TEEN PREGNANCY PREVENTION: WHAT ROLE ARE STATES PLAYING?

Volume 29, Issue 510 March 3, 2008

Anna Wolke

The costs of teen pregnancy are enormous, to teens and their children, as well as the public sector. Teen childbearing costs taxpayers at least $9 billion each year, for everything from health care to incarceration. Children born to teens are two times more likely to suffer abuse and neglect than the children of older mothers.

But there’s been some good news lately on the teen pregnancy front. NCSL’s Anna Wolke talked to Andrea Kane, senior director of policy and partnerships at the National Campaign to Prevent Teen and Unplanned Pregnancy, about why the teen pregnancy rate has dropped, what role states played and what states are doing to advance a new campaign to prevent unplanned pregnancies among young adults. (The National Campaign is a strictly non-partisan group that seeks to help ensure that children are born into stable, two-parent families by preventing teen pregnancy and unplanned pregnancy among single, young adults.)

The pregnancy rate among teens, aged 15 to 19, declined by 36 percent between 1990 and 2002. What factors contributed to this decrease?

We have a lot of good news here and also some not-so-good news. On the good news front, teen pregnancy has declined more than a third since the early 1990’s, which was a goal set by the National Campaign when we started. Thanks to the hard work of lots of people around the country, there has been progress in decreasing the teen pregnancy rate in all states and among all racial and ethnic groups.

As for why this has happened, to put it simply fewer teens are having sex, and those that are doing so are being more responsible. We’ve seen:

a 14 percent decline in the proportion of teens who have had sex;
a 24 percent decline in the number of teens with four or more partners; and
a 47 percent increase in those using protection when they are sexually active.

Those things combined have contributed to this remarkable decline in the teen pregnancy rate.

It’s not an easy things for teens, or, for that matter, anyone, to abstain from sex or to use contraception consistently. We are often asked: what is motivating teenagers to do either one of those things? It appears to be a combination of factors that includes more serious attention to the problem of teen pregnancy over the past decade by organizations, such as the National Campaign, state policymakers, practitioners and many other people as well. Teens are getting the message loud and clear that it would be better not to become pregnant and start their families as teenagers. A second factor is fear of HIV/AIDS and other sexually transmitted diseases. A third important factor is the availability of more long-acting and effective hormonal methods of birth control. Particularly for teens, those can really make a difference.

On the bad news front, in December, new data from the National Center for Health Statistics showed that the teen birth rate had increased for the first time in 15years. While it’s too early to tell whether this is a “blip” or a trend, it comes on the heels of several years where we were seeing a slowdown in the progress we were making in decreasing the rate of teen births. Certainly, we see this as a cause for serious concern, and it reminds us that although we’ve had this wonderful, steady decline in teen pregnancies, we can’t become complacent.

Another issue to mention on the not-so-good news front, is that progress in decreasing teen pregnancies has not been even across different population groups and states. For example, the teen pregnancy rate among Latinas has gone down about half as fast as among other groups. Right now, 51 percent of Latina teens get pregnant at least once before they turn 20. Last year, the National Campaign launched a Latino initiative to provide tailored, culturally appropriate support to Latino communities to address teen pregnancy.

So, while there is a lot of good news and a lot to celebrate, at the same time, we need to keep our eye on the ball.

What kinds of programs have been most effective in reducing teen pregnancy?

There are now 15 programs with strong evidence of success, so states and communities have a fairly large number of programs from which to choose. They range from sex-education programs which typically present both the benefits of waiting (or abstinence) and the importance of contraception, to community service, learning programs that don’t emphasize sex. A number of these programs are highlighted in a recent National Campaign report called Emerging Answers 2007. These programs have been shown, through rigorous research, to be effective in not only changing teens’ attitudes but also their behavior, which is very important. Research has shown that these programs can delay sex, improve contraceptive use or prevent pregnancy among teens.

It’s wonderful that state and local leaders understand the importance of implementing science-based programs, which, I think, has been a growing trend over the last number of years. When state legislators want to address teen pregnancy, there are several science-based programs that they can invest in, so taxpayer dollars will have a better chance of being well spent. Certainly, more investment is needed because too often, effective programs are weakly funded and cannot be sustained or widely replicated.

It would be unfair to assume that these programs, as effective as they may be, can alone solve the problem of teen pregnancy. To make continued progress on this issue, it is very important that all sectors play a strong role. This includes parents, faith leaders, the media, elected officials, and last but not least, teens themselves.

How have states contributed to the decrease in teen pregnancies? Have any states been particularly successful?

States and localities, as well as the private sector, have played a very important role in the successes thus far. States that have seen the steepest decline to date in the teen birth rate include Vermont, California, New Hampshire and Michigan, which indicates that both small and large states can and have made progress.

