Final Program Proposal

Executive Summary

According to American Pregnancy Association (2003), teenage pregnancy refers to “pregnancy in a

woman under the age of 20”. Although there is a global downward trend in teenage pregnancy rate
in industrialized nations since 1991, the United states (US) teenage birth rate is significantly higher
than competing nations like Canada (Osterman et al. 2022), and the United Kingdom (Maddow-
Zimet & Kost, 2021). In the United States, over 200,000 babies are born to teenage girls yearly. The
World Population Review (2023) reported that in 2021, the US birth rate in 15-19 age groups was
13.9 births per 1000 persons with a significant geographic variation observed in teenage birth rates
in the country. The report has it that teenage birth rates tend to be lower in the north eastern states
like New Hampshire than southern states such as Louisiana which ranked 48 th in ten birth rates
among 15-19 years at 24.5 per 1000 persons while Mississippi ranked 50 th with a teen birth rate of
27.9 in the country. (World Population Review, 2023). Among Louisiana parishes, St Mary is one of
the parishes with the highest birth rates in the states at 42.1 as compared to Louisiana state rate of
24.5 (Louisiana Health Report Card, 2022).

Unintended pregnancies among teenagers are considered a high-risk pregnancy due to undesirable
outcomes for both the teenage mother and the baby. According to World Health Organization
(WHO, 2017s), “maternal complications during pregnancy and delivery are the leading cause of
death of women aged 15-19 years worldwide”. The report also mentions that about 17 million
teenagers give birth yearly. This is alarming and constitutes a major public health issue in
industrialized and developing countries globally. In 2021, the Centers for Disease Prevention and
Control (CDC, 2016b) reported that the maternal mortality rate for women under 25 years of age
was 20.4 deaths per 100000 live births, and most of the are preventable.

Teen pregnancies often lead to unintended consequences. According to World Population Review
(2023), there is a significant health, social and economic burden associated with teen pregnancies.
Teen mothers often experience poor birth outcomes such as preterm/low birth weight babies,
miscarriages, maternal illness such as pre-eclampsia, eclampsia, hypertension, stillbirths, neonatal
deaths, among others. They are more likely to be school dropouts and more likely to not get a
college degree. They are also unlikely to find employment leading to poverty. Children born to
teenage mothers are likely to end up in foster care and the cycle is repeated in most cases (World
Population Review, 2023).

According to Todhunter et al. (2022), teenage pregnancy could have a significant social and
psychological influence on the mother, leading to mental health issues like depression, puerperal
psychosis, and lack of self-worth. Lastly, the risk of sexually transmitted infections is very high among
teenage mothers.

Affected populations

A recent research by Todhunter et al. (2022), shows that approximately 11% of births occur in
adolescents aged 15 and 19 years globally, and 10 million intendent pregnancies occur in
adolescents yearly. In the US, teen birth rates continue to show disparities in geographic location
and race/ethnicity. According to the CDC (2021s), teen birth rate for Hispanic teens were 25.3, and
non-Hispanic Black teens 25.8, which were more than double the rates for non-Hispanic White teens
(11.4). The highest teen birth rates were observed in American Indian/Alaska Native teens (29.2).
also, teens in certain setting, such as those in foster care experience higher rates. This report also
mentioned factors such as social determinants of health, health-low-income status, low educational
attainment, and food insecurity contribute to teen pregnancy.

Geographic location also significantly affects teenage pregnancy rates. According to World
Population Review (2023), teen birth rates are higher in the southern states of Mississippi, Arkansas,
and Louisiana than the norther states such as New Hampshire, Massachusetts, and Vermont. Some
of these states in the south do not provide sex education at any level, for example, Oklahoma City
Public Schools. Some of the southern states have more conservative beliefs, and restrictive
reproductive rights policies.

Social determinants of health contribute significantly to poor pregnancy outcomes in teenagers.

