By the numbers
2015 birth rate among girls 15-19: 22.3 births per 1,000 girls (national), or 2.23%
2015 birth rate among girls younger than 15: 17.7 births per 1,000 girls (Pa.), or 1.77%
Pa. ranking among 50 states: 15th lowest
Percentage change in teen birth rate for Pa.: -62% (1991-2015), -9% (2014-15)
2011 teen pregnancy rate: 44 per 1,000, or 4.4%
Percentage change in teen pregnancy rate: minus 49% (1988-2011), -10% (2010-11)
Percent of Pa. high school students who said they ...
Have had sex: 36% (41% nationally)
Used alcohol or drugs before sex: 19% (21%)
They or partner used a condom during last time having sex: 63% (57%)
Used birth control pills or LARC before last time having sex: 25% (27%)
Used no contraception during last time having sex: 11% (14%)
2015 live births for girls 15-19 in Western Pennsylvania counties:
Pennsylvania is one of 34 states that mandate HIV education. Parents must be given notice and may opt their children out. Curriculum must stress abstinence. The state does not mandate sex education.
Sources: Guttmacher Institute; Pennsylvania Department of Health; U.S. Department of Health & Human Services, Office of Adolescent Health; Centers for Disease Control and Prevention; National Campaign to Prevent Teen and Unplanned Pregnancy.
Note: Unlike the birth rate, the pregnancy rate includes live births, abortions and miscarriages.
Despite a career spent working with pregnant women, Mary Pat Draghi still dreads phone calls like the one she got recently from the mother of a 14-year-old girl.
Her daughter was pregnant, and she was desperately looking for answers. Draghi, OB coordinator at the Westmoreland Women’s Health Center in Greensburg, couldn’t help feeling sad as she explained the clinic’s array of services.
“It breaks my heart. I’m a parent,” Draghi said.
Although such cases are rare — 1.4 percent of teenage pregnancies in Westmoreland County in 2015 involved girls under 15 — they’re a reminder to Draghi that teenage pregnancy is a complex problem that involves girls, boys, parents, schools, communities and health care providers.
“When you’re working with teens, you can talk all you want, but you’re still dealing with a teenage brain,” she said.
New data that seek to explain the complexities of teen sexual behavior give Draghi and other women’s health care professionals in Western Pennsylvania reason for hope.
A study by the Centers for Disease Control and Prevention released June 22 noted that teen pregnancy and birth rates in the United States have reached historic lows, even as levels of sexual activity among teens since 2002 have remained static. The CDC study aggregates data from the National Survey of Family Growth and other sources.
The birth rate among females ages 15-19 in 2015 was 22.3 births per 1,000 females (2.23 percent) — an 8 percent decline from the previous year and a 64 percent decline from 1991, the CDC study said. The pregnancy rate, which includes those that result in births, miscarriages and abortions, was 44 per 1,000 in 2011, the most recent year for which there is data.
The teen birth rate in Pennsylvania was even lower (17.7 per 1,000), making it the 15th-lowest state in the country, according to the National Campaign to Prevent Teen and Unplanned Pregnancy .
The CDC study noted that female teenagers’ use of contraception when first having sex increased from 74.5 percent in 2002 to 81 percent in 2011-15. Forty-two percent of never-married female teens (4 million) reported having had sexual intercourse at least once, the study said.
A 2016 survey of Pennsylvania high school students found that 36 percent said they had had sex and that 25 percent said they or a partner had used birth control pills or some form of long-acting reversible contraception (LARC) before their most recent sexual intercourse.
Dr. Elizabeth Miller, chief of adolescent and young adult medicine at Children’s Hospital of Pittsburgh of UPMC, explains the historically low teen birth rate as largely the result of more, and more effective, contraceptive use on the part of teens.
“There’s not been a decrease in sexual activity, but adolescents are using contraception more consistently,” Miller said. “Clinically, we have seen a huge increase of young persons seeking LARCs.”
The latter include the intrauterine device (IUD), implants and other reversible contraceptives, she said. A recent committee report by the American College of Obstetricians and Gynecologists attributed low teen birth rates primarily to “more effective” contraceptive use on the part of adolescents.
“Although modest, this increase represents a tripling in the use of LARC methods among adolescents. Between 2007 and 2012, significant increases in the use of any method at last sexual experience in the prior three months and the use of multiple methods were noted,” the ACOG report said.
Draghi said LARCs seem tailor-made for teens who tend to be absent-minded about taking pills or irresponsible about using condoms.
“I think we have better long-term methods — better than just the pill. It’s also the availability of those methods, and clinicians offering those methods,” Draghi said. “When you have long-term methods that work for three to five years, that’s going to decrease your teen pregnancy rate.”
Miller said Pennsylvania has strong laws protecting the privacy of teens seeking contraception but lacks the ease of access of states such as New York, which makes birth control available through clinics in middle schools and high schools.
“I would put Pennsylvania somewhere in the middle of the road in terms of access to contraception and sexual health education,” Miller said.
The state’s promise of confidentiality — that teens don’t have to seek a parent’s permission to obtain free contraceptives — is what “gets young people in the front door,” Miller said, but good clinical practice includes improving communication between teens and parents.
Changing social norms
Bill Albert, spokesman for the National Campaign, said there is no “silver bullet” to explain the low teen birth rate. In addition to low-maintenance contraception, he would add positive peer pressure, sex education programs and reality TV shows such as MTV’s “Teen Mom” and “16 and Pregnant.”
“What we’re seeing here is a change in social norms. As more teens decide to delay sex, that has a positive influence on their peers,” Albert said.
The Jeannette-based PACT program , which helps pregnant and parenting teenagers finish high school, has seen its client numbers drop over the years, said program coordinator Susan McFarland. PACT, which stands for Pregnant Adolescent Childcare Training, works in 14 of the 17 public school districts in Westmoreland County.
“We’re typically funded for 50 kids per year, and we’re definitely not seeing that many in the last few years,” McFarland said, noting that the decline may have to do with the rise in online schools.
“Some kids, as soon as they get pregnant, they transfer to a cyber program, so we don’t necessarily get referrals and we don’t know about them,” she said. “Unfortunately, they get lost in the system.”
Amy Scheuring, executive director of the Pittsburgh-based Women’s Choice Network , said the downside of contraception promotion is that it can lead to a false sense of security and to an increase in sexually risky behavior on the part of teens.
Scheuring cites a recent study in the Journal of Health Economics that found a small decline in teen pregnancy rates in Great Britain despite cuts in public birth control programs since 2010.
“Put simply,” the researchers said, “birth control will reduce the risk of pregnancy for sex acts which would have occurred anyway, but may increase the risk among teenagers who are induced by easier access to birth control either to start having sex or to have sex more frequently.”
Scheuring said she was not surprised by the study’s findings. “I think largely students do what we tell them to do. And when we tell them they can’t abstain and their only option is birth control, they believe us,” she said.
The Women’s Choice Network operates four clinics in Allegheny County that offer pregnancy tests, STD tests, ultrasound scans and pre- and postnatal counseling. Staffed by three medical doctors and four registered nurses, the clinics do not provide birth control prescriptions or devices, abortions or abortion referrals.
Scheuring believes abstinence education should be part of the discussion about teen pregnancy rates. “No matter where people stand on the contraceptive issue, everyone will agree that bringing down this number is what we all want,” she said. “This is something we all should be celebrating.”
Stephen Huba is a Tribune-Review staff writer. Reach him at 724-850-1280, firstname.lastname@example.org or via Twitter @shuba_trib.