Early Pregnancy

Midwest Study Courtney, et. al., 2007

Big Picture of Early Pregnancy

In recent decades, services and programs have effectively reduced pregnancy for teens overall. Teen birth rate in California is down 77% since 1991. Unfortunately, that trend has not yet translated over into the child welfare system:
• When Midwest Study participants were interviewed at age 21, 71 percent of females had ever been pregnant while 49 percent of males had ever gotten a female pregnant (Courtney et al., 2007).
• This is significantly higher than rates for peers in the Add Health Study, where 34 percent of females had ever been pregnant and 19 percent of males reported ever getting a female pregnant (Courtney et al., 2007). Young mothers transitioning out of foster care have also been found to have high rates of repeat pregnancies prior to age 20 (Dworsky & DeCoursey, 2009; Putnam-Hornstein & King, 2014).

Placement in disadvantaged neighborhoods, lack of access to contraception and health resources, inadequate education on developing healthy relationships, and adverse childhood experiences of young adults in care may play a role in unplanned pregnancies among foster care youth (Plax, Jain, & Kaushik, 2016).

Unintended Pregnancy

CalYOUTH, Courtney et. al., 2016

In the CalYOUTH study, more than two thirds of foster youth reported that their pregnancy was not intentional. Many of these young people go on to be very resilient and successful parents, but an early pregnancy that wasn’t planned for is a challenge for anyone, but especially youth with limited family support.
There is a common misconception that foster youth want to have babies to “make a family for themselves.” This study shows that isn’t true. Rather, youth tell us they didn’t have the knowledge or support necessary to prevent their pregnancy. While there certainly are some youth who intend to get pregnant (and that choice is theirs to make), it is not as common as we often hear. This is why it is so important to ask youth what it is they want. And, obviously, to provide information and access to pre-natal care whether the pregnancy was intended or not.

What are the implications of unintended pregnancies?
Having a child makes going to college a lot tougher. At age 19, of those who had not enrolled in higher education, 30% cited the need for childcare as a major barrier to returning to school. It also creates economic instability for both the youth and child welfare system as having a child poses additional educational, employment, and mental health costs. At age 24, having a child reduced a woman’s odds of being employed by 30%—even after holding educational attainment constant. Additionally, children born to foster youth were 3 times more likely to have a substantiated report of maltreatment by age 5 than children born to the same-age youth not in foster care.

Given the disparities and related outcomes just discussed, it became clear that foster youth needed more intentional support to ensure they receive education, information, and services about their sexual and reproductive health. SB 89, which became effective in 2017 aims to do this for young people in foster care age 10 and older.

Pregnancy Prevention
Youth need accurate information and decision-making skills to help protect them from pressure to have sex and to protect against unintended pregnancy if they choose to be sexually active.
Caregivers may assist foster youth in their care by directing them to reliable sources of information. It is important that foster youth learn about reproductive health and family planning from reliable sources, including reputable websites, healthcare professionals, and from clinics specializing in reproductive health. Accurate, non-judgmental, comprehensive information on sexuality and pregnancy prevention, related services, and options available coupled with careful guidance, will assist youth in making the best choices for themselves.

Youth need to be comfortable with their healthcare provider and trust the information and services they receive in order to feel empowered to make good choices regarding their health and well being. Youth can actively participate in the process of selecting a healthcare provider and receive assistance in setting up their own health appointments, as well as the steps involved in preparing for them. Youth in foster care are permitted to choose their own healthcare providers as long as the payment for the health-related services is authorized. Caregivers are required to arrange for timely transportation to health-related services, as many reproductive health services are time-sensitive.
• As referenced in ACL Number 16-82 16ACL Number 16-82ACL Number 16-82 , under Right #5, youth have “the right to obtain, possess, and use the contraception of his/her choice, including condoms.” (Family Code, section 6925; WIC, section 369(h)).

A youth may choose to be abstinent. Abstinence is a reasonable option for youth who do not want to be sexually active or to stop being sexually active. A caregiver may provide support related to the youth’s decision to practice abstinence. However, requiring the youth to agree to be abstinent or to sign an abstinence agreement may constitute a personal rights violation.

Another way to prevent pregnancy, which allows a youth to release sexual tension and urges, is to masturbate in private. Masturbation may have other benefits related to healthy sexual development, including helping a youth have a sense of ownership of their bodies. If a caregiver has cultural or religious beliefs that would make it difficult to talk with a youth about masturbation, then the caregiver should direct the youth to reliable sources of information or suggest the youth talk with a healthcare provider.

Pregnancy requires a youth to make important choices about their future. It is a young woman’s right to make important personal decisions for herself and her unborn child. She may need assistance and input from her partner, family, friends, counselors and mentors to make these decisions. It is important that she have unbiased guidance from the caregiver who can assist her in finding a counselor or with gathering accurate information on her choice to keep the baby, terminate the pregnancy (abortion), safely surrender the baby, or to place the baby up for adoption.

ScenarioWhat To Do
The youth tells
the caregiver
she is pregnant.
• The caregiver can provide the youth with reliable websites with information about various options including parenting, terminating the pregnancy (abortion), safely surrendering the baby, or placing the child for adoption.
• The caregiver can encourage the youth to gather information from trusted and supportive
individuals in order to arrive at an informed decision about her future.
• The caregiver shall assist the youth in making a health care appointment and transporting the youth to the appointment so a health provider can review options with the youth, if the youth requests such assistance.
• The caregiver can assist the youth in finding a support group for pregnant and parenting youth.
• If the youth chooses to continue the pregnancy, the caregiver shall transport the youth to prenatal appointments (provided the youth requests such assistance).
The youth discloses she is pregnant and would like an abortion.• The caregiver shall assist the youth in making an abortion appointment with a health provider in a timely manner, if the youth requests such assistance. The caregiver shall provide transportation to the appointment, if the youth requests such assistance.