According to Amjad et al. (2019, pp88-99), “African American race, rural, residence, inadequate
education, and low SES are markers for poor pregnancy outcomes in adolescent mothers.”

Priority population

According to Todd & Black (2020), there is a very high incidence of unintended pregnancies in
teenage girls aged 15-19 years old. As reported by Garney et al. (2019), ethnic minorities and certain
populations continue to experience persistently higher rates. As previously reported by Todhunter et
al. (2022), non-Hispanic teenage black rates are more than double those of non-Hispanic Whites.
Therefore, the focus of this project will be with this population in St Mary Parish in Louisiana which
has one of the highest rates of non-Hispanic Black teenage pregnancy in the state (42.1) (Louisiana
Health Report Card, 2022), due to the impact of poor socioeconomic status, limited access to
reproductive health services, social determinants of health, lack of education, cultural norms and
beliefs which uniquely predispose these teenagers to unintended pregnancies.

Associated behaviors

Adolescents have many behaviours in references to growing up and discovering themselves. With
this comes the incentive to experiment; in this case these behaviours lead to unwanted pregnancies
in teens. It is found that most have had sexual experiences at a young age. For example, statistics
show that about 30% of youths age 15-16 have been sexually active (Finner &Philbin, 2013). This
population has its own set of social norms, behaviours, and attitudes toward sexual encounters.
These behaviours are grouped under high-risk sexual behaviours. For example, the CDC’s National
Youth Risk Behaviour Survey reports that “48% did not use a condom the last time they had sex”
(CDC, 2023). This demonstrates that nearly half of adolescents are not using proper protection
against STDs, STIs, and unwanted pregnancy. There is universal understanding that safe sex practices
have higher percentages of success. Murray et al. (2013), analysed the attitudes of teen to college
age African American women toward relationships. In their findings, they discovered that just over
half of the study participants reported that a STD diagnosis is the worst outcome and that the
potential or positive diagnosis of pregnancy is a bad outcome. A continuation that there is an
understanding of reducing risk and clear engagement of high-risk sexual behaviours. With this there
are choices after sexual encounter in the forms of emergency contraceptives and STD testing.
Though there are accessible services, the CDC (2021b), found that only 5% of all students have been
screened for sexual transmitted diseases in the preceding year. A significantly low number in
comparison to the previous statistics of the percentage of teens engaging in sexual activities. These
behaviours may stem from having unhealthy relationships, low self-esteem, lack of sexual education,
and other high-risk behaviours.

Selected behaviour
Lack of contraceptive use, which could be because of poor access to reproductive health services
and lack of education about contraceptives coupled with the overturning of Roe v Wade, is crucial in
unintended pregnancies in adolescents. Recent research has found that there has been a prevalence
of sexual intercourse, there still evidence of high-risk behaviours. Yet there is need to understand
the urgency in a society post Roe v Wade, and the loss of the right to access safe abortions. The most
prominent behaviour is the misuse of contraceptives in the target population. Access is certainly an
area that is considered within this, but even with accessible contraceptives and condoms, there is no
guarantee of proper use. For example, the attitudes of priority population are a potential main
factor in the lack of prevention tactics used. Hiltabiddle, S.J. (1996), analysed this perspective
through the lens of health belief model. Through his research, he notes that the perceived
susceptibility is one aspect of the Health Belief Model that is not direct to the priority population.
The author posited that long-term consequences of these risky sexual behaviours including pelvic
infections, infertility and cervical cancer, may seem implausible to the adolescent. This lends
credence to the overall attitude and perspectives of the teenager. The priority population is
adolescents that have poor values and choices based on thoughts of invincibility, innocence, and
naivety. Though this study is dated just over 25 years ago; it shows a clear trend of consistency in a
type of behaviour. Thus, it further emphasizes the importance of teen pregnancy behaviours. It is
the lack of use of contraceptives and the attitudes toward proper usage that is the central behaviour
in correlation to teen pregnancy.

