After more than a decade in decline, the United States teen pregnancy has been rising in recent years. According to momlogic.com, the estimated public cost for teen pregnancy in the United States is between $6 and $9 billion a year. Eighty percent of teen moms are on some form of public assistance. Seven out of 10 teen mothers are unlikely to receive prenatal care, which of course has great negative health impacts for their children. Aside from the health risks, kids born to teen mothers are at greater risk for emotional and physical abuse, especially if there is no family support.
“It really is a public health issue,” said Bill Albert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy. “This administration and this Congress have made a historic investment in preventing teen pregnancy. In our view, this investment could not be more timely… given the fact that the teen pregnancy rate in the United States is on the rise. I think one might say, without hyperbole…that one of the nation’s great success stories of the past two decades may be in danger of unraveling. So, this investment is right on for content and right on for timeliness.”
Teenage mothers are also at higher risk of having emotional and academic problems later in life. Another startling statistic: baby boys of teen mothers are at an increased risk for incarceration later in their lives, while girls born to teens are more likely to become teen moms themselves.
In the beginning of 2009, President Barack Obama signed an appropriations bill that ended federal funding for existing abstinence-only-until-marriage programs and put a new teenage pregnancy prevention initiative in the newly funded Office of Adolescent Health within the U.S. Department of Health and Human Services that was supported with more than $114 million in federal funds.
The prevention initiative was being hailed by health advocates for its focus on the evidence. Of the $114 million, $75 million will go toward replicating pregnancy prevention programs that had been thoroughly evaluated and provided the strongest evidence of success, while $25 million went to programs that show promise and innovation. There are roughly 400,000 teen births every year in the United States, with about $9 billion in associated public costs.
While the nation’s teen pregnancy rate declined about 40 percent between 1990 and 2005, data released by the Guttmacher Institute in January 2010 showed that the rate rose three percent in 2006. According to the institute, the new data is “especially noteworthy because they provide the first documentation of what experts have suspected for several years, based on trends in teens’ contraceptive use — that the overall teen pregnancy rate would increase in the mid-2000s following steep declines in the 1990s and a subsequent plateau in the early 2000s.”
And like many other health issues, the U.S. teen pregnancy rate is checkered with disparities. In 2006, among Black and Hispanic teens ages 15 to 19, there were about 126 pregnancies per 1,000 women, while among white teens, it was 44 per 1,000. Such statistics mean the United States has the highest teen birth rate among Western, industrialized nations.
First there was a study from the Guttmacher Institute, a nonpartisan think tank that concluded the teen pregnancy rate is on the rise after more than a decade of decline. Then there was a federally-funded report that said the cure to the problem might just be those much-maligned abstinence-only sex education classes – despite experts’ opinions, offered in connection with the previous report, that those classes are the cause of the rise.
Although the Guttmacher report does not discuss the poverty factor in detail, the correlation is easy to see. The report’s rankings of states by teen pregnancy rates look eerily similar to the U.S. Census rankings of states by poverty rates.
Mississippi, for example, has the nation’s highest rate of poverty and the third highest rate of teen pregnancies. New Mexico is third in poverty and second in teen pregnancies. Texas leads in teen pregnancies and comes in ninth in the poverty rankings.
Other “risk factors” for teenage pregnancy – being a person of color, being disinterested in school, etc. – similarly dovetail with living in poverty. Pennsylvania is ranked 39th in teenage pregnancies.
According to the National Campaign to Prevent Teen Pregnancy, a child born to an unmarried teen mother has a 27 percent chance of growing up in poverty. If the mother has not earned a high school diploma or equivalency degree, the child will grow up in poverty 64 percent of the time. If those numbers are correct, the steep decline in teen pregnancy rates between 1991 and 2002 kept an additional 460,000 children from being born into poverty.
“As a society, we have to continually redouble our efforts to sustain these kinds of (downward) trends over time,” said Heather Boonstra, a senior public policy associate at the Guttmacher Institute, which conducts research on a range of sexual and reproductive health issues. “We can’t just sit back, because new teens are constantly coming into the field and we have to remain vigilant.”
Factors shaping the recent rise in teen pregnancy are varied and complex, prevention advocates say, ranging from years of federal support for rigid abstinence-only programs to tempered fears of contracting HIV, to less teen contraceptive use. According to the 2007 National Youth Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention, rates of teens who were sexually active and those who used a condom during their last sexual encounter remained statistically stalled from 2005 to 2007, following years of positive behavior change.
The CDC reported that of the teens who were sexually active, only about 61 percent used a condom the last time they had sex. And according to Lorrie Gavin, PhD, MPH, a health scientist with the CDC’s Division of Reproductive Health, current trends point to more than just a teen pregnancy problem — “there’s something else going on … improvements in sexual risk behavior have leveled off in recent years, and rates of some sexually transmitted diseases have increased.”
“We have the tools we need (to prevent teen pregnancy and disease) — and we can always improve on them — but we need to better apply them,” Gavin told The Nation’s Health. “In addition to disseminating evidence-based sexuality education and youth development programs, it is critically important that we make sure that sexually active youth have access to contraceptive services and that there is a supportive social and policy environment.”
With a focus on the evidence, the new federal teen pregnancy initiative could go far in creating such an environment, say prevention advocates, many of whom criticized previous federal support of often ineffective abstinence-only programs. Federal funding of abstinence-only programs increased significantly beginning in the mid-1990s and since 1998; $50 million per year was going toward programs that teach abstinence from sex outside of marriage.
The debate over the effectiveness of abstinence vs. contraception made headlines after a study published in the February 2009 issue of Archives of Pediatrics and Adolescent Medicine found that one specific abstinence-based intervention was successful at delaying sexual initiation. However, the study authors noted that the intervention studied “would not meet federal criteria for abstinence programs… (and) was not moralistic and did not criticize the use of condoms.”
For the Obama administration, the sticking point will be evidence, not content, Albert said.
“It used to be, to get this federal pot of money, you had to stick to a certain curriculum — the variable was content, not evidence,” Albert told The Nation’s Health. “Now, our ‘sort variable’ is going to be evidence, and for geeks like us, that’s music to our ears.”
While garnering praise, advocates warn that the new federal teen pregnancy prevention effort is not necessarily permanent, and that abstinence-only-until-marriage proponents are not giving up. In the health reform bill passed by the U.S. Senate, Sen. Orrin Hatch, R-Utah, successfully included an amendment to restore $50 million a year in abstinence-only state funds — a move that extended abstinence-only funds by another five years. In addition, funds for President Obama’s new teen pregnancy prevention effort must be re-appropriated by Congress every year, which means its future is far from secure.
The American Public Health Association contributed to this report.
Zack Burgess is the Enterprise Writer for The Tribune. He is a freelance writer and Editor who covers culture, politics and sports. •
He can be contacted at zackburgess.com and followed on Twitter @zackburgess1.