1. No category

Center for Research on Women
Examining Issues of Gender and Social Inequality
Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Prepared By:
CONTENTS
Lynda M. Sagrestano, Ph.D.
Ruthbeth Finerman, Ph.D.
Joy Clay, Ph.D.
Teresa Diener, M.A.
Naketa M. Edney, M.A.
Ace F. Madjlesi, M.A.
Introduction [pg. 3]
Snapshot of Teen Pregnancy in Shelby County [pg. 4]
Key Themes [pg. 6]
Case Study : Latavia [pg. 7]
Case Study : Don [pg.9]
Published by:
Center for Research on Women
The University of Memphis
337 Clement Hall
Memphis, TN 38152
901-678-2770
[email protected]
http://crow.memphis.edu
June 2012
Layout and Design by:
Teresa Diener
Acknowledgements
Key Program, Service, and Policy Needs [pg. 10]
Case Study : Lauren [pg. 12]
Community-Level Recommendations [pg. 14]
Appendices [pg. 15]
A: Research Methods Summary
B: Literature Review Summary
C: Birth Certificate Data Analysis
D: GIS Map Analysis and Maps
E: Resource Inventory Analysis and Program Resource List
F: Youth Risk Behavioral Surveillance Study Data Analysis
G: Teen Pregnancy and Parenting Survey Data Analysis
H: Parental Attitudes Toward Sex Education Data Analysis
I: Provider Focus Group Summaries
Reproductive Healthcare Providers
MemTV and TPPS Providers
J: Community Focus Group and Case Study Summaries
Teen Girls Who Are Pregnant or Parenting
Teen Girls Who Have Never Been Pregnant
Teen Boys
Parents of Teens
K: Condom Access Data Analysis
L: Economic Impact of Teen Pregnancy Report Summary
References [pg. 94]
We wish to thank the many individuals whose help proved invaluable to our efforts. Most importantly, we wish to thank all
of the teens, parents, service providers, and community leaders who participated in this study. In addition, we would like to
thank those who helped facilitate data collection, listed in Appendix M. Special thanks to the Teen Pregnancy and Parenting
Success Core Leadership Team and Memphis Teen Vision for their help with many aspects of this project. We would like
to thank the Center for Community Building and Neighborhood Action (CBANA), including Dr. Phyllis Betts, Carol Goethe,
Elizabeth Henderson, and TK Buchanan, for their assistance with the epidemiologic data and GIS mapping, and Dr. David
Ciscel for conducting the economic analysis report. Additionally, we would like to thank Jennifer Gooch; Nikia Grayson; the
graduate students at the University of Memphis who assisted with focus group data collection, especially August Marshall,
Laura Meyer, Susanne Salehi, Courtney Robertson, Carlos Torres, Preeti Rao, Amber Sanders, Lloyd Thomas, LaKenya Smith,
Richard Cash, Gayle Ozanne, and Jennifer Earheart; and graduate students in Anthropology 7511 who assisted with the
resource inventory. Finally, thanks to the US Department of Health and Human Services Office of Adolescent Health, The
Children’s Foundation, and the National Institute for Reproductive Health for funding this project.
2 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
INTRODUCTION
Adolescent pregnancy significantly impacts the educational attainment, economic security, and wellbeing of
both teen parents and their children as well as teens’ ability to achieve their full potential. Recently the Centers
for Disease Control and Prevention (CDC) declared “Preventing Teen Pregnancy” one of six “winnable battles”
because there is no cure yet to be found – we already know what works. The CDC points to four key strategies:
1) increase public awareness, 2) support evidence-based sex education programs, 3) increase access to
contraception, and 4) get parents involved.1 Despite this seemingly concrete advice, teen pregnancy remains
a complex challenge for communities to prioritize and systematically address. Shelby County teen birth rates
are significantly higher than rates for the state. For teens 15-17, the county birthrate is 36.7/1000 women aged
15-17, as compared to 24/1000 at the state level. Similarly, for teens 18-19 the county birthrate is 107.8 per
1000 girls aged 18-19, as compared to 85.9/1000 for the state. Moreover, birth rates only tell part of the teen
pregnancy story, as these numbers do not include cases of miscarriage or other termination. Furthermore, these
statistics say nothing about the experiences and needs of teen parents. Therefore, a broader understanding of
teen experiences in the Memphis community is essential. Ultimately, supporting the prevention of adolescent
pregnancy and promoting effective teen parenting will have a significant positive impact on our community.
In 2011, Tennessee was one of 17 states that received funding from the US Department of Health and Human
Services, Office of Adolescent Health to design, implement, and evaluate a system of care aimed at supporting
pregnant teens and improving outcomes for teen parents. Tennessee is unique in that, rather than dispersing the
federal funds to several counties, the State chose to concentrate all of the federal monies on streamlining the
coordination of community-based pregnancy and parenting services in Shelby County, coordinated by the Shelby
County Office of Early Childhood and Youth.
As part of this initiative, The University of Memphis Center for Research on Women (CROW) worked with
community stakeholders to conduct a needs assessment of pregnant and parenting teens in Shelby County.
An inventory of programmatic resources for pregnant and parenting teens, and a survey of condom access
in select Shelby County zip codes were compiled and analyzed. In addition, the research team conducted a
series of focus groups and case studies with key stakeholders, including teens, parents, program and healthcare
providers, educators, and community leaders. Survey data were collected from 285 Shelby County teenagers, and
epidemiologic, economic, and GIS data on teen pregnancy were examined. Detailed analyses of these data are
presented in the Appendices of this report.
The report that follows briefly describes the status of teen pregnancy in Shelby County. Drawing on data from all
sources, key themes are identified, as well as key program, service, and policy needs. Finally, some broad based,
community-level recommendations are made. This assessment informs and facilitates the implementation of a
coordinated community response targeting pregnant and parenting teens in Shelby County.
1
http://www.cdc.gov/WinnableBattles/
Shelby County Teen Pregnancy and Parenting Needs Assessment | 3
The University of Memphis
Center for Research on Women
SNAPSHOT OF TEEN PREGNANCY IN SHELBY COUNTY
Although there is a vast range of individual experiences of teen pregnancy, some trends can be drawn from the
data. The following section is excerpted from analyses of the 2009 linked birth-death records for babies born
in Shelby County (see Appendix C), and key findings are highlighted below. Case studies help to illustrate the
diversity of experiences of local teens impacted by teen pregnancy.
Birth Rate per 1,000 Women
Tennessee ranks
in the top ten
of states with
the highest
teen birth rates.
Additionally,
Shelby County
rates are among
the highest in the
State.
107.8
18-19
85.9
Age
Shelby
TN
36.7
15-17
24
0
20
40
60
80
100
120
Previous Births by Age of Mother
in Shelby County
25
Age
20-24
7
18-19
0
2 or More Previous Live
Births
23
1 Previous Live Birth
1
17 and under
32
10
10
20
30
40
Precentage
4 | Shelby County Teen Pregnancy and Parenting Needs Assessment
Teenage girls in
Shelby County
who give birth
under the age of
17 are vulnerable
to repeat
pregnancies in
their teen years.
The University of Memphis
High School Graduation Rates of
Women Giving Birth Between Ages
20 and 24
P
e
r
c
e
n
t
100
83
70
80
52
60
40
20
0
Center for Research on Women
Among young
women giving birth
between the ages of
20 and 24, the more
children that they
had already had as
teens, the less likely
they were to have
graduated from
high school or
earned a GED.
No Previous Births
One Previous Birth Two or More Previous
Births
Number of Previous Births
•
•
•
Over 20% of teen mothers fall under the legal definition of victims of statutory rape in the state of Tennessee2.
78% of teen mothers report household incomes of less than $10,000 per year.
Eighty-six percent of mothers under age 20 give birth under TennCare.
•
Among Shelby County mothers 17 and
under, 21% had a sexually transmitted
infection during pregnancy, and among
mothers 19 and under, 18% had a
sexually transmitted infection during
pregnancy.
•
11% of teen girls who gave birth in
Shelby County received no prenatal care,
and 40% did not receive prenatal care
until sometime in the second trimester.
In TN, statutory rape is defined as sex with girl aged 13-14 with man who is 4 or more years older; or sex with girl aged 15-17 with a
man who is 5 or more years older. http://www.state.tn.us/tccy/tnchild/39/39-13-506.htm
2
Shelby County Teen Pregnancy and Parenting Needs Assessment | 5
The University of Memphis
Center for Research on Women
KEY THEMES
The following themes emerged from analysis of all research materials, including qualitative and quantitative
data collected by CROW as well as ancillary materials compiled by research partners.
Gender Matters
•
Teenage pregnancy and parenting have a more profound impact
on girls than boys, in multiple ways. Girls consistently report
experiencing shame, stigma, and being ostracized, leaving them
socially isolated and without important sources of support.
Girls also report voluntary or involuntary withdrawal from peer
networks and social engagements in order to focus on parenting
responsibilities. Pregnant teenage girls experience being ejected
from their family home, condemned by peers, and losing
friendships after being declared a “bad influence.”
•
Pregnant girls are often accused of using their pregnancy to “hold
onto” a boy. Pregnant girls may also be accused of lying about
who fathered their child.
•
Pregnant and parenting girls experience significant barriers to
completing their education, as class attendance may conflict with
prenatal care appointments and the demands of pregnancy and
parenting.
•
Pregnant and parenting girls report barriers to securing and
sustaining employment, due to limited education and skill
training, as well as employer concerns about liability for pregnant
girls and the reliability of workers who are teen parents.
•
Teenage girls report a low awareness of options, including the
ability to say “no” to sexual activity or pregnancy. The result for
many is a cycle of teen parenting and the expectancy of teen
pregnancy across generations within a family.
•
Teenage boys report that both sexual activity and parenting can
yield prestige among peers, yet boys may be denied regular
involvement in the lives of their offspring.
•
Teenage boys report pressure to seek work to provide financially
for children, which can lead to poor class attendance, dropping
out of school, and withdrawal from social engagements,
narrowing interpersonal networks and leaving them socially
isolated.
6 | Shelby County Teen Pregnancy and Parenting Needs Assessment
“They [my parents] were both
incredibly angry throughout
the whole pregnancy.
They worried about what the
neighbors would think.”
--teen mom
“He didn’t believe me and then
he was like, ‘Well, it is not mine.’”
--teen mom
“While pregnant, I had to deal
with swollen legs, back pain and
I had to stand a lot at my job and
could not lift heavy things.”
--teen mom
“My child is crying for food, and
I’m hungry too, and school is
providing no income,”
--teen father
The University of Memphis
Center for Research on Women
CASE STUDY: LATAVIA
At the age of 18, Latavia became pregnant. Her story is unusual
because she felt that she did not have any parents. As she explains, “I
was a foster child from 15 and aged out at 18. Right after I aged out, I
was pretty much homeless. I was very stressed about having to leave
and not having anywhere to go, so I didn’t tell anyone…my therapist
was the first person that I told.” Latavia says that her therapist was very
supportive, but she could not visit her as often as she wished. Latavia
says of the baby’s father, “Well, he denied it up until the very end. After
I lost my child at three months, he was just like, ‘Oh, I would have been
there’… I was only four months. I was getting ready for college when I
lost my child.” Latavia feels that her pregnancy had a major impact on
her life. She did not have biological family that she felt close enough
with to talk to about her pregnancy. As she points out, “I was living
with my mom’s aunt before I got into foster care. She would always
tell me that I would be pregnant by age 13. When I turned 13, then she
would say that I would be pregnant by 14, and it just went on and on.
So, even though I was technically an adult when I got pregnant, I felt
like I could not go back and tell my aunt because she would rub it in
my face.” Her sister is 26 and has five children; she did not want to be
compared to her. To some extent, the pregnancy caused her to become
more of a private person: “When I became pregnant, I didn’t really
have anyone to talk to at that point in time. So, now I keep a lot of
things to myself.” Yet, her pregnancy also helped her to become more
independent and self-reliant: “Well, I knew that if I had this baby, then
I would have to do it all by myself. I don’t have parents and I don’t have a close relationship with my blood family,
so it has really taught me to be self sufficient and that I just really had to take care of myself.” Although she could
not talk to her biological kin, she turned to a trusted adult that she now calls “mom.” According to her, “Other than
my therapist, my ‘mom’ and you lovely ladies, no one else know about my pregnancy. I am so thankful for my mom
because I can talk to her and she is trustworthy.” Latavia thought that she had a number of friends, but they seemed
to abandon her once she was pregnant. She comments: “That was one of the most vulnerable points in time in my
life and I couldn’t find anyone to talk to that wasn’t getting paid. That made me really not trust people and so, I don’t
have a lot of friends who are my age.”
Latavia’s pregnancy did not directly affect her high school attendance or grades because she became pregnant
two weeks prior to graduating and was preparing for college. Instead, her fears concerned attending college while
pregnant. According to her, “It was really challenging for me to think about how I would go to college pregnant. I
go to a private and expensive college and the majority of the students are white people. I knew that it was not only
going to be difficult being pregnant…but being the pregnant black girl and I considered dropping out. It was just
difficult.” Latavia felt that she would probably be kicked out of college due to her pregnancy status.
Latavia thinks that it is difficult to find employment as a pregnant or parenting teen. Immediately following high
school, she was hired through the Summer Youth Employment Program, but could not attend work when she was
sick from the pregnancy. She did not know of any available resources. Latavia notes, “I was a part of that program
and they have rules, I did not want to tell them and lose my job. Trying to find a way to work and knowing rules
about being pregnant and working and that support for you while you are pregnant… I didn’t know where to
start with those things.” Latavia used the internet in her employment search because many jobs require online
applications. She found the internet to be a good way to get all types of information.
Latavia did not receive any government assistance during her pregnancy. She lost her baby during her third month
and was only able to make one doctor’s appointment during the pregnancy. She advises other teens that there are
resources to help them, but they must search for them. She also recommends: “In some cases, you will not be able
to go to your parents, so you really have to be a go-getter and go out and find the information on your own because
once you get pregnant, that is your situation and you have to be able to take care of yourself.”
Shelby County Teen Pregnancy and Parenting Needs Assessment | 7
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Center for Research on Women
Poverty Matters
•
Teen pregnancy and parenting strongly correlate with poverty.
o Map B reveals that teen pregnancy clusters in areas with higher rates of poverty.
o Map C indicates that nearly all teenage women giving birth in Shelby County live in poverty.
•
Although there are many resources available, none compensate for the costs and challenges of being a
teen parent.
“[Some teen mothers are]
under control of the baby’s
father, who are probably not in
high school.”
--provider
“A large number of girls have
children by men. They are
afraid to tell because they don’t
want to get him in trouble.”
--provider
Age Matters
•
Younger teens report less awareness of pregnancy and parenting
resources, including a limited understanding of how to obtain
information and reproductive health services.
•
Younger teens voice greater fear about disclosing sexual activity and
pregnancy to parents or guardians.
•
Younger teens report smaller and more fragile support networks; often,
the only connections they cite are to immediate family.
•
Teenage girls report age-discordant relationships,3 where sexual partners
are older boys and men. This difference compromises girls’ confidence
and ability to say “no” to sexual activity, and to demand that partners use
condoms.
“They tried to get the people
on him [father of her child]
because he was 18 and it was
statutory rape.”
--teen mom
3
Age-discordant relationships are those in which one partner is under the age of 18 and the partners are more than 4 years apart
in age.
8 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
CASE STUDY: DON
Don was 15 years old when he found out he was going to be a father for the first time. He recalls telling his mother
the news, “I was crying, she was crying, but she said we would make it through this.” And he feels he has, though it
has not always been easy.
The mother of his child and her family did not want Don to have much contact with the baby, and he missed out on
seeing his son born. He turned to his mother for support. “My momma encouraged me to try to keep contact and try
to provide, even if they weren’t calling…to still take the initiative and provide for their needs.” In order to provide for
his family, Don took on a job during the summer. He worked hard and was able to go to college, but after having two
more children at ages 20 and 22, Don found that he could no longer afford to stay in school and make enough money
for child support. “My child is crying for food, and I’m hungry too, and school is providing no income.” Don eventually
dropped out and turned to “hustling” and selling marijuana on the streets. Don realized the dangers of selling drugs,
but he was OK with his choices. He refused to seek government assistance because he believed it was his duty to
provide for his children. He remembered the feeling of bringing home money from drug sales: “I was able to provide
for all my mommas’ needs, all my kids needs…even though I wasn’t living right and breaking laws, just to see them
happy and to see them getting what they needed brought joy inside of me.”
Hustling allowed Don to feel self-sufficient and provide for his family. He slowly became “engulfed by the lifestyle,”
constantly using marijuana and frequently running into dangerous situations. Being a committed father led Don to
re-examine his life choices: “Going to pick them [his children] up from school and spending time with them triggered
a bond where I didn’t want to get locked up or be dead and not play a role in their life like I didn’t have my father in
my life.” Don decided to leave hustling behind, but it came at a price. He had married the mother of his third child,
but when he could no longer maintain their luxurious lifestyle, she divorced him. Many of his friends deserted him
as well. But for Don, fatherhood was always an obligation beyond friends and high-end living. Moreover, fatherhood
profoundly changed him: “God blessed me with something that means a lot to me, and I truly believe that’s what
triggered my passion, compassion, and love for the youth of today…for kids that aren’t even mine.”
At 35 Don runs his own company and volunteers with local youth. He works with many young men who are not
raised by their parents, and he hopes he can offer them opportunities to create self-esteem. Having been raised by a
single mother led him to realize the importance of being a father who offers time, financial support, and emotional
guidance to his children. Reflecting on his own experience with his mostly absent father, Don said; “He always sent
money, paid child support, I visited him during the summers, stuff like that. But it wasn’t enough. I needed him there
every day, to guide me.” He said: “I’m not able to give [my children] extravagant things, but I’m able to give them what
they need, and I’m able to give them the
most valuable thing I possess, and that’s
time.”
Don thinks it is a natural instinct to want to
raise your own child, though he understands
that a man’s own upbringing can affect
his views on fatherhood: “Psychologically
in their mind, [a teen] might say ‘well, my
mother wasn’t there for me, so I won’t be
there for this child.” In part, this is why he is
so committed to working with youth: “They
are the future and many of the boys and
young men I work with now may someday
become fathers themselves.” He wants
to instill in those young men a sense of
responsibility and caring for their own future
children.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 9
The University of Memphis
Center for Research on Women
KEY PROGRAM, SERVICE, AND POLICY NEEDS
Memphis and Shelby County feature a number of relevant resources for pregnant and parenting teenagers,
including education and information dissemination (e.g. health, family life, family planning), healthcare services
(e.g., pregnancy testing, prenatal care), support services (e.g. counseling), and material goods (e.g., diapers,
baby clothing). The vast majority of resources (78%) are educational. Although there are many resources,
there are nevertheless unmet program needs; teens often lack immediate access to resources; and there is
insufficient infrastructure for a coordinated community response. Teens and their parents consistently reveal
a lack of awareness of resources, reducing the potential impact of programs. There is a need to strengthen
resources and programs which address teen pregnancy in order to promote opportunities that foster the
wellbeing of our youth and community.
Based on our data, the research team recommends addressing the following needs and gaps in services:
Parenting Support Programs
•
•
•
•
There is an unmet need for parental skill training and
support, including the promotion of parenting across the
lifespan (e.g., parenting infants, children, and teens; single
parents; parenting time management; the ability to develop one’s own parenting style).
Programs are needed to help parents of teens to discuss
healthy sexuality.
There is a demand for accessible, affordable, reliable, and
high quality infant and childcare programs to help enable
teenage parents to complete school or retain jobs.
There are insufficient job training and youth employment
programs specifically targeted at pregnant and parenting
teens to promote goals of financial independence.
Teen Male Engagement
•
•
There is a need for more programs that promote male
awareness, education, responsibility, and engagement in
reproductive health and parenting; only 5% of all resources
target boys.
Males are a significant but often underutilized resource for
preventing sexually transmitted infections and unplanned
pregnancies, as well as promoting prenatal care and
positive parenting.
“[Classes] don’t really teach you what to
do after you get a kid…they talk about
preventative measures, not about what you
do when you get a kid.”
--teen mom
“The community is a barrier because they
are not willing to talk about sex.”
--provider
“Trying to find a way to work and
knowing rules about being pregnant
and working and that support for you
while you are pregnant… I didn’t know
where to start with those things.”
--teen mom
“Boys are just as afraid and uninformed
about sex as girls are.”
--provider
Healthy Sexuality Programs
•
•
•
There is an unmet need for comprehensive communitybased education about healthy sexuality, preconception
health, preventing sexually transmitted infections, family
planning, and reproductive health.
Programs are needed to build competent and confident
staff who can teach comprehensive sex education.
There is a need for programs that address sexual abuse.
“Girls don’t get pregnant by themselves
… [the lack of male-oriented programs]
leaves little responsibility for the boys …
he feels like the rest is up to her.”
--provider
10 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Program and Service Access
•
•
•
•
Short-term outreach activities into targeted
neighborhoods may be insufficient to build optimal
community awareness, trust, and sustainability.
•
Teens without insurance or TennCare eligibility face
significant barriers to accessing medical services; there
is a need for early eligibility to allow teens to access
prenatal care in the first trimester.
All teens who visit health providers for reproductiverelated services (e.g., STI and pregnancy testing) should
receive prevention information.
Only one-half of all programs are open after school
hours, and just 20% of all programs are open during
weekends. Teens skip classes or work in order to obtain
prenatal care and other programs and services. Hours
need to be reconsidered.
There is a need for small-scale and gender-specific
programs. Teenagers report that they cannot be open or
honest in large and/or mixed-gender groups.
•
•
•
•
“If you have a doctor’s appointment
and an important test on the same
day, you have to contemplate on
which one is more important.”
--teen mom
A majority of resources are housed in just two zip codes,
comprising Memphis’ Medical Center and Midtown
districts. Although this proximity facilitates potential
collaboration among agencies, neighborhoods with high
rates of teen pregnancy and parenting have the least
agency presence
Although an overwhelming majority of teens giving birth
in Shelby County do so on TennCare, most pregnant
teens live in proximity to few if any TennCare Providers;
some reside as far as 20 miles away from the nearest
TennCare provider.
Pregnant and parenting teens lack transportation to
easily access programs and providers. Transportation
challenges need to be addressed. More programs need
to be located in targeted areas.
Condom retailers should make products easily
accessible (not locked in cabinets), and provide staff
training to improve customer service, courtesy, and
discretion.
“We have to make sure that we are
able to talk about these things and
we’re able to provide this information,
and not withhold information because
it makes us uncomfortable.”
--educator
“Access for young women on
TennCare is more complicated
than for women who are not
on TennCare… These are rules
that don’t have to be.”
--healthcare provider
“Not all information is good
information.”
--teenage boy
Program and Service Awareness
•
•
There is a need for user-friendly websites and
phone reception training. Although almost all
programs inventoried have an active website
and telephone number, the following trends
were noted:
• Staff who answer telephones are not
consistently aware of their agency’s
programs.
• Websites do not consistently offer
ready access to program information.
Teens report that they instead prefer
to visit popular websites (e.g., social
networking and gossip sites) which
unfortunately may offer unreliable
information.
Social marketing is needed to promote teen
pregnancy prevention and parenting programs.
