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Low Income Teen Mothers in the Medicaid System Essay (Critical Writing)

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Updated: Apr 1st, 2022

Introduction

Teenage pregnancy is said to occur when a girl conceives and gives birth before she reaches the age of twenty years by the time she gives birth. The term encompasses such girls their marital status notwithstanding. In most cases, teen pregnancy tends to create the impression that such pregnancies occur in unmarried teens.

Unlike in the recent past where teen pregnancy was not a big issue since there was a somewhat justified need to bear many children given the high child mortality and a much shorter lifespan of the time, teenage pregnancy and motherhood raises a major concern among parents, health care practitioners as well as authorities nowadays. This owes to the huge social and economic cost that accompanies it. This paper seeks to demonstrate the profound effect which high volume of teen pregnancies has on a healthcare system in terms of cost, quality and access of healthcare.

Impact of teen pregnancies

Even though teen pregnancies are highly undesired and equally discouraged in the modern world for the simple reason that advances in modern medicine have enabled people to live longer besides hugely increasing survival rates of infants, statistics for teen pregnancies are still high even in the industrialized nations. In 2001, for instance, teenage birth rate for the US was reported to be 52.1 per a thousand births; the highest (up to five times higher than Europe’s) teen birth rate among developed countries (UNICEF 2). In 2006, one in every ten children born in the United States was born to an adolescent mother. These figures had a positive side in the fact that they represented a downward trend in the rates of teenage pregnancies. In regard to this, between 1990 and 2005 teenage pregnancies dropped by 40 percent (from 116.8 per 1000 births to 70.6 per 1,000 births) (Ventura et al. 6). However, beginning 2006 the rates have been on an upward trend again.

How teen pregnancies affect cost, quality and access of healthcare

Substantial costs are incurred by public authorities both at state and national levels in efforts to provide for the significant needs of teen mothers and their children. This is because of the fact that even at subsequent stages of their lives, adolescent mothers for the reasons that they are highly likely to drop out of school, remain unmarried and to raise their child or children on their own. Consequently, they are highly likely to earn very low income barely enough to cover for their own needs as well as the needs of their children. According to the American College of Obstetricians and Gynecologists (ACOG) (4), this places them at great need of social services and other public assistance programs as well, and has consequently led to higher rates of enrollment of teen mothers in Medicaid upon deliver compared to the rates of older mothers.

In 2004 alone, an estimated nine billion dollars was incurred by public authorities in the US to cater for costs linked to adolescent motherhood. This estimate, as intriguing as it is, was hardly all-inclusive as it factored a small portion of categories of costs; health care for the children, foster care, incarceration, lost revenues from unpaid tax, and public assistance costs (March of Dimes 3).

Adolescent girls are more likely to give birth prematurely compared to women who are over age twenty. For instance, the average preterm birth rate for adolescent mothers was fourteen and a half percent between 2003 and 2005 while the rate for mothers between ages twenty to twenty nine years was slightly lower at just under twelve percent (11.9%) over the same period (March of Dimes 3).

Increased likelihood of premature births occurring to adolescent girls as well as similarly increased risk of low birth weight of children born to teen mothers has the implication of raising the risk of children born under such circumstances developing health complications both in the short-term and in the long-term. These risks are brought about by the fact that, on becoming pregnant, adolescent girls may be forced by unfavorable economic state of affairs to change their lifestyle such that they may resort to smoking, taking drugs, drinking alcohol and, more importantly, eating unhealthy foods (Center for Disease Control and Prevention (CDC) 2). Such unhealthy lifestyles may have far reaching consequences on the health of both the teen mother and her child, including placental complications for both.

In 2004, a research conducted by CDC found that seventeen percent of pregnant mothers of between ages 15 to 19 smoked, while the rate for pregnant women aged between twenty-five and thirty-four was ten percent (Martin et. al 12).

In another study conducted in ten states to examine teenage mothers’ post-welfare reform costs to the taxpayer, Adams , Gavin, Ayadi, Santelli , and Raskind-Hood found that more than half a billion dollars was spent yearly in four public programmes designed to cater for teenage mothers (53). In addition, they established that the amount spent on every adolescent mother exceeded yearly birth expenses for older mothers by nearly 1500 dollars. Medicaid coverage alone made up to 87% of the total costs. As such, the ten states were found to lose a total of seventy five million dollars of public funds to teenage pregnancies.

In analyzing the economic impact on the social services as well as on the tax payers, Depelchin Children Center (1) reports the following specific costs as accruing to every birth to a teenage mother; Medicaid cost on delivery is estimated at 4,225 dollars per year, child care assistance at 6,240 dollars per year, food stamps at 2,760 dollars per year, and Medicare health coverage at 1,200 dollars per child per year.

In total, all the above aspects of increased volume of teenage pregnancy have a combined impact of increasing the cost of health care provision to both local and the national government. As a result, although access to health care may remain largely intact, the quality of health care services provided by health care professionals, more so pre-natal antenatal care is likely to go down as health care providers have to deal with more health cases associated with teenage pregnancies.

Recommendations for reducing the volume and costs of Teenage Pregnancy

There are many approaches that can prevent teenage pregnancies. However, public programmes designed to assist teenage mothers remain costly to the tax payer. In addition, the high rates of unintended teen pregnancies and births as well as a similarly high level of incremental teenage birth costs clearly indicate an urgent need for developing cost-saving intervention programmes to reduce teenage pregnancies and births. In light of this need, school-based sex education programs are the most effective programs in bringing down the volume of teenage pregnancies. This is especially so if the sex education programs are tied to initiatives that promote easy access to contraceptive services by teenage girls. Studies have shown that this approach, contrary to the argument of its opponents that such programs have the undesired impact of pushing up sexual activity among teenagers, is largely effective in reducing the rates of teenage pregnancies, and does so by a significant margin (NHS 4).

