Community Action Plan

Couse Project: Community Action Plan

Pregnancy Prevention Policy for Children and Adolescents

Patricia Coss-Maxwell

Eastern Washington University

EDUC 581: The Science of Early Childhood

Dr. Angela Haberman

Winter 2022

Statement of the Problem

Naomi got pregnant at the age of 15. She was a bit wild, and she drank alcohol and used illegal drugs when she found out that she was expecting a baby. She decided to drop out of school and look for a job to support her baby. Naomi is African American and the father of her unborn baby too. He does not want to take responsibility for his actions. Naomi lives with her mother, Sonja, and three more siblings in a two-bedroom apartment in a low-income complex. Every child is from a different father. Sonja herself dropped out of school at 16 and had her first child at 17. She had three more children by the time she was 21. For Sonja, life hasn't been easy as a single mother with little education or support from her family.

According to Child Welfare Information Getaway (2015), mothers between 15 and 18 years old. Non-Hispanic blacks have a more significant percentage of low-birth-weight babies. Low income, poor education, social isolation, drugs, and alcohol use, and lack of early prenatal care tend to be associated with teenage pregnancy (CWIG, 2015). Pregnancy in children and adolescents is caused by multiple social factors, such as lack of access to information and health services. The lack of access to such services prevents children and adolescents from using their human rights, including sexual and reproductive rights, at different stages of life. Also, the weakness of protection systems against all forms of violence, including sexual violence, is a mitigating factor for practicing those rights (UNPF, 2016). Most cases of pregnancy in children and adolescents happen when they are outside the educational system. Their pregnancy condition forced them to drop from school, which has long-term repercussions on their academic and employment opportunities, economic security, and ability to participate in the community—public and political life. As a result, adolescent mothers, their sons, daughters, and families are more vulnerable to poverty and social exclusion (UNPF, 2016). The impact of teenage mothers in the community perpetuates violence and inequality. When a girl becomes a teenage mother, it is almost impossible to achieve financial independence. She becomes dependent on government programs that may help her pay for food, housing, health care, and other basic living expenses. Early pregnancies also harm both the mother's physical health and the baby on the way; malnutrition, premature birth, children with developmental problems or malformations, and even a probability of babies losing their lives during the first weeks of their lives. Also, adolescent mothers are exposed to a lack of medical attention due to a lack of information or access to medical services. Teenage mothers become at risk of suffering from different gynecological diseases such as preeclampsia or eclampsia, high mortality rates, complications resulting from abortions, and sexually transmitted infections. Most women who become teenage mothers also must deal with psychological consequences, depression, insecurity, shame, and trauma. Likewise, early pregnancies have a significant social and economic impact: adolescent mothers are forced to drop out of school to care for their baby, with very few skills and opportunities to find a job and get ahead with a better future (CWIG, 2015). The impact of teenage mothers in the community perpetuates violence and inequality. When a girl becomes a teenage mother, it is almost impossible to achieve financial independence. She becomes dependent on government programs that may help her pay for food, housing, health care, and other basic living expenses. Early pregnancies also harm both the mother's physical health and the baby on the way; malnutrition, premature birth, children with developmental problems or malformations, and even a probability of babies losing their lives during the first weeks of their lives. Also, adolescent mothers are exposed to a lack of medical attention due to the absence of information or access to medical services. Teenage mothers become at risk of suffering from different gynecological diseases such as preeclampsia or eclampsia, high mortality rates, complications resulting from abortions, and sexually transmitted infections. Most women who become teenage mothers also must deal with psychological consequences, depression, insecurity, shame, and trauma. Likewise, early pregnancies have a significant social and economic impact: adolescent mothers are forced to drop out of school to care for their baby, with very few skills and opportunities to find a job and get ahead with a better future (CWIG, 2015). The adolescent fertility rate is directly related to socioeconomic conditions and the level of development of the area where they live or SES. These situations explain the differences between pregnancy rates and the course of prevalence that this phenomenon presents in each person, family, and community (UNPF, 2016). It is essential to highlight that the pregnancy of children and adolescents has multiple causes has many consequences in the personal, family, community, and social order. By guaranteeing adolescents, their right to education, health services, sexual information, and reproduction, better levels of health, well-being, education, recreation, protection, security, and a life free of violence are promoted. Their participation also ensures the improvement of conditions to develop their full potential. Investing in adolescents has a triple benefit: a) for their health and well-being now, b) for their health and well-being in adult life, and c) for the health and well-being of generations to come.

