This article first appeared in the St. Louis Beacon, Nov. 30, 2009 - The white Christmas tree, with colorfully wrapped gifts underneath, went up a week before Thanksgiving in the Williams family household. The tree is a sign that life is merry in this north St. Louis home in spite of the fact that a teen-age daughter, Antionette, is pregnant.
Antionette counts herself luckier than most girls in her situation. Nurses for Newborns has taken her under its wings and is helping her to prepare for a healthy delivery. As important -- if not more -- it's helping her realize that having a baby need not stand in the way of her dreams. Antionette is 18, a senior at Imagine College Prep High School on Jefferson near Delmar and is already making plans for college next fall as a music major.
"I always said I wasn't going to do anything like this and stay on the smart side. But this happened," she says of her pregnancy. "The people at Nurses for Newborn have helped me by letting me know about services and about staying focused on my education. That's one reason that I strive to do more for myself."
The teen pregnancy problem in St. Louis is complicated by race, class and zip codes. Antionette lives in the 63115 zip code in northwest St. Louis, and her future seems brighter than most pregnant girls in this part of town because she is getting services and seems determined to work for a better life for herself and the girl she will give birth to next month.
According to a 2002 study of public health in St. Louis by zip codes, people in the 63115 fare poorly:
- More than 25 percent of the residents are poor
- 11.2 percent of the births are to women between 10 and 17
- 12.7 percent of the live births are infants weighing less than 5.5 pounds, meaning a higher risk of death or long-term illnesses
- And the infant mortality rate itself, defined as the number of infants who die before the first birthday, is a high 17.1 per 1,000 live births.
The overall rate for African Americans in St. Louis has dropped to about 14 per 1,000 live births. But even that figure is at least twice the rate of whites, about 5.9 per 1,000 live births.
Helping girls help themselves
These figures are offset by a few bright spots. One is that the girls are eligible for Medicaid, federal-state health insurance for the needy. But that's a mixed blessing because Medicaid eligibility is, of course, an indicator of poverty, which is associated with poorer health outcomes.
Still, the outcomes can be good, too. Most of the girls at the Teen Pregnancy Center at BJC are Medicaid patients. According to Kate Barbier, who runs the center, a study done in 2003 showed that about 10 percent of girls in her program gave birth to low birth weight babies, compared to 24.5 percent among girls in a control group.
Barbier says the outcome speaks highly of the center's approach. Typically, she says pregnant women are seen by a doctor or nurse practitioner once a month and get five to 10 minutes of attention.
"They come to the teen pregnancy center every other week, so they are coming in for care twice as often," says Barbier. "They get not only their prenatal care but education and support services from the staff here and from their peers. That woman-to-woman support is really crucial."
Asked about the relationship between race and the health of these women, Barbier thought a minute, then said the issue was really complex.
"Obviously, what we know is that race or ethnicity plays a significant role in whether you are going to have access to health care, whether you are going to get good health care."
She stresses that many minorities also get good health care.
"But if you look at the impact that oppression has had, you know, in terms of access to care and the quality of care, it means we have a long way to go, and there's a lot of work (needed) by both health institutions and society."
Even so, she says the center places responsibility on the patients, requiring them to take the lead in arranging transportation to and from the center, for example. That's one example of how the center helps the women understand that whether they have healthy pregnancies is "ultimately up to them," she says.
Even so, poverty and cultural habits can stand in the way of good prenatal care, says Dr. Nathaniel H. Murdock, a retired ob-gyn.
He remembers how difficult it was in his practice to convince teen girls to show up for appointments, take medicine and follow advice.
"Most of the time, if you hounded them enough, they'd come back for their next appointment," he remembers. "I'd ask them why they didn't read the literature I gave them, why they didn't take the vitamins or get the flu shot or go to the lab for a blood test, and the response was that they didn't have time or didn't have anybody to take them or they missed the appointment because their boyfriend's car broke down."
Barbier fully understands Murdock's frustrations. Such concerns are one reason, she says, the center has incentives to encourage patients to do the right thing.
"We really expect a lot from our girls here, and in most cases, they come through."
