YEAH! Network response to the 2009 Teen Birth Data: A Collective Impact Approach to Reducing the Disparity

Written by Amy Cronin DiCaprio, YEAH! Network Director of Research Development

Two weeks ago, the Massachusetts Department of Public Health released the Massachusetts 2009 Birth Data. Their report highlighted the continued disparity in the teen birth rate in many western Massachusetts communities, and underscores the continued need for a sustained and comprehensive response to improving sexual health outcomes for youth.

Massachusetts teen births have declined 11% since 2007, pushing the overall state teen birth rate to its lowest in decades.  However, the statewide birth rate for Hispanic teenagers is still five times that of white teens, and there is a continued stark disparity between the state teen birth rate compared with several cities in western Massachusetts, most notably Springfield and Holyoke.

CITY-SPECIFIC ANALYSIS

For the fifth year in a row, Holyoke reported the highest teen birth rate in Massachusetts, at 96.8 per 1,000 teen girls aged 15-19, which is almost 5 times the state rate of 19.6 per 1000. Springfield saw 65 more teen births in 2009 than in the previous year, with a 2009 teen birth rate of 72.1 per 1000. The percentage of teen births to Hispanic mothers in each city has trended upwards over the last decade: in Holyoke, 86.3% of teen births in 2009 were to Hispanic mothers (compared with 82.9 in 1996), and the increase was even sharper in Springfield, with 67.6% of teen births in 2009 to Hispanic mothers (compared with 48.7% in 1996). In each city, the majority of teen births were to older teens (aged 18-19): 64.4% of teen births in Holyoke and 64.8% of teen births in Springfield were to older teens. However, births among younger adolescents are on the rise in Springfield: 2009 saw 12 births to mothers aged 12-14 (an increase of 7 over the previous year).

COLLECTIVE IMPACT

For nearly two decades, Springfield and Holyoke have consistently held some of the highest teen birth rates in the state, with both cities ranking in the top five nearly every year. A new way of addressing this disparity is long overdue. Teen pregnancy and community responses to teen pregnancy are influenced by a myriad of factors including economics, education, opportunity, culture, and politics. The task of creating a meaningful impact on such a complex issue is too much for any single agency, single strategy, or even single sector: it requires a collaboration that goes beyond the approach of traditional coalitions and networks.

            An article in last winter’s Stanford Social Innovation Review examined the concept of “collective impact.” The authors define collective impact as “the commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem.” (Kania and Kramer, 2011, p.36) In contrast to the traditional approach used by nonprofits where single agencies try to invent independent solutions to major social problems (also known as isolated impact), collective impact emphasizes cross-sector coalitions, led by a single agency using a systemic approach to social impact that prioritizes the relationship between sectors, organizations, and communities.

Adopting a collective impact philosophy and approach to addressing the high teen birth rates in Springfield and Holyoke resonates with the core values of the YEAH! Network. The YEAH! Network has consistently worked to advocate for a long-term and sustainable multi-sector approach to addressing the disparities in adolescent sexual health. By making it our policy to operate in multiple cities, have steering committee members from multiple cities and sectors, resisting the pressure to seek short-term single-initiative funding, and working to link our philosophies and practices to research and national priorities, the YEAH! Network has been modeling the beginning stages of collective impact.

YOUTH FIRST INITIATIVE

The YEAH! Network believes that a collective impact approach is the best way to reduce the disparity in the teen birth rates in Springfield and Holyoke. There is a unique window of opportunity to create this collective impact strategy to address teen pregnancy in Springfield and Holyoke. Last year, in partnership with the YEAH! Network, the Massachusetts Alliance on Teen Pregnancy was awarded one of nine $1.1 million federal grants from the Centers for Disease Control and Prevention to test the effectiveness of community-wide approaches to reducing teen pregnancy. We’ve called this project the Youth First initiative. There is an unprecedented alignment of goals and stakeholders in Springfield and Holyoke, and the timing for a collective impact approach couldn’t be better: city leadership in both cities passed policy changes (within one year of each other) in support of evidence-based comprehensive sex education in schools. Two city-wide, mayor-supported task forces exist solely to influence policy around adolescent sexual health. As part of a collective impact strategy, the Youth First initiative aims to bring together all sectors of the community in this effort, and the YEAH! Network and the Massachusetts Alliance on Teen Pregnancy have been continually building and deepening the relationships with parents of adolescents, teachers, faith leaders, youth, business owners, school administrators, social workers, community-based organizations, clinical providers, pediatricians, employers, and policy makers.

