Education and access

Diana Shalabi had to be sure. She was 15 when she told her dad she needed cash for a high school football game. Actually, it was for pregnancy tests. Test after test confirmed the news she wasn’t ready to face.

“I was like, ‘This is not happening,’” Shalabi said. “I was crying every day.”

That was four years ago, and she gave birth to a daughter, Amina. Her marriage to the baby’s father lasted less than a year. Today she says she has sole responsibility for Amina, and they live in Delano, a farming town of 52,000 north of Bakersfield in Kern County.

While Kern County still has one of the highest teen pregnancy rates in California, across the state rates are dropping to record lows, according to the newest data, from 2017.

It shows California with a rate of nearly 14 births per 1,000 females ages 15 to 19. That’s the 16th-lowest teen birth rate in the nation, and below the national average of nearly 19 births per 1,000 females in that age range. Arkansas ranks highest with 33; Massachusetts lowest with 8.

But within California, there are wide variations. Affluent Marin County has the lowest rate with just over six births, while Imperial County is highest, with an Arkansas-like level of just over 33. Butte County has just over 14 births. Kern County, with nearly 32, ranks third-highest and is nearly double the state average.

Even so, teen birth rates are falling in every California county—sometimes dramatically. Kern’s rate has actually been cut almost in half in just a decade.

What explains the drop?

Many experts cite California’s comprehensive sex education and guarantees of confidential access to birth control. California law allows anyone under 18 to seek birth control services or the morning-after pill on their own. Minors 12 and older can seek treatment for sexually transmitted diseases without parental consent. And as a result of a California Supreme Court ruling, they can get an abortion without parental consent or notification.

But a variety of factors are no doubt at play. Research has even shown that the struggles depicted in MTV’s 16 and Pregnant and Teen Mom may have prompted some teens to be more vigilant about birth control, according to a 2014 Brookings Report.

Abortion rates are falling, too

Although the state has among the nation’s most liberal abortion policies, that doesn’t seem to be what’s driving the drop in adolescent births. The latest numbers from the Guttmacher Institute, a reproductive rights nonprofit, indicate a California abortion rate of just over 16 abortions per every 1,000 women of reproductive age. (There isn’t solid data on teen abortion rates).

The state’s overall abortion rate is somewhat higher than the national rate of nearly 14 abortions per 1,000 females ages 15 to 44—but since 2014, the state abortion rate has declined twice as much as the 8 percent decline nationwide.

Nationwide, the percentage of females ages 15 to 19 receiving an abortion has dropped significantly in the past decade.

“There’s a long history of California being the beacon state in terms of a strong commitment to family planning and the rights of adolescents to get confidential, nonjudgmental health care around reproductive health,” said Claire Brindis, founding director of UC San Francisco’s Bixby Center for Global Reproductive Health.

One example is the state’s Family Planning, Access, Care, and Treatment program, which gives more than a million low-income Californians free contraceptives and counseling to better understand their family-planning options. The program is available through 2,200 private and public providers, including CSU and UC campus health centers and local community clinics.

It’s “the gold standard to providing access for folks who don’t have insurance, as well as for young people who might have insurance but have confidentiality concerns,” said Amy Moy of Essential Access Health. She said California’s use of Title X dollars, a federal family-planning grant program created in 1970, also helped drive the state’s teen birth rate downward—by, for instance, helping pay for teen-only hours at family planning clinics.

In Fresno County, a nonprofit relied on Title X money to fund a van that gives about 25 teenagers a week free rides to a community health center. They can get birth control, pregnancy testing and STD treatment at the center.

“Going to the clinic is an experience,” said Julio Romero of the Fresno Economic Opportunities Commission, which runs the program. “It can be complicated. It can be scary.”

The Trump administration has since placed restrictions on the funding, which California is suing to preserve, as well as to overturn a “gag” rule that took effect in July barring health clinics that provide abortions or abortion referrals from Title X funding. The change caused Planned Parenthood to withdraw from the program.

“We’re deeply concerned that changes in the Title X program that have come into effect recently will threaten some of that progress that we’ve made. Because without Title X funding in California, there will likely be longer wait times and delays in access,” Moy said.

