Good News About Teen Pregnancy

You probably saw this on the front page of the Washington Post this morning, but I figure it belongs front and center on our site, too.

Teen pregnancy and birth rates have dropped sharply across the Washington region in the past decade, with the District cutting its numbers by more than half to historic lows.

Arlington and Prince George's counties also have recorded striking decreases in both rates, which are among the most important indicators of children's well-being. And in virtually every jurisdiction, the trajectories have been particularly marked among African American teens, closing much of a once-intractable gap with white rates.

The reversals reflect national trends that have public health experts hopeful that programs and messages aimed at adolescents have hit their mark at last.

"We think kids are making better choices," said Donald Shell, health officer for Prince George's, where the birthrate for females age 15 to 19 fell by nearly a third between 1996 and 2005. "Our efforts finally are bringing forth some fruit."

The District has accomplished dramatic improvement. In 1996, its pregnancy rate for the same age group was 164.5 per 1,000. Appalled by the triple digits, a coalition of nonprofit groups and city agencies began reaching out to various communities, holding public discussions and trying to teach parents how to talk to their children about love, sex and relationships.

"The city was remarkably unified," recalled Brenda Rhodes Miller, executive director of the D.C. Campaign to Prevent Teen Pregnancy. Advocates vowed to reduce the rate to the mid-70s by 2005. Instead, as statistics released this month show, it plunged to 64.4. The reduction in the birthrate paralleled that. Teen Pregnancy, Birth Rates Plummet Across D.C. Region

Typically in our discussions here we lump pregnancy and sexually transmitted infections together, both being things we don't want unmarried teenagers to have to deal with. In that case, the answer is abstinence or condoms, and that's why MCPS focuses so much on those two approaches to prevention. But remember, there are contraceptives that don't protect against disease, and couples who are in a committed relationship generally have less reason to worry about getting infected with something, at least if they know the health status of their partner.

I'm sure everybody's going to claim credit for this decrease in teen pregnancy. Watch how long it takes for abstinence advocates to say this is because teens are "getting the message" about abstinence, and how long it takes the "safer sex" advocates to claim this is caused by teens having more knowledge about how to be careful.

Skipping down a little bit ...

Alexandria, which began tackling the issue "way back in the '70s," was the only jurisdiction to have its teen birthrate increase over the most recent decade and managed a minimal decline in its pregnancy rate. "I cannot say why," Jasper said.

In a country with the worst rates in the industrialized world, officials have focused on teen pregnancies and births because of their distressing, lifelong ramifications.

Adolescent mothers frequently compromise not only their health but also their future, dropping out of school and struggling financially. Their babies are at greater risk for a host of problems, including low birth weight and abuse, neglect and poor academic performance.

"Teen childbearing affects young people at both ends of childhood," the Annie E. Casey Foundation has noted.

Interesting that "tackling the issue" in Alexandria didn't seem to work.

Let me tell you, I don't take a lot of stock in government programs to change people's behavior. Did anybody "just say no" during the Reagan years? Has the "war on drugs" reduced anybody's drug use? Did Prohibition stop people from drinking? Do you think teenagers are going to make their most personal decisions based on something they read on a billboard somewhere? There ought to be a lesson in all of this.

OK, now the article is going to try to talk about the reasons for the decline.

The achievements since the mid-1990s are attributed in part to a delay in teenagers' start of sexual activity. Reasons for that are not easy to tease out, and the politicized push for abstinence-only curriculum in schools has made the discussion more volatile.

Most studies give more credit to teens' greater use of condoms and other protection and the wider array of options available to them, including such long-acting choices as the birth control patch.

Calvert County makes contraception accessible to girls at its family planning clinics for no charge and, except in rare cases, no questions. The approach might explain why the teen birthrate there fell 46 percent by 2005.

"Our underlying message is they should not be sexually active," health officer David Rogers said. Any counsel, like the contraception itself, is delivered in "a nonjudgmental way. . . . Surely our success is based on that."

Yes, the "politicized push for abstinence-only curriculum in schools" has made it much more difficult to talk about these things. There is a real question here: what kinds of conditions result in reduction of the rate of teen pregnancy. It's a straightforward question, really, you measure changes in the rate and some variables that you hypothesize might affect it. You elaborate on what works, drop what doesn't work. But no, the discussion is politicized, one side insists that the only thing that works is telling young people to abstain from sex. Nothing else can have any good effect, only that. So when studies come out, certain people jump up and either announce that "the study was flawed," or they twist the results in a way that fits their preconception, or whatever it takes for them to retain their conviction that they were right all along. And that is no way to actually learn what decisions can result in good outcomes, it seems to me.

Skipping down toward the end.

But even steady progress can suddenly slip. This summer, Montgomery County officials were surprised to learn that their teen birthrate had jumped to 20.1 in 2005 from 17.9 the previous year. It was the third consecutive increase, powered exclusively by births in the Latino community.

"The cultural component is one piece of a very complex story," said Judy Covich, the county's school health director.

Given the Washington region's changing demographics, as well as the country's, many communities soon could be facing the same challenge. Most family planning services lag in providing for language needs and cultural sensitivities, said David Landry of the Guttmacher Institute, which studies sexual and reproductive health.

Landry celebrates the undeniable headway that has been made with teen pregnancy and birthrates across the United States. He is uncertain what lies ahead, though.

"It's a very unclear future we are moving into," he said.

People can fight about the reasons for it, but I'm happy to see that the rates have gone down like they have.