As California's teen birth rate reached its lowest level in two decades, Kern County's teen birth rate dropped but remained among the highest in the state, according to a new state report.

Statewide, the teen birth rate -- defined as the number of births per 1,000 teens 15 to 19 years old -- plunged 60.5 percent from 1991 to 2011, according to the California Department of Public Health report posted online Tuesday.

Kern's teen birth rate also fell, from 62.2 in 2009 to 52.7 in 2011, according to the state figures.

Despite the progress, Kern's combined teen birth rate from 2009 to 2011 was 57.6, twice the state's rate and the fourth highest among California counties. Tulare County was first with an three-year aggregated teen birth rate of 60.2, and other San Joaquin Valley counties ranked high as well.

Still, teen health workers said the decline is good news. The trend also highlights the need to maintain funding for programs that provide a comprehensive approach to preventing teen pregnancy, they said.

"California has put resources into the Central Valley, but as a Latino woman I can tell you that we still have a long way to go," said Claire Brindis, a professor at the University of California, San Francisco.

Health workers offered on Wednesday a variety of reasons for Kern's historically high teen birth rate. Bill Phelps, Clinica Sierra Vista's chief of programs, said higher rates of poverty, lower education levels and a higher immigrant population contribute to the problem. Michelle Curioso, the Kern County Public Health Services Department's maternal, child and adolescent health coordinator, said she didn't have an answer for Kern's high teen birth rates, but her personal hunch is that it is linked to a lack of sex education and communication with adults, as well as low self-esteem in some teens.

Reducing teenage pregnancies takes more than sex education, health workers said. Teens also need to a sense of hope and goals, which may be hard to come by in areas prone to poverty and violence, Brindis said. Teen boys and girls are complex, and efforts to stem teen pregnancy needs to respond to their various needs, Brindis said.

Kern County teen health program managers said their methods are multi-faceted. For example, health educators for a state-funded program run by Ebony Counseling Center reach out to girls at five Bakersfield middle schools to teach them how to avoid becoming pregnant and help them identify their goals, said Scheneak Patterson, the information and education project coordinator.

"We go through various skits with them about them being in various scenarios and tell them different ways to say 'no'" to sex, she said.

The educators refer girls to Clinica Sierra Vista and Planned Parenthood, but they also guide the girls through a workbook that focuses not only on how to avoid pregnancy, but also achieving their short-term and long-term goals.

Clinica has provided family life education programs in local schools for several decades and was awarded a $555,000-a-year sex education grant by the state in 2012. Phelps said he thinks Clinica's programs can delay sex among teens and encourage consistent use of contraceptives for those who are active.

News of decreasing teen birth rates reaffirms the importance of those efforts, the program leaders said.

"It's encouraging because it makes you feel like what you're doing counts. It'll be encouraging to my health educators to know that they are making a difference," she said.

The downward trend in teen births continued last year in Kern, with preliminary numbers showing about 130 fewer births among 15 to 19 year olds, according to Kirt Emery, health assessment and epidemiology program manager for the Kern County Public Health Services Department.

Emery said Kern had a more than 50 percent decline in its teen birth rate from 1994 to 2012.

"It's huge, it's amazing -- it gives me goose bumps to say it," Emery said.

Statewide, California's teen birth rate fell from 70.9 in 1991 to 28 in 2011, Tuesday's report said. The state report noted that the decline puts California below the nation's 2011 teen birth rate of 31.3, but still above other developed countries, including Canada, Japan and Germany.

The state's teen birth rate fell across ethnic groups but remained the highest among Hispanics, who accounted for 73.8 percent of teen births in 2011.