Asian Pacific islander subpopulations: A true look at teen pregnancy

Ever the past two decades, there has been a national focus on the issue of teen pregnancy. However, the agenda created to address this important issue has been based on an incomplete understanding of the available data.

The box titled "US Teen Pregnancy Rates, 1998" presents the picture of how teen pregnancy has been constructed as a racial/ethnic issue.' The impression given is that teen pregnancy is not a concern for Asians and Pacific Islanders (APIs).

The diversity of the API subpopulations that comprise this aggregate, however, is obscured. As a result, API communities are often ignored by public health campaigns, policymakers, and community services programs working on the critical issue of teen pregnancy prevention.

In 2000, a collaborative project was developed to debunk the myth that adolescent pregnancy is not an issue for the API community and inform policymakers of the need to provide resources to support teen pregnancy-- prevention efforts in the API subpopulation communities.

TEEN PREGNANCY AND APIs

Over the past two years, a team comprised of members of the National Center for Excellence in Women's Health at the University of California at San Francisco (USCF), the Center for Reproductive Health, Research, and Policy at USCF and Asians and Pacific Islanders for Reproductive Health has sought to understand teen pregnancy as an issue that includes API communities.

The project, Teen Pregnancy among API Communities: The Importance of Understanding Subpopulations, was funded by The California Wellness Foundation as part of its Teen Pregnancy Prevention Initiative.

The project has two concentric goals: to include APIs in discussions about teen pregnancy while simultaneously understanding the large context in which the problem of teen pregnancy is situated and constructed.

To meet these goals, the project team has undertaken:

* An analysis of teen births among APIs, using the California birth certificate data

* An analysis of the utilization of California state family planning services provided through the FamilyPACT program

* Interviews with community representatives regarding how they see the issue of teen pregnancy

* Direct work with API youth to understand how they negotiate the issues of teen pregnancy and teen pregnancy prevention

* An analysis of the role of teen pregnancy in welfare reform efforts

* The development of policy recommendations

This article presents highlights from each of these project activities. A full report is available from the UCSF Center for Reproductive Health Research and Policy at wwwreprohealth. ucsf.edu.

DISAGGREGATION

According to the 2000 Census, approximately 3.8 million APIs currently live in California.3 Although they comprise only four percent of the national population, APIs make up over 11 percent of the population in California, and 36 percent of all APIs living in the United States reside in the state.4

By the year 2020, it is estimated that between 7.4 and 8.5 million APIs will live in California.5 The Californian API adolescent population (ages 10 through 19) will also increase nearly 45 percent from 1995 to 2005, to roughly 750,000 youths.6

The box titled "APIs in California, 2000 Census" presents the distribution of APIs by subpopulation.8 Chinese and Filipinos make up the largest majority of APIs, with nearly 27 percent and 25 percent, respectively, followed by Vietnamese (12 percent), Korean (9 percent), Asian Indian (8.5 percent) and Japanese (8 percent).9

Nearly half of the Filipino population in the United States lives in California,10 and the state also has the largest Hmong population in the United States at approximately 70,000.11

The API population, however, comprises more than 50 distinct ethnic populations, with large variations in national origin, language, culture, socioeconomic profile, immigration experiences, and levels of acculturation.

Aggregation of the data continues to keep API teen concerns hidden, with limited resources and services addressing their needs. Throughout this project, disaggregation of the data related to teen pregnancy was a major goal.

PROJECT RESULTS

Utilizing the California Birth Certificate Data for years 1989 through 1998, analysis was conducted for 15 subpopulations of APIs: Chinese, Japanese, Korean, Indian, Filipino, Vietnamese, Cambodian,Thai, Laotian, Samoan, Guamanian, Eskimo/Aleut, Hawaiian, and two residual categories for other Asians and other Pacific Islanders.

Eight variables were included in the analyses of teen births: ethnicity, marital status, age of baby's mother and father, mother's education level, foreign-born status, health insurance status, use of prenatal care, and zip code of residence.

