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Community Engagement Can Help Prevent Unintended Teenage Pregnancies
July 1, 2025 6 minutes read
By Melinda Young
Various studies show that comprehensive sex education for youth can reduce unintended teen pregnancies.1-3 The challenge is the patchwork of state and local programs addressing — or not addressing — sex education in schools or among youth populations. One model for solving this issue is a program sponsored by a large children’s health system that includes adolescent sexual and reproductive healthcare in its overall mission to improve the health of families in its community.2
Nationwide Children’s Hospital in Columbus, OH, has a school-based reproductive health education program that works with community partners to provide reproductive health education to Columbus City Schools middle school students. The program seeks to improve students’ health and empower them to make better decisions about it. Funded through a $2.8 million federal grant, the goal is to reach 7,000 seventh- and eighth-grade students.3 The health system launched its Pediatric Vital Signs (PVS) Initiative in May 2018 to reduce Franklin County’s teenage birth rate, which was 20.9 per 1,000 female adolescents in 2017.1
Five years later, in 2022, the Franklin County teen birth rate per 1,000 female adolescents, ages 15-19 years, fell to 15.2. The PVS goal is to decrease the teenage birth rate to 6.0 per 1,000 women, ages 15-19 years.1,2 “Working with internal and external, community-based partners, this project saw declines in the teenage pregnancy rate in Franklin County,” says Elise D. Berlan, MD, MPH, a professor of clinical pediatrics in the department of pediatrics, division of adolescent medicine at The Ohio State University and a faculty physician at Nationwide Children’s Hospital in Columbus. Berlan answered questions via email.
The program increased the availability of comprehensive sexuality education in schools and increased use of contraceptives among adolescents seen through the health system, Berlan adds. “None of these were surprising — as we used an evidence-based approach and these changes were not unexpected,” Berlan says.
The health system used a curriculum called Get Real, launched in 2020 in seven Columbus schools, later expanding to 19 schools. Get Real provides an evidence-based, comprehensive reproductive health and teen pregnancy prevention curriculum. It emphasizes social and emotional skills to develop healthy relationships and responsible decision making.3
Ohio — unique among the states — has no health education content standards for primary and secondary school students, and there are challenges for schools to establish these programs. The state has legislation on venereal disease that requires instruction to focus on sexual abstinence until marriage. By contrast, the Get Real program, as a collaboration with Columbus City Schools and the Sexual Health Education Partnership (SHEP), provided best practices in sexual health education. The sexual health education curricula they used had been evaluated by the U.S. Department of Health and Human Services and was deemed evidence-based. It was implemented in more than 30 states and had demonstrated effectiveness.1
The nine-session education program taught middle school students basic life skills, including communicating with others and how to find a clinic and get help.3
It also had these features:
- AwkTalk: a website with sexual and reproductive health information geared toward younger teens. The website also contains information for parents, 10 video modules with learning activities, and two-minute videos modeling healthy parent-child conversations on difficult topics.4 For example, the AwkTalk website has a banner with various questions teens might ask. One is “What’s the difference between sex and gender?”4 The answer, via a link, answers this way: “Sex refers to your body parts. You are assigned a ‘sex’ (male or female) at birth, based on the organs (genitals) and chromosomes you’re born with. The sex is added to your birth certificate. Sometimes this is referred to as your biological sex or assigned sex.”4“Gender refers to expectations society (a large group of people) may have about people based on their assigned sex. Society may expect a person to think, act, or look a certain way based on the sex they were assigned at birth. For example: A culture may expect people who are assigned a ‘male’ sex to always act tough, or strong; a culture may expect people who are assigned a ‘female’ sex to be timid, or kind.”4
- Health Peer Leader Program: This program recruits 12 students from middle schools and provides them with in-depth training on topics they have learned in the curriculum. They can use the skills they have learned to speak with friends and family about various topics, including consent, boundaries, communication skills, and being in a healthy relationship.3
- YES! (Youth Empowerment Skills): A summer educational program, YES! engaged 55 children, ages 14-18, across Columbus to serve as paid interns over eight weeks. They participated via Zoom six hours a day, three days a week and took classes in reproductive health, workforce development, interviewing skills, financial literacy, and others.3
The health system’s Pediatric Vital Signs program and its Contraceptive Access Quality Improvement Collaborative also are aimed at improving child and adolescent health. “The Pediatric Vital Signs initiative is a large project to improve child and adolescent health and wellbeing in the Columbus area, sponsored and led by Nationwide Children’s Hospital,” Berlan says. “My experience was to be the executive champion of the arm of the project focused on reducing unintended births among adolescents.”