• Teens typically seek reproductive
information from their own parents or
trusted relatives, or - in the absence of
family - trusted peers and adults, who
may be unaware of programs.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 11
The University of Memphis
Center for Research on Women
CASE STUDY: LAUREN
Lauren learned she was pregnant as an 18 year old college freshman.
When giving her parents the news, “I had to be blunt about it. I didn’t
know about my parent’s reaction.” She explained that “This was not my
first pregnancy. The first time, I was 16 and it was a statutory rape and I
had to have an abortion. I didn’t know if my parents were going to have
the same reaction as the first time. My dad fussed… but my mom didn’t
react like I thought she would. She gave me the silent treatment.” By
contrast, her boyfriend stood by her as she made the announcement to
her parents. After the initial shock, her parents yielded, and her mother
offered her guidance on a range of government assistance programs that
would help her care for the child.
Pregnancy has altered Lauren’s plans for the future: “I have a dream of
owning my own business. My parents owned their own restaurant, but
they don’t have it right now.” But, now she feels that she might have to
wait to start her business. She explains, “My dreams might have to get
put on hold because now I have a baby to raise.” Her mother has been
very supportive of her finishing school, noting “One thing my mom said
was that I was finishing school.” Although she has been able to remain
in college thus far, her pregnancy has affected her attendance. She
explains, “Sometimes it is just hard and I don’t feel like doing it.” She
hopes to continue her studies, though she might take some online
courses. Lauren’s pregnancy also means that she must change some of
her spending habits; she loves to shop but must save for baby clothes.
Lauren’s pregnancy has also caused some friction with her boyfriend’s parents.
After hearing the news, his mother asked, “Well, are you sure it is yours?” This upset Lauren, who did not want to be
compared to other teen moms. She reports, “They kinda hurt my feelings, you know…I am not like all of these other
girls that are just getting pregnant by anybody. This time I took the time and I waited and this is the person that I am
going to be with. I am not like everybody else that just sits around and jumps from bed to bed to please my needs
and he wasn’t that type of person.” Lauren has not informed everyone she knows about her pregnancy because she
does not wish to be judged. At the same time, she feels that her pregnancy has strengthened her relationship with
her parents.
Lauren reports that it is very difficult for a teen parent to find employment. She managed to hold two jobs and
continue with school until the 20th week of her pregnancy but, “It was getting very hard to work two jobs. My boss
wouldn’t let me sit down and eat sometimes.” She claims that her father advised her to drop one of her two jobs. In
her opinion, “Sometimes teens get lazy and just want to sit at home, but I grew up working in the family business.
Some teens just want things handed to them. I like to have my own money.”
To improve her childcare skills, Lauren has enrolled in pregnancy and parenting classes. Currently, she attends
Operation Smart Child, a four-week program that will allow her to earn “baby bucks” to purchase baby items. In a
few weeks, she will begin two other programs, The Sunrise Program and First Steps. Lauren is also receiving WIC and
is waiting for an update on her application for food stamps and TennCare. Lauren advises pregnant teens to keep
pushing to succeed and do the research to find resources.
12 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Public Policy
•
•
•
•
•
•
•
3
There is a need to bring together a broad
spectrum of stakeholders, including
corporate, faith-based, and community
leaders, for a coordinated community
response that would have a sustainable
impact on teenage pregnancy and
parenting.
Legislation and policies that create
challenges for implementing effective teen
pregnancy prevention should be revisited.
There is an unmet need to raise
awareness of the impact of age-discordant
relationships,4 and to enforce State laws
regarding statutory rape.
Parental and community support needs to
be engaged in neighborhoods with high
rates of teen pregnancy.
Schools and communities need best practices they can implement in the area of
preconception health and healthy sexuality.
Confidentiality in schools and healthcare
settings should be promoted.
There is a need to address structural
barriers to teenage access to reproductive
healthcare and contraception, including high
cost, insurance regulations, and pharmacy
policies. Center for Research on Women
“People that attend [sex ed curriculum]
meetings have kids that don’t get pregnant and
they are the ones making decisions.”
--provider
“It [abstinence-only sex education] doesn’t work
for students who are already pregnant or sexually
active.”
--educator
“Principals are worried about backlash and
community perceptions about what they are
doing in their schools. That’s a huge fear. They
don’t want their school in the news.”
--educator
“I think there’s probably a direct connection
between the start of prenatal care and that family
support. I’ve known a lot of teens who have not
received early prenatal care because they did not
want to tell their family that they’re pregnant.”
--provider
“Some young ladies, if they know their guidance
counselor has a big mouth, then they think, ‘I’m
not telling them nothing!’ … But if they know you
will keep it confidential they will tell you.”
--educator
Age-discordant relationships are those in which one partner is under the age of 18 and the partners are more than 4 years apart
in age.
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COMMUNITY LEVEL RECOMMENDATIONS
In addition to addressing the above gaps, we offer the following broad-based recommendations:
•
To demonstrate a long-term and sustainable commitment to addressing teen pregnancy, parenting, and
broader health issues, appoint a centralized official to coordinate with the mayors, business sector, faith
community, and other key stakeholders.
•
Raise awareness by sponsoring community-driven, grassroots-based social marketing campaigns which
engage teens to design websites and social media that are authoritative, but also popular, easy to
navigate, and which speak directly to Shelby County youth.
•
Provide cultural competency training for all educators, as well as program and service providers who interact with teens and their families.
•
Support a coordinated community response by committing to sustained funding for teen pregnancy and
parenting initiatives.
We would like to thank the following Community Partners for their
assistance in recruiting participants for this report.
Andrea Curry, North Memphis Community Development Corporation
Aretha Milligan, University of Memphis
Audrey May, LINC 211, Memphis Library
Bridges
Carol Peterson, North Side High School
Cathedral of Faith
Claudia Haltom, A Step Ahead Foundation
Crystal Hall, Boys and Girls Club
ESC Core Leadership Team
Hickory Hill Community Redevelopment Corporation
Kristine Strickland, Orange Mound Community Center
Lashard Smith, Airways Middle School
Memphis Area Gay Youth
Memphis Teen Vision
Orisha Henry Bowers
Pearl Lee, Youth Striving for Excellence
Porter-Leath
Rangeline CDC
Reginald Johnson, Boys Inc.
Shelby County Department of Children’s Services
South Memphis Alliance
Toni Blankenship
TPPS Core Leadership Team
Women’s Foundation for Greater Memphis
14 | Shelby County Teen Pregnancy and Parenting Needs Assessment
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Center for Research on Women
APPENDIX A
RESEARCH METHODS SUMMARY
For the purposes of this needs assessment multiple methods were employed to collect primary information on
teen pregnancy and parenting in Shelby County. These methods included: Geographical Information Systems (GIS)
mapping, resource inventory, surveys, focus groups, and case studies. For all methods, the needs assessment team
utilized grant partners as liaisons to participants. The local teen pregnancy collaborative, Memphis Teen Vision
(MemTV), also facilitated in identifying study participants. All methodologies were reviewed and approved by the
University of Memphis Institutional Review Board for the protection of confidentiality and the rights of participants.
All data and recordings are securely stored in locked cabinets only accessible to the research team, and all
identifying information has been removed.
GIS Mapping. GIS is a system for mapping, visualizing, and analyzing geographic data. For this project, CROW
partnered with the Center for Community Building and Neighborhood Action (CBANA) to develop maps that visually
depict the relationships among poverty, teen births, and related health outcomes for teen mothers in Shelby County.
Additionally, GIS was used to map community assets in relation to the neighborhoods where teen mothers live.
These maps help to explain some of the barriers teens face in accessing healthcare services as well as pregnancy
and parenting resources. Maps have been included as an appendix to this report [Appendix D]. All maps depict the
most recent linked birth-death data available (2009).
Resource Inventory. The CROW research team compiled a resource inventory of programs and services for
pregnant or parenting teenagers in Shelby County. Data were collected from April through December of 2011, and
compiled from a range of sources, including an online database of nonprofit agencies in Memphis, MemTV partners,
the Memphis and Shelby County Health Department Fetal and Infant Mortality Review (FIMR) Committee, and other
community collaborators. Resources were checked by calling agencies and services to confirm information obtained
from available sources.
Survey. An 8‐page, self‐administered survey was developed to elicit a broad range of information from local
teens, including demographic and background information, sexual history and behavior, pregnancy and parenting
history, family dynamics, and mental health factors. Survey data collection was completed in Spring 2012 through
various community partners who serve teens. In addition, data were collected from first year students at Southwest
Community College and the University of Memphis. A total of 285 surveys were completed. Parental Consent was
obtained for all participants under the age of 18. Participants who completed the survey received a $10 gift card
immediately upon completing the survey.
Focus Groups and Case Study Interviews. Eleven focus groups, ranging from 5-35 participants per group, and
8 case studies were undertaken between April 2011 and March 2012 to better understand the context of adolescent
sexuality, pregnancy, risk prevention, sex education, and programs and services related to pregnancy and parenting
available to adolescents. The research team developed protocols that focused on the challenges of being a teen
parent; key resources available for family planning, STD prevention, pregnancy and prenatal care, and parenting;
barriers to pregnancy prevention; and impediments to finishing school and obtaining employment as a pregnant or
parenting teen. Questions were tailored to the different target populations: 1) teen girls who were pregnant and/
or parenting; 2) teen girls who had never been pregnant; 3) teen boys; 4) parents of teens; and 5) service providers
recruited through MemTV membership and the Teen Pregnancy and Parenting Success (TPPS) Initiative funded
partners.
Community partners helped the research team identify focus group and case study participants by distributing
recruitment flyers. Interested individuals provided their names and contact information, and potential participants
were contacted by telephone by a trained member of the research team. Focus groups were held at various
locations throughout areas targeted by the TPPS project. Interviews with volunteer participants were scheduled at a
mutually acceptable time. Interviews took place in private settings either at a place convenient to the interviewee, or
in a research room at the University of Memphis, depending on the interviewee’s preferences. The focus groups and
interviews each lasted approximately sixty to ninety minutes. Upon completion, participants were offered a $25 gift
card. Cases of rape and statutory rape were reported according to legal requirements.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 15
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Center for Research on Women
APPENDIX B
LITERATURE REVIEW
Researchers are increasingly finding that health disparities such as teen pregnancy or infant mortality involve a
complex set of factors that are biological, psychosocial, and structural or institutional in nature (Bronfenbrenner,
1979; Kelly, Ryan, Altman, & Stelzner, 2000; Ryerson Espino & Trickett, 2008; Sallis, Owen, & Fisher et al., 2008;
Hall, Moreau, & Trussell, 2012). As summarized in the literature review that follows, adolescent sexual behavior is
shaped by a broad range of variables, including family structure and context, family processes and relationships, and
biologic or hereditary factors. Community variables also impact adolescent intentions, actions, and risk behaviors.
Health and transportation systems directly affect adolescents’ access to reproductive health services and medically
reliable information. Neighborhood resources and needs, opportunities for teen employment, and cultural norms
about appropriate relationships also play important roles in influencing teens’ reproductive behaviors. Public health
interventions designed to address health disparities operate within complex social systems and their social and
historical contexts consequently shape community perceptions of health and sexuality (Asthana & Halliday, 2006).
Consequently, the most effective interventions should purposefully target multiple levels in the system to have the
greatest impact (Sagrestano & Paikoff, 1997; Sallis et al., 2008), while seeking to accommodate conflicting values
and other community needs competing for policy makers’ attention.
All American teenagers should have the opportunity to make choices that
allow them to live a long, healthy life regardless of their income, education,
or ethnic background.
Teens are not just young adults; they have yet to fully develop their decision-making capacity. As a result, judgment
missteps can have long term consequences on their potential to have productive lives. Unfortunately, many teens
are engaging in sexual behaviors that make them and their offspring vulnerable to poor health and negative life
outcomes. Pregnant adolescents experience higher rates of certain medical complications during pregnancy (Martin
et al., 2005) which place their infants at risk for adverse birth outcomes and at higher risk for cognitive, behavioral,
and emotional impairment (Gilbert, Jandial, Filed, Bigelow, & Danielson, 2004). Nationally more than 80% of teen
mothers live in poverty during their children’s important developmental years (Hoffman & Maynard, 2008), and
many will not graduate from high school (Hoffman, 2006). Thus, postponing parenting until they have achieved
other key milestones such as completing their education will result in a greater likelihood of achieving their full
potential.
Risk/Protective Factors and Teen Pregnancy Prevention: The Impact of
Quality Relationships and Communication
The opportunity for positive life outcomes begins in our families, neighborhoods, and schools. Understanding
risk factors that are associated with a higher likelihood of negative life outcomes such as teenage pregnancy and
dropping out of school (Coie et al., 1993) can help the community better design adolescent pregnancy prevention
interventions. The challenge is that risk factors tend to cross domains as adolescents interact with families, peers,
schools, and the community (Synder & Patterson, 1987) and operate cumulatively and interactively (Oldentettel &
Wordes, 2000). Fortunately, protective (resilience) factors, that is, variables that directly or indirectly buffer against
such risks (Coie et al., 1993), can also be enhanced or enriched to help teens make better and more responsible
choices and have the skills to counter pressures to act otherwise. The challenge for program designers is that
research has identified more than 500 diverse risk and protective factors. Kirby, however, notes that among the
many factors “teens’ own, sexual beliefs, values, attitudes, and intentions are the most strongly related to sexual
behavior” (2007, p. 14). The following key conclusions emerge from the literature:
1. Parents Matter.
• Parent-child connectedness, defined as parental closeness, supervision, and behavioral monitoring, is associated
with reduced adolescent pregnancy risk (e.g., delayed onset of sexual behavior) and transmission of parental
16 | Shelby County Teen Pregnancy and Parenting Needs Assessment
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•
•
•
Center for Research on Women
values regarding appropriate sexual behavior (Commendador, 2010; Huang, Murphy, & Hser, 2011; Miller, 2002;
Oman, Vesely, & Aspy, 2005; Short, Yates, Biro, & Rosenthal, 2005).
Teens living in one-parent households are more likely to engage in sexual activity and related risk behaviors at a
younger age than are those in two-parent households (Abma, Martinez, Mosher, & Dawson, 2002; Bonell et al.,
2006; Miller, 2002; Oman et al., 2005).
Researchers hypothesize that parental supervision of teens may be connected with lower teen pregnancy
risk, and that single parent households might have more trouble supervising their teens than do two parent
households (Miller, 2002; Oman et al., 2005).
Positive relationships and communications with parents and health care providers/case managers can enhance
teens’ decision making skills and understanding of contraceptive issues (Akers, Schwarz, Borrero, & Corbie-Smith,
2010; Lemay, Cashman, Elfenbein, & Felice, 2007; Garwick, Nerdahl, Banken, Muenzenberger, & Sieving, 2004;
Hacker, Amare, Strunk, & Horst, 2000).
2. Age Matters.
• Younger teens report low levels of knowledge about safe sex/contraceptive options (Phipps et al., 2008; Iuliano,
Speizer, Santelli, & Kendall, 2006; Kalmuss, Davidson, Coball, laraque, & Cassell, 2003) and high levels of
“unplanned” sexual activity (Phipps et al., 2008).
• Older teens (15 years or older) are more likely to report having a higher knowledge of contraception and slightly
higher rates of contraceptive use than younger teens (Phipps et al., 2008).
• Physical maturity may also be a factor in sexual activity (Kirby, 2007). Of note, older teens (who show higher
rates of consistent contraceptive use) also report experiencing more side effects from birth control, which teens
report as a potential variable for nonuse (Phipps et al., 2008; Iuliano et al., 2006).
• Teen attitudes about contraception generally become more positive as they age. Researchers suggest that
the variance in teen attitudes about contraception use by age groups [12-14, 15-17, 18-21] may relate to
increased sexual experiences (Phipps et al., 2008), greater exposure to contraceptive options, and reduced fear
surrounding their parents finding out (Iuliano et al., 2006).
• Research suggests the need to tailor pregnancy prevention and teen parenting programs to specific age
subgroups (Phipps et al., 2008; Kalmuss et al., 2003).
3. Intentions Matter.
• The pregnancy intentions of teen girls (measured by their beliefs about pregnancy likelihood and their plans to
become pregnant), along with their perceptions of pregnancy consequences, influence their contraceptive use
(Rosengard, Phipps, Adler, & Ellen, 2004; Bruckner, Martin, & Bearman, 2004; Stevens-Simon, Sheeder, Beach, &
Harter, 2005; Spear, 2004).
• One key factor related to teens’ desire to avoid pregnancy was the importance of “achieving future goals and
maintaining positive self-esteem” (Stevens-Simon et al., 2005, p. 243e20).
• Teenagers who are ambivalent about becoming pregnant have lower rates of contraception use and higher rates
of unintended pregnancy (Bruckner et al., 2004; Spear, 2004).
• Higher “unplanned” pregnancy rates are seen in teens who see no serious, negative consequences associated
with teen pregnancies, or who see both positive and negative consequences (consequences discussed include:
embarrassment, future education goals, finances, stress, relationship with family/friends/boyfriend) (StevensSimon et al., 2005; Jaccard, Dodge, & Dittus, 2003; Bruckne et al., 2004).
4. Reproductive Health Knowledge Matters, for Both Parents and Teens.
• One factor affecting the form of contraceptive methods teens choose to use is knowledge of perceived
risks, defined as the level of ambivalence surrounding possibly getting pregnant, and how likely they believe
pregnancy is with their current contraceptive behavior (Ott et al., 2002; Manning, Longmore, & Giordano, 2000).
• US teen girls have reported the mistaken belief that their behavior could not result in pregnancy or was a very
low risk, for example, not considering having intercourse only once or twice as being sexually active (Lemay,
Cashman, Elfenbein, & Felice, 2007; Iuliano et al., 2006).
• Teens report that some of the most common barriers to obtaining and using contraceptives are embarrassment,
confidentiality concerns, and inability to obtain contraception without parental knowledge (Lemay et al., 2007, p.
233).
• Lack of access to confidential care is a barrier to obtaining STI prevention and treatment services (Lemay et al.,
2007).
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•
•
•
•
•
•
•
Center for Research on Women
Disparities in health provider access by young women, especially those uninsured, underinsured, and
immigrants, result in barriers to reproductive health services utilization (Hall, Moreau, & Trussell, 2012).
Perceived negative side effects from using the pill, such as weight gain, are a barrier to its use (Garwick et
al., 2004) and such side effects appear to be the reason for selecting or changing to a different method of
contraception (Lemay et al., 2007).
Parental values and knowledge affect teen use of contraceptives. The majority of parents with teenage
children report “low levels of contraceptive knowledge…as well as negative attitudes toward some long-acting
methods” (Akers et al., 2010, p. 165).
Very conservative parents tend to hold very negative, yet medically inaccurate, views about condoms and oral
contraceptives (Eisenberg et al., 2004).
To reduce the incidence of STIs, researchers suggest that formal sex education may improve condom
consistency, thus reinforcing the need to target teens and parents about sexual health prior to the initiation of
sexual activity (Manlove, Ikramullah, & Terry-Humen, 2008).
Adolescents who are offered education about safe sex and birth control (including medically accurate
information about the pill, condom use, and other safe sex options), show higher rates of contraceptive use
(Longmore, Manning, Giordano, & Rudolph, 2003; Klein, 2005; Bruckner & Bearman, 2005). Research suggests
that exposure to sexuality education that includes contraception does not lead to increased sexual activity
(Klein, 2005).
Students in school-based risk reduction programs where they engage in activities that improve their belief in
their ability to use condoms were more likely to have protected sex (Longmore et al., 2003, p. 56).
5. Relationships with Peers and Partners Matter.
• Researchers have documented the effects of peer pressure on teen sexual behaviors. Consistent with Kirby’s
findings (2007), Garwick found that teens who have “friendships with older peers who were engaged in risky
behaviors” (2004, p. 346) engage in similar risk behaviors.
• The research on how the degree of intimacy and commitment in a relationship may affect a couple’s use of
contraception is mixed. Teen boys in romantic relationships who consistently engage in “couple-like activities”
are more likely to use contraception; however, teens may become less careful when they believe they are in a
committed relationship (Manlove, Ryan, & Franzetta, 2004).
• Both teen girls and boys reported higher rates of overall contraceptive use (Manning et al., 2000), less condom
use, and more hormonal contraceptive use (Ott et al., 2002) with serious/close partners than casual partners.
• Because there is significant variation in contraceptive use across relationships, length and degree of
commitment (Manlove et al., 2004; Lemay et al., 2007), Manlove and her colleagues conclude: “program
providers should address the possibility that decisions on contraceptive use are compromised by teenagers’
needs for intimacy” (2004, p. 272).
• Research suggests that successful sex education curricula should stress developing skills to help teens navigate
relationship communication related to risk reduction (Wight et al., 2002).
Educate, Involve the Community, and Invest in Our Teens: Provide Clear,
Consistent and Appropriate Messages
Kirby, a recognized expert in the field of adolescent pregnancy prevention, convincingly argues that communitybased programs aimed at reducing teen pregnancy and sexually transmitted infections should clearly establish
goals, be straightforward, and set specific outcomes expected from the effort. Further, program designers should
implement programs that have demonstrated their effectiveness for similar teen populations, base the curriculum
on an assessment of needs of the target population, and assure that the program is implemented with fidelity and
consistent with community values (Kirby, 2007). Adolescents have suggested that sex education programs should
frame the issues more positively, emphasizing fewer scare tactics and focusing more on anatomy; on negotiation
and communication skills; and on providing information on health clinics in areas that teens frequent (DiCenso,
Guyatt, Willan, & Griffith, 2002).
Over 80% of U. S. adults support comprehensive sex education programs that emphasize abstinence but also
inform youth about contraception (Kirby, 2007, p. 14). Part of the challenge facing communities in countering
teen risk behaviors is an increasingly sexualized society. A recent American Psychological Task Force argues that
sexualization is especially problematic for adolescents who are developing into sexual beings and learning how
18 | Shelby County Teen Pregnancy and Parenting Needs Assessment
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Center for Research on Women
to engage in intimate relationships (APA, 2007). Consequently, teen pregnancy prevention programs need
to integrate an understanding of child development, socialization influences, and relational skills in order to
collaborate with parents, schools, the faith community, and policy makers to develop a community-based
comprehensive/coordinated approach to adolescent pregnancy prevention.
Adopted by many states, comprehensive sex education programs are designed to be age appropriate and
medically accurate. Available curricula include various topics, such as reproductive anatomy, relationships, and
decision-making. Curricula should be approved by school systems, and be available for review by parents. Existing
curricula may or may not include information about contraception. Comprehensive sex education programs
can reduce sexual risk behaviors (Kirby, 2007; Kohler, Manhart, & Lafferty, 2008). Outcomes from abstinenceonly programs, however, present a mixed picture as such programs may improve teen values or intentions
about abstinence, but improvements have not been demonstrated to endure (Kirby, 2007, pp. 14-15). Pledging
abstinence also has been a strategy for delaying sexual initiation. Rosenbaum (2009), however, found that those
pledging abstinence had equal STI rates as nonpledgers, were less likely to use contraception, and held more
negative and fearful attitudes about sex and birth control.
