I Chose the Baby

Although teen pregnancy and birth rates in the United States declined for the 10th year in a row, nearly one in 10 teenage girls still got pregnant, and half of those gave birth in 2001. And while the U.S. teen birthrate is still the highest in the industrialized world, it is also less than half what it was in 1957, when it hit an all-time high.

To be sure, teen pregnancy plays out much differently today than it did during the more sexually conservative 1950s, when Dwight D. Eisenhower was president and teens wore bobby socks and saddle shoes. Then, some 80 percent of teens who got pregnant were either already married or had “shotgun weddings.” Typically, teen moms stayed home to take care of the baby. And Dad? He went out and got a decent-paying, blue-collar job.

While that may not have been a perfect solution, it’s a far cry from many of today’s scenarios. Consider Monika Williams and Shirley Anderson, two teen mothers from Milwaukee. Williams, who gave birth to a baby boy in Milwaukee a little more than two years ago at the age of 16, says that even after she got pregnant, she never really imagined herself married to her baby’s father. Then, just days after Williams delivered her baby, the young man was arrested and sentenced to three months in jail. Williams describes the man, now back in jail on another offense, as “not someone I want to be with.” Nor was marriage a viable option for Anderson (not her real name), who recently turned 21 and has a three-year-old daughter. “After I got pregnant, he got abusive,” she says. “We broke up. It was either the baby or him, and I chose the baby.”

Young and unmarried, Williams and Anderson struggle – often completely on their own or with very little help – to support themselves and their children while trying to finish high school and/or hold down one or more part-time, minimum- wage jobs. And even as experts cheer declining pregnancy, birth, abortion, and sexual activity rates among teens, they know millions of other girls are still destined to end up in similar circumstances.

“That’s my greatest concern – that we’ll become complacent,” says Tamara Kreinin, president and CEO of the Sexuality Information and Education Council of the United States (SIECUS), a national nonprofit organization that promotes comprehensive sexuality education. “I hear a lot of policymakers saying, ‘Great. Teen pregnancy is down. Now we can worry about something else.’ When in fact, we still have the highest rates in the developed world.” William Albert, spokesman for the National Campaign to Prevent Teen Pregnancy, is also encouraged by the lower rates. “But obviously,” he says, “there’s still a lot of work to do.”

Indeed. Consider the statistics. Roughly a million American teens get pregnant, and half a million give birth, every year. At that rate, one in every four teen girls gets pregnant before turning 20. What’s more, 78 percent of pregnancies to U.S. teens are unintended. And 80 percent occur outside of marriage. And while teen pregnancy and birth rates have declined across the board for teens of all races and ethnic groups, rates for minority youth remain disproportionately high. As do rates for teens living in poverty – most often in the nation’s biggest cities or the rural Southeast.

Why worry about teen pregnancy? Those who study adolescent reproductive health say it is closely linked to social issues such as welfare dependency, poverty, the well-being of children, child support, and the vitality of the nation’s workforce. Albert says reducing teen pregnancy is “perhaps the single straightest shot,” the most effective way available to reduce childhood poverty in the United States.

THE TRENDS

The newest data from the National Center for Health Statistics, an agency of the U.S. Centers for Disease Control and Prevention, put the 2001 teen birthrate at 45.9 births per 1,000 women ages 15-19, down from 48.5 per 1,000 women in 2000. The latest decline continues a 10-year trend that has brought the rate down 26 percent since 1991. The 2001 rate is less than half that reported in 1957, when births to teens peaked at 96.3 per 1,000 women. Birthrates then began falling, and continued to fall throughout the 1960s and 1970s. Rates leveled out during most of the 1980s and rose sharply between 1988 and 1991.

Teen pregnancy rates and abortion rates also continue to fall. The pregnancy rate in 1997, the last year for which data are available, is 94.3 per 1,000 women ages 15 to 19, compared with 116 per 1,000 in 1991. Generally, about half of all pregnant teens give birth, and four percent put their babies up for adoption. The rest end in either spontaneous or planned abortions. Not all states collect information on abortion, but according to the CDC, the teen abortion rate decreased in 32 of the 43 geographic areas in the United States for which age-specific data were available.

Kreinin says most people are shocked to learn that teen pregnancy and birth rates peaked in 1957. She says they assume that teens began getting pregnant in large numbers as a result of the “sexual revolution” of the 1960s. “What it tells us is that young people have been sexually active for a long time,” she says.

