CDC Winnable Battle: Teen
Pregnancy
Group members: Nicole Bumgartner, Patty Marchlowska, and Dave Sheneman
The Goal: To reduce teen pregnancy and its contribution to the cycle of poverty for teens and their families.
Why teen pregnancy?
- In 2011, over 329,000 babies were born to women age 15 to 19, meaning that nearly 1,000 teen girls give birth every day.
- 50% of those that have a child will not have a high school diploma by 22, versus 90% of those who haven't given birth.
- In 2008, teen pregnancy and childbirth accounted for nearly $11 billion per year in costs to U.S. taxpayers for increased health care and foster care, incarceration rates among children of teen parents, and lost tax revenue.
- In the U.S. rates of teen pregnancy, birth, STDs and abortions are all significantly higher than in other developed countries.
- Racial and socioeconomic disparities still exist, with socioeconomically disadvantaged youth experiencing the highest rates of teen pregnancy and 57% of births comprising of black and Hispanic youths.
How can we fix this?
CDC 2015 Targets
Indicator
|
Baseline
|
2015 Target
|
Teen birth rate among adolescent females ages 15 to 19
|
37.9 births per 1,000 females ages 15 to 19 (2009)
|
30.3 births per 1,000 females ages 15 to 19 (20% reduction)
|
CDC Recommendations for achieving the 2015 target:
- Monitor teen pregnancy/birth rates and prevention policies
- Promote the delay of sexual initiation through evidence-based programs and social norm changes
- Expand the reach of Medicaid family planning services
- Promote the use of effective contraceptive methods, including long-acting reversible contraception, by sexually active teens
Timeline of Teen Pregnancy
Historical and Social Events
Christ time: Probably the most famous teen pregnancy story is that Mary is believed to have been between the age of 13-15 when she had Jesus.
19th Century: teenage pregnancy is relatively common, but is shown to begin to decline with higher socioeconomic status. Rates decline steadily overall.
1918: condoms became legal in the US.
1957: 96 out of every 1,000 teens in the U.S. became pregnant.
1960: first FDA approved birth control pill.
May 1995: Advocates for Youth became the national sponsor of National Teen Pregnancy Prevention.
1998: first emergency contraception is FDA approved- can be taken up to 72 hours after sex to prevent pregnancy.
2001: NTPPM designating May to be the National Month to Prevent Teen Pregnancy.
2005-2006: The CDC reports that teen pregnancy rates rise for the first time in 14 years.
2006: emergency contraception becomes available over the counter.
2007: The National Campaign published a study in 2007 titled, "Emerging Answers 2007", which stated that "comprehensive [teen pregnancy prevention] programs worked for both genders, for all major ethnic groups, for sexually inexperienced and experienced teens, in different settings, and in different communities."
2013: emergency contraception becomes available to teens 15 and older without parental consent as an over the counter medication
May 1st 2013: Marked the 12th annual National Day to prevent Teen Pregnancy.
Historical and Social Events
Christ time: Probably the most famous teen pregnancy story is that Mary is believed to have been between the age of 13-15 when she had Jesus.
19th Century: teenage pregnancy is relatively common, but is shown to begin to decline with higher socioeconomic status. Rates decline steadily overall.
1918: condoms became legal in the US.
1957: 96 out of every 1,000 teens in the U.S. became pregnant.
1960: first FDA approved birth control pill.
May 1995: Advocates for Youth became the national sponsor of National Teen Pregnancy Prevention.
1998: first emergency contraception is FDA approved- can be taken up to 72 hours after sex to prevent pregnancy.
2001: NTPPM designating May to be the National Month to Prevent Teen Pregnancy.
2005-2006: The CDC reports that teen pregnancy rates rise for the first time in 14 years.
2006: emergency contraception becomes available over the counter.
2007: The National Campaign published a study in 2007 titled, "Emerging Answers 2007", which stated that "comprehensive [teen pregnancy prevention] programs worked for both genders, for all major ethnic groups, for sexually inexperienced and experienced teens, in different settings, and in different communities."
