10 minute read
Preventing Teen Pregnancy: National, State and Local Landscape
WHERE WE ARE
In most places around the country, teen pregnancy is down. After peaking in 1991, the national teen birth rate went down 64% by 2015.1 Preventing at least 428,000 births to teen parents saved $4.4 billion in public spending in 2015 alone. By delaying pregnancy and parenting just one to three years, young people are more likely to access economic resources, including finishing school, ensuring a brighter future for themselves and the children they may have someday. For all teens, systemic changes that increase access to resources defined in the social determinants of health can dramatically improve life options for them and for their children.
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Texas—and particularly Dallas-- are the lowest achievers of the national downward trend in teen pregnancy, unfortunately. Of the twenty largest counties in America in 2017, Dallas County had the very highest teen birth rate. When ranking these largest counties by teen birth rate, of the top 5, 4 were counties in Texas. As high as the Dallas County rate was, several zip codes within the county have rates two to three times higher. A study of the 2017 STD Surveillance Report by the Centers for Disease Control and Prevention (CDC) found that Dallas County saw the highest percentage increase in the nation for cases of chlamydia and gonorrhea between 2016 and 2017.
BECAUSE EVEN THOUGH I SEE
PEOPLE TALKING ABOUT IT TO A CERTAIN EXTENT, IT’S AMONG THEMSELVES AND THEIR FAMILIES. IT’S NOT ON A GRAND SCALE TO THE COMMUNITY AND THE LEADERS RUNNING IT. IT’S STILL SEEN AS A VERY TABOO TOPIC AND I DON’T SEE WHY.”
--DALLAS HIGH SCHOOL SENIOR, AGE 18
35
30
25
20
15
10
5 US TEEN BIRTH RATES (YEAR 2017) 20 Largest Counties Based on Age 15-19 Female Population Listed by Age 15-19 Birth Rate
31.8
27.4 27.1
23.5 23.3
21.5 21.3 21
19.3
15.9
14.7 14.4
13.3 12.9 12.9
11.7
10.6
7.5 7.3
4
0
Dallas CountyHarris CountyBexar CountyWayne CountyTarrant CountyClark County San Bernadino CountyMaricopa CountyCook CountyRiverside CountyLos Angeles CountyMiami-Dade CountyKings CountyBroward CountySan Diego CountyQueens CountyOrange CountyKing CountySanta Clara CountyMiddlesex County
Source:CDC Wonder US State and TEEN BIRTH RATE: County Birth data BIRTHS PER 1000 FEMAILS OF THE AGE 15-19 AGE GROUP IN THE COUNTY 4 • ntarupt.org
10 HIGHEST ZIP CODES IN DALLAS (Teen Birth Rate, Dallas, 2016) American Community Survey Data
DALLAS COUNTY BIRTHS TO TEENS, 20182
I THINK (PREVENTING TEEN PREGNANCY) IS IMPORTANT TO SOME OF THEM BECAUSE IT’S A PART OF ENDING A CYCLE OF POVERTY. I MEAN YOU THINK ABOUT IT. MANY HIGH SCHOOL STUDENTS DON’T EVEN HAVE A JOB, SO IF THEY ARE ALL GOING TO ALL HAVE BABIES AT A YOUNG AGE, IT’S GOING TO AFFECT THEIR FUTURE.” --DALLAS HIGH SCHOOL FRESHMAN, AGE 14
Even when compared with other large counties with significant teen birth rates, Dallas County is high.4 Figure 4 on page 6 is the percentage of three counties when compared with the state average.