Forty or fifty years ago, “There was a huge stigma to getting pregnant,” says Kreinin. “Girls were ostracized, and quietly sent away. Or there were shotgun weddings. Mostly, we didn’t talk about it.” In fact, up until passage of Title IX of the Education Amendments in 1972, pregnant teens were routinely expelled from regular high schools. (See story, next page.)

Still, William O’Hare, a demographer who coordinates the Kids Count initiative for the Annie E. Casey Foundation, points out that 80 percent of teens who got pregnant in the 1950s were able to fall back on the safety net of marriage. Although their husbands left school, they were still able to get jobs – often on factory assembly lines – and make enough money to support a wife and child. Today, he adds, “That kind of job is very, very rare, and teen fathers are not well-situated to support a family.”

Not that marriage is necessarily the best answer for a pregnant teen. “Even though in the olden days, teens got married,” says Kreinin.” We know that teen marriages are four to five times more likely to end in divorce” than those of older couples. “It’s not necessarily something we want to recommend to young people.” Albert agrees. “The reality is,” he says, “married or not, 15-to 18-year-olds are not in a position to be responsible parents.”

RISK FACTORS

The experts say the spike in teen pregnancy during the late 1980s and early 1990s came about in large part due to the 1980 economic recession and an increase in the availability of crack cocaine, both of which led to an upsurge in urban violence and poverty, particularly in American cities. “If there’s one thing we know, it’s that teen childbearing in the United States and every other place in the world is related to poverty, disadvantage, lack of education and social disorganization,” says Kristin Moore, president and senior scholar at Child Trends, a nonprofit research organization dedicated to improving the lives of children and families. Moore concedes that other factors contributed to the increasing teen pregnancy rate during the late 1980s. Media images, for example, were becoming more sexual. And few teen fathers were being held accountable for child support. However, she says, “The fact is, middle-class kids in this country do not become teen parents.”

The data bear her out. In one study, for example, Child Trends identified four risk factors closely associated with teen parenthood – early school failure, early behavior problems, family dysfunction, and poverty. Researchers then analyzed how the number of risk factors experienced by an eighth-grade girl affected the likelihood that she would get pregnant before the age of 20. Only 11 percent of the girls who experienced none of the risk factors became pregnant, compared with 29 percent of those facing one risk factor, 35 percent of those facing two risk factors, and 60 percent of those facing three or four risk factors.

Carol Cassell, a member of the National Campaign’s board of directors and director of Critical Pathways, a private consulting practice that provides technical support on teen pregnancy prevention, has studied the link between lack of school success and adolescent pregnancy and childbearing. She notes that most people assume that the major reason teenage girls drop out of school is pregnancy. Yet, according to the results of a survey of one group of mothers in their 20s who had dropped out of school, 61 percent reported dropping out before getting pregnant. And those who do stay in school, says Cassell, have lower attendance rates, test scores, and grades than their non-pregnant peers.

‘IT COULDN’T HAPPEN TO ME.’

Monika Williams was at high risk for becoming a teen parent. She had dropped out of school, run away from home, and was living in foster care when she got pregnant. “I didn’t care about school. And I didn’t think about the consequences of what I was doing. I was just thinking about the moment. I thought I knew everything. And that it couldn’t happen to me.”

Along with pregnancy came a big dose of reality. “It was my fault,” Williams says of her pregnancy, “and my responsibility.” She never considered having an abortion, or giving her baby up for adoption. But she soon realized she had to go back to school. “I had someone else to take care of.”

Two years later, Williams says she’s grown up a lot. She’s done well at Lady Pitts High School, a special school for pregnant and parenting teens. (See story, next page.) She’ll graduate in June, and hopes to enter the University of Wisconsin-Milwaukee in the near future to pursue a nursing degree. But it hasn’t been easy. She’s currently living on her own, supporting herself by busing tables at an Italian restaurant and cleaning a local church. As long as she’s in school, Williams also receives a monthly welfare check that helps pay for day care.

Williams says she doesn’t regret giving birth to her son. “He’s so cute, and I love him so much,” she says. Yet she cautions other teenage girls to think about how their lives will change once they become pregnant. “It’s not just about you anymore,” she says.

Shirley Anderson’s story is eerily similar. She, too, had run away from home and just dropped out of school when she got pregnant. “I didn’t like school,” she recalled. “Dropping out was no big deal.” Once she got pregnant, Anderson and the baby’s father got engaged, but when he became obsessive and abusive, she broke off their relationship. As she bounced from the home of one relative to another, she began to realize how much she needed a high school diploma.