2013: emergency contraception becomes available to teens 15 and older without parental consent as an over the counter medication
May 1st 2013: Marked the 12th annual National Day to prevent Teen Pregnancy.
What should we do moving forward?
Successful Interventions:
1. Colorado Youth Matter: this program engages the Colorado communities to promote the healthy sexual and reproductive development of all teens and advance the well-being of parenting teens. The program focuses on community, excellence in service, cultural competency and social justice to delay initiation of sexual activity and lower teen birth rates in selected at-risk populations.
2. Aban Aya: an Afrocentric Social Development curriculum instructed over a four-year period, beginning in the fifth grade. This curriculum encourages abstinence, protection from unsafe sex, and avoidance of drugs and alcohol. The name of the intervention is drawn from two words in the Akan (Ghanaian) language: Aban (fence) signifies double/social protection, and Aya (the unfurling fern) signifies self-determination. The purpose of this intervention is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. Aban Aya was implemented and evaluated in a low-income, predominately African American population of 5th through 8th graders in Chicago schools. It has been shown that the intervention reduced recent sexual activity and increased condom use among male participants, but not among its female participants.
3. R.E.A.L. Men: a program that encourages communication between adolescent boys and their fathers/father figures to help youth delay sexual activity and increase condom use among those who are sexually active. The parents of boys enrolled in the Boys and Girls club participated in six two-hour sessions emphasizing the importance of father-son conversations in helping boys to make responsible decisions about sex. The fathers were given information on how to communicate through watching videos of demonstrations of this communication and role plays. They also receive information about preventing HIV, practice the correct use of condoms, and have homework assignments to do together.
4. Sisters Saving Sisters: this program was designed specifically for use in a clinic, and was targeted to urban African-American and Hispanic female adolescents. The program adapted earlier curriculum-based programs for use in the clinic, and was found to increased condom use, decrease the number of sexual partners, and decreases rates of STIs. Participants practiced condom skills, handled condoms, practiced putting condoms on models, and role played condom use negotiation. The effective skills-based workshop addressed topics such as perceived vulnerability to STIs, elevated risk of inner-city minority women for contracting an STI, beliefs relevant to HIV/STI risk reduction, the importance of condoms, and the belief that condoms interfere with sexual enjoyment.
5. ¡Cuídate!: ¡Cuídate! is an HIV risk-reduction program specifically for Hispanic youth, adapted from the 'Be Proud! Be Responsible!' program. ¡Cuídate! also incorporates aspects of Hispanic culture, specifically the importance of family and gender role expectations. The program presented both abstinence and condom use as culturally accepted and effective ways to prevent sexually transmitted diseases, including HIV. The evaluation of ¡Cuídate! found that the program reduced the frequency of sex, number of sexual partners, and frequency of unprotected sex. It also increased consistent condom use over a one year period.
Healthy People 2020 Goals:
Successful Interventions:
1. Colorado Youth Matter: this program engages the Colorado communities to promote the healthy sexual and reproductive development of all teens and advance the well-being of parenting teens. The program focuses on community, excellence in service, cultural competency and social justice to delay initiation of sexual activity and lower teen birth rates in selected at-risk populations.
2. Aban Aya: an Afrocentric Social Development curriculum instructed over a four-year period, beginning in the fifth grade. This curriculum encourages abstinence, protection from unsafe sex, and avoidance of drugs and alcohol. The name of the intervention is drawn from two words in the Akan (Ghanaian) language: Aban (fence) signifies double/social protection, and Aya (the unfurling fern) signifies self-determination. The purpose of this intervention is to promote abstinence from sex, and to teach students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. Aban Aya was implemented and evaluated in a low-income, predominately African American population of 5th through 8th graders in Chicago schools. It has been shown that the intervention reduced recent sexual activity and increased condom use among male participants, but not among its female participants.
