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Article

Kathleen A. Rounds and Traci L. Wike

Although rates of adolescent pregnancy have exhibited a downward trend since 1991, the United States continues to have a significantly higher rate than other industrialized nations. Adolescent pregnancy, especially in early and middle adolescence, has long-term developmental and economic impact on the teen and her child, in addition to high social costs. This entry describes the current trends in adolescent pregnancy in the United States, and examines factors reported in the research literature as associated with adolescent pregnancy, discusses federal policy directed toward adolescent pregnancy prevention, and identifies various intervention programs.

Article

Carol M. Lewis and Shanti Kulkarni

Despite downward trends in the U.S. teen birth rate overall, the associated social and economic costs are still significant. Historically, teen pregnancy prevention policy and program adoption have been influenced by the sociopolitical environment at national, state, and local levels. Recent federal efforts have begun to re-emphasize the importance of developing and supporting evidence-based prevention efforts. Current teen pregnancy prevention approaches are reviewed with attention to the range of program philosophies, components, settings, populations served, and documented effectiveness. Promising directions in pregnancy prevention program development for adolescents are also highlighted.

Article

In American cinema from 1916 to 2000, two main archetypes emerge in portrayals of women seeking abortion: prima donnas and martyrs/victims. While the prima donna category faded over the course of the 20th century, study of abortion in American cinema from 2001 to 2016 shows that the victim archetype persists in many films. Women who have abortions are cast as victims in films across a variety of genres: Christian, thriller, horror, and historical. Some recent films, however, namely, Obvious Child (2014) and Grandma (2015), reject this hundred-year-old tendency to portray abortion as regrettable and tragic—especially for the women choosing it—and instead show it as a liberating experience that brings women together, breaking new ground for the depiction of abortion in American film.

Article

Ana Luiza Vilela Borges, Christiane Borges do Nascimento Chofakian, and Ana Paula Sayuri Sato

The focus on non-sexually transmitted infections during pregnancy is relevant, as they are one of the main causes of fetal and neonatal morbidity and mortality in many regions of the world, especially in low- and middle-income countries, respecting no national boundaries. While their possible vertical transmission may lead to adverse pregnancy outcomes, congenital rubella syndrome, measles, mumps, varicella, influenza, Zika virus, dengue, malaria, and toxoplasmosis are all preventable by measures such as vector control or improvement in sanitation, education, and socioeconomic status. Some are likewise preventable by specific vaccines already available, which can be administered in the first years of childhood. A package for intervention also includes adequate preconception care, routine antenatal screening, diagnosis, and treatment during pregnancy. Non-sexually transmitted diseases during pregnancy have different worldwide distributions and occasionally display as emerging or re-emerging diseases. Their epidemiological and clinical aspects, as well as evidence-based prevention and control measures, are relevant to settings with ongoing transmission or those about to be in vulnerable situations. Non-sexually transmitted infections are major public and global health concerns as potential causes of epidemics or pandemics, with numerous social, economic, and societal impacts..

Article

This article explores the most effective approaches to reducing unintended pregnancies and improving girls’ education. Unintended adolescent pregnancies have gained substantial media attention across the globe over the past 20 years as the number of pregnant girls has increased annually. Multiple approaches have been implemented in attempt to reduce unintended adolescent pregnancies, such as sex education, the provision of contraceptives by the Department of Health, and addressing the role of young men, which are deemed to be the most commonly used approaches in South African schools. Study findings reveal that the most effective approaches to reducing adolescent pregnancies are sex education, access to contraceptives, peer education programs, and life skills training.

Article

Justin C. Konje and Oladipo A. Ladipo

Central to the survival of any species is the ability to procreate. In most cases, procreation is sexual, involving a process that ensures appropriate and timed contact between the male and female gametes. Successful human reproduction is premised on sexual intercourse occurring at a time when there is a receptive endometrium as well as an ovum ready for fertilization by spermatozoa. This time window of the menstrual cycle known as the fertile or fecund window is poorly defined and highly variable from one individual to another. Furthermore, while spermatogenesis is a continuous process, the impact of too frequent intercourse (defined as that occurring more than every 2 to 3 days) on fertilization has often been thought to be associated with a decreased fertilization potential of spermatozoa. Current evidence challenges previously held views on the fertile window and how it is determined, the timing of intercourse and how it is related to conception and miscarriages, the length of the luteal phase, and the precise time period during which the chances of fertilization are highest in any given menstrual cycle. The ability of spermatozoa to survive in the female genital tract for 5 days means fertilization can occur up to 5 days from sexual intercourse. During each menstrual cycle, there is a window of 5 to 6 days for fertilization to occur, and this period is defined not by the length of the cycle but by the timing of ovulation, with the chances of fertilization highest with intercourse occurring 1 to 2 days before ovulation.

