Laurisa Rodrigues, health educator at the Pueblo City-County Health Department clinic, shows off some of the pharmaceutical models she uses to explain the qualities of the different long-acting reversible contraceptives available to clinic patients.

(Photo: CPR/Megan Verlee)

A Colorado program credited with helping driving the teen pregnancy rate down by 40 percent since 2007 is at risk of running out of cash. 

Five years ago, a private grant funded the state program that's made intrauterine devices (IUDs) and contraceptive implants much more widely available. That grant runs out later this year, so a group of state lawmakers are asking for public money to keep it going. They're running into opposition though, from conservative colleagues, concerned about the type of contraception being provided and the possible impact on teens' behavior.

"Are we communicating anything in that message that says 'you don't have to worry, you're covered'?" asked Rep. Kathleen Conti, R-Littleton, at the funding bill's first hearing last week. "Does that allow a lot of young ladies to go out there and look for love in all the wrong places, as the old song goes?"

In the first few years of the effort, the number of young, low-income women using one of these forms of contraception went from one in 170 to one in 15. At the same time, Colorado's teen and unintentional birth rate dropped faster than the national average.

This map shows how the rate has changed by county over time; drag the slider back and forth to see the change. 

Maps: Courtesy Colorado Youth Matter

Contraception conundrum

The program enables municipalities like Pueblo to offer IUDs free of charge to patients that visit the city and county's health department clinic, said nurse Stacy Herrera.

"If the monies go away, we will not have that luxury," Herrera said.

Pueblo does more than just make the devices available; it actively encourages young women to consider them among their birth control options. The clinic's health educator, Laurisa Rodrigues, meets with patients to discuss how the different forms are administered. Rodrigues said she dispels myths about IUDs permanently preventing child birth and other health concerns. 

The birth rate big picture

In Colorado, as in the rest of the country, the teen birth rate has been on an almost unbroken decline since the early 1990s, down more than 50 percent.

The first 15 years of that drop are likely due to the AIDS epidemic, as fear of the disease led more teenagers to use condoms, according to Columbia University professor John Santelli, who studies teen pregnancy trends.

But the decline has only picked up steam in recent years, dropping sharply since 2007, while stories about AIDS have all but disappeared from the headlines. "The big question is 'why?'" said Santelli, "and to be honest I can't tell you."

There are a lot of possible explanations. Some researchers note teens having sex now were exposed to less lead as children than past generations, as leaded gasoline and paint have been phased out. Lead toxicity can lower IQ and has been correlated with increased teen pregnancy rates.

Others give the credit to the rise of smart phones and other technology that make it easier for teens to privately search for information about sex and contraception online. 

For many in the public health field, the declining birth rate is confirmation that the years of effort to address this problem through public awareness campaigns and youth engagement efforts are finally paying off.

"The reason for this success could be that we're starting to create this perfect storm of good sex ed policies, more access to health care and confidential services for young people," said Lisa Olcese of Colorado Youth Matter, a group that advocates for comprehensive sex education and resources for teen parents.

Not your mother's sex ed

Two years ago, Colorado Youth Matter spearheaded an effort to update Colorado's sex education policies. The 2013 law emphasized that if school districts teach sex ed, the approach has to include information about birth control, not just abstinence.

The law may be clear. But when it comes to what's actually taught in Colorado schools, the picture is murky. The state doesn't appear to track which schools offer sex ed or what gets taught and there's no direct state funding for the subject.

What's clear though is that the most nuanced sex ed programs go way beyond anatomical charts and condom demonstrations. Instead the focus is on getting teenagers to think about their long-term goals and to talk more with their parents about sex, two approaches that have had some success. 

At the Pueblo Health Department, much of the outreach around sex education has focused on parents. They’re encouraged to be "askable adults," someone their child trusts to address questions about sex.

"Our ultimate goal is to normalize the conversation," said Pueblo nurse Stacey Hererra. "We talk to our kiddos about eating healthy foods. We talk to them about washing their hands, looking both ways when crossing the street. This is just one of those things of keeping kids safe."

Even as "comprehensive" sex education is required in public schools, many still work with organizations that aim to get young people to delay having sex entirely. But don't call those groups abstinence-only. That term is “incredibly limiting,” according to Elycia Cook, executive director of Friends First in Littleton, an organization that focuses on mentoring and character development.

"Evidence is showing that a 'no' message - 'just say no, don't do it, don't do that' - is not necessarily working for youth," said Cook. "The trend has been guiding kids toward what they should be doing, instead of what they should not be doing."

The child poverty link

The drop in the teen pregnancies is good news for Colorado's child poverty rate. According to the National Campaign to Prevent Teen and Unintended Pregnancy, nearly half of all teen mothers live in poverty and two-thirds receive public assistance in the year after their child is born.

The odds they will be able to improve their economic situation aren't good, either; only 48 percent of women who give birth in high school manage to get a diploma before they age out of the public school system at 22, and only 2 percent have a bachelors degree by age 30.

At the same time that teen births have been falling, Colorado has also seen a slight decline in the poverty rate for children age zero to six. And statewide enrollment in WIC, government assistance to new mothers and their children, has dropped by nearly a quarter.

The relationship between teen pregnancy and poverty goes both ways. Not only are single, teen mothers are likely to live in poverty; growing up poor is also a significant risk factor for becoming a teen mother.

"We know that women and girls raised in poverty often times have a more bleak outlook on their future, see less possibility and opportunity for themselves over the long term and view parenthood as one positive step that they can take in their future," said Cody Belzley, vice president of health initiatives at the Colorado Children's Campaign.

For that reason, Belzley and others who work in this field see efforts to cut the teen and unintentional pregnancy rate as antipoverty programs. The more the state can do to help young women delay having children until they're on their fiscal feet, the better chances those kids will have in life, too.

This story is part of our ongoing exploration of Colorado kids who are living in poverty, how it affects their lives and our common future. We'd like to hear your ideas about about what can be done about child poverty in Colorado.  Share your thoughts through our Public Insight Network.