Pregnancy Prevention

The number of pregnant and parenting youths in foster care continues to remain at disproportionately high rates.

While teenage pregnancy and birth rates have hit historic lows, the number of pregnant and parenting youths in foster care continues to remain at disproportionately high rates. Research reveals that 33% of females in foster care have been pregnant by age 17 or 18, compared to just 14% of their peers in the general population.1 Repeat pregnancies are also common, with 62% of this population being pregnant more than once within that time frame. For adolescent males, the Midwest study reported that 50% had gotten a female pregnant, compared with 19 percent of their non-foster peers.2

Adolescents in foster care are at a higher risk for pregnancy for a number of reasons. Many don’t have a consistent and trusted adult in their life who they can confide in about personal issues and who can educate them about reproductive health which makes them more susceptible to peer pressure to become sexually active. They don’t often have access to accurate information about reproductive health in the way that their non-foster peers do. In addition, many young women in foster care see benefits to having a baby, perceiving the child as a means of achieving unconditional love and having the stable family and sense of belonging they never experienced themselves. Many youths in foster care may come from family cultures where teenage pregnancy is accepted.

Unplanned teenage pregnancies have serious health and educational impacts on both mother and child. For young mothers, securing housing and finding employment when transitioning out of foster care is much more challenging with a young child. The children of teen mothers are more likely to drop out of school, become incarcerated at some point during adolescence, and are more likely to have young children themselves.3

Teenage mothers in foster care are twice as likely to be reported for abuse and neglect and have their children removed from their care when compared to older mothers.4

Advocates play an important role in addressing the well-being of the children and youths they support, including connecting them to services that support reproductive health and unplanned pregnancy when appropriate. Actions that may help reduce unplanned teenage pregnancy among youth in foster care include:

  • Understand what your program policies are around this issue and learn what the child welfare agency’s policies and procedures are. Child welfare agencies should have specific policies and procedures to help prevent unplanned pregnancies and promote sexual health among youth in foster care. These should include clarifying roles and responsibilities of all the adults who care for these youth, including caseworkers, foster parents, and other supportive adults including volunteers. Find out who is responsible for ensuring that youth have access to regular reproductive health care screenings once they become adolescents.
  • Participate in training if available and if not, encourage your program to consider training on this issue. Many adults may feel unprepared to talk with youth directly about personal issues such as pregnancy prevention. Training should be provided on sexual and reproductive health, contraception, healthy relationships, and how to effectively communicate these topics in non-judgmental and supportive ways, as well as the psychological reasons that females in foster care are more likely to become pregnant. These types of trainings should be open to all concerned adults including caregivers.
  • Provide youth the information they need to make good decisions: Both males and females in foster care need accurate information and good decision-making skills to protect them from unintended pregnancy if they choose to be sexually active. Check to see that adolescents you provide advocacy for have sexual and reproductive health as an integral part of their case plan and ensure that all youth receive the support, knowledge, and tools needed to make healthy long-term decisions regarding sex, sexually transmitted diseases and pregnancy planning. Child welfare agencies can offer sex education programs for youth in foster care and make this a component of existing programs within child welfare agencies. Check with the agency to see if they are providing these programs and encourage them to do so if they are not.
  • Determine if Independent Living programs include information on sexual health: While many states have integrated this information into their Independent Living programs (ILPs), at this time there is only one evidence-based pregnancy prevention program that has been adapted for youth in foster care: Making Proud Choices for Youth in Out of Home Care.5 Depending on state requirements, adolescent youth in foster care should be attending ILPs by no later than age 16.
  • Ensure youth have access to health care: All youth are entitled to health screenings, yet due to frequent changes in placement, may not have a regular health care provider or know where to find a clinic. Advocates, along with caseworkers should ensure that all youth, starting at puberty, receive regular screenings that provide age-appropriate information about reproductive health, including methods of contraception and how to access them.
  • Don’t be shy or embarrassed! Just as you might ask about any other health related issue for a youth you are advocating for, this is just one more topic to address. Modeling for youth that discussing reproductive health is not taboo will help them feel more at ease and more confident discussing this issue.
  • Partner with caregivers. The best-case scenario is that all parties are on the same page. However, if they aren’t and you suspect that the youth is or will soon be sexually active, someone needs to step up and provide them information they need to make smart choices and informed decisions. Work with the child’s caregiver, caseworker and other connected adults in their lives on providing the right information.
  • Include boys and young men. In addition to the obvious role of males in the prevention of pregnancy, they need just as much information as females when it comes to reproductive and sexual health including protecting themselves from STDs and engaging in healthy relationships.