Evidence shows that adolescent health problems and death are severe global problems (Patton, G. C. et al., 2012). In the United States, significant progress has been made in the social area. However, the rights of children and adolescents still present breaches determined by economic, gender, social and ethnic inequities. The health of adolescents, and sexual and reproductive health, constitutes an aspect of particular concern due to the high rates of fertility and maternity in adolescents, obstetric complications, unsafe abortions, HIV infection, gender-based violence, and sexual violence ((UNPF, 2016). Pregnancy consequences in children and adolescents are permanent abandonment or discontinuity in studies, lack of access to formal work, poor social integration, poverty, little empowerment, and non-compliance with their life projects. Moreover, there is a risk of dying during pregnancy, childbirth, or postpartum of up to four times more in pregnant women of 15 years old or those related to abortion. Mental health problems such as depression self-inflicted injuries such as suicide have also been linked to teen pregnancy.

Furthermore, the consequences are not only for the young mothers but also for infants born with premature birth, low birth weight, or infant death (WHO, 2020).

To improve health and education, provide opportunities for children and adolescents, and respond effectively to their demands, I propose implementing a comprehensive Community Action Plan. I have called it the Pregnancy Prevention Policy for Children and Adolescents or PPPCA that incorporates actions of promotion, prevention, care, protection, and restitution of rights for this population. Additionally, the PPPCA looks to reduce premature and low birth weight babies born and thus infant mortality.

Description of the Program and Intervention

The PPPCA establishes inter-institutional coordination between the Departments of Health, Human Rights, Justice, Health and Social Services, Commerce, and Children, Youth, and Families. Each Department is responsible for complying with the indicators proposed to reduce births in children and adolescents under 14 and 15 to 19 years of age. The purpose of this PPPGA is to contribute to the prevention and reduction of pregnancy in children and adolescents within the framework of the exercise of sexual and reproductive rights, the right to personal integrity, the right to a life free of violence, as well as society's obligation to protect children and adolescents against all forms of gender-based violence, including sexual violence.

For this, I propose the following:

Create an Inter-Institutional PPPCA Committee.
Strengthen inter-institutional coordination, social participation, and knowledge management to prevent pregnancy in children and adolescents.
Allocate economic resources for health, education, and protection of children and adolescents.
Involvement of social organizations and adolescents in processes aimed at the positive development of children and adolescents.

The implementation of the PPPCA will contribute to the following short-, medium-, and long-term outcomes results (expected effects of the Policy),

Create an Impact Framework that is structured but flexible.

Increase the number of schools that incorporate Comprehensive Sex Education based on international rights.

Increase the number of institutions that provide adolescent-friendly comprehensive care, including sexual and reproductive health.
Increase contraceptive methods, including long-acting reversible methods in adolescents aged 15 to 19 years.
Guarantee the comprehensive health, emotional and social protection of pregnant girls under 14 years.
Increase the number of complaints of sexual violence against children and adolescents and solve them in the justice system of age.
Increase the number of complaints of sexual violence against children and adolescents and solve them in the justice system.
Straighten information systems on pregnancy and sexual violence in girls and adolescents.
Implemented public policies based on research and strengthened information systems on pregnancy and sexual violence in children and adolescents.
Increase community participation.
Decrease negative socio-cultural patterns regarding sexuality and increase sexual rights, reproductive rights, and the right to a life free of violence.
Increase the number of adolescent parents with a high school diploma.
Prevent domestic violence and gender-based violence.
Increase the number of adolescents using their sexual and reproductive rights and a life free of violence.
Increase the strategies that encourage healthy habits, a healthy lifestyle, and growth in adolescents.
Reduction of premature and low birth weight babies born and thus infant mortality.

