For years, New Hampshire has had the lowest teen birth rate in the country.
But those on the front lines of preventing teen pregnancy were surprised - and pleased - to learn that the state also saw one of the nation's most dramatic drops in that rate from 1991 to 2012, according to a new report by the Centers for Disease Control and Prevention.
Rhonda Siegel, administrator of the maternal and child health section at the state Division of Public Health Services, said there seems to be a "confluence" of factors behind the continuing drop in teen birth rates here. They include "access to reproductive health care, knowledge of the consequences and the not-so-favorable economic climate."
"Maybe all those things are interacting to make teens say it's just not worth it," she said.
In 2012, New Hampshire had a birth rate of 13.8 per 1,000 females aged 15 to 19. That's a 58 percent drop from the rate in 1991, which was 33.1 per 1,000 teens.
The national teen birth rate in 2012 was more than double New Hampshire's rate, 29.4 per 1,000, but that still represents a 52 percent decrease since 1991.
Even when researchers "standardized" the data to account for racial and ethnic variations, New Hampshire's standardized rate of 17.2 per 1,000 teens was second only to New Jersey's standardized rate of 17.1.
Researchers in the CDC's Division of Vital Statistics credit both abstinence programs and better access to effective contraception for the decline in teen birth rates nationwide. The trend does not appear to be the result of an increase in abortion, they noted.
In fact, a May report by the Guttmacher Institute found that the 2010 teen abortion rate, 14.7 per 1,000, was the lowest since abortion was legalized and is 66 percent lower than the peak in 1988 (43.5 per 1,000).
New Hampshire currently does not collect data about abortion rates. However, a bill requiring the Department of Health and Human Services to do so was sent to interim study in the last session; that committee is due to meet again this week.
DHHS estimated it would cost $85,814 to administer such a program in the first year, and more in succeeding years.
Siegel said more teens are using long-acting reversible contraceptives (known as LARCs), including intrauterine devices and hormonal implants that work in the same way as the contraceptive pill.
These methods are highly effective, she said, because young women don't have to remember to take a daily pill. While the most effective way to prevent pregnancy is abstinence, she said, some LARCs have a less than 1 percent failure rate.
In New Hampshire, Siegel said, most teen births are among the older population, 18- and 19-year-olds; the birth rate for these teens was 23.6 per 1,000 women. The birth rate for 15-to-17-year-olds here was 6.2, the lowest in the nation.
So, the CDC's report that New Hampshire saw a 37 percent drop in the birth rate among the older teens from 2007 to 2012 was especially welcome news to health policy experts here.
Still, there are some places in the state where the teen birth rate is closer to the national average. And that's where officials are targeting programs and funding.
David Laflamme, a research assistant professor at the University of New Hampshire's Institute for Health Policy & Practice, works as an epidemiologist with the Division of Public Health Services. He has been tracking teen birth rates and found significant disparities among counties and even individual cities.
For instance, the birth rate in Manchester from 2010 to 2012 was 33.8 per 1,000 teens, with 331 births among a population of 9,800 females aged 15 to 19.
Nashua's teen birth rate from 2010 to 2012 was 21.6, with 177 births among a population of 8,202.
Laflamme then calculated the birth rate for Hillsborough County without including the data for Manchester and Nashua. There were 182 births among a population of 22,057 from 2010 to 2012; that's a rate of 8.3 per 1,000 teens.
In Rockingham County, the birth rate in that period was 9.1, out of a population of 29,246 teens.
In sharp contrast, Sullivan County had a teen birth rate of 25.4 per 1,000 teens from 2010 to 2012. There were 92 births among a population of 3,627 teens.
Laflamme's research found that about 93 percent of teens who gave birth from 2010 to 2012 were unmarried; for women 20 and over, it was about 31 percent.
And "not surprisingly," he said, about 42 percent of teen births in that time period were to girls who had not yet completed high school.
Cost to taxpayers
The CDC report estimated a cost to taxpayers, for every child born to a teen mother, of $1,700 per year from birth to age 15. By that calculation, it estimates that $12 billion was saved in 2010 alone, as a result of the 45 percent drop in the teen birth rate from 1991 to 2010.
Laflamme has been working on a project to quantify what those costs are for New Hampshire.
The National Campaign to Prevent Teen and Unplanned Pregnancy, meanwhile, estimates the public cost of teen childbearing in New Hampshire was at least $20 million in 2010 alone. They cite costs associated with public health care, child welfare programs, increased risks of incarceration and lost tax revenue from reduced earnings.
The same organization claims that the decline in teen births saved taxpayers here an estimated $33 million in 2010, compared to what the state would have spent had the rate remained at the 1991 level.
Laflamme said health policy experts face tough decisions about where to allocate limited resources."We always have this choice in New Hampshire where we're choosing between picking somewhere that might have a very high rate but very few teen births ... or a place where maybe the rate is lower but perhaps their population is larger and more concentrated, in a city.""If we put resources in a more densely populated area, then we can affect more lives with those resources," he said. "We have this balancing act."
That's why the state has awarded federal grant funding for prevention programs in Manchester, with its higher teen population, and Sullivan County, with its higher teen birth rate.
There's some indication the efforts may be having an effect; preliminary data for 2013 shows a teen birth rate of 27.3 per 1,000 in Manchester, with 87 births out of 3,187 teens. "That looks like a drop," Laflamme said.
Siegel said public health officials are mindful that efforts to reach teens need to continue.
The worst response to the good news in the CDC report, she said, would be apathy: "checking it off our list and saying OK, we solved that problem."