3. R.E.A.L. Men: a program that encourages communication between adolescent boys and their fathers/father figures to help youth delay sexual activity and increase condom use among those who are sexually active. The parents of boys enrolled in the Boys and Girls club participated in six two-hour sessions emphasizing the importance of father-son conversations in helping boys to make responsible decisions about sex. The fathers were given information on how to communicate through watching videos of demonstrations of this communication and role plays. They also receive information about preventing HIV, practice the correct use of condoms, and have homework assignments to do together.
4. Sisters Saving Sisters: this program was designed specifically for use in a clinic, and was targeted to urban African-American and Hispanic female adolescents. The program adapted earlier curriculum-based programs for use in the clinic, and was found to increased condom use, decrease the number of sexual partners, and decreases rates of STIs. Participants practiced condom skills, handled condoms, practiced putting condoms on models, and role played condom use negotiation. The effective skills-based workshop addressed topics such as perceived vulnerability to STIs, elevated risk of inner-city minority women for contracting an STI, beliefs relevant to HIV/STI risk reduction, the importance of condoms, and the belief that condoms interfere with sexual enjoyment.
5. ¡Cuídate!: ¡Cuídate! is an HIV risk-reduction program specifically for Hispanic youth, adapted from the 'Be Proud! Be Responsible!' program. ¡Cuídate! also incorporates aspects of Hispanic culture, specifically the importance of family and gender role expectations. The program presented both abstinence and condom use as culturally accepted and effective ways to prevent sexually transmitted diseases, including HIV. The evaluation of ¡Cuídate! found that the program reduced the frequency of sex, number of sexual partners, and frequency of unprotected sex. It also increased consistent condom use over a one year period.
Healthy People 2020 Goals:
- Increase the proportion of sexually experienced females aged 15 to 44 years who received reproductive health services in the past 12 months.
- 78.6% of sexually experienced females aged 15 to 44 years received reproductive health services in the past 12 months, as reported in 2006–10
- New target: 86.5% -10% improvement
- Increase the proportion of female adolescents aged 15-17 who have never had sexual intercourse.
- 72.9 percent of female adolescents aged 15 to 17 years reported they had never had sexual intercourse in 2006–10
- New target: 80.2% -10% improvement
- Increase the proportion of female adolescents aged 15 years and under who had never sexual intercourse
- 85.4 percent of female adolescents aged 15 years and under had never had sexual intercourse in 2006–10
- New target: 93.9% -10% improvement
- Reduce the pregnancy rate among adolescent females aged 15 to 17 years
- 2020 target: 36.2 pregnancies per 1,000
- Baseline: 40.2 pregnancies per 1,000 (2005)
- Reduce the pregnancy rate among adolescent females aged 18 to 19 years
- 2020 target: 105.9 pregnancies per 1,000
- Baseline: 117.7 pregnancies per 1,000 (2005)
- Overall a 10% decrease in pregnancies per 1,000 for females ages 15-19
Data
from: Guttmacher Institute Abortion
Provider Survey (APS), Guttmacher Institute
Surveillance Data for Abortion, CDC/NCCDPHP
National Survey of Family Growth (NSFG), CDC/NCHS
National Vital Statistics System-Natality (NVSS-N), CDC/NCHS)
Group Recommendations:
Resources
Hamilton, B. E., Martin, J. A., & Ventura, S. J. Births: preliminary data for 2011. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf
Perper, K., Peterson, K., & Manlove, J. Diploma attainment among teen mothers. (n.d.). Retrieved from http://www.childtrends.org/Files/Child_Trends-2010_01_22_FS_DiplomaAttainment.pdf
Counting it up: the public costs of teen childbearing. (n.d.). Retrieved from http://www.thenationalcampaign.org/costs/default.aspx
Singh, S., & Darroch, J. E. Adolescent pregnancy and childbearing: levels and trends in developed countries. (n.d.). Retrieved from http://www.guttmacher.org/pubs/journals/3201400.html
Centers for Disease Control and Prevention. Teen pregnancy prevention 2010-2015. Retrieved from http://www.cdc.gov/TeenPregnancy/PreventTeenPreg.htm
Centers for Disease Control and Prevention. Teen births (2008) and medicaid waiver expansion (2011). Retrieved from http://www.cdc.gov/program/data/policyanalyses/DataforActionPolicyTables_TP.pdf
Centers for Disease Control and Prevention. United States Medical Eligibility Criteria (USMEC) for Contraceptive Use. (n.d.). Retrieved from http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
Centers for Disease Control and Prevention. Teen birthrates rise for the first time in 14 years. http://www.cdc.gov/media/pressrel/2007/r071205.htm
Colorado Youth Matter. (n.d.). Retrieved from http://www.coloradoyouthmatter.org/
The National Campaign to Prevent Teen and Unwanted Pregnancy. ¡Cuídate! http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=8
The National Campaign to Prevent Teen and Unwanted Pregnancy. Aban Aya. http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=2
The National Campaign to Prevent Teen and Unwanted Pregnancy. R.E.A.L. Men.
