FARGO — North Dakota’s teen birth rate has decreased significantly in recent years, falling by almost a third, but has not kept pace with the sharp declines seen in neighboring states and in the national average.
North Dakota’s teen birth rate dropped from 29.7 births per 1,000 in 2005 to 20.3 in 2016, as measured by the Centers for Disease Control and Prevention, or a reduction of 31.6 percent.
During the same period, the rate of teen births in Minnesota, to mothers ages 15 to 19, decreased 51.7 percent and the national average dropped almost by half, 49.9 percent.
North Dakota’s teen birth rate was significantly better than the national average in 2005 — 29.7 compared to 40.5 — but by 2016, the most recent comparative figures available, equaled the national rate, 20.3, a position reflecting the higher rate of declines in some other states.
During that period, North Dakota passed a law, in 2012, requiring schools to provide abstinence-based sex education, with curriculum pertaining to “the risks associated with adolescent sexual activity and the social, psychological and physical health gains to be realized by abstaining from sexual activity before and outside of marriage.”
North Dakota schools can teach a more comprehensive approach to sex education, including information about contraception methods, but that is left to individual school districts.
Reactions to the drop in North Dakota’s teen birth rate — and the fact the rate of decline in North Dakota lags behind nearby states and the U.S. average — vary widely between advocates of the state’s abstinence-based sex education policy and those who favor the comprehensive approach.
'A healthier next generation'
Molly Secor-Turner, a nursing professor at North Dakota State University, says North Dakota could do more to decrease its teen birth rate if it embraced comprehensive sex education and made contraception more readily available.
“I would say a big factor is we don’t have very good access in North Dakota to contraceptives, especially in rural areas,” she said. Along with the state’s law mandating abstinence-based sex education, “We’re really missing an opportunity to create a healthier next generation of North Dakotans.”
Comprehensive sex education includes the benefits of abstaining from sexual activity, and studies have shown that it is more effective than sex education focused on abstinence, Secor-Turner said.
“That’s a message that’s loud and clear in comprehensive sex education programming,” she said.
Scientific studies have repeatedly shown that comprehensive sex education is more effective, Secor-Turner said. It's also more realistic, since youth risk surveys typically show that about two-thirds of young people have engaged in sexual activity by the time they graduate from high school, she said.
“It’s just a little bit more meeting young people where they are,” Secor-Turner said. “It’s clear what strategies work for young people, and unfortunately those are not accessible for young people in North Dakota.”
A study review by the Journal of Adolescent Health in 2017 said abstinence sex education, also called sexual risk avoidance, has been “widely rejected by medical and public health professionals. Although abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail.”
The authors added: “Young people need access to accurate and comprehensive sexual health information to protect their health and lives.”
Secor-Turner and a colleague at NDSU, Brandy Randall, found themselves in the midst of controversy after obtaining a $1.2 million federal grant in 2012 to offer a new sex education program aimed at preventing teen pregnancy and sexually transmitted infections among at-risk teens.
The grant funds were temporarily frozen after some legislators objected to spending the money, and university administrators worried doing so could violate a 1979 law. But spending the grant was deemed legal, and the program was launched and continues.
'Code' for contraception
Religious proponents of abstinence-based or sexual risk avoidance education argue that North Dakota’s priority on teaching the importance of young people abstaining from sexual activity has proven its effectiveness by the sharp decline in teen pregnancies and births in the state.
“Comparing to other states I don’t think is the right measure,” said Christopher Dodson, executive director of the North Dakota Catholic Conference. But, he added, “We certainly can learn from them.”
The teen pregnancy rate in North Dakota, 19.5 in 2017, is down significantly from 34.8 in 2010, according to state figures, he said.
Also, teen pregnancies as a percent of all pregnancies have “precipitously dropped,” Dodson said. In 1988, teen pregnancies were 10.9 percent of births, but the proportion plunged to 3.8 percent by 2017, according to state vital statistics reports.
“What we’re doing must be working,” Dodson said. “I’m very pleased by looking at these numbers and hope they continue.”
Efforts at decreasing out-of-wedlock pregnancies and pregnancies among “majority age” teens, those who are 18 and 19, and young adults have shown less progress, however, he said.
“It’s demeaning to teenagers to say they completely lack self-control,” he said of sex education that includes contraception. “Our view is that’s the wrong approach for a number of reasons. It’s like throwing in the towel.”
Mark Jorritsma, executive director of the Family Policy Alliance of North Dakota, which he describes as pro-life, pro-family and Bible-based, said North Dakota residents are solidly behind abstinence-based education.
“Common sense tells you that avoidance is the best way to prevent pregnancy in the first place,” he said. “You prevent it (pregnancy) before it happens.”
If students are to be taught about contraception as part of comprehensive sex education, “It’s really up to the parents,” Jorritsma said. “The parents know what’s best for their children.”
Dodson agreed, and said comprehensive sex education is “code” for contraception. “The Catholic Church thinks that’s the wrong approach,” he said. “We think a lot of North Dakota parents think that’s the wrong approach.”
Comprehensive sex education is popular among parents in many states, according to surveys. A Minnesota Department of Health survey in 2015, for instance, found that 89 percent of Minnesota parents think sex education should include information about abstinence as well as prevention of pregnancy and sexually transmitted diseases.
As in North Dakota, Minnesota school districts largely decide what students are taught about sex. People understandably fear that teaching students about contraception will increase their likelihood to become sexually active, but that’s actually not the case, said Lynn Bretl, who teaches maternal and child health epidemiology at the University of Minnesota.
“By and large parents, they want schools to be talking about comprehensive sex education,” she said. “They really do.”
Dodson said there are “study battles” about whether abstinence-based or comprehensive sex education is more effective. Studies have shown contraception availability does not actually decrease pregnancy, he said, except slightly when long-term forms are used, such as an intrauterine device.
After several years, the sex education program for at-risk teens has shown results, Secor-Turner said. The program is adapted from a Planned Parenthood curriculum that is evidence-based and has been proven effective, she said.
After the program, communication with trusted adults increased by 20 percent on abstinence, by 14 percent on how to say no to sex, and more than 10 percent on birth-control methods.
“We talk about the whole range” of topics in the course, including “how to stay healthy” and “how to connect to your own values,” Secor-Turner said.
The course, which targets at-risk teens, many referred by service providers, consists of 18 to 22 hours of instruction over six to eight weeks, said Kailyn Ohm, education and outreach programs manager for Planned Parenthood of Minnesota, North Dakota and South Dakota.
“We have had students say they didn’t realize they were in unhealthy relationships” until they took the course, Ohm said. Students are required to pass along what they learn, and teach one another.
“A big part of our class is peer education,” she said. “I think it would make a world of difference if this was available to every student. We know that when young people have access to information they make better decisions.”
Dodson and Jorritsma said that because Planned Parenthood provides abortions, it should not be a model of sex education in North Dakota. “Do you really want this organization teaching sex education to your children?” Jorritsma said.
Attempts to get Planned Parenthood programs in North Dakota schools were stopped, Dodson said.
Planned Parenthood’s sex education programs have been proven effective, Bretl said, although she acknowledged the organization is controversial.
“It’s unfortunate that it becomes such a lightning rod,” she said.