Anderson got off to a good start at Lady Pitts, earning a 3.6 grade point average. “This school was smaller and there were no boys – no distractions,” Anderson says. “And I really put my mind into it.” But Anderson’s baby was fussy. She cried a lot, and daycare workers were constantly calling Anderson out of class to attend to her daughter. Five months after giving birth, Anderson dropped out again and moved back home. For two years she struggled to find a decent job, but finally realized, “You need a high school diploma for everything.”

Anderson’s goal is to someday work in the construction industry. But in late January, just a little more than four months from graduation, she dropped out of school for the third time, over-whelmed by a combination of personal and economic problems. Too old to continue in Milwaukee Public Schools, she’ll now have to pursue a high school diploma or GED elsewhere – perhaps at Milwaukee Area Technical College. Meanwhile, her struggle is one she hopes other teenage girls can avoid. Her advice: “Use birth control. Know the person you’re with. Finish school.”

LESS SEX, MORE CONTRACEPTION

Experts say more teens are taking at least some of Anderson’s advice, and are using more contraception than in the past. They’re also having less sex. As a result, teen pregnancy and birth rates are falling. Why less sex and more contraception? Partly because of the strong U.S. economy during the 1990s. “A good economy gives young people hope,” says Kreinin. “When teenagers feel they have a future – that they can get good jobs or go to college – they are much more motivated to delay sex or become good contraceptors.”

But consider the flip side of that argument – that a sluggish economy under-mines teens’ hope for the future and, as a result, drives up teen pregnancy. Says O’Hare: “It’s a concern. If the current economic downturn continues, it could have an impact on teen childbearing.”

But a strong economy over the last 10 years or so isn’t the only reason teen pregnancy rates are down. Experts also credit the increase in activity around teen pregnancy prevention, including more sex education in schools. The National Campaign, for example, was founded in 1996 to improve the well-being of children, youth, and families by reducing teen pregnancy. Its goal: to reduce the rate of teen pregnancy by one-third between 1996 and 2005. (So far, the rate is down 16 percent.)

But the effort began in earnest, Kreinin says, in the late 1980s, and was spurred on in large part by the growing AIDS epidemic. “Teen pregnancy rates were skyrocketing, and suddenly there was a lot of urgency around the need for comprehensive sex education that included information about AIDS,” she says.

While no one objected to giving teens information about AIDS, there was opposition to giving them information on birth control, particularly from the Religious Right. Their response: abstinence- only sex education programs teach that abstinence is the “only certain way” to avoid pregnancy and sexually transmitted diseases. Moore says she believes that both comprehensive and abstinence-only sex education programs are helping reduce the teen pregnancy rate. To be sure, there is a lack of scientific evidence proving that abstinence- only programs reduce the incidence of sexual intercourse among teens. Still, Moore says for those “very concerned about the moral issue of sex activity before marriage,” an abstinence message can have an effect. On the other hand, she credits new and improved methods of birth control – such as once-every-three-month injections of Depo-Provera – with significantly driving down the pregnancy rate of sexually active teens. Depo-Provera, she says, is particularly effective at preventing a teen mother from getting pregnant a second time.

Moore notes that the U.S., unlike some other countries with far lower teen pregnancy rates, has no one single approach to preventing teen pregnancy. Japan, for example, has attempted to limit teens’ sexual activity with a strong, universal, abstinence message. The view in Sweden, on the other hand, is more accepting of adolescent sex as long as teens practice birth control. As a result, contraception is strongly promoted. “We in the U.S. do neither, and that, I think, has been very detrimental to adolescents,” says Moore. “They’ve gotten caught in the middle. There’s a lot of pressure and enticement to have sex, yet not enough information or support for contraception.”

DEVASTATING EFFECTS

Meanwhile, teen pregnancy continues to take an immense toll on child welfare, particularly for minorities. According to O’Hare, 25 percent of teen births occur to African-American teens, and 28 percent to Latina teens, despite the fact that African Americans and Latinos each account for only 15 percent of the total teen population.

There are also geographic pockets of higher-than-average teen pregnancy rates – generally in older cities and in the South. According to data released by the Casey Foundation, Baltimore led the way, with 21.5 percent of all births to teens in 2000.

