Teen pregnancy in the United States was declared one of seven “winnable battles” by the Centers for Disease Control and Prevention (CDC) in 2014, highlighting the importance of reducing teen pregnancy and birth rates.

Since then, local and national efforts to prevent teen pregnancy appear to be showing results. In 2016, the teen birth rate dropped 9% compared to the previous year, a new report published by the CDC’s National Center for Health Statistics found, with 20.3 births occurring per 1,000 teenage women aged 15-19 – a historic low.

The provisional birth rate among teen girls has dropped 67% since 1991, according to the report, which presented preliminary data for 2016 based on a majority (99.9%) of births.

Bexar County’s teen pregnancy rate has followed the downward national trend, with “more teens waiting [to have sex] and more choosing to use birth control,” said Dr. Kristen Plastino, professor of obstetrics and gynecology and director of the UT Teen Health program at UT Health San Antonio.

Since 2000, Bexar County has experienced a steady decline in rates. In the latest statistics available, a 2014 Metro Health report showed a 47% decline in teen pregnancies from 2000-2013. However, even with the decline, the county’s rate still hovered at 55% higher than the national average at that time.

National researchers and healthcare professionals point to increased access and use of contraceptives as an important factor leading to the decline in teen pregnancy.

Separate data released late last week through the National Center for Health Statistics noted that contraceptive use among teenagers in the U.S. has increased.

The percentage of teenage females using any method at first sex and at last sex increased from 74.5% in 2002 to 81% in 2015, while the percentage for males remained stable at nearly 77%. The percentage of males using any contraception at last sex remains high at 94.9%.

Overall, the percentage of teenagers who disclosed having sexual intercourse at least one time remained unchanged over roughly the past 10 years.

Texas ranked fifth highest in the nation in teen birth rates in 2015, with 41 births per 1,000 women aged 15 to 19, according to data from the CDC. That ranking remained unchanged in 2016.

Research has shown a significant correlation between teen birth rates and sex education, with lower rates in states where more schools include sex education curriculum.

One-quarter of Texas public school districts offered no sex education at all during the 2015-2016 school year, according to a study released in February by the Texas Freedom Network. Nearly 60% of districts used abstinence-only education programs over the same period.

While 58.3% of school districts in Texas taught abstinence-only programs, that’s down from 94% in 2008, according to the study.

While teen birth rates are down overall, the rate of repeat births to teens remains unchanged, something that Plastino says is a major point of focus for the Teen Health programs.

“My personal experience is that [teen mothers] want to wait for the next pregnancy, so we want to make sure they are having that conversation so they can get an effective message [of pregnancy prevention] right when they deliver,” Plastino said.

Plastino says UT Health’s prevention programs are evidence-based. “These are programs that have shown a change in behavior, such as increased abstinence, improved contraception use, [and] increased refusal skills.”

Plastino said that part of her job is to work around the stigma attached to the word “abstinence” and ensure that organizations and schools are using evidence-based programs that fit the needs of their specific communities.

“There are abstinence and contraception programs that shouldn’t be used because they aren’t evidence-based,” Plastino said. “The question should always be ‘Does this work within this culturally diverse community?’”

Plastino said that Bexar County schools are largely utilizing evidence-based programs. There is a School Health Advisory Council for every school district, comprised of at least 50% community members who work to ensure that local community values are reflected in health education instruction. This has resulted in the uptick of “abstinence-plus,” programs that promote abstinence as the only guaranteed prevention strategy, while also educating students about contraceptives and resources within the community.

Plastino noted that some abstinence-only programs are evidence-based and proven to prevent pregnancy within specific populations and change behavior. In these situations, it is important to draw away from the politicalization of abstinence, and embrace what is working within a community to effectively combat the issue.

For UT Health’s Teen Program, Plastino says that its multi-pronged focus on pregnancy prevention focuses on “teens as assets and not as problems,” working to engage teens on a personal level to highlight their strengths and frame their education around their specific background and needs.

“We want to treat the teen, family, and community to help them make healthy decisions,” Plastino said.

The San Antonio Teen Pregnancy Collaborative out of Metro Health is a multi-organization workgroup whose mission is to reduce the teen pregnancy rate in Bexar County by 50% by 2020.

“I am so impressed with the community,” Plastino said. “We don’t come in with a pre-made agenda. We come in and do a needs assessment, and work with individuals and organization to help them determine: what do you want, what do you see, how can we help.”

Participating organizations include UT Health, Healthy Futures of Texas, Girls Inc., San Antonio Youth for Christ, Communities In Schools, and the Martinez Street Women’s Center.

Mario Martinez is the program manager at Project Worth, Metro Health’s teen pregnancy prevention program, and has been working to prevent teen pregnancy in Bexar County for 12 years.

“I have definitely seen a change in our community from when we started and nobody really wanted to talk about teen pregnancy prevention even though the numbers told a story,” Martinez said.

Martinez echoed the sentiment that what has been effective for Bexar County is working to create and implement evidence-based programs that meet the needs of specific communities, what he calls a “turning point” for teen pregnancy prevention.

“We have some great things happening,” Martinez said.

Roseanna Garza reports on health and bioscience for the San Antonio Report.