Since 2006, health officials at the federal Centers for Disease Control and Prevention have watched warily as the teen birth rate has crept up. The increases come after nearly two decades of steep declines. Looking at teen birth rates alone, however, they said it was too early to say that this represented a reversal of a trend toward improvement in teen sexual behavior.
The larger picture, taking into account what teens say they're being taught about sexual and reproductive health, rates of HIV and other sexually transmitted diseases among teens, and sexual activity among certain age groups and ethnic and racial groups, are much more worrisome.
Success Until Now
For much of the 1990s, high school students put off having sex, according to Lorrie Gavin, a CDC researcher. "You see overall patterns through the '90s and early 2000s of general improvements in the sexual and reproductive health of our young people."
That was especially true of younger teens. For example, surveys of African American teens, whose teen birth rates have always been the highest, show sexual activity dropped from 59.3 percent in 1991 to 46 percent in 2007. Most teens who had sex said they used a condom.
As a result, teen births and abortions declined, with the steepest decline occurring among black adolescents. But in 2006, something happened. Adolescent birth rates rose two years in a row — first by 3 percent and then by 1 percent. For white and Hispanic teens, teen pregnancy rates flattened. Most of the increase occurred among older teens and African American teenagers, where the rate of increase was 5 percent in 2006 alone.
"You know there's been a lot of talk about what does this increase in teen birth rate mean in the last two years," Gavin says. "I think the fact that we are starting to see again some trends in these other outcomes is a re-inforcement that there might be something real going on."
The other outcomes include continuing high rates of sexually transmitted infections. One million young people were infected in 2006. Gonorrhea, syphilis and Chlamydia infection rates have all increased, although some increases are due to better reporting. Especially worrisome is that older teens say the first time they had sex, it was forced.
The Value Of Education
While the country became embroiled in controversy over such issues as sex education and abstinence, some experts say that research on young people's sexual behavior lagged. One survey conducted periodically by Health and Human Services found that most adolescents, over 80 percent, were receiving abstinence instruction, but fewer than 70 percent got information about birth control.
Altogether these data suggest that programs have not been effective in keeping up with teens, particularly their use of technology. "The bottom line is that what young people define as risky behavior has changed," says Michael Fraser of the Association of Maternal and Child Health Programs, "The research doesn't reflect the impact of the Internet." Prevention programs, he says have not developed ways to deal with texting, or "sexting," where young people send highly suggestive messages and sexually graphic pictures to each other.
In the current economy, as resources become limited, Fraser worries that research into teens' risky sexual behavior and programs that address them are often the first to go. These are programs like Planned Parenthood's Ophelia Egypt Center in one of Washington D.C.'s poorest neighborhoods, where Irwin Royster works. Royster says young people are getting information online, but they need help understanding it and putting it to good use.
"This is what the youth are reporting to us. First of all, 'I don't have access to prophylactics,'" Royster says, "'There is no one in school teaching me how to protect myself. I didn't learn about this in school.'"
Royster says kids are getting information from their peers and videos, and they spend a lot of time at the center on the computer but what they're learning is not always helpful. He turned to 20 year-old Pierre Whiting and 19 year-old Ivan Bradley to ask them what they see going on.
"You guys, over the course of five years, do you think teen pregnancy has decreased or increased?" he asked. In unison, they responded, "Increased. You see people pregnant everyday," they said, and they described attitudes among their peers in the Anacostia neighborhood where they live.
"Some of (the young girls) think that if they see one of their friends pregnant they got to get pregnant. It's like a cool way to fit in," says Bradley.
While the picture they have of teen pregnancy rates seems to conform to the data, it is in conflict with what they know about sexually transmitted infections. When Royster asks them about rates of HIV for example, they once again answer in unison, "Decreased." Whiting explains that he says decreased, "because everybody knows you are supposed to use condoms if you want to be safe."
Actually, that's not the case. Rates of HIV and other sexually transmitted infections among young black men are increasing. So, Royster confronts this mixture of sophistication and misinformation, by driving home the facts using the Socratic method.
Royster asks the young men if they understand that having unprotected sex can cause not only pregnancy, but also HIV.
Whiting and Bradley have an "aha" moment and respond, "No. I don't think they get the point. They don't get the point."
Helping Them Look To The Future
Royster explains that he tries to motivate them not to engage in risky behavior by showing them other worlds and opportunities that they don't want to miss west of the river, downtown in the nation's capital.
"We look beyond just teen pregnancy prevention," Royster says. "We look at goal setting where teens see themselves five, 10, 15 years from now. We're going to make sure that all of our kids have access to college and have the ability to go away. Is that happening? Yes."
But Royster also wants policy makers to know that sexual and reproductive health problems that get in the way of so many young people's futures haven't gone away.