POLICY

BRIEF

The Interplay between Demographics, Teen Fertility Outcomes,

and State-Level Policies in the Sooner State

November 2014

PAM 3360
Evolving Families:
Challenges to Public Policy

Teenage pregnancy rates have declined across the United States,

but Oklahoma maintains one of the highest teen birthrates in the
nation. Why?

Emily Frech
Professor Sharon Sassler
PAM 3360
November 2014

INTRODUCTION

17,880
Pregnancies in 2010
for Oklahoma women
younger than 20 9

#5
Oklahomas national
rank for teen
pregnancy9

$190
million
Annual cost of teen
pregnancy for OK
taxpayers1

What do you get when you

combine outdated and medically
inaccurate sex education programs
in public schools, restrictive
abortion laws, and a statewide lack
of
constructive
dialogue
concerning teenage sexuality? The
answer: 17,880 pregnancies for
Oklahomas
128,638
teenage
9
women in 2010 alone . Do the
math and youll realize that 13.9%
of Oklahomas teenage girls
became pregnant in 2010.9 Issues
surrounding teenage sexuality
include sex education, the right of a
minor woman to an abortion, and
teenagers access to contraception.
Teenage pregnancy is a huge
economic, social, policy, and
ethical issue for Oklahoma. It is
isontentious topic that makes our
lawmakers

a critical, contentious topic that makes

Oklahoma lawmakers squirm. But our
young men and women deserve better
than a rank of #5 for teenage birthrate,
and our taxpayers deserve better than
their annual tab of $190 million for
teenage pregnancy1.

Wake up, Oklahoma: its time to

talk about sex.

OKLAHOMA DEMOGRAPHIC DATA

OKLAHOMA TEEN FERTILITY OUTCOMES

Race/Ethnicity: The racial and ethnic composition of

The Sooner State consistently ranks in the top 5 states in the

U.S. for teenage pregnancy and birth rates. Oklahoma
currently holds the rank of #5 in the nation for teen birthrate
9
and #6 for teenage pregnancy rate (Figure 3) .

Oklahoma is significantly different than that of the

United States (Figure 1). Oklahoma has a much larger
American Indian population than the United States as a
whole. Additionally, just 5.5% of Oklahomans are
foreign-born, compared to 12.9% of United States
citizens.11
Figure 1: Racial and Ethnic Composition of Oklahoma and
the United States
Race or
Oklahoma U.S.A.
Ethnicity
Caucasian/White 75.4%
77.7%
Black/African
7.7%
13.2%
American
American Indian 9.0%
1.2%
and Alaska
Native
Asian
2.0%
5.3%
Native Hawaiian 0.2%
0.2%
and Pacific
Islander
Hispanic/Latino
9.6%
17.1%

Figure 2: Teen Fertility Measures in Oklahoma and the

United States, 2010
Measure (2010)
Oklahoma Rank U.S.
Teen pregnancy rate
(number of
pregnancies per 1000
women aged 15-19)
Teen birthrate
(number of live
births per 1000
women aged 15-19)
Teen abortion rate
(number of abortions
per 1000 women
aged 15-19)
Abortion ratio
(abortions/[abortions
+live births])

69

58.4

50

34.8

41

15.2

13

30

Source: United States Census Bureau11: State and Country QuickFacts:

Oklahoma.

Source: Guttmacher Institute9: U.S. Teenage Pregnancies, Births, and

Abortion, 2010: National and State Trends by Age, Race, and Ethnicity.

Education: Educational attainment, measured by the

From our low rank in teen abortion rate (#41) and abortion
ratio (13 in Oklahoma vs. 30 in the USA) we see that the
majority of teen pregnancies in Oklahoma result in live births.
This results in huge costs for the Oklahoma government and
1
taxpayers: $190 million in 2008 alone.

Economics: Compared to the rest of the United States,

Oklahomans obtain less education and make less
money: 16.6% of Oklahomans live below the federal
poverty level, compared to 14.9% of United States
citizens. The median household income for an
Oklahoma family in 2008-2012: $44,891. The median
household income for a United States family in the
same time period: $53,046, representing a 16.6%
difference.11

Marriage: Oklahomans are more married than the rest

of the country. 53.3% of Oklahomans were married
during the 2008-2012 data collection period, compared
to 51.1% of the United States as a whole during 20082012.11

Figure 4: Changes in Oklahoma Teen Birthrate (1988-2010)

Live Births per 1000 Women
Aged 15-19

American Community Survey in 2008-2012, is defined as

the percent of the population aged 25 and older with a
bachelors degree or higher. Educational attainment is
lower in Oklahoma than in the United States; while
28.5% of United States citizens have at least a
bachelors degree, only 23.2% of Oklahomans have a
bachelors degree or higher.11

80

Oklahoma Teen Birthrate 1988-2010

60
40
20
0
1988 1992 1996 2000 2005 2008 2010
Year

Source: Guttmacher Institute9: U.S. Teenage Pregnancies, Births, and

Abortion, 2010: National and State Trends by Age, Race, and Ethnicity.