O’Hare says the implications of high teen pregnancy rates are huge. “Even though the numbers are going down, you still have 21 percent of all the children born in Baltimore who are likely going to end up being disadvantaged,” he says. That’s because the poverty rate of children born to unmarried, teenage, high school dropouts is 80 percent, compared to 8 percent for children whose mothers are married high school graduates over the age of 20. “The way children are brought into the world has big implications for their childhoods and the rest of their lives,” says O’Hare. “It’s hard to think of anything that would do more for more children than to lower the teen pregnancy rate.”

A SUCCESSFUL MODEL

The best way of doing that, say the experts, is by investing in high-quality early childhood and youth development programs designed to ensure that children and teens at risk of doing poorly in school or getting in trouble with the law make a successful transition to school and complete 12th grade.

“We know that if kids do better and are more engaged in school, and have positive relationships with adults, they’re more likely to have a sense of hope for the future and a reason to delay sex,” says Moore. “That, combined with programs to encourage kids to delay – as well as information about contraception if they are having sex – is the kind of intervention strategy that’s been proven effective.”

The Carrera Adolescent Sexuality and Pregnancy Prevention Program, based in New York City, exemplifies Moore’s point. Launched in 1984 in New York City in conjunction with the Children’s Aid Society, the program now serves about 2,500 adolescents at 50 sites nationwide. The program offers students academic support such as homework help, tutoring, and SAT preparation; includes an employment training program for which they are paid a stipend; and provides classes in family life, sex education, the arts, and athletics. Students also receive medical, health, and dental services, including annual physical exams. Mental health care is provided by social workers and counselors. The program meets every day after school and on Saturdays. It serves youth as young as 11.

Founded by Michael Carrera, a past president of SIECUS who holds a doctorate in education from Columbia University, the program aims to convince its participants that they are “at promise” rather than “at risk.” Says Carrera, “There’s no genius to this. We teach kids that they have gifts and talents, that all things are possible, that if they do well in school they can be successful in life.”

Carrera says his program differs from other sex education programs in that its focus is “above the waist.” Although students learn about abstinence and contraception, “I learned a long time ago,” says Carrera, “that unless you link your pregnancy prevention interventions to all the aspects that make a young person whole, to all the systems that affect their lives, providing information is not enough.”

Last year, an independent evaluation of the program found that female participants were almost 50 percent less likely to become pregnant than those in a control group. Specifically it found that girls in the Carrera program delayed sex longer, had fewer sexual partners, and were three times more likely to have used effective contraception at last intercourse. They were also able to better withstand “coercive” pressure to engage in sexual intercourse. The evaluation did not find comparable results for boys in the program. Carrera speculated that might be due to the fact that many reported having had multiple sexual partners prior to joining the program.

Among the evaluation’s other findings: All participants exhibited great participation in the workforce, more frequent use of healthcare programs, greater knowledge and use of computers, and more visits to colleges than those in the control group.

Carrera works closely with those seeking to replicate the program, helping them find philanthropists and other donors, and hiring and training staff. He puts the cost of the program, which is funded by foundations, at about $4,000 per student per year. (According to a 2001 report by the U.S. Department of Agriculture, it cost a single-parent family with a before-tax income of less than $39,100 an average of $5,440 to raise a child from birth to two years of age.)

STAYING THE COURSE

Moore, with Child Trends, echoes Kreinin’s concern that falling teen pregnancy and birth rates will lead to complacency, something she says would be a big mistake. She points out, for example, that the 26 percent decline in the teen birthrate since 1991 was immediately preceded by a 24 percent increase beginning in 1986. And that that increase reversed several decades of declining teen birthrates.

Another concern: repeat births to teen mothers. According to the National Campaign, about 19 percent of teens who give birth between 15 and 17, and 25 percent of those 18 or 19, have a second child within two years. Researchers say teen mothers with two children are much less likely to complete high school and much more likely to be unemployed or working in a low-paying job than those with just one child.

To be sure, Moore and others take heart from the research showing that programs that invest in teens by boosting their academic skills, increasing their connection to school, and providing positive relationships with adults, can lower teen pregnancy rates. They are also encouraged by evidence that teens value, listen to, and heed their parents’ advice about avoiding risky sexual activity. And they realize a drop in teens’ sexual activity and an increase in contraceptive use bode well for the future.

“We have made progress, and that’s heartening,” says Moore. Still, she adds, “It’s foolhardy to push teen childbearing off the nation’s radar screen.”