By: Elise D. Berlan, MD, MPH, FAAP
Teenage pregnancy rates have been declining for decades, recently dropping to their lowest point in more than 70 years in the United States. Still, many girls in their teens or younger become pregnant each year. To help sort through the life-changing and emotional decisions they face, pregnant adolescents need prompt and straightforward information and judgment-free medical guidance, support and care.
In our policy statement, "Options Counseling for the Pregnant Adolescent Patient," the American Academy of Pediatrics (AAP) explains how to help teens get prompt medical care and basic, accurate information about all their options—while respecting everyone's personal, spiritual and cultural perspectives. These options usually include having and raising the baby, making plans for relatives or an adoptive family to raise the baby or terminating the pregnancy.
Federal and state policies may threaten to restrict health care providers from providing pregnant teens with unbiased counseling that includes the full range of pregnancy options. However, our approach to this issue has not changed since our original policy statement on the issue in 1989.
When children have children
Most teenagers who become pregnant decide to continue the pregnancy. Adolescents, especially younger ones, are more likely than women in their 20s to have medical complications during pregnancy. Their babies are also more likely to be born preterm, with low birth weight, and are less likely to survive. It's important to connect pregnant teens with early prenatal care and to encourage a healthy lifestyle—a well-balanced diet, daily exercise and staying away from tobacco, alcohol and drugs.
If the teen decides to have and raise the baby, they may need help identifying a strong support system. Teens and young girls who have babies can certainly achieve their personal life goals and raise healthy successful children, but often they will have more challenges to overcome. See "Helping Teen Parents and Their Children Build Healthy Futures."
Kinship care or foster care
In
kinship care arrangements, which have become increasingly common in recent years, a grandparent or other relative serves as a parent to the infant. This may be through an informal, private arrangement or through child welfare systems, which vary by state. Some adolescents may choose foster care for their baby when kinship care is unavailable or not suitable.
Kinship care arrangements can give a teen an opportunity to be involved with raising their child, as well as the chance to take on responsibilities of parenthood in the future. Growing evidence also suggests that babies in kinship care arrangements fare better than those cared for by unrelated foster parents. However, kinship care arrangements face unique challenges.
If you are considering raising your grandchild, here are some things to keep in mind:
Most children living with relatives are in informal arrangements, and this creates a problem if the relatives do not have the authority to give legal consent for needed medical care, including immunizations and other non-emergency health services. Your pediatrician can help connect you with community legal resources to help you take steps to gain legal authority to help children get the medical care they need to stay healthy.
Older family caregivers who haven't parented an infant for several years may not be aware of changes to safety standards for
sleep,
car seats and
injury prevention.
Raising an infant the second time around can be a deeply rewarding and invigorating experience. However, it's a good idea for older caregivers to have a plan in place for guardianship in the event they experience health declines.
Adoption
Adoption is another option for teens who want to have their baby but don't feel ready or able to become a parent. About one to two million families are currently waiting to adopt, love and care for a baby in the United States.
The decision to place a baby with an adoptive family is legal and binding. However, most states do allow the birth mother anywhere from several days to several months after the child is born to change their mind. Information about adoption laws can be found on the
Child Welfare Information Gateway, which is a service of the Children's Bureau in the U.S. Department of Health and Human Services.
If your teen is considering adoption, here are some basic things to know:
The adoption process can take place through public or private channels and be closed or open.
In public adoptions, the child is placed in a family by an agency operated or contracted by the state.
In private or independent adoptions, the birth parents may work with an attorney, physician, clergy member, or a licensed or unlicensed facilitator.
In closed adoptions, the names of the birth mother and the adoptive parents are kept secret from each other.
In open adoptions, the birth parent may choose to personally select the adoptive parents, meet with them, and even maintain contact and an ongoing relationship. Open adoptions, research shows, may lessen feelings such as grief or guilt some birth parents who make an adoption plan for their child may experience.
Abortion
Because some pregnant teens will consider abortion, the AAP believes they should be offered accurate information free of judgment. Because of the harms of restrictive abortion laws and the dangers of unsafe abortions, adolescents should have access to legal abortion services. The AAP respects the diversity of beliefs about abortion and encourages any teenager considering an abortion talk to a parent or trusted adult before making such a big decision.
Teens who feel safe and are willing to involve their parents in their abortion decision, as most are, usually benefit from adult experience, wisdom, emotional and financial support. Parental notification laws exist and vary from state to state.
See Confidentiality for Teens Considering Abortion: AAP Policy Explained for more information.
If your teen is considering abortion:
Talk to your pediatrician about local laws affecting the availability of pregnancy termination options and where to find trained and licensed providers in your community or region. Medical and surgical abortions are safe when performed by licensed and experienced physicians.
Out-of-pocket costs for abortion services can be a barrier for pregnant teens and their families. Lack of money can cause delays, which can lead to more complicated procedures further along in the pregnancy. Sources of financial assistance may be available in your community or state.
Use caution before speaking with a "pregnancy crisis center." Many of these offices have an agenda and may not offer accurate, non-judgmental counseling. For accurate information, it is best to talk with your pediatrician, or someone recommended by your provider.
Remember, pregnant teens need access to all options available to them—not judgment.
Finding out they're pregnant is a sensitive and emotional time for a teen, their family, and their sexual partner. Whatever their decision—to become a parent, make an adoption or kinship care plan, or have an abortion—it will likely have life-changing consequences. Creating an accepting environment for a pregnant teen allows them to feel safe to explore their own feelings about the pregnancy and their future.
More information
About Dr. Berlan
Dr. Berlan is a member of the AAP Committee on Adolescence and lead author of the updated policy statements,
Options Counseling for the Pregnant Adolescent Patient, and
The Adolescent's Right to Confidential Care When Considering Abortion.