Check to see that adolescents you provide advocacy for have sexual and reproductive health as an integral part of their case plan, and ensure that all youth receive the support, knowledge, and tools needed to make healthy long-term decisions.

Power through Choices (PTC) Maryland, California and Oklahoma

Power through Choices (PTC) is a sexual education and skill-building curriculum designed for youth living in foster care and other out-of-home settings, with the goal of reducing risks related to teen pregnancy and sexually transmitted diseases (STDs). PTC is intentionally designed with and for youth in foster care and other out-of-home placements. With a focus on self-empowerment and the impact of choices, PTC uses interactive learning to provide information and skills that help youth in out-of-home settings avoid risk-taking sexual behaviors. The curriculum challenges youth to set goals for their future and helps them recognize the importance of making healthy choices to accomplish those goals.

The PTC curriculum is delivered by two facilitators in ten 90-minute sessions over a five-week period. It is designed for female and male adolescents between the ages of 13–18. Due to the interactive nature of the curriculum and the needs of the participants, it is best suited for small groups of 8–20. Topics addressed in the curriculum are female and male reproductive anatomy, STDs and HIV transmission and prevention, contraceptive methods, communication skills, making choices that fit your goals and lifestyle and reproductive health resources available to participants. The curriculum uses a combination of role-playing demonstrations, individual reflection, group discussions, along with interactive games and activities. Each session includes time for Q an A.

To learn more:

Below are tools, and a selection of resources to support the prevention of unplanned pregnancies and reproductive health.

Guttmacher Institute, Teen Pregnancy among Young Women in Foster Care: A Primer 6
This article explores the reasons why youth in foster care have high rates of teenage pregnancy. It suggests that the basic policy framework needed to support interventions to reduce teen pregnancy among young women in foster care is already in place at the federal level and that child welfare agencies and program planners should be thinking about ways to maximize these levers to help adolescents in foster care delay pregnancy.

Making Proud Choices! An Evidenced Based Program7

This is evidence-informed sexual health curriculum is designed to help teens understand behaviors that put them at risk for pregnancy, HIV and other sexually transmitted infections, and to empower them to reduce this risk through healthy decision-making. The main message incorporated throughout the adapted curriculum is that “Youth can make proud and responsible choices in spite of what has happened to them in the past.”

National Center for Child Welfare Excellence at the Silberman School of Social Work, Information Packet: Pregnancy Prevention for Youth in Foster Care 8

This information packet provides best practice tips, and models of pregnancy prevention programs for youth in foster care.

U.S. Department of Health & Human Services, Office of Adolescent Health, Evaluation of Adolescent Pregnancy Prevention Approaches, Addressing Teen Pregnancy Risks for Youth Living in Out-of-Home Care: Implementing POWER through Choices. 9

This report provides an overview of the Oklahoma Institute for Child Advocacy’s (OICA) comprehensive sexual health education curriculum for high-risk youth. The summary includes the implementation study findings.

  1. Finer, L.B., & Henshaw, S.K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38 (2), 90-96.
  2. Finer, L.B., & Zolna, M.R. (2014). Shifts in intended and unintended pregnancies in the United States, 2001-2008. American Journal of Public Health, (104) S1, S44-S48.
  3. Hoffman, S.D. (2006). By the Numbers: The Public Costs of Adolescent Childbearing. Washington, DC: The National Campaign to Prevent Teen Pregnancy. Retrieved from:
  4. Ibid.
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