At a time when overall U.S. teen birthrates are at record lows, Chattanooga is seeing dramatic improvements of its own in what health officials acknowledge has been a deeply entrenched problem.
Hamilton County has recorded steep declines in teen birthrates, particularly among black girls ages 15 to 17 for whom the rate is down by nearly half in the last three years, state figures show.
But for all the gains, Harriett Tubman Express Director David Sabir said Chattanooga still has a problem with teen pregnancy, particularly in low-income areas. The intensive after-school program, part of the local health department, aims to prevent teen pregnancy among residents of the Harriet Tubman public housing development.
"The numbers are down, but when you come out of your house and look up the street and look down the street in areas where you have more poverty, you may feel like teen pregnancy is on the increase," Sabir said.
A local network of youth advocacy programs appears to be making inroads into the complex problem, local health officials say.
In Hamilton County the 2009 birthrate among black girls ages 15 to 17 was 35.4 per 1,000 girls. That's down from 42.9 in 2008 and nearly 50 percent lower than 69.7 rate in 2006, according to the Tennessee Department of Health.
The Harriet Tubman Express program has had only four pregnancies among its 1,100 members in the past two decades, Sabir said.
Among all girls ages 15 to 19, Tennessee's birthrate has decreased by 26 percent since 1991 and Georgia's has dropped by 32 percent, according to data from the U.S. Centers for Disease Control and Prevention.
"There's a lot to celebrate, but I think there's a lot we still need to focus on and work on," said Diana Kreider, maternal-child health director for the Chattanooga-Hamilton County Health Department.
Nationwide, the U.S. teen birthrate is the lowest in 70 years, according to new CDC data.
In 2009, the rate among ages 15-19 fell to 39.1 births per 1,000, a 6 percent drop from 2008 and the lowest rate since the government began keeping track in 1940. The peak rate was 61.8 per 1,000 in 1991, according to the CDC.
The CDC report also noted that birthrates have slowed across the board, possibly because of the economic uncertainty of the ongoing recession.
Despite major progress nationwide, Southern states still lag behind national statistics on teen pregnancy and birthrates.
Tennessee was among the worst 10 states for high teen birthrates in 2008, according to the CDC.
That year, the U.S. rate for girls ages 15 to 19 was 41.5 per 1,000. Tennessee's rate was 55.6, seventh-highest in the nation. Georgia had the 13th highest rate at 51.8.
Teen pregnancy is a social issue deeply entwined with other major health and economic concerns, including infant mortality, poverty and high school dropout rates, said Michael Warren, director of maternal and child health for the Tennessee Department of Health. The effects are lifelong and potentially devastating, he said.
Teen mothers are more likely to give birth to premature or low birthweight babies, a major risk factor for infant mortality, he said. Young mothers are also more likely to live in poverty and drop out of high school, he said.
"We're setting ourselves up to have a mom and now a baby who are going to have lesser chances of success down the road," he said.
The abstinence education program On Point, formerly called Why Know, has been in Chattanooga for nearly 20 years. During that time the teen pregnancy rate has declined by more than 50 percent, Executive Director Lesley Scearce said.
The program works in 57 middle and high schools in Chattanooga and North Georgia. It focuses on abstinence as a core principle, but also on building leadership skills and self-esteem and addressing other risk factors for teens, she said.
Scearce thinks there's a silver lining to teen pregnancy being in the media spotlight through TV shows like MTV's "16 and Pregnant" and celebrity examples such as former Alaska Gov. Sarah Palin's daughter Bristol.
"We're seeing a lot of real-life consequences of teen pregnancy," she said. "I think that's always good when the media is giving us tangible things to talk about with our kids when it comes to consequences and behavior."
But critics question the effectiveness of abstinence-only education.
A 2007 study from Mathematica Policy Research, a nonpartisan social research group based in Princeton, N.J., found that students in abstinence-only programs were no more likely to abstain or delay having sex than those who received no sex education.
Partnerships between local organizations are key to reducing teen pregnancy, said Christina Featherstone, who works on the Chattanooga-Hamilton County Health Department's youth risk-prevention efforts including pregnancy prevention. The department partners with agencies including On Point, Girls Inc. and Harriet Tubman Express.
When asked in focus groups what information is important to them regarding teen pregnancy, local teens overwhelmingly asked for honesty and straightforward relationship talk. They also want to know about contraception, Featherstone said.
"Telling them not to have sex is not quite enough of what they need," she said. "Whether they've having sex or not, they feel they need to be prepared."
Though the past presidential administration provided funding only to abstinence programs and only discussed the limitations of contraception, President Obama has shifted more funding to programs that don't focus solely on abstinence.
Starting this year, $375 million in federal grants will be shared over five years among 28 programs proven to decrease pregnancy, including some that distribute condoms, The Associated Press reported.
Abstinence programs, which received $100 million a year in direct funding since 2005, now will get just $50 million a year for five years through state-administered Title V grants.
Scearce said that On Point's multifaceted approach is more than just telling kids not to have sex; it's focused on underlying factors that put teens at risk, such as low self-esteem.
"I think opponents of abstinence education are making the issue too simplistic. There's no one reason why the rates increase or decrease," Scearce said. "It takes a lot more than a 'Just say no' approach to reducing pregnancy. But I also think it takes a lot more than a 'Just use birth control' approach."