EXECUTIVE SUMMARY
New data indicate that births among Hispanic and black teens have dropped by almost half since 2006, which mirrors a substantial national decline. Births to all American teens have dropped more than 40% within the past decade.
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Although the teen birth rates among blacks and Hispanics have fallen faster than among whites, the racial disparity in adolescent childbearing remains wide.
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Federal efforts are focusing on community-wide initiatives. Preliminary data indicate that such efforts have increased the number of teens who received evidence-based teen pregnancy prevention interventions and reproductive health services, as well as raised the percentage of teens who received moderately or highly effective contraceptive methods, including long-acting reversible contraception.
Just-published data indicate that births among Hispanic and black teens have dropped by almost half since 2006, which mirrors a substantial national decline. Births to all American teenagers have dropped more than 40% within the past decade.1
Although the teen birth rates among blacks and Hispanics have fallen faster than among whites, the racial disparity in adolescent childbearing remains wide. According to the data from the National Center for Health Statistics of the CDC, nationally, the teen birth rate declined 41% overall (from 41.1 per 1,000 to 24.2 per 1,000). The largest decline occurred among Hispanics (51%, from 77.4 to 38.0), followed by blacks (44%, from 61.9 to 34.9), and then whites (35%, from 26.7 to 17.3). Correspondingly, the birth rate ratio for Hispanic teens and black teens compared with white teens declined from 2.9 to 2.2 and from 2.3 to 2.0, respectively.1
Researchers looked at national- and state-level data from the National Vital Statistics System (NVSS) to examine trends in births to American teens ages 15-19 from 2006 to 2014. County-level NVSS data for 2013 and 2014 offered a point-in-time picture of local birth rates. To better understand the relationship between key social and economic factors and teen birth rates, researchers also analyzed data from the American Community Survey between 2010 and 2014. Here is what they discovered in terms of key community- and state-level patterns:
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In some states, birth rates among Hispanic and black teens were more than three times as high as those of whites. An example is New Jersey, where the teen birth rate among whites (4.8 per 1,000 teenagers ages 15-19) was well below the national rate for this group (18.0). While New Jersey teen birth rates among blacks (27.4) and Hispanics (31.3) also were lower than the national rates for these groups (blacks: 37.0; Hispanics: 39.8), they were approximately sixfold to sevenfold higher than the rate for whites.
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Higher unemployment and lower income and education are more common in communities with the highest teen birth rates, regardless of race.
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In some states with low overall birth rates, pockets of high birth rates exist in some counties.
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Counties with higher teen birth rates were clustered in southern and southwestern states.1
“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” says Tom Frieden, MD, MPH, CDC director. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”
The CDC is working on several fronts to prevent teen pregnancy. One key component of its work is encouraging community-centered efforts. Between 2010 and 2015, the CDC and the Department of Health and Human Services’ Office of Adolescent Health collaborated to demonstrate the effectiveness of innovative, multicomponent, communitywide initiatives in reducing rates of teen pregnancy and births in communities with the highest rates, with a focus on reaching African American and Latino or Hispanic teens ages 15-19.
Preliminary outcome data indicate that the communitywide initiatives have been successful. Each community increased the number of teens who received evidence-based teen pregnancy prevention interventions and reproductive health services, as well as the percentage of teens who received moderately or highly effective contraceptive methods, including long-acting reversible contraception (LARC). Many of those strategies are being implemented across the United States through 84 five-year teen pregnancy prevention grants for programs supported through the Office on Adolescent Health.
The new data underscore that the solution to the national teen pregnancy problem is not going to be a “one-size-fits-all” solution, because teen birth rates vary greatly across state lines and even within states, says Lisa Romero, DrPH, a health scientist in CDC’s Division of Reproductive Health and lead author of the analysis.
“We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues,” says Romero. “Together, we can work to implement proven prevention programs that take into account unique, local needs.”
“Teen-friendly” care
How can clinicians enhance their practice for the best in “teen-friendly” care? Melissa Kottke, MD, MPH, MBA, associate professor at Emory University and director of the Jane Fonda Center for Adolescent Reproductive Health and medical director of the Grady Teen Clinic, all in Atlanta, offered advice at the most recent Contraceptive Technology conferences.2
What barriers prevent adolescents from seeking reproductive health care? According to Kottke, these include:
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inaccessible locations and/or limited services;
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limited office hours;
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lack of money, insurance, and transportation;
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poor communication and/or insensitive attitudes by providers;
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lack of provider knowledge and skills;
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perceived lack of confidentiality and restrictions (parental consent/notification).
Clinicians need to find ways to make it easier for teens, says Kottke. She points to a free infographic from the CDC that outlines a teen-friendly reproductive health visit. (The infographic is available online at http://1.usa.gov/1QnAdLh).
Ease teens’ fears when it comes to a provider encounter. Let them know that a pelvic exam is not a prerequisite for starting contraception. It is necessary only if a woman is having symptoms, says Kottke. Screening for sexually transmitted infections can be done via a urine test or a vaginal swab, she points out. National guidance calls for cervical cancer screenings to begin at age 21.
One way to provide teen-friendly options is to offer LARCs for adolescent birth control, notes Kottke. Intrauterine contraceptives and the contraceptive implant offer top-tier pregnancy prevention, and their use is supported by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. Both national organizations have issued policy statements affirming that LARC methods are safe, effective, and appropriate options for teens.3,4 (Contraceptive Technology Update reported on the subject. See the January 2014 article, “LARC methods: 7 things you need to know,” which is available at http://bit.ly/1T73i2V.)
When talking with adolescent females about sex, build a foundation that rests on sexuality, self, relatioships, and the future, not just sex, advises Kottke. Start with her current context, strengths, and goals for the future, then follow up on the partner. Encourage discussions, and use role-play during counseling. Be aware of judgment and jargon, and use open-ended questions. Motivational interviewing techniques work well with teens, says Kottke. These techniques place the focus of the interview on future goals, belief in the adolescent’s capacity to change, and engagement of the adolescent in adopting health-promoting behaviors. (To obtain more information on motivational interviewing, see the article “Use motivational interviewing with teens,” December 2014 Contraceptive Technology Update, which can be accessed online at http://bit.ly/1Yq2wfr.)
Adolescence is a time of rapid change, notes Kottke. Provision of contraception should not be limited by age, she states. “Supporting overall sexual health of young people often involves access, removing barriers, including those of historical practice patterns, and discussion,” Kottke states. (In an upcoming issue, Contraceptive Technology Update will examine some of the reasons teen births are the lowest in the history of the United States.)
REFERENCES
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Romero L, Pazol K, Warner L, et al. Reduced disparities in birth rates among teens aged 15-19 years — United States, 2006-2007 and 2013-2014. MMWR Morb Mortal Wkly Rep 2016; 65:409-414.
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Kottke M. Adolescent contraception. Presented at the 2016 Contraceptive Technology conference. San Francisco; March 2016; Boston, April 2016.
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American College of Obstetricians and Gynecologists. Committee Opinion #539. Adolescents and long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol 2012; 120(4):983-988.
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American Academy of Pediatrics, Committee on Adolescence. Policy statement: Contraception for adolescents. Pediatrics 2014; 134:e1244-e1256.
