While recent research has shown that the rate of teen births in the United States is down — with Massachusetts showing one of the biggest declines in the country — activists who work to combat teen pregnancy in Boston are still hard at work.
According to those who head these efforts, building trust with teens, providing education on sexual health and continuing funding for resources are the necessary steps to continue to prevent teen pregnancies.
Birth rates for U.S. teenagers reached an all-time low for all age and ethnic groups, according to the most recent comprehensive study, released in 2012 by the Centers for Disease Control and Prevention.
An especially impressive drop of 44 percent took place between 1991 and 2010. With another 9 percent drop from 2009 to 2010, the teen birth rate reached a historic low at 34.3 births per 1,000 women aged 15-19.
The study also found that Massachusetts was one of the dozen or so top states in terms of teen birth rate declines, dropping over 20 percent from 2009 to 2010. Massachusetts has one of the lowest teen birth rates, with less than 20 births per 1,000 women aged 15-19.
The 2010 rates ranged from 10.9 per 1,000 for Asian or Pacific Islanders to 23.5 for non-Latino white teenagers to 51.5 for non-Latino black teenagers to 55.7 for Latino teenagers.
At the heart of the teen pregnancy prevention fight in Boston are community health centers like Roxbury’s Dimock Center.
Dimock’s Chief Medical Officer, Dr. Holly Oh, says that the success the center has found in regards to teen pregnancy prevention comes through a long-view approach. At Dimock, which serves Roxbury, Dorchester, Mattapan and Jamaica Plain and is one of the largest health centers in Boston, the goal is to educate its teen patients about pregnancy from a young age and continue to support them through adulthood.
According to Oh, Dimock serves about 3,000 patients through its pediatric clinic, of which she estimates about one-third or 1,000 of them are teens. She believes building trust with the teen patients is the first step in pregnancy prevention, because that trust allows teens to feel comfortable talking about sexual health and know they have a place to turn for information and help.
“We really do develop relationships with kids and teenagers on the way up and having that relationship and trust does help significantly,” Oh said. “We begin talking about sexual health from the time they turn into teenagers and we start telling the parents we are talking about these issues.
“We begin to talk to the teenagers on their own … just so they can kind of get comfortable by themselves to start talking about some of these issues,” she added. “We talk about everything you need to stay safe from a sexual standpoint.”
This includes abstinence, safer sex, contraception and family planning. “We always talk about it in a preventive way — what will it take to keep you healthy,” Oh said.
At Dimock, pediatrics patients receive a survey at the age of 13 that has some question about sexual health on it. The center uses responses from this to guide the next step in addressing teen pregnancy with each individual teen.
According to Oh, it is important to offer teens a confidential outlet to talk about sexual health, but she stresses that both the teens and parents know that if any issues arise that are harmful to a teen’s health or life, center staff will find a way to involve the parents. She said that most teens and parents are comfortable with this approach.
Oh also emphasized that simply having community health centers where teens know they can go for sexual health help and resources is important and that the more work such centers do with teens the more they will spread the word about the help that is offered. She added that many teen patients come in to Dimock because their friends told them of their experiences there.
While community health centers are one approach to teen pregnancy prevention, Boston also has the Massachusetts Alliance on Teen Pregnancy, which is a statewide coalition of over 100 health and human service agencies working to prevent teen pregnancy and support teen parents. The organization offers teen pregnancy prevention programs, family planning, teen parent support and public policy advocacy. Started in 1979, the organization has trained over 10,000 individuals in teen pregnancy prevention and support and worked with an estimated 400,000 teen parents and their children.
According to Elizabeth Peck, the interim executive director at the Massachusetts Alliance on Teen Pregnancy, there are three main elements that prevent teen pregnancy and have contributed to the decline in teen birth rates in Massachusetts over the last several decades: access to health education, access to contraception for teens who are sexually active and perception of future opportunities.
Peck points out that, though the teen birth rate is down, most reports show sexual activity is the same, so the difference is that teens are making better use of condoms and contraception.
“Young people absolutely have the capacity to make the best decision for themselves,” Peck said. “For us, it is about how the adults in the community can make sure the right things are in place for those young people to make the best decisions they can make.”
Though it may not be the first thing people think about as a strategy for teen pregnancy prevention, Peck says that helping teens see opportunity for the future in terms of a work career or graduating high school can be a huge factor in getting them to make smarter choices about sexual behavior.
“A real theme in our work at the alliance is we really believe that our young people hold promise,” Peck said. “One goal is to ensure that they hold promise and let them know that they have tremendous potential.
“We believe that this enables young people to be successful,” she added.
The Commonwealth of Massachusetts runs teen pregnancy prevention through its Bureau of Community Health Access and Promotion. Paula Doherty is the state’s coordinator of teen pregnancy prevention initiatives.
The state takes what is calls a “science-based” approach to the task, with a goal to “promote healthy behavior, responsible decision making and increased opportunities for at-risk youth,” according to the program’s description. The program targets specific cities — currently over a dozen — including Chelsea, Lowell and Worcester.
The goals of the program are increased abstinence and delayed onset of sexual activity among teens, reduced rates of youth engaging in health-related risk behaviors including risky sexual behaviors and decreased incidence of teen pregnancies and births, STDs and HIV infection.
Through Doherty’s office the state replicates several programs in its teen pregnancy prevention efforts. These include the after-school program “Making Proud Choices,” the service-learning program “Teen Outreach Program,” the community-based risk-reduction program “Focus on Kids” and “California Siblings Program,” a case-management program targeting siblings of parenting teens.
Statistics and reports about teen birth rates have some issues presenting the most up-to-date picture of trends throughout the country due to lag times inherent in collecting this kind of data. But those who work on teen pregnancy prevention in the state are encouraged and will certainly keep up their efforts.
“It is hard to know whether this trend downward is going to be a sustained one. Time will certainly tell. I think all the attention and support, from a public-health standpoint, is certainly helpful,” said Oh.