It is necessary to have inputs and processes that will translate into macro activities. Each Department must execute individually and collectively under the guidance of the PPPCA Committee to achieve the results mentioned above, which must be implemented immediately, constantly monitored, and evaluated annually and at the end of the implementation of this Policy.

It is necessary to develop an operational plan to comply with the products and results of the PPPCA and promote investment that will create a budget to achieve the outcomes.

General Outcome

Reduction of adolescent mothers who give birth to premature and low birth weight babies and thus reduce infant mortality by helping children and adolescents, especially the most vulnerable, live a life free of violence and fully exercise their rights, including their sexual and reproductive rights.

Specific Outcomes

Implement public policies to prevent pregnancy and violence based on gender towards children and adolescents.
Promote the change of negative socio-cultural patterns that limit the experience of sexuality, sexual health, and reproductive health.
Guarantee the enrollment, reintegration, and permanence of adolescents in the educational system until the completion of High School.
Promote safe family environments and strengthen protective factors for the integral development of sexuality in children and adolescents.

To comply with the PPPCA's outcomes, I propose the following activities,

Work on creating an Inter-Institutional PPPCA Committee
1. Develop a Framework for the program development, implementation, monitoring, evaluation, and fast-cycle iteration.
Work on public policies to prevent pregnancy and gender-based violence in children and adolescents to address pregnancy prevention in children and adolescents according to international standards.
1. Guarantee the implementation of comprehensive sexuality education based on rights and international standards within the school and other everyday settings.
2. Guarantee adolescents' access to adequate and comprehensive care in sexual, mental, and reproductive health, ensuring advice and access to effective methods of contraception, including long-acting and reversible interval and post-obstetrical methods.
3. Protect the rights of children and adolescents in situations of vulnerability, especially pregnant women under 14 years of age victims of sexual violence and disability.
4. Develop evidence for decision-making about pregnancy in children and adolescents.
Work to guarantee adolescents' entry, reintegration, and permanence in the educational system until they finish high school to create spaces for community participation to prevent pregnancy in children and adolescents.
1. Promote the change of negative socio-cultural patterns linked to gender-based violence and teenage pregnancy.
2. Strengthen the promotion of sexual rights, reproductive rights, and the right to a life free of violence in community spaces.
Work to guarantee adolescents' entry, reintegration, and permanence in the educational system until they finish high school to ensure their access and completion of their high school.
1. Promote the inclusion and permanence of adolescents in the educational system.
2. Promote adolescent mothers and fathers' entry, insertion, and continuation in the educational system.
Work to promote safe family environments and strengthen protective factors for the comprehensive development of sexuality in children and adolescents to develop favorable environments in the family to prevent pregnancy in children and adolescents.
1. Promote respect within the family as a strategy for developing comprehensive sexuality, the prevention of pregnancy in children and adolescents, and gender-based violence.
Work to promote positive health and development in adolescents to strengthen the comprehensive individual development of adolescents and prevent premature birth, low birth weight, or infant deaths.
1. Strengthen adolescents' involvement to promote the use of sexual and reproductive rights and a life free of violence.
2. Implement strategies that contribute to the positive development of adolescents, promote their life projects, and reduce unplanned pregnancy, infant mortality, and the birth of premature or low birth weight babies.

Outcome Map

The topic for Change: Reduction of adolescent mothers who give birth to premature and low birth weight babies to reduce infant mortality.

Powerful

Strategies

Implement public policies to prevent pregnancy and violence based on gender towards children and adolescents

Promote the change of negative socio-cultural patterns that limit the experience of sexuality, sexual health, and reproductive health

Guarantee the enrollment, reintegration, and permanence of adolescents in the educational system until the completion of High School.

Promote safe family environments and strengthen protective factors for the integral development of sexuality in children and adolescents.



Short-Term

Outcomes

Implement comprehensive communication based on human rights and international standards

Implement effective protection systems for girls and adolescents in situations of vulnerability, especially those that are pregnant under 14 years old, with disabilities, or victims of violence

Implement strategies to change negative socio-cultural patterns linked to gender-based violence, teenage pregnancy, and early unions.