When disaggregation is taken into account, the teen birth picture for APIs is very different from the picture presented earlier. As an aggregate, fewer than six percent of births to APIs in California are teen births, whereas the proportion for whites is double that figure at 12 percent, for Hispanics 16 percent, and for African Americans 18 percent.

This aggregate figure, however, masks the very high proportion of teen births among certain API subpopulations. In the Laotian community, for example, 19 percent of births are to teen mothers and in the Guamanian community, 17 percent of births are to teen mothers. Among Cambodians and Thais, 11 percent of births are to teen mothers. At the other extreme, less than one percent of Chinese births are to teen mothers, and fewer than two percent of Japanese, Korean, and Indian births are to teens. The Vietnamese and Filipinos are close to the overall average for APIs. Data for the 15 subpopulations for which data is available is in "Percentage of All Births within an Ethnicity to Teens by Ethnicity in California, 1989-1998."

In addition to overall birth data, sub-analyses were conducted for each subpopulation which include:

* Percentage of births to teens

* Average age of teen mothers

* US. and foreign-born status

* Average age difference with father of baby

* Percentage of births to married teens

* Percentage entrance into prenatal care (PNC) in first trimester

* Health insurance coverage for PNC

* State map locating hot spots for teen births

A summary table of results for each population was produced for the project. An example for the Laotian community is in "California Laotian Teen Births, 1989-1998." Across subpopulations, comparisons allow for the identification of features unique to the subpopulation of interest.

In the case of the Laotian community, it is important to highlight that 59 percent of Latoian girls are married at the time they give birth. This figure is distinctly different from the one included in the national dialogue on teen pregnancy, where 79 percent of births to teen mothers are considered "out-of-wedlock."12

As a result, efforts directed at promoting abstinenceonly-until-marriage may not address the needs of teens giving birth within the Laotian community.

Limitations of the analysis. Data is usually reported as pregnancy rates for the population of interest. Pregnancy rates are calculated as the number of pregnancies divided by the population, usually presented as pregnancies per 1,000 women.

To conduct these calculations, three variables are required: number of births to the population, number of abortions to the population, and number of girls in the population. The analysis conducted for this project was only able to calculate the first of these figures-number of births.

There is currently no accurate data for abortions to API subpopulations. California does not collect data on abortions for any population, thus limiting even the ability to estimate the number for APIs.

The estimate for abortions among the API population at the national level was developed using data from independent periodic surveys of abortion clients and reports to the US. Centers for Disease Control and Prevention (CDC) from states that do have abortion reporting requirements (most of which do not collect data specifically for APIs but rather for the category of"other").

As such, the estimated number of abortions for APIs is not well established. In addition, given that births vary so dramatically across API subpopulations, it is assumed that abortion numbers also vary. As such, utilizing the aggregate estimate for abortions for APIs, even if available, would result in highly problematic calculations for API subpopulations.

Given these limitations, pregnancy rates cannot be calculated for API subpopulation youth. In utilizing the birth certificate data, the project calculates the proportion of all births that are to teens, by subpopulation. A limitation of this methodology is that the results reflect the age structure of the subpopulations. That is, if a group has many young members, as with recent immigrants, then, as a whole, the group will have relatively more births to young women 15 through 19 years of age than to older women, compared to that of a subpopulation with an older age structure.

To construct a teen birth rate that is clean of the age structure of the population, Census data of how many women in each sub-population live in California at the time is required. However, since the API population is rapidly growing, and the increases are uneven among the different ethnicities, the 1990 Census data is obsolete for that purpose.

Utilization of California family planning services provided through the FamilyPACT program. California's innovative FamilyPACT (Planning, Access, Care, and Treatment) program provides comprehensive family planning services, including STD screening and treatment, pregnancy tests, contraception, and HIV screening and counseling to low-income men and women who are at or below 200 percent of the federal poverty level and who do not have insurance or Medi-Cal (Medicaid) for services.

