It was ironic. In the same month that CDC invited Robert Blum, the head of the Johns Hopkins Bloomberg School of Public Health Department of Population, Family, and Reproductive Health to give the 2012 Alexander Langmuir Lecture on the problem of teen pregnancy, the CDC’s National Center for Health Statistics issued a data brief showing that birth rates for US teenagers were at an all time for the seven decades during which consistent records have been kept. However, there’s more to the story.

The Good News

First the good news. According to NCHS, birth rate for US teenagers fell 9 percent from 2009 to 2010 to 34.3, the lowest level since 1940. Looking at recent times only, the 2010 rate was 44 percent below the recent peak in 1991 and 64 percent below the all time high level of 96.3 recorded during the baby boom year of 1957.

Impressively, the rate has been falling in the both the youngest age group 15-17 years and the 18-19 age group. Equally striking, the rates declined across all racial and ethnic groups—by 9 percent in 2010 for non-Hispanic white and black teenagers, by 12 percent for American Indian or Alaska Native and Hispanic teenagers, and by 13 percent for Asian or Pacific Island teenagers.

If the 1991 rates had persisted without decline, there would have been an estimated 3.4 million additional births to teenagers over the almost two-decade period 1992 through 2010.

Geographic Variation

Finally, the decline was widespread geographically, including all states except  Montana, North Dakota, and West Virginia between 2007-2010. However, birth rates continue to show impressive differences between states with New Hampshire recording a low of 15.7 and Mississippi recording a rate of 55.0 in 2010. This differential between the Northeast and the South has persisted for many years with the highest rates sweeping the southern tier of the country in a belt from as far as Arizona in the southwest to as far as Alabama in the southeast.  The rate in Mississippi is almost four times greater than the rate in New Hampshire and almost double the average rate for the country as a whole.

Other Countries

Interestingly, in a CDC report on teen pregnancy rates from other countries for the years 2008-09, the US has one of the highest rates, surpassed only by Bulgaria at 43 per thousand girls 15-19 years. Many other developed countries have rates in the single or low double digits from 4-14 per thousand.

Reasons for the Declines

NCHS cites studies which have identified strong pregnancy prevention messages directed to teenagers as responsible for the national declines. CDC has itself documented increased use of contraception at first initiation of sex and use of both contraception and hormonal methods among sexually active female and male teenagers. These increases have taken place while the percentage of teens who are sexually active has remained relatively constant.

The reasons for tackling the teen pregnancy is because it has huge economic, social, and health costs on teen parents and their families, according to CDC.

Not So Simple

Dr Blum began his lecture on teen pregnancy by noting the strong variation by geographic region and population. According to Blum, who worked originally in Minnesota, “Baltimore is a very different universe than Minnesota.”

Winnable Battle??

Blum quoted CDC Director Tom Frieden who has called reducing teen pregnancy a “winnable battle”. Blum asked if this is so, and if it is, how could it be won? He agreed with the importance of two factors highlighted by the CDC Director—1) changing social norms to make having babies at a young age unacceptable, and 2) making contraceptive and reproductive services more accessible. However necessary these two interventions may be, they are not sufficient, according to Blum. He went on to describe his more complex conceptual framework which he called a contextual model for thinking about teen pregnancy and he argued that the problem is multi-factoral and cannot be solved simply by better norms and more contraception.

Macro-Level Factors

According to Blum,  at the macro-level social policies such as minimum age at marriage laws and universal sex education, the type of neighborhood teens live in, social norms, and the type of poverty they may be subjected to also exert an influence. Then there are what Blum called more proximal factors such as an individual’s biological development including brain changes in adolescence and the adolescent’s temperament and cognition that play into the risk of teen pregnancy. Blum told his audience at CDC that we have decontextualized teen pregnancy and politicized it by making it appear as if it is only a matter of individual behavior choice.

Most Important

In attempting to prioritize the multiple risk factors for teen pregnancy, Blum pointed to a teen’s family as the most protective factor. He asserted that this finding is the most consistent risk factor found globally. He added more specifically that “connectedness to one or more parents” makes it less likely that teens will engage in early sex behaviors. 

School As Contraception

Following the importance of family, Blum said schools are the second most important factor. He told CDC epidemiologists that “a good school is good contraception”, and that “school retention is pregnancy prevention.”  What also works for pregnancy prevention is training to provide skills, expanding opportunities for youth participation, and empowering parents.

In an interesting twist, Blum not only highlighted what works but what does not work to prevent teen pregnancy. In this ineffective category he placed 1) providing information alone, 2) scare tactics, 3) short-term only interventions, 4) promoting abstinence only, and 5) contraception only. In short, according to Blum, preventing teen pregnancy is not just about sex. It’s providing the support kids need. He ended his talk by referring again to CDC Director Frieden’s belief that teen pregnancy is a “winnable battle”. Blum agrees and says, “Yes, but…”