Women’s Health and Wellness Promotion Paper

Family Planning

The women’s health and wellness promotion subject chosen from Healthy People 2020 is

family planning. Specifically, sexually active females aged 15-19 years who use a condom and

hormonal or intrauterine contraception at first intercourse. (Healthy People 2020, 2017)

Review of Literature

The study done by the CDC and the U.S. Office of Population Affairs in October 2015 states that over the last 20 years 50% of all pregnancies are unintended. The recommendation is to offer long acting reversible contraception methods (LARC) such as IUD’s or implants. LARC is highly effective and does not depend on the user to remember to take it or use it daily. The article stated IUD and LARC is 20 times more effective than the pill, patches or the ring. It also reduces repeat pregnancy soon after delivery or after abortions in young teens. That would also be an opportunity to test for STD/STI’s and give education regarding STD/STI’s. With the Affordable Care Act most contraceptives are covered at little or no cost to the patient.

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According to our text book Adolescent and Young Adult Health Care Practical Guide 6^th ed. Neinstein, Lawrence S. (2016) Family planning is one of the 10 great public health achievements of the 20th century. “The availability of family planning services allows individuals to achieve desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families”. (Neinstein, 2016) Neinstein also stated that the earlier that an adolescent transition to living independently and has financial autonomy or is in an intimate relationship it is associated with poorer adult outcomes. This can lead to anxiety and poor health choices including criminal behavior, substance abuse, lower socioeconomic status, unemployment and divorce if married in teen years. Early independence can also lead to poorer outcomes for chronic diseases such as diabetes, that can affect fertility or a high-risk pregnancy.

According to Healthy 2020, family planning is very important to a women’s overall health and wellness. Family planning is important because it allows prevention of unwanted or unintended pregnancy, and a decrease of sexually transmitted diseases. Family planning also impacts the risk of acquiring a STD/STI. This can affect future fertility. An unintended or unwanted pregnancy can cause loss of freedom and increased responsibility of early parenthood, which can increase the risk for depression, increase risk of physical violence during pregnancy, reduce likelihood of breastfeeding and delays in initiating prenatal care. This can lead to birth defects, low birth weights and other health issues for the newborn. It also increases the mortality/morbidity for women and infants. Early parenthood is associated with health risks, due to lack of maturity, resources, social support and can led to social isolation. Although adolescent birth rates declined by more than 61% during 1991–2012, the United States has one of the highest adolescent pregnancy rates in the developed world, with >700,000 adolescents aged 15–19 years becoming pregnant each year and >300,000 giving birth. (CDC 2018) Approximately one of eight pregnancies in the United States results in a preterm birth, and infant mortality rates remain high compared with other developed countries. Even though pregnancy rates have dropped research suggests the decline is due to an increase in percentage of adolescents waiting to have sexual intercourse and increased use of effective contraceptives.

It also impacts our economy and social system. Having an unintended pregnancy can lead to a decrease in potential income earning, ongoing federal/state assistance for longer periods of time. Which adds to the cost for state and federal care and increase in taxes. It is estimated that the cost of unattended pregnancy cost of $21 billion in 2010. (Healthy People 2020, 2017) This money could be better utilized in education or other health issues within the community or state. It also impacts men by decreasing income potential, they are more likely to be incarcerated and the daughters of adolescent parents can repeat the cycle of adolescent motherhood. Also, children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems. It would be beneficial to society and future generations to be able to have access to family planning (Healthy People 2020, 2017) This may be the first encounter for a young woman into the health care system and the earlier she can get the correct information the better physical and social health she can achieve. The goal is to” improve pregnancy planning and spacing, and prevent unintended pregnancy” (Healthy People 2020, 2018).

