October 2010 Archives
Oct 28 2010Southern Discomfort: Are Teen Births the South's Problem and Is Abstinence to Blame?
From the category of no good deed goes unpunished...
The hard-working, under-appreciated, over-performing public servants at the CDC's National Center for Health Statistics (NCHS) released new data last week on disparities in state teen birth rates. The data and analysis garnered quite a bit of informative media attention. That's the good news.
The not-so-good news is that much of the coverage was--to put it charitably--overwrought (see here and here for examples). In short, some coverage seemed to suggest that teen pregnancy and childbearing is only a problem in the south and that abstinence-only education is to blame for the high rates in the south.
Well. Let us ponder:
- True, rates of teen childbearing are high in many southern states. However, NCHS analysis makes clear that even within racial/ethnic subgroups, there are great differences across states. For example, some northern states with lower rates of overall teen births are among those states with the highest rates for some racial/ethnic groups.
- The proposition that teen birth rates are highest in the south because of abstinence education is a head-scratcher. Teen birth rates were higher in many southern states before the federal government made abstinence education funds available during the Clinton and Bush Administrations.
- Moreover, 49 states across the length and breadth of this great land accepted federal funding for abstinence education, many of them for a number of years. Why might it be that abstinence education only "caused" higher birth rates in southern states?
- It is also the case that teen birth rates have declined in all 50 states (yep, that includes southern states). If we are blaming abstinence education for higher birth rates in the south, should we credit abstinence education for the declines in those states as well?
Despite impressive progress over the past two decades, it is still the case that three in ten girls in the United States become pregnant by age 20. A number that large suggests that teen pregnancy is not limited to a particular region, to particular groups, or to those girls. It is a problem that is wide and deep, my friends. Let's resist pointing fingers or looking for overly-simple answers to a complicated challenge.
Oct 26 2010"16 and Pregnant" Is Back!
Oct 25 2010Study Finds that Health Care Providers Recommend IUDs Less to Poor White Women
The October issue of the American Journal of Obstetrics and Gynecology includes a study conducted by the University of California, San Francisco, examining contraceptive recommendations based on race and socioeconomic status factors. The study found that health care providers recommend IUDs--one of the longest-acting and most effective methods of birth control available today--less frequently to poor white women than to other groups of women.
In other words, clinicians' recommendations for IUDs were affected by both the patient's class and her race/ethnicity. For example:
- Clinicians were less likely to recommend IUDs to white women of low socioeconomic status than to white women of high socioeconomic status.
- Socioeconomic status had no significant effect on recommendations for IUDs for Latinas and black women.
- But when the researchers evaluated the groups by race/ethnicity, clinicians were more likely to recommend IUDs to Latinas and black women of low socioeconomic status than to white women of low socioeconomic status.
Previous research on the effect of patient race/ethnicity and class on clinicians' recommendations has focused on patient-provider interactions involving medical decisions about diseases, such as coronary artery disease, for which there is general consensus about appropriate treatments. Decisions about family planning are obviously a different animal altogether. The most effective option will depend not on race or socioeconomic status, but on the patient herself--is she comfortable with the IUD as a birth control method? Does she use condoms to prevent STIs? Is there another long-acting method (Implanon or Depo, for example) more appropriate for her lifestyle? These are obviously factors that cannot be sussed out without a detailed conversation between provider and patient.
The bottom line is that access to contraception--particularly contraception as effective as the IUD--should never come down to race, ethnicity, or socioeconomic status. In fact, according to another Pregnant Pause post by my colleague Lisa Shuger, "nearly three-fourths of American voters (71 percent) believe insurers should be required to fully cover the birth control pill and other forms of prescription contraception as they will be required to do for other preventive health care services under the new health care reform law" (read the full post here). In other words, of the million factors that go into choosing a method of birth control, cost shouldn't be one of them.
Jody Steinauer, senior study author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences sums it up nicely: "This is an especially important area of research given the high rate of unintended pregnancy in the US. It is critical that we provide comprehensive contraceptive counseling and equitable access to highly effective long-acting reversible contraceptives such as the IUD to all women."
Oct 21 2010The Adoption Option
Our pals at the Center for American Progress released an interesting report earlier this week about adoption. Those of us who spend our days working to improve the lives of children and families certainly think about adoption a lot. In addition, anyone who has cried their eyes out over the Catelynn and Tyler segments of 16 and Pregnant and Teen Mom (guilty!) has probably thought a lot about adoption too and contemplated what it takes to make such a selfless and courageous choice.
Oct 20 2010Teen Births Version 2008 (By State)
The good people at the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) have some more data upon which we can all chew. Today they released preliminary 2008 state data on teen births. They also released new analysis of state disparities in teen birth rates based on 2007 teen birth data.