housing or financial aid before they got pregnant and what they thought they knew often turned out to be wrong. childhood environment girls exposed to abuse, domestic violence, and family strife in childhood are more likely to become pregnant as teenagers, and the risk of becoming pregnant as a teenager increases with the number of adverse childhood experiences. according to a 2004 study, one-third of teenage pregnancies could be prevented by eliminating exposure to abuse, violence, and family strife. the researchers note that "family dysfunction has enduring and unfavorable health consequences for women during the adolescent years, the childbearing years, and beyond." when the family environment does not include adverse childhood experiences, becoming pregnant as an adolescent does not appear to raise the likelihood of long-term, negative psychosocial consequences. studies have also found that boys raised in homes with a battered mother, or who experienced physical violence directly, were significantly more likely to impregnate a girl. studies have also found that girls whose fathers left the family early in their lives had the highest rates of early sexual activity and adolescent pregnancy. girls whose fathers left them at a later age had a lower rate of early sexual activity, and the lowest rates are found in girls whose fathers were present throughout their childhood. even when the researchers took into account other factors that could have contributed to early sexual activity and pregnancy, such as behavioral problems and life adversity, early father-absent girls were still about five times more likely in the us and three times more likely in new zealand to become pregnant as adolescents than were father-present girls. low educational expectations have been pinpointed as a risk factor. a girl is also more likely to become a teenage parent if her mother or older sister gave birth in her teens. a majority of respondents in a 1988 joint center for political and economic studies survey attributed the occurrence of adolescent pregnancy to a breakdown of communication between parents and child and also to inadequate parental supervision. foster care youth are more likely than their peers to become pregnant as teenagers. the national casey alumni study, which surveyed foster care alumni from 23 communities across the us, found the birth rate for girls in foster care was more than double the rate of their peers outside the foster care system. a university of chicago study of youth transitioning out of foster care in illinois, iowa, and wisconsin found that nearly half of the females had been pregnant by age 19. the utah department of human services found that girls who had left the foster care system between 1999 and 2004 had a birth rate nearly three times the rate for girls in the general population. media influence a study conducted in 2006 found that, adolescents who were more exposed to sexuality in the media were also more likely to engage in sexual activity themselves. according to time, "teens exposed to the most sexual content on tv are twice as likely as teens watching less of this material to become pregnant before they reach age 20". prevented comprehensive sex education and access to birth control appear to reduce unplanned teenage pregnancy. it is unclear which type of intervention is most effective. in the us free access to a long acting form of reversible birth control along with education decreased the rates of teen pregnancies by around 80% and the rate of abortions by more than 75%. currently there are four federal programs aimed at preventing teenage pregnancy: teen pregnancy prevention (tpp), personal responsibility education program (prep), title v sexual risk avoidance education, and sexual risk avoidance education. education the dutch approach to preventing teenage pregnancy has often been seen as a model by other countries. the curriculum focuses on values, attitudes, communication and negotiation skills, as well as biological aspects of reproduction. the media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. in the united states, only 39 states and the district of columbia out of the 50 states require some form of sex education of hiv education. out of these 39 states and the district of columbia, only 17 states require that the sexual education provided be medically accurate, and only 3 states prohibit a program from promoting sexual education in a religious way. these three states include california, colorado, and louisiana. additionally, 19 of those 39 states stress the importance of only having sex when in a committed marriage. from this data, 11 states currently have no requirement for sexual education for any years of schooling, meaning these 11 states may have no sexual education at all. this could also mean these states are allowed to teach sexual education in any way they would like, including in medically inaccurate ways. this point is also valid for those 22 states that do not require sexual education to be medically accurate. comprehensive sexual education has been proven to work to reduce the risk of teen pregnancies. without a nationwide mandate for medically accurate programs, teenagers in the united states are at risk for missing out on valuable information that can protect them. it is unfair to expect teenagers to make educated decisions about sex that can lead to teen pregnancy when they have never been properly educated about the issue. a program developed by experts in public health and sexual education titled national sexuality education standards, is a valuable resource that describes what the minimum requirements of sexual education should be across the nation. giving teenagers the tools that are outlined in that roadmap would have positive effects, as it gives teenagers the resources to make educated decisions. currently, there is not a national implementation of this program in the united states. teen pregnancy can be reduced by sex education as a study in 55 us counties (out of 2,927 counties) showed. the study used federal funded sex education programs as a proxy for sex education, but provided no details about funding levels, the number of students reached, or the amount of time spent on sex education. nevertheless, the reduction of teenage births (not pregnancy) was significant, at 3% reduction, indicating that an increase in funding, education, or reach could increase teenage pregnancy