Postpartum contraceptive behavior and delay of a second pregnancy among teen mothers in the Subsequent Pregnancy Program

Each year nearly one in five births to American teens are second or higher order births. The birth of a second child to a teen mother greatly increases the likelihood of school drop-out and long-term poverty. For two decades, the Subsequent Pregnancy Program (SPP), one of the oldest and most effective home visiting programs in the country, has helped teen mothers delay a second pregnancy and graduate from high school. Among the 4,000 young mothers in SPP, all of whom had their baby before the age of 18, 97% delayed a second pregnancy and 85-90% graduated from high school each year. Outcomes are consistent over time and within diverse ethnic and racial groups. The SPP program model provides a personal relationship with a Home Visitor and intense training through group participation, plus an explicit focus on knowledge and postpartum contraceptive use by young mothers in the program. Home Visitors help each young mother choose the best method of contraception based on a realistic assessment of her lifestyle, provide access to reproductive health services and monitor use and compliance. CDC (2013) reports only one in four teens use highly effective methods of contraception postpartum. In 2013, almost all SPP participants reported use of an effective method of contraception at year-end: 23% IUD, 26% Implant, 9% Pills and 40% Medroxyprogesterone Acetate. Use of effective methods of contraception with continuous monitoring is largely responsible for the extremely low rates of second pregnancy among SPP participants.