Tuesday, May 18, 1999

By Ken Ige, Star-Bulletin
Echan Riveira, 17, is due June 24. She and the baby's father
are still together. She plans to go to college and become a
pediatrician. Riveira has been receiving guidance and
education from the Waianae Coast Comprehensive
Health Center's Perinatal Support Services program.


Health wanes
for isle youth

Teen pregnancies push
Hawaii from 8th to 13th place on
a study of kids' well-being;
but the number is falling

Kids Count coordinator says
figures are misleading

By Helen Altonn


Echan Riveira, 17, considered her options when she learned she was pregnant just before school began last year.

"It was hard; I didn't know what I wanted to do," she said. "A lot of people I talked to brought a different point of view. I decided to keep it."

She stopped attending school but has been studying for a general equivalency diploma and will take the GED test in July after her baby is born, due about June 24.

She said she's still looking forward to college. She wants to be a pediatrician.

A high teen pregnancy rate figured in Hawaii's drop from eighth to 13th place among states in a national study released today on the overall well-being of children.

But officials say teen pregnancies have been declining in Hawaii and across the country since 1991 because of health education programs. The study, by the Annie E. Casey Foundation, was based on 1985-1996 data.

Riveira discussed her future as a teen mother during a recent checkup and meeting with Shirley Aipa at the Waianae Coast Comprehensive Health Center.

A community outreach worker in the center's Perinatal Support Services, Aipa works with pregnant girls 19 and younger. Another outreach worker cares for pregnant adults. The perinatal team also includes a social worker.

Riveira says it's a great program: "I learned a lot the first night, like wow! They taught us about our insides, how we were made to do this. It was neat."

By Ken Ige, Star-Bulletin
Shirley Aipa, left, a community outreach worker in the
Waianae Coast Comprehensive Health Center's Perinatal
Support Services program, has been a friend to
17-year-old mother-to-be Echan Riveira.

She said she met the baby's father while living in Nanakuli in 1995-96. She returned after living with an aunt in Manoa about 1 years ago, and they met again.

"We've been together since," she said.

The father, a 16-year-old high school student, wasn't very happy about the baby at first, she said. "Now he's coming around." They live with his mother and grandfather in Waianae.

Family members on both sides were "a little shaky in the beginning" about the situation, Riveira said. "Now it's a lot better -- my mom especially." Her mother lives on the Big Island and wants her to move there, Riveira said.

She said she knows all about safe sex but wasn't practicing it at the time. "I know what I could have done. ... This I hope is the last (baby)."

Tough odds

Aipa said all her teens -- some as young as 13 -- are at risk. Some return a second and third time.

"One came in for pregnancy testing until she got pregnant," she said.

Another ended up with three babies but is "doing real good," living in her own place with the father of two of the children and planning on getting a GED, said Aipa.

Joyce O'Brien, the Waianae health center's associate director, said it served 534 pregnant women last year. The teen population averages about 172, she said.

She said much family planning goes on in schools but that a lot of kids aren't in school and many girls become pregnant by older men -- not their high school peers.

More people are seeking early prenatal care because the facility tracks them, O'Brien said. "If they miss an appointment, we are notified immediately so we can find them and get them back in."

She said "the main thing is follow-through" by outreach and case workers. Low birth weights have been reduced through improved care, she said.

Aipa said she focuses on health education and problems at home, such as domestic violence and substance abuse. Good support services and collaboration with agencies, Healthy Start and schools help the program work, she said.

Biggest challenges

Keeping pregnant teens in school and drug use by their parents are the two biggest things to deal with, Aipa said. "And no communication between the parents and teens."

Records are sent automatically to outreach workers if clients don't keep medical appointments, Aipa said. "We call home, make home visits and call counselors, and we go and get them. We do whatever it takes to get the patient in."

In five years in the perinatal department, Aipa said she's "never had to battle" with pregnant adolescents to get them into prenatal services. However, it's more difficult to convince substance abusers and diabetics, she said.

If they say they're too tired to go to the health center or they have no ride, they're given free transportation. They also get appointment reminder calls.


Making a choice

Like Riveira, most pregnant teens know about family planning and contraceptives and where to get them, Aipa said.

But some deliberately get pregnant to try to keep a boyfriend or have someone to love, she said. And that's OK with some parents, she said.

"What gets to me is when a family says it's OK, and she's with a guy two times older than she is."

Some boyfriends are supportive, but adolescents often must rely on family, Aipa said.

"Only my auntie ... helps me a lot," said Riveira, who has a brother and four sisters.

Parents usually are angry when they find out their daughter is pregnant, but they change, Aipa said, especially after the baby is born.

Motherly love

She said the workers discuss alternatives with teen mothers, but she couldn't recall any cases where a teen chose abortion or adoption. "Two were thinking of abortion. ... They delivered and ended up keeping the babies."

When pregnant teens enter the program, workers try to determine problems, goals and needed services, and follow their patients until the babies are born, Aipa said.

"We try to get the family to give them the love, the bond, they need. After delivery, there is a need to still take care of the mother -- a child herself.

"Children having children -- too young."


