Recognizing a Great Public Health Achievement
By Brent Ewig, MHS
Director, Public Policy & Government Affairs, AMCHP
In 1999, the CDC published a series of reports highlighting ten of the greatest public health achievements of the 20th Century. Maternal and child health professionals should take great pride that "healthier mothers and babies" and "family planning" are included on that list. In 2011, the CDC revisited the list to cover the first decade of the 21st century and once again "maternal and infant health" was featured. Now, just as we are going to press with this issue of Pulse, the CDC released a new report showing that the teen birth rate fell an almost unbelievable 57 percent from between 1991 and 2013. Surely this will qualify as one of the greatest achievements of our time.
According to the CDC, this success "reflects a number of behavioral changes, including decreased sexual activity, increases in the use of contraception at first sex and at most recent sex, and the adoption and increased use of hormonal contraception, injectables, and intrauterine devices." In other words, teens are having less sex, and those who are active are much more likely to use effective contraception.
This being Washington, DC, we are wise to anticipate that policymakers will want to know what are the key factors behind this trend with an eye toward continuing "what works" and what is "evidence-based." And this is where things get interesting, because in my view this is a great case study in how there is not one silver bullet we can point to but rather the collective impact of a number of efforts.
The authors of the CDC report allude to this by noting toward the very end of the report that an increase in teen birth rates in the late 80s "led to a variety of initiatives at the federal, state, and local levels, including public, private, and joint efforts to influence the attitudes and behaviors of teenagers with a strong focus on pregnancy prevention through abstinence and, for sexually active teenagers, the use of effective contraception." They conclude by stating that "disaggregating the relative role of behavioral and other factors can be difficult, suggesting the need for further research."
It would be great if we could point to one policy or program as the game changer, such as the founding of the National Campaign to Prevent Teen Pregnancy in 1996, inclusion of teen pregnancy as a Title V national performance measure in 1997, or the inception of the president's teen pregnancy prevention initiative 2010, or creation of the personal responsibility education program (PREP) as a new section of Title V in the Affordable Care Act in 2010, or Dr. Tom Frieden's leadership in declaring teen pregnancy a "winnable battle" in 2010. The reality is that each of these efforts and more have all contributed to this success. Each deserves our thanks and congratulations, as well as continued advocacy to make sure they are sustained. AMCHP looks forward to continuing to be a partner in this work, but now for just one moment, we should all celebrate this stunning success and recommit to accelerating this progress.