Despite declining teen birth rates across the U.S., nearly 1 in 5 is still a repeat birth.
That means nearly 20 percent of the more than 367,000 teenage girls who gave birth in the U.S. in 2010 had at least two children before turning 20, say the Centers for Disease Control and Prevention (CDC).
In a new report, the agency says that repeat birth rates are highest among the Latino, black and Native American communities. Still, repeat births aren't as common as they were in 2007 – they've declined about 6 percent since then.
"I have a lot of pregnant teenagers," said Ann Cavanagh, a family nurse practitioner at St. John's Well Child and Family Center in South Los Angeles. She estimates that about 1 in 10 of her patients who are pregnant teens aren't on their first pregnancy.
Cavanagh says the "why" is simple: "It's because they don't use anything to prevent pregnancy."
Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic, said repeat births among teens are "fairly common" in the area, and suggested certain cultural views may even reinforce that.
"A lot of patients in our community do not see a teen pregnancy as something terrible, but as the next step for a teenager on the path to become an adult," he said.
According to the L.A. County Department of Public Health, South L.A. had the highest teen birth rate in the county in 2010: about 59 births for every 1,000 teenage girls. Compare that to the county average: about 31 births per 1,000 girls.
How teen mothers use contraception
The authors of the CDC study also looked at how teen girls used birth control after giving birth. They found that more than 9 in 10 used some form of contraception in the two to six months after birth – but only about 1 in 5 used the most effective methods: tubal ligation (or a vasectomy for the male), implants or an intrauterine device (IUD). More than 50 percent used "moderately effective" methods – birth control pills, an injection, the patch or a vaginal ring.
Another 15 percent reported using "less effective methods" (condoms, diaphragms, pulling out); about 9 percent didn't use birth control at all, noted the study's authors. Among the latter, about 18 percent said they didn't use contraception because they wanted to get pregnant again.
"I don't know how many girls want to get pregnant," said Cavanagh. "Most of the teens I've seen get pregnant a second time are not happy about it."
She said repeat births, when they're unintended, are partly the fault of the provider who took care of a teen mother-to-be during her first pregnancy, because they "didn't stress birth control strongly enough."
"Starting when they're six months pregnant, I start asking them what they're going to do," said Cavanagh.
Meaning what pregnant teens will do in terms of birth control after they deliver their child. Cavanagh said she advocates for IUDs, injections or implants.
"Condoms are effective if you use them, but I recommend they use condoms with a spermicidal gel, then have the emergency contraceptive pill [ready] in case they have an accident," she said. And if the male doesn't want to wear a condom "every single time," added Cavanagh, "they should not have sex."
One snag with condoms is they require perfect use in order to be an effective birth control method. "That takes a lot of sense of responsibility and a lot of organization, and a lot of kids don't have that, especially after they have a new kid running around," she said. "Their lives are chaotic, so I try to stress the long-term contraceptives like the implant or the IUD."
Cavanagh said these birth control methods "won't cost them anything" if they're covered by Medi-Cal or enroll in Family PACT.