Women are key to maintaining the health of families and are primary care givers for children. By having early care and ease of access is vital to future generations. An unintended or intended pregnancy can be a significant event in the life of young women. By increasing the awareness of the importance of preconception healthcare and ease of access to care allows women to utilize family planning, contraception and prevention of STI’s. It allows them to finish their education and be financially independent and be able to care for their families. The goal is to increase awareness of services by community outreach and improved collaboration between health care providers. (Breshears Wheeler, Foreman, Rueschoff, 2013)

The APRN’s impact on women’s health promotion can be tremendous. By offering family planning services the APRN can offer pregnancy test and counseling, basic infertility services, prevent unintended or unwanted pregnancies and decrease the number of abortions per year. By educating patients on different methods of contraception these young women would be able to finish their education, thereby better job/income opportunities. Decreasing the burden on federal, state, and local agencies. Decrease the rate of STD/STI infections and HIV by providing prevention education, counseling, testing and referral when needed. Contraceptive services can include pregnancy testing, counseling including preconception health services, breast and pelvic exams, breast and cervical cancer screenings. Broader reproductive health services, including patient education and counseling that can also include young males and parents of preteens. Educating pediatricians on reproductive health of their patients and referring to OB/Gyn that provide appropriate family planning if they choose not to counsel on reproductive health.

Community and in school clinics in collaboration with health care providers need to reach out and promote the importance of preconception care. Preconception care has been defined as “a set of intervention designed to identify and reduce risks to a women’s health and improve pregnancy outcomes through prevention and management of health conditions. Preconception care can significantly reduce birth defects and disorders caused by preterm birth”. (Healthy People 2020, 2018)

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Several things can be done to make access to care easier for young adults or teens interested in family planning, by locating clinics in low income communities so transportation is not an issue. The hours that clinics are open. Clinics in schools. Theses clinics also need to include males in family planning. Having information available at schools, and community centers where kids are, will be able reach all ages. Making the public aware of funded services, access to insurance that is not financially out of reach for young adults. The NP can get involved in policy making for health care by advocating for family planning in schools and expanding Medicaid for women of reproductive age. The NP can also get involved in research through funding programs by the Health and Human Services to present the best evidence-based approaches to family planning and contraceptive health of women. The NP should also make adolescents and young women aware of their state laws regarding access to care and confidentiality when it comes to family planning.

A great deal of attention is given to the health of young children, who are generally well-understood to be in a critical developmental period by both health practitioners and the public. What is often overlooked is the importance of adolescent development. The Teen Pregnancy Prevention program is just one of the Office of Adolescent Health’s efforts to address Congress’ call for new attention to the adolescent years as a critically important decade. (Kappeler, Feldman Farb, 2014) The tools, resources, lessons learned in undertaking such a program, and ultimately the results of the numerous rigorous outcome evaluations within OAH, and in collaboration with our partner offices within HHS, will be shared with those working toward improving the health of adolescents. Together, great progress is being made toward improving the lives of our country’s adolescents and putting them on a path to healthy adult years. Contraception should be integrated into every primary care visit for women. It should not be limited to one single visit but continued thru the lifespan of reproduction. Family planning should be based on the patient’s personal values and life plan because of the impact it can have on their future. The health care providers must reach out to all women or they do a great disservice for our future and economy. The evidence is there to see, it is time to face the reality of family planning.

References

Breshears Wheeler, Jennifer; Foreman, Megan; Rueschoff, Austin (2013) Improving Women’s Health and Health Challenges, Access and Prevention June 2013. Retrieved from http://www.ncsl.org/documents/health/ImprovingWH613.pdf
Centers for Disease Control (2017) Family Planning. Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/mm6509a3.htm
Gavin L, Pazol K. Update: Providing Quality Family Planning Services — Recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:231–234. DOI: http://dx.doi.org/10.15585/mmwr.mm6509a3.
Kappeler, Evelyn M ., Feldman Farb, Amy (2014) Teen pregnancy; Evidence-based programs; Adolescent health; Program implementation. Journal of Adolescent Health 54 (2014) S3eS9.
Neinstein, Lawrence S. (2016) Adolescent and Young Adult Health Care A Practical Guide 6^th edition. Wolters Kluwer.