COMMENTARY

Teen Pregnancy and Reproductive Health

Wanda D. Barfield, MD, MPH

Disclosures

August 29, 2011

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Hello, I am Wanda Barfield, Director of CDC's Division of Reproductive Health, and I'm pleased to speak with you today as part of the CDC Expert Commentary Series on Medscape.

We know that you are aware of the persistent problem of teen pregnancy in the United States -- perhaps seeing it in your patient population and in the community. Most teen pregnancies are unintended -- the result of not using a contraceptive or not using one correctly and consistently.

Clinicians have a special role to play in helping to reduce teen pregnancy in our nation. That's why I am going to talk about simple things that we can do to help teens avoid unintended pregnancy.

The first thing we must do, as clinicians, is recognize that age is not a contraindication for many highly effective modern contraceptives. Our recent publication in CDC's weekly report looks at Medical Eligibility Criteria for Contraceptives -- better known as the MEC. It reported findings from a systematic review of the literature. The findings confirm that young women can use almost every form of birth control.

Then we must eliminate barriers to teens getting the information and services they need. Numerous professional organizations as well as the US Public Health Service recommend that we not miss opportunities to help teens adopt healthy behaviors. In this case, ask teens about their past and current sexual and reproductive history during clinical visits. That's the starting point of an ongoing conversation about sexual and reproductive health, including the importance of healthy relationships and the benefits of contraceptives to prevent unintended pregnancy, sexually transmitted diseases (STDs), and HIV. You can use data from the MEC to discuss contraceptive failure rates so that a teen can understand the probability of unintended pregnancy associated with each method type.

We also know that there are conditions associated with adverse health events as a result of unintended pregnancy or that may lead to a high-risk pregnancy. This is important if your female patient has, for example, a history of epilepsy, HIV/AIDS, sickle cell disease, lupus, organ transplant, or bariatric surgery. Remember, young women living with these conditions may become sexually active -- either now or later in life.

Don't forget to talk with young men about their sexual health and responsibilities as sexual partners. Teach them the facts about contraceptives and safe sex practices. Encourage them to adopt practices to protect themselves and their sexual partners from unintended pregnancy, STDs, and HIV.

Also, take a good hard look at your office and clinical practices. Do you remove barriers to teens getting information and contraceptives? Remember, today's teens need information about sex and contraceptives. One example is the use of emergency contraception. Again, we have information about it in our MEC, and we agree it should not be used as a substitute for routine and correct use of modern contraceptives.

Teens will respect us when we talk with them -- yes, talk with them -- about the challenges and responsibilities that come along with sexual relationships. They depend on us to protect their future and their health.

To learn more about our programs, our scientific evidence, and resources on adolescent reproductive health, visit www.cdc.gov/teenpregnancy .

Web Resources

Centers for Disease Control and Prevention (CDC). Teen pregnancy. Available at: http://www.cdc.gov/TeenPregnancy/index.htm Accessed August 15, 2011.

girlshealth.gov. Available at: http://www.girlshealth.gov/ Accessed August 15, 2011.

US Department of Health & Human Services. Office of Adolescent Health (OAH). Available at: http://www.hhs.gov/ash/oah/ Accessed August 15, 2011.

MedlinePlus. Teenage pregnancy. Available at: http://www.nlm.nih.gov/medlineplus/teenagepregnancy.html Accessed August 15, 2011.

Centers for Disease Control and Prevention (CDC). Preventing teen pregnancy in the US. Available at: http://www.cdc.gov/vitalsigns/TeenPregnancy/index.html Accessed August 15, 2011.

American Congress of Obstetrics and Gynecologists. Patient education pamphlets and fact sheets. Available at: http://www.acog.org/publications/patient_education/ Accessed August 15, 2011.

Wanda D. Barfield, MD, MPH , was selected as the new Director of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, at the US Centers for Disease Control and Prevention (CDC) in June 2010. With a staff of over 180 members and a budget of approximately $57 million, she is responsible for promoting optimal reproductive, maternal, and infant health and quality of life through research, surveillance, and partnerships. The Division's top-priority areas include women's and global reproductive health, maternal health, infant health, and unintended pregnancy prevention.

Dr. Barfield joined the CDC in 2000 as a member of its prestigious Epidemic Intelligence Service. Dr. Barfield worked in the area of racial disparities in preterm delivery and infant health. In 2003, she was assigned to the Massachusetts Department of Public Health as a CDC Maternal and Child Health (MCH) Epidemiology Field Assignee where she focused on improving and creating equitable perinatal systems of care. She returned to Atlanta, Georgia, in 2006 and became Team Leader for the MCH Epidemiology Program in the Division of Reproductive Health. In this role, she created an Atlanta-based technical and program support structure to assist in the advancement of MCH epidemiology capacity building nationwide. Through the assignment of senior MCH epidemiologists and CDC-sponsored MCH fellows from the Council of State and Territorial Epidemiologists (CSTE), she built capacity at the state, tribal, and local levels. Her development of a mentor-based structure for scientific leadership is a model for other CDC Field Assignee programs. She also worked to build and strengthen effective partnerships with MCH organizations such as the Health Services Resources Administration/Maternal and Child Health Bureau. As a result of numerous federal, state/tribal/local, academic, and private partnerships and collaborations, the field of MCH Epidemiology has increased its capacity by 55% since 2004.

Dr. Barfield is a Captain in the US Public Health Service; Adjunct Associate Professor of Pediatrics at Boston University School of Medicine, Boston, Massachusetts; and Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Barfield is a Fellow in the American Academy of Pediatrics and serves as the CDC Liaison to the American Academy of Pediatrics (AAP), Committee on Fetus and Newborn. Her research includes over 50 peer-reviewed publications on informing policy in the area of racial disparities in perinatal mortality and early child health service utilization; improving access to risk-appropriate perinatal services; and advancing the quality of women's, maternal, and child health data through longitudinal linkage.

Prior to the CDC, Dr. Barfield served as a US Army Officer and Director of the Neonatal Intensive Care Unit at Madigan Army Medical Center in Tacoma, Washington. She received her bachelor of science degree in biology from the University of California, Irvine, and her medical and public health degrees from Harvard University, Boston. She completed a pediatrics residency at Walter Reed Army Medical Center, Washington, DC, and a neonatal-perinatal medicine fellowship at Harvard's Joint Program in Neonatology (Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, and Children's Hospital, Boston). She is a practicing neonatologist, board certified in both general pediatrics and neonatal-perinatal medicine.

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