Alabama has the 5th highest teenage birth rate in the US, but abstinence rules and lack of funding are hampering progress

Portia Shepherd has worked with about 50 teens in small, rural Alabama communities since March, teaching them about abstinence as well as contraceptive use and personal responsibility.

“We see the difference,” said Shepherd, executive director of BlackBelt Women Rising, an organization selected by the Alabama Department of Public Health to provide federally funded sexual health programs to teens in Choctaw Counties. and Marengo. “I see students in grocery stores laughing in the aisles that sell contraceptives, or parents come to tell me about a discussion they had with their children.”

Alabama’s black belt counties have the highest teen pregnancy and birth rates in Alabama, with some rates more than double the state average. The black belt is rural and predominantly black and low-income, all factors that explain the disparities.

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Overall, the teenage birth rate in the country and in Alabama has fallen in recent decades, but Alabama’s remains relatively high. The state reported the fifth highest teenage birth rate in the nation for 2020.

Doctors say it could have deadly consequences after legalized abortion ends in Alabama and many neighboring states.

“The teenage birth rate is absolutely going to go up, but what worries me are the death rates,” said Dr. Leah Torres, obstetrician/gynecologist and reproductive health specialist at the West Alabama Women’s Center. “The maternal mortality rate will increase when you have more births. These are just calculations. But young people, people at these extreme ages, have a much higher risk of dying in childbirth.”

Torres, who serves women in Black Belt counties and statewide, said she has patients — especially those on Medicaid or living in rural communities — on waiting lists for several months for IUDs and birth control. Often, the only option for her patients to access contraceptives is through their county health department, which can have long wait times to get an appointment. Fewer than 50% of Alabama counties have a hospital with obstetrical services, according to the Alabama Medical Association.

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Six state agencies found in a 2017 report that implementing a more comprehensive sex education curriculum and expanding federally funded pregnancy prevention programs in schools would help reduce teenage pregnancy rate.

But the recommendations have not been implemented and a combination of factors, namely a state sex education standard that emphasizes abstinence, makes existing programs less effective, advocates said. .

“These programs need to be in all schools and not just for bad or at-risk kids,” Shepherd said. “A lot of things in our community are done in a reactive way, and that’s why we see (high teenage pregnancy rates). You can’t wait until someone has had sex to teach birth control. “

“Patchworks” services

Shortly after the U.S. Supreme Court’s decision to end federal abortion protections, abortion became illegal in Alabama except in cases where the life of the mother is at stake. across the state canceled hundreds of appointments and suspended services.

While most abortions and pregnancies occur in adults, the state reported 3,837 births and 5,296 teen pregnancies under the age of 19 in 2020. In this age group, approximately 600 teens underwent abortions, the youngest patient being 11 years old.

Teenage births carry a high risk for both mother and baby and can lead to maternal mortality, premature births and low birth weight.

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The 2017 state agencies report found that “teen pregnancy rates are significantly lower in states that offer a comprehensive sex education curriculum taught in schools.”

At the time the research was conducted, Massachusetts had the lowest teenage birth rate in the country – 9.6 compared to Alabama’s rate of 30.1 per 1,000 teens. The researchers found that Massachusetts used $2.6 million in federal funding in community settings and classrooms, while Alabama only distributed its $2.1 million to community organizations due to the state abstinence standard, according to the report.

Federal funding is the only money allocated to preventing teenage pregnancies. Alabama is not using any state funds for this effort.

“Not all teenage pregnancies are planned or unwanted, but when they are, you see part of the failure in education and the state not investing in health care, let alone health care. reproductive health care,” Torres said.

Schools in Alabama are not required to teach sex education. When they do, students learn abstinence, even though more than 40 percent of high school students in the state have been sexually active, according to the most recent Youth Risk Behavior Survey.

A 1975 state code stipulates that all sex education materials must emphasize that abstinence from sexual activity is the only fully effective protection against pregnancy, sexually transmitted infections and HIV/AIDS, and that abstinence out of wedlock is the “expected social norm” for the school. age children.

These standards also note that all students should “analyze the benefits of practicing abstinence from sex,” but do not mention birth control, condoms, or any other form of pregnancy or STD prevention.

Fewer than half of Alabama’s middle schools taught the health consequences of HIV, sexually transmitted diseases and pregnancy, and only about half of high schools taught students how to use a condom correctly, according to a profile of Centers for Disease Control and Prevention School Health 2018.

“It’s all left to local control, so it’s very disparate across the state,” said Christina Clark Okarmus, executive director of the Alabama Campaign for Teen Sexual Health. “And unfortunately, because it’s disparate and because it’s not compulsory, we don’t really have a clear picture of who teaches what in different schools.”

According to the Alabama State Department of Education, if a teenage girl becomes pregnant, schools have no resources available to her, although teenage pregnancy and birth contribute significantly to rates. high school dropout rate, with only about 50% of teenage mothers graduating. . Instead, school districts may choose to partner with local organizations to provide materials, training, or counseling for pregnant women.

Options outside of schools are also limited.

The Alabama Department of Public Health coordinates the state’s teen pregnancy prevention efforts; Valerie Lockett heads the Teen Pregnancy Prevention Directorate and manages and distributes federal funds to community organizations such as BlackBelt Women Rising.

The state received nearly $2 million in federal funding in 2021 to teach comprehensive sex education, including pregnancy prevention, through the Sexual Risk Avoidance Education and Education programs. the personal responsibility of the US government. But the state health department only allocates this funding to community organizations, although an organization can partner with a school if local districts agree.

In 2021, the Department of Health selected six organizations to administer the programs in their communities, choosing entities that primarily work with at-risk youth, including adolescents in juvenile detention, foster families, and counties to low income. But the programs are voluntary, and enrollment is less than 1% of the state’s total population of 989,800 children under 18.

Participation has dropped sharply this year, from 2,407 teens enrolled in the two federally funded programs in 2019 to just 663 in 2021, bringing the average cost of running the programs to $2,400 per participant in the program. sexual risk avoidance education and $3,350 for personal responsibility education programs.

“With COVID, that was a really big hurdle because it’s a face-to-face program,” said Lockett, of the Department of Health.

Advocates say they will continue to work with teens, but more state resources are needed.

“Adolescents in particular are a very vulnerable population. They’re children and they don’t have the same rights as adults,” Torres said. “And we don’t recognize that, and we’re doing everything we can to hurt them more, it seems, by refusing to educate them and actively preventing them from accessing health care.”

As for Shepherd, she hopes to expand these programs in her community, including in high schools, to reach more young people with their funding, which will continue through the next fiscal year.

“Prevention education is very important and often overlooked. The more we teach this information to students, the more they can pass it on to their peers.”

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