Article

Women in all countries use substances, and for some women, such use continues during pregnancy. When substance use impairs life functioning and becomes a use disorder, regardless of the type of substance, effective treatments are available (e.g., medication to treat opioid and alcohol use disorders and behavioral approaches to treat tobacco, stimulant, and other substances). In two very different cultural contexts, the United States and Afghanistan, pregnant women face common issues when using substances and seeking and/or receiving help for problem substance use. In both countries, and around the world, many women who have substance use disorders during and after pregnancy face tremendous stigma and discrimination. Yet, similarly, in both the United States and Afghanistan, when women receive integrated medical and behavioral health care for their substance use disorder, they and their children have more optimized opportunities for healthy life outcomes.

Article

Valire C. Copeland and Betty Braxter

The upward trend in the number of Black maternal deaths between 2005 and 2020 warrants an in-depth assessment of risk factors associated with the increased maternal mortality rate in the United States for this subgroup population. The risk factors are multifactorial and, in part, have been organized into several categories: demographics, social determinants of health (SDOH), medical conditions, and the quality-of-care interventions by health systems providers. In addition, the overall trends, causes, and solutions to decrease maternal mortality current rates reflect the social inequities in our society. Black maternal deaths have been rising in recent years due to complex causes which stem from structural and systemic health inequities. In part, unvaccinated pregnant women were at greater risk of severe illness and hospitalization and even death if they were diagnosed with COVID-19. While Black Americans were disproportionately impacted by the pandemic, the disparities in maternal mortality predate and extend beyond the pandemic. In part, and together, the leading causes of pregnancy-related deaths include cardiovascular disease, other medical conditions and infections, cardiomyopathy, blood clots in the lung hypertensive disorders related to pregnancy, adverse pregnancy outcomes, racial bias of providers, and perceived racial discrimination from patients. In addition, an overview of nonmedical factors referred to as SDOH, which intersect with health status outcomes, will be discussed. An overview of Black women’s maternal mortality and morbidity, factors contributing to poor maternal health status outcomes, and intervention strategies at the provider, health systems, and policy levels are provided. Social workers in health care systems function as health care providers and clinicians. Therefore, contributing medical and nonmedical issues are factors to consider for a holistic perspective during engagement, assessment, and intervention. The terms Black women and Black birthing persons are used interchangeably.

Article

Cynthia Franklin and Melissa Reeder

Adolescent parenthood continues to be a public health concern despite the fact that the numbers of adolescent births have been declining over the past decade. The United States ranks number one in adolescent pregnancies out of all the industrialized nations. While reducing the number of adolescent pregnancies is important, supporting those who do become young parents is equally vital and an important concern for social workers. This chapter covers the demographics of adolescent parents as well as the risk and protective factors associated with adolescent pregnancy and parenthood. In addition, it reviews the current state of program development and the need for additional research and evaluation.

Article

Development of the brain in the first 3 years of life is genetically programmed but occurs in response to environmental stimuli. The brain is organized “from the bottom up,” that is, from simpler to more complex structures and functions, so the experiences and environment that shape early development have consequences that reach far into the future. This entry describes the ontogeny and processes of fetal and infant brain development, as well as major risks to early brain development (during pregnancy and after birth), with emphasis on the factors seen in social-work practice. Neuroscience research is changing social work practice, and understanding early brain development and the contributors to poor development is critical for social workers in medical, mental health, child welfare, and other practice settings.

Article

Virginia C. Strand

Between 1990 and 2003, the single-parent family continued to emerge as a major family form in the United States. Individuals come to single parenthood through different routes (divorce, separation, birth outside of marriage, widowhood, and adoption). And most of them are women. Intervention implications are framed in terms of primary, secondary, and tertiary strategies. Increasing family benefits and child care provisions are highlighted as well as strategies for preventing teen pregnancy, increasing access to educational and entry to the work force for low-income women, and identifying mothers early on in the process of marital disruption.

Article

Crystal Machado and Wenxi Schwab

Early pregnancy is a global issue that occurs in high-, middle-, and low-income countries. Although the teen birth rate in the United States, which is high on the Human Development Index (HDI), has been declining since 1991, it continues to be substantially higher than that of other Western industrialized nations. For countries that are lower on the HDI, the teen birth rate is higher, partly because early marriages, pregnancy rates, and infant mortality rates are higher and more common in these regions. Except for some influential articles written by scholars in the Global south, much of the scholarship related to early pregnancy has been written by those in the Global north. Nevertheless, analysis of available scholarly literature in English confirms that several sociocultural factors—child sexual abuse, intimate partner violence/dating violence, family-related factors, poverty, early marriages, and rurality—lead to early pregnancy and/or school dropout. Although pregnancy can occasionally increase pregnant and parenting teens’ desire to persevere, the scholarly literature confirms that the majority need support to overcome the short- and long-term ramifications associated with early motherhood, such as stigma, expulsion and criminal charges, segregation, transition, strain and struggle, depression, children with behavioral problems, and financial instability. Based on the availability of human and financial resources, educators can use U.S.-based illustrative examples, with context-specific modification, to empower this marginalized group. Providing pregnant and parenting teen mothers with thoughtfully developed context-specific school and community-based programs has the potential to promote resilience, persistence, and a positive attitude toward degree completion. Schools that do not have access to federal, state, and locally funded programs can help teen moms thrive in the new and uncharted territory with inclusive community or school-driven policies and procedures such as the use of early warning systems (EWS) that generate data for academic interventions, mentoring, counseling, health care, and day care for young children.

