The teen birth rate is back on the rise in many working-class Massachusetts communities, mirroring a trend that has seen teen birth rates rise around the country for the first time in 15 years.
Among the Massachusetts communities that traditionally have high teen birth rates, nine showed double-digit percentage increases in 2006, according to new numbers published last month by the state Department of Public Health. The spike in those larger cities and towns stands in contrast to a 2 percent drop in the state's overall teen birth rate.
The increases in Leominster, Fitchburg, and other Massachusetts communities are occurring after years of dropping teen birth rates in many of these towns and cities. The Centers for Disease Control reported a 3 percent jump in the national teen birth rate in 2006.
The national increases remain puzzling to public health officials and may be just a blip. But in Massachusetts, the trend appears to be continuing in some communities in the past year.
In school cafeterias and classrooms from Framingham to Haverhill, officials say they are finding a growing number of teenagers who are soon-to-be mothers. Haverhill's public schools are on pace to have 14 pregnancies this year, nearly double what they recorded in 2006. Gloucester High School reported 10 pregnancies this year, up from the average of three a year. And in Framingham, school officials have recorded more student pregnancies and births this school year - 24 and 10, respectively - than they did all of last year.
"We're definitely feeling the increased workload," said Cheryl Aglio-Girelli, one of two teen pregnancy and parenting nurses for Framingham public schools. "Everywhere we go, people say to us, even the kids in school say to us, 'There are a lot more pregnant kids this year.' It's become an obvious issue to the community now. It's right there in your face."
Dr. Lauren Smith, medical director at the state Department of Public Health, cautions that it is too early to read much into the figures. She notes that the state's overall teen birth rate - which has been falling steadily since 1990 - is still declining and is 49 percent lower than the US rate. And given the fact that a single town's numbers can fluctuate from year to year, Smith cannot say whether the recent increase is just a blip or an indication of a larger trend. But some specialists contend that the latest state figures, combined with the national increase and anecdotal reports from school nurses, may be a sign of continued increases in years to come.
"If we continue in this vein, for the first time in a long time we may see an increase in the overall state rate," said Patricia Quinn, executive director of the Massachusetts Alliance on Teen Pregnancy. "Maybe that's what will get people to wake up."
Sex education varies from school district to school district. In Framingham, for example, teachers focus on abstinence, talking about contraception only if asked to by students, while in Haverhill teachers offer an entire lesson on contraceptives. But the issue is complex, school officials point out, and far bigger than the schools themselves.
Teen pregnancy, according to public health officials, is often a symptom of other problems, including poverty, broken family lives, lack of access to information and contraceptives, and a child's inability to dream of a brighter future. Possible reasons for the national increase, according to the CDC, will require more analysis, but could include changes in teen sexual activity, contraception use, or attitudes. And these factors could be at play in Massachusetts, where some school officials say they are noticing a disturbing shift.
"They used to say that 80 percent of teens who got pregnant didn't want to be teen moms, that it was not a planned pregnancy," said Carol Ireland, the pregnancy and parenting teen specialist for Haverhill public schools. But now, Ireland said, more and more teenage girls are telling her they want to be pregnant.
"There are more girls right now - because of a lack of direction - who say, 'Well, I know I shouldn't be a mom, but I kind of want to be.' Because they don't have the goals, they don't have the direction. And that's what really troubles me," Ireland said.
According to the state Department of Public Health, teenagers expecting a baby are more likely to smoke cigarettes while pregnant and less likely to receive adequate prenatal care than other pregnant women. And once born, according to studies, these children are more prone than their peers to becoming teen mothers themselves or ending up in prison or dropping out of high school.
For these reasons, public health officials are always concerned about teen birth rates and about other aspects of the issue, such as data that show the birth rate among Hispanic teens in Massachusetts is almost six times that of their non-Hispanic peers.
But Quinn worries that the state may be turning its focus elsewhere, cutting valuable money to community programs, given the overall improvement in teen pregnancy prevention over the years.
State funding for teen pregnancy prevention is down 26 percent in recent years, from $5.4 million in 2001 to $4 million this year. And these cuts, combined with the financial crunches facing many communities, have taken a toll in places such as Haverhill, where there is now one health teacher for 1,700 middle school students. With so many children to see, and so much other work to do, Lori Curry, that teacher, said the students get about half as many sex education lessons as they once did and far less contact with a trusted adult who might be able to answer the questions that come with adolescence.
"I feel bad when I do a unit and I see all these kids who want information, who trust me, want to talk to me, want to get facts," she said. "And now, all of a sudden, 'I won't see you for the rest of the year.' I have to go to the next building."
Haverhill school officials said there may be a direct correlation between decreased funding for health education and their rising teen birth rate. But officials in Framingham, Leominster, and Lawrence say they can't explain their recent increases in pregnant youths by pointing to key changes in funding or in curriculum.
For many girls, the biggest problem is often getting access to birth control, said Aglio-Girelli, one of the teen pregnancy nurses in Framingham's schools.
Access to birth control, however, wasn't a problem for Jalisa Luna, a 17-year-old Framingham senior who gave birth to a girl last fall. She knew enough to be on the pill, she said, yet missed a couple of days and got pregnant. She was 16 when she got the news and began to cry. Classmate Janell Ortiz was stunned when she found out about her own pregnancy. Here she was, just 16, Ortiz said, and about to become a teenage mother, just like her own mother before her.
"I had no words," she said. "I guess I was in shock. And then I told my baby's daddy and he was shocked. He just walked away from me."
Ortiz, now 18, gave birth in April to a daughter named Jadalize, a brown-eyed doll of a girl. Jadalize is walking now, and Ortiz, like most any mother, loves her child.
"Dame besos," Ortiz, who is Puerto Rican, told Jadaliz one afternoon last week as they played together after school. "Give me kisses."
But life with her is hard, Ortiz admits. She is raising little Jada on her own, living for now with friends in a public housing development in Framingham. Her dreams of becoming a dancer are dashed. And when she hears classmates frequently wishing that they, too, were pregnant, she scoffs at their naïveté.
"None of them know," she said.
They don't know, she explained, what it's like to juggle school and a baby, what it's like to be a teenager and have to be so grown up. Ortiz said she worries about the future, where they will live next and how they will survive on her $9 hourly wage at a local shoe store.
Sometimes, she said, she feels like giving up. But then she knows that she can't.
"What are you doing, Jada?" she said last week, calling to her daughter. "Vente. Vente.
"Come here. Come here."
Keith O'Brien can be reached at email@example.com.