The center has a "baby bucks" program in which the women earn Monopoly-like dollars for positive behavior during pregnancy -- keeping an appointment, showing up on time, doing well in school, quitting smoking or connecting with organizations such as Parents as Teachers. The girls can "spend" the money at the center's "store" for items ranging from diapers to a car seat.
Barbier is troubled by the rate of teen pregnancy among poor girls in north St. Louis. She notes that only about 30 percent of the girls who are teen parents nationally are poor. But the infant mortality rate for poor African-American girls in St. Louis is more than twice that of whites.
"The issue is incredibly complex," she says. "You can't just assume it is caused by one single thing. A lot of it has to do" with the prevalence of health disparities on the north side. Among young African-American girls, "their access to prenatal care is different from that of a white girl in west county. (The black girl) might not have access to good prenatal care, might not be informed about what she needs to do to maintain a healthy pregnancy.
"And she might not have the social support she needs."
She adds that poor women also might be more prone to certain infections that put her and her pregnancy at risk.
Sex Education Is Needed
Allison Hile, director of the Teen Pregnancy and Prevention Partnership, says good prenatal care for girls and comprehensive sex education for boys and girls could help prevent risky teen pregnancies.
"One problem we have is trying to implement science-based sex education curriculum in schools," Hile says. Missouri requires "only one semester of health and that's only one piece of the health curriculum."
She notes that Missouri law says sex education must be based either on medically accurate information or follow abstinence-only guidelines. She's especially big on evidence-based methods of sex education.
"We have good science that (abstinence-only) curriculums are unrealistic. They do not (cause women to) delay first intercourse and do not increase the use of protection when youths do have intercourse."
Meanwhile, she says, comprehensive sex education in city schools is thwarted by the lack of family and consumer-science teachers. These, she says, have more training in contraceptives, pregnancies and sexually transmitted infections than regular health teachers.
"In the city, even if you had a perfect curriculum, if you handed (sex ed) to 'Coach Bob,' if he has no training to talk about issues related to sexuality, it's not going to be taken seriously. He's going to be uncomfortable and (students) are going to be uncomfortable," says Hile.
She says comprehensive sex education is needed to counteract a culture that seems to glorify celebrities who have babies out of wedlock.
Adding to the problem of poor girls is race, she says.
"It comes into play in the disparity of services. I'm talking about health services, after school programs, good schools. We're not addressing those issues. We're just talking about them."
Where's the dad?
Murdock, the retired ob-gyn, says the absent father is another issue. Murdock is always disappointed that most fathers of unwed mothers don't accompany the women to the doctor or take much interest in the the pregnancy.
"You'd think that if somebody got the lady pregnant, they should feel responsible enough to come with her for the appointments and be supportive. But in 80 to 90 percent of the teen pregnancy cases, this does not happen."
One who does show up is Orlando Shelton. He seemed to have a lot on his mind as he waited in the corridor at BJC's OB-Gyn Clinic, which is separate from the Teen Pregnancy Center. His girlfriend, who is in her late 20s, was at the clinic. At age 20, Shelton is already the unwed father of one child, and today, he's thinking about life as the father of a second child by another woman.
"The first time, I was so in love and wanted the baby," he says. "But I didn't realize all the responsibiliities of being a father. This time, I didn't want this baby. I'm worried because (the mother) will expect me to stay in the house for six whole weeks to help her take care of the child."
But that's just a minor issue compared to the quality of life Orlando can provide for his child. A school dropout, he has a GED, no job and no clue of what he will do with his own life.
It's one reason BJC's center also offers classes to fathers, too.
"We just had a session on paternity and child support," Barbier says. "The fathers attend regardless of whether they are romantically involved with the baby's moms. Between 30 and 40 percent of the dads participate. Most of these dads still live at home"with their parent or parents.
Antionette, the positive-thinking teen who hopes to attend college, didn't mention the father of her child. Still, she seems aware of the difficulty of raising a child as a teen, with or without a husband. She seems up to the task.
"Some teen-age girls drop out of school after they get pregnant," she says. "Some really don't want (the child), and they're not doing everything they can to take care of it and take care of themselves. But that's not going to happen to me. That’s why I got started on prenatal care as soon as I realized I was pregnant."
