Reducing Teen and Unplanned Pregnancy to Strengthen the Future ...

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costs taxpayers at least $10.9 billion annually.3 Less than half of teen parents ... either through their own employer o
Reducing Teen and Unplanned Pregnancy to Strengthen the Future Workforce 1

For the first time in history, America’s college-age generation is less well-educated than that of its parents. 2 Every day about 7,000 students drop out of high school, totaling 1.2 million students each year. This results in fewer workers with meaningful skills available in the job market and an estimated annual loss of $319 1 billion in potential earnings. One of the major factors in this reversal of a higher educational level is teen pregnancy, with 30% of teen 3 girls citing pregnancy or parenthood as a key reason for dropping out of high school. Thus, one powerful way to ensure that women complete their education, and, as a result, strengthen the emerging workforce, is to help teenagers and women avoid too-early pregnancy and unplanned parenthood. Teen childbearing 3 costs taxpayers at least $10.9 billion annually. Less than half of teen parents (40%) go on to finish high 3 school, and less than 2% will complete college by the time they turn 30. Considering the fact that 59% of all women in the United States are covered by job-based health coverage, either through their own employer or their spouse's, businesses can play an important role in preventing teen 4 pregnancy and encouraging planned pregnancies. In the first three months of 2011, more than half (53%) 5 of adults ages 19–25 were covered by a private plan. Though the teen birth rate in the U.S. dropped to its lowest level in nearly 40 years, it is still almost three times that of Germany and France, and over four times 6,7 that of the Netherlands.

What Employers Can Do Understand Your Employee Demographics. It is important to know who is covered under your health plans as employees and beneficiaries. For example, is your workforce primarily women, or is it mostly men over the age of 40? Almost half (49%) of pregnancies in the U.S. are unplanned as reported by women 3,28 With the Affordable themselves, including four in ten women in their late 20s (ages 25–29) (see Figure 1). Care Act expanding health insurance coverage up to age 26, dependents may become parents with increasing frequency. Figure 1: Percent of Unplanned Pregnancies by Age Group

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Share the Data on Unintended Pregnancies. Half of women in the U.S. have a child by age 26, and half of men by 8 age 28.5. A child born as the result of an unintended pregnancy is at greater risk of poor pregnancy outcomes, such as premature birth and low-birth weight. Babies who are born early or too small have a greater chance of dying in their first year of life and suffering short- or 29 long-term health consequences. In addition, children born as a result of unintended pregnancy are at greater risk 29 for abuse and neglect.

This Tip Sheet was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2012 National Business Group on Health.

Verify and Communicate that Contraception is Covered. Currently, 28 states require insurance policies that cover other prescription drugs to also cover all FDA-approved contraceptive drugs and devices, as well 20 as related medical services. Most large employers currently offer this. The Patient Protection and Affordable Care Act of 2010 requires new private health plans written on or after August 1, 2012, to cover contraceptive counseling and services and all FDA-approved methods without out-of-pocket costs to patients 20 (with a few exemptions). Research shows that the long-term decline in teen pregnancy, birth and abortion rates was driven primarily 6 by improved use of contraception among teens. Teen girls have patterns of contraceptive use similar to 21 women in their twenties. Oral contraceptives—the mostly commonly used reversible contraceptive method in the U.S.—save almost $13,000 over a five-year period, when compared with the direct medical costs of 30 the unintended pregnancies that would otherwise occur. For a large employer, the average costs associated with the birth of a healthy baby (prenatal care, delivery and newborn care for one year following 31 birth) are at least $10,000, compared with $300–$350 per year for oral contraceptives. While the monthly cost of contraception for women ranges from $30 to $50, insurers and experts agree that savings more than 22 offset the cost. Develop a ‘Preparing for Pregnancy’ Preconception Program. Employers can help employees prepare for pregnancy and offer contraceptive counseling such as information about preconception care and how to time and space pregnancies. This would help women Folic Acid’s Role in Helping to Prevent prevent pregnancy if they are not ready to have children. Birth Defects Employers should consider implementing a program about preparing for pregnancy that is targeted to all women of childbearing age. Since intention does not always play a Neural tube defects (NTDs) are among the role in pregnancy, all women ages 15-44 are considered to most common group of serious birth defects.25 be in the preconception period. Ideally, the program would Folic acid has been shown to reduce include nutrition counseling, adequate exercise, disease effectively the risk of NTDs; 50% to 70% of management, evaluation of medications, family history cases of NTDs could be prevented by the 9 evaluation and genetic counseling. Health coaches, appropriate consumption of folic acid before Employee Assistance Program (EAP) staff, case managers conception and during early pregnancy.26 In and the use of online resources can increase the bandwidth 1992, the U.S. Public Health Service of these messages.

recommended that all women capable of

becoming pregnant consume 0.4 mg of folic Create and Emphasize a Robust Prenatal Program. Due to the frequency and cost of complications, pregnancy is the acid daily to reduce their risk for having a 10,11 Many of largest single health claim for many employers. pregnancy affected by NTDs. 27 the excess costs that come from complications--such as low-birth weight, preterm delivery and elective Caesarean At American Express, folic acid is covered as sections--could be avoided through better pregnancy a free preventive medication under the planning/spacing and high-quality prenatal care and consumer-directed health plan. education. For example, studies show a positive relationship between comprehensive prenatal care and a reduction in 12 low-birth weight and infant mortality. Mothers who receive no prenatal care have an infant mortality rate 13 over five times that of mothers whose prenatal care is initiated in the first trimester of pregnancy. In addition, one of the main predictors of an early start to prenatal care is a planned, intentional pregnancy, which reinforces the value of helping women avoid unplanned, unintended pregnancies. Incorporate Healthy Pregnancy Best Practices into Plan Design. These include the following: • Provide incentives (e.g., a baby car seat, a gift certificate to a retail store) for employees to report their pregnancies to their health care plans or health professionals; also, offer a way for women to give this information to a third party, in case employees are hesitant about letting their supervisors know they are pregnant; • Lower their cost sharing or provide incentives for women who participate in prenatal education programs; • Emphasize available benefits of tobacco cessation and alcohol/drug screening, counseling and treatment so that women can cease using these substances before becoming pregnant, or as soon as possible once pregnancy is known; and This Tip Sheet was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2012 National Business Group on Health.

