The National Association of School Nurses (NASN) believes that the school nurse is in a prime position to support the health and wellbeing of pregnant and parenting students and contribute to their lifelong success by linking them to resources and advocating for policies and practices that promote high school graduation. It is the position of NASN that school nurses have a vital role in the development and implementation of evidenced-based policies, nursing care procedures, educational programs and materials for students and their parents relating to pregnancy prevention, teen parenting and school completion. School nurses track pregnancy trends, review the school’s human growth and development curriculum, assist in the selection of high-quality educational materials and programs based on the age, culture, and level of risk of the target population, and evaluate the short-term and long-term outcomes of the school’s programs.
The role of the school nurse with pregnant and parenting students is complex and includes assistance in pregnancy identification, providing parenting education, support in preventing additional pregnancies, and participation / leadership of multidisciplinary teams that plan and support accommodations for the student (Will, 2008).
“The teenage birth rate declined 8 percent in the United States from 2007 through 2009, reaching a historic low at 39.1 births per 1,000 teens aged 15-19 years” (Ventura & Hamilton 2011), but continues to be among the highest in western industrialized nations (Martin, J.A., et al. 2010). About three quarters of a million teenagers become pregnant each year and over half of these will give birth and become parents (Kost, Henshaw & Carlin, 2010). Thirty to fifty percent of all adolescent mothers have a second pregnancy and about 25 % have a repeat birth within two years of the first (National Campaign to Prevent Teen Pregnancy [NCPTP], 2010a).
The passage of Title IX of the Education Amendment Act in 1972 prohibited discrimination against pregnant and parenting students in public schools (SmithBattle, 2006). These students are entitled to a free and appropriate education in the least restrictive environment (some students may attend alternative education programs). Parenting students must have accommodations to their educational program to meet their specific or individual needs. (SmithBattle, 2006).
DESCRIPTION OF ISSUE
Centers for Disease Control and Prevention (CDC)(2011) data shows that while teen birth rates have declined, data varies by state with more births to teens in southern states. Teen birth rates are especially high among black and Hispanic teens compared to white teens (CDC, 2011). With only 40% of teen mothers finishing high school (America’s Promise Alliance /NCPTP, 2010), the economic impact can be devastating. It is estimated that over the course of her lifetime, a single high school dropout costs the nation approximately $260,000 in lost earnings, taxes and productivity. (Alliance for Excellent Education, 2008). Despite advanced medical care in the US, infants born to teens are at greater risk for preterm birth, low birth weight and infant mortality costing the nation approximately $3 billion in public expenditures (CDC, 2011).
The well-being of pregnant and parenting adolescents influences the physical, cognitive, behavioral and emotional status of their children. Teen parents are at risk for dropping out of school and more likely to have additional teen pregnancies affecting their current and future socio-economic level. Children of teen mothers start school at a disadvantage with lower “levels of school readiness—including lower math and reading scores, language and communication skills, social skills and physical and emotional well-being” compared to children born to women in their twenties (America’s Promise Alliance /NCPTP, 2010).
The adolescent parent’s developmental, social, and economic concerns need to be considered when programming education and connecting them with community resources. Comprehensive evidence-based programs, including school-based infant and childcare, and effective parenting practices, can promote high school completion rates and enhance the health of the adolescent parents and offspring. Programs should be tailored to specific communities and include programs that teach youth knowledge and skills (Ball & Moore, 2008).
Supporting students in “school achievement, attendance, and involvement can help reduce the risk of teen pregnancy “(NCPTP, 2010b). School nurses play a vital role in helping students understand their sexuality and making responsible choices that will affect their future. As trusted health professionals, school nurses provide nursing care during a student’s pregnancy, offer guidance for decision-making and accessing community resources including state or federal welfare and legal assistance. School nurses collaborate with the student, family, school staff, and medical providers to plan for the care and academic success of the student during pregnancy. The school nurse writes Individual Health Plans (IHP) to assess the needs of each pregnant student and documents compliance with medical treatments and general health status (Marcontel-Shattuck, 2006).
Adolescents play an important role in identifying and establishing solutions to meet their own needs. School nurses encourage adolescents’ active participation in the development of pregnancy prevention and teen parenting programs. School nurses provide support and interventions to the childbearing adolescent as her pregnancy progresses and recommend modifications necessary for the safety and well-being of the student in the school setting. The school nurse can assist teen fathers by providing educational programs addressing responsibilities of fatherhood (Will, 2008). Studies reflect that social support of the pregnant teen and their significant others (parent, boyfriend, etc.) has a positive impact on the pregnant teen’s ability to cope with stress during pregnancy and parenthood (Devereux, Weigel, Ballard-Reisch, Leigh, & Cahoon, 2009). The school nurse working with adolescent parents can create a parent friendly school culture for teen parents, and advocate for comprehensive school site childcare facilities to foster high school completion rates (Will, 2008).
