A health care quality measure goes beyond simple counts of how many patients are being served; it tells us about the quality of the service they are receiving and thus provides information on the likely health impact. For example, one current quality measure is the percent of two-year-old children who receive certain vaccinations. Quality measures exist for many areas of medicine including 700 National Quality Forum-endorsed measures, but there is not yet a measure for contraception. A number of organizations have highlighted the need for one or more quality measures for contraception. For example, the recommendations from the Association of Reproductive Health Professionals’ Sexual and Reproductive Health (SRH) Workforce Summit include "Develop one Healthcare Effectiveness Data and Information Set measure on SRH" and "Define SRH quality metrics for use in new models of care." A quality measure that affects how much health centers get paid by insurers can encourage providers to focus on contraception and deliver valuable information to managers on how health centers and agencies are performing. Primary care providers in particular have many demands on their time. They understandably allocate their time in part based on financial incentives. Establishing a quality measure for contraception that affects payment is a key tool in the effort to have primary care sites provide higher quality contraceptive services.
The teen birth rate in the United States has declined to an all-time low, down by an amazing 52 percent since the early 1990s. And according to new analysis by the National Campaign to Prevent Teen and Unplanned Pregnancy, a Hewlett grantee, there is even more good news. Taxpayers saved an estimated $12 billion in 2010 alone due to the nearly one-half decline in the teen birth rate between 1991 and 2010. The National Campaign celebrated the remarkable progress made by the nation’s teens at a “52 and Falling” event on December 3. There were many exciting parts of the event, including a presentation on a fantastic TV show, East Los High. The event didn’t just cover the amazing progress from the past, it also included a discussion of what new additional strategies might keep the trend going. Here is my list of some new strategies that might help continue the progress for the next decade:
1. Set the goal of zero teen births. At the event, the president of the Institute of Medicine and incoming Chair of the Hewlett Foundation’s Board, Harvey Fineberg, suggested quite seriously that we collectively shoot for a teen birth rate of zero. I agree with Dr. Fineberg that all teens can achieve this. Most already do. I believe that setting a goal of zero helps to put the onus on adults. If all teens are capable of doing the right thing, then it is our responsibility as adults to create the policies, programs, and environment to enable all teens to do what I believe they are all capable of doing.
2. Launch an SAT for sex education. If there were a standardized test administered before and after sex-ed it would be possible to compare different sex-ed curricula to see which does a better job of improving student knowledge. The test could also compare the performance of different teachers using the same curricula. A test won’t tell us everything, but in most cases it would be an improvement over what we have now in terms of information on how much teens are learning when they receive sex ed. We can’t wait for the government to develop this. A nongovernmental organization could certainly do it faster. The challenge will be getting wide use of the test.
3. Create a Khan Academy-like sex-ed course. Courses offered online through Khan Academy and similar venues are able to capture the most effective teachers in a given subject area so that their presentations are available to millions. These courses also incorporate frequent online quizzes and thus can tailor the pace based on whether a student is learning the material. Some of these lectures can even be viewed as homework, freeing up class time for role-playing and question and answer time. As with the sex-ed SAT, the problem here will be achieving wide adoption.
4. Help teen moms avoid a second teen pregnancy. Teens who are moms are more likely to get pregnant again while still a teen than teens who have never been pregnant. A few organizations, like Teen Success, Inc., work with teen moms to help them succeed, support their current child, and postpone a second pregnancy until adulthood. But too often teen moms are overlooked. We know they are particularly likely to have a second teen pregnancy. They deserve special attention.
What new approaches do you think could help further reduce the teen birth rate?
Congratulations to the American Academy of Pediatrics (AAP) for theNovember 26 policy statement, “Emergency Contraception.” The AAP deserves praise for following science and promoting public health. However, the policy statement omits a critical point: the copper intrauterine device (IUD) is considerably more effective than emergency contraception pills (EC)–99% effective versus 90% effective. Shouldn’t pediatricians be encouraged to talk to their patients aboutthe most efficacious method of EC?
Based on conversations I’ve had with people across the field, it’s clear that the pro-choice movement in the United States is ready for an expanded set of goals for abortion that go beyond safe, legal, and rare.
Peter Belden, writing with Cynthia C. Hopper and J. Joseph Speidel, in Contraception:
Reducing unintended pregnancy requires a multifaceted approach that includes better education about sexuality and contraception, improved access to higher-quality family planning counseling and services, and more affordable methods and services. A transition from contraceptive methods that require continuing motivation and conscientious use to long-acting reversible contraceptives (LARC) would markedly reduce unintended pregnancies.
Most people perceive family planning and reproductive rights as women’s issues. I think that is largely the fault of those of us who work in the field of family planning and reproductive rights. We talk primarily about the benefits this field has for women’s health and autonomy. While these benefits are great, I believe that when we focus only on them, we fail explain to many audiences why they might also be interested in family planning and reproductive rights.