Teen Pregnancy, Birth Rates Plummet Across D.C. Region

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

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."

The work that remains is daunting.

In the District, nearly one in four teen births is not a young mother's first. Midwife Loral Patchen works with many of those adolescents through a program she directs at Washington Hospital Center. Their average age is 16, and their lives often are in tumult. Patchen hears about HIV-infected parents, abusive boyfriends and fears of homelessness.

Staff members dispense education, contraception and encompassing support. Their objective is to help the teens avert subsequent pregnancies.

"So many of them are so ambivalent," she said. "It's not that they want to have a child. It's just that they didn't not want to have a child enough to do something about it."

Maria Cruz enrolled when she became pregnant at 13. She stuck with the program through her daughter's birth and said it has kept her from repeating the mistakes of her very unfocused youth. She returned to class and graduated from Cardozo Senior High School in June.

"I have matured a lot," explained Cruz, who juggles a part-time bank teller's job and college preparation as she takes care of 4-year-old Katie. She talks of having another child -- after college, when she is married.

"When I am ready, not now," she said.

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.