“Nationwide and statewide, teen pregnancy for the 15 to 19 year old age group has gone down in the 1990s. Jackson County rates have plummeted ridiculously low, even further than the trend. Guess what’s happened in Macon County? The [number of teen pregnancies] has increased,” says Stan Polanski, a physicians assistant at the Macon County Health Department.

The United States has the highest teen birth rate in the industrialized world, four times the rate of France, Germany and Japan. North Carolina has the sixth highest pregnancy rate for teens ages 15 to 19, according to information from the Adolescent Pregnancy Prevention Coalition of North Carolina.

In 1992, teen pregnancy rates in Macon County were lower than the state average. However, in 1993, 1995 and 1998 the pregnancy rate for females ages 15 to 19 in Macon County was higher than the state average. In 1998, 95.5 pregnant females out of every 1,000 between 15 and 19 were pregnant. The state average was 68.6.

In Macon County in 1999, 76.5 out of every 1,000 teenage females ages 10 to19 were pregnant. In neighboring Jackson County, 39 out of every 1,000 teenagers was pregnant. Macon County’s caucasian teen pregnancy is 50 percent higher than statewide rates.

“There is only one response I’ve seen when a teenage girl is told she’s pregnant. They’re devastated, as if it’s the worst thing they’ve ever heard,” said Polanski.

What is responsible for so many teenage girls going through this experience every year and what can be done?

“Teenagers need to become more educated to know how to protect themselves,” says Kathy McGaha of the Macon County Health Department. “Abstinence is all that the North Carolina curriculum teaches. A lot of factors can be discussed in terms of abstinence; it’s the only way to protect yourself 100 percent. But I want to protect those who are active as well. There needs to be some education on contraception.”

Polanski is certain of the effectiveness of sex education.

“I’ve seen research results and studies that show comprehensive sex education does keep pregnancy rates down. It’s documented.”

Abstinence-only sex education is taught at Franklin High School for one semester in the ninth grade. It is a section in a health class that meets every other day between physical education classes.

The approach to sex education may be responsible for the vast differences in the pregnancy rates of neighboring Jackson and Macon counties.

What McGaha refers to as Jackson County’s “quite elaborate program” consists of five years of sex education. Starting in seventh grade, students participate in a “Postponing Sexual Involvement” course. In eighth grade, high-risk groups are selected for education in self-esteem and goal setting. Healthy relationship classes are available for all. As a part of the “Baby Think It Over” class, ninth-grade students are given life-like dolls for a weekend that are programmed to cry for food and care at all hours.
According to McGaha, she has heard that this program affects not only teenagers but their parents, who realize they do not want to become grandparents. It serves as a catalyst for them to talk to their children about pregnancy.

“Get Real About Aids” is taught in tenth grade, and in twelfth grade a senior seminar is taught that suggests abstinence and gives information on contraception.

In addition, Jackson County has a program, “Complete Connection,” that encourages teenage parents to stay in school. For sixth through eighth grade, parent involvement classes, “Let’s Talk,” are offered, with separate sessions for fathers and daughters, mothers and daughters, sons and fathers and sons and mothers.

Part of Jackson County’s more favorable statistics on pregnancies in 15- to 19-year- olds may be due to the inclusion of Western Carolina University students, who McGaha characterizes as more educated.

Macon County youth, in general, demonstrate high-risk behaviors, indicated by the frequency of underage use of alcohol and tobacco and the prevalence of sexually transmitted diseases, particularly HPV. Virtually all cervical cancer is caused by HPV.

“We see pre-cancerous pap smears for 15- to 16-year-old girls quite frequently,” Polanski said.

“It seems like some of the reasons and causes for teen pregnancy trickle over into other health issues.
The same reasons that explain sexual behavior at an early age are the same reasons that explain drinking and smoking at a young age,” says McGaha.

“You can develop a program unique to the county that can be broader than teaching abstinence,” she says.

Swain County developed a teen pregnancy video that included churches as an option for help. Grants for improving sex education programs are available from state agencies and foundations.

“There’s all sorts of stuff out there, but if we don’t start from a solid base, if it’s not supported by the community, it’s a waste,” McGaha said.

“Efforts have been made over the years to have more comprehensive sex education, but objections from the conservative Christian faction of the area have repeatedly blocked such programs,” said one health-care provider in the Franklin area who did not want to be identified.

Among current potentially helpful programs in Macon County is one called “Parent to Parent” that the Franklin High School PTO has begun work on. The goal is to keep healthy families healthy by teaching parenting skills at the fifth- and sixth-grade level, a critical time for counteracting peer pressure and media influences, the facilitators feel.

A community health assessment developed for the county has set a long-term objective of reducing Macon County’s total pregnancy rate for females ages 15 to 17 from 57.8 out 1,000 to 45 out of 1,000. With the help of Macon Partners for a Healthy Future, through presentations and press releases, information about teen pregnancy will be distributed and published in local media. A short-term objective is to develop a countywide education program by 2005 for students ages 10 to 17 on the risk factors of teen pregnancy.

McGaha is involved in a Teen Pregnancy Prevention Taskforce that she says is well rounded, including youth ministers and health department, school and social services employees. She hopes the new school superintendent will become involved.

A significant problem with teenage pregnancy is that younger age groups are becoming sexually active. In North Carolina in 1999, enough girls age 10 to 14 became pregnant to fill 11 school buses. Even the Jackson County program is not flawless, McGaha says, noting that contraceptive education does not begin until 12th grade, when many students are 18, and long after some may have needed the information.

While North Carolina is enforcing an abstinence only curriculum, students can be referred to county health departments. The health department plays a key role in education that can’t be done through the school system.

Responding to the embarrassment of many young women seeking medical help for STDs or birth control, Polanski says, “Private doctors and going to a health department out of the county are very acceptable options.” However, he says “A lot of fears people have are unwarranted. We think we have a good record of confidentiality and are sensitive to these issues.”

However, young people may not know how to take the necessary steps to protect themselves.
Take the case of an 18-year-old college student from what she describes as “an involved, intelligent family” who went through the Macon County school system.

“I didn’t know much about [birth control pills], about the side-effects or that it took a month to work or that you have to take it at a certain time. A friend told me in an email. Luckily nothing happened, but I had sex with no protection at first,” she said.

Another young woman who lives in Franklin and became a mother at 17 said, “I love my family and my son is the best thing that’s happened to me, but it could have come later. It’s been very hard and I wonder if I could have even been a better mother later.”

She did not complete high school and says education is just one of the things she’s missed out on.
“High school classes didn’t seem useful at the time, but sex ed certainly could have been the one class with a practical application. Obviously, I didn’t know much about birth control.”

Polanski says, “We know something is lacking in Macon County as compared to Jackson County. And we know they have a sex ed program.”

 

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