Most adolescents in California are eligible to receive FamilyPACT services since eligibility is calculated on the basis of personal income rather than family income. Analysis, based on the billing and claims data from the FamilyPACT program, 1997 through 1998, shows that API teen enrollment in the program comprises six percent of total teen enrollment, a relatively smaller proportion than the percentage of API teens in the state population (11 percent).

Unfortunately for the purposes of linking family planning and birth data, the FamilyPACT program does not utilize the same racial/ethnic categories as the birth certificate data. Instead, clients are categorized into three ethnicities: Asian, Pacific Islander, and Filipino. Clients can further identify by primary language: English, Cantonese, Hmong, Cambodian, Korean, and Vietnamese.

To develop the most complete subpopulation analysis possible within the existing data, these two fields are combined to create nine subpopulations for analysis: Filipino, Pacific Islander, Asian-English-speaking, Cantonese-speaking, Hmongspeaking,Vietnamese-speaking, Cambodian-speaking, Koreanspeaking, and other Asian language-speaking.

There are, however, limitations to these classifications. For example, if an English-speaking Chinese teen seeks FamilyPACT services, she will be categorized as "AsianEnglish-speaking" as would an English-speaking Vietnamese teen, and an English-speaking Cambodian teen.

Thus this data provides challenges to trying to understand family planning utilization by API subpopulations. Despite these limitations, analysis of the FamilyPACT data provides additional insight into the needs of subpopulations of API youth in California at risk for teen pregnancy.

A breakdown of the percentage of API clients served by ethnicity/language grouping is provided in the box titled "API FamilyPACT Clients." A little over 40 percent of the clients identify as Filipina. Another 30 percent are Asian, English-speaking clients.

Analyses were conducted for both services sought and the types of contraception received by API teens.

Of particular note is the number of teens who sought only a pregnancy test. This information has important implications for understanding risk of pregnancy among API youth since they indicate that youth are engaging in sexual activity and may not be using contraception.

Overall, nearly 40,000 teens or 20 percent of the total number of enrolled teenagers in FamilyPACT, visited the clinic for a pregnancy test and no other services. By comparison, approximately 28 percent of the total number of API clients receiving family planning services received only a pregnancy test. Pacific Islanders, Filipinos, and Vietnamesespeaking teens were more likely among the APIs to have a pregnancy test, with Cantonese-speaking and Asian Englishspeaking the least likely to request only a pregnancy test. Results for all available subpopulations are in "Teens Seeking Pregnancy Tests from FamilyPACT Provider."

Analysis of welfare reform. Both the community representatives and the youth identified the issue of welfare reform as central to understanding teen pregnancy in API subpopulations. In regard to its impact, both youth and service providers spoke mostly about its negative effects.

Participants shared their dismay over the ways in which the recipients of Temporary Assistance to Needy Families (TANF) are treated. They cited the lack of available interpreters, the invasion of privacy by social workers, the dead-end job placements, and the overall disrespect shown by government staff.

When presented with the major components of welfare reform and asked about their effect on teen pregnancy prevention, many youth talked about their regressive values. For example, some of the youth challenged the use of paternity identification. One youth said, "What does that have anything to do with whether the girls should get assistance? That's discrimination."

Others felt that the "pro-marriage" and "family cap" tenets mirrored the agenda of controlling the reproductive rights of women in the United States. "This is an outright attack on the rights of poor women! The government doesn't dictate the number of children middle-class families have, and they should not be trying to promote the notion that a nuclear family is the best for everyone," said one participant.

When asked to identify the major consequences of welfare reform on API youth and their families, service providers expressed feelings of frustration. Many were unhappy with the stipulations which they felt prevented poor families from moving out of poverty: "With the fiveyear limit coming up, we are seeing a lot of our families being bumped off of the roles. These are families with hard working parents who are holding down two to three jobs, and they are still not able to earn enough to support themselves and their kids. This hurts our communities and our youth. How are they supposed to have a future?"

In summary, they found that low-income and poor women of color often bear the brunt of welfare reform policies. By promoting abstinence-only programs, mandating that teenagers receiving assistance live at home, providing a paternity requirement, and a dictating a cap on children who are eligible, lawmakers are severely restricting the reproductive freedom of poor women and their families.

