By Rahmat Na’Allah, MD, MPH
It’s easy to get lost in medicine. We regularly deal with complex challenges, patients, procedures, etc. It’s not hard to forget the basics. To reconnect, I like to ground experiences in the people involved, their stories. So, as such, I start this blog with a firsthand story from one of my patients, friend, and mentee.
TC was born to a single mother of two. Her mother was sixteen and her father was incarcerated shortly after she was born. “Questions about him always brought a lot of yelling and curse words, so I stopped asking.” She watched her mother cycle through bad relationships with different men but “secretly hoped I would get a dad to look up to like my friends.”
TC’s mother became a mother of three at age eighteen. The father was abusive. He got mad whenever her mother asked for help. Regardless, their relationship lasted for six years. “I remember my mother saying she settled for taking the abuse, housing, feeding, and paying our bills all so she could at least hold on to him.” She worked two jobs, came home, and cried herself to sleep at night. Soon she resorted to drugs and alcohol to numb her pain. At age nine, TC and her two siblings were taken by DCFS.
“I went from one foster home to another. I desperately just wanted someone to love me.” TC started running away from home and became a frequent visitor at the juvenile detention center. During one of her runaways at age 12, she met JN. “He was the first boy to tell me he loved me.” At age 14, JN’s life story rang similar to TC’s. Soon, they were inseparable and two months into their relationship, TC was going to be a mom.
“I am now twenty-one, have four children by four different fathers, all in DCFS custody. I’ve struggled with homelessness, drug addiction, incarcerations, and multiple suicide attempts requiring hospitalization. I’ve been diagnosed with schizophrenia and bipolar disorder.” Now she asks me what is the point of staying alive. “Why am I still here?”
Why Should We Care
The challenge of teen pregnancy does not begin at the pregnancy. It starts with the homes, families, and communities we’re all a part of. According to the CDC, the US teen pregnancy rate is higher than that of the other ten industrialized nations with racial/ethnic and geographic disparities continuing to persist. In 2017, the US birth rate for 15-19 aged moms was 20.3 per 1,000 females, 18.4 for the state of Illinois and 25.9 for Peoria County. The city of Peoria alone accounted for 73.6% of the county’s teen births.
When stratified by zip codes, teenagers who lived in the highest risk zip codes (61603, 61604, 61605) became mothers at a rate of 58.5 per 1,000 females as compared to 9.2 for the remaining zip codes in the county. Being poor in Peoria makes you six times more likely to be a teen parent.
In 2017 Peoria County, the teen birth rate for 15-19 aged AA/Blacks was 65.1 compared to 15.3 per 1000 females for their White counterparts. A black teenager is four times more likely to be a mom than her White counterparts are. In Peoria today, our community, the color of your skin and where you live could be a bad predictor for your future.
What is Being Done?
- Investments in communities to address the social health factors that specifically affect high-risk neighborhoods and ethnic groups
- Evidence-based educational programs that address knowledge gaps in reproductive health
- The Peoria School District 150 received the DASH grant from the state of Illinois to address “comprehensive sex education, youth advisory committee and expand the safe schools initiative.”
- Expansion of in-school clinics in high-risk zip codes with the capability to provide contraception including long-acting reversible contraceptive (LARC) methods – Nexplanons and IUDs
- Collaborative work with clinician offices who provide care to teens using the evidence-based method of CDC sexual health history taking called 5P’s
What You Can Do
In your clinic:
- Ask the questions using the 5P’s
- Be non-judgmental
- Empower your staff to do the same
- Improve access to contraception
- Rather than have patients come back, provide it at their first visit.
- Follow the evidence on oral contraceptive prescription – give one year and with refills.
As an organization:
- Immediate postpartum LARC in hospitals
- Enforce adolescent sexual health best practices among your providers
- Provide social work, mental health, case management, substance abuse, lactation, and doula support
- Regular staff education on diversity, inclusion, and implicit bias training
As a community:
- Parental support in school such as daycare services
- Help for GED and services to reduce the dropout rate
- Safe after-school programs including evening schools for young parents
- Community investment to address social determinants of health – safer neighborhood, gun violence control, work re-entry programs for ex-convicts, diversity among law enforcements who also live in the neighborhoods
As an individual:
- Be a mentor, role model
- Volunteer in the community programs – could be physical and/or financial
TC is a victim of unfair circumstances and she’s far from alone. Our privilege comes with a responsibility to our communities. We can pay it forward, and we must. We can empower each other to uplift the countless TCs and JNs of our society. I’m very passionate about any form of injustice. I know that’s a bond we as doctors share. The ability to provide the most comprehensive, compassionate and unbiased care to the most vulnerable members of our society is what truly gives us the opportunity to be the best physicians and human beings we can be. So join me in this effort as we together nullify the disparity gap in teen pregnancy in our community.