In 1991, within the course of a single year, close to 16 out of every 100 teenage girls in California became pregnant — a rate that ranked among the worst in the country (the national average was 6.18 births for every 100 teens) and far exceeded those of other developed countries, sometimes by double digits.
Staggering as those statistics were, there’s been an equally stunning development in the 20 years since. By 2011, the teen pregnancy rate nationwide dropped 37 percent, and by more than half in the Golden State, a decline that’s “one of the nation’s great but unheralded success stories of the past two plus decades,” says Bill Albert, chief program officer for The National Campaign to Prevent Teen and Unplanned Pregnancy.
Despite the drastic drop in teen pregnancies, the fact remains uncelebrated — perhaps because no one can pinpoint exactly how it happened. Researchers haven’t yet explained how so many states’ divergent (and sometimes contradictory) strategies could consistently result in such steep declines.
The simple explanation? A “magic combination of less sex and more contraception,” as Albert puts it. But that only begs the question, What changed about the way teens have sex?
Studies point to a number of cultural factors. Some claim that mandatory sex education in schools after the AIDS crisis increased use of contraception. Others cite welfare reform and the strong economy. One hypothesis holds that MTV’s reality shows “16 and Pregnant” and “Teen Mom” discouraged sex with their gritty looks at the challenges of childbearing at a young age. Another theory says kids saw their parents marrying and having children later in life, so they likewise didn’t experiment until they were older and perhaps more mature.
A hard look at California’s programs, however, may reveal the best practices and a model to adopt nationwide. After all, the state is leading the way in reducing all three key areas — teen pregnancy, births and abortions. It’s “the undisputed heavyweight champion of prevention,” Albert remarks.
The Golden State, as a whole, saw teen birth rates drop by 60 percent from their peak in 1991. That number reflects improvement across all races; Hispanic teens still have the highest rate (4.27 births per 100 female teens), but it’s down 42 percent in the past 10 years.
Many public health officials point to the state’s sex education as an essential element in their multi-pronged approach. State law passed in 2003 requires the education to be “comprehensive, medically accurate and age- and culturally-appropriate.” Within the context of preventing HIV/AIDS, California teaches abstinence, but otherwise says abstinence-only education is “not permitted” in public schools. (It’s the only state in the union that didn’t accept lucrative federal dollars tied to “abstinence-only-until-marriage” programs included in a 1996 welfare reform package, after the state found its own pilot ineffective compared to one that included information on contraceptives.)
From there, the state’s approach focuses on access to healthcare, pioneering an innovative funding model that allows teen patients at hospitals or community clinics to qualify as their own household, making them eligible to receive public assistance for their medical expenses.
Additionally, California takes a more personalized approach to the social issues that surround — and lead to — teen pregnancy by helping local school districts and community healthcare providers tailor their programs to specific geographic areas. There’s vast differences, for example, in urban, affluent San Francisco and the rural farmlands of the San Joaquin Valley, where teen pregnancy rates still double those of the Bay Area.
“The problem isn’t the across-the-board teen birth rate in California, it’s the inequities that are revealed when you look at the rate,” Alison Chopel, senior program manager of the California Adolescent Health Collaborative and champion of the effort, says. “Why are black girls and Latina girls having babies younger than white girls? It’s because of the opportunity landscape that’s available to them.”
For Chopel, the need to customize the programs is very personal. As a teenager, she saw herself becoming another statistic. Raised in a poor household, she struggled with schoolwork, took drugs to cope, failed her classes and barely graduated from high school. College didn’t seem to be in her future, especially not after she had a baby boy. “I didn’t mean to get pregnant,” she says, “but I meant to have him.”
With the help of a Pell Grant, she graduated from college and went on to graduate school to study public health. She came to recognize the wide scope of factors contributing to unintended pregnancies: family structure, education, poverty, access to healthcare, race and culture.
Recently, public health advocates have questioned whether a baby is really the cause of the negative life outcomes — dropping out of school, living in poverty, depending on food stamps — for teen moms or whether they would have been just as likely to end up there because of their upbringing. (Chopel points to new research showing that young mothers from impoverished backgrounds may actually perform better than their peers because they receive family support and are motivated to succeed for their child’s sake.) Poverty, in other words, isn’t a symptom of unwanted teen pregnancies. If anything, it’s the cause.
California’s “innovative” strategies and community-based partnerships worked: they’re “helping young women and men make responsible choices,” says Dr. Ron Chapman, director of the state’s public health department, so the state is focused on continuing to make prevention programs available. “In all communities,” Chapman adds emphatically.
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