The teenage birthrate in Oklahoma has declined in the last

twenty years (Figure 4). However, our state experiences a
difference in teenage fertility rates among different racial and
ethnic groups in the state (Figure 5, Figure 6). Non-Hispanic
blacks comprise just 7.7% of Oklahomas population but
represent 54% of all OK teen births.

Figure 5: Teen Pregnancy and Fertility Rates in Oklahoma,

by Race/Ethnicity
Non-Hispanic Black
Hispanic
White
Teen pregnancy 59
88
97
rate (number of
pregnancies per
1000 women
aged 15-19)
Teen birthrate
(number of live
births per 1000
women aged 1519)

43

61

75

Source: Guttmacher Institute9: U.S. Teenage Pregnancies, Births, and

Abortion, 2010: National and State Trends by Age, Race, and Ethnicity.

Figure 6: Teen Birthrate by Race/Ethnicity in 2011

Race/Ethnicity
Percent of all births to females
under 20 years of age, by
race/ethnicity
Non-Hispanic black
54%
Non-Hispanic white
14%
American Indian or
16%
Alaska Native
Asian or Pacific Islander
1%
Hispanic
17%
Source: Department of Health and Human Services3: Oklahoma Adolescent
Reproductive Health Facts.

As shown in Figure 1, Oklahoma is more demographically

homogenous than the rest of the U.S; our state has
proportionally smaller populations of African Americans,
Asian Americans, and Hispanic/Latinos than the U.S. as a
whole. The exception: Oklahoma has a larger American
Indian population than the rest of the United States. We
see in Figure 6 that the birthrate for American Indians is
disproportionately high. Why? According to the National
Campaign to Prevent Teen and Unplanned Pregnancy,
Native youth are much more likely than youth of other
racial/ethnic groups to report not receiving necessary
medical care (27% vs. 19%).10 The campaign also reports
that Native American teenage females are more likely to
have had sex and are less likely to use birth control pills.10
Additionally, many Native American youth live in rural
areas. Indian Health Services resources in rural areas are
much more limited than in large urban areas.10

16%

19%

Percent of all
Oklahoma teen births
to American Indian
women3

Percent of all repeat

Oklahoma teen births to
American Indian women3

OKLAHOMA STATE-LEVEL POLICIES

Oklahoma has a problem with teenage pregnancy;
could our high teen birthrate be due to the Sooner
States dated sex education programs and teens
limited
access
to
information
regarding
contraception?

SEX AND HIV EDUCATION:

Oklahoma promotes a standard abstinence only
format of sex education in public schools.8 Sex
education is NOT mandated in public schools.8
Parents are required to be notified of any sex ed
instruction and can opt their children out of said
instruction.8 When provided, sex or HIV education
does not have to be medically accurate, age
appropriate, culturally appropriate, secular, or
unbiased.8 HIV education is mandated in Oklahoma
public schools, and HIV education must include
information on condoms and cover abstinence.8 No
life skills for avoiding coercion, health decisionmaking, or family communication are required to be
taught as part of the sex or HIV education curricula.8
When Provided, Sex
Education Program
Must be medically
accurate
Must be age appropriate
Must be culturally
appropriate
Must stress abstinence
Must be unbiased
Can promote a religion
Can be opted-out-of by
parents
Must include information
on condoms and
contraception
Must include life skills for
avoiding coercion
Must include life skills for
health decision-making
Must include life skills for
family communication

Yes

No
X
X
X

X
X
X
X

Source: Guttmacher Institute8, State Policies in Brief: Sex/HIV

Education.

X
X
X

CONSENT TO REPRODUCTIVE HEALTH

SERVICES:
Oklahoma teens can only consent to contraceptive services if
5
they are married, pregnant, or have ever been pregnant.
Even then, physicians may (but are not required to) inform
parents if teenagers want access to non-OTC contraceptives
5
(birth control pills, NuvaRing, Depo-Provera).
Oklahoma teenagers may consent to STI services and
prenatal care, with the physician able to share a minors
private medical information and conversations with her
5
parents.
Oklahoma has one of the strictest policies in the nation
regarding minors consent to abortion services. An Oklahoma
minor seeking an abortion must:
Prove notification of and provide notarized consent
from her parents
Receive state-directed counseling to discourage her
from having an abortion
Wait 24 hours between counseling and the procedure
Locating an abortion provider is yet another obstacle: as of
2011, there were just 5 abortion providers in the state of
Oklahoma. 96% of OK counties have no abortion provider,
4
and 55% of all OK women reside within these counties.

REPRODUCTIVE HEALTH POLICYMAKING:

Many lawmakers are unaware of the proximate
determinants of fertility.
1. Factors affecting exposure to intercourse: timing of
sexual activity
2. Factors affecting
contraception

exposure

to

conception:

3. Factors affecting gestation: abortion

Which proximate determinant of fertility should
Oklahoma policymakers focus on to accomplish the
policy goal of reducing teen pregnancy, birth, and
abortion rates?

