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Focus On Sexual And Reproductive Health

Across the United States, young people are at risk for unintended pregnancy and sexually transmitted infections (STIs) including HIV. Due to structural barriers and policies that do not support young people’s rights to honest, medically accurate information and services, Mississippi’s youth face some of the highest rates of pregnancy, HIV, AIDS, and other STI diagnoses, in the nation. Comprehensive sexuality education, health equity, and access to contraception are more important than ever to the health of young people in the state.

MISSISSIPPI’S YOUTH POPULATION: AN OVERVIEW

• According to the 2014 American Communities Survey, Mississippi’s population is 59.7 percent white, 37.5 percent African American, 1 percent Asian, 3 percent Hispanic or Latino, .6 percent American Indian, and less than .1 percent Native Hawaiian or Pacific Islander. [1]
• As of 2010, there are 435,513 young people ages 15-24 living in Mississippi, making up 14.7 percent of the state’s population. [2]
• Mississippi faces the highest levels of poverty in the country, and poverty is concentrated primarily in the African American community and among young people: While white people in Mississippi are equally as likely to have an income below the federal poverty line as white people in the rest of the country, African Americans in Mississippi have a poverty rate of 40 percent compared to 27 percent in the country as a whole. [3] Similarly, children and youth under 18 are 8 percent more likely to have a family income below the federal poverty line in Mississippi than in the country as a whole. [4]

SEXUAL HEALTH OUTCOMES IN MISSISSIPPI: YOUNG PEOPLE HAVE HIGH RATES OF PREGNANCY, HIV, AND STIS

• In 2010, there were 76 pregnancies per 1,000 women age 15-19 – the second-highest teen pregnancy rate in the United States. However, there were only 9 abortions per 1,000 women age 15-19, the 32nd highest rate in the U.S.5
• There were 12.1 HIV diagnoses for every 100,000 young people aged 13-19 in Mississippi in 2013, almost double the national rate.6 The rate of AIDS diagnoses among young people 13-19 was 5.3 per 100,000 – more than triple the national rate of 1.6 per 100,000.7 These high rates also exist for young people 20-24, whose rate of HIV and AIDS diagnoses – at 59.7 per 100,000 and 9.8 per 100,000 – were both double the national rate. [8]
• In 2013, Mississippi had the fifth highest rate of chlamydia and fourth-highest rate of gonorrhea among young people age 15-19.9
• According to the Mississippi Youth Risk Behavior Survey, in 2013 40.5 percent of high school students reported being currently sexually active, compared with 34 percent nationwide. 54.2 percent of high school students reported ever having sex, with 11.8 percent reporting having sex before age 13 and 19.7 percent reporting having sex with four or more partners during their lifetime –all 5-10 percent points higher than nationwide.10 13.9 percent of high schoolers in Mississippi had used no contraception method to prevent pregnancy during the last time they had sexual intercourse, compared with 13.7 percent nationwide. [11]

SOCIAL AND STRUCTURAL FACTORS PUT YOUTH OF COLOR AND LGBTQ YOUTH IN MISSISSIPPI AT RISK

• Racial disparities in health outcomes for young people in Mississippi are stark: Although African Americans make up 37.5 percent of Mississippi’s population in 2011 56.9 percent of births to women under 20 were to black women. [12] In 2013, 88.3 percent of new HIV diagnoses among young people ages 13-24 were among Black/African American young people. [13]
• Disparities in barriers to accessing healthcare services, poverty, structural exclusion, and disadvantage all contribute to young people’s ability and motivation to prevent unintended pregnancy, HIV, and STIs. For example, young people under the age of majority rarely may consent to contraceptives, abortion or their own HIV treatment without parental permission [14], disproportionately burdening youth in the foster care system or who are otherwise not living with their parents.
• Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth in Mississippi are marginalized, increasing their risk of HIV, STIs, and other negative health outcomes: the National Youth Risk Behavior Survey found that 11 percent to 30 percent of gay and lesbian students and 12 percent to 25 percent of bisexual students surveyed did not go to school at least one day during the prior month because of safety concerns. These concerns put LGBTQ youth greater risk for depression, substance use, and sexual behaviors that place them at risk for HIV and STIs. [15] As a result, in Mississippi the HIV epidemic in the state is disproportionately concentrated among men who have sex with men, with almost 80 percent of new infections among men in 2012 related to male to male sexual contact. [16]

SEX ED IN MISSISSIPPI: WHAT PARENTS WANT IS NOT WHAT THERE IS

• As of 2014, over 90 percent of Mississippi parents support comprehensive, age appropriate sex education. [17]
• Yet, Section 37-13-171 of the Mississippi Code, which expires in 2016, requires each school district adopt either abstinence-only or abstinence-plus education policy, both of which must teach that “monogamous marriage is the only appropriate setting for sexual intercourse” and require that parents request for their child to participate in their school’s sex education curriculum. Schools are not allowed to “include instruction and demonstrations on the application and use of condoms” or that “abortion can be used to prevent the birth of a baby.” [18] The current law has no enforcement mechanism, and as of February 2014, 12 percent of districts were not teaching any form of sex education. [19]
• Recent research on abstinence-only programs found them ineffective, with no impact on reducing teen pregnancy, delaying sexual initiation, or reducing STIs. Recent research on comprehensive sexuality education has shown that young people who receive complete and accurate information about abstinence, condoms, and contraception were not more likely to acquire an STI, but were significantly less likely to be involved in teen pregnancy and were significantly more likely to use condoms once sexually active. [20]
• Although Mississippi youth face much higher rates of HIV and AIDS diagnoses than the national average, 23.2 percent of high school students in 2013 had never learned about HIV or AIDS in school, compared with 14.7 percent of high school students nationwide. [21]
• In Fiscal Year 2014 agencies and organizations in Mississippi received a total of $1,514,493 in Teen Pregnancy Prevention Program grants, $379,997 in Department of Adolescent & Sexual Health grants, and $521,606 Personal Responsibility Education Program grants, to help implement targeted programs that have more comprehensive approaches to sexual health education for certain groups of young people. [22] That year, agencies and organizations in Mississippi also received $700,096 in Title V Abstinence-Only-Until-Marriage funding and $496,244 in Competitive Abstinence Education funding. [23]

