Unifem July 11, 2009Melissa Gilliam MD, MPHChief, Section of Family Planning and Contraceptive ResearchHead, Program in Gynecology for Girls, Adolescents and Young Adult Women

The University of Chicago

Planning Families: A Road to Health for Women and Girls

The Section of Family Planning at the University of Chicago Research

Clinical Community based

Policy Program Fellowship Program Program in Gynecology

for girls, adolescents and young adult women

The Ryan Center

Life course perspective: women’s health is essential to the health of the individual, family and society over time

Multifaceted role for women: childbearing, childrearing, providing for family, role in society, workforce and community

Goal: women’s lifelong health and wellbeing Family planning is part of the continuum of lifelong

health

A life course approach to women’s health

Overview

Adolescent Health Repeat pregnancy

Adolescent health

Adolescence is a time of growing independence

from family. This challenging but essential period enables youth to lead healthy adult

lives

Discover

by engaging with youth Understand

by conducting qualitative, quantitative and clinical research

Change

through policy and advocacy

Understand

Change

Discover

Program in gynecology for girls, adolescents and young adult women

Comprehensive reproductive healthcare for girls and young women with chronic or acute illness affecting their reproductive health

Teen Pregnancy

Each year 750,000 teens become pregnant. One third are 17 and under. Half of these pregnancies result in birth. One third end in abortion.

Guttmacher Institute, U.S. teenage pregnancy statistics: national and state trends and trends by race and ethnicity, New York: Guttmacher Institute, September 2006, http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf accessed September 12, 2006; and Finer LB et al., Disparities in unintended pregnancy in the United States, 1994 and 2001, Perspectives on Sexual and Reproductive Health, 2006, 38(2):90–96.

Sexually Transmitted Infections Teens and young adults (aged 15–24) account for an

estimated one-half of all new STIs

Nine million teenagers and young adults acquire an STI each year

Two young people every hour become infected with HIV Recent CDC data show ¼ teens has an STI (Chlamydia,

HPV, Trichomonas, HSV)

Weinstock H., Perspectives on Sexual and Reproductive Health, 2004, 36(1):6–10.

Forhan, S Oral abstract, 2008 National STD Prevention Conference

Teen Pregnancy

Teen birth rates up in 26 states --USA Today January 2009

2/3 of families begun by young unmarried women are poor

Over half of women receiving welfare had first child has a teen

Teen moms and moms-to-be take a class in the Bronx, N.Y., to help them have healthy pregnancies and healthy babies.

Repeat

Teen Pregnancy

Repeat Teen Pregnancy 28% to 63% of

adolescent mothers become pregnant again within 18 months

20–37% experience a repeat birth within 24 months

Meade CS and Ickovics JR, Social Science and Medicine, 2005, 60(4):661–678.

Shifting paradigms: Bronfenbrenner’s Ecological Theory of Human Development

Human development placed in context of social entities: “like a set of Russian dolls” Family Neighborhood Community Society

Behavior is a function of the person and the environment

Limitation of Comparative Research

Racial comparisons Comparisons across

socioeconomic strata “at risk” or “deviant” Heterogeneity of ethnic

minority populations What is race?

McLoyd V., “The Imperative of Research on Minority Adolescents”. In Studying Minority Adolescents. London, 1998

Postpartum-ABCs

Contraceptive use behaviors Focus groups with first time adolescent mothers Teens with repeat pregnancies Determined domains of influence for adolescent

mothers’ contraceptive behaviors: Biology Psychology Social (family, partner, community, school) Neighborhoods

Longitudinal study of first time postpartum adolescent mothers 14-18

40 youth interviewed 5 times in the first postpartum year

Qualitative and quantitative techniques

Post Partum Adolescent Birth Control Study (PP-ABCs)

Research with Adolescent of Color“The challenge then is not to create databases on

minority children that necessarily parallel those that exist on non-Latino white, middle class children. Rather, it is to formulate culturally relevant constructs, and systematically document the precursors and consequences of developmental outcomes in the context of a culturally sensitive framework. Research of this kind is more arduous and slower-paced”

McLoyd, 1998

“Judgments of untimeliness should be tentative. Their purpose is not primarily to diagnose and certainly not to blame but rather to prevent or alleviate unnecessary suffering for young women and their children.”

Sara Ruddick

Ruddick in Procreative choice for adolescent women. The Politics of Pregnancy. Lawson and Rhode eds. Yale New Haven Press 1993

Section

Letitia BennettSabrina HolmquistMishka TerplanStephanie MistrettaSandra TilmonBri TristanAmy WhitakerAmy NeustadtAsha QuansahErica SmithDebbie StulbergJim PuricelliRobert Webster

Thank you