If policymakers want to lower the teen abortion rate,

acting at Determinate 3 (exposure to gestation) is too
downstream. Restricting access to abortion does not
lower the teen pregnancy rate; abortion restrictions
lower abortion rates but increase birth rates. We want
to lower teen pregnancy, birth, and abortion rates.
Thus, we must look further upstream. Parents, not
policymakers, arguably have the most influence
concerning factors affecting exposure to intercourse
(Determinate 1). The age of sexual consent in Oklahoma
is 16; policymakers cannot simply prohibit teenage sex.
Thus, Oklahoma policymakers should focus on
Determinate 2 (factors affecting exposure to
conception) in order to reduce teen fertility rates.
Educating teenagers on how to use contraception in
order to prevent pregnancy will lower exposure to
conception and thus, lower teen pregnancy, birth, and
fertility rates in Oklahoma.

CONCLUSIONS
Demographically, socially, and religiously, Oklahoma
has unique needs as a state. Compared to the United
States as a whole, Oklahomans have less education and
lower family incomes. Oklahomas large Native
American population, conservative politics, and intense
religiosity present immense policy challenges when it
comes to the issue of teenage sexuality.
We cannot as a state continue to pretend that teenage
sex does not happen: it does, and often, as indicated by
our states high pregnancy and birth rates. We can
decrease our teen pregnancy rates and consequently
lower the number of abortions performed in Oklahoma
by introducing better sex/HIV education programs into
our public schools. Additionally, expansion of access to
affordable health insurance will allow more women to
have access to reliable birth control methods, lowering
the number of unintended pregnancies. Oklahoma
lawmakers: dont like abortions? Increase access to birth
control and student exposure to comprehensive sex ed.
Failure to do so will result in Oklahoma remaining in the
top 10 worst states for teenage fertility measures.
Oklahoma students deserve better. Access to medically
accurate, culturally and age appropriate, unbiased,
secular, and comprehensive sexual education is not a
radical or immoral concept: it is the basic right of a
student to have access to medically accurate
information about his or her health. And once our
policymakers recognize this right, teenage pregnancy,
birth, and abortion rates will decline in the state of
Oklahoma.

ACKNOWLEDGMENTS
Emily Frech, a 2013 graduate of Norman High School in
Norman, OK, is an undergraduate student studying
biological sciences and health policy at Cornell University
in Ithaca, NY. This brief was written with assistance from
Dr. Sharon Sassler, Professor in the Department of Policy
Analysis and Management at Cornell University.

REFERENCES
1

Centers for Disease Control and Prevention. (2014). Prevention

Status Report 2013: Teen Pregnancy, Oklahoma. Washington,
D.C.: Office of Tribal, Local, and Territorial Support. Retrieved from
<ftp://ftp.cdc.gov/pub/OSTLTS/PSR-PDFs/TeenPregnancy/OKtp.pdf>.
2

Centers for Disease Control and Prevention. (2014). Reportable

STDs in Young People 15-24 Years of Age by State. Washington,
D.C.: Division of STD Prevention at the CDC. Retrieved from
<http://www.cdc.gov/std/stats/by-age/15-24-all-stds/default.htm>.
3

Department of Health and Human Services. (2014). Oklahoma

Adolescent Reproductive Health Facts. Washington D.C.: Office of
Adolescent Health. Retrieved from <
http://www.hhs.gov/ash/oah/adolescent-healthtopics/reproductive-health/states/ok.html>.
4

Guttmacher Institute. (2014). State Facts about Abortion:

Oklahoma. New York: Guttmacher Institute. Retrieved from
<http://www.guttmacher.org/pubs/sfaa/oklahoma.html>.
5

Guttmacher Institute. (2014). State Policies in Brief: An Overview

of Minors Consent Law. New York: Guttmacher Institute.
Retrieved from <
<http://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf>.
6

Guttmacher Institute. (2014). State Policies in Brief: Minors

Access to Contraceptive Services. New York: Guttmacher
Institute. Retrieved from
<http://www.guttmacher.org/statecenter/spibs/spib_MACS.pdf>.
7

Guttmacher Institute. (2014). State Policies in Brief: Parental

Involvement in Minors Abortions. New York: Guttmacher
Institute. Retrieved from <
http://www.guttmacher.org/statecenter/spibs/spib_PIMA.pdf>.
8

Guttmacher Institute. (2014). State Policies in Brief: Sex and HIV

Education. New York: Guttmacher Institute. Retrieved from
<http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf>.
9

Kost, Kathryn, and Henshaw, Stanley. (2014). U.S. Teenage

Pregnancies, Births, and Abortion, 2010: National and State Trends
by Age, Race, and Ethnicity. New York: Guttmacher Institute.
Retrieved from
<http://www.guttmacher.org/pubs/USTPtrends10.pdf>.
10

The National Campaign to Prevent Teen and Unplanned

Pregnancy. (2009). American Indian/Alaska Native Youth and
Teen Pregnancy Prevention. Retrieved from
<http://thenationalcampaign.org/sites/default/files/resourceprimary-download/ss39_nativeamericans.pdf>.
11

United States Census Bureau. (2014). State and Country

QuickFacts: Oklahoma. Retrieved from
<http://quickfacts.census.gov/qfd/states/40000.html>.