POLICY RECOMMENDATIONS

The report makes the following policy recommendations:

* Teen pregnancy should be recognized as an important issue for API communities

* Data should be collected by subpopulations at all levels of policymaking and program development

* API communities experiencing high teen births should have access to resources, services, and programs related to teen pregnancy prevention

* Programs and services should be designed specifically to address the unique cultural and linguistic features of API subpopulations of high need

* Programs and services should address the root causes of teen pregnancy

* The dialogue of teen pregnancy should be reframed within the context of reproductive freedom

* Welfare reform should be seen as central to understanding teen pregnancy among API communities

REFERENCES

1. S. J. Ventura, S. C. Curtin, and T J. Mathews, "Variations in Teenage Birth Rates, 1991-98: National and State Trends," National Vital Statistics Report, April 24, 2000, vol. 48, no. 6, pp. 1-113.

2. [bid.

3. U. S. Census Bureau, DP-1, "Profile of General Demographic Characteristics: 2000, Data Set: Census 2000 Summary File 1 (SF 1) 100-Percent Date, Geographic Area: California, U S Census Bureau. Available at: http://factfinder.census.gov/servlet/QTTable?ds_name =DEC_2000_SFl LT&geo id=04000US06&qr_name=DEC_200 0_SF 1-U-DPl.Accessed March 5, 2002.

4. U. S. Census Bureau, DP-1, "Profile of General Demographic Characteristics: 2000, Data Set: Census 2000 Summary File 1 (SFl) 100-Percent Data, Geographic Area: United States, U. S. Census Bureau. Available at: http://factfinder.census.gov/bf/lang=en-vt name=DEC_2000_SF 1-U-DPI_geo-id=Ol OOOUS.html. Accessed March 5, 2002.

5. P M. Ong and S. J. Hee, Twenty Million in 2020, The State ofAsian Pacific Americans:A Public Policy Report (Los Angeles, CA: Center for Pacific Rim Studies, University of California, Los Angeles, 1993); US. Census Bureau, "Census 2000 Redistricting Data (Public Law 94-171)," U.S. Census Bureau. Available at: http://factfinder.census.gov/bf/_lang=en-vt name=DEC_2000_PL_U_QTPL-geo id=04000US06.html. Accessed May 31, 2000.

6. California Department of Finance, Race/Ethnic Population with Age and Sex Detail, 1970, 2040 (Sacramento, CA: California Department of Finance, 1995).

7. U.S. Census Bureau, DP-1, "Profile of General Demographic Characteristics: 2000, Data set: Census 2000 Summary File I (SF 1) 100-Percent Data, Geographic Area: California, US. Census Bureau.

8. Ibid.

9. U. S. Census Bureau, 2000 US. Census Data, US. Census Bureau. Available at http://venus.census.gov/cdrom/lookup/989281080, http://www.census.gov/Press-Release/www/2001 /tables/ dp_ca_2000.PDE Accessed June 5, 2001.

10. Filipinology.com. California Pinoys in Cali, The Golden State. Filipinology.com. Available at: http://wwwfortunecity.com/meltingpot/redriver/1066/california.htm. Accessed May 31, 2001.

11. S. Magagnini, "States with the Largest Hmong Populations," Sacramento Bee, September 10, 2000.

12. National Campaign to Prevent Teen Pregnancy. Fact Sheet: Recent Trends in Teen Pregnancy. Available at http://www. teenpregnancy.org/rectrend.htm. Accessed May 31, 2001.

Tracy A. Weitz, M.P.A.*

Project Director National Center of Excellence in Women's Health Center for Re productive Health, Research, and Policy University of California at San Francisco San Francisco, CA

The project team included Tracy A. Weitz, M.PA., Cynthia Harper, Ph.D., Eveline Shen, M.PH., Regina Acebo, B.A.,Anshu P Mohllajee, B.A., and Nancy Milliken, M.D. -Editor

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