CONCLUSION

Young people in Mississippi are at serious risk for unintended pregnancy, HIV and STIs. Youth of color and LGBT youth are at even higher risk for negative sexual health outcomes. To address these risks, research shows that comprehensive sexuality education and access to contraceptive services can help young people protect their health and well-being.24 In addition to helping young people choose healthier behaviors, we must also dismantle barriers to health equity (including poverty, lack of insurance, and disparities in education) and support structural interventions that help allow all young people to build healthy lives.

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REFERENCES

1. U.S. Census Bureau, State and County Quick Facts. Mississippi Available at: http://quickfacts.census.gov/qfd/states/28000.html. Accessed January 21, 2016.

2. U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates.Mississippi. Available at: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF. Accessed January 21, 2016.

3. Ibid.

4. Kaiser Family Foundation, State Health Facts: Poverty Rate by Age. Available at http://kff.org/other/state-indicator/poverty-rate-by-age/ . Accessed January 21, 2016.

5. Guttmacher Institute, State Reproductive Health Profile. Mississippi. Available at: http://www.guttmacher.org/datacenter/profiles/MS.jsp. Accessed January 21, 2016.

6. Slide 9: “Rates of Diagnosis of HIV Infection among Adolescents Aged 13–19 Years, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention). Available at www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed January 21, 2016.

7. Slide 18: “Rates of Stage 3 (AIDS) Classifications among Adolescents Aged 13–19 Years with HIV Infection, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention). Available at www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed January 21, 2016.

8. Slide 10: “Rates of Diagnoses of HIV Infection among Young Adults Aged 20–24 Years, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention), available at www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed January 21, 2016; Slide 19: “Rates of Stage 3 (AIDS) Classifications among Adolescents Aged 20–24 Years with HIV Infection, 2013—United States and 6 Dependent Areas,” HIV Surveillance in Adolescents and Young Adults (Atlanta, GA: Centers for Disease Control and Prevention), available at www.cdc.gov/hiv/pdf/statistics_surveillance_Adolescents.pdf. Accessed on January 21, 2016;

9. NCHHSTP Atlas, “STD Surveillance Data” (Atlanta, GA: Centers for Disease Control and Prevention). Available at: http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html. Accessed on January 21, 2016.

10. Centers for Disease Control & Prevention, Adolescent and School Health: YRBSS Results. Available at: http://www.cdc.gov/healthyyouth/data/yrbs/results.htm. Accessed on January 21, 2016.

11. Ibid.

12. Office of Adolescent Health, Mississippi Reproductive Health Facts. Available at http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/states/ms.html#. Accessed on January 21, 2016.

13. Mississippi Department of Health, Reported Cases of HIV Disease: MS, 2009-2013 by Race/Ethnicity, Age Group, and Sex. Available at: http://www.msdh.state.ms.us/msdhsite/index.cfm/14,6014,150,pdf/HIV09-13.pdf. Accessed on January 21, 2016.

14. Guttmacher Institute, State Reproductive Health Profile. Mississippi. Available at: http://www.guttmacher.org/datacenter/profiles/MS.jsp. Accessed January 21, 2016.

15. Centers for Disease Control & Prevention, LGBT Youth. Available at http://www.cdc.gov/lgbthealth/youth.htm. Accessed on January 21, 2016.

16. Aids Vu, Mississippi Highlights. Available at http://aidsvu.org/state/mississippi/. Accessed on January 21, 2016.

17.http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1253&context=jhdrp

18.http://siecus.org/document/docWindow.cfm?fuseaction=document.viewDocument&documentid=532&documentFormatId=613

19.http://articles.latimes.com/2014/apr/02/nation/la-na-ms-teen-pregnancy-20140403

20. Kohler et al. “Abstinence-only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health, 42(4): 344-351. 20. McKee et al. “What Do Parents in Mississippi Really Think About Sex Education in Schools? Results of a State-Level Survey.” Journal of Health Disparities Research and Practice 7(1): 97-110.

21.Sexuality Education Information Council of the United States. State Profile: Mississippi. 2014. Available at: http://siecus.org/document/docWindow.cfm?fuseaction=document.viewDocument&documentid=532&documentFormatId=613. Accessed January 21, 2016.

22. Ibid.

23. Alford S. Science and Success: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003.

25. Millet, GA. Explaining Disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS 21 (15) 2083-2091. AND Hallfors DD. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. American Journal of Public Health 2007; 97(1): 125-132.

26. Alford S. Science and Success: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003.

27. Sexuality Education Information Council of the United States. Fact Sheet: On Our Side: Public Support for Comprehensive Sex Education. Available at http://www.siecus.org/index.cfm?fuseaction=Page.ViewPage&PageID=1197.Accessed on January 21, 2016.