The teen birth rate has fallen dramatically in the U.S. over the last two decades, with the exception of the Choctaw Nation in Oklahoma.

According to MSNBC, the pregnancy rate for Choctaw Nation teens between 15 and 19 years old is 36.2 per 1,000. That's nearly twice as high as the national rate and much higher than the rate for all American Indians and Alaska Natives.

Autumn Sisco is one of the teen mothers -- she gave birth when she was 15. Her husband, Mike Sisco, was only 15 at the time.

The tribe offers sexual education and STD prevention courses but the efforts are stymied by Oklahoma's conservative environment.

“It’s the cycle. Their mothers went through the same thing," Shonda Shomo, an outreach worker for the tribe's federally funded Better Beginnings program, told MSNBC.

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16 and pregnant in the Choctaw Nation (MSNBC 3/24)