SNOW HILL – Despite common perceptions that high rates of teen pregnancy are only a problem for urban areas, four of the five highest rates in Maryland are found in rural counties of the Eastern Shore and Western Maryland, according to state records.
Caroline, Dorchester, Washington and Wicomico counties were behind only Baltimore in birth rates among 15- to 19-year-old females in 2002.
“Because Eastern Shore counties tend to have a lower socioeconomic status, as well as education, that influences our teen pregnancy (rate),” said Marty Pusey, director of the Worcester County Health Department Office of Prevention.
All of the top-five jurisdictions have a median annual income at or below about $41,000, and Baltimore’s is the lowest in the state at about $29,000.
And the state has made it hard to improve the statistics.
Social services funding was cut by about 30 percent last year, making it harder to find funds for prevention programs, said Karen Christof, director of the Family Center in Hagerstown, which runs a program to help pregnant and mothering teens finish high school.
Research into which programs are more effective – abstinence or prevention – has been inconclusive, said Freya Sonenstein, a professor at the Johns Hopkins University Bloomberg School of Public Health.
Hagerstown is the seat for Washington County, which had the fourth-highest teen birth rate in Maryland in 2002.
Though the center is one of 21 statewide providing alternative education programs, the High School Credit Program here is one of only a few offering in-house child care and education for pregnant and mothering teens.
Christof pieced together a fragile network of county and state funding last year to make up for the cuts, but six similar centers in other areas of the state closed last year, she said.
With less money to spend on comprehensive programs that include prevention education and services for pregnant teens, many rural counties rely on the more plentiful resources available for abstinence-based programs, which draw federal funds.
Federal abstinence-only program funding has increased dramatically since 1996 with welfare reform, and almost every state has taken the offer, said Bill Albert, spokesman for the National Campaign to Prevent Teen Pregnancy.
“Prevention programs are a hard sell even in the best of economic times,” Albert said.
But abstinence is not a reality for many teenagers at the Family Center, who are proof that public school sex education programs are not sinking in with everyone.
“They show you pictures of your body parts and that’s it,” said Erica, a 16-year-old in the program who plans to attend Hagerstown Community College after graduation in January.
Christof said the sex education curriculum originated in the 1970s, but contains some updated information about sexually transmitted infections. Adding information about prevention methods – other than abstinence – is problematic, too, because a vocal minority of county residents is opposed to making contraception available at schools.
The sex education program at the Family Center, which is focused on pregnancy and STD prevention, was where some girls first learned about proper contraceptive use – and the instructor shares personal stories with them, so the girls are confident she knows what she’s talking about.
Culture is another major factor in Washington County’s high teen pregnancy rate, said Stephanie Stone, executive director of the County Community Partnership for Children and Families.
Many pregnant teens there are children of women who were pregnant teens – fostering less stigmatization for young mothers. Plus, teens have a lot of idle time.
“There’s not as much to do in rural areas as there would be in a city,” Stone said. “(Teen pregnancy) doesn’t seem to be as stigmatized as it might be elsewhere.”
Baltimore had the state’s highest teen birth rate in 2002 at 80.1 births per 1,000 girls in the 15-19 age range, a decrease of about 3.6 percent from 2001.
The city is a huge challenge for the Governor’s Council on Adolescent Pregnancy, a program supported by Gov. Robert Ehrlich and Lt. Gov. Michael Steele.
Although state and national teen birth rates decreased from 2001 to 2002, 10 of the 24 state jurisdictions have teen birth rates above Maryland’s average of 35.4 per 1,000 girls. The national average is 43 per 1,000 girls.
Worcester County, which had the fifth highest rate in 2001, experienced a decrease of nearly 33 percent in 2002, dropping to the 12th highest rate of all jurisdictions with a rate of 33.9 births per 1,000 15- to 19-year-old girls.
Though the declining rate is promising, Pusey is cautious.
“It looks like a significant drop, but it may or may not indicate a trend,” Pusey said. “I think these kinds of things really take time. The impact of a program generally can’t be seen in one year.”
Pusey’s department began an abstinence education program five years ago in Snow Hill, where the first class of girls is now in high school and some are mentoring middle school students.
“We like to believe that there has been some carryover impact of that program,” Pusey said.
Iesha, a seventh-grader in Snow Hill’s Just For Girls program, already speaks knowingly about the challenge of staying abstinent.
When she helped report that one of her classmates had been sexually abused, she saw the intense stress her friend went through worrying about pregnancy and disease. She doesn’t want to put herself through that kind of worry.
The program’s director, Paula Truitt, and her assistant, Nikkii Dennis, are surrogate parents and disciplinarians for the 22 girls.
The girls trust Truitt and Dennis, they said, because they are honest and share personal experiences.
Truitt’s approach is a balance of guidance and respect for their personal space and individual personalities.
“As trivial as the issue may seem to me, it’s real to them,” Truitt said.
Because of the abstinence curriculum, Truitt can’t talk to the girls in any detail about birth control. When it comes up, she sends the questions home, hoping parental involvement will foster open communication about sex.
College, career and waiting until marriage to have sex are what she helps the girls aim for, but she is realistic that not all the girls will wait that long.
“I think their intentions are to wait,” Truitt said.
The 30 percent decrease in national teen birth rates between 1991 and 2002 is the result of the combination of prevention and abstinence programs, Albert said.
And while socioeconomic factors are a predictor, Albert said parents have the most powerful impact of all.
“In a time when everyone is still in a panic over the fallout from Janet (Jackson) and Justin (Timberlake)’s behavior (at the Super Bowl halftime show), it’s hard to convince parents that they have a huge influence on their kids’ decisions about sex, love and relationships, but they do,” Albert said.
“When parents are scratching their heads saying, ‘What should I do?’ ‘What can I do?'” Albert said, “the answer isn’t necessarily outside the home.”