FIGURE 4: TEEN BIRTH RATE: ABOVE OR BELOW STATE AVERAGE The personal and community impacts of teen pregnancies in Dallas County are staggering. Teens’ lives are always made more challenging when they become parents. The tremendous responsibility of raising a child is one for which few teens are prepared. The following statistics demonstrate the limitations imposed by teen parenthood:
2%
JUST 2% OF TEEN MOTHERS COMPLETE A COLLEGE DEGREE BY AGE 30.5
IN TEXAS FOSTER CARE, ONE OF EVERY 20 GIRLS AGES 13 TO 17 WILL BECOME PREGNANT. 6
20%
25.7%
FOR MOMS UNDER AGE 15, 25.7% RECEIVED LATE
OR NO PRENATAL CARE,
WHILE FOR MOMS 15-19, THE RATE WAS 11%.7
TEEN FATHERS HAVE UP TO A 30% LOWER PROBABILITY OF GRADUATING FROM HIGH SCHOOL THAN THEIR NON-PARENT PEERS.8,9
30%
50%
BY AGE 22, JUST 50% OF TEEN MOTHERS OBTAIN A HIGH SCHOOL DIPLOMA, WITH 30% RECEIVING THEIR GEDS. THE NATIONWIDE AVERAGE GRADUATION RATE IS 90% FOR TEENS WHO DID NOT GIVE BIRTH DURING HIGH SCHOOL.10
We know what works. Significant investment in better access to comprehensive reproductive health care and medically accurate sexuality education in schools or in the community has fueled the national downward trend. Research shows us that for every $1 of public money spent to provide family planning services, the public receives more than $7 in benefits.11 , 12 These benefits are wide-ranging and include preventing teen childbirths, reducing abortions, cervical cancers, HIV, sexually transmitted infections (STI), low birthweight babies, preterm births, and many others.
THE SOCIOECOLOGICAL MODEL
Successful campaigns in Milwaukee, Wisconsin and Tulsa, Oklahoma included the entire community in their plans to address teen pregnancy. Ntarupt and its partners know that teen pregnancy is a community issue that requires a community solution. When addressing complicated societal issues, the Socioecological Model is often the framework that best describes the role the community plays in offering solutions.
The Socioecological Model provides a framework for understanding and modifying the social and environmental factors that influence teen behavior and helps address broader systemic issues that may affect this work. The individual is at the center of a range of influences in the broader environment, and each level of the model is critical when we plan strategies that focus on teens. This model showcases the synergy needed to create large-scale social change, enabling us to co-create an environment that supports individual change. Teens are still able to influence the community that surrounds them in this model.
SUCCESS IN ACTION IN MILWAUKEE, WISCONSIN & TULSA, OKLAHOMA
In 2006, the City of Milwaukee confronted an ugly truth: one out of every 20 girls gave birth to a child. Health department epidemiologists, academics, and United Way of Greater Milwaukee and Waukesha County staff came together to set a goal to reduce teen pregnancy. The initial, highly ambitious goal was to reduce teen birth rates by 46% by 2015. In 2013, the United Way’s Teen Pregnancy Prevention Initiative announced that it had met its initial goal two years early. It then established a new goal, to reduce to 11.4 births per 1,000 teens ages 15-19 by 2023.
The program used a several of unique strategies to draw in and retain community attention and effectively leveraged in-kind and monetary support to decrease teen pregnancy. This approach included:
Bringing together business, government, education, the medical field, the faith community, law enforcement and other groups to collaborate on this community issue. Encouraging parents/caregivers to talk to the youth in their lives by distributing the Family Communication Toolkit, available free of charge in English and Spanish. Investing in the Healthy Youth Initiative program to fund youth-focused efforts designed to educate youth about the consequences of teen pregnancy. Maintaining the BabyCanWait.com web site with medically accurate, age-appropriate information on preventing pregnancy and promoting healthy relationships for youth. A public awareness campaign targeting teens with messaging. The campaign kicked off in 2006 and culminated with a thank you campaign in 2017, thanking teens for making better choices. Funding of reproductive health education throughout the City
In Tulsa, these same focus areas where employed by the Community Service Council who developed the Tulsa Campaign to Prevent Teen Pregnancy (now “Amplify”) to address the critical issue of our high teen birth rate in Tulsa County. Launched in 2013, Tulsa Campaign focused on four main areas: » Education: Expanding sex education within Tulsa Public Schools, » Public Awareness: increasing awareness on issues affecting youth health » Developing and evaluating teen-friendly clinics, and » Using public perception polling and national and state data to influence the direction of teen pregnancy prevention in Tulsa.
