About 40 girls under the age of 15 become pregnant each year in Rhode Island.

The number of girls ages 10 to 14 who become pregnant is substantially lower than for older teens. But it underscores the need for better sex education in middle school and at home, say health and education officials.

“This is a public health issue,” said Miriam C. Inocencio, president of Planned Parenthood of Rhode Island. “We should not be seeing kids this age getting pregnant, many of whom don’t have enough information and don’t know any better.”

Dr. Patricia Flanagan, who heads the Rhode Island Teen Pregnancy Coalition, says that while most youth are not sexually active in middle school, adults should ask themselves if they are doing enough to talk to young teenagers and make sure they understand the consequences of being sexually active.

“We are so bad about being able to have conversations with young people about sex,” Flanagan said. “Yet we as a society use sex to sell everything — beer, clothes, cars. But we don’t give [teenagers] an honest and safe place to talk about sexuality, about feelings they may have, about changes in their bodies. We do them a disservice.”

Flanagan said Rhode Island needs more culturally diverse workshops for parents and educators, designed to give them skills to talk with young people about abstinence, birth control and diseases.

In the past, some parents worried that talking about sex with their children would encourage them to have sex, Flanagan said. However, studies have shown that talking to young people about sex does not encourage them to be sexually active, she said. According to surveys, about half of high school students in Rhode Island report they are sexually active.

“Burying our heads in the sand and saying ‘don’t do it’ is not helping,” Flanagan said. “Now is the time to have a healthy conversation about sex, and not have it be some dirty little secret.”

A NATIONAL controversy emerged last month when a Maine school district decided to allow middle school students access to birth control if their parents gave them permission to use school-based health centers.

In Rhode Island, neither middle school students nor nearly all high school students have access to contraception through their schools.

The one exception is the Met School in Providence, a high school that began offering contraception to students in 2005 through its Adolescent Health Center — the only school-based health center in Providence.

In addition, a handful of schools in urban districts — Central Falls, Pawtucket, West Warwick and Woonsocket, which along with Providence claim the highest teen pregnancy rates in the state — have school-based health centers that are sponsored by community health programs, such as Thundermist and Blackstone Valley Community Healthcare. The programs can refer students who want birth control to their off-campus offices after school hours. Parental consent is not required, as the community health programs receive Title X federal financing, which permits them to offer “family planning services” to young people without notifying their parents, said Rosemary Reilly-Chammat, the Health Department’s coordinator of the school health program.

The school-based health centers were once financed by a combination of grants and federal and state dollars, and had a budget of more than $1 million a year. Now, the centers receive only state money, $450,000 this year.

When asked why more schools do not have school-based centers, particularly as they are recommended by both the state education and health departments, Reilly-Chammat noted a combination of limited money and lack of interest.

“One thing that is essential for the school-based health center model to work is support from school administration,” Reilly-Chammat said. “If the focus is on academics and [a health center] is seen as taking away from that, that would drive the decision [to not have one].”

RHODE ISLAND’S sex education program, approved by the state Department of Education, promotes abstinence as the first and best method to prevent pregnancy and the transmission of disease. However, the state’s 800 certified health teachers are also required to offer “comprehensive AIDS instruction, which shall provide students with accurate information and instruction on AIDS transmission and prevention.”

It is unclear how many districts require an in-depth discussion about birth control at the middle school level.

Districts decide what is taught in health classes. State officials said they were not certain exactly what middle school students are learning, beyond broad frameworks established by the state that require students in grades 5 through 8 to learn about how to prevent sexually transmitted diseases using precautions such as condoms. A yearly health-education assessment that districts submitted to the Education Department was discontinued a few years ago for budgeting reasons, said Midge Sabatini, who coordinates school health programs.

“By and large, we don’t know who is teaching what to whom in our schools,” Flanagan said. “I would guess some districts and schools are doing [sex education] really well and some are doing it really poorly.”

Planned Parenthood, which offers workshops to health teachers each spring, has been told by teachers that they lack sufficient training and the proper instructional materials, Inocencio said. The organization also runs a Teen Clinic that receives Title X money and provides contraception to teens.

“It is an ongoing concern to us, whether students are really receiving comprehensive, medically accurate information,” Inocencio said. “Ideally, you want young people to put off sex as long as possible. But they need to know what safe sex means.”

Health teachers are asked to teach the most sensitive topics — depression, suicide, drug use and sexual activity — yet have little preparation or comfort with such complex subjects, said Steven Cohen, a health teacher at Classical High School in Providence. In reality, he said, students end up learning only what the teacher is comfortable with, rather than a full curriculum.

“The most common question I hear from health educators is, ‘What can we say in class and what can we not say?’ ” said Cohen, who is also the executive director of the Rhode Island Association for Health, Physical Education, Recreation and Dance.

“Most of the time, you have phys-ed teachers also delivering health ed,” Cohen said. “The topics are extremely sensitive and the information is constantly changing and they don’t have much time to teach it.”

Cohen said middle school students should learn about pregnancy prevention and disease prevention along with abstinence, but says those topics would require training beyond what health teachers currently receive.

“The discussions at the middle school level need to happen in a very sensitive and appropriate way, and that would require additional training, for that age group,” he said. “It’s a very vulnerable group.”

TEEN PREGNANCY rates, nationally and locally, have been falling for several years, although Rhode Island continues to rank highest among the six New England states. Adolescents waiting longer to have sex and correctly using birth control are cited as reasons for the decline.

Each year, there are roughly 600 pregnancies among 15- to 17-year-olds and about 1,300 pregnancies among 18- to 19-year-olds in Rhode Island. In about half of the cases, the teens give birth, with the other half of the pregnancies ending in abortion, miscarriage or stillbirth.

Statistically, teen mothers tend to be poor and at risk for dropping out of school, remaining in poverty and having another child before age 20.

There are few programs and resources to help teen mothers stay in school, Flanagan said.

Health and school officials said they do not have a clear picture of how many middle school students are sexually active. Middle school students were included for the first time last spring in an anonymous, voluntary Youth Risk Behavior Survey given to a random selection of adolescents throughout the country. The results are expected in December, Sabatini said.

The 2005 survey of 2,362 Rhode Island ninth through twelfth graders indicated that almost half — 46.7 percent — had had sex. Of those, about 66 percent reported they had sex within the past three months and used a condom.

Flanagan said she sees “red flags” when very young teens are sexually active.

“Studies have shown that the younger a girl is when she becomes pregnant, the more likely she is to be a victim of sexual abuse, either before the pregnancy or by the act itself [that caused the pregnancy],” Flanagan said. “In my mind, being voluntarily sexually active when you are 13 does not fit with your sexual development at that age. Normally, you would be wondering about what’s happening with your body, becoming comfortable with who you are, and relationships would be romantic rather than sexual.”

For more information, see the following Web sites:

• www.neahin.org/canwetalk/ — Sponsored by the teacher union, National Education Association’s health-information network.

• www.parentlinkri.org — Parenting skills geared toward teens.

• www.thriveri.org — Rhode Island’s school health program, run by the state Health and Education Department.

jjordan@projo.com