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Lack of Access to Health Care Part of the Teen Pregnancy Puzzle

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In case you feel like you've been missing something since the last season of Teen Mom 2concluded just a few weeks ago, never fear. In a mere matter of days, yet another incarnation of the series will premiere.

Really, the popularity of the show, (a spin off of MTV's earlier, 16 and Pregnant) is not all that surprising given the fact that America is the leader in teen pregnancies and births among all fully industrialized nations.

This first place billing is nothing new and neither are attempts to address it. Throughout much of the 1990s and early 2000's those hoping to lower teen pregnancy rates tried to do so through education. Some, like myself, favored a comprehensive approach. Other adopted the abstinence-only method. Abstinence was a proven disaster, and while I stand by the material I still teach, I know it isn't enough.

Others agree, and in recent years more attention has turned to the external forces that may contribute to teen pregnancies.

Last week, for example, researchers from the University of Pennsylvania shared the findings of their research. These demonstrated a clear link between teen pregnancy and low levels of literacy in pre-teen girls.

There has also been a fair amount of research into poverty and teen pregnancy. A report released in March by Auburn University showed that areas with high poverty levels and low educational attainment among women also have a high rates of teen pregnancy and births. Earlier studies have looked at the relationship between poverty and low self-esteem, something that can make girls less likely to use birth control.  Additionally, there has been a discussion of the fact that poor girls are less likely to have abortions, which are often too expensive, or deeply stigmatized in many of their communities.

To be sure, these are important findings, but they aren't enough.

There is something else at play here, and that is the simple fact that a huge number of girls don't have access to the most basic preventative reproductive health care. Now so long as the Affordable Care Act--the future of which will be a little clearer on Tuesday--is upheld, hopefully that will begin to change, since this legislation is key both in terms of coverage for contraception, and in terms of getting teens covered themselves. (Appallingly, in 2010 almost 10% of the under 18 population had no health insurance!).

But even girls with insurance can find it challenging to prevent pregnancies.

Suburban and rural teens are often unable to travel to the doctor without their parents, and teens fearing that doctors won't respect their privacy may avoid needed visits altogether. Additionally, a significant number of drug stores refuse to sell teens condoms and emergency contraception.

In these situations, no amount of money, no level of confidence, and no style of sex education alone can truly prevent teen pregnancy.

So what can? As studies have found, abstinence-only education is a failure. What we need is to ensure that teens not only receive accurate information in the form of comprehensive sex education, but that that they are also able to put what they have learned into practice. This can be done by making reproductive health care and birth control easily available to them.

Increasing the use of school based health centers is one way to start. We also need to see legislation permitting girls under 18 to obtain emergency contraception without a prescription. Additionally, retailers must be required to respect laws mandating that they sell condoms regardless of age, and doctors need to be counseled on the importance of maintaining a minor's confidentially.

As teenage girls will tell you, knowledge is power and confidence is key, but when it comes to avoiding pregnancy, the importance of access to solid health care and contraception can't be ignored.