MOVING FORWARD

            It is increasingly clear to those of us who work with youth, care about youth, and to youth themselves, that the strategies of the past 20 years are not effectively addressing the disproportionately high teen birth rates in Springfield and Holyoke. A collective impact approach, supported by the 5-year Youth First initiative, is a sustainable, logical, and timely strategy. Changing the way we work, and changing the way we work together as communities, is absolutely essential to create the conditions required for improved sexual health outcomes for youth in Springfield and Holyoke: access to information and education; access to reproductive health services; and access to opportunity for the future.

Response to success of Abstinence-only curriculum

A response posted by Cristin O'Grady:    

Efficacy of a Theory-based Abstinence-Only Intervention over 24 Months: A randomized Controlled Trial with Young Adolescents was published in the February 2010 edition of the Archives of Pediatric Adolescent Medicine.  The article has gained notoriety because it is the first study that reports that an abstinence-only intervention can be an effective method of delaying sexual initiation. There are several critical points that must be considered when evaluating the author’s finding that the abstinence-only curriculum was effective.

           First, the study uses a different definition of  “abstinence-only” than we commonly are accustomed to in the United States.  There are 8 tenets of any federally approved abstinence-only education plan, the main principle being abstinence-only until marriage.  In contrast, in the abstinence-only intervention evaluated in the study “the target behavior was abstaining…until a time later in life when the adolescent is more prepared to handle the consequences of sex.” Further, the curriculum “did not contain inaccurate information, portray sex in a negative light, or use a moralistic tone.” The curriculum did not attempt to portray abstinence as a morally correct behavior but rather as a healthy decision for a young person to make.  Further, the curriculum recognizes that “waiting for marriage” is not the only healthy, safe way to discuss sex.  In letting go of the moral overtones that tend to dominate abstinence-only education, the decision to have sex becomes less about what one’s church says or one’s community says and more about individual health, safety and autonomy – which might be easier for the ego-driven young person to understand and accept. 

           The curriculum was implemented with a very specific group: 6^th and 7^th grade African Americans in an economically deprived area of the East coast.  The sample size was quite small, and the participants had to be willing to participate in a weekend health education class. The vast majority of participants in the study had not had sex, a situation that would certainly be different in high school.  As the authors state,  “theory based abstinence-only interventions might be effective with young adolescents but ineffective with older people or people in committed relationships.”  Further, participation in a weekend health intervention may indicate that, as a group, those in the study might be more motivated towards healthy behaviors than the general population. 

            Finally, and perhaps most importantly, the abstinence-only program involved teaching life skills, negotiation skills, and career planning. When children and young adults are taught about sexual decision-making in this context, they learn to evaluate their sexual decisions in the context of life goals.  The ability to make such an evaluation gives much greater meaning to personal decisions made about sex, and provides the individual with more internal motivation to abstain. 

            While none of these issues serve to discredit the results of the study in any way, they do provide a lens through which to view the results and understand how to apply them. This study is just a first step in understanding how an abstinence-only education program with no moral-agenda can be effective.  The study should not serve as an excuse to stop talking about sex with young people, but rather evidence of a way in which sex can be discussed that actually helps young people to make their own healthy decisions. 

Other responses to the article:  

Early Intervention Important To Decrease STDs, HIV, Pregnancy - Medical News Today

Quick Response to Study of Abstinence Education  - NY Times

'Landmark Study' Says Sex Education Focusing on Abstinence Can Work - Poynter Online

A response to: Not so cheap: Teen mom rejects the sterotype

In the March 12, 2009 edition of The Sophian, the Smith College student newspaper, a feature article was published discussing the life of Charlie Rose, a young mother who chose at age 15 to have a child.  Though the article was published nearly a year ago, it discusses issues that impact the way we talk and think about teen pregnancy and young mothers, issues that have not gone away. 


 A response from Sarah Perez McAdoo:  
 
The article frames teen pregnancy and births as an empowering experience for young women.  Teen mothers that are able to have a positive parenting experience are resilient and determined individuals who defy all odds.  The sad reality is that teen parenting is not typically an empowering experience for young women.  For communities already compromised by poor education, poverty and poor health, teen parenting becomes an additional burden. Teen parenting makes it increasingly difficult for these young parents to succeed, creating obstacles to a promising education and financial indepence. It is great that Charlie Rose is a teen parent success story, but her story neglects to highlight the difficult realities that most teen parents face.  Local communities need to create empowering experiences for teens that allow them to choose options other than becoming young parents.