Cristin Parks always had an open relationship with her mom. She felt she could talk to her about anything — except birth control.
A missed period led Parks' mom to believe she was pregnant, so she purchased a home pregnancy test. In July 1997, Parks, who had just turned 15, realized she was pregnant.
Parks's story is not unique in West Virginia. The state was the only one in the country to see an increase in teen birth rates in 2009, according to the West Virginia Perinatal Partnership. Teens also are using less protection but having more sex, leading to an increase in unplanned pregnancies. Now, the West Virginia Legislature is taking steps to address the issue that results in adverse social, economic and health conditions for both mother and child.
Statistics
The increase in teen birth rates contradicts a decade-long trend where West Virginia's rate decreased consistently. Between 1991 and 2004, teen birth rates dropped by 24 percent. However, in 2006, the rate of teen births increased, "with alarming social and economic costs," according to the Study on the Incidence of Teen Pregnancy and Childbearing in West Virginia report published by West Virginia Free.
According to the report, teen moms are less likely to graduate from high school and more likely to live in poverty, while their children are more likely to suffer from low birth weight, low literacy, neglect, and health problems. They have a higher risk of becoming teen parents themselves and a higher risk of becoming incarcerated.
Teens in the U.S. are more at-risk for unintended pregnancy than in any other industrialized country. West Virginia's teen birth rate of 43.4 births per 1,000 women is higher than the national average of 40.5. Teen pregnancy is also more prevalent in the state's African American population, which sees 103 pregnancies per 1,000 women, according to the report.
Economic Impact
Teen pregnancy has a huge impact on the state's taxpayers, according to Megan Forman of the National Conference of State Legislatures. According to her study, West Virginia taxpayers pay about $67 million in Medicaid and other health care costs, and 25 percent of teen moms go on welfare within three years of their child's birth. Fewer than 2 percent of teen moms complete college before age 30.
"There are most definitely linkages to the state's work force and their lifetime earning potential and state tax revenue," Foreman said.
According to several experts who have testified before the Subcommittee on Health Education CSOs, the state can actually save money by investing in family planning programs. Nancy Tolliver of the Perinatal Partnership said for every $1 invested in family planning, the state could save $3.74 in other areas. And although 156 family planning programs exist across the state, many are simply inconvenient to teens because they're either open during school hours or don't offer family planning services daily.
"That's the issue," Tolliver said. "It all goes back to finances."
West Virginia's family planning facilities receive an average of $125 per woman in need, compared with the $149 national average, according to the Kaiser Family Foundation. Title X federal funding accounts for $2.4 million of the West Virginia Family Planning program's $7.2 million budget and the program receives about $3.6 million from the state.
Education
The committee is currently not considering any legislation but instead is looking at how to improve the health education system across the state.
According to Tolliver, state code requires health education for grades 6-12, including comprehensive sex education. However, "the implementation is not consistent in all counties across the state," Tolliver said.
Parks said her high school was not allowed to hand out condoms or other forms of birth control. Her health classes, generally taught by male football coaches, did not teach about reproduction and teens had little to no access to family planning clinics. These factors and more led Parks to believe teen pregnancy was a bigger issue in the late 1990s than it is today.
"I think it was a lot worse when I was in school," she said. "I don't know how it is now, but they weren't allowed to tell you where to get condoms or birth control. There was no talk about it."
Parks participated in a sexual education class called "Growing and Being" in sixth grade. She said that's the last she remembers talking openly about sex in school.
Brenda Dawley, chairwoman of the Committee on Unplanned Pregnancy, said counties with the lowest birth rates among teens had six things in common: teachers who taught the health curriculum were more experienced and certified to teach health education; the health curriculum addressed issues such as reproduction, sexually transmitted diseases, planning and nutrition for a healthy pregnancy and responsibilities of parenting, among others; use of community resources, such as doctors and nurses, to supplement teaching; counties had school-based health services available to students; and requirements included 90 minutes of general health education daily per semester.
According to Dawley's presentation to the Legislature, details of sex education lessons and the material covered are locally controlled and vary from school to school.
"We need better health education for teens," Tolliver said.
Insurance
When an unplanned pregnancy occurs, many teens are left to figure out how to pay for doctor's visits themselves. That's because many insurance companies, including Public Employees Insurance Agency, don't cover prenatal care or contraception for minor dependents.
According to a Center for Business and Economic Research study released in 2010, it is "very clear that covering contraception services for dependents will reduce unplanned pregnancy in just the first year." The center estimates that would result in 20 percent fewer births and save an estimated $980,991. According to Tolliver, pregnant teens who lose their parents' insurance coverage must rely on publicly-funded family planning clinics for prenatal care. She said this is a disservice to the teens.
"It's great we have those resources, but wouldn't it be better for my daughter to go see the family doctor instead of finding those services somewhere else?" Tolliver asked. "It doesn't make sense to me."
The Affordable Care Act would require insurance plans offered through exchanges to cover maternity care as part of an "essential benefits package." But that won't go into effect until 2014, according to Foreman.
The study published by West Virginia Free lists 11 recommendations for reducing teen pregnancy. Some recommendations include implementing Medicaid improvements, including adding emergency contraception to the Medicaid formulary, and mandating PEIA and private insurance to cover dependents' pregnancies, abortions and preventative reproductive health care.
A Parent's Role
Parks' daughter is now 14. She took the same sex education class her mom took, but she doesn't talk too openly about what she learned. Parks said she tries to be honest and open about her own experiences as a teen mom.
"I'm very honest with her about sex, STDs, using protection," Parks said. "We openly discuss it. If I think something is going on with her friends, we'll kind of talk about it again. When's the last time you had to tell your kid something once? I try to be open about my own experience, and I try to answer her questions because I know if she doesn't hear it from me, she'll hear it from her friends, and I'd rather her get correct information."
Although she tries to do her best to educate her daughter, Parks said the school system could do more because not all parents are proactive in teaching their kids about sex.
"I think the schools can do more, but I think it's hard for them to do more because it's a medical issue — you're giving kids medication," she said. "But I feel like if they want to help the teen birth rate, they're going to have to at least do more education in the schools. Even if they're not comfortable handing out condoms or birth control, there needs to be more education at the very least, or at least resources."
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