Promote safe family environments promoting respect of human rights and guaranteeing a comprehensive development of sexuality, preventing pregnancy in girls and adolescents, and gender-based violence.



Increase comprehensive sexual and reproductive health care, including family planning, and contraception

Generate evidence-based awareness about pregnancy in girls and adolescents

Ensure that adolescents, especially those who will be mothers and fathers, enter and continue in the education system.

Create mechanisms for the participation of adolescents to promote sexual rights and a life free of violence



Ensure early sexuality education in the education system based on rights and international standards

Strengthen adolescents' adequate access to sexual and reproductive health information and services, including family planning and contraception.

Guarantee effective social protection services, especially for girls and adolescents in vulnerable situations, including those who have been victims of sexual violence and those with disabilities.

Increase the number of policies based on research-based methods.



Ensure access to comprehensive adolescent-friendly services including sexual health, reproductive health, sexual violence following international standards

Guarantee the integral health, particular and social protection of pregnant girls under 14 years old

Strengthen information systems on pregnancy and sexual violence in girls and adolescents for the implementation of research-based interventions

Implement community participation mechanisms for the prevention of pregnancy in girls and adolescents and a life free of violence



Ensure adolescents' entry, reintegration, and permanence, especially those who are mothers and fathers to the educational system.

Implement a comprehensive sexuality education program based on rights and international standards and for the forecasting of gender-based violence.

Implement mechanisms for adolescents' participation to exert their sexual and reproductive rights and a life free of violence.

Implement strategies that encourage healthy habits and lifestyles and positive development in adolescents



Long-Term

Community Goal

Pregnancy prevention in adolescents is possible with social participation, education, and respect for human rights to avoid premature and low birth weight babies to reduce infant mortality.

Monitoring and Evaluation Methods

Monitoring will be considered the process that allows the collection, analysis, and use of information to monitor the progress of the PPPCA and the process that would enable timely decision-making and the implementation of rapid improvement cycles to achieve the outcomes.

The monitoring process will address the outcomes requested in the PPPCA regarding how, when, and where the activities scheduled by each Department will take place, how it is executed, and how many people or entities will benefit. The monitoring process is carried out once the program begins and will continue throughout the implementation period, annually and at the end of the PPPCA term. Additionally, the evaluation will be considered the process that materializes in the expected and achieved achievements of the PPPCA as a systematic and objective procedure. The essential function of the evaluation is to determine whether the implementation of the PPPCA is effective. If not, then it would be necessary to decide on the mechanisms for improvement; seeking timely and creative ways to overcome the limitations involves the analysis of capacities, technical and political resources invested, and the specific results of its implementation. The monitoring and evaluation processes will observe and analyze the results obtained from the performance of the PPPCA to determine if the programmed and executed interventions achieved the proposed objectives and to what extent they were achieved. The Inter-Institutional Committee for the Prevention of Pregnancy in Children and Adolescents (IICPPPCA) will establish coordination, cooperation, communication, monitoring, and evaluation mechanisms. Likewise, the IICPPPCA will jointly integrate a Monitoring and Evaluation Plan based on the PPPCA operational plan.

Logic Model

Resources

Activities

Outputs

Short-Medium- & Long-Term Outcomes

Impact

To accomplish our set of activities, we will need the following:

To address our problem, we will conduct the following activities:

We expect that once completed or underway; these activities will produce the following activities:

We expect that if completed or ongoing, these activities will lead to the following changes in 1-3 (weeks/months/years):

We expect that if completed, these activities will lead to the following changes in 7-10 (months/years):

The participation of the following organizations and agencies.

American Academy of Pediatrics

American Pregnancy Association

Centers for Disease Control and Prevention (CDC)

Center for the Study of Social Policy

Child Care Aware of Washington

Substance Abuse and mental Health Services Administration (SAMHSA)

Washington State Board of Education

Washington State Department of Health

Washington State Human Rights Commission

U.S. Department of Justice

Washington State Department of Social and Health Services

Washington State Department of Commerce

Washingtons State Department of Children, Youth and Families (DCYF)

United Nations; Sexual and Reproductive Health Agency (UNFPA)

Work on creating an Inter-institutional PPPCA Committee

Responsible for organizing, complying, monitoring, evaluating, adapting, and scaling the PPPCA

Create an Impact Framework, structured but flexible

Program development, implementation, monitoring, evaluation, and fast-cycle iteration.