even further. although 3% sounds like a small number, given a teenage girl population of 10 million females aged 15–19 (in 2020), and ~190,000 teenage births per year, a 3% reduction would translate to about 6000 prevented teenage births per year when extrapolated to the whole nation. abstinence only education ad promoting abstinence in ghana for prevention of unplanned pregnancy and hiv/aids (2005) some schools provide abstinence-only sex education. evidence does not support the effectiveness of abstinence-only sex education. it has been found to be ineffective in decreasing hiv risk in the developed world, and does not decrease rates of unplanned pregnancy when compared to comprehensive sex education. it does not decrease the sexual activity rates of students, when compared to students who undertake comprehensive sexual education classes. assistance nurse-family partnership (nfp) is a non-profit organization operating in the united states and the uk designed to serve the needs of young mothers who may have special needs in their first pregnancy. each mother served is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child's second birthday. nfp intervention has been associated with improvements in maternal health, child health, and economic security. canada in 2018, québec's institut national de santé publique (inspq) began implementing adjustments to the protocole de contraception du québec (québec contraception protocol). the new protocol allows registered nurses to prescribe hormonal birth control, an iud or emergency birth control to women, as long as they comply with prescribed standards in the prescription infirmière : guide explicatif conjoint, and are properly trained in providing contraceptives. in 2020, québec will offer online training to registered nurses, provided by the ordre des infirmières et infirmiers du québec (oiiq). nurses that do not have training in the areas of sexually transmitted and blood borne infections may have to take additional online courses provided by the inspq. united states us statistics in april 2015 in the us, one policy initiative that has been used to increase rates of contraceptive use is title x. title x of the family planning services and population research act of 1970 (pub. l. 91–572) provides family planning services for those who do not qualify for medicaid by distributing "funding to a network of public, private, and nonprofit entities services on a sliding scale based on income." studies indicate that, internationally, success in reducing teen pregnancy rates is directly correlated with the kind of access that title x provides: “what appears crucial to success is that adolescents know where they can go to obtain information and services, can get there easily and are assured of receiving confidential, nonjudgmental care, and that these services and contraceptive supplies are free or cost very little.” in addressing high rates of unplanned teen pregnancies, scholars agree that the problem must be confronted from both the biological and cultural contexts. on september 30, 2010, the us department of health and human services approved $155 million in new funding for comprehensive sex education programs designed to prevent teenage pregnancy. the money is being awarded "to states, non-profit organizations, school districts, universities and others. these grants will support the replication of teen pregnancy prevention programs that have been shown to be effective through rigorous research as well as the testing of new, innovative approaches to combating teen pregnancy." of the total of $150 million, $55 million is funded by affordable care act through the personal responsibility education program, which requires states receiving funding to incorporate lessons about both abstinence and contraception. developing countries in the developing world, programs of reproductive health aimed at teenagers are often small scale and not centrally coordinated, although some countries such as sri lanka have a systematic policy framework for teaching about sex within schools. non-governmental agencies such as the international planned parenthood federation and marie stopes international provide contraceptive advice for young women worldwide. laws against child marriage have reduced but not eliminated the practice. improved female literacy and educational prospects have led to an increase in the age at first birth in areas such as iran, indonesia, and the indian state of kerala. other a team of researchers and educators in california have published a list of "best practices" in the prevention of teen pregnancy, which includes, in addition to the previously mentioned concepts, working to "instill a belief in a successful future", male involvement in the prevention process, and designing interventions that are culturally relevant. prevalence main article: prevalence of teenage pregnancy adolescent birth rate in women aged 10-19 years as of 2016 in reporting teenage pregnancy rates, the number of pregnancies per 1,000 females aged 15 to 19 when the pregnancy ends is generally used. worldwide, teenage pregnancy rates range from 143 per 1,000 in some sub-saharan african countries to 2.9 per 1,000 in south korea. in the us, 82% of pregnancies in those between 15 and 19 are unplanned. among oecd developed countries, the us, the uk and new zealand have the highest level of teenage pregnancy, while japan and south korea have the lowest in 2001. according to the unfpa, “in every region of the world – including high-income countries – girls who are poor, poorly educated or living in rural areas are at greater risk of becoming pregnant than those who are wealthier, well-educated or urban. this is true on a global level, as well: 95 per cent of the world’s births to adolescents (aged 15–19) take place in developing countries. every year, some 3 million girls in this age bracket resort to unsafe abortions, risking their lives and health.” according to a 2001 unicef survey, in 10 out of 12 developed nations with available data, more than two thirds of young people have had sexual intercourse while still in their teens. in denmark, finland, germany, iceland, norway, the uk and the us, the proportion is over 80%. in australia, the uk and the us, approximately 25% of 15-year-olds and 50% of 17-year-olds have had sex. according to the encyclopedia of women's health, published in 2004, approximately 15 million girls under the