Public health researchers say teen birth rates are at a record low in the United States, falling 44 percent since the peak in 1991. But the problem remains, with more than a thousand teenagers giving birth every day.
Now, for the first time, the Centers for Disease Control and Prevention has examined a troubling sub-group: teens who give birth to a second, third or even fourth child. These are called “repeat teen births.” Of all 50 states, Texas ranks #1 for this phenomenon. (CDC Factsheet.)
Jajuana Thomas, 19, is five months pregnant with her second son.
“I wasn’t expecting to have a second child but now that I am I’m happy about it,” she said during an interview at her apartment in the Greenspoint neighborhood of Houston. “I wanted a girl, but I’m having another boy. So it’s okay.”
Thomas’ son Nathan is 20 months. Thomas watched as he scampered outside on the balcony, dodging and playing with his uncle.
“I’m kind of nervous about another baby, because he probably is going to be jealous,” she admitted. “It’s probably going to be hard for him. I don’t know, but he’ll get used to it.”
It will also be hard on Thomas. She’s unmarried and not interested in working on her relationship with Nathan’s father. Although she did complete high school, she does not have the money yet to attend college. She was working at a Burger King for awhile, but had to stop when the pregnancy made standing up all day too hard. Now she lives with her aunt, and gets help from her mother and Nathan’s father.
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Studies show that teen childbearing puts families at great risk for a life of poverty and struggle:
- Two-thirds of families begun by a young unmarried mother are poor.
- One-quarter of teen mothers go on welfare within 3 years of the child’s birth
- Only 38 percent of mothers who give birth before 18 get a high school diploma.
As a society, the costs have been estimated at $11 billion per year (from increased costs for health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers).
The new study from the CDC reveals that 18 percent of teen births are repeat teen births. Texas has the highest rate, with 22 percent being repeats.
enlarge CDC graphic
One factor may be the fact that Hispanics, who make up 38 percent of the state’s population, have a higher repeat rate than some other ethnic groups.
But access to affordable contraception may also play a role, says Dr. Peggy Smith, director of the Baylor Teen Health Clinic in Houston. Recent legislative cuts to women’s reproductive programs led to the closing of 56 family-planning clinics across Texas, and an estimated 30,0000 additional unintended pregnancies. (Visit the Texas Policy Evaluation Project’s data finder on family planning.)
Theoretically, it should be easy to intervene with a teen who has already given birth. Those teens are already in contact with the health system, so there are multiple opportunities for doctors or nurses to discuss contraception going forward, said Lee Warner, the associate director for science in the CDC’s Division of Reproductive Health.
But even when teen mothers have access to birth control, they still sometimes get pregnant. The CDC study showed that 91 percent of sexually-active teen mothers were using some form of birth control, but only 22 percent were using the most effective types, like hormonal implants or IUDs. Those are considered best because they don’t require remembering to take a daily pill or going back to a clinic every few months.
That’s what happened to Jajuana Thomas. Every three months, she was getting a shot of Depo-Provera, a contraceptive. But she was busy with Nathan, and she lost track of the schedule.
“I didn’t get it for a couple of months, I think I missed my appointment,” she said. “And then I went to go get it back, and that’s when I was pregnant already.”
The CDC’s Warner says teens who give birth again cite a number of reasons. In surveys, the young mothers say they didn’t want to use contraception or their partner objected; they couldn’t afford contraception; or they wanted to get pregnant again.
Warner says in addition to the obvious financial impacts on the parents, a repeat teen birth also puts the baby’s health at risk.
“For the mother, it limits the educational and employment possibilities,” he said. “But I think more importantly for the infants, those who are second or subsequent births have higher rates of being premature and low birth weight.”
At the Teen Health Clinic in Houston, contraception is free or low-cost and counseling is offered to both young women and their male partners.
Smith, the clinic’s director, says it’s not enough to hope that a teen who already gave birth will then have learned a lesson, and will be more careful about birth control in the future. Some do, but many go on to have more children.
“People who are younger tend to be more impulsive,” she said. “So thinking that one pregnancy is an inoculation for a second pregnancy is probably too generous.”
The best long-term solution, according to Smith, is more funding for long-acting reversible birth control — methods known as “LARCs” in clinic parlance. LARCs include Nexplanon, a three-year implant for the upper arm, and Mirena, an intrauterine device. But they’re expensive. Smith says Nexplanon can cost up to $900, but through a state purchasing program her clinicians can get it for $324.
But for at-risk teenagers, there also needs to be counseling, sexual education and general social support, Smith said.
“Poverty has not gone away,” Smith said. “Many of these young people go home to an empty house, they leave to go to school from an empty house.”
“So when I look at these issues, I say this is sort of the consequence of young people who don’t have hope and don’t see there are better things to be than a mother with three kids.”
Jimena Levy, 35, says that’s exactly what she experienced. She lost hope during high school, and started thinking that a baby would make her feel “whole.”
Levy was the oldest of three girls being raised by an exhausted single mother in Houston. Levy felt stressed and isolated, tasked with helping raising her younger sisters and intimidated by the experience of going to a more affluent high school where she was one of just a few African-American students.
“That’s when my life I felt was going in a downward spiral, in the ninth grade. I started failing classes, skipping school, not doing my work.”
Levy said her heart really broke when she proudly brought her report card to her mother to look at. Her mother waved her away, too tired to care.
“What I couldn’t fathom was the simple fact that she couldn’t even look at my report card, and be proud of me. And I just wanted her to be proud of me. I think if she had done that, at least that, and cared about what was going on with me, I wouldn’t have been an at-risk teen. And I became that statistic, and I hate that.”
Levy had her son Gene at 18.
“I wanted a baby,” she said. “I was just so focused on being loved and getting attention and I wasn’t getting it from my mom, so I figured the best way for someone to give me the love that I need, was I child of my own.”
Levy had another son at 23, and later on a daughter. She’s now confident and independent, working at an oil-change business. But there were years of struggle and even a period of homelessness.
Now she’d like to mentor at-risk young women, “girls who remind me of how I was.” She loves her children, but if she could do it over again, she would not have had them so young, and she would get married first.
“The reality is that it is hard. That’s the reality,” she said. “I know that I love my children, and I know that they love me, but don’t bring a child in just because you feel like you need someone to love you.”
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