The challenge for demonstrated effective programs is the difficult issue of learning the lessons from implemented
programs and then replicating what works with fidelity. The research suggests that sex education curricula need
to be medically accurate, comprehensive, age-appropriate, and culturally sensitive; incorporate community
values; yet maintain legitimacy and effectively influence youth behaviors. Without a national standard of medical
accuracy, however, individual states and school systems define the accuracy of their curriculum. Added to this is
the challenge of having a teacher’s personal perspectives potentially impede information dissemination, such as
withholding information or promoting stereotypes (Santelli, 2008).
Communities embarking on the process of changing teen sexual behavior face a daunting challenge. Fortunately,
the research evidence has identified through rigorous evaluation (experimental design) 25 programs and an
additional seven effective programs (quasi-experimental design) to select from when launching a teen pregnancy
prevention program (Suellentrop , 2011). Convincingly, the experts advise that before launching a program
communities should take the proactive steps of defining outcomes expected and the targeted behaviors sought
to be affected, reflecting the commitment of the broader community to youth development, and involving parents
and adolescents (Suellentrop, 2011).
Shelby County Teen Pregnancy and Parenting Needs Assessment | 19
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APPENDIX C
ANALYSIS OF BIRTH CERTIFICATE DATA FOR INFANTS BORN TO
TEEN MOTHERS LIVING IN SHELBY COUNTY, TENNESSEE
The following section is based on analyses of the 2009 linked birth-death records for babies born in Shelby
County, conducted by the Center for Community Building and Neighborhood Action.
In 2009, 14,407 infants were born to mothers living in Shelby County, Tennessee. This was down from 15,045
in 2008, a 4% decrease. Of all the babies born in Shelby County in 2009, 15%, or 2,181 were born to women
under the age of 20. Out of 14,407 infants born in 2009, 171 died, giving us a county wide infant mortality
rate of almost 12 per 1,000 births, about the same as in 2008 and almost double the national rate for 20091,
reinforcing the perception of Shelby County as a location with unusually high incidences of infant mortality.
Births to Teen Mothers in 2009
In 2008, Tennessee ranked in the top ten of states with the highest teen birth rates. The rates were even
higher in Shelby County both then and in 2009. For 2009, Shelby County reported 36.7 births per 1,000
women aged 15-17, and 107.8 births per 1,000 women aged 18 and 19 This compares with state rates of
24.0 for women aged 15 to 17 and 85.9 for women aged 18 and 19.2 Nationally, there was a decrease in the
number of teen births from 2008 to 2009. Shelby County also experienced decreasing numbers of teen births,
with births to mothers 17 and under decreasing by 8%, and births to all mothers 19 and under decreasing by
6% between 2008 and 2009.
Birth Rate per 1,000 Women
107.8
18-19
85.9
Age
Shelby
TN
36.7
15-17
24
0
20
40
60
80
100
120
1HEALTH2 Infant mortality: Death rates among infants by detailed race and Hispanic origin of mother, 1983–1991 and 1995–2009, http://www.
childstats.gov/americaschildren/tables/health2.asp?popup=true#b, accessed 1/2/2012.
2Selected Data on Teenage Pregnancies, Resident Data, Tennessee Division of Health Statistics, http://health.state.tn.us/statistics/PdfFiles/VS_
Rate_Sheets_2009/Births15-1709.pdf, http://health.state.tn.us/statistics/PdfFiles/VS_Rate_Sheets_2009/Births18-1909.pdf.
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Births by Age Category, Shelby County, Comparing 2008 and 2009
Age Category
2008 Total Births
2009 Total Births
% Difference
Under 15
50
34
-32%
15 to 17
800
744
-7%
17 and under
850
778
-8%
18 and 19
1,476
1,403
-5%
19 and under
2,326
2,181
-6%
20 to 24
4,373
4,243
-3%
25 to 29
4,006
3,817
-5%
30 to 34
2,741
2,646
-3%
35 to 39
1,269
1,245
-2%
40 and over
235
275
17%
Total all ages
14,950
14,407
-4%
History of Previous Births. The number of teen births to mothers who have previously given birth
was 11% of mothers under 17. This percentage jumps to 30% for the mothers between the ages
of 18 and 19. This compares to 9% of mothers under 17, and 23% for mothers between the ages
of 18 and 19 in the state of Tennessee.
Previous Births by Age of Mother
in Shelby County
25
Age
20-24
7
18-19
0
2 or More Previous Live
Births
23
1 Previous Live Birth
1
17 and under
32
10
10
20
30
40
Precentage
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Previous Births by Age of Mother, Shelby County, 2009
Age Category
Under 15*
No Previous
Live Births
1 Previous
Live Birth
More Than 1
Previous Live Birth
Total Births
33
1
0
34
15 to 17
88%
10%
1%
744
17 and under
89%
10%
1%
778
18 and 19
70%
23%
7%
1,403
19 and under
77%
19
5%
2,181
20 to 24
43%
32%
25%
4,243
Total all ages
39%
29%
32%
14,407
*Raw numbers are reported for this age group due to the small total.
Demographic Characteristics of Teen Mothers
Race/Ethnicity. Eighty-one percent of mothers under the age of 20 in Shelby County in 2009 were
African American, 10% were Hispanic, 8% were white, and about 1% were Asian or Pacific Islander.
Less than one percent would fall into the category of ‘other’. Thirty-six percent of those infants born
to mothers under the age of 20 were born to very young mothers 17 or under.
Race and Ethnicity of Teen Mothers
8%
1%
10%
Black/AA
Hispanic
White
Asian/PI
81%
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Center for Research on Women
Race and Ethnicity of Mother by Age Categories, Shelby County, 2009
Age Category
Under 15*
Black or AA
White
Hispanic
Asian/PI
Total
Births
27
1
6
0
34
15 to 17
82%
6%
11%
1%
744
17 and under
82%
6%
12%
1%
778
18 and 19
81%
10%
8%
1%
1,403
19 and under
81%
8%
10%
1%
2,181
Total all ages
60%
26%
11%
3%
14,407
*Raw numbers are reported for this age group due to the small total.
Age of Baby’s Father. When available, birth certificate data includes the age of the father. For the 776
unmarried Shelby County women under the age of 18, only 238, or 31% reported the age of the
father. Of these 238 women, 21% would fall under the legal definition of victims of statutory rape
(sex with girl aged 13-14 with man who is 4 or more years older; sex with girl aged 15-17 with a
man who is 5 or more years older) in the state of Tennessee.3
Income Level. Teen mothers report very low incomes: 78% with household incomes less than
$10,000 per year. Eighty-six percent of mothers under age 20 give birth under TennCare. Teens are
also more likely to be receiving WIC benefits, although the percent enrolled in WIC is about 10% less
than those reporting TennCare as the method of payment.
Income Status Indicators by Age Categories, Shelby County, 2009
Age Category
Under 15*
Less Than
10,000
Less Than
25,000
Medicaid/
Teen Care
Private
Insurance
Self-Pay
WIC
Total
Births
15
20
27
4
2
24
34
15 to 17
78%
92%
85%
10%
5%
73%
744
17 and under
78%
92%
84%
10%
5%
73%
778
18 and 19
78%
94%
87%
8%
4%
67%
1,403
19 and under
78%
93%
86%
9%
4%
69%
2,181
Total all ages
48%
63%
60%
34%
6%
48%
14,407
*Raw numbers are reported for this age group due to the small total
Educational Level. Teen mothers are highly unlikely to have completed high school. Of more concern
are the challenges these young women will face in completing their education after having a child. If
we look at the cohort of Shelby County women giving birth between the ages of 20 and 24 in 2009,
we find that 83% who did not report any previous births had at least finished high school. For those
with one previous birth, 70% had at least a high school diploma or GED. For those women with two
or more previous births in this age range, only 52% had achieved that level of education.
3Tennessee Compilation of Selected Laws on Children, Youth and Families, 2011 Edition, Tennessee Code Annotated, Title 39 Criminal Offenses, Chapter 13 Offenses Against Person, Part 5 Sexual Offenses, 39-13-506. Statutory rape. http://www.state.tn.us/tccy/tnchild/39/39-13-506.htm, accessed
2/2/2012.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 23
The University of Memphis
Center for Research on Women
Education Status of Mother by Age Categories, Shelby County, 2009
Age Category
No HS Diploma
Under 15*
HS Grad or GED
Post HS Ed
Total Births
34
0
0
34
15 to 17
94%
6%
0%
744
17 and under
94%
6%
0%
778
18 and 19
45%
40%
14%
1,403
19 and under
94%
6%
9%
2,181
20 to 24
29%
36%
35%
4,243
25 to 29
21%
23%
56%
3,817
30 to 34
15%
17%
68%
2,646
35 to 39
15%
14%
70%
1,245
40 and over
18%
16%
66%
275
Total all ages
28%
25%
46%
14,407
*Raw numbers are reported for this age group due to the small total
Medical Risk Factors
Infant Mortality. In 2009, infant mortality rates were slightly higher for mothers ages 18 and 19 (13
per 1,000 births) than for mothers between the ages 15 to 17 (11 per 1,000). The small number
of births to mothers aged 15 and under make comparisons in this group difficult and invalidate the
robustness of calculated rates and percentages for this subset of births. In 2009, there was only 1
infant death to the 34 young women in this age group.
Infant Mortality per 1000 births
Infant Mortality Rate by Age
16
14
12
11.6
13.6
12.8
10.6
14.5
14.5
35-39
40 and
over
9.4
10
8
6
4
2
0
17 and
under
18-19
20-24
25-29
30-34
Age of Mother
24 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Infant Mortality by Age Category, Shelby County, Comparing 2008 and 2009
Age Category
2008 Total
Births
2009
Total
Births
%
Difference
2008
Infant
Deaths
2009
Infant
Deaths
2008
IM Rate
2009
IM
Rate
Under 15
50
34
-32%
0
1
--
--
15 to 17
80
744
-7%
20
8
25
11
17 and under
850
778
-8%
20
9
24
12
18 and 19
1,476
1,403
-5%
24
18
16
13
19 and under
2,326
2,181
-6%
44
27
19
12
20 to 24
4,373
4,243
-3%
50
45
11
11
25 to 29
4,006
3,817
-3%
42
52
10
14
30 to 34
2,741
2,646
-4%
21
25
8
9
35 to 39
1,269
1,245
-2%
16
18
13
14
40 and over
235
275
17%
7
4
30
15
Total all ages
14,950
14,407
-4%
180
171
12
12
Prematurity and Low Birth Weight. Births to teen mothers were only slightly more likely to be
premature or of low birth weight than infants born to mothers aged twenty or above.
Fetal Maturity and Birth Weight by Age of Mother, Shelby County, 2009
Age Category
Under 15*
Mature
PreMature
Very PreMature
Extremely
Premature
High
Birth
Weight
Normal
Birth
Weight
Low
Birth
Weight
30
3
1
0
1
29
4
15 to 17
88%
8%
3%
1%
3%
86%
11%
17 and under
88%
8%
3%
1%
3%
86%
11%
18 and 19
88%
8%
3%
1%
2%
86%
12%
19 and under
88%
8%
3%
1%
3%
86%
12%
20 to 24
86%
10%
3%
1%
4%
84%
12%
25 to 29
87%
8%
3%
2%
6%
84%
10%
30 to 34
87%
8%
3%
1%
8%
81%
11%
35 to 39
85%
10%
4%
1%
8%
80%
12%
40 and over
81%
16%
2%
0%
11%
79%
10%
Total all ages
87%
10%
3%
1%
5%
83%
11%
*Raw numbers are reported for this age group due to the small total.
Obesity. Obesity is a variable related to age in Shelby County. The older the mother is, the more
likely she is to be overweight. Although teens were less likely than their older counterparts to
be overweight or obese, one third were overweight or obese according to pre-pregnancy BMIs
measurements. This compares to almost 50% for young women aged 20 to 24. Obesity is of
particular concern as it has been identified as a risk factor for infant mortality in Shelby County.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 25
The University of Memphis
Center for Research on Women
Obesity by Age of Mother
70
64
60
57
Percentage
50
45
46
44
43
40
30
20
10
9
17
10
25
24
21
15
7
6
25
28
24
27
26
40
30
26
29
Underweight
Normal
Overweight
3
4
4
2
Obese
0
17 and 18-19 20-24 25-29 30-34 35-39 40 and
under
over
Age
Pre-Pregnancy BMI Groupings by Age Categories, Shelby County, 2009
Age Category
Underweight
Normal
1
21
9
11
15 to 17
9%
64%
16%
11%
17 and under
9%
64%
17%
10%
18 and 19
7%
57%
21%
15%
19 and under
8%
59%
19%
14%
20 to 24
6%
45%
24%
5%
25 to 29
4%
44%
25%
27%
30 to 34
3%
46%
24%
28%
35 to 39
2%
43%
26%
29%
40 and over
4%
40%
26%
30%
Total all ages
5%
47%
24%
25%
Under 15*
Overweight
Obese
*Raw numbers are reported for this age group due to the small total.
Being overweight is also related to race, with 25% of white mothers, 35% of African American
mothers, and 26% of Hispanic mothers 19 and under being obese or overweight.
26 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Percentage
Obesity of Teen Mothers by Race
45
40
35
30
25
20
15
10
5
0
39
28
32
30
23
18
Black/AA
White
Hispanic
17 and under
18-19
Age
Overweight and Obese Mothers by Race/Ethnicity, Shelby County, 2009
Age Category
Percent Overweight or Obese
African American
White
Hispanic
Asian
17 and under
28%
30%
18%
*
18 and 19
39%
23%
32%
*
19 and under
35%
25%
26%
*
20 to 24
52%
42%
39%
*
25 to 29
63%
37%
50%
*
30 to 34
70%
34%
58%
*
35 to 39
75%
40%
53%
*
40 and over
76%
40%
*
*
Total all ages
55%
37%
67%
23%
Sexually Transmitted Infections. Teen mothers stand out in having high rates of sexually transmitted
infections.4 In Shelby County, the younger the mother, the higher the percentage of births to
infected mothers. Among mothers 17 and under, 21% had a sexually transmitted infection during
pregnancy, and among mothers 19 and under, 18% had a sexually transmitted infection during
pregnancy.
4In our data, we coded a positive for STD infection if the data indicated the mother had Gonorrhea, syphilis, herpes simplex, Chlamydia, hepatitis B, or
hepatitis C. Hepatitis C is often, but not always contacted sexually and may be considered by some to not be a “STD”.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 27
The University of Memphis
Center for Research on Women
The most common infection in 2009 was Chlamydia, with a total of 799 or 6% of all births affected.
The rates for teen mothers were much higher than for mothers over 20. Herpes simplex, the next
most common sexually transmitted disease, affected older mothers at a higher rate than teens. Only
2% of births to teen mothers were affected by herpes. For Shelby County mothers 20 to 24, 2% of
births were affected, 3% for births to mothers 25-34, and 4% for mothers 35 and above.
Chlamydia by Age
35 and over
1
30-34
1
Age
25-29
3
20-24
7
18-19
15
17 and under
18
0
5
10
15
20
Percentage
Births to Mothers with Chlamydia by Age of Mother, Shelby County, 2009
Age Category
Number of
Births Affected
Number of Births
Affected
15 to 17
136
18%
17 and under
141
18%
18 and 19
207
15%
19 and under
348
16%
20 to 24
306
7%
25 to 29
106
3%
30 to 34
25
1%
35 to 39
13
1%
40 and over
1
<1%
Total all ages
799
6%
Hypertension, Diabetes, and Smoking During Pregnancy. Gestational hypertension and diabetes
(gestational and pre-pregnancy diagnoses together) were associated more with older mothers than
teens, yet 4% of births to teen mothers were to mothers with hypertension. Very few mothers of
any age reported smoking during pregnancy.
28 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Risk Factors by Age of Mother
25
Percentage
20
15
STI
Gestational Hypertension
10
Diabetes
5
Smoking During Pregnancy
0
17 and 18-19
under
20-24
25-29
30-34
35-39 40 and
over
Age
Risk Factors By Age of Mother, Shelby County, 2009
Age Category
Under 15*
STD/Infection
Gestational
Hypertension
Diabetes
No Smoking
During
Pregnancy
Smoke
<1 Pack
Per Day
Smoke
1 Pack+
Per Day
1
2
0
34
0
0
15 to 17
21%
4%
1%
97%
2%
0%
17 and under
21%
4%
1%
97%
2%
0%
18 and 19
18%
4%
1%
94%
4%
1%
19 and under
19%
4%
1%
95%
4%
1%
20 to 24
11%
5%
3%
91%
7%
2%
25 to 29
6%
6%
5%
91%
7%
2%
30 to 34
5%
6%
9%
93.%
5%
2%
35 to 39
6%
6%
11%
95%
4%
2%
40 and over
5%
6%
14%
93%
5%
2%
Total all ages
9%
5%
5%
93%
6%
2%
*Raw numbers are reported for this age group due to the small total.
Prenatal Care. Although most mothers in Shelby County receive at least some prenatal care, care for
those mothers aged 19 and under is less frequent and more often begins later in the pregnancy.
Eleven percent of teen births are to mothers who received no prenatal care, and 40% do not have
access to care until sometime in the second trimester.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 29
The University of Memphis
Center for Research on Women
Percentage
Entry into Prental Care by Age
80
First Trimester
70
Second Trimester
60
Third Trimester
50
No Prenatal Care
40
30
20
10
0
17 and
under
18-19
20-24
25-29
30-34
35-39
40 and
over
Age
Trimester Prenatal Care Began by Age of Mother, Shelby County, 2009
Age Category
Under 15*
No Prenatal
Care
First
Trimester Care
Second
Third
Trimester Care Trimester Care
4
7
12
8
15 to 17
12%
37%
40%
11%
17 and under
12%
36%
40%
12%
18 and 19
10%
40%
41%
9%
19 and under
11%
39%
40%
10%
Total all ages
9%
57%
26%
7%
*Raw numbers are reported for this age group due to the small total.
Labor and Delivery. Younger women were more likely to have labor induced and/or experience
augmented labor. They were as likely to receive anesthesia as were older mothers. Younger women
were less likely to have a cesarean section than older women. Rates of anesthesia during childbirth
were not significantly different for different age groupings.
30 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Nature of Labor by Age of Mother, Shelby County, 2009
Age Category
Labor
Cesarean
Precipitous
Induction
Augmentation
Anesthesia
7
3
15
10
24
34
1
--
15 to 17
21%
3%
26%
28/%
65%
744
8
10.8
17 and under
21%
3%
27%
28%
65%
778
9
11.6
18 and 19
27%
3%
29%
29%
67%
1,403
18
12.8
19 and under
25%
3%
28%
29%
66%
2,181
27
12.4
Total all ages
34%
3%
27%
21%
67%
14,407
171
11.9
Under 15*
Total
Births
Infant
Mort.
Infant
Mort.
Rate
*Raw numbers are reported for this age group due to the small total.
Unintended Pregnancy
To more fully understand teen pregnancy in Shelby County, a comprehensive picture would
include a continuum of pregnancy outcomes, including births, miscarriages, and terminations.
Although miscarriages are not tracked, and many happen before a woman detects her pregnancy
or confirms a pregnancy when accessing prenatal care, research suggests that between 20% and
31% of pregnancies end in miscarriage (Wilcox et al., 1988)
Some women who have unintended pregnancies choose to terminate the pregnancy. In
Tennessee, the state tracks induced abortions primarily from clinics that perform large
numbers of abortions. Smaller providers and individual doctors do not have to report abortions
performed unless the number is “substantial,” which historically has not been defined. Thus,
the reported numbers presented below are incomplete and disproportionately represent
women who are without private insurance. As White women are more likely to have private
insurance than women of color, terminations among white women are likely disproportionately
underrepresented in the data. Nonetheless, based on the reported data below, 25% of
pregnancies in Shelby County in 2009 ended in induced abortions, and this rate was consistent
across age categories, indicating that unintended pregnancies affect fertile women of all ages.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 31
Center for Research on Women
The University of Memphis
Births and Induced Abortions by Age Category, 2009
Age Category
2009 Total Birth
2009 Induced Abortions
2009 “Total” Pregnancies
Under 15
34
25
59
15 to 17
744
234
987
17 and under
778
259
1,037
18 and 19
1,403
480
1,883
19 and under
2,181
739
2.920
20 to 24
4,243
1,632
5,875
25 to 29
3,817
1,297
5,114
30 to 34
2,646
715
3,361
35 to 39
1,245
402
1,647
40 and over
275
108
383
Total all ages
14,407
4,893
19,300
Induced Abortions Among Teens
by Age and Race
600
480
500
405
400
10-14
300
234
205
200
100
25
0
All Races
5
27
61
Whites
20
Non Whites
32 | Shelby County Teen Pregnancy and Parenting Needs Assessment
15-17
18-19
The University of Memphis
Center for Research on Women
APPENDIX D
GIS MAP ANALYSIS AND MAPS
GIS Analysis
Geographic Information Systems (GIS) is a system for mapping, visualizing, and analyzing geographic data. For this
project, CROW partnered with the Center for Community Building and Neighborhood Action (CBANA) to develop
maps that visually depict the relationships between poverty, adolescent pregnancy, and related health outcomes for
teen mothers in Shelby County. Additionally, GIS was used to map community assets in relation to the neighborhoods where teen mothers live. These maps help to explain some of the barriers teens face in accessing healthcare
services as well as pregnancy and parenting resources. Maps have been included as an appendix to this report [Appendix D]. All maps depict the most recent data available (2009); an analysis of these maps is detailed below.
Poverty, Adolescent Pregnancy, and Reproductive Health Outcomes
To understand how poverty and adolescent pregnancy are related, poverty data, as indicated by colored gradations,
drawn from the American Community Survey (http://www.census.gov/acs/www/), served as the base layer for all
maps. Epidemiological data from the Tennessee Department of Health on births and reproductive health status
were then mapped over the poverty information.
Map A illustrates the number of births to all women by zip code, compared with poverty levels across Shelby County.
Of note, this map does not demonstrate a causal relationship between poverty and number of overall births. That is
to say, the poverty level of a neighborhood does appear to directly predict the number of births to women of all ages
living in that neighborhood.
Map B is more telling, as the incidence of adolescent pregnancy is clearly clustered in areas with relatively higher
rates of poverty. This relationship is constant, regardless of maternal age. The relationship between poverty and
adolescent pregnancy is also apparent in Map C, which suggests that nearly all teenage women giving birth in Shelby
County live in poverty.
Maps D, E, F, and G examine the relationships between poverty and various reproductive health outcomes for teens
giving birth in Shelby County. The incidence of births with low birth weight (LBW) shown in Map D, premature
births to teens shown in Map E, and rates of sexually transmitted infections (STIs) among teens giving birth shown in
Map G, are represented visually as point data. These points have a similar shape to cases presented in Maps B and
C; in other words, the incidence of LBW, prematurity, and STIs are significantly higher in areas of high poverty. Of
note, Map F indicates that infant death is uncommon among teen births. However there were only 19 total cases for
that year; this is likely too few to reveal a clear pattern. Even so, at least 7 of these deaths occurred in neighborhoods
with little or no poverty, suggesting that infant death might be impacted by numerous factors in addition to poverty.