Determinants of selected behaviours

Teenage pregnancy is associated with multi-level factors ranging from individual, interpersonal,
community and societal factors. According to Amjad et al. (2018), teenage pregnancy is closely
related to three important determinants including; social determinants of health, African American
race, and poor educational status. According to the WHO, social determinants of health are “non-
medical factors that influence health or rather they are the conditions in which people are born,
grow, work, live, and age” (WHO, 2017B). the list includes income, education, housing, early
childhood development, unemployment, food insecurity, access to affordable health care, safe
housing, transportation, neighbourhood and built environment, among others. These are all related
to structural factors like economic policies, social policies, systemic racism, political systems, and
social norms (WHO, 2017b). thus, there are multi-level social and environmental factors associated
with unintended pregnancies among the teenagers. According to CDC (2021a), low education
attainment and low-income levels contribute to teenage pregnancies. This article also mentioned
that teens in the foster care homes are twice as likely to become pregnant.

Another important determinant in teenage pregnancy is lack of access to reproductive healthcare

and contraception. Most teens have limited access in obtaining contraception which could be due to
cost, the limited number of reproductive care centers, restrictive laws, and lack of transportation to
service centers (Chakole et al., 2020). In addition, teens may not have the self-efficacy to effectively
use contraceptives even when they are available.

As noted earlier, economic factors play a key role in teenage pregnancy and birth outcomes.
According to Orben et al. (2020), teenagers from poor families have fewer choices and opportunities
and are more likely to engage in risky behaviours such as substance use, unhealthy relationships,
and high-risk sexual behaviours. The authors also reported other determining factors for unplanned
pregnancies in teenagers and their parents or families which could limit opportunities for discussion
about sexual health and contraception. These are important in teen decision-making processes and
in reducing the risk of unintended pregnancies in teens.
Other factors that play a role in unintended pregnancies in teenagers are social norms, cultural and
religious beliefs about premarital sex and contraception, and peer influence. Also, social media has a
significant influence on teenagers’ perceptions about sex, relationships, and culture.

Program Description

 Recruitment and retention methods

Unintended pregnancies among 15-19 year-old non-Hispanic black women living below the poverty
level in St. Mary parish, Louisiana.

 Sample of intervention material

Priority population has been narrowed down to 15-19-year-old non-Hispanic black women living
below the poverty level in St. Mary parish, Louisiana.

The problem statement has been modified to read: To increase contraceptive use among 15-19-
year-old non-Hispanic black women living below the poverty level in St. Mary parish, Louisiana, with
a view to reducing the prevalence and impact of sexually transmitted infections.

In text citations have been changed to APA citation style, and the references section has been
updated to reflect that.

The most important health outcome has been modified to Sexually Transmitted Infections (STIs)

Other elements/information cited in the feedback have been addressed.

 Community engagement and cultural tailoring

Conducting a community-engaged assessment is critical in order to understand the underlying

factors at play with the prioritize health issue, if there is a true need for the program within the
community, the resources within the community, and how to appropriately tailor the program
towards the community’s distinct values, needs, and assets.

In this program planning step, it begins by considering the program stakeholders, how to effectively
engage them in the program planning process, and what methods would be optimal for community-
engaged assessment.

 Evaluation
 Dissemination (describe how you will disseminate the evaluation results, including to whom and what methods will be
used. A table can be used for this section)
 Sustainability (describe strategies that will be put in place so the program can be sustained after funding cycle ends)
 Anticipated challenges and solution (what challenges (3) might your program face and what strategies (3) might
you use to overcome these concerns?)

1. Anticipated Challenges

Some anticipated concerns and challenges faced by this priority population and community include
limited access to reproductive healthcare services, lack of sexual education and awareness, stigma,
and social norms.