Work on public policies to prevent pregnancy and gender-based violence in children and adolescents

Address the prevention of pregnancy in children and adolescents according to international standards

Increase the number of schools that incorporate Comprehensive Sex Education based on international rights.

Guarantee the performance of comprehensive sexuality education based on international rights

Increase the number of institutions that provide adolescent-friendly comprehensive care, including sexual and reproductive health.

Guarantee adolescents' access to adequate and comprehensive care in sexual, mental, and reproductive health.

Increase contraceptive methods, including long-acting reversible methods in adolescents aged 15 to 19 years.

Guarantee the comprehensive health, emotional and social protection of pregnant children under 14 years old.

Guarantee the rights of adolescents in situations of vulnerability, especially pregnant adolescents under 14 years of age, victims of violence, and children with special needs.

Increase the number of complaints of sexual violence against children and adolescents and solve them in the justice system

Straighten information systems on pregnancy and sexual violence in children and adolescents.

Implemented public policies based on research and strengthened information systems on pregnancy and sexual violence in children and adolescents.

Develop evidence for decision-making about pregnancy in children and adolescents.

Increase community participation.

Work to change negative socio-cultural patterns that limit the experience of sexuality, sexual health, and reproductive health and naturalize gender-based violence in children and adolescents

Create spaces for community participation in the prevention of pregnancy in children and adolescents

Decrease negative socio-cultural patterns regarding sexuality and increase sexual rights, reproductive rights, and the right to a life free of violence.

Promote the change of negative socio-cultural patterns linked to gender-based violence and teenage pregnancy.

Strengthen the promotion of sexual rights, reproductive rights, and the right to a life free of violence in community spaces.

Work to guarantee adolescents' entry, reintegration, and permanence in the educational system until they finish their high school. Create a mentor program to support their education.

Guarantee the adolescents' access and completion of their high school

Increase the number of adolescent parents with a high school diploma

Promote the inclusion and permanence of adolescents in the educational system

Increase the number of pregnant mothers and fathers with a high school diploma

Promote adolescent mothers and fathers' entry, insertion, and continue in the educational system with the support of mentors

Work to promote safe family environments and strengthen protective factors for the comprehensive development of sexuality in children and adolescents.

Develop favorable environments in the family for the prevention of pregnancy in children and adolescents

Prevent domestic violence and gender-based violence

Promote respect within the family as a strategy for developing comprehensive sexuality, the prevention of pregnancy in children and adolescents, and gender-based violence.

Work so that adolescents can have sexual and reproductive rights

Strengthen the participation of adolescents in decision-making about their sexuality

Increase the number of adolescents

utilizing their sexual and reproductive rights and a life free of violence.

Strengthen the adolescents' involvement to promote the use of sexual and reproductive rights and a life free of violence

Work to promote positive health and development in adolescents

Strengthen the comprehensive individual development of adolescents and prevent premature birth, low birth weight, or infant deaths

Increase the strategies that encourage healthy habits, a healthy lifestyle, and growth in adolescents

Implement strategies that contribute to the positive development of adolescents, promote their life projects, and reduce unplanned pregnancy, infant mortality, and the birth of premature or low birth weight babies.

Reduction of premature and low birth weight babies born and thus infant mortality.

Key Stakeholders

American Academy of Pediatrics
American Pregnancy Association
Centers for Disease Control and Prevention (CDC)
Center for the Study of Soci9al Policy
Child Care Aware of Washington
Substance Abuse and Mental health Services Administration (SAMHSA)
Washington State Board of Education
Washington State Department of Health

Washington State Human Rights Commission

U.S. Department of Justice

Washington State Department of Social and Health Services

Washington State Department of Commerce

Washingtons State Department of Children, Youth and Families (DCYF)

United Nations; Sexual and Reproductive Health Agency (UNFPA)

Inter-Institutional Committee for the Prevention of Pregnancy in Children and Adolescents (IICPPPCA)

Evaluation Questions

The Inter-Institutional Committee for the Prevention of Pregnancy in Children and Adolescents should answer the following question.

