delivery situations and funding, and the different providers and services available to teenage clients makes assessments of the effects of family planning services on teenager pregnancy challenging. This study finds that these family planning service programs are effective towards ensuring reduced teenage pregnancy. At the same time, this study finds that the earlier programs that have been implemented have not been effective in reducing the vice.

Background and Context

There are widespread concerns related to the incidence of teenage childbearing that have caused the formation of various intervention programs in Nottingham. Regardless of the different initiatives and creative interventions that have been introduced, the birth rate among teenagers has risen significantly (Mezey et al. 2017). Some programs have involved families while most of them have focused on female adolescents. The adolescent males and older males who are the fathers of the sired babies are not the focus of the efforts of these initiatives. There is increasing interest in the immediate identification of the ongoing interventions that have sustained and large impacts in minimizing childbearing among teenagers. However, these programs which produce long-lasting and large effects on adolescent pregnancy have not been identified. Only small numbers of programs identified currently are conceptualized considerately, implemented carefully, and evaluated thoroughly.

Even though they do not offer proof of long-term or substantial effects, these projects have offered the foundation for building further initiatives. Most of the programs that have been adopted to impact childbearing among teenagers have been unsystematic, poorly designed and small projects that do not have any useful evaluation strategy. There is need for new interventions that are executed with careful conceptual and theoretical learning and with strict assessments. The process of being a teenage parent includes sequences of transitions and decisions that involve sexual intercourse, using contraceptives, abortion, marriage and even adoption (Lohan et al. 2018). However, the interventions can be used at one or all stages. this means that program providers, parents and the policymakers must seek to delay sexual activity initiation while encouraging adolescents who engage in sex to delay it further. The interventions can also emphasize on improvement of using contraceptives among adolescents who are sexually active or affect decisions related to pregnancy resolutions. This paper focuses on the intervention called family planning services.

Family Planning Services Program

The main goal of the providers of family planning services is offering access to reproductive health services and contraception, reducing specific barriers to contraceptive care and offering teenagers with skills required for effective and consistent use of contraception. The family planning service interventions use a medical model. However, some of the quite promising and recent methods have started using psychosocial approaches that focus on both behavioral and cognitive skills, satisfaction with services, and using services meant for young clients. Ensuring affordability and accessibility of family planning services is an efficient method of increasing the use of contraceptives (Hayter, & Jones, 2018). Many teenagers are already accessing pregnancy prevention services by using the family planning service delivery system. However, there is still room for considerable improvements in using contraception among the Nottingham teenagers and their parents. The best method for providing these series, or the most relevant service delivery unit is very challenging to ascertain. For instance, family planning services are provided in various settings by different providers such as hospital outpatient departments, family planning clinics, private physician practices and health maintenance companies. Teenage clients may obtain care from these kinds of providers, but it only reflects a portion of the clients served by the family planning providers at a given time. Besides, funding for the family planning services is obtained from various sources such as public funds, and the private sources (Brinkman et al. 2016). All types of settings of service delivery have varied funding streams or mixtures of sources of funding, and not all the funds allocated for family planning services are utilized to provide initiatives to the teenager clients.

The variability in service delivery situations and funding, and the different providers and services available to teenage clients makes assessments of the effects of family planning services on teenager pregnancy challenging. Nonetheless, the effective and consistent use of contraceptives has led to lower chances of pregnancy. This translates to the importance of family planning initiatives in preventing teenage pregnancy. There is some proof from assessments of information that imply that funding for family planning reduces fertility among adolescents. More specifically, the greater funding for the family planning or contraceptive services have been linked with fewer unintended pregnancy and the lower rates of childbearing out of wedlock among teenagers (Starbird, Norton, & Marcus, 2016). The percentage of teens at risk of pregnancy who are serviced at the family planning clinics is also linked with the lower birth rates at Nottingham. However, what is not understood is the elements of clinic services that are helpful in the initiation and sustenance of using contraceptive among the teenagers. There is also more need for understanding the best strategies for reaching the young clients in the broader clinic delivery system. The first method of promoting use of contraceptives among teenagers through the family planning services is the attraction of teen clients before first sex. Studies prove that averagely, teenagers delay using contraceptive services for almost a year before they become active sexually (Hardee, Croce-Galis, & Gay, 2017). Ambivalence, concern and procrastination are some of the reasons identified for not using contraceptives. A study carried out by Zabin & Clark (1981) identified that 1243 teenage patients received services, and they could make their original contraceptive visits earlier than expected.