PVS addresses all child mortality, suicide, infant mortality, kindergarten readiness, high school graduation, preventive services delivery, teen pregnancy, and obesity. Under the teen pregnancy category, it focuses on comprehensive sexuality education and timely access to reproductive health services.2 All of its metrics address racial and ethnic disparity, and all rely on a broad coalition of stakeholders, including public health officials, schools, nonprofit organizations, civic organizations, and local governments.2
Launched in 2018, the Contraceptive Access Quality Improvement Collaborative (CAC) achieved an increase in the proportion of female adolescents seen at Nationwide Children’s Hospital who are prescribed contraceptives.1 CAC’s goal was to increase the use of prescription contraceptives among the health system’s patients and within the health system’s affiliated accountable care organization, Partners For Kids. The collaborative used a quality improvement framework and supports measurement and shared learning across health system departments.1
“The Contraceptive Access Quality Improvement Collaborative includes members from a variety of hospital departments who are all interested in supporting adolescent patients’ access to information about contraception and access to contraceptives,” Berlan says.
“Early on, we determined that the following values were important to this work: person- and family-centeredness, evidence-based, and noncoercive,” she explains. “We use the Institute for Healthcare Improvement quality improvement model, and each member department determines their own customized project that advances to overall goals of the collaborative.”
CAC’s leadership team, which includes an adolescent medicine physician, a community wellness administrator, a quality improvement professional, and a project manager, meets bimonthly and shares status updates and participating in education.1 The team identified shared decision-making, noncoercive and patient/family-centered care, and an evidence-informed approach to serve as the program’s guiding values. Its overall focus was on promoting access to equitable, reproductive justice-informed, person-centered contraception care.1
Various internal departments were involved to address challenges to reaching optimal outcomes. For instance, the electronic health record needed to be modified, and there were policy barriers. CAC partners were invited, initially, to participate based on data showing where female adolescent patients presented for care. These initial partners included BC4Teens and Teen and Pregnant clinics, Pediatric and Adolescent Gynecology, Primary Care Pediatrics, Pediatric Hospital Medicine, Partners for Kids, and Pediatric Rheumatology. They were later joined by Pediatric Neurology and Fostering Connections, a program for youth in foster care.1
The program used monthly electronic health record data to measure contraceptive use since its primary aim was to increase prescription contraceptive use among female adolescent patients, ages 15-19 years, from 27.1% in 2018 to 35% by 2025.1 To achieve this, CAC’s interventions focused on increasing the number of hospital divisions that provide or refer adolescents for contraception care and providing contraceptive implant procedural training.1
Other health systems that serve an adolescent population could use these initiatives to reduce the rate of unintended teen pregnancies in their communities. “Health systems can use a quality improvement framework or something similar,” Berlan says. “It is also recommended to reach out to internal and external partners to engage in this work together.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Berlan ED, Abenaim A, Barnett KS, et al. Preventing unintended teenage pregnancies with community engagement and quality improvement. Pediatrics. 2025;155(S1):e2024069159F.
2. Phillips J. Pediatric Vital Signs: Measuring and improving the health of a population. Pediatrics Nationwide. Oct. 1, 2020. https://pediatricsnationwide.org/2020/10/01/pediatric-vital-signs-measuring-and-improving-the-health-of-a-population/
3. The Collaboratory for Kids and Community Health, Nationwide Children’s. Better health outcomes with school-based reproductive health education programs. https://www.nationwidechildrens.org/about-us/collaboratory/improving-neighborhoods/school-based-reproductive-health-education
4. AwkTalk. Real answers. For real (awkward) questions. awktalk.org
Various studies show that comprehensive sex education for youth can reduce unintended teen pregnancies.
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