National and local programs aimed at pregnancy prevention and fostering parenting skills for those adolescents with children have steadily increased over the last several decades. In attempting to disrupt the intergenerational cycle of adolescent parenthood, school nurses can promote positive parenting practices, support responsible parenthood through evidenced-based programming and connect parenting students with school and community resources. School nurses can be instrumental in helping adolescent parents plan for their long-term future. By developing a supportive relationship with a student parent, the school nurse can affect the future of the student by encouraging the postpartum adolescent to return to school and to prevent a subsequent teen pregnancy.
School nurses collaborate with policy makers, local school superintendents and state officials, to support the connection between education and teen pregnancy. Adoption of action plans to address teen pregnancy and parenting is a key component of any school completion strategy and preparing young men and women to succeed in the 21st century.
Alliance for Excellent Education. (2008). The high cost of high school dropouts: What the nation pays for inadequate high schools. Washington, DC: Author. Retrieved from http://all4ed.org/files/HighCost.pdf
America’s Promise Alliance /National Campaign to Prevent Teen and Unplanned Pregnancy (NCPTP). (2010). Policy brief: Preventing teen pregnancy is critical to school completion. Retrieved from http://www.thenationalcampaign.org/resources/pdf/Briefly_PolicyBrief_School_Completion.pdf
Ball, V. & Moore, K.A. (2008). What works for adolescent reproductive health: Lessons from experimental evaluations of programs and interventions. Child trends fact sheet. Publication #2008-20. Retrieved from http://raiseinspiredkids.com/files/resources/ChildTrendsTeenPregnancy.pdf.pdf
Centers for Disease Control and Prevention [CDC]. (2011). Vital signs: Teen pregnancy—United States, 1991-2009. MMWR , 60(13);414-420. Atlanta, GA: Author. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6013a5.htm
Devereux, P. G., Weigel, D. J., Ballard-Reisch, D., Leigh, G., & Cahoon, K. L. (2009). Immediate and long-term connections between support and stress in pregnant/ parenting and non-pregnant/ non-parenting adolescents. Child and Adolescent Social Work Journal, 26, 431-446. doi: 10.1007/s10560-009-0175-z
Kost, K., Henshaw S. & Carlin L. (2010). U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity. Retrieved from http://www.guttmacher.org/pubs/USTPtrends.pdf
Marcontel-Shattuck, M. (2006). Pregnant and parenting teens. In J. Selekman (Ed. ) School nursing: A comprehensive text. (pp. 982-985). Philadelphia: F.A. Davis Company.
Martin, J.A., Hamilton, B.E., Sutton, P.D., Ventura, S.J., Matthews, T.J., & Osterman, M.J. (2010). Births: Final data for 2008. United States. National Vital Statistics Reports, 59 (1). Other Countries: United Nations Statistical Division. Demographic Yearbook 2008. New York: United Nations.
National Campaign to Prevent Teen and Unplanned Pregnancy (NCPTP). (2010a). Why it matters. Teen pregnancy and education. Washington, DC: Author. Retrieved from http://www.thenationalcampaign.org/why-it-matters/pdf/education.pdf
National Campaign to Prevent Teen and Unplanned Pregnancy (NCPTP). (2010b). Fast facts: Teen pregnancy in the United States. Washington, DC: Author. Retrieved from http://www.thenationalcampaign.org/resources/pdf/FastFacts_TeenPregnancyinUS.pdf
SmithBattle, L. (2006). Helping teens mothers succeed. Journal of School Nursing, 22,130-135. doi: 10.1177/10598405060220030201
Ventura, S.J. & Hamilton B.E. (2011). U.S. teenage birth rate resumes decline. NCHS data brief, no 58. Hyattsville, MD: National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db58.htm
Will, S. (2008). CDC reports increase in teen birth rate, school nurses review pregnancy prevention programs and student/parent support activities. NASN School Nurse, 23,158-160. doi:10.1177/1942602X08322167
Acknowledgement of Authors:
Linda Davis-Alldritt, MA, PHN, RN, FNASN
Margo Bushmiaer, MNSc, RN, NCSN
Marie Desisto, MSN, BSN, RN
Patrice Lambert, MSN, RN, SNC
M. Kathleen Murphy, DNP, RN, FNP-BC
Sharon Roland, BSN, RN
Kendra Selser, MHS, BSN, RN
Leah Wyckoff, MS, BSN, RN
Adopted: 1971 (Originally a resolution: School Age Parents)
June 2011 (Formerly titled “The Role of the School Nurse in Supporting Adolescent Parents”)