When a teenager in foster care gets pregnant, the child welfare system has failed. The barriers to future education and employment for these young people are bad enough without the added burden of a baby. And of course, the risk of bad outcomes (including abuse, neglect and placement in foster care) are high for babies born to teen mothers.
Unfortunately, teenagers in foster care are much more likely to become pregnant than other teens. According to data compiled by the National Campaign to Prevent Teen and Unplanned Pregnancy, nearly half of teenage girls in foster care are pregnant by age 19, compared to 27 percent of all teenage girls. (Fatherhood data, sadly, is not available.)
It is not surprising that teens in foster care are more likely to get pregnant. Research indicates that teens in foster care are about twice as likely to be sexually active as teens not in foster care. Girls in foster care are much less likely to use contraception than their peers who are not in care. Risky behavior by teens in care is probably related to their adverse childhood experiences and the fact that they have fewer protective factors, like attachment to a caregiver.
Some teen pregnancies are intentional, and these may be more likely among young people in foster care. For some, a baby may provide the unconditional love and attachment that some teens in foster care have never experienced. For others, the opportunity to get an independent living apartment may be an incentive for pregnancy where such opportunities are available.
Even if they don’t want to get pregnant, teens are likely to conceive by accident if they don’t use effective methods of birth control. Methods that must be taken each day or used each time (like a condom) are not very reliable for teens. Because foster children move frequently, a method that requires repeat medical visits is not practical for them.
The availability of Long Acting Reversible Contraceptives (LARCs), such as an interuterine device (IUD) or a birth control implant, offers an opportunity to reduce pregnancy among teens in foster care. LARCs are safe and easy to use, and they last from five to ten years.
Unfortunately, LARCs are still not widely known or understood among teens, adults and even health care professionals. Problems with earlier versions of the IUD and contraceptive implant contribute to an impression that these methods are not safe. Teenagers and even clinicians continue to express concerns about LARCs, often based on myths and misconceptions.
Secondly, foster youth are not likely to be offered LARCs in most systems. Many foster care teens get their care at primary care clinics that take Medicaid. Research shows that primary care clinics are less likely to offer LARCs than are clinics focused on reproductive health care.
A few places are starting to see the value of long-term protection. The Colorado Initiative to Reduce Unintended Pregnancy made LARCs free and widely available. The initiative began in 2009; since then, the state’s birth rate among teens ages 15 to 19 has dropped from 37.7 per thousand to 25.4 per thousand.
When it comes to foster youth in particular, Los Angeles is setting an example for other jurisdictions. As recently reported in the Chronicle, a new program there provides LARCs to foster youth and those at risk of entering into foster care in all of the “medical hubs” affiliated with the county’s Department of Health Services. Staff at these clinics are being trained in inserting the devices.
Jurisdictions should follow Los Angeles’ example and make LARC’s available to all teens in foster care. In addition, agencies should train foster parents, group home staff, and social workers to provide accurate information about the effectiveness of LARC’s and other birth control methods.
Contraception and education alone do not provide the solution to the problem of births to foster care teens. Research indicates that youth who received more monitoring by their caregivers were less likely to be sexually active, and more frequent use of contraception was likely among youth who reported feeling connected to their caregivers.
But as I have written in previous columns, many teens in foster care do not receive adequate attention or monitoring and do not have strong relationships with their caregivers. We need to find a way to replace these bad foster homes, be it with professional foster homes or family-style group homes.
Preventing pregnancy among teens in foster care should be a top priority for all child welfare systems. Teens in foster care need to complete their educations and defer childbearing until they are in a better position to support a child economically and emotionally. Unfortunately, Congress may be close to cutting resources for teen pregnancy prevention and family planning.
We can only hope that state leaders see the problems of teen pregnancy first-hand, and will be smart enough to ensure that prevention services to teens in foster care and other at-risk teens are increased, not decreased.