A clinic-based method is to encourage the earlier usage of family planning services and efficient birth control for teenagers through removing service delivery aspect that are difficult or intimidating for adolescents. The Smart Start initiative reduces fears of medical procedures linked with the examination of the pelvic region and testing blood that are performed at the earlier visit for family planning (Krugu, Mevissen, Münkel, & Ruiter, 2017). This initiative uses three various intervention approaches. The first approach is anticipatory counseling where personalized sessions are carried out, and they emphasize on the circumstances and needs of every teenager. The more time spent discussing about the concerns of the teenagers about medical procedure and the selection methods is also part of this stage. The second method is a delay option. At this stage, the oral contraceptives are offered at the earlier visit, but the clients have the alternative of postponing medical assessments until another visits. The goal is to offer teenagers with enough time to ensure familiarity and comfortability with the clinical procedures (Dansereau et al. 2017). The third approach is the telephone follow-up that is carried out between five and ten days after the teenager visits or schedules a return appointment and answering concerns related to procedures or methods. Even though the assessment outcomes of this method are still incomplete and preliminary, the outcomes are promising. Around 25% of the teenagers have decided to delay the examination of their pelvic regions while 40% have delayed tests to their blood until after their first visit. Teenagers who have delayed these medical procedures are highly likely to come back to the clinic in their subsequent visits.

The clinic-based methods have also targeted other elements of service delivery towards increasing clinic attendance among the teenagers. An example of this initiative is the Responsible Education on Sexually and Pregnancy for Every Community’s Teens (RESPECT). The initiative includes expanded clinic hours that have been reserved for teenage clients, adolescent educators, and improved staff training. The focus is on the special needs of teenagers. The initiative incorporates a community and school-based element and a media campaign. the teenagers within the targeted societies have showed zero improvements in the childbearing or pregnancy rates (Sharma et al. 2018). The trends in the use of contraceptives have improved in the catchment areas, while the use of contraceptives have reduced in the city-wide region. At the same time, the disparities lack statistical significance. These inadequate statistics are because of the small size of the sample. It is challenging to identify the changes in the delivery of service. A total service delivery strategy has targeted specific teenage clients. The strategy for delivering services utilizes a psychosocial instead of a medical approach for providing contraceptive care. This approach divides what is known as an initial visit to clinics into two basic appointments. The first visit to the clinic involves education and counselling while the second visit includes medical assessment after the client has started using the medical method of birth control.

The approach incorporates face to face education sessions that adds fifteen minutes to the education sessions and adding extra six weeks after the medical examinations have been carried out. In-service training is needed for personnel concerning the development of teenage psychosocial state, and a staff who has specially trained teenage counsellor. The teenage clients that have been exposed to the changed clinic delivery system have shown higher contraceptive rates. There is restricted data related to elements of the service delivery method that are linked with lower rates of pregnancy and the higher continuation rates of using contraceptives. The tailored approach is promising but has high costs of executions. The extra service tasks have increased the workloads for the personnel. These extra costs are critical for the identification of the aspects of the package that are important and whether some of the elements can be dropped. Other methods for increasing the use of contraceptives among teenagers in the clinic-based systems have been provided as well (Sharma et al. 2018). These strategies include involving the family members of the teenagers towards increasing communications related to contraception and supporting contraceptive services. It also includes regular contact through telephone with teenage clients towards addressing questions and issues linked to contraceptive techniques. These efforts have shown significant effect on regular contraceptive use, rates of pregnancy and the rates of clinic continuation. For the methods that targeted sexual activity, behavioral and cognitive skills training have appeared efficient towards promoting contraceptive behavior. This method of reducing pregnancy among teenagers is effective to curb the higher pregnancy rates.

Implementation

Generally, an institution takes the leading front in designing and implementation of the evaluation of the family planning services, even though it is vital to enlist the help of other research organizations. In some institutions, the motivation of the large-scale assessment comes from the nation itself. The most common situation is that the donors and program administrators have mutual interests to learn if or not the program is on the right path and the way it can be enhanced further. The lead organization is among the main provider of services in the country, particularly when it is a governing institution such as the Nottingham’s Ministry of Health. The private family planning associations could take the lead, particularly when it is a primary player in delivering services or has a strong evaluation or research capability. Whoever has the main goal of assessment, it is necessary to identify and involve stakeholders (Lindo, & Packham, 2017). The key stakeholders must be involved in the planning process for family services. To maximize utility and benefit of assessing the family planning services, it is critical to include most stakeholders in the process from the beginning. The stakeholders are all individuals or organizations that are possibly interested in the way the assessment is carried out, the results, and the use of information. At the same time, the list must include all institutions expected to contribute information to the effort. These potential stakeholders include the official government agents that are accountable for monitoring the population.

