The MTV Effect

Tackling Teen Pregnancy

American birth rates are lower than ever—unless you're in Texas. Amanda Marcotte runs down what works (free condoms) and what doesn't (abstinence-only education) when it comes to preventing teen pregnancies.

If you’re a typical American, odds are you think the teen birth rate is going up or, at best, staying stable. The actual truth may surprise you: Not only has the general trend in teen births been going down since the 1950s, but the year 2012 turned out to have the lowest teen birth rate ever. Well, at least since the government started to track it 73 years ago. Indeed, it fell at a rapid rate of 6 percent just between 2011 and 2012.

That’s the good news. The bad news is that there’s still a long way to go. The United States has a teen birth rate of 29.4 births per 1,000 girls ages 15–19, but Western European nations like France, Germany, and the Netherlands have rates that are a third of that and lower. Canada has a birth rates of only about 13 girls out of 1,000. In addition, the reduction in the teen birth rate hasn’t been consistent across the country. Red states still tend to have higher teen birth rates and Texas’s rate even went up in 2011 while most of the country was going down. So what can be done to bring the U.S. down to the levels of a place like Canada? How do we get red states to catch up with blue states? What strategies work and which ones don’t work? Here’s an examination.

What works: Comprehensive sex education that doesn’t flinch from addressing specifics. California has been a major success story on the teen birth front, getting their birth rate down from 70 births per 1,000 in 1991 to 28 in 2011. A huge part of their success has been implementing comprehensive sex education across the state, requiring schools not just to educate students about the existence of contraception but also explain the specifics of how to use it. It’s not enough to have a chart detailing the failure rate of every contraception method. Kids need to know the details, such as taking the pill at the same time every day or leaving a little room at the tip in condoms, or even their best intentions to use contraception may still fail them.

What works: Youth programs designed specifically with teens’ actual needs in mind. Another part of California’s success was implementing various programs, often outside of schools, that reached teenagers on their own level. Using guidelines laid out by the CDC and other organizations, the programs address teen-specific concerns for ease of access and multiple reassurances of confidentiality. In addition, the programs aim to be culturally relevant, employing bilingual counselors so no one is left out.

Other research has shown that sex education programs improve contraception use if the programs focus heavily on issues that teenagers care about: Relationships, personal safety, and individualized attention. In addition, if programs offer leadership opportunities to students, the boost in self-esteem and control also helps them make healthier contraception choices.

What doesn’t work: Abstinence-only programs. From nearly the moment that the Bush administration started to require schools to implement abstinence-until-marriage programs in order to get federal sex education funding, researchers started showing that the programs didn’t work. These programs, which often include condescending and very conservative gender role propaganda, are quietly being abandoned in many states, which is part of the reason why teen pregnancy rates are dropping, but states that cling to abstinence-only programs unsurprisingly find that they continue to have higher teen birth rates, as well.

What works: Pop culture that emphasizes waiting to have babies until you’re a little older. While most people tend to think of teen parenthood shows on MTV like 16 & Pregnant as just more of the same reality TV trash, there’s strong evidence that the popularity of these shows may be encouraging kids to avoid pregnancy. Research from the National Campaign to Prevent Teen and Unplanned Pregnancy found that 82 percent of the viewers of 16 & Pregnant said the show helped them better understand the challenges of teen parenting. Seventy-nine percent of girls and 67 percent of boys said seeing teen pregnancy on TV reminded them of their own risk of accidental pregnancy, and half of respondents to their survey said that teen pregnancy in the media instigated a conversation about prevention with their parents.

What doesn’t work: Shaming campaigns. Some cities have embraced a tactic of putting up ads that shame teen parents, and even sometimes suggest that they are pariahs. While there’s no good data on how effective these campaigns are, experts in the field—many who were teen parents themselves—say that these kinds of campaigns don’t really work. Research has shown that shame actually causes people to engage in the bad behavior that the shaming is trying to prevent, and there’s no reason to think that would be any different with sex. Campaigns do better when they focus on specific and immediate outcomes, and if they tie in straightforward and practical advice on how to prevent the outcomes, such as using contraception.

What works: Free contraception. One of the quickest and easiest ways to prevent people from having unprotected sex—and therefore more unwanted births and abortions—is to simply give them unlimited access to the contraception of their choosing. A major study out of St. Louis called the Contraceptive Choice Project started with a simple premise: What if you gave women not just free contraception but free counseling so they were set up with the method that, after assessment, they and their provider felt worked best for them? One thing they found is that most women, when given thorough information on all their options, chose long-acting methods like IUDs or implants, where you put it in once and don’t think about it again for years. (Doctors particularly like IUDs for teenagers because most teens don’t want to start having babies for many years, often even 10 or more, after they first start having sex.)

The results were astounding. The teen birth rate amongst the participants fell to a mere 6.3 births per 1,000, less than a quarter of the national birth rate. The abortion rate was cut in half, as well. Turns out the double whammy of thorough counseling and free contraception is exactly what teenagers need to prevent pregnancy.

What doesn’t work: Slashing family planning funding. In a fit of misogynist, anti-choice fervor, Texas Republicans cut $73 million in family planning funds, no doubt hoping that young women would simply respond by cutting out all that sex that humans have been engaging in since the beginning of time. Upon finding out that the cuts are expected to lead to an additional 24,000 unintended births—with a huge chunk being teenage mothers—they immediately started talking about adding $100 million back. Of course, it could very well take years to restore the family planning infrastructure damaged by the cuts. Fifty clinics have closed, and it’s not that easy getting them running again. But the lesson is learned. When young women and teens can’t get birth control, a whole bunch of them are going to get pregnant when they don’t want to be.

Can we get our teen pregnancy rates down to a level that makes us look more like France or Canada? It used to seem nearly impossible, but the teen birth rate is now currently half of what it was in 1991 and a third of what it was in the 50s. We can cut it by two thirds again, if we pay attention to what actually works and refuse to let judgmental, shaming attitudes get in our way.