ENID, Okla. — Teen pregnancy rates are high in Oklahoma, higher in Garfield County, and higher still among the Marshallese.
To some in the tight-knit Micronesian community, it's a problem. To many others, new life is a welcome blessing at any age, regardless of consequence.
"In our culture, we believe that having more children is how you protect your culture and preserve it," Terry Mote said. "We have never seen having a baby as a problem."
Mote works full-time as Micronesian health coordinator for Garfield County Health Department, where he functions as a sort of bridge between the Marshallese community and the department, building trust and communication.
Mote isn't a stranger to parenthood, or childbirth, as he has four kids himself, but said there is a proper time in life for these things.
That's the lesson he has for his children. It's a lesson he'd like to share, but he's not the one to do it, he said. He's not quite sure who is.
Since the 1986 adoption of the Compact of Free Association (COFA), an offer extended to the Marshallese by the U.S. government as compensation for using their islands as nuclear testing grounds, Marshall Islanders began immigrating to the United States in larger numbers.
The COFA allows the Marshallese to live in the United States as non-immigrant residents. They don't need any green cards to put down roots on American soil, and Enid is one of the largest Marshallese communities established in the U.S.
Because they have no trouble entering the country, many Marshallese don't pursue citizenship, and are unfamiliar with the process to achieve it, Mote said.
Their unique status makes it easy to move to the U.S., but difficult to receive many government-backed benefits. As non-immigrant residents, they cannot qualify for Medicare or Medicaid in Oklahoma.
"We have huge health disparities" between the Marshallese and the rest of the population, Garfield County Health Department director Maggie Jackson said. "They don't have access to care, and so we want to advocate for that however we can."
At the county Health Department at least, care is available, and made more accessible to those uninsured and of limited financial means.
The department has plenty of family planning resources available, too, but word doesn't always get out to everyone when barriers like language and culture stand in the way.
"Terry (Mote) has been a huge help in increasing awareness," she said.
Most methods of birth control are on hand at the department, Jackson said, available at discounted rates for the uninsured. A nurse practitioner is available in Enid two to three days a week, and provides family planning and counseling services.
"We want to make sure that youth feel comfortable that there's someone they can come talk to here," she said.
In Garfield County, the teen birth rate is 26.3 percent higher than the state average, according to Oklahoma State Department of Health. Rural counties often trend higher in this area, for a number of reasons.
There isn't a uniform or comprehensive approach in Oklahoma for teaching youth about their bodies, according to the department, and educational and medical resources, including contraceptives, are less available outside urban centers.
A breakdown of that 26.3 percent figure by ethnicity shows that more than 1 in 10 "Asian" teens are having children, a significantly higher rate than other ethnic groups in the county.
As Pacific Islanders, the Marshallese are categorized as "Asian" in the OSDH data, but a deeper look using separate census figures reveals that the number of Pacific Islanders in Garfield County is significantly higher than those of all other Asian heritage combined.
The census estimated fewer than 500 "Asian alone" lived in the county, as opposed to 1,753 "Native Hawaiian and Other Pacific Islander alone."
However, due to a lack of census participation among the Marshallese, it is difficult to gauge their total population in county, Mote said. By measuring attendance at various Marshallese churches in the community, he estimates the number to be around 3,500.
'We have to do something'
"In our culture, we don't talk about 'parts.' We don't discuss what parts are used for what, and what could be the consequences of using them," Mote said.
He's tried in the past to bring it up, earning cold stares for his trouble.
"In our every day lives at home we talk about culture, we talk about our finances, at church we talk about spiritual things, but when it comes to talking about things like that, few people ever do," he said.
A general desire to avoid such conversations is hardly unique to the Marshallese, but Mote said the taboo is particularly strong within the culture.
That he would bring it up with his own family is unusual, he said. That he would try and do so outside of it is beyond inappropriate.
Maybe it is inappropriate, he said, "but we have to do something to protect our kids."
A needed change
Whether at the Marshall Islands, or in Enid, teen pregnancy is common in the culture, to the point that it's seen as a non-issue, Mote said. It is normalized.
Mote's love for his culture, for its traditions, is "very strong," but this is one thing that needs to change.
The teen birth rate is limiting the community's potential, he said. Young mothers and fathers will struggle to balance their new responsibility with school. Grades will suffer, future plans, like college, may be put on hold or taken off the table entirely.
Mote's second oldest is in the midst of missionary work, and plans to wrap up college when he returns. He'll find a wife and start a family after he's finished, not before.
His two younger siblings want to follow in their big brother's footsteps, Mote said. They have learned by his example. Mote credits some of his son's success to the uncomfortable, "inappropriate" but necessary conversations they shared in his formative years.
"If there's a way we can educate the community on pregnancy, that would be a huge change for us," he said.
He can't take on that task, and it probably shouldn't be anybody from the culture, he said. An outside voice would be best.
"When foreign people are coming to our community, our churches, we really pay attention to what they say, and then we learn from them," Mote said. "But when I stand up and speak, they think, 'Who is that old man talking?'"
Were a non-Islander to come and speak on the topic, the taboo might loosen, allowing more conversations to take place within the community, he said.