Texas led the nation in 2010 in the rate of teen-age girls who had second children, according to the Centers for Disease Control (CDC).
About 22 percent of births for Texas girls ages 15-19 were repeat births. The U.S. rate is 18.3 percent, compared with 19.5 percent in 2007.
CDC director Tom Frieden, MD, MPH, said in a statement, “Teen birth rates in the U.S. have declined to a record low, which is good news. But rates are still far too high. Repeat births can negatively impact the mother’s education and job opportunities as well as the health of the next generation. Teens, parents, health care providers, and others need to do much more to reduce unintended pregnancies.”
An estimated 80 percent of teen births are unintended and cost American taxpayers about $11 billion a year, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. The cost to Texas in 2008 was $1.2 billion.
The report pointed out that second teen births are more likely to be preterm and low birth weight, compared with first births.
American Indians and Alaska Natives had the highest rate of repeat pregnancy at nearly 22 percent, followed by Hispanics at about 21 percent and non-Hispanic blacks at about 20 percent. Non-Hispanic whites had the lowest repeat pregnancy rate at less than 15 percent. New Hampshire had the lowest teen repeat birth rate at 10 percent.
According to the study, the vast majority of teen mothers used contraception 2 to 6 months after giving birth, but less than 1 out of 4 used the most effective methods, such as tubal ligation, vasectomy, implant, and an intrauterine device. Nearly 10 percent of sexually active teen mothers did not use contraceptives, with the most frequently used reasons were partner disapproval or inability to afford contraceptives.
The reasons for the state’s No. 1 repeat birth rate likely is a mix of factors, including a high rate of teen pregnancy, abstinence-only sex education and lack of resources geared toward teen pregnancy prevention.
According to Guttmacher Institute, the Texas teen pregnancy rate in 2005 was 88 per 1,000, compared with the U.S. rate of 70 per 1,000. Most of those pregnancies were unintended. The rate of unintended pregnancy in Texas for all women was 53 percent, compared with 49 percent nationally, in 2006.
Kathryn Cardarelli, associate professor at the School of Public Health at the University of North Texas Health Science Center in Fort Worth, said, “Texas overall does not supply adequate resources to prevent pregnancy, and that includes teen-agers. In the last legislative session, family planning services were slashed dramatically. Every dollar you spend on family planning saves $3.50 in Medicaid expenses.”
The legislature slashed $73 million in family planning funds in 2011, forcing more than 50 clinics to close. The Texas Health and Human Services Commission has estimated that the cuts will result in 24,000 more births to low-income mothers and may require the state to spend an additional $273 million on Medicaid in its upcoming budget cycle.
According to Guttmacher, about 3 out of 4 Texas unintended pregnancies were publicly funded, compared with about 2 out of 3 elsewhere in the U.S in 2006. The public tab in that year was $1.3 billion in Texas, of which the state spent 39 percent. Each Texas unintended pregnancy cost $257 in public funds, compared with $180 nationally. The institute estimated that Texas family planning centers prevented an estimated 98,700 pregnancies in 2008, of which 43,900 would have been births and 41,200 would have been abortions.
Cardarelli said Texas generally does not support “robust sex education,” despite evidence that abstinence-only education is not as effective as classes that include discussion of contraception.
Texas refuses to accept federal funding for sex education programs that teach children how to avoid pregnancy and sexually transmitted diseases with tactics other than celibacy. The state does not actually dictate what kind of sex education public schools should offer, beyond requiring that abstinence must always be presented as the best choice.
According to an analysis by two Texas State University professors for the Texas Freedom Network, about 3 out of 4 Texas school districts were teaching abstinence-only sex education in the 2010-11 school year. As late as the 2007-08 school year, less than 4 percent of districts were teaching sex education that included discussion of contraceptives.
Allison Whitehead, executive director of Dallas-based Alley’s House that works with teen mothers, blames the pervasiveness of abstinence-only sex education for multiple births. She said 85 percent of girls who become pregnant drop out of school, which separates them from those support services. She said teens in her program, which seeks to foster independence through education and mentoring, must sign an agreement not to become pregnant again. About 98 percent achieve that goal. Whitehead also said the inability to obtain affordable contraceptives also contributed to multiple pregnancies.
Jeff Livingston is an obstetrician and gynecologist at MacArthur OB/GYN in Irving and is on the medical staff at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford.
Livingston said Texas does a good of job giving low-income women prenatal care through the Medicaid program. However, they lose insurance coverage 60 days after deliver, making it more difficult to afford contraception. Another factor contributing to second pregnancies is that the risk factors that contributed to the first pregnancy, such as poverty and a poor parental support system still exist after the first child is born, he said.
Livingston said surveys of teen mothers in California show that 50 percent of Latinos said their pregnancies were intentional. In 2010, Latino teens in Texas had about three times as many births as non-Hispanic whites, according to the U.S. Office of Adolescent Health.
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected]