Pregnant Pause

Dizzied by a seesawing teenage-pregnancy rate, an Oregon community tries to recapture the spirit of its initial drive to deter adolescent pregnancy.

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On a sleepy stretch of the Pacific Coast Highway that zigzags along the ocean here, logging trucks cart lumber to local mills, passing dairy farms and oyster boats rocking in the bay. Giant forests of fir trees dwarf the seaside villages, making the sparsely populated towns look miniature by comparison. The farmers, loggers, and fishermen in this working-poor community like to joke that more cows dwell here than people.

Until recently, Tillamook County's sole claim to fame was its nationally renowned cheddar cheese. But this rural hamlet of 23,800 people now has earned another distinction, this time for something it does not produce in bulk--pregnant teenagers.

After the community organized an adolescent-pregnancy-prevention campaign in the late 1980s that enlisted the health department, churches, schools, and parents, Tillamook's teenage-pregnancy rate plummeted. The achievement, which has eluded most other American communities both large and small, delighted teen-pregnancy experts and state politicians.

Tillamook's statistical feat also sparked the interest of a White House eager to discover ways to end "the scourge of teen pregnancy," as President Clinton characterized the problem.

Almost as soon as it was elevated as a shining example of progress, however, Tillamook's reputation began to pale. After four years of rapid decline, its adolescent-pregnancy rate nearly doubled in a single year.

Local leaders, somewhat dizzied by the statistical seesawing, are now trying to figure out what went awry so they can coax the rate back down again. And watching this soul-searching exercise are national health and education groups who hope to discover if this little burg's success can be duplicated and if its pitfalls can be sidestepped.

Nationwide, the teenage birthrate has tapered off in recent years--down to 57 births per 1,000 15- to 19-year-olds in 1995. Experts attribute the decline in part to lower rates of sexual activity and more consistent contraceptive use.

Even so, experts estimate that one million teenagers will become pregnant each year. With pregnancy comes potential hardship. Research has shown that early childbearing often threatens the young mothers' education and economic opportunities.

To curb adolescent pregnancy on the national front, President Clinton recently launched a multimillion-dollar effort to finance more abstinence-based education in schools and communities. In addition, two members of Congress this spring introduced a bill that would provide $13.5 million in grants to subsidize and evaluate teenage-pregnancy-prevention programs.

Compared with the rest of the country, Oregon's teenage-pregnancy rate is slightly better than average, ranking 27th.

That lower-than-average rate, though, is not because Tillamook County has sustained its dramatic drop in teenage pregnancy. In 1990, it had the second-highest rate in the state, with 24 pregnancies for every 1,000 10- to 17-year-old girls. By 1994, the county's rate of seven pregnancies per 1,000 had dropped to the lowest, plunging 75 percent in four years. And these were no statistical blips either, despite the small population base.

But only a year later, the pregnancy rate had shot back to 15 per 1,000 girls--halfway back to its previous high.

Since then, nearly every official in town has become an amateur social scientist with a theory for how the county lost ground. Some say complacency crept in after their initial success at preventing teenage pregnancies. Others point to a leadership drain and the general burnout that often follows grassroots crusades. Still others point to a lackluster sex education curriculum in the schools.

"We are trying to figure out what went right and what went wrong, so we can re-create our success," says one county official.

As a spring gale whips the trees outside her third-floor office, Sue Cameron hovers at her desk like a hummingbird debating where to land. The Tillamook County commissioner has the restless demeanor of someone whose urgent business makes her much too busy to keep still.

Cameron is keenly interested in getting to the bottom of the rise in the pregnancy rate because she was one of the architects of its fall.

When she is asked what provoked the campaign's original success, she settles on one word--controversy.

In the mid-1980s, when Cameron was the county's health commissioner, she ordered a survey whose results made her gasp: Sixty-six percent of the county's high school students said they were sexually active, and 33 percent of those teenagers said they used birth control.

"The survey told us we had a major problem. That teens were sexually active and couldn't access a doctor," she says.

So Cameron in 1985 applied for a state grant to install a health clinic in the town of Tillamook's only high school. The idea percolated in the town halls and teachers' lounges. But when it was introduced at some church meetings, the plan ruptured. Religious leaders who objected to the project wrote angry opinion pieces that were published in the local newspaper, claiming that the health department intended to dispense contraceptives in the school.

"They called us Hindu Taoist cultists," says Judy Marvis, a counselor at the high school who fought for the clinic. "We just wanted a nurse to help with illnesses" and make family-planning referrals.

Marvis, Cameron, and other proponents of the school-based health project argued that the school clinic was never intended to deliver birth control, only to offer referrals to students who requested contraceptives.

But the opposition was overwhelming, and the Tillamook school board quashed the proposal in a 4-1 vote.

In dozens of other communities around the country, school-clinic battles have crippled new adolescent-health projects for years. But in Tillamook, the controversy became an unexpected springboard, catapulting many residents into addressing a teenage-pregnancy crisis they didn't even know they had.

People started taking the teenage-pregnancy problem personally, Cameron says, once they realized that "even though the strategy of the clinic was abandoned, the problem wasn't solved."

Suddenly, it seemed, everyone was talking about it. The high rate was the topic of conversation at the grocery store, at the Tillamook cheese factory, and at the local livestock feed store. People compared the unsettling statistics while they waited in line at Tillamook's one movie theater. The small-town rumor mills churned with talk of potential prevention programs and coalitions. The local papers chronicled the plans.

While all the local groups involved agreed on the aim of reducing adolescent pregnancy, they differed on the approach. So people simply agreed to disagree on the strategy and focus on the ultimate goal. "You can take a lot of roads to the same end," Cameron says.

One factor instrumental in broadening support for the multipronged effort, many say, was its focus on preventing teenagers from becoming pregnant, not from giving birth. Redefining the problem helped enlist the aid of many church leaders who saw the effort as another way to deter abortions.

The churches preached abstinence in their youth groups, health-care workers visited teenage parents, and recreation centers expanded their sports offerings. Moreover, the Tillamook County health department accelerated its services to dispense contraceptives to sexually active youths. Some schools created alternative-degree programs for teenage parents and provided referrals to the health clinic.

As funding was tight, various county agencies and local groups pooled their resources, held fund-raisers, and applied for state grants to pay for the activities.

With the demise of the school-clinic proposal, health officials still were faced with finding ways to provide sexually active youths with better access to contraceptives. Unlike their counterparts in the urban settings of Portland or Salem, teenagers in Tillamook County couldn't easily pop into a Planned Parenthood office for a confidential appointment after school. Few teenagers chose to visit their family doctor for fear their parents would find out they were having, or at least contemplating, sex.

'Some people's attitude is you'll burn in hell if you have sex. That's counteractive for some kids.'

Diane Widmer,
Case Manager,
Tillamook County Health Department

So in the early 1990s, local health leaders offered adolescents special services at the Tillamook health department to get contraceptives and counseling within 48 hours. The new service replaced what had been a monthlong wait for birth control in the crowded clinic.

Cameron believes the no-wait policy--and the confidentiality of the visit--was critical in reducing the pregnancy rate.

Even though the Tillamook health department is a 45-minute trek from her home, one local teenager says it's a small inconvenience for anonymity. Sitting in the waiting room filling out a medical questionnaire about her sexual history, Emmalea, a gangling 15-year-old, says she started having sex at 11. If she bought condoms at the drugstore in the tiny town where she lives, she's certain the news would travel. "In Cloverdale, no matter what, somebody is going to find out," Emmalea says.

A few weeks ago, she got a shot of the long-acting contraceptive Depo-Provera after she thought she might be pregnant. Now, she's back for the required follow-up physical. "Having a baby would affect me because I want to finish being a teenager," she says. "So, I'm responsible."

Besides this speedy delivery of confidential services, clinic staff members brief young people about sexually transmitted diseases and counsel them about family-planning options and abstinence.

Diane Widmer, a case manager at the health department, says the staff tries to provide young people with the best information without being judgmental.

"Some people's attitude is you'll burn in hell if you have sex," she says, as more teenagers filter into the clinic. "That's counterproductive for some kids."

When the services for teenagers first began, the health clinic staff worked closely with the schools to spread the word. If girls were pregnant, or afraid that they might be, their school counselor could usher them directly to the health clinic to discuss family-planning options.

"It was a crucial partnership," Marvis remembers. "The school was a direct link to getting the word out about the clinic."

As the health program took off, Marvis and others began to set up a program for teenage mothers to earn their high school degree. In a separate classroom at Tillamook High School, girls learned about caring for their infants in between units on algebra and literature. The purpose was to provide a place where likely dropouts could complete school on a flexible schedule and develop career plans.

The program, now run out of a local community college, has an impressive record: Thirty-six percent of last year's graduates went to college; 91 percent got full- or part-time jobs. Graduates of the teenage-parent program are far less likely to have an additional child than those who do not participate, records show. Some of these mothers even guest-lectured in the schools as part of a revised sex education approach.

In the 1980s, Marvis says the sex education classes at school consisted mostly of lectures on anatomy and menstruation. But in the early 1990s, teachers began working more with school counselors and health officials to enhance the curriculum, incorporating role-playing and visitations by the teenage moms in the middle and high school grades.

Though the schools served as hubs of the community network, the school-clinic dispute made many residents reluctant to steer an aggressive teenage-pregnancy-prevention campaign through them. As a result, the three districts in the county stopped short of a complete overhaul of their sex education curriculum.

While the clinic was doling out prophylactics for free, George Hodgdon was busy dispensing a different message to Tillamook County teenagers--that faith in God is the most powerful contraceptive.

"What motivates a person to be sexually abstinent? A good relationship with the Lord," says Hodgdon, a devout Nazarene who has spent much of the last decade promoting a series of abstinence-education lectures and church group events for local youths.

When the clinic controversy broke, Hodgdon decided to aggressively market the abstinence message to teenagers through Tillamook County's many houses of worship. A road builder by trade, Hodgdon volunteered to lay the groundwork for a six-week guest lecture series called "Sex on the Safe Side." The sessions had such titles as: "The ABCs of Touch," designed to help teenagers recognize and repel unwanted advances; and "Media Sexploitation," an expose of how the media influence sexual behavior and attitudes.

The first series, which was held in the Tillamook High School auditorium, drew 300 students from the dozen towns in the county, about one-eighth of the area's teenage population. The ministers' association, the Kiwanis Club, and even the health department supplied volunteers. It was universally applauded.

Hodgdon says the collaboration was smooth because all the key people in town knew each other. Cameron and Hodgdon's families used to go trout fishing on the Trask River together when they were in junior high school. So a friendly call for assistance didn't require a formal introduction.

In addition to the popular seminars, Hodgdon and some local ministers also bolstered after-school options by adding to the existing array of youth activities at churches.

After-school game nights, the latest church offering, are well attended. On a recent school night, the Church of the Nazarene in Tillamook is filled with adolescent laughter.

Every Wednesday evening here, boys and girls gather to engage in hours of good, clean mayhem. In a small gym off the main chapel, teams of teenagers drag each other across the wooden floor on blankets as a coach signals the start of the "chariot races" with a piercing whistle.

Many teenagers say these activities help support young men and women who have chosen to postpone sexual involvement but often feel compelled to experiment.

"A lot of kids who are pressured turn around and have sex," says 15-year-old Heather McVay, shouting above the din. "But being involved in sports and youth group takes a lot of your time."

'What motivates a person to be sexually abstinent? A good relationship with the Lord.'

George Hodgdon,
Coordinator, Church Activities

Trenda Fletcher, a 17-year-old senior, says when she feels such peer pressure, she finds comfort in the Bible. Turning to a familiar passage, she reads: "The marriage bed should be kept pure, for God will judge the adulterer and all sexually immoral."

The popularity of the youth groups and the seminars was a sign to the community that the churches' participation was crucial in the fight against teenage pregnancy. It was an ideal way, many believed, to reach the youngest teenagers and especially those who may not yet be sexually active.

The church activities were not appealing, however, to those young people who eschewed both religion and the message of abstinence until marriage.

When teenagers here are asked why they think most of their peers are having sex, they routinely respond with the same phrase: "There's nothing to do here."

The string of tiny towns offers little entertainment other than going to parties, smoking marijuana, and fooling around, many of them say.

The stunning vistas of mountain peaks overlooking the shimmering blue bay are lost on many young people who pine for CD stores, McDonald's, and video arcades. Fred Meyer, Tillamook's lone department store, is the closest thing here to a shopping mall.

"It's boring," says Cody Martin, an 18-year-old from Cloverdale, who points out that the nearest multiplex theater is an hour away. A typical weekend scenario goes like this: "On Friday and Saturday, you party and get drunk and have sex," says Cody, whose girlfriend is expecting a baby in August.

To answer this cry to increase young people's entertainment options, several community leaders in the early 1990s decided to devise some wholesome distractions for local youths.

The Tillamook County YMCA bolstered its sports programs for adolescent girls who were traditionally underserved in community sports programs. The YMCA started girls' basketball leagues and promoted them on radio and in the local papers. It added a girls' softball league for 9- to 11- year-olds and fast-pitch practice for high school girls. In four years, the YMCA's participation rate doubled.

Mike Ellis, the YMCA's executive director, as well as the Tillamook school board chairman, says the program had multiple benefits.

"Studies show kids are most at risk of getting into trouble between the hours of 3 and 6, whether it's teen pregnancy or drugs or gangs," says Ellis. "This occupies that time."

By 1994, with all the community efforts in full swing, the teenage-pregnancy rate hit bottom. Once second from the top, Tillamook was now ranked 36 out of 36 counties in the state.

State and national child-health advocates heaped praise on the community leaders. The National Campaign to Prevent Teenage Pregnancy was considering Cameron and the county for a prestigious award.

Research has shown that early childbearing often threatens the young mothers' education and economic opportunities.

Outside observers wondered at the alchemy that had transformed the county's contentious players into a harmonious coalition with a common purpose.

But as people cheered, the pregnancy rate, which the community had been tracking religiously, began to climb back up.

Local leaders here have found it easier to identify tangible evidence of their successes than root out the source of their failures. But a common explanation for the increase is that after all the accolades, people became complacent. In the late 1980s, "everybody was getting on the bandwagon and was fired up to get their hands dirty," says Hodgdon. "I guess when people thought the problem was taken care of, they backed off and got real passive."

Cameron and others say another factor was the loss of several prominent church leaders who helped cement the original coalition. No charismatic leaders immediately stepped in to replace them when they moved on to new congregations.

Some people in the county speculated that more girls were getting pregnant because they had fewer pregnant teenagers around them as visual deterrents.

In a modest house at the edge of town, Cristine Clapp, 18, sits on a rocking chair cuddling her 3-month-old son, Devon, just up from his afternoon nap. Across the room, her 16-year-old sister, Stacy, is coaxing her 3-month-old baby girl to burp.

The teenagers, who live at home with their parents, have the weary demeanor of sleep-deprived new moms.

"I love Devon, but it's really hard to take care of him," moans Cristine, as the infant squeals. "If people know how hard it was to have a kid, they wouldn't do it."

Devon's father, slumped in a chair nearby, says he would have preferred to wait to be a dad. "I just wish I would have been older," says 19-year-old Tim McCoog.

Though the Clapp girls say they often feel self-conscious when they walk around town with their babies, stigmatizing young mothers isn't going to be much of a deterrent, they argue. It may have worked in the 1950s when being a teenage parent was such a cultural no-no that pregnant girls were shipped off to their relatives in shame to have their children.

But these young parents say a more effective way to lower the pregnancy rate is to address the teenage drug problem.

Marijuana use among teenagers here and across the country has been rising for years, and alcohol consumption has remained high. Stacy says she was drunk and high on marijuana when she had sex.

While the substance-abuse issues are relevant, other factors are equally responsible for the creeping rise in the teen-pregnancy rate, many community leaders say.

Elaine Hopson, one of the three school superintendents in the county, says sex education courses often have not been effective because many teachers are uncomfortable with the subject. It's not material they were trained to teach, says Hopson, who was hired in 1993.

"No one gets in a twit about the digestive tract, but when you are talking about sex, it's a different ball game," she says.

"To some teachers, using the word penis is a quantum leap."

That discomfort is common. In fact, many experts suggest that America's reluctance to have a frank public dialogue about sex and it's consequences, while sexual images abound in the media, is one of the main reasons why the United States has the highest teenage-pregnancy rate in the industrialized world.

But Hopson and others say the pregnancy-prevention effort also lagged in Tillamook County because people were ultimately exhausted after years of constant work, most of it performed by volunteers.

"People got burned out and couldn't keep up the high intensity," says Dr. Paul Betlinski, a family practice physician in the health department.

But national experts point out that it often takes more than vigilance to alter teenagers' behavior.

A certain percentage of girls who become pregnant have been raped or coerced, they say. High teenage-pregnancy rates are also associated with poverty and the lack of educational opportunities. Research shows that the better adolescents feel about school or their work, the less they are inclined to start a family.

"If you could change the labor market and education and employment opportunities, you would have a larger effect that would be easier to sustain," says Kristin Moore, the president of Child Trends, a Washington-based research group.

In the past few months, leaders in Tillamook have begun to revive their campaign. Because the community has no public transportation, and many adolescents were unable to make their way to the health clinic, the county hired Hannah Cavanaugh, an AmeriCorps worker, to shuttle young people there in her car one night a week. Clad in a sweatshirt and long skirt, the freckle-faced 21-year-old fits right in with her adolescent clients.

"They feel pretty comfortable talking to me," says Cavanaugh as she ushers tonight's crew in for a checkup.

Cavanaugh says that despite the recreational options already in place, Tillamook County teenagers continue to gripe about the lack of exciting entertainment possibilities. Consequently, a group of parents who run a local recreation center decided this spring to open their doors to youths two afternoons a week.

One recent Monday afternoon at the youth center in Nehalem, a remote village in the north end of the county, three high school boys practice jump shots on a indoor basketball court as the rain puddles in the grass outside.

Next to the gym, the center's main hall is decorated with bright murals and equipped with a VCR, a stereo system, a bank of board games, and a pool table. The youths can buy 50-cent burritos and licorice for a nickel.

"We wanted to give kids something positive to do because they end up drinking a lot," says Susan Hills, who runs the center.

This year, the center began to offer something more to teenagers than Monopoly and chocolate, however. When she's not transporting teenagers to the health department, Cavanaugh dispenses free condoms to young people at the center who ask for them. She stashes the prophylactics in a sparkly black velvet bag behind the refreshment table.

As he shoots baskets, 17-year-old Chad Winfrey says that having contraceptives available at the center is a good idea. "People are going to have sex if they want to. You're not going to stop them," says the young man in mid-dribble. "I'm going to grab a couple of condoms before I go."

Tillamook's school-based programs are also due for a makeover, school officials say. Hopson is seeking funds from the state for her 2,300-student district to start an abstinence-based sex education program for 6th and 7th graders. The program uses older students as mentors to help preteens resist pressures to become sexually active.

'If people know how hard it was to have a kid, they wouldn't do it.'

Cristine Clapp

The program, called STARS, is being championed by Sharon Kitzhaber, the wife of Oregon Gov. John A. Kitzhaber, a Democrat.

The first lady, talking from her Portland office, says the education effort is a bargain when the price of doing nothing is considered.

Kitzhaber estimates that teenage pregnancy costs the state $200 million each year in welfare, prison, and lost labor costs.

"I decided I wanted to do early intervention because once a teen is in trouble, it's hard to turn them around," she says.

As Hopson speeds through a forested highway to a school board meeting, she seems confident that the county will win the STARS grant and pull the rate back down.

Whipping past groves of trees, her hand gripping the wheel of her Chevy Blazer, she recalls stories of Tillamook residents who have overcome difficult odds.

In the 1930s and 1940s, Hopson remembers, during the Tillamook Burn, hundreds of acres of the Coastal Range Forest went up in smoke after a logging crew accidentally sparked a fire. In the early 1950s, people from across the county descended on the forest for weeks in a massive tree-planting expedition.

And a year and a half ago, when the county was hit with a deluge that washed out the main highway and submerged it in mud for months, residents helped farmers move cattle to higher ground and sandbagged their neighbors' houses.

But reducing the teen-pregnancy rate, Hopson knows, is a little trickier than staving off a flood: You can never stop sandbagging, she says.

Vol. 16, Issue 38, Page 26-31

Published in Print: June 18, 1997, as Pregnant Pause
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