Limited access to reproductive healthcare services in St. Mary Parish: According to Data USA, in
2020, about 19.8% of the population in St. Mary Parish, LA lives below the poverty level, a number
that is higher than the national average of 12.8% (Data USA, 2020). High rates of poverty can have a
significant and a long-lasting influence on a community, affecting different facets of social, economic,
and general well-being. One anticipated effect of high poverty rate on a community such as the St.
Mary Parish would be limited access to reproductive healthcare services. Ensuring easy access to
affordable and confidential reproductive health services is a major concern for 15-19-year-old non-
Hispanic black women living below poverty level in the St. Mary Parish community. This could be due
to financial constraints, a lack of transportation or limited availability of healthcare facilities in rural
areas like St. Mary Parish.

Lack of comprehensive sexual education and awareness: Comprehensive sexual health education
helps young people take steps to protect their health, including delaying sex until ready, and using
condoms and contraception when they do become sexually active. According to Bridges & Hauser
(2014), every year since 1997, the government has invested a lot of money into abstinence-only
programs. These programs have not reduced the rates of pregnancy in teens and have only resulted
in wasting government money. A lack of comprehensive sexual education and awareness exist
among non-Hispanic black teenagers in the St Mary Parish, particularly within schools, leading to
limited knowledge about contraception, safe sex practices, and the risks associated with
unprotected sex. This knowledge gap can contribute to higher rates of unintended pregnancies and
STIs. Consequently, there is a need for educational programs that provide accurate information
about sexual health, STIs, and contraceptive options.

Stigma and cultural barriers: Stigma and sexual health discussions and contraceptive use can be a
significant concern for this priority population. Cultural or social norms may discourage open
conversation about sex and contraception, thereby making it challenging for young women to seek
information and resources without fear of judgement or social consequences. In some communities,
discussing sexual health openly may be considered taboo. It is essential to address these cultural
sensitivities and engage community leaders to advocate for responsible sexual behaviour and
contraceptive use (Denny et al., 2002). Culturally sensitive approaches that consider the specific
needs of non-Hispanic black women should be employed.

2. Anticipated solutions

Three known assets or resources that already exist within this community would be Louisiana
Reproductive Health Program (LRP), St. Mary Parish Unit, Ochsner St. Mary, and non-profit
organizations.

Louisiana Reproductive Health Program (LRP): With more than 60 clinics across the state, the
Louisiana Reproductive Health Program helps thousands of men, women, and children. Anyone who
needs to talk to a provider about birth control, screening for STIs, or other reproductive health needs
can do so over the phone or in person. Telehealth visits can be done in private, either by a device
that connects to the internet through a wire or with a phone. Patients can get birth control by email
or at a neighbourhood pharmacy, and they can get enough of up to a year (Louisiana Department of
Health, 2022a).

St. Mary Parish Health Unit: The St. Mary Health Unit is in Morgan City, LA, at 1200 David Dr. They
offer birth control, STD testing, treatment, and vaccines, women’s healthcare, and pregnancy
services. You can walk to make an appointment for the same day (Louisiana Department Health
Program, 2022b).

Qchsner St Mary Health Center: Qchsner St Mary, a non-profit healthcare center formerly known as
Teche Regional Medical Center, is one of the best places to get medical care in Morgan city. It
provides emergency care for people in St. Mary parish and the nearby places and comprehensive
reproductive health care services for women including teenagers (Qchsner St Mary, 2021).
Project Management and Staffing

 Organization capacity (for the purpose of this project, you can attach your program to an existing organization or
invent your own. Describe the organization and how the program fits within its scope. Create an organizational chart that
displays the key staff positions for the program)
 Gantt Chart/Timeline (provide a visual depiction of major components of the program, from needs assessment, to its
implementation, to the valuation. Timeline format must be a Gantt chart in landscape layout with all sections and text visible )

Budget

 Line-item Budget (provide a table by program year that outlines all expense for the program. Include total program cost
($750000) distributed within 3 years. Each year’s spending must be less than $500000 ).
 Budget Justification (describe and justify each program cost, explain how you determine each expense. Include any in-
kind support as its own section)