For decades, teen births had been decreasing in West Virginia and nationally, but the state numbers started rising again between 2005 and 2009. The problem is now particularly acute in eight southern and central counties: McDowell, Mingo, Clay, Boone, Fayette, Calhoun, Mercer and Logan.
McDowell, plagued by high unemployment, poverty and drug abuse, also has the state's highest infant-mortality rate, at 16 per 1,000 live births, the report says. That's a 50 percent increase from 2005.
And it has the state's second-highest rate of child abuse and neglect, with 46 cases per 1,000 children. That's up 39 percent from 2005, the report says.
McDowell also ranks worst in West Virginia for births to women and girls with less than a 12th-grade education, at 31 percent, and worst for children living in poverty, 45 percent.
For the past year, educators, government agencies, private companies and nonprofits have focused on McDowell, hoping to improve the school system and address other chronic problems created by the economic challenges.
The Reconnecting McDowell initiative is a year old and has made some progress in expanding broadband access, literacy programs and health services. Teen pregnancy is one of the areas it hopes to tackle, along with dropout rates, substance abuse, poor nutrition and a lack of physical activity.
Hale said giving teen girls a "credible vision of a positive future'' is critical to reversing the trend.
"A large factor contributing to teen pregnancy there is teenagers having no sense of themselves in the future,'' she said. "They have no career goals. They have no sense of how to get education, training, jobs. ... That kind of thinking makes you slip into risky behaviors.''
More than a third of McDowell residents live in poverty, and median incomes are less than half the U.S. average.
The county ranks last in the state in many other health measures, with a premature death rate nearly double the state average and high rates of physical inactivity, adult smoking and obesity. It also has led the nation in fatal prescription-painkiller overdoses.