http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=37
The National Campaign to Prevent Teen and Unwanted Pregnancy. Sisters saving sisters.
http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=11
Guttmacher Institute. Guttmacher Institute Abortion Provider Survey (APS).
Centers for Disease Control and Prevention. Surveillance Data for Abortion. CDC/NCCDPHP.
Centers for Disease Control and Prevention. National Survey of Family Growth (NSFG). CDC/NCHS.
Centers for Disease Control and Prevention. National Vital Statistics System-Natality (NVSS-N). CDC/NCHS).
Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for contraceptive use, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_e
Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs). http://www.cdc.gov/std/
Centers for Disease Control and Prevention. HIV/AIDS. Retrieved from http://www.cdc.gov/hiv/
Centers for Disease Control and Prevention. Parent and guardian resources. Retrieved from http://www.cdc.gov/TeenPregnancy/Parents.htm
Centers for Disease Control and Prevention. Contraception. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
Centers for Disease Control and Prevention. Sexual health. http://www.cdc.gov/sexualhealth/
U.S. Department of Health and Human Services. Office of population affairs. http://www.hhs.gov/opa/
U.S. Department of Health and Human Services. Maternal, infant and early childhood home visiting program. http://mchb.hrsa.gov/programs/homevisiting/
Surveillance Data for Abortion, CDC/NCCDPHP
National Survey of Family Growth (NSFG), CDC/NCHS
National Vital Statistics System-Natality (NVSS-N), CDC/NCHS)
Group Recommendations:
Doctors, nurses, and
other health care professionals can:
- Counsel parenting teens on how
they can avoid additional pregnancies by not having sex.
- Discuss with sexually active teens
the most effective types of birth control to prevent repeat pregnancies.
Refer to CDC guidelines: United States Medical Eligibility
Criteria for Contraceptive Use
(USMEC).
- Remind sexually active teens to
also use a condom every time to prevent sexually transmitted
diseases, including HIV/AIDS.
- Connect teen mothers with support
services that can help prevent repeat pregnancies, such as home visiting
programs.
- Advise teen mothers that births
should be spaced at least 2 years apart to support the health of the baby,
and that having more than one child during the teen years can make it
difficult for teen parents to reach their educational and work goals.
Parents, guardians,
and caregivers can:
- Talk about how to avoid repeat
births with both male
and female teens.
- Check with your insurer about
coverage of preventive services. In some cases, preventive services, such
as birth control methods and counseling, are available with no
out-of-pocket costs.
- Talk with community leaders,
including faith-based organizations, about using effective programs that
can help prevent repeat teen pregnancies.
Teens, including teen
parents, can:
- Choose not to have sex.
- Use birth control correctly every time if you are
having sex. Use condoms every time to prevent disease.
- Discuss sexual
health issues with
your parents, partner, health care professionals, and other adults and
friends you trust.
- Find a family planning clinic near you for birth control if you
choose to be sexually active.
The federal
government is:
- Funding states and tribes through
the Pregnancy Assistance Fund to provide pregnant and parenting teens with
a complete network of support services.
- Promoting home visiting and other programs shown to
prevent repeat teen pregnancy and reduce sexual risk behavior.
- Conducting and evaluating programs
that work, as well as innovative approaches to reduce teen pregnancy and
births in communities with the highest rates.