A key factor in this success is finding the resources necessary to invest in effective programs. To highlight one example, California started in 1992 with the highest teen pregnancy rate in the nation. With a combination of public and private investments and bipartisan support that has been sustained through several Governors, California has now seen the steepest decline in the teen pregnancy rate in the country and the second steepest decline in the teen birth rate. The program in California has a number of different components funded through a variety of different sources, including Temporary Assistance for Needy Families (TANF), the state general fund and a large investment from the philanthropic community. California’s progress has been really note-worthy.

More recently, a number of state legislatures have invested new resources in teen pregnancy prevention, which is quite exciting. In Massachusetts, the Department of Public Health has received new funding to support six science-based teen pregnancy prevention programs for several high-risk communities. In South Carolina, the Department of Social Services has been using TANF dollars to fund what they call the Community Adolescent Pregnancy Prevention Initiative, which has been going on since 1998. These are community-based programs organized by local leaders, and they use science-based approaches to plan programs that will target the teens who are at the greatest risk. Another recent example is Maryland, where some TANF funds were allocated to address the unique challenge of teen pregnancy prevention among youth in foster care, a population at very high risk and of great concern to state policymakers. These funds also were invested in family planning services for Latino teens’ parents who are receiving TANF.

Michigan has also taken a very interesting approach. The Governor developed a program to help parents of middle-schoolers talk to their children about abstinence and teen pregnancy. This program demonstrates that there are a lot of different ways to address this problem, and one of them is helping and supporting parents in the very critical role they play with their children.

While the teen pregnancy rate has declined, recent statistics indicate that the teen birth rate rose by 3 percent between 2005-2006—the first increase in 15 years. What are the implications of this?

The increase is definitely a red flag and is something we all need to better understand and pay attention to. It is important to note however, that the birth rate is up not just for teens, it is up for women of all ages, as well as among all racial and ethnic groups. Fertility is now at a 35-year high in the United States, so it seems that there may be something bigger going on here—that it’s not just about the teens. This is a very important, broad phenomenon that we need to better understand.

That said, the increase in the teen birth rate did come on the heels of several years where the rate of decrease in teen births was slowing down, so the increase did not come as a complete surprise. It is also important to note that while we do not have state-level data for 2006, we do know that in 2005, the teen birth rate increased in eight states and there was no change at all in six states. The lesson here is that we cannot let the steady stream of progress that we have seen for a number of years let us think that we have solved this problem. One third of girls still get pregnant before they turn 20, and the United States still has the highest teen pregnancy and birth rates of all the countries we like to compare ourselves to. We still have a lot of work to do.

Can you talk about why the Campaign has added reducing “unplanned pregnancies” to its goals? How does this change the prevention message?

The National Campaign is absolutely continuing to focus on teen pregnancy, as the recent increase in the teen birth rate reminds us we must do. But in addition to that, we are now beginning to focus on unplanned pregnancies among single, young adults, those in their 20’s. Most unplanned pregnancies in this country occur in this age group, and 75 percent of all unplanned pregnancies occur to women under 30. While we’ve seen significant progress in reducing teen pregnancy and teen birth rates over the past decade or so, we have not seen similar progress in reducing unplanned pregnancies among young adult women. Unplanned pregnancies among young adults have remained stable or “stuck.” Unplanned pregnancies among young adults also have some of the same serious consequences as they do among teenagers, in terms of outcomes for the parents and, even more importantly, the children.

For these reasons we are now moving up the age scale and beginning to see if we can’t help start a conversation, raise awareness and begin to change the picture of unplanned pregnancy among those in their 20s, which is much less well understood than the problem of teen pregnancy. The public tends to assume that unplanned pregnancies, abortions and unwed pregnancies are problems only among teens, but in fact, the majority of unplanned pregnancies, abortions and unwed pregnancies occur among young adults.

In terms of how this might change the prevention message, needless to say, the message for a 25-year-old might be quite different from the message we give to a 16-year-old. We all still have a lot to learn here. We, and many other people, have been very focused on teen pregnancy since the early 1990’s, and we like to say that we have a whole room full of data and ideas on how do address that issue. But we only have, at most, a shelf-full of information on the issue of unplanned pregnancy among young adults.

Do you see a role for states in researching and developing programs to prevent unplanned pregnancies among young adults?

Absolutely. In fact, several states are already beginning to lead the way on the issue of unplanned pregnancy. For example, Michigan has a statewide unintended pregnancy initiative. Indiana recently issued a “call to action” on reducing unplanned pregnancy. A number of other states are also beginning to look at this issue. In fact, as the National Campaign has expanded its mission, one of the things we have done is embark on a learning tour, which involves going around the country and spending time in a number of states. We are listening, learning with and talking to a wide range of public and private officials, individuals and organizations to understand how they approach this issue, what they are already doing, what they think some of the gaps are, and how an organization such as the National Campaign can help.