Teen births declining in Michigan. But hurdles in northern, rural counties.

Hopeful data nuggets in thorny social problems are difficult to find, and yet, for some years now, a once-dire national conundrum has been slowly repairing itself. While no one can say with certainty exactly why the teen birth rate is dropping, it is undeniably headed downward from its high point 24 years ago.

The teen birth rate fell 57 percent nationwide between 1991 and 2013, according to the Washington D.C.-based nonprofit National Campaign to Prevent Teen and Unplanned Pregnancy, though the U.S. still trails other developed nations. Michigan made even more progress over this period, with a 60 percent drop. And the overall percentage of births to women under 20 continues to steadily tick downward, year after year.

For a problem that once sparked after-school specials and newsmagazine cover stories, this is good news. Children born to teenagers are more likely to suffer from such complications as prematurity and low birth weight, with mothers more likely to be living in poverty and getting less schooling.

But for all the optimism this turn of events might inspire, teen birth rates in some – mostly rural – Michigan counties lag the rest of the state and the nation.

Northern Michigan faces persistent shortages in health care generally, and in women’s care in particular, notes Lori Carpentier, president and CEO of Planned Parenthood Mid and South Michigan, one of two regional Planned Parenthood organizations in the state, which provide reproductive care, family planning and abortion services.

In many of these areas, as Bridge has written, gynecological services are scarce or non-existent, and schools are not required to feature comprehensive sex education that includes information on various forms of birth control. So too, in many rural counties there are simply fewer teens, making those who do give birth a larger proportion of total births.

“Every county in the state has a vet, but 22 don’t have an OB-GYN provider of any kind,” Carpentier said. “That makes a difference.”

Yes to abstinence; maybe to contraception

Michigan public school students are required to be taught about HIV and other sexually transmitted diseases, but comprehensive sex ed is optional. If a district offers a curriculum, state law dictates it must “stress that abstinence from sex is a responsible and effective method of preventing unplanned or out-of-wedlock pregnancy.” No instruction about contraception is required by the state, though local districts are free to craft their own approaches.

Districts may opt for an abstinence-only curriculum. A voluntary survey taken by the state Department of Education in the 2011-12 school year showed that 84 percent of local education agencies that have sex ed at the high-school level teach either abstinence-based or a comprehensive curriculum, while 16 percent teach abstinence-only, said Laurie Bechhofer, HIV education consultant for the department. (“Comprehensive,” in this case, describes “age-appropriate, medically accurate information on a broad set of topics related to sexuality including human development, relationships, decision making, abstinence, contraception and disease prevention.”)

MDE does not require the collection of data on sex education approaches used by school districts across Michigan.

Charter schools, or public-school academies, are less likely to teach sex ed of any kind, Bechhofer said – only 45 percent of the roughly 300 in the state had a sex-ed curriculum at any grade level.

Teen pregnancy “is a multi-, multi-faceted problem,” said Carpentier, of Planned Parenthood. But “when you introduce the opportunity for young women to get routine family planning care, the teen pregnancy rate will decline.”

Many reasons for decline

Teenage pregnancy rates are been going down for years in Michigan, and across the nation.

Carpentier and others say there’s more to a declining teen birth rate than what is taught, or not taught, in health class.

A teen’s school may not offer comprehensive sex education, but the Internet is readily available, and it does. Birth control technology keeps improving, and options abound, from condoms to morning-after pills. And, experts note, the cultural climate teens live in has generally de-glamorized young parenthood.

“Some have said television shows like ‘Teen Mom’ and ‘16 and Pregnant’ are changing the conduct of teens,” said Michael J. New, assistant professor of social sciences at the University of Michigan-Dearborn and a contributor to the conservative National Review. “One study found a strong regional correlation between MTV viewership and teen pregnancy declines.”

New, and other conservatives, say that even if abstinence is delivered as only one part of a comprehensive curriculum, its message is welcomed by teens, particularly younger ones. Yes, a slew of studies indicate abstinence-only education is ineffective and that students in states requiring abstinence-only education have higher teen pregnancy and birth rates than states with more comprehensive sex education, but even so, New and other says, teens want to know it’s okay to opt out.

“Even our pregnancy-test numbers are down,” said Carolyn Doyle, director of Lakeshore Pregnancy Center in Holland. From that base she also oversees Positive Options, a faith-based, abstinence-centered education program that contracts with 13 public and private schools in Michigan to offer curricula on sexuality.

“I would hope that some of it is due to abstinence education and overall sexual-health awareness,” Doyle said of declining teen pregnancy. “But that’s not the whole answer. One big contributor is Plan B,” or morning-after pills, available over-the-counter to 17-year-olds. “It’s a huge factor, I think.”

Data compiled by the U.S. Centers for Disease Control show that the percentage of teens who have had sex is down from 54.1 to 46.8 percent between 1991 and 2013, but it’s been flat since 2000, while the teen birth rate has continued to fall. Those teens who are currently sexually active, defined as having at least one partner in the last three months, also fell between 1991 and 2013, but by far less – from 37.5 to 34 percent.

So while fewer teens may be having sex, that rate of decline has been eclipsed by the far more dramatic drop in the birth rate. This is what experts struggle to explain.

Doyle’s center and curriculum doesn’t cover much about birth control beyond basic information, she said. The center doesn’t condemn their use; and while she said she believes teens should abstain from sex outside of marriage, she acknowledges that those who do have sex are better off using contraception.

At her center, which discourages women from seeking abortions, Doyle said, some teen clients ask about what’s known in the field as long-acting reversible contraception, or LARC, which covers such set-and-forget methods as implants, IUDs and hormone injections, and are less susceptible to human error than, say, condoms.

Use of these forms of birth control is small but growing; they are now used by fewer than 5 percent of teens. But when Colorado invested heavily in LARC for lower-income women and teens, the state saw its teen birth rate plummet 40 percent in four years.

One parent’s tweetstorm

But for all the positive trajectory of the teen birth rate statewide, teens and sexuality remain fertile ground for the culture wars.

Alice Dreger, mother of a then-freshman at East Lansing High School, happened to be in her son’s health classroom last spring when abstinence was the lesson of the day.

Alice Dreger made national headlines when she tweeted from her son’s sex-ed class in East Lansing, pointing out what she called exaggerations and inaccuracies in the lesson. (Courtesy photo)

 

And, to the eventual embarrassment of many in the school, she brought her laptop.

Dreger came to a class given over for a day to a group called SMART, or Sexually Mature Aware Responsible Teens, who were operating as district-hired subcontractors for abstinence-based education that day. In a series of tweets during and after the class, she mocked, with sarcasm and occasional profanity, a class she saw as alarmist, inaccurate and ultimately worthless in guiding teens to make good decisions about their sexual activity. Teachers, she tweeted, told students that premarital sex was "part of a terrible lifestyle. Drugs, unemployment, failure to finish school -- sex is part of the disaster” and that “safe sex is a misnomer.”

And while the principal banned her from returning to the campus (because of the f-bombs), Dreger came out on top – SMART was dropped, and the district is now crafting a new curriculum for teaching sexuality.

Dreger, an author and medical historian, said she doesn’t regret the splash she made. Sex education, she said, needs to include not only biology and birth control, but information on LGBT issues and another aspect many adults don’t even understand – the mysteries of the human heart.

“What I heard from teens all over Michigan after this is that no one in their classrooms are addressing the emotional consequences of having sex,” Dreger said in a recent interview. “They have the Internet. Teens are accessing and sharing information better. But they need to talk about this.”