While teen pregnancy rates in the United States have declined some 22% (U.S. Department of Health and Human Services, 2001), the need for programs for pregnant and parenting teenagers has not decreased. The actual number of births to teens is slightly up, owing to larger proportions of young people in the population. Moreover, upcoming increases in the number of teens portend increases in teen births.
The programs for these young parents assume many forms and use many techniques to assist both them and their offspring. Some programs are school-based (e.g., Walruff, 1994; Fuscaldo et al., 1998; Higginson, 1998). Guidelines on how to create programs in school settings have been presented (Sipe et al., 1994); the National Education Association (2000-2001) has also issued guidelines on the desirable features of these programs. Other programs are located in health facilities (e.g., Fischer, 1997), and still other programs serving pregnant and parenting teens are located in communities (Maynard & Rangarajan, 1994) or are residential (e.g., Collins et al., 2000). The American Academy of Pediatrics has issued guidelines for the care of adolescent parents (Committee on Adolescence, 2001).
Some programs offer many services, while others try more limited interventions such as health passports (Stevens-Simon et al., 2001), videotapes to promote mother-child communication during mealtime (Black & Tei, 1997), and use of technology in classrooms (Cocalis, 1995). Case management, home visits, counseling, and workshops are all prevalent interventions (Key et al., 2001; Granger & Cytron, 1999; Long et al., 1994; Olds, 1992; Olds et al., 1988). More recently, with the advent of welfare reform, programs have included incentives and punishments to encourage participation and reduce attrition (Maynard, 1995). Most of these programs serve young mothers only, neglecting young fathers (Kiselica et al., 1998; Kiselica & Sturmer, 1993) even though they too experience negative consequences from early parenthood (Maynard, 1996).
The goals and outcomes of these programs also vary widely. Some target health-related gains for both mothers and children, such as use of medical services, early entry into prenatal care, greater prevalence of immunization, less use of emergency rooms for care (Stevens-Simon et al., 2001; Wiemann et al., 1997), and reduction in low birth weight babies (Cameto & Wagner, 1995; Fischer, 1997; Olds et al., 1988; Wagner et al., 1995). While improvements in birth weight have been reported (e.g., Olds et al., 1988; Wagner et al., 1995), improvements in the use of health care have been more elusive.
Other programs have focused on increased use of contraceptives, primarily as a strategy to reduce subsequent pregnancies. Highly effective methods that do not require user motivation, such as implants and long-acting hormonal contraceptives, have been found to be particularly successful (Coard et al., 2000; Polaneczky et al., 1994; Stevens-Simon et al., 1999). On the other hand, some comprehensive programs have not been able to bring about change in the use of contraceptives among young parents (Cameto & Wagner, 1995; Quint et al., 1994; Polit, 1989).
The effects of these programs on repeat pregnancy have been decidedly mixed. Repeat pregnancies among young mothers are particularly problematic (Kalmuss & Namerow, 1994; Martin & Wu, 1998) and the second children born to teens have higher infant mortality rates (Cowden & Funkhouser, 2001). While some programs have reported success in reducing repeat pregnancies (Fuscaldo et al., 1998; Key et al., 2001; Kuziel-Perri & Snarey, 1991; Olds, 1992; Olds et al., 1998; O'Sullivan & Jacobsen, 1992; Ruch-Ross et al., 1992; Solomon & Liefeld, 1998), others have had much less impact on this important outcome (Cameto & Wagner, 1995; Marsh & Winick, 1991; Maynard, 1993; Maynard & Rangarajan, 1994; Stevens-Simon et al. …