Spatial Distribution of Healthcare Services and Teen Mothers
Map H shows the location of healthcare facilities and OB-GYNs who accept TennCare coverage, in relation to the
residences of TennCare-eligible teens giving birth in Shelby County; note that mobile healthcare services are not
included on this map. OB-GYN offices were mapped on the basis of the number of health providers who practice
at each location. However, some physicians have offices in multiple locations, thus this map may overestimate the
availability of relevant medical services. Even so, important patterns are evident in this map. OB-GYN services tend
to cluster around healthcare facilities; the majority of both doctors and facilities are located within the Interstate
240 loop. The majority of teen mothers, however, live outside this central area. Some pregnant teens qualify for
TennCare, but live up to 20 miles away from the nearest provider, posing a significant barrier to accessing prenatal
care and other health services. Outside of the I-240 area, services exist in another cluster in Germantown - an area
with few adolescent pregnancies and low poverty rates. Finally, the map reveals that most pregnant teens living
in neighborhoods with high concentrations of adolescent pregnancies and/or poverty (i.e., those most reliant on
TennCare for services) live in proximity to just one or two medical facilities or doctors’ offices, suggesting that few
providers are geographically accessible in the highest risk neighborhoods.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 33
The University of Memphis
Center for Research on Women
Spatial Distribution of Pregnancy and Parenting Resources and Teen Mothers
Organizations that provide pregnancy and parenting programs are shown on Map I in relation to the residences
of teens giving birth in Shelby County. It must be stressed that this map is limited to depicting “brick and mortar”
organizations; mobile or transient programs and virtual services (i.e., informational internet sites and telephone hotlines) could not be mapped. As with Map H, Map I displays a cluster of services within the I-240 loop; outside this
area are fewer agencies and programs with no discernible patterning. This finding suggests that organizations are
not based in proximity to teens’ residences, posing a potential barrier to program use. Furthermore, many parenting
resources are located in areas with low adolescent pregnancy rates, which could prevent these programs from maximizing their capacity. All but one organization mapped offers pregnancy and/or parenting resources; thus, once their
children are born, teen parents will be forced to travel to different and often distant locations to access programs.
Conclusion
Poverty is clearly connected to the incidence of adolescent pregnancy as well as negative birth outcomes among
teenage parents; although this relationship is less clear for the incidence of infant deaths. In addition to poverty, the
spatial distribution of clinics and agencies could prevent teens at the highest risk of pregnancy and parenting from
accessing essential medical services and other key resources.
34 | Shelby County Teen Pregnancy and Parenting Needs Assessment
Center for Research on Women
MAP A
The University of Memphis
Shelby County Teen Pregnancy and Parenting Needs Assessment |
35
The University of Memphis
Center for Research on Women
MAP B
MAP B
36 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
MAP C
MAP C
Shelby County Teen Pregnancy and Parenting Needs Assessment | 37
The University of Memphis
Center for Research on Women
MAP D
MAP D
38 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
MAP E
MAP E
Shelby County Teen Pregnancy and Parenting Needs Assessment | 39
The University of Memphis
Center for Research on Women
MAP F
MAP F
40 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
MAP G
MAP G
Shelby County Teen Pregnancy and Parenting Needs Assessment | 41
The University of Memphis
Center for Research on Women
MAP H
MAP H
42 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
MAP I
MAP I
Shelby County Teen Pregnancy and Parenting Needs Assessment | 43
The University of Memphis
Center for Research on Women
APPENDIX E
RESOURCE INVENTORY ANALYSIS AND
PROGRAM RESOURCE LIST
The CROW research team compiled a comprehensive resource inventory of programs and services for
pregnant or parenting teenagers in Shelby County. Data were collected from April through December of
2011, and compiled from a range of sources, including an online database of nonprofit agencies in Memphis,
MemTV partners, the Memphis and Shelby County Health Department Fetal and Infant Mortality Review
(FIMR) Committee, and other community collaborators. Results of the analysis of the resource inventory are
summarized below.
Geographic Access: The list of resources was evaluated for several key variables. Accessibility was initially
evaluated on the basis of the agency’s zip code. Results reveal that 38104 housed the largest proportion of
resources, comprising 27.3% of all programs. Another 10.4% of agencies were based in zip code 38103. The
remaining programs were distributed across a range of settings. This pattern is notable because zip codes 38104
and 38103 are not areas with high density of teen births, and are not the center for a significant number of
targeted teen pregnancy interventions. By contrast, areas with higher density of teen births (e.g., 38127) lacked a
significant number of brick-and-mortar agencies. Yet, many agencies housed in the 38104 and 38103 areas did
outreach work in high density areas (e.g., mobile services or in-home visitation).
Number of Agencies by Zip Code
Providing Resources to Pregnant or
Parenting Teens
Zip Code
Frequency
38016
38103
38104
38105
38106
38107
38109
38111
38112
38115
38119
38120
38126
38127
38128
38129
38130
38134
38152
38183
Flexible
Locations
1
8
21
4
2
3
1
4
5
4
1
4
1
2
3
1
1
3
1
3
3
Resource access was also evaluated by comparing programs that are consistently run from a single physical
location, programs that are consistently run from multiple locations, programs run from a single temporary
location (e.g., one-time workshops or biannual conferences), programs run from a variety of temporary
locations, programs that offer home visits, and programs that have a virtual location (i.e., website only). The
analysis found that 49% of all programs had a single physical location, 22% had multiple locations that they use
consistently, and 16% had locations that vary. The research team determined that there is not a significant gap in
brick-and-mortar agencies. However, few resources are situated in areas with high density of teen births.
44 | Shelby County Teen Pregnancy and Parenting Needs Assessment
Center for Research on Women
The University of Memphis
P
e
r
c
e
n
t
a
g
e
Types of Locations of Agencies Providing
Resources to Pregnant and
Parenting Teens*
60
50
49.4
40
30
22.1
15.6
20
10
2.6
5.2
5.2
0
Physical
Location
Temporary Home Visits
Location (i.e.
conferences)
Non
Phyisical
Location
Flexible
Location
Mulitple
Locations
*Some programs have multiple types of locations, thus percentages
exceed 100%
In addition to physical access, teenagers may obtain program information online. The team determined that 96%
of the agencies had working e-mail addresses, and 99% percent of the programs had websites. However, when
contacted, a number of agencies did not respond to email requests for more information. Moreover, most websites
were difficult to navigate, making it a challenge to find information. Some agency websites failed to mention key
programs offered, and some had inaccurate or outdated information. Overall, the presence of a website offers
an anonymous, stigma-free way of obtaining information about many of the programs. However, accessing this
information is contingent on having access to the internet, which can be a barrier in lower-income communities.
Time of Day Access: An additional consideration is whether programs operate outside school days and hours.
The team analyzed services available after school hours and on weekends. School days and hours were defined
as Monday through Friday from 8:00 a.m. to 2:15 p.m. or later; the times when both Shelby County and Memphis
City High Schools close for the day. Analysis revealed that 49% of agencies are open after school hours. Many
others feature variable hours or virtual access, indicating that teenagers can generally access most programs after
school, provided they have transportation and no other time commitments. Even so, many agencies have variable
business days and hours, which could complicate access for potential program participants. Moreover, only 25%
of the programs offered weekend services. Thus, teens with after-school jobs, extracurricular activities, or lack of
transportation may face barriers to access.
Types of Programs/Services Offered: In addition to access, the team evaluated the variety of programs and
services offered by agencies. This was undertaken to identify opportunities for smaller agencies to collaborate
with larger, multi-service agencies to expand outreach and better meet the needs of teens and their families.
Overall, 56% of the agencies ran multiple programs, whereas 44% only offered a single relevant program. This
high number of single-program agencies suggests an opportunity to partner across agencies and avoid potential
program redundancy.
Programs and services were divided into several categories: resources serving pregnant individuals, programs that
advance parenting, comprehensive sex education, abstinence-only education, and other (e.g. media campaigns).
Analysis revealed that a clear majority of resources were focused on pregnant individuals, suggesting an apparent
gap in resources for teen parenting and other post-partum needs.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 45
The University of Memphis
Center for Research on Women
Focus of Programs and Services Related to
Pregnancy and Parenting*
32.5
35
30
25
20
15
10
5
0
24.7
16.9
14.3
11.7
Pregnancy
Resources
Parenting
Resources
Comprehensive Abstinence-Only
Sex Education
Education
Other
Percentage
*Some programs fit under multiple types, thus percentages exceed …
Resources were also reviewed for specific types of program or service provided. Programs included: education
(e.g., classes), material goods and services (e.g., diapers, baby clothing), medical care, annual/biannual events,
support groups/counseling, and other. Some programs fit under multiple headings and were coded accordingly,
thus percentages exceed 100%. A clear majority of programs (78%) had an educational component. Another
26% of resources featured support group or counseling. Material goods and services were supplied by 19.5% of
programs, 18% offered medical testing, and 13% qualified as “other.” In all, 4% were annual or biannual events.
Overall, there was a clear emphasis on educational resources, and a comparative lack of tangible goods and
services, indicating that the material needs of teen parents constitute a lower priority.
Types of Pregnancy and Parenting
Programs and Services*
P
100
e
80
r
c 60
e 40
n 20
t
0
a
g
e
77.9
5.2
Educational
Annual or
Biannual
Event
19.5
18.2
Goods and
Services
Medical
Testing
26
Support
Group or
Counseling
13
Other
*Some programs fit under multiple types, thus percentages exceed
100%
46 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Representatives for each agency were contacted and asked if programs were faith-based or secular. A total
of 52% of agencies identified their programs as secular, and 48% reported that their programs were faithbased. This finding is significant as many faith-based programs favor abstinence-only education, and such
organizations may be reluctant to refer teens to either comprehensive sex education programs or other
unapproved secular services. Of note, the data validation process identified some confusion among agency
representatives about the definition of “faith-based,” and some were uncertain whether their organization
identified as faith-based.
The evaluation team also examined whether resources targeted specific genders. A majority of programs
(57%) were open to both males and females, and 36% were designed as female-only, whereas only
5% were intended exclusively for males. Moreover, the analysis identified a significant gap in resources
designed specifically for teenage fathers. Although 57% of the programs have no gender restrictions, maleonly programs may afford a more supportive environment for young men to share their questions, fears,
and experiences regarding reproductive health and teen fatherhood. This gap implies that young men are
a lower priority for services, and it reinforces social assumptions that young women bear the burden of
responsibility for family planning, prenatal care, and parenting.
Finally, the team documented resource capacity, which was defined as the total number of teens a
program served at the time of inventory. Programs were divided into small (>20 participants), medium
(21 – 100 participants), large (100+ participants) and “unlimited.” Nearly one third of all agencies (29%)
claimed to serve a large number of teens. However, estimates appear to be unreliable, as a number of
agency representatives lacked detailed knowledge about their organization’s programs or services. A
number of representatives claimed that their organization had an “unlimited” capacity. However, many of
these programs were grant-funded and housed in smaller organizations, suggesting that they lacked the
infrastructure to sustain a truly unlimited capacity.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 47
The University of Memphis
Center for Research on Women
TPPS PROGRAM RESOURCE INVENTORY
100 Black Women of Memphis
HIV/AIDS Education and Testing
Young Women of Excellence
These programs offer three to five opportunities for HIV
testing and group educational classes. The classes focus
on safe sex, sexually transmitted diseases, relationships,
and stigma.
Contact Info:
901-831-8739
3931 Ross Road, 38115
www.ncbwmemphis.org
A Better Memphis
Fresh Starts Community Baby Shower
Fresh Starts is an annual community event that offers a
mix of education, empowerment, and opportunity resources to expecting mothers. Donations of baby goods
are given out to expecting mothers. You must be able to
show proof of pregnancy to attend.
Contact Info:
901-379-9101
3795 Frayser Raleigh Road, 38128
www.freshstartsbabyshower.com
[email protected]
A Step Ahead Foundation, Inc.
A Step Ahead provides funding for long-term, reversible
birth control for women. Clients can receive birth control services through Memphis Health Center and Christ
Community Health Center Health Center. Free transportation is included.
Contact Info:
901-320-7837
www.stepahead.me
[email protected]
Agape Child and Family Services
Powerlines Community Network
Agape has been trained by Christ Community Health
Center to begin a program which will cover sexual
transmitted diseases. This training includes general sex
education and STI information/prevention.
Contact Info:
901-323-3600
111 Racine Street, 38111
www.agapemeanslove.org
Arc of the MidSouth
Life Skills Training
Focuses on life skills training for teens with disabilities
and teaches basic life skills including how to avoid fetal
alcohol syndrome.
Contact Info:
901-327-2473
3485 Poplar Ave, 38111
www.thearcmidsouth.org
Baptist Memorial Hospital for Women
Beautiful Bundles
Beautiful Bundles is an open support group where mothers are encouraged to bring their babies. There are also
guest speakers and topics include breastfeeding, bottle
feeding, and general information about nutrition for
mother and baby.
MidSouth Baby Expo
This is an annual event, the primary mission of which is
to provide educational resources to expectant and new
parents. Seminars include Breast is Best, Pediatric Zone,
Infant Safety Zone, and Sibling/Kids Zone.
Dynamic Dads
Dynamic Dads is a workshop for new dads focusing on
the father’s role in the parenting process, how to connect
with the baby, how to support mom, as well as information on community support groups.
Expectant Parents Class
Classes focusing on preparing for your baby and parenting, topics include: baby basics, what to expect, and
home safety for the baby.
Specific Package for Pregnant Teen Girls
Baptist offers a short-term package for pregnant girls
under the age of 18 which includes: prenatal classes,
nutrition/exercise classes, and parenting classes focusing
on teen life, teen life choices, and self-care. Classes can
be in small groups, or one-on-one.
Contact Info:
901-227-9873
901-260-8506 (Dynamic Dads)
901-226-5764 (Expectant Parents Class)
6225 Humphreys Blvd, 38120
www.baptistonline.org
www.midsouthbabyexpo.com
48 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Bethany Christian Services
Online Parenting Counseling
On-Site Abstinence Education / Counseling
Bethany offers online and on-site counseling in regards to
parenting and adoption. Topics include planning for your
child, what to expect, information for community resources appropriate to individual, and adoption resources. Also
offers an abstinence-only sex education program for teens.
Contact Info:
901-818-9996
1044 Brookfield Road, 38119
www.bethany.org/memphis
Birthright of Memphis
Parents Learning And Networking Together (P.L.A.N.T.)
Life skills parenting program for expectant moms who
need a little more support. An incentive-driven program
which offers eight classes taught by guest speakers. Class
topics include:
Get Organized / Manage Your Time
Be the Best Parent for Your Baby
Infant First Aid and CPR Training
Proper Nutrition
Labor and Delivery
Relationships
Learn to Relax -- Not Just React
Breastfeeding
During each P.L.A.N.T. class, every client is encouraged to
participate actively in "hands on" learning activities, which
help them to become better mothers. A special incentive is given to each participant after every class. Upon
completion of the eight topics, reunion classes are offered
for continued support until the client's child reaches the
age of 3 years.
Contact Info:
901-327-8109
115 Alexander Street, 38111
www.birthrightofmemphis.org
[email protected]
Boys Incorporated
Holistic education program (scholastic, health, economic
skills, family/parenting skills) with HIV/sex education components; will also discuss abstinence.
Contact Info:
901-361-6433
715 St. Paul Ave, 38126
www.boysincorporated.org
Center for Research on Women
Cathedral of Faith
I’m Somebody, Not Some Body
Mentoring program for girls designed to create selfawareness and self-esteem. Teaching girls and young
ladies to dream and believe that they have the ability to
bring those dreams to life in spite of their past or present
circumstances.
Contact Info:
901-327-1616
2212 Jackson Ave, 38122
www.cofccministries.org
Catholic Diocese of Memphis
Teen Services
Program is faith-based and teaches teens the benefits of
chastity, fertility appreciation and the sanctity of all human life. Girl-only classes also discuss hormonal changes
and the “gift of sexuality.” Mother/daughter or father/son
classes are also available.
Contact Info:
901-373-1285
5825 Shelby Oaks Drive, 38134
www.cdom.org
Centering Pregnancy
Centering Pregnancy is a clinic-based program where
expectant mothers attend regular meetings (once per
month during first seven months of pregnancy, then
once every other week until birth) facilitated by Christ
Community staff. Mothers are placed into groups with
women who are in the same stage of pregnancy. This
strategy allows mothers to bond, form friendships and
go through all stages of pregnancy and birth around the
same time. Meetings cover individual check-ups for all
women along with group discussions of group dynamics,
general pregnancy issues, general parenting issues, and
comprehensive birth control. Centering Pregnancy is
offered through the following community partners:
Christ Community Health Services
Broad Avenue Health Center
2861 Broad Ave, 38112
901-260-8473
www.christcommunityhealth.org
Health Loop - Med-Plex Clinic
880 Madison, Suite 3E01, 38103
901-449-4241
http://www.utmem.edu/gim/medplex/index.html
Health Loop – Hollywood Clinic
2500 Peres, 38108
901-515-5500
Shelby County Teen Pregnancy and Parenting Needs Assessment | 49
The University of Memphis
Center for Research on Women
CHOICES (Memphis Center for Reproductive Health)
Between Teens
In addition to comprehensive reproductive health services,
CHOICES also offers a six-week course specifically for
teens that educates girls about their developing bodies,
making responsible choices, avoiding teen pregnancy
and navigating the health care system for sexual health
screenings and STI treatment; includes girls-only support
groups facilitated by nurse practitioner and free, limited
reproductive health care. Reproductive health information
is delivered in an interactive group setting co-facilitated by
a nurse practitioner specializing in adolescent reproductive
health. Participants spend 6 - 8 hours learning about such
topics as reproductive anatomy and physiology, menstrual
cycles, birth control options, sexually transmitted infections, and obtaining reproductive health care services.
Contact Info:
901-274-3550
800-843-9895
1726 Poplar Ave, 38104
www.memphischoices.org
Christ Community Health Center (CCHC)
Christ Community Health Center has multiple centers (all
of which are listed within the medical facilities section),
as well as mobile units. In addition to hosting a Centering Pregnancy, CCHC also offers an HIV/AIDS Program.
Patients in this program receive treatment, education, and
support - this program offers HIV testing, counseling with
social worker, and information on social support systems
in the Memphis area. A complete list of locations is included in the list of medical facilities.
Contact Info:
901-271-6000 (appointment line)
[email protected] (for general info)
www.christcommunityhealth.org
Creative Life / Saving Station Christian Church
Pure Destiny (after school program)
Focus on Youth (summer program)
Classes based around abstinence and purity, character
development, and life choices. This program aims to deter
premarital sex and STIs.
Contact Info:
901-775-0304
1222 Riverside Blvd, 38106
www.creativelifeinc.org
Exchange Club Family Center
First S.T.E.P.S. (Skills To Ensure Parenting Success)
Designed for disadvantaged, first-time teen mothers who
show a risk for becoming abusive or negligent parents,
this special in-home intervention program teaches young
mothers how to become responsible parents. First STEPS
provides pregnancy prevention, prenatal support, life skills
(safe sex and STI information), parenting skills including nutrition and general health. Guest speakers include
pediatricians and dentists. First Steps begins with weekly
classes, each teen is then paired with a parent aid as a
mentor and after the initial course of classes monthly support groups are offered for the rest of the year.
In-Home Parent Aides
Volunteers trained by the Family Center staff provide inhome assistance to parents who either have a long-term
history or a risk of abusing or neglecting their children.
Aides provide emotional support and serve as role models
while helping families with daily parenting and household
management tasks. Parent aids can also help parents
apply for social service benefits such as WIC and Families
First.
Contact Info:
901-276-2200
2180 Union Ave, 38104
www.exchangeclub.net
Faith Keepers Ministry
Teen Talk
Teen Talk is a youth counseling program lead by a youth
pastor that focuses on teens’ self esteem, individuality, and
relationships. Topics are always open to suggestions from
the participating teens.
Contact Info:
901-372-3684
3362 Jewel Road, 38128
Family Matters Memphis
Dynamic Dads
This program is a community-based boot camp for fathers
and fathers-to-be. Provides a safe environment where
rookie dads can learn how to care for their partners and
new babies; and speak openly concerning their relationship with their fathers and their own fears about fatherhood.
Connections
This program is used in Memphis City Schools to teach
teens how to build healthy romantic relationships. One
component offers abstinence-only sex education.
Love’s Cradle
This is a program for teenage parents to learn how to
build healthy relationships with each other and their new
babies.
50 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Contact Info:
901-260-8520
2595 Central Ave, 38104
www.familiesmattermemphis.org
Friends for Life
HIV Testing and HIV Education
Free HIV testing on Tuesdays and Thursdays. While the
individual waits for their test results, a trained counselor
works with them to develop an individualized plan to help
prevent HIV.
Contact Info:
901-272-0855
43 North Cleveland Street, 38104
www.friendsforlifecorp.org
Girl Talk
Girl Talk is a national mentoring program that covers topics
such as healthy relationships, sex education, teen pregnancy and pregnancy prevention, empowerment, self love/
worth, and college preparation.
Contact Info:
901-416-4582
1212 Vollintine Ave, 38107
www.desiretoinspire.org
[email protected]
Girls Inc
Preventing Adolescent Pregnancy (PAP)
PAP is a pregnancy prevention curriculum administered by
Girls Inc during regular after-school programming.
Contact Info:
901-523-0217
2670 Union Ave Extended, #606, 38103
www.girlsincmemphis.org
Hickory Hill Community Redevelopment Corp
Community Voice
Lay Health Advisors complete a 10-hour training equipping
them to reach, teach, and motivate the community about
preconception and pregnancy health. Training is open and
available to anyone.
The Baby Store
These stores offer community resources for expectant and
new mothers within Shelby County. The Baby Store first
links pregnant and new mothers with resources within
the community, such as social service agencies, home
visitation programs, prenatal care programs, and other
services that will ensure that women and children receive
the care needed. The Baby Store also provides new infant
items to women in need. Women will be able to access
Center for Research on Women
these items, at no cost, by redeeming vouchers received
by attending prenatal care visits, completing referrals for
services, ensuring infants receive adequate well-child
services and immunizations as well as keeping other
scheduled appointments (such as home visits).
Contact Info:
901-844-3926 (main office)
901-794-2234 (Community Voice)
901-362-2128 (Baby Store)
3665 Kirby Parkway, Suite 4, 38115
Hickory Ridge Mall
http://hickoryhillcrc.org
Infant Mortality Force
Baby Feat Project
The Baby Feat Project houses a Diaper Duty Diaper Bank,
Cribs for Kids, Child Passenger Safety Inspection Safety
Center, First-Aid for Babies, and Books from Birth programs. Monthly workshops will be held for Frayser families on various topics by partnering agencies. Clients are
required to participate in educational consultation while
they are receiving safety items. Currently, the Baby Feat
Project will only serve the families of 38127.
Contact Info:
901-214-5463
647 Creekstone Circle, 38127
www.mimemphis.wordpress.com
[email protected]
La Leche League
Monthly meetings cover the following topics: Benefits of
breastfeeding, being at home with your baby, weaning and
nutrition. The La Leche League leaders also offer support
and information via telephone at any time.
Contact Info:
901-3254-8215
2385 Riverdale Rd, 38183
3245 Central Ave, 38104
http://www.llleus.org/web/MemphisTn.html
Le Bonheur Children’s Hospital
Healthy Families
Healthy Families is an intensive and long-term home
visitation program for first-time, teen mothers. Le Bonheur
Healthy Families is credentialed in this evidence-based
program by Healthy Families America. Participants are
encouraged to enroll pre-natally but can be accepted
until the baby is two weeks old. A trained home visitor
supports families in learning parenting skills, promoting
positive parent-child interactions, promoting child development and school readiness, and child health through wellchild visits and immunizations. Services are provided until
Shelby County Teen Pregnancy and Parenting Needs Assessment | 51
The University of Memphis
Center for Research on Women
the child reaches at least three years of age, but families
may continue until the child is five years old. There is no
fee for participants.