A combination of sex education and improved access of contraceptives would increase the use of contraceptives among sexually active teenage girls. One effective approach to such a program would be to integrate confidence building programs and peer-led prevention skills with increased access to contraceptives (especially condoms) as well as easy access to contraceptive clinics. Efforts at provision of elaborate information on how to use contraceptives spearheaded by peer educators, teachers as well as health care workers in the school setting, besides being critical for the success of sex education programs, are also bound to produce positive results in the short run and even better results in the long run.

The recommended teenage pregnancy intervention program ought to be started earlier enough: before the young people become sexually active. This is because studies have shown that sex education programs commenced after the subjects have already become sexually active are far less likely to produce as much positive impact as that produced by early intervention programs since participants tend to stick to their already established sexual as well as contraceptive behavior. Furthermore, the intervention programs should be designed taking into consideration specific characteristics the group they target to serve as there are many sub-groups within the larger group of teenagers.

School-based sex education programs linked with easy access to contraceptives should also be multi-faceted in that they should involve the local community as well as local authorities. This strategic approach however should be guarded against the risk of participating educators losing their genuine commitment to the success of the programs due to increased bottlenecks in coordination of activities of such programs which may result from crowding of program executors. In such an approach, both local and national governments would play key roles in the success of the programs by developing appropriate and effective teenage services plans as well as enforcing children’s welfare laws which would, among other things, make available financial and other resources required to run the programs. Further, local and national governments have the responsibility of setting up appropriate anti-poverty strategies for adolescent girls from poor backgrounds such as social support, provision of supplementary nutrition as well as sponsoring the education of such group of teenagers.

In developing contraceptive services, health practitioners ought to put into consideration the needs of the community that they serve. As such, needs assessment should be conducted in the light of the demographic characteristics and current service availability along with its utilization by the target group (teenage girls). Moreover, health care workers should take into consideration the attitude of the key stakeholders in the programs such as parents of participants and their teachers as far as best approach to tackling the problem of teenage pregnancies is concerned. This way the contraceptive services developed by health care professionals are likely to register substantive success for they are more likely to win not only acceptance from the key stakeholders, but also their genuine support.

Another key element essential in ensuring the success of school-based sex education linked with access to contraceptives is publicity of the “easy access to contraceptive services” element of the program. In this regard, health care providers ought to put in extra efforts to ensure the target groups are assured of their confidentiality in the process of seeking contraceptive services through such strategies as offering them contraceptive services at weekends and/or outside school hours.

To help pregnant teenagers overcome the many health risks associated with teenage pregnancies through access to appropriate prenatal and antenatal health care, hospitals and their staff should design antenatal programs specifically for pregnant teens. These could include such initiatives as home visits to pregnant teens and teen mothers and home-based parenting schemes for teen parents who could be unwilling to attend hospital-based schemes due to embarrassment. This way their health outcome would be improved substantially and, thus, cases of other illnesses related to teen pregnancy would be reduced by a significant margin.

Conclusion

Considerably high rates of adolescent pregnancies, despite the advances of modern contraceptive methods, continue to be a source of major concern to parents, health care providers and authorities. Teenage girls who become pregnant are likely to develop birth complications as well as other health complications long after the end of pregnancy, besides giving birth to babies with low birth weight. Health risks associated with teenage pregnancies could be aggravated further by the fact that teenage mothers are likely to suffer from stress in addition to living together with their children in deprived conditions. In light of these health risks, the school-based sex education program linked with easy access to contraceptives initiative has the capacity to make tremendous impact on the effort to reduce the rates of teenage pregnancies which, in turn, could reduce the health care expenditure (especially the burden of teenage pregnancies on Medicaid). Ultimately the quality of health care services, particularly on prenatal and antenatal care, would most probably improve.

Works Cited

ACOG. Strategies for Adolescent Pregnancy Prevention. 2007. Web.

Adams, Gavin, Ayadi, Santelli, and Raskind-Hood. “The Costs of Public Services for Teenage Mothers’ Post-Welfare Reform: A Ten-State Study. Journal of Health Care Finance 35.3 (2009): 44-58.

CDC. Preventing Smoking and Exposure to Secondhand Smoke Before, During and After Pregnancy. 2007. Web.

DePelchin Children’s Center. Teen Pregnancy Prevention: Fact Sheet. 2011. Web.

March of Dimes. Teenage Pregnancy. Nov. 2009. Web.

Martin, Joyce, Brady Hamilton, Paul Sutton, Stephanie Ventura, Fay Menacker, Sharon Kirmeyer, and T. Mathews. “Births: Final Data for 2006”. National Vital Statistics Reports, 57.7 (2009):1-102.

NHS Centre for Reviews and Disseminations, University of York. “Preventing and Reducing the Adverse Effects of Unintended Teenage Pregnancies”. Effective Health Care 3 (1997): 1-12.

UNICEF. A League Table of Teenage Births in Rich Nations. 2001. Web.

Ventura Stephanie, Joyce Abma, William Mosher, and Stanley Henshaw. “Estimated Pregnancy Rates by Outcome for the United States, 1990-2005: An Update”. National Vital Statistics Reports 58.4 (2009): 1-16.

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