Baltimore's teen pregnancy rate dropped by nearly a third from 2009 to 2013, far surpassing the city's goal for reducing the rate, Mayor Stephanie Rawlings-Blake plans to announce today.
While public health officials cheered the reduction, the city's rate remains twice as high as the state's and significantly higher than the national average, which experienced a similar drop, according to government statistics. It's a particular problem in black and Hispanic communities.
"We made this a target because Baltimore had some of the highest rates in the country, and we know our young women are significantly hampered from reaching their full potential when they become teen mothers," Rawlings-Blake said. "We want young girls to have dreams and aspirations, and choose those dreams for themselves."
She and city health officials said pregnancy is a top reason young women do not complete high school, which contributes to persistent poverty and unemployment. Further, research shows children of teen mothers have more health problems, and are more likely to be incarcerated, to give birth as teens themselves, and to face unemployment.
Health officials say their efforts were multi-pronged and included educational campaigns and peer counseling, as well as a program to encourage girls to think about their futures. Increasing access to long-term birth control also helped.
In 2011, public health officials set a goal of reducing the teen pregnancy rate by 20 percent by 2015 as part of a larger plan to cut a host of chronic health problems facing residents. Two years ahead of that schedule, Baltimore reduced the pregnancy rate by 32 percent for teens aged 15 to 19.
The rate is now 43.4 pregnancies per 1,000 female teens, the mayor and city health officials plan to announce today during a news conference with youth advocates.
The state rate is 19.3 per 1,000 and the national rate is 26.5 per 1,000. Nationally, the rate dropped about 30 percent from 2009 to 2013, according to federal data.
The city reported that actual number of births to teenage mothers in the city in 2013 was 831, down from 1,494, or 44 percent (the difference between the rate and the number of births is due to a change in the female teen population).
"One of our top priorities in public health in the city is teen pregnancy," said Leana Wen, Baltimore City health commissioner. "I think it is a testament to what can happen in our city when all of us work together on this common goal."
The city worked with several groups to lower the teen pregnancy rate and on related issues, specifically targeting groups with the highest rates, including black and Hispanic youth and economically disadvantaged teens of all ethnicities.
Black and Hispanic teens accounted for more than half of teen births nationally in 2012, a rate unchanged from years before, according to the U.S. Centers for Disease Control and Prevention.
In Baltimore, teen pregnancy rates were significantly higher for African-American teens (51.1 per 1,000) and Hispanic teens (65.4 per 1,000) than for white teens (23.4 per 1,000).
Baltimore health officials work with the Family League of Baltimore on the B'More for Healthy Babies program that focused on teen pregnancy and other issues in at-risk communities. The group attends more than 40 events, such as health fairs, each quarter to promote safe sex practices and family planning.
"We help you identify when you would like to have a child rather than have it happen haphazardly," said Cathy Costa, director of B'more for Healthy Babies.
City officials also reached many teens through an initiative called "Know What U Want" which challenges teens to think about their futures. If they want to go to college, they are asked to think about what they need to do, for example, becoming a parent later.
"A lot of what teen pregnancy is about is hope for the future," said Rebecca Dineen, assistant commissioner for maternal and child health for the Baltimore Health Department. "It's all about thinking about what you might want in the future."
The program was promoted through social media and "guerrilla" marketing, such as sidewalk messages written in chalk or spray paint. The messages directed teens to an educational website with a list of community centers and birth control methods. They also used teens to talk to other teens.
Greater acceptance of, and access to, long-term birth control methods such as IUDs also contributed to the decline in pregnancy rates, city officials said. So has better education to clear up misconceptions about birth control, such as that it promotes weight gain.
But state officials know they are missing some teens and are working on other ways to address the issue, including applying for funds to create a comprehensive sex education curriculum for schools. They also want to get educational videos into health centers to reach those teens not attending school.
The methods are similar to those used nationally to lower teen pregnancy rates, said Dr. Melissa Gilliam, professor of obstetrics and gynecology and pediatrics and chief of family planning at the University of Chicago.
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She said teen pregnancy rates have been falling since 1990, and over the years there have been several reasons. The economy pushed down pregnancy rates in general. But for teens, she said, "people began taking the issue seriously."
She also cited increased access to more varieties of contraception. A study in Colorado, for example, found offering free contraception to teens made a big difference.
And other studies found benefits when parents share their feelings and morals on sex with their children, she said. Programs purely focused on abstinence, however, were not found to be effective.
The disparities are tougher to address, Gilliam said, because when minorities also live in poverty, they don't have access to quality education, health care or safety and are less motivated to delay pregnancy to stay in school.
"We've made a lot of inroads," she said. "But you're going to hit these bigger barriers and we need to address them."