Parent Outreach
Parent Outreach provides parenting education and support
through the evidence-based curriculum, Nurturing Parenting. It is a short-term, intensive program in which a parent
educator meets with the family in their home on a weekly
or bi-weekly basis for six months to address specific parenting needs. Families with young children (infants to age
five) are eligible. There is no fee to participants.
Nurse-Family Partnership (NFP)
NFP is an evidence-based home visitation program for
first-time, low-income mothers. Expectant mothers must
enroll before the 28th week of pregnancy and receive
services until the child’s second birthday. NFP has three
primary goals: improve pregnancy outcomes, improve
child health and development, and improve the economic
self-sufficiency of the family. Services are provided by
bachelor-prepared registered nurses who visit weekly or
biweekly. There is no fee to participants.
Fatherhood
This program works with young males to help them reach
their potential. They work in conjunction with MCS and
various agencies to help the young fathers build life and
job skills and provide a wide variety of job-training opportunities to help increase employability.
Be Proud! Be Responsible!
Evidence-based comprehensive sex education curriculum
taught at MCS, community centers and churches. Classes
can be single-sex or coed. It’s a six-module program, with
the modules covering topics such as HIV/STI prevention,
birth control (including a condom demonstration) and
negotiation skills.
Community HIV Network
The Community HIV Network has a family care program
where support personnel meet with HIV-positive mothers
and go with them to their doctor’s appointments. After the
baby is born, they follow the baby for 12-18 months. If the
baby tests positive for HIV, they are referred to St. Jude’s.
Contact Info:
901-287-5437 (mainline)
901-287-4700 (Healthy Families / Parent Outreach)
901-287-4723 (NFP)
901-287-4778 (Fatherhood)
901-287-4965 (Be Proud Be Responsible)
901-287-4751 (Community HIV Network)
50 Peabody Place, Suite 400, 38103
[email protected]
www.lebonheur.org
Life Choices
Life Choices offers free pregnancy testing, treatment of
STIs, adoption services, and an abstinence-only sex education (the curriculum is called Sexual Integrity). Offer early
prenatal care, then refer to OBGYN.
Bridges (Partnered with One-by-One Ministries)
Teen parents are paired up one on one with a mentor until
child is one year old. Parents earn redeemable points for
supplies.
Contact Info:
901-274-8895
806 South Cooper, 38104
901-388-1172
5575 Raleigh-LaGrange, 38134
www.lifechoicesmemphis.org
Literacy MidSouth
Family Reading Workshops
Literacy MidSouth offers individual and group tutoring for
parents and families with literacy issues.
Contact Info:
901-327-6000 (ext. 1007)
902 South Cooper, 38104
www.literacymidsouth.org
Living Legacy Inc.
This organization offers classes on anger management and
parenting as well as workshops on teen dating violence.
Contact Info:
901-672-7857
5100 Poplar Ave, 38109
[email protected]
www.theliving-legacy.com
Maternal League
Signature Layette Program
This program provides needy mothers and babies with
layettes (diapers, blankets, sleepers, bottles) through the
Memphis and Shelby County Health Department. Layettes
are distributed in the spring around Mothers Day. Layette
and financial donations accepted year-round.
This Side Up
SIDS prevention program. Aim is to educate mothers and
fathers in the Memphis area about the dangers of SIDS
and the preventative measures they can take to keep their
baby safe. Maternal League travels to other organizations
and events (upon request) to set up an information booth.
They can also do a presentation to the group if requested.
52 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Contact Info:
901-289-8999
901-682-2599
P.O. Box 382958, 38183
[email protected]
www.maternalleagueofmemphis.org
Memphis Sexual Assault Resource Center (MSARC)
This organization offers assistance to sexual assault
victims, including STI testing, forensic examinations,
crisis counseling, crisis intervention, psychotherapy,
group therapy assessments, referrals, advocacy, court
accompaniment, case management. MSARC also
conducts community education and outreach.
Memphis Center for Independent Living
Youth Outreach Program
Youth Outreach, life skills training for teens with disabilities, includes a sex education component. Outreach is
typically conducted through local high schools.
Contact Info:
901-222-4350
1750 Madison Ave Ste 102, 38104
Contact Info:
901-726-6404
1633 Madison Ave, 38104
www.mcil.org
Memphis City Schools
MCS Adolescent Parenting Program
The Adolescent Parenting Program (APP) is a site-based
school that offers a coordinated academic and vocational
curriculum designed to meet state requirements for graduation, while simultaneously providing the knowledge and
skills needed to cope with the realities of parenting and
adult living. Courses are offered for students in grades
7-12, and students may attend the APP for up to 2 years.
Support services include an on-site nurse and social
worker, teen parenting classes, after school tutoring, and
an on-site day care center. Key outcomes for students include progress toward person growth, responsible parenting, drop-out prevention, graduation, development toward
career goals, and responsible future family planning.
Contact Info:
901-416-6322
1266 Poplar Ave, 38104
http://www.mcsk12.net/schools/adolescent.alt/site/index.
shtml
Memphis Gay and Lesbian Community Center
Queer as Youth and Gen Q
These youth groups provide an informal arena to discuss
issues such as healthy eating, body image, and healthy
sexuality. No formal curriculum. Gen Q is more of a social
gathering and is self-run rather than facilitated. MGLCC
also offers free HIV testing.
Contact Info:
901-278-6422
872 South Cooper, 38104
www.mglcc.org
Neighborhood Christian Centers Inc.
Operation Smart Child
Program focuses on stimulating early brain development.
Formal curriculum with 8 modules - an introduction, and
two modules of each: touch, talk, read, and play. Teens
must attend the orientation before they can take the other
modules. Classes teach teens about positive and negative
ways of touching, talking, etc, as well as car seat safety
and potty training. Participants earn points by attending classes. These points can be spent on new items like
strollers or diapers. The program covers abstinence only
sex education and STIs.
Contact Info:
901-881-6013
785 Jackson Ave, 38105
www.ncclife.org
One by One Ministries Inc
One by One Ministries Inc partners with area churches and
community organizations to provide in-home mentoring
services for new parents.
Contact Info:
901-356-1758
www.onebyoneusa.org
Planned Parenthood Greater Memphis Region
Health Sexuality Classes
There are many classes that offer comprehensive sex ed
and all have a formal curriculum; Becoming a Responsible Teen: HIV Prevention for African American Teens;
Streetwise-to-Sexwise: Comprehensive Sexuality Education
for African American Teens; Family Planning and Sexual
Health: School-Based Comprehensive Sexuality Education
for Teens; ¡Cuidate!: HIV Prevention for Hispanic Teens;
Making Sense of Abstinence: Abstinence Education for
Teens; Sex Ed 101: Comprehensive Sexuality Education for
Teens; Sex Matters: Comprehensive Sexuality Education for
Young Adults
Shelby County Teen Pregnancy and Parenting Needs Assessment | 53
The University of Memphis
Center for Research on Women
HIV/STI Testing
Planned Parenthood offers HIV testing at four locations in
addition to its primary location, and offers other STI testing
at its primary location. Fees are addressed on a sliding
scale - if a teen comes in with a parent, the sliding scale
will be adjusted for the parent’s income. However, if the
teen comes in alone, the scale will be adjusted for the
teen’s income (and will generally be free). The STI testing
comes in addition to the annual wellness exam - which
includes a pap smear and birth control.
Contact Info:
901-725-1717
2430 Poplar Ave, 38112
www.plannedparenthood.org/memphis
[email protected]
Porter-Leath
Born to Learn
Born to Learn is an evidence-based home-visitation program for pregnant women and new mothers with children
up to age 5. This program empowers parents, prepares
children for school, prevents child abuse and develops
home-school-community partnerships on behalf of the
child.
Cornerstone
Cornerstone uses formal, evidence-based Parents as
Teachers (PATS) curriculum in two parts. Part 1 is geared
towards parents of children 3 and under and includes preventative health, healthy parenting practices and self-sufficiency in pregnant women as well as parenting families.
Part 2 is geared towards parents of children ages 3-5 and
includes training parents to be their children’s first teachers. Both parts include home visitation, referrals, pre- and
post-program testing and health screenings. Also includes
a special program just for teen parents.
Early Head Start
Early Head Start is an evidence-based home-visitation
program for low-income pregnant women and mothers
with children up to age 3. The program seeks to improve
parenting skills, early childhood cognitive development,
and social-emotional development of the family.
Contact Info:
901-577-2500
868 North Manassass, 38107
www.porterleath.org
Project Single Moms
Project Teen Moms Memphis
Mentorship program in which adult single mom members
of PSM mentor single teen mothers. In addition,
professional women who are not single moms also
serve as mentors. This program includes partnerships
with Planned Parenthood and Dress for Success. Teen
mothers can also receive help with college applications
and financial aid forms, financial literacy, or attend an
“empowerment boot camp” that works on building
healthy relationships and self-esteem.
Contact Info:
901-281-0603 or 901-213-6861
2285 Frayser Blvd, 38127
http://psmmemphis.wordpress.com/
Rangeline Community Development Corporation
Baby Feat / Baby Store
Baby Feat is a store that provides disadvantaged pregnant
mothers with baby items and information which will help
them to raise healthy babies.
Contact Info:
901-859-6832 or 901-881-3885
2285 Frayser Blvd, 38127
www.rangelinencdc.com
Regional Medical Center at Memphis/The Med
Sunrise Program for Pregnant Teens
Four-week prenatal educational program for teens with
a formal curriculum that covers comprehensive sex education, healthy relationships (violence prevention), teen
family planning, child passenger safety seats, and birth
orientation. It has been in place since 1988. The teens in
the program are to deliver their babies at the Med and are
placed in groups according to due dates.
Contact Info:
901-545-8449
877 Jefferson Ave, 38103
www.the-med.org
Shelby County Health Department
Help Us Grow up Successfully (HUGS)
Developed by the Tennessee Department of Health, Help
Us Grow Successfully (HUGS) is a free evidence-based
home-visitation program that also coordinates additional
services for pregnant and postpartum women up to two
years and children ages birth through 5 years. Trained
nurses visit at least once a month and talk about care.
They also provide developmental assessments, and make
referrals as needed. Another goal is to provide education
about childcare using the Partners curriculum. They
strive to reduce infant mortality and improve pregnancy
outcomes.
54 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Healthy Start Initiative
This program offers evidence-based home-visitation
services to high-risk pre- and postnatal teens and women
who can be accepted to the program up to 6 months after
the birth of their last child. Healthy Start services are
offered during and after pregnancy and to children up to 2
years old. Nurses, social workers, and lactation specialists
directly provide services and also connect women to
additional community-based services.
Contact Info:
901-379-7461
814 Jefferson Ave, 38104
Shelby County Office of Early Childhood and Youth
(SCOECY)
All Babies Count (ABC Media Campaign)
This campaign includes speeches, canvassing and
informing churches about the campaign. It is a grassroots
public awareness campaign around infant mortality
reduction. On the website, you can download a ‘toolkit’ to
use in order to host your own ABC meeting.
Ask First: Is It Good For The Children? (Media Campaign)
Ask First is an awareness campaign to encourage both
the public and private sector to consider the impact that
their decisions have on children. The goal is to ask them to
weigh what impact any decision would have on children.
Contact Info:
901-385-4224
600 Jefferson Ave, 38105
South Memphis Alliance
Dream Seekers Initiative
SMA’s Dream Seekers Initiative enrolls young people, (ages
14 – 25) who are or were in foster care in the Opportunity
Passport which includes:
Financial Literacy training
An Individual Development Account (matched savings
account) to be used for saving towards long-term assets
A personal bank account to be used for short-term
expenses.
Opportunities for advancement and support specifically
designed to help young people aging out of care gain
access to area resources.
Substance abuse prevention/counseling
HIV/AIDS education and testing
Classes in anger management, goal-setting, parenting,
among others.
Baby Store
Part of a demonstrations project through the Shelby
County Office of Early Childhood and Youth, Hope's
Chest will provide support services to pregnant and
parenting teens who are or were in foster care. These
Center for Research on Women
young mothers, through referral, will receive prenatal
care, parenting education, connections to Early Success
partners, and access to a vouchered community "baby
store" housed at SMA with items such as diapers, formula,
clothing and cribs.
Memphis CARES: Project Advance to 18
The Memphis CARES Mentoring Movement, a local affiliate
of the National CARES Mentoring Movement founded by
Susan L. Taylor, is partnering with South Memphis Alliance
to establish a mentoring program for children in foster
care. The mission of Memphis CARES is to recruit and
deploy mentors to local organizations serving children in
our community.
The major goal of Advance to 18 will be to provide the
framework for adult volunteers to serve as positive role
models in the lives of young people who are in foster care.
Contact Info:
901-774-9582
1048 South Bellevue Blvd, 38106
www.smaweb.org
St. Andrew A.M.E.
Project Hope
This program offers HIV outreach prevention and education by using a behavioral change model. There is group
level and individual level intervention that consists of HIV
education. Project Hope collaborates on two major community events a year: for the last 10 years, they have been
the lead agency on the observance of National Black HIV/
AIDS Awareness Day, which takes place around Feb 7th.
They target 3500 individuals for those efforts and collaborate with other agencies during other national observances, such as National HIV Testing Day, National Condom
Week, or National STD Awareness Month.
Contact Info:
901-775-2968
1472 Mississippi Blvd, 38106
[email protected]
www.saintandrewamec.org
St. Jude Children’s Research Hospital
Connect to Protect (C2P)
Seeks to reduce HIV/AIDS infection rates among teens and
young adults through collaboration among community
leaders and health researchers. C2P forms action-oriented
partnerships, learns about young people and communities
affected by HIV, and produces targeted strategies for
preventing HIV infection among youth. The goal of C2P
Memphis is to mobilize the community to reduce the
prevalence of HIV infection among the target population.
C2P Memphis works to create sustainable policies,
Shelby County Teen Pregnancy and Parenting Needs Assessment | 55
The University of Memphis
Center for Research on Women
practices, and programs around the identified root
causes of age discordant relationships, lack of knowledge
and information on HIV/AIDS, and a culture of silence
regarding sexual violence and domestic abuse.
Contact Info:
901-495-5989
262 North Danny Thomas Place, 38105
[email protected]
www.stjude.org
The Power of Abstinence
Abstinence-Only Classes
Faith-Based class offers visual aids, plays, testimonies,
words of wisdom, and praise songs related to abstinence.
Youth Striving For Excellence
Discipleship Club
Provides discipleship and club meetings; groups are divided by age for Bible study, fellowship, sexual abstinence
programs and leadership training; other programs and
services include: Boy2Men, Rocking & Reading, Tutoring,
and Community Service
Contact Info:
901-864-3968
2886 Allen Road, 38128
[email protected]
Contact Info:
901-452-4144
3030 Poplar Ave, 38130
[email protected]
www.abstinence100.org
Threads of Love
Skillbuilders Sewing Ministry
Free program that provides students with a teacher and a
place to sew. Students can learn to make clothes for their
children using a sewing machine. Students bring in their
own supplies; they will be told where to buy the desired
pattern/fabric.
Contact Info:
901-324-4943
480 South Highland, 38111
[email protected]
www.threadsoflove.org
UT Extension – Shelby County
Nutrition Classes
Classes on dietary needs/guidelines, healthy foods for
children, effective use of assistance program (food stamps,
etc.). Primary class attendees are young mothers.
Contact Info:
901-752-1207
7777 Walnut Grove Road, 38120
56 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
MEDICAL FACILITIES
The following list includes contact information for major
medical facilities that offer reproductive health care
services in Shelby County. A brief list of services has been
included, when possible.
Baptist Memorial Hospital for Women
6225 Humphreys Blvd, 38120
901-227-9000
www.baptistonline.org
Labor and delivery, gynecological surgery, a newborn
intensive care unit (NICU) and the Comprehensive
Breast Center and is a regional referral center for highrisk pregnancies, mammography diagnostics and urogynecology.
Health Loop Center (The Med)
South Third Health Loop
1955 South 3rd Street, 38109
901-515-5800
Pediatrics and Family Medicine
Frayser Health Loop
2574 Frayser Blvd, 38127
901-515-5300
Pediatrics and Family Medicine
Guthrie Health Loop
1064 Breedlove, 38107
901-515-5400
Pediatrics and Family Medicine; WIC
CHOICES (Memphis Reproductive Health Center)
1726 Poplar Ave, 38104
901-274-3550
800-843-9895
www.memphischoices.org
Comprehensive reproductive health services
Hollywood Health Loop
2500 Peres, 38108
901-515-5500
Pediatrics, Family Medicine and OB/GYN daily, WIC,
Centering Pregnancy
Christ Community Health Center (CCHC)
Broad Avenue Health Center
2861 Broad Ave, 38112
901-260-8450
OB/GYN, STI testing, pediatrics, family medicine
The Med – Women and Baby Center
877 Jefferson Ave, 38103
901.545.7100 (main line)
Comprehensive prenatal as well as labor and delivery,
NICU, high risk pregnancies
CCHC - Frayser Health Center
3124 North Thomas St, 38127
901-260-8400
OB/GYN, STI testing, pediatrics, family medicine
CCHC - Third Street Health Center
3362 South 3rd St, 38109
901-271-6300
OB/GYN, STI testing, pediatrics, family medicine
CCHC - Orange Mound Health Center
2569 Douglass Ave, 38114
901-271-6200
OB/GYN, STI testing, pediatrics, family medicine
CCHC - Hickory Hill Health Center
5366 Winchester Road, 38115
901-271-6100
OB/GYN, STI testing, pediatrics, family medicine
CCHC - University Health Center
1211 Union Ave, 38104
901-271-0330
OB/GYN, STI testing, pediatrics, family medicine
Memphis Health Center
360 East EH Crump Blvd, 38126 (main site)
(901) 261-2000
www.memphishealthcenter.org
Clinical services include: immunizations and early
screening, family practice, obstetrics and gynecology,
internal medicine, HIV/AIDS primary medical services,
dental, medical laboratory, pediatrics, pharmacy, radiology,
ophthalmology, homeless services, student health
services, and podiatry. MHC has an array of support and
enabling service programs inclusive of social services, case
management, health education, transportation (at the
rural location), Women, Infant and Children (WIC), family
planning, Community Health Outreach Education Service
Program, Community Network Program (CNP) cancer
education and outreach program.
915 East McLemore Ave, 38126
Clinical services include: immunizations and early
screening, family practice, obstetrics and gynecology,
internal medicine, HIV/AIDS primary medical services,
dental, medical laboratory, pediatrics, pharmacy, radiology,
ophthalmology, and homeless services.
Shelby County Teen Pregnancy and Parenting Needs Assessment | 57
The University of Memphis
Center for Research on Women
Methodist LeBonheur Germantown Hospital –
Germantown Women’s & Children Pavilion
7691 Poplar Ave, 38138
901.516.6000
http://www.methodisthealth.org/locations/methodist-lebonheur-germantown-hospital/index.dot
Prenatal classes, NICU, comprehensive labor/delivery and
neonatal care services, breastfeeding services
Shelby Crossing
6170 Macon Rd. (Located at Sycamore View and I-40),
38134
901-222-9800
Methodist South Hospital – Maternity Center
1300 Wesley Drive, 38116
(901) 516-3700
http://www.methodisthealth.org/locations/methodistsouth-hospital
Breastfeeding services, pregnancy classes, comprehensive
labor/delivery care services
Well Child Inc. Regional Health Clinics
Northwest Regional Clinic
Northside High School
1212 Vollintine
(901) 416 – 4530
[email protected]
Planned Parenthood – Greater Memphis Region
2430 Poplar Ave, 38112
901-725-1717
www.plannedparenthood.org/memphis
Comprehensive reproductive health services
Shelby County Health Department
Parents can receive pregnancy testing, immunizations,
WIC, breastfeeding support, family planning services, well
child exams, STI testing and treatment, and safe havens for
newborns at the Shelby County Health Department. The
health department has multiple locations, listed below.
Services and hours available at each clinic can be found at
http://www.shelbycountytn.gov/index.aspx?nid=595
Cawthon Clinic
1000 Haynes, 38114
901-222-9866
Southland Mall Clinic
1287 Southland Mall, 38116
901-222-9828
Southest Regional Clinic
Sheffield Career & Technology Center
4530 Chuck Avenue
(901) 416 – 9090
[email protected]
Northeast Regional Clinic
East High School
3206 Poplar Avenue
(901) 416 – 6230
[email protected]
Southwest Regional Clinic
Westwood High School
4480 Westmount
(901) 416 – 8025
[email protected]
Collierville Clinic
167 Washington, 38017
901-222-9900
Galloway Clinic
477 N. Manassas, 38105
901-522-8268
Hickory Hill
6590 Kirby Center Cove, 38115
901-365-1045
Immunization Clinic
814 Jefferson, Room 216, 38105
901-222-9331
Millington Clinic
8225 Hwy. 51 N, 38053
901-873-4433
58 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
APPENDIX F
YOUTH RISK BEHAVIORAL SURVEILLANCE
STUDY DATA ANALYSIS
Sexual Behavior of Teens in Memphis City Schools
Every other year, the Centers for Disease Control (CDC) conducts the Youth Risk Behavioral Surveillance Study with
a national sample of middle and high school students. In addition, the CDC targets several cities for data collection,
including Memphis, resulting in a local sample that can be compared to the national sample. In Memphis, data
were collected in 2009 in a random sample of 33 Memphis City Schools high schools, and 1171 students completed the survey. The charts below summarize the findings from the questions related to sexual behavior. When
available, data are presented by gender, however for several questions the data are not available by gender due to
insufficient sample sizes. Data are not presented by race as the sample is primarily African American, reflecting the
MCS population.
Sexual Intercourse. By ninth grade, 40% of the Memphis sample reported they had engaged in sexual
intercourse. By tenth grade, this number approached 50%, 60% by 11th grade, and 66% by twelth grade. These
rates are signficantly higher than the national average. A small percentage, 4-10% depending on the grade, reported
that their first sexual experience was before the age of 13. Among 9th graders, 10% had already had sex with 4
or more partners. This increased to 14% of 10th graders, 20% of 11th graders, and 23% of 12th graders. Higher
percentages of Memphis high school students had engaged in sex with 4 or more partners than the national
sample.