- Helping other groups with information to duplicate teen pregnancy prevention programs that have been shown to be effective through rigorous research.
The President's Teen Pregnancy Prevention Initiative
As part of the President's
Teen Pregnancy Prevention Initiative (TPPI), the CDC is partnering with the federal
Office of the Assistant Secretary for Health (OASH) to reduce teenage pregnancy
and address disparities in teen pregnancy and birth rates. The OASH Office of Adolescent Health (OAH) is supporting public and private entities
to fund medically accurate and age appropriate evidence-based or innovative
program models to reduce teen pregnancy.
The purpose of this program is to demonstrate the effectiveness of innovative, multicomponent, community-wide initiatives in reducing rates of teen pregnancy and births in communities with the highest rates, with a focus on reaching African American and Latino/Hispanic youth aged 15–19 years. A community-wide model is an intervention implemented in defined communities (specified geographic area) applying a common approach with different strategies.
Community-wide approaches will be tailored to the specified community, and will include broad-based strategies that reach a majority of youth in the community (i.e., through communication strategies and media campaigns); and intensive strategies reaching youth most in need of prevention programming (i.e., through implementation of evidence-based programs and improved links to services).
The purpose of this program is to demonstrate the effectiveness of innovative, multicomponent, community-wide initiatives in reducing rates of teen pregnancy and births in communities with the highest rates, with a focus on reaching African American and Latino/Hispanic youth aged 15–19 years. A community-wide model is an intervention implemented in defined communities (specified geographic area) applying a common approach with different strategies.
Community-wide approaches will be tailored to the specified community, and will include broad-based strategies that reach a majority of youth in the community (i.e., through communication strategies and media campaigns); and intensive strategies reaching youth most in need of prevention programming (i.e., through implementation of evidence-based programs and improved links to services).
Program
goals are:
- Reduce the rates of pregnancies and births to youth in the target areas.
- Increase youth access to evidence-based and evidence-informed programs to prevent teen pregnancy.
- Increase linkages between teen pregnancy prevention programs and community-based clinical services.Educate stakeholders about relevant evidence-based and evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities.
To achieve these goals for FY 2011–2015, nine state- and community-based organizations, including two Title X agencies, and five
national organizations were funded through the cooperative agreement, Teenage
Pregnancy Prevention: Integrating Services, Programs, and Strategies Through
Community-wide Initiatives. These awards were made through two competitive
funding opportunity announcements (FOA): one through a joint FOA from OAH and
CDC, and one from a joint Office of Population Affairs and CDC FOA.
The national organizations will provide training
and technical assistance to all funded organizations within this initiative.
The state- and community-based grantees will provide training and technical
assistance to youth-serving organizations and partners to implement the Key
Components described below.
Five
key components to be addressed through this program model are:
Component 1: Community Mobilization and Sustainability
Component 1: Community Mobilization and Sustainability
Engaging all sectors of the population in a community-wide effort
to address teen pregnancy prevention. Community mobilization supports the
sustainability of teen pregnancy prevention efforts by empowering community
members and groups to take action to facilitate change. This component includes
mobilizing necessary resources, disseminating information, generating support,
and fostering cooperation across public and private sectors in the community.
Providing teens with evidence-based teen pregnancy prevention
programs, including youth development and curriculum-based programs that reduce
teen pregnancy and associated risk factors.
Ensuring clinical partners are providing teen friendly, culturally
competent reproductive health care services that are easily accessible to all
youth in the community, and establishing linkages between teen pregnancy
prevention program partners and clinics that serve at risk youth from the
target community.
Educating civic leaders, parents, and other community members
about evidence-based strategies to reduce teen pregnancy and improve adolescent
reproductive health, including needs and available resources in the target
community.
Raising awareness of community partners about the link between
teen pregnancy and social determinants of health, and ensuring culturally and
linguistically appropriate programs and reproductive health care services are
available to youth.
By addressing these core components, the
following performance measures are expected within five years:
Youth
outcomes:
- Reduce teen birth rates by 10% in targeted communities.