Article

Robert S. Bridges

Prolactin (PRL) is a protein hormone with a molecular weight of approximately 23 KD, although variants in size exist. It binds to receptor dimers on the cytoplasmic surface of its target cells and acts primarily through the activation of the STAT5 pathway, which in turn alters gene activity. Pituitary prolactin, while being the main, but not only, source of PRL, is primarily under inhibitory control by hypothalamic dopaminergic neurons. Release of dopamine (DA) into the hypothalamo-hypophyseal portal system binds on DA D2 receptors on PRL-producing lactotrophs within the anterior pituitary gland. Prolactin’s functions include the regulation of behaviors that include maternal care, anxiety, and feeding as well as lactogenesis, hepatic bile formation, immune function, corpora lutea function, and more generally cell proliferation and differentiation. Dysfunctional conditions related to prolactin’s actions include its role in erectile dysfunction and male infertility, mood disorders such as depression during the postpartum period, possible roles in breast and hepatic cancer, prostate hyperplasia, galactorrhea, obesity, immune function, and diabetes. Future studies will further elucidate both the underlying mechanisms of prolactin action together with prolactin’s involvement in these clinical disorders.

Article

Marjorie R. Sable and Patricia J. Kelly

Reproductive health includes family planning, prenatal care, and the broader scope of primary care. Because a woman's health status at conception is as important as prenatal care, genetic screening and 20th century medical technology, reproductive health includes “the preconceptual and interconceptual periods and the menopause, and finally, not only reproductive tract problems but the wide range of risk factors that influence a woman's health in general.” Quantitative indicators of reproductive outcomes are useful for summarizing progress in reproductive health. Important indicators are discussed and reveal significant racial disparities.

Article

Elizabeth C. Pomeroy, Danielle Parrish, Angela M. Nonaka, and Kathleen H. Anderson

This article reviews existing knowledge on the assessment of children with fetal alcohol spectrum disorders (FASD) and available screening, prevention, and intervention services. The wide range of preventable conditions associated with FASD throughout the life cycle is described, along with associated high-risk maternal behaviors. In addition, cultural and social determinants are discussed, in an effort to inform social work practice. The differentiation of FASD and protective factors that have been identified as reducing negative outcomes for children and their families affected by prenatal alcohol exposure are also explained. Finally, multidisciplinary and culturally appropriate prevention services are emphasized as well as early diagnosis and strength-based intervention strategies.

Article

Shireen Jejeebhoy, K. G. Santhya, and A. J. Francis Zavier

India has demonstrated its commitment to improving the sexual and reproductive health of its population. Its policy and program environment has shifted from a narrow focus on family planning to a broader orientation that stresses sexual and reproductive health and the exercise of rights. Significant strides have been made. The total fertility rate is 2.2 (2015–2016) and has reached replacement level in 18 of its 29 states. The age structure places the country in the advantageous position of being able to reap the demographic dividend. Maternal, neonatal, and perinatal mortality have declined, child marriage has declined steeply, contraceptive use and skilled attendance at delivery have increased, and HIV prevalence estimates suggest that the situation is not as dire as assumed earlier. Yet there is a long way to go. Notwithstanding impressive improvements, pregnancy-related outcomes, both in terms of maternal and neonatal mortality and morbidity, remain unacceptably high. Postpartum care eludes many women. Contraceptive practice patterns reflect a continued focus on female sterilization, limited use of male methods, limited use of non-terminal methods, and persisting unmet need. The overwhelming majority of abortions take place outside of legally sanctioned provider and facility structures. Over one-quarter of young women continues to marry in childhood. Comprehensive sexuality education reaches few adolescents, and in general, sexual and reproductive health promoting information needs are poorly met. Access to and quality of services, as well as the exercise of informed choice are far from optimal. Inequities are widespread, and certain geographies, as well as the poor, the rural, the young, and the socially excluded are notably disadvantaged. Moving forward and, in particular, achieving national goals and SDGs 3 and 5 require multi-pronged efforts to accelerate the pace of change in all of these dimensions of health and rights.