Ever Had Sexual Intercourse
80
P
e
r
c
e
n
t
a
g
e
70
60
46.0
50
40
53.2
49.6
45.9
62.8
60.2
58.1
69.9
66.1
62.1
Total
39.9
33.3
Female
30
Male
20
10
0
9th
10th
11th
12th
Shelby County Teen Pregnancy and Parenting Needs Assessment | 59
The University of Memphis
Center for Research on Women
Had Sexual Intercourse Before Age 13
18
16.5
16
P
14
e
r 12
c
e 10
n 8
t
a 6
g
4
e
14.0
10.8
9.8
Total
7.8
Female
6.0
Male
4.7
4.1 4.0 4.2
2.5
1.7
2
0
9th
10th
11th
12th
Had Sexual Intercourse with Four or More Persons
30
25
P
e
r 20
c
e
15
n
t
a 10
g
e 5
21.3
22.5
23.5 24.1 23.0
19.6
17.1
14.0
Total
14.4
Female
10
Male
7.6
5.3
0
9th
10th
11th
60 | Shelby County Teen Pregnancy and Parenting Needs Assessment
12th
The University of Memphis
Center for Research on Women
Had Sexual Intercourse with At Least One Person
(during the 3 months before the survey)
70
P
e
r
c
e
n
t
a
g
e
59.0
60
53.7
50
44.2
40
30
34.8
24.7
20
28.3
44.2
48.2
44.5
37.6
Total
32.2
Female
Male
20.5
10
0
9th
10th
11th
12th
Although many teens may have sex once or twice and not again, among students in the Memphis YRBSS sample,
25% of 9th graders, 35% of 10th graders, 44% of 11th graders, and 54% of 12th graders have had sex in the
previous three months. The Memphis sample was more likely to report having sex in the last 3 months than the
national sample. In contrast, the Memphis sample was less likely to have used alcohol or drugs before sex than the
national sample.
Drank Alcohol or Used Drugs Before Last Sexual
Intercourse (among students who were currently
sexually active)
P
e
r
c
e
n
t
a
g
e
28.5
30
25
20
22.6
18.3
18.1
14.0
15
Total
10.2
10
Female
Male
5
0
9th*
10th*
11th*
12th
*Insufficient sample size to report gender differences
Shelby County Teen Pregnancy and Parenting Needs Assessment | 61
The University of Memphis
Center for Research on Women
Contraceptive Use. Rates of condom use among Memphis high school students were higher than among the
national sample. Of particular interest, 9th graders were most likely to have used a condom the last time they had
sex, and 12th graders were least likely to have used a condom.
Converely, 9th graders were least likely to have used hormonal methods of birth control (only 13%), with usage
increasing among older students. Memphis students were less likely to use hormonal methods than the national
sample.
Did Not Use a Condom During Last Sexual
Intercourse (among students who were currently
sexually active)
P
e
r
c
e
n
t
a
g
e
70
58.6
60
50.5
50
40
32.7
40.8
36.9
36.4
Total
30
Female
20
Male
10
0
9th*
10th*
11th*
12th
*Insufficient sample size to report gender differences
P
e
r 100
c
80
e
n 60
t 40
a
20
g
0
e
Did Not Use Birth Control Pills or Depo-Provera
Before Last Sexual Intercourse
(to prevent pregnancy, among students who were
currently sexually active)
87
83.1
76.9
70.8
Total
9th*
10th*
11th*
*Insufficient sample size to report gender differences
62 | RShelby County Teen Pregnancy and Parenting Needs Assessment
12th*
The University of Memphis
Center for Research on Women
Although Healthy People 2020 recommends backing up hormonal methods of birth control with condom use to
prevent transmission of sexually transmitted infections, very few students (5% of 9th and 10th graders, 12% of 11th
graders, and 10% of 12th graders) engaged in multiple methods of prevention.
Did Not Use Both a Condom During Last Sexual
Intercourse and Birth Control Pills or Depo-Provera
Before Last Sexual Intercourse
P
e
r
c
e
n
t
a
g
e
96
95
95.0
94
92
89.6
90
87.9
88
Total
86
84
9th*
10th*
11th*
*Insufficient sample size to report gender differences
12th*
Sex Education. In Tennessee, state law requires that all students be taught HIV prevention. The majority of students reported that they had been taught about HIV/AIDS, yet approximately 15% of students reported that they
had not been taught about HIV in school, and this rate is higher than the national sample.
Were Never Taught in School
About AIDS or HIV Infection
25
P
20
e
r
c 15
e
n
t 10
a
g
5
e
19.4
13.9
15.3
18.9
20.5
17.4
16.9
15.4
15.0
13.7
12.6
10.4
Total
Female
Male
0
9th
10th
11th
12th
Shelby County Teen Pregnancy and Parenting Needs Assessment | 63
The University of Memphis
Center for Research on Women
APPENDIX G
TEEN PREGNANCY AND PARENTING
SURVEY DATA ANALYSIS
The CROW survey completed by teen participants was designed to elicit a broad range of information from local
teens. Findings are listed below by topic area (i.e., demographic and background information, sexual history and
behavior, pregnancy and parenting history, family dynamics, mental health factors). For all analyses, comparisons
were made by sex, age, and race. When statistically significant differences emerged, they are reported. The sample is
not random and should not be considered representative of all teens living in Memphis/Shelby County.
Respondent Demographic and Background Data.
Participants included 285 adolescents aged 19 and under. The demographics of the sample are as follows:
•
Gender: 72% girls, 28% boys
•
Race: 79% African American, 21% white or other
•
Average Age: 17, range 11-19
•
Grade: range 5th to 12th and the first year of college
•
Sexual Orientation (self-identified): 81% heterosexual, 5% gay and lesbian, 6% bisexual
Grade in School
70
63.9
60
P
e
r
c
e
n
t
50
40
30
21.8
20
11.3
10
3.2
0
Middle School
High School
Some College
Not in School
When asked about employment history, 66% reported they had been employed at some point in their lifetime, and
41% reported that they were currently employed. Teens in the 18-19 age group were more likely to report lifetime
and current employment than those in the 11-17 age range. In addition, girls were less likely than boys to report
having been employed in their lifetime, and African Americans were more likely than whites/others to report that
they were not currently employed.
64 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Employment History
80
P
e
r
c
e
n
t
70
75.7
74.7
62.9
60
50
46.5
40.9
41.3
Have You Ever Had a Job?
41.6
40
27.3
30
Do you Have a Job Right
Now?
Y 20
e 10
s
0
Girls
Boys
11-17
18-19
Sexual History and Behavior
Lifetime Sexual Experiences
A series of items asked teens about their lifetime sexual experiences. The majority of students had kissed someone
on the mouth (88%), touched someone’s breasts or someone else had touched their breasts (75%), and touched
someone else’s private parts or had someone else touch their private parts (76%). Over half (52%) had engaged
in oral sex, 20% in anal sex, and 61% in sexual intercourse. As expected, younger students were less likely to have
engaged in many behaviors than their older peers, but nonetheless, fully a third of the 11-17 year olds had engaged
in sexual intercourse. In addition, girls were more likely than boys to report having engaged in vaginal sex, and
African Americans were less likely than whites and others to have engaged in anal sex.
Percent Who Answered “Yes” on Lifetime Sexual Experiences Questions
Girls
Boys
Ages 11-17
Ages 18-19
Have you ever kissed someone on the
mouth?
89.3
85
83.3
90.3
Have you ever touched someone else’s
breasts, or someone touched your breasts?
Have you ever touched someone else’s
private parts, or someone else touched
your private parts?
74.1
77.5
51.3+
84.5+
77.5
71.8
52.6+
85.2+
54.5
55.0*
21.3
24.7+
32.1+
17.9+
62.9+
72.3+
20.5+
Have you ever had oral sex?
51.2
Have you ever had sexual intercourse?
63.4*
Have you ever had anal sex?
19.1
*indicates statistical significance for sex difference
+indicates statistical significance for age difference
Shelby County Teen Pregnancy and Parenting Needs Assessment | 65
The University of Memphis
Center for Research on Women
Sexual Experiences By Age
Have you ever kissed someone on the
mouth?
90.3
83.3
Have you ever touched someone else’s
breasts, or someone touched your breasts?
84.5
51.3
Have you ever touched someone else’s
private parts, or someone else touched your
private parts?
85.2
52.6
Have you ever had oral sex?
24.7
Have you ever had sexual intercourse?
18-19
62.9
11-17
72.3
32.1
20.5
17.9
Have you ever had anal sex?
0
20
40
60
80
100
Percent Yes
Sexual Experiences By Sex and Race
51.2
54.5
50.7
58.9
Have you ever had oral sex?
Have you ever had sexual
intercourse?
55
63.4
Girls
61.8
57.9
Boys
African Americans
19.1
21.3
17.3
29.8
Have you ever had anal sex?
0
20
40
Whites/Others
60
80
Percent Yes
Youth Risk Behavioral Surveillance Survey Sexual Behavior Questions
Teens also completed a series of questions about sexual behavior that were drawn from the YRBSS, which allows
comparison to the data collected by the CDC among MCS students. Because the YRBSS questions specifically ask
about sexual intercourse, 29% of respondents skipped these questions as not relevant, resulting in a sample size of
201 teens.
66 | Shelby County Teen Pregnancy and Parenting Needs Assessment
The University of Memphis
Center for Research on Women
Among this set of respondents, the average age of first sexual intercourse was 15 years, although the YRBSS response
options ranged from “9 or younger” to “17 or older,” thus restricting the range. Sex differences emerged such that
boys (14.7) reported earlier first intercourse than girls (15.3). Research shows that earlier initiation of sexual behavior
is associated the less consistent use of condoms and other contraception (see Literature Review, Appendix B).
How Old Were You When You Had Sexual
Intercourse for the First Time?
35
P
e
r
c
e
n
t
a
g
e
30.8
30
23.4
25
20
16.9
15
10
5
5.5
2.5
1.5
1
9 or
younger
10
11
8.5
10
0
12
13
14
15
16
17 or
older
Age
The average number of lifetime partners among teen respondents was 3.63; because the scale capped at 6 partners,
this average may underestimate the actual number.
During Your Life,
With How Many People Have
You Had Sexual Intercourse?
P
e
r
c
e
n
t
a
g
e
42.3
45
40
35
30
25
20
17.1
17.3
15
19.3
15.4
10
22.1
16.4
13.6
15.4
5.8
Girls
Boys
11.4
3.8
5
0
1 Person
2 People
3 People
4 People
5 People
6 People
Shelby County Teen Pregnancy and Parenting Needs Assessment | 67
Center for Research on Women
The University of Memphis
Among those who had engaged in intercourse, 18% reported drinking or using drugs before the last time they had
sex; however, African Americans were less likely than whites and others to report drinking or using drugs.
Did You Drink or Use Drugs
Before You Had Sexual Intercourse
the Last Time?
P
e
r
c
e
n
t
Y
e
s
35
32.5
27.8
30
25
20
15
15.4
15.2
10
5
0
Girls
Boys
African American
White/Other
With respect to contraception, 63% reported using a condom the last time they had intercourse. Boys were more
likely to report that they had used a condom the last time they had intercourse than were girls. Teens were also
asked to report the one method they used to prevent pregnancy the last time they had intercourse. The method most
used was condoms (50%), followed by birth control pills (16%). Unfortunately, at least 20% of the sample reported
either using no contraception (13.3%) or relied on withdrawal (7%), which is not an effective way to prevent
pregnancy or disease transmission.
The Last Time You Had Sexual Intercourse,
Did You or Your
Partner Use a Condom?
P
e
r
c
e
n
t
90
78.8
80
71.1
70
60
60.9
57.2
50
40
30
Y 20
e
10
s
0
Girls
Boys
African American
68 | Shelby County Teen Pregnancy and Parenting Needs Assessment
White/Other
The University of Memphis
Center for Research on Women
The Last Time You Had Sexual Intercouse,
What One Method Did You or Your
Partner Use to Prevent Pregnancy?
No Method Was Used
Birth Control Pills
Condoms
Depo-Provera
Withdrawal
Some Other Method
Not Sure
Multiple Methods
13.3
16.3
50
4.1
7.1
1
4.1
4.1
0
10
20
30
Percent
40
50
60
Sexual Risk Index
Using seven items from the lifetime sexual behavior and YRBSS sections (touching breasts, touching genitals, oral sex,
anal sex, sexual intercourse, alcohol or drugs before sex, not using condom last time they had sex), a sexual risk index
was computed. A large majority of the students (84%) had engaged in at least one of the risk taking behaviors, and
the average number of behaviors engaged in was 3.4. As expected, older participants had engaged in more sexual risk
taking behaviors (3.8 on average for 18-19 year olds) than younger participants (2.2 on average for 11-17 year olds).
Number of Sexual Risk Taking
Behaviors Teens Reported
25
P 20
e
r 15
c
e 10
n
5
t
23.2
21.1
15.8
13
11.6
9.1
4.9
1.4
0
None
One
Two
Three
Four
Five
Six
Seven
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First Sexual Experience
A series of questions were asked about teens’ first sexual experiences. For these questions, the sexual experience
was defined as some sort of physical sexual contact that was more than kissing, but not necessarily including sexual
intercourse. The age of first sexual experience ranged from 6 to 19, with a mean age of 15.2 years old. Boys (14.4
years old) reported earlier initiation of sexual activity than girls (15.5 years old). During the first sexual experience,
60% of the participants reported that had engaged in vaginal intercourse, 24% in oral sex, 6% in anal sex, and 58%
reported they engaged in other forms of sexual contact (more than kissing). Boys were more likely than girls to report
oral sex and anal sex during the first sexual experience. African Americans were less likely than whites or others to
report having oral sex during their first sexual experience.
First Sexual Experience
18.2
During your first sexual experience,
did you have oral sex?
15.7
39.4
27.3
4.8
10.3
7.2
5.9
During your first sexual experience,
did you have anal sex?
During your first sexual experience,
did you have vaginal sex?
Girls
35.2
During your first sexual experience,
did you have other forms of sexual
contact?
43.8
0
20
40
Boys
62.1
53.2
Ages 11-17
68.2
Ages 18-19
56.8
59.7
62.4
60
80
Percent Yes
The majority (63%) reported that their partner in their first sexual experience was a boyfriend or girlfriend, and
another 18% had their first sexual experience with a friend. Less than 3% reported that their first experience was with
a family member or a stranger. The age of teens’ first partners ranged from 8 to 55, with an average of 18.3 years old,
and the majority of responses clustering between 12 and 24. The discrepancy between age at first sexual experience
and age of partner at first sexual experience was calculated. The mean age discrepancy was 3.1 years older, and over
17% reported an age discrepancy of 4 or more years, suggesting high rates of statutory rape during the first sexual
experience in the sample of teens who participated in the survey.
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Age Discrepency Between Partners
at First Sexual Experience
28.1
30
P
e
r
c
e
n
t
25
22.4
20
16.3
15
8.2
10
5
5.1
4.1
0.5 0.5 1.5
2
2.5 1.5 1.5
2
2
0
0
1
Age Discrepency in Years
Although most of the teens who participated in the survey reported that they were willing partners (72%) during their
first sexual experience, 19% were not, and another 9% were not sure. Furthermore, when asked whether they had
ever had a sexual experience against their will, over 6% reported at least 1 forced sexual experience, 18% reported an
experience where they eventually gave in against their will, and almost 6% were not sure.
P
e
r
c
e
n
t
Were You a Willing Partner During
Your First Sexual Experience?
90
80
71.4
78.5
75.8
70
54.4
60
50
40
30
Y
20
e
s 10
0
Girls
Boys
11-17
18-19
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Sex Education and STI Testing
The majority of the sample reported that their parents had talked to them about sex (77%) and how to prevent
pregnancy and sexually transmitted infections such as HIV/AIDS (95%). In addition, most had been taught some
form of sex education in a class at school (69%), and about how to prevent pregnancy and sexually transmitted
infections such as HIV/AIDS in a class at school (81%).
Percent Who Answered “Yes” on Questions Related to Sex Education and STI Testing Girls
Boys
Ages 11-17
Ages 18-19
Have your parents talked to you about sex?
75.9
78.5
78.9
78.6
Have your parents talked to you about how
to prevent pregnancy and STDs?
73.3
83.3
76
76.5
Have you been taught sex education in a
class at school?
71.4
62
63.2
71.2
Have you been taught how to prevent
pregnancy and STDs in a class at school?
82.8
79.9
73.7
84.4
*indicates statistical significance for sex difference
+indicates statistical significance for age difference
Less than half the sample (48%) had been tested for sexually transmitted infections (STIs), and even fewer (43%)
had been tested for HIV/AIDS. Not surprisingly, older teens (18-19) were more likely to be tested for STIs and HIV/
AIDS than younger (11-17) teens.
60
P
e
r
c
e
n
t
a
g
e
50
Have You Ever Been Tested for STDs or HIV/AIDS?
54.5
49.5
45.5
46.9
43.8
38.7
40
34.3
29.9
30
STDs
AIDs
20
Y
e 10
s
0
Girls
Boys
11-17
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Pregnancy and Parenting History
Among the teens sampled, 13% had ever been pregnant or had a girlfriend who got pregnant (11% of girls, 18% of
boys). Of those, only 36% reported that they had gotten prenatal care while pregnant. A small portion of the sample
(5%) reported they had lost a pregnancy. In addition, approximately 2% reported a preterm or low birth weight
pregnancy, or a baby that spent time in the NICU. Only 7% of the sample reported that they had children, and of
those, the majority had only 1 child (range 1-6). Approximately 2% of the girls were pregnant at the time of survey
completion, and 5% of boys reported a current girlfriend pregnant.
Approximately a third (37%) of the teens who completed the survey had a mother who was a teen mother. In
addition, 19% had a sister who was a teen mother, 13% had a brother who was a teen father, and 58% had another
family member who was a teen parent. African Americans were more likely than whites or others to report a family
member had been a teen parent.
Percent Who Answered “Yes” on Questions Related to Pregnancy and Parenting History African
White/Other
Ages 11-17
Ages 18-19
American
Did your mother have a child before the
age of 19?
37.6
30.2
44.1
34
Do you have a sister that had a child
before the age of 19?
19.3
17.0
24.6
17.8
Do you have a brother that had a child
before the age of 19?
14.1
5.9
21.9+
9.7+
63.1
38.0
58.3
58.4
Do you have any other family member
close to you that had a child before the
age of 19?
*indicates statistical significance for sex difference
+indicates statistical significance for age difference
Family Dynamics
A series of scales were used to assess teen perceptions of family dynamics. Teens rated the extent to which their
family engaged in positive communication strategies such as talking about problems and listening to both sides of the
story during an argument. Overall, teens reported only moderate levels of positive communication: 4.5 on a 7 point
scale where a high score indicated high frequency of positive communication (4 = about half the time).
A measure of family support was included to assess the extent to which teens have people they can turn to when
they need to talk about problems, need financial assistance, or have a crisis. Teens reported a moderate to high level
of family support, on average 5.2 on a 7 point scale (5= slightly agree).
Finally, a measure of parental monitoring was included to assess the extent to which teens spent time without
parental supervision and teen perceptions of whether or not parents monitor the whereabouts and behavior of teens.
On a scale of 1 (almost never) to 3 (often), teens reported an average score of 2.1, indicating the parents sometimes
monitor their teens’ behavior, but are not consistent. Consistent with expectations, significant age differences
indicated that younger teens reported more parental monitoring than older teens, although apparently the monitoring
of younger teens is still not consistent.
This suggests the need for intervention around positive family communication strategies, increasing family support
for teens, and increasing parental monitoring. Parental monitoring, in particular, has been shown to be an effective
method of postponing the initiation of sexual behavior (See Literature Review, Appendix B).
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Mental Health
Two measures of mental health were included in the survey: perceived control and depression. Perceived control
measures the extent to which individuals believe they have control over important things in their life. Research
shows that a higher score on perceived control predicts more positive outcomes for adolescents. Overall, the
teens who completed the survey reported moderate perceived control (3.9 on a 5 point scale with 5 representing
high perceived control). The depression scale used assesses whether or not those who complete it are at risk for
depression. The scale can have possible range of scores from 0 to 30, and a score of 10 or greater is considered at
risk for depression, 13 and above considered to be suffering from depressive illness of varying severity. Among the
teens that completed the survey, the average score was 10. In addition, sex differences emerged on this scale, with
girls reporting significantly higher average scores than boys. With respect to the scoring cutoffs, 49% of the sample
scored 9 or lower, 18% of the sample scores between 10 and 12, indicating risk for depression, and 33% of the
sample scored 13 or higher, indicating likely depressive illness. Although not statistically significant, 54% of girls and
42% of boys scored 10 or above, indicating risk for depression or depressive illness.
Depression Scale
70
P
e
r
c
e
n
t
a
g
e
57.5
60
50
45.9
40
35.6
Girls
30
25
18.5
20
Boys
17.5
10
0
Not Depressed
At Risk of Depression
Depressive Illness at
Varying Severity
Relationships Among Variables
To better understand how family dynamics and mental health factors are related to behavioral outcomes, a series
of correlations were conducted. Correlations are an indication that patterns of responses are related to each other,
however, a correlation is not an indication that one factor causes another factor.
Results of these analyses show that teens who report more family communication have engaged in fewer sexual
risk taking behaviors, were older when they initiated sexual activity, have had fewer partners, and are more likely
to have talked to their parents about sex and about preventing pregnancy and sexually transmitted infections. In
addition, the more supportive teens perceive their parents to be, the more likely they were to report talking about
sex. Similarly, the more likely parents are to monitor their teens’ behavioral the fewer sexual risk taking behaviors
reported, and the more likely they were to report talking about sex and about pregnancy and STI prevention. In
contrast, the more depressed teens are, the more sexual risk taking behaviors they engage in.
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APPENDIX H
PARENTAL ATTITUDES TOWARD SEX
EDUCATION DATA ANALYSIS
In the spring of 2011, The Urban Child Insititute conducted a brief parent survey using random digit dialing. The
sample consisted of 400 individuals who live in Shelby County and have at least 1 child. Three questions were
included to assess attitudes towards sex education. The data from those questions is presented below.
Parents indicated agreement with various ways that schools could be involved with the prevention of teen
pregnancy, ranging from providing information on abstinence and contraceptives (46%), to providing info on
prevention and contraceptives (29%), to actually providing contraception (5%). Only 16% of parents indicated that
schools should not have a role in preventing teen pregnancy. In addition, the majority of parents surveyed (60%)
believed that talking to teens about birth control does not encourage sexual activity.
Role of Public Schools in Preventing Teen Pregnancy
Provide information on ways to prevent pregnancy
including abstinence and contraceptive methods
45.8
Provide both information on preventing pregnancy
and contraceptives
29.3
It is not the role of schools to provide information
on preventing pregnacy or to provide contraceptives
16
Provide contraceptives themselves, such as condoms
or emergency contraceptive pills
5.5
Refused/Don't Know
3.5
0
5
10
15
20
25
30
35
40
45
50
Percentage
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Does Talking To Teens About Birth Control
Encourage Sexual Activity?
70
P 60
e
r 50
c
40
e
n
30
t
a 20
g
e 10
59.8
38.3
2
0
Encourages sexual Activity
Does not encourage sexual
activity
Refused
Parents were asked to indicate whether they had talked to their kids about sex and preventing pregnancy. The
majority of the sample had talked to their kids about sex and pregnancy prevention, whether just once (14%),
more than once (17%), or on an ongoing basis (32%). More than a third (37%) had not yet talked to their kids
about sex or preventing pregnancy.
Have You Talked To Your Kids About Sex
and Preventing Pregnancy?
Yes we talked about sex and preventing pregnancy
once
13.8
Yes we have talked about sex and preventing
pregnancy more than once
16.8
Yes we talk about sex and preventing pregnancy on
an ongoing basis
31.5
No I have not yet talked to my kids about sex and
preventing pregnancy
37.3
0
5
10
15
20
25
Percentage
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35
40
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APPENDIX I
PROVIDER FOCUS GROUP SUMMARIES
Reproductive Healthcare Provider Roundtable Summary
Memphis Teen Vision (MemTV) is a community collaborative of over 30 organizations dedicated to addressing
the high rate of teen pregnancy in our community. In 2011, MemTV gathered Shelby County health providers to
discuss the current landscape of reproductive and pre-natal services for adolescents. Individuals from 15 different
organizations participated, representing public and private OB/GYN and prenatal healthcare providers, Early Home
Visitation Providers, family practice physicians, TennCare payors, and private funders and foundations.
