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Holyoke and Springfield have garnered two of the top four spots in that category for several years running, public health officials noted yesterday, with no prospects of marked improvement in sight.

"In the western region of the state there's isn't any targeted state funding for programs to decrease pregnancy among teens," said Helen Caulton-Harris, director of the Springfield's Office of Health and Human Services. "People are really working in silos as far as the work of prevention is concerned. We're not really working together in any measurable way."

Those numbers are particularly jarring when compared to statewide teen pregnancy rates, which are 49 percent lower than the national average, according to the report. The state's preterm delivery rate also was lower than the national average by 30 percent, the numbers show.

Holding with past trends, black and Hispanic teens in this area give birth at a higher rate than do white teens.

In Springfield, of the women ages 15 to 19 who gave birth in 2005, 10 percent are white; 24 percent are black; and 65 percent are Hispanic. In Holyoke, those numbers are broken out for whites and Hispanics: 14 percent versus nearly 85 percent.

Showing a sliver of a silver lining in the numbers, the teen birth rate in Holyoke declined by almost 27 percent between 1996 and 2006, the report states.

However, a birthing physician in Holyoke yesterday said she does not anticipate further significant decreases in the near future.

"I don't see it," Dr. Gretchen E. Loebel, medical director of Midwifery Care of Holyoke.

"It's a cultural issue. In the Puerto Rican community they tend to start their parenting very young. The Hispanic community in general tends to put a high value on parenting," she said.

Patricia Quinn, executive director of the Massachusetts Alliance on Teen Pregnancy, said communities laden with high rates of young women giving birth must focus on sexual education, contraception for teens who are sexually active and opportunities for teens.

"Look at the drop-out rates. It's a pretty close correlation," Quinn said. "The same cities and towns with high drop-out rates also have high teen pregnancy rates."

Other significant findings of the report centered around birth weight, infant mortality, prenatal care and rising numbers of Caesarean-section births and incidents of gestational diabetes.

Caesarean sections have hit an all-time high at just over 33 per thousand, the report shows.

Loebel said that many times, physicians are driven to do more Caesareans by patient demands and the fear of getting sued for not doing the surgery fast enough if complications arise.

She said that Holyoke Medical Center's Caesarean rates are the among the lowest in the state, and her practice resists planned surgeries. One such surgery often results in subsequent surgeries, which increases risk to the mother, Loebel said.

At Baystate Medical Center, where Caesareans are performed at a higher rate, Dr. Heather Z. Sankey said the surgeries have fluctuated with cultural attitudes about what's best for mother and baby.

"In the late 80s, there was a big push. In the 90s, we would track rates and tell someone if they were performing too many," said Sankey, director of the General Obstetrics and Gynecology Division at Baystate.

Now, she believes doctors are making more concessions for elective Caesareans.

"If we can't tell you (a vaginal birth) is not safer for the baby and if you're willing to take that risk, is it fair for us to say no?" she asked.
http://www.masslive.com/republican/stories/index.ssf?/base/news-2/1202977365225050.xml&coll=1

Pregnancy derails Hispanic teens
Friday, February 15, 2008

New state health statistics showing that the cities of Springfield and Holyoke have failed to make a dent in rising teen pregnancies, especially among Hispanics, is discouraging news - not only for the ill-equipped young mothers, but for the economic well-being of the entire region.

In Springfield, 65 percent of teen births in 2005 were to Hispanics, while Holyoke saw a greater number - 85 percent. Even more discouraging than the increase in teen pregnancies, however, is the sense that little can be done to change what some say is a "cultural" phenomenon among Hispanics.

Dr. Gretchen E. Loebel, medical director of Midwifery Care of Holyoke, said she does not anticipate significant decreases in the teenage pregnancy rate among young Hispanics. "I don't see it," she said. "It's a cultural issue. ... The Hispanic community in general tends to put a high value on parenting."

It seems, then, that the challenge for society is to help teenagers understand that postponing pregnancy until they've finished their education - and are financially able to provide for a child - enhances their chances of being good parents.

Cities with high rates of teen births must focus on sexual education, contraception for teens who are sexually active - and opportunities for teens that give them a wider sense of their possibilities. It's a message that must be delivered often and early - at least as early as middle school, perhaps even earlier. Hispanic parents - many of them only 15 or 16 years older than their teenagers - must be involved in the process as well. Because of often deeply held religious beliefs, abortions are rare among Hispanics. Perhaps, then, churches can play a role in encouraging teens to put off parenthood.

Clearly the focus must be prevention. Current state funding is sadly inadequate, and efforts to reach teens are fragmented, according to Helen Caulton-Harris, director of Springfield's Office of Health and Human Services.

If the teen pregnancy epidemic continues, so will poverty - and the cost of dealing with poor mothers and their children will strain the economy of the two cities - and the whole region. The crisis demands that we redouble our efforts to find programs that work.
http://www.masslive.com/republican/stories/index.ssf?/base/news-2/1203063777269040.xml&coll=1