Is compliance with the results indicators monitored?
Were the progress and implementation processes of the PPPCA evaluated to establish the appropriate improvements and guarantee an effective implementation?
Was PPPCA implementation progress reported periodically?
Who benefited the most from the PPPCA?
For whom does the PPPCA work or not work, and what contexts?
Were the strategies used in the PPPCA flexible and acceptable?
Did the PPPCA strategies result in expected outcomes?
Did the short-medium term outcomes predict expected changes in the impact?
How the PPPCA was delivered, who benefited most, and who helped least?
Is the PPPCA feasible and effective at scale?

Evaluation Method

The IICPPPCA will create a process for evaluation with the following considerations,

Investigate what, how, from whom, and in what contexts the PPCA work.
Not to prove that the PPPCA works but to learn what does and doesn't work to improve the program.
Gather information or data to answer specific questions
Assure that the PPPCA strategies are feasible and acceptable
Assure that the PPPCA strategies result in the expected improvement in short-medium- and long-term outcomes.
Follow the path of the evaluation stages as follows.
- Planning and development
- Process evaluation
- Outcome evaluation
- Scaling
Acquire or develop appropriate data collection measures
Develop guidance documents for recruitment, data collection, management, and analysis
Decide who will recruit participants and collect data
Choose ethical implications and determine if it is necessary to review or approve from the members of the Committee
Generate research questions and select the appropriate evaluation stage
Use learning cycles of testing to refine measures if needed
Consider ethical implications by choosing data collection measures that are culturally relevant and appropriate for language and literacy.
Cost-effective
Use a mix of qualitative and quantitative options
Provide adequate training on data collection procedures
Plan regular check-ins to address issues promptly

Budget

What?

Who?

When & Where?

How Much?

Why?

Present the PPPCA

Stakeholders

After every agency and organization receive the PPPCA, will be a meeting to explain and create the IICPPPCA.

Where? Seattle, WA.

$1,000.00 for planning, promotion, and organization of the meeting.

Present the PPPCA

Create the IICPPPCA

Stakeholders

July 2022

Seattle, WA

$5,000.00 for meeting expenses

Develop the IIPPPCA

IICPPPCA

December 2022, Seattle, WA

$1,000.00 for meeting expenses

Prepare for implementation of the PPPCA

IICPPPCA

March 2023,

Seattle, WA

$1,000.00 for meeting expenses

Provide updates of work done and inform the budget needed to implement the PPPCA.

Child Welfare Information Getaway. (2015). Promoting protective factors for pregnant and parenting teens. U.S Department of Health and Human Services Administration for Children and Families Administration on Children, Youth and Families Children's Bureau. Retrieved January 7, 2022, from https://www.childwelfare.gov/pubPDFs/guide_teen.pdf.

Bearinger, L. H., Sieving, R. E., Ferguson, J., & Sharma, V. (2007). Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. Lancet (London, England), 369(9568), 1220–1231. Retrieved from https://doi.org/10.1016/S0140-6736(07)60367-5

Patton, G. C., Coffey, C., Cappa, C., Currie, D., Riley, L., Gore, F., Degenhardt, L., Richardson, D., Astone, N., Sangowawa, A. O., Mokdad, A., & Ferguson, J. (2012). Health of the world's adolescents: a synthesis of internationally comparable data. Lancet (London, England), 379(9826), 1665–1675. https://doi.org/10.1016/S0140-6736(12)60203-7

Sexual & Reproductive Health. United Nations Population Fund. (2016). Retrieved February 2, 2022, from https://www.unfpa.org/sexual-reproductive-health#readmore-expand

World Health Organization. (2020). Adolescent pregnancy. World Health Organization. Retrieved February 2, 2022, from https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy

Patricia coss-Maxwell

Community Action Plan