The goal of this discussion was to:
• understand service provider perceptions of the needs and barriers related to reproductive and prenatal
healthcare for adolescents
• identify differences in perceptions among multiple providers (e.g., private practices, clinics, predominantly
private pay vs. TennCare providers.)
• gain input for developing strategies to increase effective outreach to adolescents
Participants were seated in small groups of four and given 20 minutes to discuss the first question. At the end of 20
minutes, participants were asked to move to different tables, with different people, to discuss the second question.
The same procedure was also used for the third question. This style allowed the participants to interact with
different providers. The discussions were recorded by note takers stationed at each table. Following the small group
discussions, participants gathered together for a larger group discussion.
Discussion Summary
Several themes emerged from the first question: Based on your experience, how do reproductive issues impact
teens’ lives and their families? What are some of your stories about this topic?
Providers indicated that in order to meaningfully discuss how reproductive issues impact teens’ lives and their
families, it is necessary to understand the cultural dynamics brought about by religious and long-standing cultural
attitudes toward teen sexual health. Providers expressed concern about the following:
• a lack of parental and teen knowledge regarding healthy sexual behaviors
• social and institutional repression of information, exemplified by a dearth of comprehensive sexual
education in schools
• social and institutional stigmatization or repression of resources for pregnant teens and their families,
such as pediatricians who do not want to offer reproductive care (including STI testing) because they
get too much “flack” from parents
Providers’ experiences indicate that parents are either uncomfortable talking to their children about sexuality, or
don’t have accurate information to give to their children. Providers shared anecdotal stories about adult women
who do not understand their own reproductive cycles, and family members who instruct girls to stand on their head
if a condom breaks during sex to reduce chances of getting pregnant. Beyond the home, providers indicated that
schools offer little by way of sexual education classes, and many religious organizations turn away from discussing
the subject.
Providers also believe that a culture of acceptance develops when children are exposed to sexual behaviors early on
by parents who themselves are still very young and without a stable partner. As examples, providers described teens
who reported having sex at 12 and 13 “just to get it out of the way” or teens who decided to become pregnant as
ways to get out of the house.
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Other unseen yet significant consequences noted by providers included psychological and physical health problems,
such as a greater risk of contracting STIs. Providers also noted the following:
• Mental health may be impacted by the loss of family support, shame and ridicule, isolation, low self-esteem,
and depression. These conditions can lead teens to make poor choices and engage in additional risky
behaviors.
• Some teen mothers are more susceptible to domestic violence and other stressors than their non-pregnant
peers and may thus be at a higher risk to drop out of school.
• Sexually transmitted infections can cause long-term infertility, especially when teens do not seek treatment
or wait too long to get treatment.
• Adolescent pregnancies may result in negative birth outcomes, including prematurity and low birth-weight
births.
The second topic providers discussed was: In your experience, what reproductive services and/or parental care are
most important for teens and why?
Because of the abundance of misinformation and the lack of sexual education in many schools, education about
reproductive health is widely seen among these as the most important service for teens. Providers suggested that
the most comprehensive and effective services provide a continuum of reproductive information that begins with
understanding sexual development and how reproduction occurs, how infections are transmitted through sexual
acts, and finally birth control and pregnancy prevention.
Providers indicated that, in addition to having access to accurate information, teens also need services that consider
their emotional and psychological well-being in order to help teens better understand consequences and make
responsible choices. This type of instruction is only effective if providers are comfortable with the information. In
other words, educators need to become “askable adults” that seem approachable to teens because teens need to
trust their provider.
Providers also noted that there are multiple subcultures in Memphis, each with their own perceptions of STIs and
pregnancy, which need to be considered. Educators and providers should tailor their services to these populations
so they remain accessible and impactful. This may require training on the part of providers. Likewise, teens need
services that will teach them how to talk to a doctor and what questions are the most important to ask during a visit.
Providers also indicated that teens need to be taught how to properly use services such as TennCare.
Providers suggested that parents must also become involved in managing their teen’s healthcare. In community
family planning programs, teens are encouraged to include their parents in the care of STIs, and several providers
indicated that many parents will get “on board” with reproductive care and will move beyond emotional issues
regarding their child’s sexual behaviors. To accomplish this, healthcare providers should take advantage of any
parents’ concern for their child’s well-being and provide education on reproductive healthcare to parents when they
have the opportunity to do so.
Providers also indicated the following gaps in reproductive healthcare and services for teens:
• There is not enough focus on teen fathers.
• There is a need for STI and teen pregnancy programs that are geared towards men and that are run by men.
• There is a need to address the high prevalence of sexual abuse. Teens frequently report varying levels of
sexual abuse, and these issues are often not dealt with on any level. It is important that teens trust their
health care providers to take appropriate action. To this end, there needs to be a system in place to address
sexual abuse reports.
The third topic providers discussed was: What barriers and gaps do you see to teen’s access to healthcare (e.g.,
transportation, fees, etc.) and how do you believe that you or others can best help teens overcome these barriers?
Providers asserted that the two most practical barriers to teens’ access to healthcare are money and transportation.
• Money plays a role in terms of time and resources. Teens and their families often can’t afford to take time off
to get to appointments, or to pay for all services and prescriptions if a family is not enrolled under TennCare.
• Transportation is an issue because the City of Memphis does not have an efficient public transportation
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•
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system, and many teens don’t have reliable transportation themselves. Providers noted that home visitation
programs or services that offer shuttles for teens and their families are crucial.
Many clinics are not open during the weekends, are far away, or have hours that are not convenient for teens
seeking services, which compound the problem when teens do not have transportation and have to work or
go to school during normal clinic hours.
In addition, lack of knowledge concerning services and healthcare systems are significant barriers preventing some
teens from accessing services. For example:
•
•
•
•
Teens might not be fully aware of all the services available to them.
TennCare MCOs often limit what services people can receive, and this often requires calling a clinic to verify
what is covered.
Privacy issues may also result in unwillingness to seek healthcare. For example, patients with insurance
receive an Explanation of Benefits letter after an appointment. This may deter teens who do not want their
parents to know from utilizing services. Providers feel that an easy and straight forward process to protect
teen privacy should be developed.
Additionally, some teens refuse to receive continuing services because of past experiences with rude,
inattentive, or shaming providers and staff.
Providers believe that using social media to reach teens with reproduction information is a must. Because of the
rampant misinformation teens receive from family and peers and because of the behaviors normalized by peers and
their community, providers need to turn to impactful outlets to get teens’ attention. Using the internet to provide
information via social media is one strategy that can make community resources more visible and accessible.
However, reproductive education in the home, at school, and through religious organizations remains an important
means of reaching children and teens before they engage in risky behaviors. Ensuring that educators are well-trained
and responsive to the unique needs of the populations they serve is crucial if interventions are to be meaningful and
impactful.
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MemTV and TPPS Provider Focus Group Summary
Two focus groups were conducted with service providers who work both directly and indirectly with teens in Shelby
County. Participants included representatives from Memphis City Schools, who comprised one focus group, and nonprofit organizations and Memphis and Shelby County governments, who comprised the second group. Providers
were asked to offer insights on the resources available to pregnant and parenting teens, gaps in services, key barriers
teens face in accessing resources, and the barriers providers face in serving teens. Key findings and illustrative
quotes from the provider focus groups are summarized below.
Major resources for pregnant and parenting teens. Participants agreed that healthcare, including both medical
services and health information, are essential resources. Prenatal care was cited most often, but services that
improve preconception health were also judged to be important. Preventive medicine, such as nutrition and physical
activity, were mentioned as essential components of such services. Participants also suggest that teens need to learn
about their bodies and reproductive health.
Education was also listed as an integral resource. Pregnant or parenting teens are more likely than their peers to
drop out of high school, leaving them more vulnerable to unemployment and economic hardship. Such teens often
require support services in order to finish high school degrees or attend college. Providers reported that MCS offers
programs that allow a pregnant teen to continue her education at home or at a local high school that serves only
pregnant and parenting young women.
Another resource is emotional support services, as pregnant teens might experience “shame, embarrassment, [or]
confusion.” In addition to improving teen parents’ psychological and emotional well-being, family support can play a
role in encouraging healthy behaviors. One participant noted: “I think there’s probably a direct connection between
the start of prenatal care and that family support. I’ve known a lot of teens who have not received early prenatal
care because they did not want to tell their family that they’re pregnant.” Although family support was emphasized,
providers recognized that teen parents may struggle to build or maintain a strong, supportive relationship with
their own parents, due to parents’ negative reaction to a pregnancy. Providers believe that many teen parents are
themselves the offspring of teen mothers: “We have many parents, especially single parents, who are struggling to
manage their own lives, and adding a pregnant child on top of that…” In the absence of a positive relationship with
parents or other relatives, teens might seek emotional support services from their school, a church, or social workers.
Perceived service gaps. Although providers agree that healthcare is essential, they cite a significant gap in health
services available to pregnant and parenting teens. Capacity is limited: “Most schools have one nurse, one day per
week” and school nurses rarely cover prenatal care. “We need a healthcare professional there [at school] everyday to
help with education, [to teach] the process of pregnancy and how delivery is going to work.” Limited infrastructure
is exacerbated by the fact that existing services are not tailored to teens: “The healthcare system was designed for
adults having babies; we have to change the system and policies to reflect teens having babies.” One healthcare
provider noted that their organization had recently undertaken a conscious effort “to make these services teenfriendly and teen-accessible because teens do feel left out of the process.”
Mental health resources are another major gap. Teens would benefit from increased mentoring and preventive
support networks, as well as psychological counseling to cope with the emotional toll of becoming a teen parent.
Providers suggested that teens need guidance on developing healthy relationships with their family and sexual or
parenting partners.
Providers cited a lack of services targeting boys and fathers. Illustrative remarks included: “He [father of baby]
needs to know information as well about the child and how he can contribute;” “By the time they [teen fathers]
are 18, they are two years behind in child support;” and “Boys are just as afraid and uninformed about sex as girls
are.” Excluding young men from such conversations can place an undue burden on young mothers. “Girls don’t get
pregnant by themselves … it [excluding boys] leaves little responsibility for the boys … he feels like the rest is up to
her.” And, “The girls get one set of information, and the boys get a whole ‘nother set of information, even though
they both need to know how to put condoms on.”
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Perceived barriers to accessing services. Some teens face physical barriers to using resources. Teens are in
school throughout weekdays, and must skip classes to consult agencies that are only open during regular business
hours. Teens also lack transportation to services. However, the most significant barrier reported was the taboo or
stigma of teen sexuality and pregnancy: “The community is a barrier because they are not willing to talk about sex.”
Stigma exacerbates several other barriers: “They are in denial about being pregnant, so they don’t get early prenatal
care; and fear, they don’t want to tell their parent because of consequences.” Providers reported that teens without
parental support were less likely to receive services, and it could also contribute to psychological or emotional stress
for the teen.
Lack of information and misinformation can also impede service access. Providers believe that teens simply do
not know or understand what resources are available or how to access them. A related issue involves teen literacy
levels, and the comprehensibility of information. Teens may also fail to solicit information from reliable sources like
school guidance counselors or healthcare providers, because of the stigma associated with pregnancy: “Problem
is teens don’t trust adults. Schools have resources but getting them in there, asking for help is a problem.” “Some
young ladies, if they know their guidance counselor has a big mouth, then they think, ‘I’m not telling them nothing!’
… But if they know you will keep it confidential they will tell you.” Moreover, potential advisors may avoid the topic
out of embarrassment: “We have to make sure that we are able to talk about these things and we’re able to provide
this information, and not withhold information because it makes us uncomfortable.” As a result, teens may get
inaccurate advice from classmates or kin, and thus lack basic information on reproductive health. Ignorance creates
its own barrier, as teens may be unaware of the importance of prenatal care or nutrition during pregnancy and
thus unlikely to seek proper care. Providers also noted that teens need parenting education that extends beyond
pregnancy.
Numerous providers discussed the problems posed by age-discordant relationships: cases where a teen is pregnant
by a man who is four or more than years older than she is. This becomes a barrier when the pregnant teen fails to
seek care, in an effort to conceal a potentially illegal relationship. “Some of them [teen mothers] are under control
of the baby’s father, who are probably not in high school,” and “A large number of girls have children by men. They
are afraid to tell because they don’t want to get him in trouble:” Providers reported that such fathers may also
discourage teen mothers from using services. Providers believe that few teen mothers in age-discordant relationships
communicate with their older partners about reproductive health needs. This can pose further risks for the teen
mother, including sexually transmitted infections and domestic violence: “they [STD clinics] give the girls the extra
prescription to give to the guys and they don’t give it to the guys so they [teen girls] just keep coming back [to the
clinic with an STD].”
Barriers service providers face in serving teens. Participants argue that, in the absence of county-wide best
practices for working with teen parents, providers (especially those that offer referrals) might not be equipped to
handle the questions and needs of pregnant teens. Providers might not be aware of available resources or be able
to keep current as resource referral lists constantly change: “We need a set of resources so when they [teens] are
sent to school professionals they have a set of identified resources where they can go to receive specific help, so it’s
a guiding process and not a dead end.”
Like teens, service providers encounter significant social stigma associated with teen sexuality and pregnancy. From
the providers’ perspective, stigma is manifested in a number of ways. Teens might hide pregnancies and postpone
care. Providers often lack support or face outright hostility from community members or parents, because their
jobs involve pregnant and parenting teens. Media exposure and public opinion also stymie provider efforts. One
participant noted: “A lot of principals are worried about backlash from parents. Principals are worried about backlash
and community perceptions about what they are doing in their schools. That’s a huge fear. They don’t want their
school in the news.” Stigma also shapes policies and legislation, which pose a major barrier for service providers. For
example, birth control access is impeded by bureaucratic and regulatory requirements: “Access for young women on
TennCare is more complicated than for women who are not on TennCare … These are rules that don’t have to be,”
and “MCS has a curriculum and they are bound by it … when students aren’t engaged in abstinence and they come
to you with a question – how do you handle that?” Providers also report that restrictive policies are set by a vocal
minority: “People that attend meeting have kids that don’t get pregnant and they are the ones making decisions.”
And, “It [abstinence-only sex education] doesn’t work for students who are already pregnant or sexually active.”
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Providers also agree that teens’ home lives pose a potential barrier, especially if a parent was a teen parent
themselves and/or if they come from a single-parent home. “Parents want them to have a better life, but they don’t
know how to instill that in them. And they will say as soon as she has a child, well, she’s grown now. And she’s not
grown; she’s still a child.” The broader neighborhood could impact a teen’s success by influencing their aspirations
and opportunities. “What you see if what you aspire to. …They need to know that there is a life beyond Memphis.”
“[Teens need a] realistic hope for a better future.”
Finally, providers reported that Shelby County faces a general lack of resources, including funding and time.
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APPENDIX J
COMMUNITY FOCUS GROUP
AND CASE STUDY SUMMARIES
Teen Girls Who Are Pregnant or Parenting
Several teen parents participated in focus groups or one-on-one interviews to explore some of the challenges
pregnant and parenting teens face as well as the resources available to them. The following represents a summary of
key points and common themes drawn from the data:
Impact of pregnancy on a teen. A majority of young mothers stressed that pregnancy and parenting made them
more responsible. The experience forced them to think about and plan matters such as time management, saving
money, and being a good mother rather than socializing with friends. Many said “It changed every aspect of my
life...” For many of the teen parents, motherhood also introduced significant barriers to finishing school. Teen parents
stressed that support systems and social networks diminished as a result of having a child. In other words, many
relationships were severed or strained because the teen’s pregnancy was stigmatizing in some way. One teen mother
noted that “They [her parents] were both incredibly angry throughout the whole pregnancy. They worried about what
the neighbors would think.” Other teens did not feel comfortable socializing as they felt that they would be judged
by others. More often, teens found it hard to balance a social life with parenting. Teens reported that they had to
sacrifice their teen years and grow up quickly to become responsible parents. They felt that they no longer fit in with
school peers and friends.
Information sources about sex, family planning, and STDs. Participants were also asked to identify sources
of pregnancy and STI prevention information used by young people. Teens cited sources such as classes, friends,
and parents, but the most common response mentioned was classes at school: “Well, I received information in my
general ninth grade wellness course…half of it was sex education and the other half was just wellness. It was this
odd division.”
Barriers to prenatal care. The most common barrier identified to accessing early and regular prenatal care was
lack of insurance. Other responses included fear of revealing the pregnancy to family and friends, or being unaware
of their pregnancy. Another barrier involved the relationships teen mothers had with the fathers of their children,
who may be considerably older than they are. One participant noted: “My baby’s father wanted me to hide my
pregnancy... it impacted me because he was going to be the one taking me to prenatal visits.”
Pregnancy and postpartum resources. The teen parents agreed that physicians are a valuable source for
information as, “When you go to the doctor they are going to tell you about most of these resources and programs.”
Other resources included Life Choices and Earned Benefits. “With Earned Benefits, the nurse comes once a month
at first, but now she comes every two weeks. I learned about this program at my doctor. After the program, they
move you into an apartment for two years, but no-one else can live there.” Another found that, “A lot of times the
information would just be given to me. If I was out with my son and people would see us, sometimes strangers
would just come up to me and start asking questions about potty training and then they would tell me that I should
try this or that.” Many received additional advice from their parents and other relatives. Other information sources
included the internet and posted flyers. One participant pointed out, “Scholarships have helped me to buy the things
that I need for my baby.” Insurance was noted as the most helpful resource as it paid for prenatal care and the
medical needs of their children.
Many focus group participants agreed that books were the least helpful resource: “Books are not helpful because
they talk like every baby is the same. Every baby has a different personality. For example, if this is going on with your
baby and the book says try this, then that might not work for your baby because your baby might have something else
going on.” Some chose not to use available resources for fear of disclosing their pregnancy.
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Childcare. Teen mothers reported that many childcare facilities will not accept newborn babies. As a result, many
turn to family members for assistance during the post-natal period. One participant noted: “My child is not here
but it is already planned out. Daycares require the child to be at least 3 months old. I am not going to expose my
baby to daycare. I am going to stay in school but I’m going to take online classes.” In addition to the barrier of
infant age limits, many parents struggle with the financial cost of childcare. As one noted, “I am about to run out
of funds.” Relying on family members to provide childcare proved problematic for many of the teens because they
often did not have backup babysitting plans, thus when relatives are not available, teen parents risk school or work
absenteeism. Aside from the issues with arranging child care, many of the teens noted difficulty in meeting all of the
requirements to remain on Families First, which provides childcare benefits.
Parenting. Teens may also face unique barriers to developing their own parenting styles. Some teens felt that their
age was a barrier, as older friends and relatives critiqued and undermined the teen’s parenting strategies. One teen
recounted the following: “When I am a parent, people don’t let me do me as a parent. Like, when I see him doing
something and I tell him to stop, other people just say that he isn’t doing anything. That teaches him to disrespect
me as a parent.”
Education. A majority of the teen mothers unanimously agreed that teen parents struggle to balance school
and parenting. Barriers are greatest for teen parents who lack strong support systems at home and school. Infant
sickness and physician appointments are a major cause of school absenteeism for teen parents. Many reported that
it is difficult to prioritize physician visits and school responsibilities. Another barrier for teen parents is studying to
maintain good grades as they prefer to spend time after school with their child rather than studying. The parents
expressed feelings of guilt for spending much of their day away from their children. Some found it too difficult to
remain in school while pregnant or parenting and made the difficult decision to drop out of school.
Employment. A significant challenge for teen parents is securing work. Most of the teen parents struggled to find
jobs that also allowed them to attend school. Many sought work immediately after school, which meant that they
would work into the evening. Childcare for such extended hours proved difficult to secure. Those who did find a
job had to juggle their work schedules with parenting and school responsibilities. Many reported that childcare
complicates the search for employment. Many of these teens relied on their parents to watch their children while
they worked: “I have to work weekends or nights, so that there is somebody to watch my son instead of a place.
Childcare has affected jobs.” This dependence on family as babysitters is most problematic when parents are not
available. As one participant phrased it, “People’s parents act different.”
Few employers willingly hire someone who is pregnant, due to concerns about health, liability, and absenteeism.
In addition to this, many jobs are not suitable for pregnant women, such as work which required that employees
stand for long periods of time, or jobs with limited break periods. Some of the teen parents also found it difficult
to eat and stay hydrated while at work. Several teens agreed that having a strong support system is essential when
searching for a job.
Father’s role. The majority of the teens interviewed indicated that their child’s father was significantly older than
the teen mother. In many cases, the child’s father was not involved during the pregnancy or after the birth. This was
especially true for girls engaged in age-discordant relationships, or situations in which the father of the child was
more than 4 years their senior. One girl who was impregnated at 14 by a man who was 26, recounted that “He
[the child’s father] didn’t care about me being pregnant.” Another mother who became pregnant at 14 explained
her strained relationship with the child’s father “They tried to get the people on him because he was 18 and it was
statutory rape.” In the few cases where the father was involved, he provided financial support and helped pay for
diapers and other essentials.
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Teen Girls Who Have Never Been Pregnant
Several teen girls participated in focus groups to explore some of the challenges pregnant and parenting teens face as
well as the resources available to them. The following represents a summary of key points and common themes drawn
from the data:
Reasons teens decide to have sex. The majority of teenage girls who participated in the focus groups reported that
peer pressure is a top motivator for the choice to have sex. As one teen phrased it, “They sometimes feel left out because
everyone else is doing it,” and “I have a friend who is a virgin and she feels like if, just because most of her friends are
not virgins but she feels like she should join too, but I was like not because I lost my virginity at an early age.”
A second compelling factor is inadequate sex education and awareness. Comments included: “It’s just some people, like
teenagers, well everybody isn’t on the same level, as far as being educated on pregnancy. For those that think it cute it’s
just, that’s probably all they know,” and “Well, not everybody is on the same level of being educated about it.”
Reasons for peers becoming pregnant. Some teens argued that teens get pregnant on purpose, “To hold a boy.
They would probably try to trap them…as they say, trap…trap means to keep him.” Others argued that pregnancy is no
guarantee that a relationship will persist. “Not being smart enough to know that, if he wants to leave, he’s going to leave
regardless; baby or not. But by some girls being naïve, they think that a baby is gonna make him stay, but it’s not.”
Strengths that prevent teen pregnancy. The majority of non-pregnant focus group participants reported that
a strong support network of family, friends, and other trusted individuals prevents teen pregnancy: “Family, church,
friends…you gonna need support.”
Others noted that fear of letting down the family deters pregnancy. Comments included, “Most people in my family are
counting on me to keep my virginity…my whole family will be disappointed if they find out I’m not a virgin. People think
you are a slut,” and “My whole family would feel disappointed if they found out I got pregnant.”
A third resource is knowledge, particularly awareness of family planning options should teens decide to engage in
sex. One example was, “They can take the pill,” whereas others cited condoms as an effective means to prevent an
unplanned pregnancy.
