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
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.
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
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
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.”
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.
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.
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,