A dramatic drop in the number of abortions performed in Hawaii over a recent five-year period has health and education experts wondering what caused the change.
The number of terminated pregnancies fell nearly 30 percent in Hawaii from 2010 to 2014, representing the greatest abortion decline in the nation. That decline to 2,147 abortions in 2014 happened as the state’s historically high teen pregnancy rate — Hawaii was 10th in the nation for teen pregnancies in 2013 — has been falling.
Changes to Hawaii’s sex education policies have played a role in reducing the number of unwanted pregnancies and the abortions that sometimes follow, agencies like Planned Parenthood say.
"There was, starting in 2010, a lot of new teen pregnancy education going on in both school and non-school settings using evidence-based curricula," said Judith Clark, executive director of Hawaii Youth Services Network. "I would certainly hope those efforts reduced the incidents of abortions by reducing the rate of pregnancies."
But others attribute the decline in abortion to the easier access to emergency contraception, which became available to teenagers as young as 14 without parental permission in 2013.
"It’s the availability of the morning-after pill," said Rep. Bob McDermott, a Republican who believes most sex education programs in Hawaii encourage teens to have sex. "The need for surgical abortions is diminished."
Health experts say there could be a variety of explanations for the abortion decline, including Hawaii residents’ high rate of use of long-acting contraception methods such as intrauterine devices or hormonal implants. Less than 20 percent of abortions in Hawaii are performed on teens, and the majority of procedures are carried out on 20 to 29-year-olds, said Dr. Donald Hayes, epidemiologist with the Hawaii Department of Health.
But some are concerned that a recent policy change by Hawaii’s Board of Education to require parental consent for students to participate in sexual health education programs could reverse those trends. There are ongoing debates at the Board of Education about whether sex education should be mandatory in public schools.
"All these gains could be lost if the education in the schools was a big portion of the reductions here," Hayes said.
Young people in Hawaii tend to wait longer to have sex than their counterparts on the mainland. But among those Hawaii teens who reported having sex in 2013, 54.1 percent did not use a condom during their last sexual intercourse, compared with 40.9 percent nationwide, according to the Hawaii Department of Health.
Public schools in Hawaii are not allowed to distribute condoms. There are resources in the community for people to get condoms or information about sexual health, but especially in Hawaii’s rural communities, some young people shy away from those resources.
"In very small clinics, if you walk in and you know aunty is going to see you, you may not want to go there," Clark said.
In 2009, the Department of Education implemented a new rule mandating that sexual health programs taught in Hawaii must provide medically accurate information. The state also was awarded a $5 million grant to spend on sex education programs over five years, Clark said.
With that cash influx, Clark’s organization set out to remake sex education videos that were produced in the 1980s, including one about HIV that featured white and black actors from the mainland wearing heavy sweaters in ice skating rinks, Clark said. "It was very didactic, very boring and very inappropriate for Hawaii because nothing looked familiar," she said.
They created new DVDs featuring surf scenes and a Polynesian tattoo shop, where the local actors, who were mostly mixed-race or Asian-Pacific Islanders, wore tank tops and slippers.
In one video about the importance of condoms, called "You cannot get HIV laddat!," the actors speak in local pidgin dialect throughout the story.
Before 2009, Catholic Charities was teaching an abstinence-based education program called "Try Wait!" in Hawaii public schools. McDermott said he would like to see more emphasis on abstinence in sex education programs.
Hawaii should consider requiring parental consent for minors to get abortions, he said.
"If a 13-year-old is pregnant, she better talk to her mother and father first," McDermott said. "That same girl can’t get an aspirin in school, but can go down and have an invasive surgical procedure without talking to her mom or dad."