Finally, self-confidence was proposed as a key strength. These teens argued that, if a young girl has self-assurance, she
is less likely to engage in any unwanted activity. As one said, “Self confidence… if you have it, you don’t have to go out
and give a boy what you don’t want to.”
Barriers to preventing teen pregnancy. A vast majority of participants identified an absent or inadequate social
support system as the top force contributing to teen pregnancy. A typical remark was, “If they don’t have nobody to care
for them, they just give themselves away. I have seen many friends….their momma is always gone and they ain’t got no
moral support.” These teens stressed that it is crucial to have parental love, otherwise youths may seek such affection
outside of the home: “Always show your child love before some dude comes along and ‘love’ them…it’s so true.” Finally,
a few subjects cited peer pressure as a barrier to family planning.
Resources for family planning, STD prevention, pregnancy, and parenting. Many teens agreed that adults,
including personal contacts and school guest speakers, are a useful source for information about sex, family planning,
and STD prevention. Adults provide valuable insights because many can share their own experiences in similar situations.
Other resources include programs; one specified that, “I’m in this program called Build a Wall. And it’s like a lot of girls,
and we go there every fourth Saturday and talk about these types of issues and situations.
Pregnant teens are also reported to seek information from adults, including mothers, cousins, other relations, and
mentors, as “Somebody that you know is going to be there for you.” These focus group participants again stress the need
for a social network to effectively manage a pregnancy, “But in most cases, some girls don’t have that, so they feel like
they really don’t have anyone to turn to at times. Sometimes they try to turn to friends who know as much as you do…
which is nothing, really.”
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Sex education program recommendations. Teens reported an interest in having access to more information
through school sex education classes. They argued that although curricula focus on abstinence, teens need
information and resources related to safe sex. As one participant reported, “Even though they try to encourage kids
not to have sex, they are still going to what they wanna do.” These teens would like to see discussions in smaller
groups, as large groups could discourage some from participating: “If you are in a big group like this, some kids
ain’t say nothing, I think if you was in here and it was just them by themselves, then they would talk. People feel
uncomfortable talking about that in a whole big group of people…”
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Teen Boys
Several teen boys participated in focus to explore some of the challenges pregnant and parenting teens face as well
as the resources available to them. The following represents a summary of key points and common themes drawn
from the data:
How having a child changes a boy’s life. There was a strong belief among the teen boys who participated in
the focus groups that it is the father’s obligation to care for the child, to provide for it financially, and to make time
to help raise it. Thus, teens realize that becoming a father leads to major life changes, including losing freedom and
having to take on new responsibilities. One teen stated that “you won’t be able to attend no sports events you want
to attend because you have to go to work to support your child.” Major responsibilities included having to work and
possibly having to drop out of school. This may include the need to change bad habits and who they associated with
in order to remove the bad influences that would deter them from being good fathers.
Where boys get information about sex, including preventing pregnancy, STDs, HIV. Some teens preferred
to ask friends or peers at school about sex whereas others preferred to ask their parents. However, teen boys agreed
that the media provided the most prolific and impactful information. Sex information “is everywhere,” though “not
all information is good information.” Regardless, it is easy to acquire information through television, radio, print, and
especially the Internet. However, where the information comes from is important, and so trust becomes an issue. It
takes a trusting relationship to truly ask questions. Although school may provide specific, scientific explanations, and
peers may provide anecdotal and “word of mouth” information, these sources are not as highly regarded as one-onone conversations with a trustworthy and knowledgeable source.
However, finding a trustworthy source, “a mentor” who “treats them equally” has been a difficult task for many
teen boys. Some do feel they have good role models at home, and those teens prefer to speak to their parents or
other trusted family members such as older cousins or uncles. Talks with family center around condom use and
pregnancy. Other teens feel they “should” get information from parents, but don’t because talking with parents can
be difficult or scary, or parents themselves may not be very knowledgeable. Thus, some teens prefer to turn to close
friends or to seemingly respectable sources on the Internet. Others, lacking trustworthy sources of any kind, turn to
their own personal experience, to their life “on the streets,” as their main source of information from which to make
meaningful decisions.
Sex education at school. Teen boys reported that their schools either did not have a formal sex education
program, or if they did, the program was poorly executed. Those schools without formal education programs opt
instead to provide some information on safe sex practices and STIs and STDs during assemblies. However, those
students who had attended classes that were part of a formal sex-ed curriculum did not feel they had fared any
better. Some students moved through lessons on the reproductive system, but didn’t get information on condoms
and birth control, which they felt they and their peers desperately needed. Others felt that the teachers just
didn’t care enough about the students or the material, and thus left out the “real important” content, such as the
psychological and sociological impact of pregnancy. One concerned adolescent mentioned that the schools “don’t
really teach you what to do after you get a kid…they talk about preventative measures, not about what you do when
you get a kid.” Instead, these students simply get a hurried and unimpassioned biology lesson.
Where teen boys get information about pregnacy related services. Despite not always seeing parents as the
most trusting or knowledgeable sources with respect to sex education, most teens would go to them if they were in
need of pregnancy information or services. Teens reported feeling “too embarrassed” to go clinics by themselves. A
challenge for those who were not too shy to use community resources was unreliable transportation to get to clinics,
offices, etc. on their own. Thus, turning to parents for assistance becomes important. Teen boys preferred to talk to
their fathers before asking their mothers for information or help.
Most teen boys were unaware of services in their county. Beyond turning to family, teen boys had a vague notion
of the information at their disposal through radio, TV, and print campaigns that they have seen advertised, such
as nobaby.org, and many assume that they can turn to the Internet for finding specific information. Teen boys
recognized that their lack of information was an issue and supported the idea of having easily available information
at school or libraries. One teen, who believed that information is “not as available as it should be” stated that he
would like “a place you can go where you can just sit down to talk or read instead of just having what they tell you at
school.”
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Barriers to using pregnancy/parenting services. Though getting a girl pregnant carries some level of status
and “fame” among teen boys, there is also an element of stigma around it, and thus seeking services feels too
“embarrassing” for many boys. Teens feared peers would see them negatively if they sought parenting services. These
reactions illustrate the complicated social constructs surrounding teen pregnancy. Some boys feared that a baby may
not be theirs, or that the mother was simply using her pregnancy to get attention or to “entrap the male”. However,
teen boys did endorse the idea that they must be responsible for their children and should be there for the pregnant
mother, but simultaneously disliked the idea of seeking services to aid in the pregnancy or in being a father.
Beyond the status games and relationship networks relevant in a teen’s life, adolescent boys recognized larger
societal pressures that bar them and their friends from using pregnancy and parenting services. “Some people are
trying to control someone’s life even though they’ve never gone through what they have…like trying to stop access
to condoms because it’s against God,” one teen lamented. Another stated that “people won’t go into a clinic because
they see so many people protesting out front…they don’t get the services they need because they don’t want to get
harassed.” As one teen stated, the reality for many people is that they “may be ashamed to get services.”
Role of the baby’s teen father during pregnancy and after the baby is born. Providing for the child
financially is the number one concern for teen boys. Teen boys clearly saw their role as father as one who “works
hard” and is willing to set aside his own interest (such as spending time with friends, playing sports, going to clubs,
etc.) in order to work longer hours and “step up to the plate.” For teen boys, fatherhood comes with a “primary
provider” mindset. However, teen boys were not opposed to caring for the child emotionally. They recognized the
importance of spending time with the child, and being there to rear and influence the child. To this end, there was
recognition that some lifestyle changes were in order, and having to leave behind bad habits, such as drinking, using
drugs, or becoming involved in criminal activity, needed to end.
Teen boys also recognized the importance of a two-parent family, and some supported creating committed,
monogamous relationships for the benefit of the child, though many knew this was not a reasonable expectation.
Teen boys believed that most relationships would break up, separate, or divorce. In the teen male mindset, this was
reconciled with the notion that the man should provide financially for the mother as well, so she could primarily
concern herself with raising the child. That is, if the teen father was not present full-time in the home, at least his
provider position would remain in effect in that home.
Relationship between teen father and the baby’s mother. The mother of the baby is often a girlfriend or a
casual sex partner; in the world of many teen boys, a pregnancy is hardly ever planned or resulting from a long-term,
committed relationship. Moreover, when referring to the mother, the term “baby mama” is frequently used as a
substitute to “girlfriend” as a way to create distance from the notion of a meaningful relationship between the father
and mother.
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Parents of Teens
A few parents of teens participated in focus groups to explore some of the challenges pregnant and parenting teens
face as well as the resources available to them. The following represents a summary of key points and common
themes drawn from the data:
Impact of having a child become pregnant. All parents agreed that teen parenting places significant
responsibility on the teen’s own parents. That is, teens would be too immature to manage parenting alone, and
much of the burden would fall on the teen’s guardians. One parent noted: “Parents of the teen would have more
responsibility because the kid is a teen so the responsibility is not shared equally between the teen and their parent;
ideally the responsibility would be shared equally or the teen would be more responsible.”
Parental guidance on reproductive health. Opinions on approaches to discussing reproductive health varied
widely, even though all parents agreed that the topics should be addressed. Some argued that teens should be
advised to delay sexual activity until marriage: “My main thing right now that I tell my kids is the correct way…how I
was taught, no sex before marriage. A lot of household are single parents now.” Others urged parents to offer teens
more information, so that youth can protect themselves: “Talk about the consequences. I try to make sure that she
knows about the whole picture.” These parents argued that discussions should be honest and open: “Don’t sugar
coat it, don’t commercialize it…tell the real part and consequences about unprotected sex [pregnancy and STDs]
because you don’t always know who the guy you’re with is having sex with; some still consider themselves virgins if
they have oral sex because they view it as not really having sex. Point out that you could still get STDs from that.”
Some parents recommended that advice focus on self-esteem and loving relationships: “Discuss that sex should be
with someone that you love. Instill in her, self-respect.” Of note, most of the parents identified the responsibility for
sexual activity with girls, rather than with boys or both girls and boys: “The girl is primarily held responsible when a
pregnancy occurs. The girl can’t just walk away from it the same way a guy can.” And, participants agreed that parents
are usually tougher on girls than boys: “Mom’s are usually harder on their girls because of it.”
Family planning resources and barriers. The top resource cited for preventing teen pregnancy was
communication. Participants argued that, if parents fail to discuss sex with their offspring, the children will get the
information from other sources, and such information could be inaccurate or misleading. Although most of these
parents recommend open communication with teens, few felt comfortable with the topic, or with helping their teens
secure birth control. Just one parent supported the concept of placing teens on some form of contraception, saying “I
would rather be safer than sorry…at least get them through high school.”
Parents identified several challenges to pregnancy prevention, with lack of communication the most common
consideration. Many parents are too embarrassed to discuss sex, and others do not listen to their kids. As one
suggested, “Sex doesn’t have meaning anymore. We have to listen to our kids and give them more positive
messages. Plant the seeds.” The parents agreed that certain subjects such as abortion are especially taboo. Finally,
participants argued that parents might take all of the “right” steps, but still experience their teen’s pregnancy.
Community resources for teen pregnancy and parenting. The majority of parents said the African American
church is one of the community’s most valuable resources. Many listed faith-based programs that prevent pregnancy
and sexually transmitted infections, such as one at St. Andrew’s. Other programs cited were Planned Parenthood,
Girl Scouts, Memphis Center for Reproductive Health, and United Way. Participants agreed that other resources
are needed, but not available. In particular, they identified a strong need for parenting classes focused on stability
in home life and parenting: “Programs don’t seem to focus on after pregnancy. Teens may have smoked or drank
before pregnancy, and then go right back to doing it afterwards. There needs to be a program to teach parents how
to parent.” Many noted that teens need basic infant care skills such as hair care, bathing, washing baby clothes, and
teaching children how to brush their teeth.
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APPENDIX K
CONDOM ACCESS DATA ANALYSIS
Purpose. To understand the potential ease of access to condoms by teenagers, research assistants investigated the
ease of access to condoms in various neighborhoods in Shelby County.
Procedures. Three neighborhoods were selected to examine condom access in the areas surrounding high schools.
Frayser (38127): 19 locations closest to the two high schools; Midtown (38104): 9 locations near the area’s sole high
school; Orange Mound (38111, 38114): 9 locations, all close to the Orange Mound Community Center and Melrose
High School. Germantown (38138) was added to provide comparison: 19 sites near area high schools. Field visits
were made to grocery stores, general stores, pharmacies, and gas station mini-markets during weekdays from 12 - 4
in the afternoon between the months of May and August, 2011.
Research Team. Graduate research assistants, who were all Caucasian females, visited the Frayser, Midtown, and
Germantown sites in groups of two or three. The Orange Mound site was visited on a Saturday by one Caucasian
female member of the research team.
Variables. Researchers first attempted to find condoms available for purchase in the store. If condoms were not
readily accessible, employee assistance was requested. When speaking to employees, the assistants asked whether or
not the store carried condoms, and if so, what the highest and lowest prices were for each. Assistants also noted the
variety of condoms (e.g. whether the store only carried one brand and quantity, or multiple brands and quantities).
Variables considered included the location and visibility of condom displays within the store, varieties of condoms
sold, condom pricing, and whether condoms could be selected by customers or required key access by sales clerks.
Research assistants also documented any indicators of vendor, staff, or patron attitudes about condoms, such as
shows of support or disapproval when queried about condom stock, as well as store employee’s knowledge about
their condom stock.
Qualitative Report. Data collection began in the neighborhood of Frayser. As the graduate research assistants were
unfamiliar with the community, they first located the area’s two high schools on a map, and then used the internet
to identify gas stations, groceries, general stores, and pharmacies in close proximity to the schools. Ultimately, 19
locations closest to the two high schools were chosen for study. This neighborhood presented the greatest number
of challenges to condom access, both in terms of product availability and product accessibility. Of the 19 locations
visited, 2 did not carry condoms, and 13 stored condoms behind the counter or in locked glass display cases; both
conditions necessitated asking employees for assistance. Only 4 locations (about 20%) provided direct access to
the condoms. The average price for a 3-pack of condoms (the most commonly sold quantity) was $3.48. Vendor
knowledge and attitude presented further barriers to access. Clerks in Frayser were not always knowledgeable about
the location of condoms, or if they actually sold condoms. At two separate stores, when asked whether they stocked
condoms, the employees had to ask other employees before coming to a definitive answer. In other cases, sales staff
displayed patent disapproval when the researchers asked about condoms. For example, one employee was observed
looking down and shaking his head disapprovingly upon overhearing the graduate research assistants ask another
clerk if the store carried condoms. At a different location, several employees laughed derisively at the assistants
when asked. At other locations, a total of three others were seen laughing uncomfortably when asked if they carried
condoms. Furthermore, one employee asked the graduate research assistants if they were lost, and another expressed
confusion surrounding the graduate research assistants’ queries, asking, “Are y’all on a scavenger hunt?” One sales
clerk openly admonished the researchers, frowning and sternly declaring, “Those are not good for you,” giving the
assistants the feeling they were doing something wrong. At one location, the clerk was behind a bulletproof glass with
a poor quality speaker system; in order to be heard, the graduate research assistants had to shout their queries about
condoms.
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Midtown was the second neighborhood canvassed. Graduate research assistants focused on locations along a
main avenue near the setting’s sole high school, visiting 9 locations. Although this neighborhood featured similar
barriers to condom availability, the researchers identified a more supportive atmosphere for condom shoppers. Of
the 9 shops visited, 2 did not sell condoms. Of note, one of these was a pharmacy located directly across the street
from the high school; thus, despite its ideal location the store was not a resource for condom access. Another 4
shops stocked condoms behind the service counter or locked glass display cases. Only 3 sites (1/3 of those visited)
featured immediate customer access. However, in contrast with Frayser, Midtown employees displayed either a
neutral or mildly positive response to inquiries. One clerk asked if the researchers were doing a study, and seemed
pleased by and supportive of the project. The average price for a 3-pack of condoms was $4.15, putting it slightly
above Frayser.
Germantown was the third neighborhood canvassed. The researchers selected 19 potential sites near area high
schools. Both availability and accessibility proved to be significantly greater in this higher-income setting than in
other neighborhoods. Of the 19 locations visited, only 2 did not stock condoms. Another 5 stored the products
behind a counter or in locked glass cabinets. However, 12 locations (more than 60%) featured condoms in open
display racks. The average price for a 3-pack of condoms was $3.72. Since assistance was less often required, there
were fewer overall interactions in Germantown. Even so, interactions that did take place tended to be positive and
stigma-free. Germantown employees often recognized that the exercise was a part of a research study; only one
clerk was brusque, refusing to answer a graduate research assistant’s query about condom pricing.
The member of the research team canvassed 9 locations in a fourth neighborhood, Orange Mound. The locations
were all fairly close to the Orange Mound Community Center and Melrose High School. Of these, 8 stores were
located along a main avenue. All stores stocked condoms, however 7 of the 9 locations kept condoms locked
behind counters or cases. However, all of the markets also sold individual condoms in a fishbowl, costing about
a $1 per condom. The remaining 2 locations had condoms that were located near the register, visible, and readily
accessible.
Summary of Key findings. Overall patterning indicates that Frayser was the most difficult area to access
condoms in, with researchers not only facing difficulty in accessing the condoms themselves, but also encountering
stigma, judgment and lack of employee knowledge about condom stock during the research. Midtown and Orange
Mound appeared to be relatively similar with regard to condom access. Although condoms were behind the
counter or behind glass in many of the locations, there was less employee stigma. In the case of Orange Mound,
although the researcher felt little outright stigma from inquiring about condoms, there was a considerable amount
of embarrassment or confusion apparent on the part of the employees, possibly because the researcher was a
Caucasian female on her own. Both Midtown and Orange Mound seemed fairly neutral with regard to employee
stigma. However, obtaining condoms still required employee assistance, making it less likely that teenagers would
purchase condoms, due to the extra employee interaction required.
Germantown was the most easily accessible area for condoms. No assistance was required to access condoms in
the majority of these locations, and when the graduate research assistants did inquire about condoms, they were
generally met with positive reactions from the store employees. Furthermore, unlike Frayser, there was never any
confusion about whether or not the store carried condoms.
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APPENDIX L
ECONOMIC IMPACT OF TEEN PREGNANCY
REPORT SUMMARY
The Economic Impact of Teen Pregnancy in Memphis/Shelby County, TN
By David H. Ciscel, Emeritus Professor of Economics, University of Memphis
Executive Summary
Cost/Benefit Ratio of Pregnancy to Prevention. The benefits of investment in contraception and pregnancy
prevention relative to the costs of pregnancy and childbirth may appear obvious, but they may be even more
financially significant than has been realized. Although many studies show what teen pregnancies cost taxpayers,
none have focused on comparing these costs to the next best alternative: the benefits of investment in teen
pregnancy prevention.
This study calculates two cost/benefit ratios. First, the short run ratio of the medical costs of pregnancy and delivery
relative to the benefits of investment in prevention and contraception are calculated. Second, the longer term ratio
of the costs of three years of health and child care for a teen mother’s child relative to the benefits in investment in
pregnancy prevention and contraception.
Short Run Costs of Childbirth vs. Contraception: The initial costs of teenage pregnancy include prenatal care (when
it is provided), physician’s services, and the costs of hospital delivery. How do these costs compare to the benefits
of preventing pregnancy through contraception? A regular hospital delivery costs $4,668 in hospital and physician’s
costs. This adds up to $10,179,826 for all the teenage births in Shelby County in 2009. In comparison, the effective
use of contraception and associated prevention of pregnancy would have cost $267 for one teen for the entire year
-- a total of $581,600 for the 2,181 young women and girls who did get pregnant during that year. The financial cost/
benefit 5 ratio for just these immediate costs is 17.5 to 1.0 – that is, the medical costs of pregnancy and childbirth
are almost eighteen times the benefits of prevention by contraception.
Early Childhood Costs vs. Pregnancy Prevention: For the first three years of her child’s life, a teenage mother is
usually a single parent. Early childhood costs include all of the costs of raising the child during the child’s first three
years of life. For a low income single parent family the average cost of raising a child for the first three years of life is
$33,344. That includes delivery, housing, clothing, health care, food, and childcare. How do these costs compare to
the benefits of pregnancy prevention? The average costs of pregnancy prevention via contraception amount to just
$800 over three years. The cost/benefit ratio of delayed childbearing is 41.7 to 1 for the first three years – that is, it is
over forty times more expensive for a female teenager to have a child than to prevent a pregnancy.
Early Pregnancy and the Earnings Gap. A teen pregnancy, particularly combined with problems of poverty, poor
education, and weak family structure, can result in a lifetime of poor economic performance for a young woman.
Work force development is important to the economic progress of Shelby County. Lack of appropriate skills to get,
to hold and to advance in a job have been problems in the region for a long period of time. And they continue to
be problems. A significant minority of Shelby County workers do not earn a living wage – enough income to be
self-sufficient without any public assistance. Teenage pregnancy contributes to the low-wage problem significantly.
Today’s job market requires skills; skills that often require a community college or university education, plus
considerable on-the-job experience. Postponing the acquisition of these skills increases the probability that the skills
will not be acquired at all. Teen pregnancy impairs educational progress and job skill development. It usually delays
completion of a high school diploma or earning a GED. It also forecloses the potential for entering a good, stable job
at age 18 or 19.
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Someone without a high school diploma begins her work experience earning $6,413 less per year than someone
with a high school diploma, $10, 669 less than an Associate’s 6 degree, and $15,395 less than a Bachelor’s degree.
These gaps only widen during the next twenty to thirty years of a woman’s working life. Lower earnings are a
continuing part of life, along with low skills and workplace instability. By age 24, the average teenage mother will
lose $51,304 in earnings by not completing a high school diploma, $85,352 by not completing an Associate’s degree,
and $123,160 by not completing a Bachelor’s degree.
Over the course of her entire worklife, a woman who begins adulthood as a teen mother loses $410,064 in
earnings by not completing a high school diploma, $980,192 by not getting an Associate’s degree, and $1,499,820
by not finishing a Bachelor’s degree. And that is for one teen mother in Shelby County. Multiplying those figures
by the number of local teen mothers shows us that the Memphis regional economy is losing millions of dollars in
productivity every year to teen pregnancies: $894 million lost for each year’s group of teenage girls who have a child
and do not complete their education and job preparation through high school. That number jumps to $2.137 billion
when one’s year group is compared to women who complete a community college education.
One result of teenage pregnancy is women earning less, and that is followed by women spending less on themselves
and on supporting their children into adulthood. Women who do not have the funds to raise the next generation of
children are likely repeat the cycle of poverty that leads to educational failure and job instability. In many cases, the
intergenerational transmission of teenage pregnancy will repeat itself 12-15 years later.
Conclusion. Teen pregnancy is central to the problem of poverty in Shelby County. By delaying the first childbirth by
just a few years, two important issues are resolved. First, the costs – largely borne by public taxpayers– of childbirth
and of raising a child during the formative years of a young woman’s educational and job preparation development
are avoided. The payoffs to delayed childbearing are very large: a ratio of 17.5 to 1 in health care expenditures in the
immediate period of having a child, and a ratio of 41.7 to 1 over the first three years of raising a child.
Second, delayed childbearing increases young women’s potential to complete schooling and develop valuable job
skills, enabling them to make positive contributions to both their own families and to the region’s economic growth.
Read the full report at www.memphis.edu/crow. Sponsored by Memphis Teen Vision.
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Current Research Agenda
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