• Provide women with educational materials and decision aids, such as Wal-Mart does through its Life With 14 Baby program. Emphasize the Importance of Full-Term Pregnancies. The children of teen mothers are at significantly 15 increased risk of low-birth weight, prematurity and mental retardation. Mothers ages 16 or younger have nearly a twofold increased risk of very preterm birth (33 weeks gestation or earlier) when compared to young 16 adult women ages 21-24. In addition to greater risks for preterm births, the average hospital stay at birth is significantly longer and more costly: 8.8 days for preterm infants, with average cost of $26,054, versus 2.2 17 days for babies at term, with average cost of $2,061. The most important action a woman can take to prevent preterm labor is to enter prenatal care as early as possible in her pregnancy, and to have regular 12 care for the duration.

In 2003, Save-A-Lot - the nation's seventh largest grocery chain under a single banner - made The National Campaign to Prevent Teen and Unplanned Pregnancy’s guide, "Parent Power: What Parents Need to Know and Do to Prevent Teen Pregnancy,” available to its 9,000 employees. Practical, easy-to-use and designed specifically for parents, the guide continues to be distributed with Save-A-Lot’s benefits information and through its EAP.17 An updated brochure, “10 Tips for Parents,” is now available.

Connect with Employees as Parents (and Grandparents). Parents have a very powerful role to play in helping their children avoid early pregnancy and parenthood. Teens who are close to their parents and feel supported by them are more likely to abstain from sex, wait until they are older to begin having sex, have fewer sexual partners, and 18 use contraception more consistently. Forty-six percent of teens say that their parents have the most influence on their sexual decisions. Six in ten teens (62%) wish they were able to talk more openly with 18 their parents about relationships. Host a “lunch ‘n learn” or brown bag series on parenting and adolescents. Work with your EAP and provide materials on communicating honestly and effectively with teenagers and young adults.

Include Adolescent Medicine Specialists as Providers. Adolescent medicine specialists are pediatricians, internists or family medicine practitioners who have undertaken an additional three-year fellowship in adolescent health care. A study of more than 6,700 teenagers found that one-third did not get the medical care they needed, often because they were afraid to tell their parents about 23 health-related problems, such as depression, conflicts in regard to sexuality or puberty-related concerns. Making these providers available in network may help young adults find the information and care they need to avoid unintended pregnancy, and also help them focus on completing their education. Highlight these providers in enrollment materials.

Resources •

Child and Adolescent Health. National Business Group on Health.



Health Tips: Preterm Birth and Elective Labor Induction Prior to 39 Weeks. National Business Group on Health, March 2012.



Issue Brief: Preventing Premature Birth: Having Healthier Babies and Lowering Employer Costs. National Business Group on Health, January 2011.



The National Campaign to Prevent Teen and Unplanned Pregnancy.



Guttmacher Institute: Adolescents.

This Tip Sheet was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2012 National Business Group on Health.

Health Tips April 2012

Reducing Teen and Unplanned Pregnancy to Strengthen the Future Workforce This Health Tips was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2012 National Business Group on Health.

Written by: Penney S. Berryman, M.P.H. Acknowledgments: Reducing Teen and Unplanned Pregnancy to Strengthen the Future Workforce was generously funded by Grant #G96MC04447 from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. All materials are in the public domain. Additional copies of this Health Tips are available at www.businessgrouphealth.org or by contacting [email protected] for more information.

About the National Business Group on Health The National Business Group on Health (the Business Group) is the nation’s only non-profit organization devoted exclusively to representing large employers’ perspective on national health policy issues and providing practical solutions to its members’ most important health care and health benefits challenges. Business Group members are primarily Fortune 500 companies and large public-sector employers— representing the nation’s most innovative health care purchasers—that provide health coverage for more than 55 million U.S. workers, retirees and their families. The Business Group fosters the development of a safe, high-quality health care delivery system and treatments based on scientific evidence of effectiveness. Business Group members share strategies for controlling health care costs, improving patient safety and quality of care, increasing productivity and supporting healthy lifestyles.

Health Tips Cassell & Fenichel Communications, L.L.C., Publications Management National Business Group on Health

20 F Street NW, Suite 200 • Washington, DC 20001 Phone (202) 558-3000 • Fax (202) 628-9244 • www.businessgrouphealth.org Helen Darling, President, National Business Group on Health

National Committee on Child and Maternal Health Joseph Hagan Jr, M.D., American Academy of Pediatrics; Wayne Burton, M.D., American Express; Martín-J. Sepúlveda, M.D., IBM Corporation; Daniel Conti, Ph.D., JPMorgan Chase; Sharon Adamo, Isadora Hare, David Heppel, M.D., Maternal and Child Health Bureau; Diane Avellar, Rose Umile, Raytheon Company

Cassell & Fenichel Communications, L.L.C., Publications Management

This Tip Sheet was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2012 National Business Group on Health.

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This Tip Sheet was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2012 National Business Group on Health.