The best, the worst

The Kids Count Data Book ranks Hawaii 13th in the welfare of its children. Here's a look at the best and worst states:

Top 5

1. New Hampshire
2. North Dakota
3. Minnesota
4. Wisconsin
5. Utah

Bottom 5

46. Mississippi
47. Louisiana
48. New Mexico
49. Alabama
50. Arizona

Number of factors affect
children’s lives

Among highlights of the Kids Count Data Book reported from 1985 to 1996:

'A lot of kids'

Bullet After improving conditions for its children for several years, Hawaii has dropped to 13th place among states for overall well-being of children. Last year, Hawaii placed eighth.

Critical factors in the slide to 13th place: More single-parent families. More unemployment. More poverty.

The Annie E. Casey Foundation, which conducts the project, advocates communitywide changes to support troubled families and help kids overcome barriers to success.

"An alarming number of America's youth are growing up outside the reach of the continuing economic boom, hampered by extraordinarily difficult family conditions that are likely to rob them of their chances of success as adults," the foundation said.

Bullet In Hawaii, 12 percent of children fall in a high-risk category with four or more family obstacles hampering their growth to adulthood.

That's slightly less than the national average of 13 percent of children, nearly one in seven, in the high-risk category, said Marcia Hartsock, project coordinator in Hawaii for Kids Count at the University of Hawaii Center on the Family.

"But poverty in this report is really understated for Hawaii because of our high cost of living," she pointed out. "I think we probably have more kids (at high-risk) than we realize.

"If you think of us having 300,000 kids, 12 percent is 40,000. ... That's a lot of kids."

One parent

Hartsock said the percentage of Hawaii children living with one parent has grown from 21 percent to 26 percent:

Bullet Hawaii is 34th in the nation with 30 percent of its children living with parents who don't have full-time, year-around employment.

Poor children

Bullet While the study shows 12 percent fewer children living in poverty in 1996 than in 1985, Hartsock said, "It is getting much, much worse and it is related to so many negative outcomes."

Bullet The report uses 1998 figures to look at education: 55 percent of fourth-graders scored below the basic reading level compared with an average 39 percent nationally; 40 percent of eighth-graders scored below the basic reading level compared with 28 percent nationally.

By the numbers

Among other highlights reported from 1985 to 1996:

Bullet Hawaii's teen birth rate (births per 1,000 females ages 15 to 17) increased 22 percent, compared with a 10 percent increase nationally.

Bullet The infant mortality rate improved by 34 percent, from 8.8 deaths per 1,000 live births in 1985 to 5.8 deaths in 1996.

Bullet Youths 16 to 19 years old leaving school before graduation remained at a 5 percent rate.

Bullet Hawaii immunized 81 percent of its 2-year-olds in 1997, compared with 78 percent nationally.

Project coordinator
questions annual study

By Helen Altonn


An alarming increase in Hawaii teen pregnancies reported in the 1999 Kids Count Data Book is misleading, officials say.

"I already yelled at national about that," said Marcia Hartsock, project coordinator in Hawaii for Kids Count, with the University of Hawaii Center on the Family.

She said the Annie E. Casey Foundation, which conducts the annual Kids Count study, "put out a book in February (about teen sex). ... The whole message was how great it is that the teen birth rate is declining, from about 1991 to present.

"It's true that we can't turn cartwheels because we're not below where we were in the early '80s," Hartsock added. "But I think we have to focus our efforts on what's happening now."

Kids Count said births per 1,000 females from ages 15 to 16 in Hawaii increased by 22 percent from 1985 to 1996, compared with a 10 percent increase nationally.

Births in the teen category increased from 23 to 28 per 1,000 females from 1985 to 1996, the study said.

An April report by the Alan Guttmacher Institute presents a more encouraging picture, said Sarah Kuzmanoff, state Health Department family planning section supervisor.

Hawaii had the nation's third-highest pregnancy rate for adolescents in 1995 and now is in 15th place, she said.

The Guttmacher report cites a continuing downward trend in America's teen pregnancy rate, with a 9 percent drop since 1986 "and, more significantly, 17 percent since peaking in 1990."

The institute ranks Hawaii:

Bullet 26th in the nation in births per 1,000 women ages 15 to 19.

Bullet Seventh in abortions per 100 pregnancies in that age group.

"We're still going down in all three categories," Kuzmanoff said, "like everyone else since 1991."

In 1995, she said, 45 percent of island students in grades 9 to 12 were sexually active. Now it's about 40 percent, she said. "We're going in the right direction."

"We like to emphasize that programs are working," she said. Still, some pockets in the state -- mostly on the Big Island and Oahu's Waianae Coast -- tend to have more at-risk kids, she said.

Kuzmanoff, who used to work with pregnant women in Waianae, said "teens obviously are at risk for all kinds of things," but their babies rarely have low birth weights.

"In Hawaii, we seem to be pretty good at getting them into programs. We don't have a lot of high-risk pregnancies and births."

The number and variety of programs to prevent pregnancies and second births to teen-agers have greatly increased in the past two years, Kuzmanoff said.

Programs encourage abstinence but also make sure students have the necessary information if they are sexually active, she said.

"People realized it was a growing problem and it really was given priority. We don't want that to slack off because we see an improvement," she said.

Candice Radner Calhoun, community adolescent health coordinator at the Health Department, said it takes a broad-based approach to prevention and health decision-making "starting from the very young."

A sex-abstinence program is being conducted under a contract with the Boys & Girls Clubs for 9- to 12-year-olds at Kapaa, Kauai; on Lanai; in Keaau on the Big Island; and Ewa Beach on Oahu.

The federally funded program teaches children resistance methods and healthy decision-making, Calhoun said.

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