Good news: Teen pregnancy rates have fallen by about 50 percent in the United States among girls 15 to 19 since 1990, according to the federal Centers for Disease Control and Prevention.

Bad news: Arizona’s teen pregnancy rate remains double the national average.

Complicated news: Experts say comprehensive sex education works, but it’s on the decline.

The national teen pregnancy rate in 2017 stood at 25 per 1,000 girls age 15-19 nationally and 30 per 1,000 in Arizona. That puts Arizona’s rate 20 percent above the national average.

By contrast, the rate in Apache County stands at 40 and the Navajo County rate at 55 per 1,000. That’s twice the national average. Gila County fell in between Navajo and Apache at 49 per 1,000.

The teen birth rate in all three counties has declined along with the national average, but has remained far above the norm.

Despite the big drop in teen pregnancies in recent decades, the U.S. still has among the highest teen birth rates in the industrialized world. Some 88 percent of the births to girls aged 15 to 17 are unplanned and unwanted. Some 1 million teenagers give birth each year in the U.S., accounting for 13 percent of all births.

Studies show such a pregnancy can have a huge impact on a girl and her baby.

Some 80 percent of teenage mothers end up on welfare at some point. They’re much more likely to drop out of school, so only one-third receive even a high school diploma. They’re also at higher risk of alcohol and substance abuse. Teen fathers also have reduced earning potential. Studies suggest teen pregnancies end up costing some $7 billion annually in lost tax revenues, public assistance, child health care and added costs for foster care and the criminal justice system, according to a summary of research by Dr. Stanley Swierzewski.

Against that backdrop, the Apache County Board of Supervisors recently renewed its contract to offer a comprehensive sex education program in Ganado High School, which has yielded big gains in the past.

The program offered on the Navajo Reservation uses many traditional Navajo concepts to teach teens about healthy relationships, going far beyond sex education to talk about issues of identity, respect, violence, dating and healthy relationships.

Past evaluations have shown students who undergo the 10- to 12-week program reported a 33 percent lower pregnancy rate, 14 percent fewer school suspensions and failed 11 percent fewer classes.

The course description concludes, “all programs use evidence-based curricula that has been proven to delay sexual activity, improve contraception use among sexually active teens and prevent teen pregnancy as well as reduce dropout rates.”

The “Smart Girls Life Skill Training Program” goals include increased knowledge of sexually transmitted disease, contraception and pregnancy as well as how to deal with dating violence, coercion and sexual assertiveness. The program aims to empower women and build self-esteem and confidence.

The “Wise Guys” program stresses male responsibility in hopes the teens will delay sexual involvement, talk to parents about sexuality, adopt healthy sex role attitudes and acquire greater knowledge of sexuality issues.

The program includes many of the hallmarks of the array of sex education programs that have proven effective in the past 30 years, according to a recent article in the Journal of the American Academy of Pediatrics.

The federal government has invested hundreds of millions of dollars in supporting sex education programs, with a big shift in funding in recent years from comprehensive sex education programs to programs that mostly stress abstinence and the dangers of sexually transmitted diseases — with minimal information on birth control.

The issue has hit home in Arizona this year, with a furor about efforts by the Arizona Department of Education to update the curriculum for sex education statewide.

Most school districts in Arizona offer little or no sex education instruction, since state law leaves it up to districts to determine what they want to teach — if anything. Many districts that do offer some instruction stress abstinence, with minimal discussion of contraceptives for fear of encouraging teens to have sex.

However, parent protests prompted Arizona Superintendent of Public Instruction Kathy Hoffman to drop her initial efforts to introduce new curriculum and requirements. Sen. Sylvia Allen, who represents Rim Country and heads the Senate Education Committee, strongly opposed efforts to expand sex education in Arizona schools, saying some of the materials were too sexually explicit and that educating teens about sex was a topic best left to parents.

Studies suggest a comprehensive, carefully-designed program that includes training for teachers can produce the kinds of broad benefits the Ganado High School program has yielded, according to the National Academy of Pediatrics.

However, research suggests that most abstinence-only programs don’t have much effect on the sexual behavior of teenagers. Some studies suggest the programs may delay the onset of sexual activity. Most studies show little difference between sexual activity, pregnancy rates and exposure to sexually transmitted diseases between students in an abstinence-only program and students who don’t take any sex ed classes at all.

The American College of Obstetricians and Gynecologists, the Society for Adolescent Health and Medicine, the AAP, the American Medical Association, the American Public Health Association, National Education Association, and the National School Boards Association all oppose abstinence-only education and endorse comprehensive sexuality education that includes both abstinence promotion and accurate information about contraception, human sexuality, and sexually transmitted diseases.

However, studies also show that such comprehensive programs have been diminishing. The studies also show that most teens don’t talk to either their parents or their doctors about these issues. Fewer than half of high school students and 20 percent of middle school students take sex education programs that include all the elements of those proven successful in reducing teen pregnancy and sexually transmitted disease rates, according to the CDC. Although 80 percent of teens in school receive the “abstinence” message, fewer than half get any information about birth control.

The most successful programs went beyond technical and medical information on things like birth control and pregnancy to talk about relationships, resisting peer pressure, taking responsibility and other more complicated topics. The successful programs mostly used community-specific approaches and involvement, along with training for teachers. Most involved role playing and a variety of approaches to conveying the message, according to one survey of effective programs.

“I wish I could tell you that there was a study that showed that this program taught in this school is going to help kids throughout the United States fulfill all the outcomes that people want to fulfill, but there isn’t such a study,” said Cora Collette Breuner, chair of the American Academy of Pediatrics’ committee on adolescence.

Leslie Kantor with Rutgers School of Public Health analyzed the most successful sex education programs in the country and concluded the best programs discussed specific sexual and protective behaviors, including the encouragement of abstinence and the use of condoms or other contraception. Some 90 percent of the effective programs included training for the educators teaching the class.

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