By Susan Levine
Washington Post Staff Writer
Monday, October 29, 2007
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.
Rhodes Miller's new goal is "to cut that 64 in half. A double-digit teen pregnancy rate for the nation's capital is just not acceptable," she said.
Yet within the region's positive news are troubling details that could undermine the progress. Several jurisdictions still have what one health worker described as "extraordinarily high" rates. In others, figures are ticking upward again because of more Latina pregnancies.
"I can look at the numbers and be very concerned," said Darhyl Jasper, a public health nursing supervisor who heads Alexandria's teen pregnancy prevention program.
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.
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.
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