Preconception Health Guidelines: Promoting Adolescent Health and Reducing Teen Pregnancy

By Sharron Corle
Associate Director, Adolescent Health, AMCHP

In the United States, almost 50 percent of pregnancies are unintended – for teenagers, the number is even higher – it’s estimated that over 66 percent of teen pregnancies are unintended. And, according to some recent data from the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, it’s not just about preventing teen pregnancy, the overall sexual and reproductive health of teens needs to be addressed. Some of the key findings from the report are: 

• Women younger than 20 years of age had a total of about 745,000 pregnancies in 2004.
• HIV/AIDS was present in about 22,000 youth aged 10 to 24 years in 33 states in 2006.
• Chlamydia, gonorrhea, or syphilis was present in about 1 million youth aged 10 to 24 years in 2006.
• During 2003 to 2004, 25 percent of women 15 to 19 years of age and 45 percent of those 20 to 24 years of age had evidence of human papilloma virus infection.
• During 2004 to 2006, about 105,000 women 10 to 24 years of age were seen at a hospital emergency department for nonfatal sexual assault injury. 

Teenage pregnancy and sexual activity are, of course, complex phenomena. Teen pregnancy is often not just about sex, but rather there can be many issues involved – poverty, gender equity, and lack of access or information, to name a few. Teen pregnancy prevention efforts, then, should do more than provide young people with information about the risks and consequences of unprotected sexual activity. Public health efforts have focused for so long on preventing pregnancy among adolescents that the idea of promoting preconception health strategies with this population may seem to be a curious notion.

In 2006, the Centers for Disease Control and Prevention released Recommendations to Improve Preconception Health and Health Care. The ultimate goal of the recommendations is to improve the health of women and couples, thus, the use of the term “preconception health” can be misleading – they’re not just about improving pregnancy outcomes, they’re about improving health outcomes. The use of “preconception” as an adjective before the term health simply implies that the health promotion activities are meant to be conducted anytime before a pregnancy occurs to address risk factors across the lifespan – including during adolescence. Many public health programs are recognizing that health trajectories, including reproductive health, are developed over the course of a lifetime and health behaviors initiated during adolescence can have a great impact not only on future reproductive outcomes, but also on present and future health.

In the fall of 2009, AMCHP, in partnership with the Association of State and Territorial Health Officials (ASTHO), launched a preconception health project designed to help a group of innovative states consider how to operationalize Preconception Health Recommendation 8 – integrating components of preconception health into existing public health programs and efforts, in this case state-level adolescent health efforts. AMCHP and ASTHO created a Request for Proposals (RFP) asking interested states to submit applications to participate in an 18 month-long Preconception Health and Adolescents Action Learning Collaborative (ALC). Twenty-four states participated in the “bidders” call for RFP and 14 states submitted applications. As funding only allowed support for a maximum of six states to participate in the project, selecting the teams was challenging for the review committee. In the end, teams from Missouri, Ohio, Oregon, Pennsylvania, South Carolina and Utah were selected. The ALC was officially launched in November 2009 during a two-day meeting in Atlanta where participants learned about the research behind the preconception health guidelines and the life span approach to health, strategized with their team members about potential opportunities in their states related to integrating the recommendations into current efforts (or creating new efforts) and planned for action. States were specifically charged with considering Recommendation 1 – promoting individual responsibility across the lifespan which involves designing strategies to encourage each woman, man, and couple to have a reproductive life plan; Recommendation 2 – raising consumer awareness, which involves designing strategies to increase public awareness of the importance of preconception health care and services by creating tools and disseminating information; and Recommendation 4 – promoting and disseminating interventions that screen for or treat identified risks, which involves increasing awareness of the importance of ongoing care for chronic conditions and disseminating existing evidence-based interventions that address risk factors.

Each of the teams is working on a project that has relevance for their particular team or state. Oregon is looking at the concept of preconception health and youth with disabilities. Ohio is taking a look at their broader efforts related to adolescent health. Pennsylvania has two complementary aspects of their project, working to raise awareness of the life course approach and preconception health with providers and school personnel and working with parents to improve their communication skills around these issues. South Carolina is targeting young adults in their efforts and seeking to raise awareness of preconception health with this population. Utah has developed a set of guiding questions relating preconception health concepts to information already included in the health curriculum for teachers and are also promoting a reproductive life plan for adolescents. Missouri is tackling a challenge that all the teams face – how to reframe preconception health concepts so that the connection to adolescent health outcomes is more obvious. Over the course of the next year, AMCHP and ASTHO will be working closely with these six teams and also thinking about the next phase of this work, so stay tuned!

Sharron Corle, Associate Director, Adolescent Health on behalf of the AMCHP’s Women’s and Infant and Adolescent Health Teams and ASTHO’s Maternal and Child Health Team.

Endnote 

[1] Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Sexual and Reproductive Health of Persons Aged 10 -24 Years – United States, 2002-2007.