Across these four program areas outcomes were: » 4,986 Tulsa Public Schools student received sex education in the 2018-2019 school year » 57.7% decrease in Tulsa County’s teen birth rate from 2009-2018 » 209 certifications were earned from participants in 2019 trainings » 88% of Tulsans support sex education implementation in Tulsa Public Schools
WHERE WE ARE GOING – DALLAS READY TO ACT COMMUNITY READINESS ASSESSMENT
In 2018 and 2019, Ntarupt enlisted the help of several people with experience on Milwaukee’s successful campaign to reduce teen pregnancy to do a Community Readiness Assessment (CRA) with support from Better Together Fund. Using a model created by the Tri-Ethnic Center at Colorado State University, 45 interviews were conducted with elected officials, parents, faith community leaders, educators, teens, health care providers, and others. More than 80 hours of interviews were analyzed and scored to determine the “readiness level” of the entire Dallas community to address reducing teen pregnancy. Through the approach of a Readiness Assessment, a readiness score measures the amount of information known by the community on the issue, leadership’s readiness level to address the issues, the community climate, and what resources are available to address the issue.
--Youth Interviewee
–Faith Community Interviewee
While the education sector interviewees were at higher readiness levels than others, the overall readiness score for the Dallas Community was a Level Three: Vague Awareness. The Vague Awareness level can best be summarized by: “Something should probably be done, but what? Maybe someone else will work on this.” Moving a community beyond that level into higher rates of readiness means working hard to raise awareness of the issue so that more people in Dallas understand the full depth and breadth. Raising awareness means public events, communicating using multimedia strategies, and working closely with parents, educators, the faith community, policymakers, and others with a vested interest.
SUCCESS IN DALLAS ISD
In Dallas, educators, as a group, were at a Level 4, the Pre-Planning stage. Ntarupt’s success in advocating for significant reproductive health curriculum change in 2019 in Dallas Independent School District (DISD) proved that Dallas is more ready than we think to do what is right for our children. The DISD school board adopted a set of curricula for grade levels 6-12 that were more consistent with what Dallas students, parents, and educators saw as the primary needs for a curriculum. The set of curricula adopted were age-appropriate, and evidence-based (an approach backed by science).
PUBLIC AWARENESS
In 2018, as a result of Ntarupt’s advocacy and participation on the Dallas Taskforce on Poverty, the City recognized teen pregnancy as a significant driver of poverty. Three years in a row, the City has earmarked funds for teen pregnancy prevention programs that included a comprehensive public awareness campaign, parent seminars, and other proven strategies and has awarded Ntarupt with three consecutive contracts to do this work. Under the first contract, Ntarupt launched a citywide public awareness campaign addressing teen pregnancy in 2019, “Talk About It Dallas.” Ntarupt set an initial goal to reduce the teen birthrate in the most affected zip codes by 50% by 2023.
THE PLAN
Leveraging lessons learned from successful programs in other cities, Dallas’ leaders in reducing teen pregnancy envision a strategy that intervenes at all levels of the model. Ntarupt has drawn on these successful efforts to identify five key areas on which to focus efforts:
• Individuals » Reproductive Health Education, » Public Awareness and Messaging and » Access to information and resources, and digital information
• Parents & Other Caregivers – Giving caregivers information and skills to be a resource for their children, including: » Education, » Awareness messaging and » Digital information
• Faith Community – Ntarupt has made it a priority to include essential the faith community and encourage families and ecumenical organizations to have difficult and necessary conversations about sex, using their own language.
• Community » Ntarupt – Ntarupt’s alliance must continue to advocate for reproductive health education, equitable reproductive healthcare, and support for teens and their caregivers » Health Care Providers & Organizations – Facilitating teen friendly clinics and availability of all contraception methods » The Business Community – Provide access to opportunity for teens, and more importantly, assist in the public awareness campaign to promote access to information in order to delay childbearing and more easily access opportunity.
• Society » Public Policy- Advocating for and creating a more equitable Dallas, creating access to overall opportunity with emphasis on in health care access and quality reproductive health education to support teens and families.
