Roxana Castro sits in an orange chair in the waiting room at Mary's Center in Washington, D.C. She's 17, and expecting a baby boy next month. The pregnancy was a surprise, she says, mostly for her parents, but also for the baby's father.
Even with her mother's help, Castro admits she's nervous. The father of the baby says he'll be there, but she knows this is a big responsibility, and says she's not ready to start a family just yet.
"A baby is so fragile," she says. "I don't know how to take care of it or anything."
The U.S. teen pregnancy rate is the highest in the developed world. In 2008, nearly 7 percent of girls between ages of 15 and 19 became pregnant. But there's good news: The numbers have been going down for a few decades, hitting a 42-percent drop by 2008. The decline occurred across all races — though blacks and Latinos continued to have higher numbers.
The dramatic decline is a huge success for those who have worked to prevent teen pregnancy, but there's still much work ahead.
Prenatal Care – And Preventive Action
Last year, Mary's Center worked with nearly 200 prenatal-care patients under 19 years old.
Bernadete Aldrich is one of the first people who talks with the girls who walk through the doors. She sees three or four pregnant teens every week.
"A lot of them come, unfortunately, in the end of pregnancy, so they would not have prenatal care," she says. They come because they're afraid. "They are afraid of parents, or society or school. They hide as much as they can. They need a lot of information."
Mary's Center offers counseling and other services to pregnant teens, but what they're most proud of here is their after-school program.
Franchesca Medina, 17, has been coming to the after-school program for a few years.
"We do homework, workshops, we have fun — we watch movies," she says.
And they talk about sex. Franchesca isn't shy about how she prevents pregnancy.
"Condoms," she says. "And also, I'm wearing the patch."
"Teens have really done a terrific job," says Sarah Brown, the CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy. "They are having less sex, and those who are having sex are using better forms of contraception."
Brown calls the ongoing decline in teen pregnancies a profound change – and last year's change absolutely surprising.
"The teen birth rate last year went down 9 percent," she says. "That is the single-largest one-year decline that's ever been noted since we started counting, I don't know, in the Truman administration."
Even so, the teen birth rate in America is still higher than every other developed country – three times higher.
"I think the primary explanation is not that they have ... fewer teens having sex, but U.S. teens are not as good ... at using good contraception," Brown says.
Someday, though, Brown says the U.S. can achieve the same figures as those other countries.
"I see no reason why we can't get there, but we'll have to focus on these things we've been talking about — sexual activity, contraceptive views, relationships, cost of contraception and how that affects choices," she says. "And all these things have been dealt with, to greater or lesser success, in some of these countries that have lower rates."
Preventing The Slide Into Poverty
There's a connection between teen motherhood and poverty that's often the subject of debate. The conventional wisdom is that a teenage girl has a baby young, maybe out of wedlock, and that is the start of a fall into poverty. New studies, however, say it is actually a lack of economic opportunity that leads teens to pregnancy. Brown says it's both.
"Teen pregnancy often is a continuation of a pattern in a family or in a neighborhood where a lot of young women have had babies at a young age," she says. "But I think the answer is that by postponing pregnancy and childbearing till an older age, these young women have a chance to escape poverty — but it's not assured."
That's one reason learning about contraception is only part of Mary's Center's strategy to prevent unplanned pregnancies.
"We just keep them busy," says Lydia Casmier-Derfler, who helps coordinate the teen program.
"We keep them busy with college prep, we keep them busy with tutoring, learning about financial management, so on and so forth, and so instead of being in the streets," she says, "they're here at Mary's Center instead."
Mary's Center is happy with its results. Last year, more than 100 teens participated in the after-school program, and not one became pregnant. Places like Mary's Center have helped to lower Washington, D.C.'s teen pregnancy rate. Still, the decline of teen pregnancy rates in the city over the past three decades is only half of what's been seen nationwide.
A Cultural Shift
One state that has long struggled with high rates of teen pregnancy is Mississippi. It used to be that sex education was not required in Mississippi school districts, and abstinence was the state's official policy.
Last summer, the state legislature voted to give school districts the choice of adopting a new policy called Abstinence Plus. A group called Mississippi First is trying to get school districts with the highest birth rates to adopt it.
"Many people don't realize that almost every single county in Mississippi has a teen birth rate that is higher than the national average," says Rachel Canter, the group's executive director. Some counties have a rate of about 111 teen births out of every 1,000 girls, she says.
The response has been encouraging; 35 school districts said they wanted to sign onto the Mississippi First program.
"One of the things that I think really helped people was seeing how bad the data really was," Canter says. "Also, there was a poll that came out that showed that 92 percent of public school parents in Mississippi support sex-ed in public schools, and I think that really changed the perception that a lot of people in politics had about whether or not parents were really supportive of this idea."
Altogether, the data and the response represent a cultural shift for the state, Canter says.
We've had these high teen birth rates for a very long time, but it was the type of issue that people didn't want to touch with a 10-foot pole, because they thought that everyone else wouldn't want to talk about it."
Not anymore, she says.
"I'm in my 30s; people in my generation have a different orientation to a lot of these issues," she says. "So many of our peers had babies as teens, we don't want it to happen to our children."