Teenage American Indians and their babies: Another addition to the Wall of the Forgotten Natives

The corridor near E. Franklin and Hiawatha avenues known as the "Wall of Forgotten Natives" has become a symbol of everything many Minnesotans have chosen to ignore about Native Americans in this state. From land disownment to population decimation to banning of cultural and religious practices to sterilization campaigns, Native Americans have experienced time after time the violent uprooting of their culture and ways of life.

The ongoing news of an emergent "tent city" in Minneapolis is only one of the many symptoms that haunt the Native American community, but it only takes looking at rural Minnesota to understand how the ongoing cycle of transgenerational historical trauma reflects in the newer generations. One consequence that is often overlooked is teenage pregnancies.

This year, the Minnesota Adolescent Sexual Health Report conducted by the University of Minnesota Healthy Youth Development Prevention Research Center indicated that American Indians between ages 15 and 19 are the only minority that has seen an increase in birthrates in the last year (5.9 percent) while birthrates among adolescents in every other racial group have been steadily decreasing. As alarming as this trend may seem, it received little attention. Instead, media coverage of the report focused on overall declines and patted Minnesota on the back.

Mahnomen County, on the White Earth Indian Reservation, has one of the largest proportions of Native Americans in Minnesota. It also has a high poverty rate, with 30 percent of its children living in poverty. This county also happens to have the highest teenage birthrates in the state since 2011. In fact, Mahnomen has triple the rate of teen births as the entire state of Minnesota and even the national average.

The lack of timely access to family-planning clinics, concerns around provider privacy and confidentiality when accessing birth control in this small community and the scarcity of youth development programs tailored to Native American adolescents are only a few of the root causes for the alarming teen birthrates in this county. Indeed, these issues are only the tip of the iceberg when considering the dire consequences for these mothers and, ironically, taxpayers alike.

While teenage childbearing is associated with social and financial hardship on top of lower educational attainment in adulthood for both mother and child, there is also a consequence for taxpayers. According to the latest figures from Youth.gov, adolescent childbirths cost U.S. taxpayers an annual average of $11 billion due to an increase in health care and foster care, higher rates of incarceration among children of teen parents and lost tax revenue from lower educational achievement and income among teen mothers.

Furthermore, in 2016, 66.9 percent of births among American Indians in the U.S. were financed by Medicaid. And mothers under 20 were the highest users. The most recent data detailing the cost of childbirth indicate that Medicaid would pay an average of $11,000 for maternal and newborn care. Considering that Mahnomen County experienced a total of 88 teen births that same year, that means taxpayers contributed close to $1 million in Medicaid payments, or 8 percent of Mahnomen's total annual revenue.

The reality is that teenage American Indians are in desperate need of a policy change. If we want to decrease the expenditure associated with the dire outcomes related to teen pregnancy, perhaps it's wise to consider investing that same money in youth development programs as a preventive measure. Teen pregnancy-prevention programs tailored to Native American adolescents that are created in cultural consultation with the community respecting their ways of knowing have been shown to have higher rates of success.

It's time for our state to remember that Native American boys and girls deserve a better hand than the one they have been dealt. Let's not leave them to give birth by the Wall of the Forgotten once more.

Ericka A. Lara Ovares is a physician and University of Minnesota public health policy and administration master's student.