- Reduce teen pregnancies in targeted communities.
- Increase the percentage of youth who abstain from or delay sexual intercourse.
- Increase the consistent and correct use of condoms and other effective methods of contraception among sexually active youth.
Program,
practices, and community support outcomes:
- Increase the number and percentage of youth within the target community who receive evidence-based and evidence-informed programs to prevent teen pregnancy.
- Increase the number and percentage of sexually active youth within the target community who are referred to and use clinical services.
- Increase adoption of state, local, or community-wide health, education, and youth service strategies supportive of adolescent reproductive health by educating relevant stakeholders on evidence-based and evidence-informed teen pregnancy prevention approaches and environmental supports.
- Through training and technical assistance, increase the capacity of the target community partners to select, implement, and evaluate evidence-based and evidence-informed programs with fidelity and with informed program adaptation as appropriate
Hamilton, B. E., Martin, J. A., & Ventura, S. J. Births: preliminary data for 2011. (n.d.). Retrieved from website: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf
Perper, K., Peterson, K., & Manlove, J. Diploma attainment among teen mothers. (n.d.). Retrieved from http://www.childtrends.org/Files/Child_Trends-2010_01_22_FS_DiplomaAttainment.pdf
Counting it up: the public costs of teen childbearing. (n.d.). Retrieved from http://www.thenationalcampaign.org/costs/default.aspx
Singh, S., & Darroch, J. E. Adolescent pregnancy and childbearing: levels and trends in developed countries. (n.d.). Retrieved from http://www.guttmacher.org/pubs/journals/3201400.html
Centers for Disease Control and Prevention. Teen pregnancy prevention 2010-2015. Retrieved from http://www.cdc.gov/TeenPregnancy/PreventTeenPreg.htm
Centers for Disease Control and Prevention. Teen births (2008) and medicaid waiver expansion (2011). Retrieved from http://www.cdc.gov/program/data/policyanalyses/DataforActionPolicyTables_TP.pdf
Centers for Disease Control and Prevention. United States Medical Eligibility Criteria (USMEC) for Contraceptive Use. (n.d.). Retrieved from http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
Centers for Disease Control and Prevention. Teen birthrates rise for the first time in 14 years. http://www.cdc.gov/media/pressrel/2007/r071205.htm
Colorado Youth Matter. (n.d.). Retrieved from http://www.coloradoyouthmatter.org/
The National Campaign to Prevent Teen and Unwanted Pregnancy. ¡Cuídate! http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=8
The National Campaign to Prevent Teen and Unwanted Pregnancy. Aban Aya. http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=2
The National Campaign to Prevent Teen and Unwanted Pregnancy. R.E.A.L. Men.
http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=37
The National Campaign to Prevent Teen and Unwanted Pregnancy. Sisters saving sisters.
http://www.thenationalcampaign.org/resources/viewprogram.aspx?id=11
Guttmacher Institute. Guttmacher Institute Abortion Provider Survey (APS).
Centers for Disease Control and Prevention. Surveillance Data for Abortion. CDC/NCCDPHP.
Centers for Disease Control and Prevention. National Survey of Family Growth (NSFG). CDC/NCHS.
Centers for Disease Control and Prevention. National Vital Statistics System-Natality (NVSS-N). CDC/NCHS).
Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for contraceptive use, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_e
Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs). http://www.cdc.gov/std/
Centers for Disease Control and Prevention. HIV/AIDS. Retrieved from http://www.cdc.gov/hiv/
Centers for Disease Control and Prevention. Parent and guardian resources. Retrieved from http://www.cdc.gov/TeenPregnancy/Parents.htm
Centers for Disease Control and Prevention. Contraception. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
Centers for Disease Control and Prevention. Sexual health. http://www.cdc.gov/sexualhealth/
U.S. Department of Health and Human Services. Office of population affairs. http://www.hhs.gov/opa/
U.S. Department of Health and Human Services. Maternal, infant and early childhood home visiting program. http://mchb.hrsa.gov/programs/homevisiting/
No comments:
Post a Comment