The implementation also covers organizations that offer family planning services to teenagers such as Ministry of Public Health, donor agencies, women’s health and other advocacy groups, and private sector organizations. Large-scale assessments of a family service program, particularly when it includes impact assessment needs technical expertise in the design of the study, preparing data tools, supervising data gathering, editing and processing of the data, its analysis and preparing the report. Various developed nations presently have workers with expertise. The next step is defining the technical needs and identifying the available sources in the city. It involves using the right people, where it lacks, we could consider using alternative sources of technical help. These areas include local research organizations, universities and private consultants that have an evaluation or research background. There is also need for establishing and maintaining effective channels of communication. It is necessary for the lead organization to have an honest dialogue with the larger stakeholder groups, and not to only expect others to approve their suggestions. This process of consultation does not finalize with the completion of data assessments. Instead, it is useful for the maintenance of the same levels of communication throughout the stages of distributing and using results. The efforts of a single institution to use findings from the assessment offers an example to other institutions on the way academic research is used in improvement of programs. The evaluation plan also outlines various data collective activities that correspond to the goals of the evaluation, which are identified or tackled in the latter stages of the project. The information for every kind of data collection is summarized to offer an overview of the activities undertaken in the later parts of the project.

The implementation of the project also involves tailoring the presentation of the outcomes to the intended audience. High-level policymakers need the main findings from a specific assessment. These include questions about the rise of the contraceptive prevalence, and the most popular contraceptive methods. Due to the various information from the top-level decision makers daily, the report for the audience must be readily understandable and attractive aesthetically. This explains why the medium of choice is an eye-catching thin booklet which has an executive summary of the main results. The family planning researchers, program administrators and those who are more linked to the program will need more details than what is contained in the executive summary. The audience benefits from full report that has a clear and comprehensive table of content and directing readers to the specific topics that are covered. The evaluation outcomes must be fed back to the system, to the service providers and program managers whose work are reflected in the assessments. The busy practitioners are put off by the thick volume of the research outcomes but are receptive to the selected findings that link directly to the delivery of services such as the trends in prevalence, changing method mix, geographic concentrations and the characteristics of the users. The research community is also another possible audience that must be taken into consideration. In the case where a journal article is used, it must focus on the topic. These are the implementation methods that will be used in this study to arrive at a conclusion.

Plans for Evaluation

Various evaluation methods were used for the family planning services program. The experimental studies are globally acknowledged as the most precise method for examining causal effects. Only when eligible organizational units or persons such as families, clinics, and schools are assigned randomly to be in either the control or treatment groups. The policymakers are assured that all the effects are linked with the program participation. It is necessary to ensure that the outcomes are not affected by some extraneous factor including the higher motivations of the youth volunteering to take part in the program. Even in these experimental researches, the impact estimation is undermined whenever strict procedures are not followed. It is necessary to ensure that random assignments are carried out without exceptions and that the experimentalist have the experimental treatment. Another evaluation strategy was the Quasi-experiment research carried out more regularly. These studies compare results for the outcomes’ treatment with the same population not receiving the treatment. There are various kinds of quasi-experiment designs that are rigorous compared to others since they control the impacts because of extraneous factors.

For example, the one-group causes issues since the researcher cannot determine the changes between post and pre-test that are connected to factors outside the interventions. More quasi-experimental method uses a single experimental group that receives the program and another comparison group that is not receiving the family service program. Stronger design combines comparison approach with post and pre-test examination approach. This study also used the individual-level or micro-level assessment through the available survey information. These include using aspects such as the National Survey of Family Growth (NSFG) and the National Longitudinal Survey of Youth (NLSY). The policy variables including sex education, welfare benefits and funding for family planning are placed on databases having information about the family characteristics, behavior of adolescent fertility, demographic characteristics, and adolescent goals. the associations between adolescent fertility and policy variable, over the impact of sociodemographic and family factors are suggestive. However, without random assignments and precise conclusions on causality, results cannot be reached. The macro-level analyses can also be conducted with information linked to one state or city to examine the birth rates. In these assessments, the states having varied policies are compared, alongside the net of demographic and social disparities.

Conclusion

As shown, there are widespread concerns related to the incidence of teenage childbearing that have caused the formation of various intervention programs in Nottingham. The reason for choosing family-based planning method is that most of the programs that have been adopted to impact childbearing among teenagers have been unsystematic, poorly designed and small projects that do not have any useful evaluation strategy. The ease of using family planning services is because they are provided in various settings by different providers such as hospital outpatient departments, family planning clinics, private physician practices and health maintenance companies. An example of a useful family planning services program is The Smart Start initiative reduces fears of medical procedures linked with the examination of the pelvic region and testing blood that are performed at the earlier visit for family planning. Involving the stakeholders such as the program providers, parents and the policymakers in implementing the program must seek to delay sexual activity initiation while encouraging adolescents who engage in sex to delay it further. This intervention can also emphasize on improvement of using contraceptives among adolescents who are sexually active or affect decisions related to pregnancy resolutions.

References

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