Lesa Cotton has worked to prevent teenage pregnancies in Calhoun County for 15 years.
As the health services coordinator for Calhoun County schools, Cotton is charged with coordinating abstinence-based sex education programs throughout schools in Calhoun County. Yet even after all the information Cotton has spread throughout the county, she still has had to deal with several teenage pregnancies in her time as coordinator.
“They’re overwhelmed,” Cotton said. “They’d realize the extent of commitment and what all having a baby at that age would entail. Many of them have to give up normal teenage extracurricular activities, give up normal teenage things.”
Cotton described life after high school as not much better, either.
“The’re still looking at difficultywith child care, trying to get their education, pairing that with work and providing for their families,” Cotton said. “But it’s 10 times harder on a single adult, or a single teenager.”
Thankfully for Cotton, the number of pregnancies and births in Calhoun County has fallen in recent years. In fact, the state of Alabama is showing record decreases in number of teenage births and pregnancies in recent years, according to the Alabama Department of Public Health.
In 2009, the ADPH recorded 8,365 confirmed teenage births, 13.4 percent of all births in Alabama. As of 2012, the year with the most current available data, the department listed 6,236 teenage births, a 25 percent decrease in a four-year period. The percentage decrease and the decrease in number of teenage births are both the largest in a four-year period in state history since 1960.
Grace Thomas, assistant state health officer for Family Health Services for the department, attributed the sharp decrease in teenage pregnancy to a combination of Alabama’s family planning programs and a trend in teenagers making better choices.
“There are a number of factors,” Thomas said. “The general feeling is, teens are making better choices. And the use of long-acting, reversible contraceptives, IUDs, hormonal implants, also helps.”
Alabama has two programs designed for family planning: Title X, a federal program devoted solelyto family planning, and Plan First, a Medicaid program for women ages 19 to 55. Thomas said anyone not covered under Plan First would be covered by Title X, both of which cover long-term contraceptives, provided at every health clinic across the state.
Title X–supported centers provided contraceptive care to 103,660 women in Alabama in 2010, 32 percent of women in the state in need of publicly supported contraceptive services and supplies. Seventy-five health department clinics and five federally qualified health centers provided contraceptive care to 96,160 and 7,500 clients, respectively. Services include contraceptive care and screenings for cervical cancer, HIV and STDs.
Plan First provides a yearly family planning exam, care support from a social worker or nurse, birth control such as birth control pills, tubal ligation for women 21 years or older, pregnancy and STD testing and help in planning when to have a baby.
“I think programs like Plan First are invaluable,” Thomas said. “They do reach the underserved and play a role in the decrease in teen birth.”
Calhoun County has followed similar trends in teenage births. Since 2010, the number of teenage births has dropped from 202 to 159, a 21 percent decrease. The number of teenage pregnancies has decreased in that same time. In 2010, Calhoun County listed an estimated 294 pregnant teenagers. In 2012, that number decreased to 225, a 23 percent decrease.The pregnancy rate also dropped substantially, to 29.6 pregnancies per 1,000 girls.
Cotton attributed the decrease in teenage births and pregnancies to a combination of factors, including state and federal programs, the state’s abstinence-based school programs and the fact that teenagers are simply making better, more informed choices.
“I would hope that it’s a trend that will continue,” Cotton said, “as we continue educating and making these people aware of it.”
Gayle Whatley, director of the department’s central perinatal care district, said the trend means good things for the state’s infant mortality rate. In 2012, 8.9 babies died in the first year of life for every 1,000 births in Alabama.
Whatley said the decrease in teenage births and pregnancies would be good for the health of Alabama’s teenage population as well, because teenage pregnancy can have adverse effects on teenagers whose bodies have not finished developing.
“Teenagers are not through growing up, although they think they are,” Whatley said. “It’s difficult on their bodies. That puts a lot of strain on them.”
Still, Whatley is not ready to say the state is seeing a “true” decrease in teenage pregnancies: It could simply be following the state’s overall decreasing number of births. From 2009 to 2012, Alabama has seen a 7 percent decrease in total number of births.
According to data from the National Campaign to Prevent Teen and Unplanned Pregnancy, Alabama’s ranking for birth rates and pregnancy rates in girls 15-19 is on the unfavorable side. (Birth rate refers to the number of live births in a given population; pregnancy rate refers to the carrying of a child, whether that ends in miscarriage, abortion or live birth. The latter measurement by definition will always be higher than the former.)
The state had 39.2 births per 1,000 girls in 2012, for a ranking of 42 in the nation. By contrast, New Hampshire, at No. 1, had 13.8 births per 1,000.
In the pregnancy rate, Alabama ranked 34 in 2010, the year for which the most current data is available, with 62 pregnancies for every 1,000 girls. New Hampshire’s figure was 28 pregnancies per 1,000.
The state has seen positive historic trends, however. From 1991, the country’s peak year in teenage birth rate, to 2012, Alabama ranked 17th nationally in percent change in teen birth rate, with a 47 percent decrease in teenage births. And from 1988, the country’s peak year in pregnancy rates, to 2010, Alabama ranked 21st nationally in percent change in the teen pregnancy rate, with a 44 percent decrease.
Whatley said it isn’t clear whether the teen birth rate is declining due to policy changes and better choices teens are making, or whether it’s part of a decline in birth rate in all age groups.
“You talk to administrators and principals and talk about the decreasing number of teenage births, and they act surprised and say they feel as they’re seeing as many as ever,” she said.