Sex ed: common sense or ‘pornography wrapped up in a bow’

Other factors behind the decline include teens waiting longer to have sex and using more than one form of contraception during sex, according to the California Department of Public Health.

Female teenagers nationwide are using contraception more—81 percent of those interviewed say they used birth control the first time they had sex, according to 2011-2015 data from the National Survey of Family Growth. The percentage has increased from just under 75 percent since 2002. More teens are using long-acting, reversible contraceptives such as intrauterine devices and contraceptive implants. And the percentage of female teens who have used the morning-after pill tripled over that time, to nearly 1 in 4.

More than half of California high-schoolers reported using a condom the last time they had sex, according to the federal Centers for Disease Control and Prevention. And 30 percent reported relying on the birth control pill, shot or IUD the last time they had sex.

California law since 2016 has required traditional public schools to provide comprehensive sex education, based on medically accurate facts and that does not mostly stress abstaining from sex. The law was expanded to public charter schools last year.

It was the first sex-ed update since 2003, when the state began requiring schools to teach students how to prevent HIV/AIDS.

But the most recent requirements sparked some outrage. Karen England, who heads the parental rights organization Capitol Resource Institute, labels the curriculum “pornography wrapped up in a bow.”

“I would tell every parent they need to opt out of all of the California Healthy Youth Act. They aren’t learning the things we used to learn in school, about the basic health changes a body goes through,” she said. “I don’t think the school district should be going behind the parent’s back and telling [children] where the local clinic is and that they can leave class to go get on birth control and have an abortion.”

She predicted the state might cause more teen pregnancies with what she regards as its how-to-have-sex curriculum.

But advocates on the other side wonder if schools have done enough.

Erica Diaz-Rodriguez grew up in Woodlake, a town of 7,000 in Tulare County, a county with the state’s second-highest teen birth rate. Growing up, she said, she had cousins who became teen moms and she watched them struggle.

“They went through teen pregnancy and a lot of them were shunned from the family for a while,” Diaz-Rodriguez said. “The women in my family who did experience teen pregnancy, that was traumatic for them. They would even tell me, ‘Oh, just don’t be like me.'”

As a sophomore in high school, she joined Act for Women and Girls, a reproductive justice organization in Visalia. Working with other girls her age, she found two common threads: relatives who were teen moms, and families and school systems refusing to teach comprehensive sex education.

Counties where teen moms are more common

Income inequality and cultural factors also played a role in counties with high teen birth rates.

In California, Latinos have the highest poverty rate across racial and ethnic groups, according to the Public Policy Institute of California. Nearly 24 percent of impoverished Californians are Latino, while about 13 percent are white.

The teen birth rate for Latinas is also much higher than other ethnic groups—a rate of 21 births per 1,000, compared with just 6 for whites, according to the California Department of Public Health.

And in Kern County, the high teen pregnancy rate has been a battle for years.

“They’re historically high and it’s something that doesn’t change overnight,” said Kimberly Hernandez of the Kern County Public Health Services Department. “What we’re seeing is it does continue to decline, which is what we’re going for.”

Much of Kern County’s population is rural, where it can be difficult to receive health care. The county has opened a mobile health clinic that treats residents in isolated places like California City, which has a population of nearly 14,000. The unit offers birth control and sexual health services.

Kern County and other counties in the state with high teen pregnancy rates have spent time tackling repeat adolescent pregnancies as well. The Adolescent Family Life Program—funded by federal dollars including Medi-Cal—helps expectant adolescents and teen parents with personal development and family health. The goal is to break the cycle of children of teen parents becoming teen parents themselves.

Shalabi, the Delano mom, used the service while she was in high school. She said the program changed her life and eased her depression as a mom working on graduating.

Growing up, Shalabi received some sexual education in junior high, but she says she didn’t really fully understand her options until after she had her daughter. When she became sexually active, she said she asked her mom to take her to a clinic, but her mother refused and incorrectly told her that she couldn’t go without parental consent.

When her high school boyfriend told her he would pull out, she said she didn’t really understand what it meant.

Now, Shalabi works full-time and is a full-time student at CSU Bakersfield studying psychology, intending to become a therapist. Her daughter attends preschool down the road from their studio apartment in Delano.

“It’s hard, but I feel like it’s way worth it in the end,” she said. “If you settle, you’re never going to be happy.”