The Statistics
There is some good news about teen pregnancy in the U.S.—it has declined 41% over the past 20 years.  But it is still very high, with about 750,000 pregnancies per year among young women age 15 to 19.  The annual rate of 7.2 pregnancies per 100 U.S. teens is much higher than the rates for other developed countries; for example, it is twice as high as the rates in Canada or Sweden.

Eighty-two percent of teen pregnancies are unplanned; teens account for about 1/5 of all unintended pregnancies annually and 10% of all U.S. births are to teenagers.  Fifty-nine percent of pregnancies among 15–19-year-olds in 2006 ended in birth, 27% in abortion and 14% in miscarriage. Black and Hispanic women have the highest teen pregnancy rates; their rates are more than double the rates of non-Hispanic whites.

Sexual Activity and Use of Contraception
Only 13% of teens have had sex by age 15, however the average age for first time sex is about 17 years old, and by age 19, 7 of 10 female and male teens have had intercourse.

The condom is the most common contraceptive method used at first intercourse; 68% of females and 80% of males use it the first time they have sex.  In 2006–2010, some 96% of sexually experienced female teens had used a condom at least once, 57% had used withdrawal and 56% had used the pill. Smaller proportions had used other methods.

Almost the entire decline in teen pregnancy rates in the United States is the result of improved contraceptive use; the remaining share is from increased proportions of teens choosing to delay sexual activity.  In 2006–2010, some 86% of female teens and 93% of male teens reported using contraceptives at last sex. These proportions represent a marked improvement since 1995.

The Consequences of Teen Sex and Pregnancy
Since young people today typically do not marry until their mid-20s, unless they have access to contraceptive information and services, they may be at increased risk for unintended pregnancy and STIs for nearly a decade or longer.

As a recent Guttmacher Institute report noted: “Unintended pregnancy can force women and their families to confront difficult abortion decisions or the potentially negative consequences associated with unplanned childbearing—including child health and development issues, relationship instability, and compromises in education and employment that may exacerbate ongoing poverty.”

U.S. women aged 15-19 had more than 200,000 abortions in 2006. The reasons teens most frequently give for having an abortion are that they are concerned about how having a baby would change their lives, they cannot afford a baby now and do not feel mature enough to raise a child. 

Babies born to teens are more likely to be low birth-weight than are those born to women in their 20s and 30s.  Teen childbearing is associated with reduced educational attainment. Teen mothers are substantially less likely than women who delay childbearing to complete high school or obtain a GED by age 22 (66% vs. 94%). And of important consequence to future careers and earning potential, fewer than 2% of teens who have a baby before age 18 attain a college degree by age 30.

Although ages 15-24 years represent only 1/4 of the sexually active population, they account for nearly half (9.1 million) of the 18.9 million new cases of STIs each year. Young people aged 13-24 made up about 17% of all people diagnosed with HIV/AIDS in the United States in 2008. The CDC reports that although blacks represent approximately 14% of the US population, they acquired an estimated 44% of new HIV infections in 2009 with the greatest incidence among men who have sex with men. In 2009, the rate of new HIV infections among black men was 6 1/2 times higher than that of white men, and the estimated rate of new HIV infections among black women was 15 times that of white women and more than three times that of Latina women. The CDC estimates that the lifetime risk of being diagnosed with HIV is approximately 1 in 16 for black men and 1 in 32 for black women.

Sexuality Education
In contrast to other countries, the U.S. has formal policies and provision of state and federal funds for educational programs that have as their sole purpose the promotion of abstinence.  About 1/3 of all local U.S. school districts that have policies on sexuality education require that abstinence be taught as the only appropriate option for unmarried people.

Following many years of experience and research, a clear picture of the effectiveness of abstinence-only education has emerged.  As described by a Guttmacher Institute report, “A recent, congressionally mandated evaluation of federally funded abstinence-only programs by Mathematica Policy Research—conducted over 9 years at a cost of almost $8 million—found that these programs have no beneficial impact on young people’s sexual behavior [1].”  Furthermore, to the extent that they ignore contraception and the benefits of safer-sex practices generally, abstinence-only programs do nothing to help prepare young people for when they will become sexually active.

In contrast, based on hundreds of program evaluations, there is strong evidence that comprehensive sex education can effectively delay sex among young people, even as it increases condom and overall contraceptive use among sexually active youth.  Surveys among adults, parents, teachers
and young people show that most Americans (82% in one study) believe that sex education should promote abstinence and provide information about the effectiveness and benefits of contraception [1].

Access to Contraceptive Services
No state explicitly requires parental consent or notification for contraceptive services.  However, two states (Texas and Utah) require parental consent for contraceptive services paid for with state funds.  Twenty-one states and the District of Columbia explicitly allow minors to obtain contraceptive services without a parent’s involvement. Another 25 states have affirmed that right for certain classes of minors, while four states have no law. In the absence of a specific law, courts have determined that minors’ privacy rights include the right to obtain contraceptive services. 

In 2002, some 90% of publicly funded family planning clinics counseled clients younger than 18 about abstinence, the importance of communicating with parents about sex or both topics. Nearly 2 million women younger than 20 were served by publicly supported family planning centers in 2005; these teens represented 1/4 of the centers’ contraceptive clients.  In 2006, only 5% of American high schools made condoms available to students.

Access to Abortion
As of October 2011, laws in 36 states required that a minor seeking an abortion involve her parents in the decision.  Most of these states require the consent or notification of only one parent, usually 24 or 48 hours before the procedure, but a handful of states require the involvement of both parents. Some states require the parental consent documentation to be notarized. Because the Supreme Court has ruled that states may not give parents an absolute veto over their daughter’s decision to have an abortion, most state parental involvement requirements include a judicial bypass procedure that allows a minor to receive court approval for an abortion without her parents’ knowledge or consent.

Lessons Learned
The experience of other countries with low rates of teen pregnancy and successful programs in the U.S. provide insights about what works to decrease unplanned and unwanted pregnancies among teens.  European countries strongly encourage teens to wait until they have established themselves before having children, but are more likely to view teen sexual expression as normal and positive.  There is also widespread expectation that young people who are having sex will take actions to protect themselves and their partners from pregnancy and sexually transmitted diseases.

To facilitate these views, schools in England and Wales, France and Sweden and in most of Canada provide age appropriate sexuality education at many grade levels that include explicit and comprehensive information about contraception and STI prevention.

These same countries provide contraceptive services that are integrated into other types of primary care and are available free or at low cost for all teenagers. Generally, teens know where to obtain confidential information and services and receive nonjudgmental care.

These same principles have worked well when implemented in the U.S. such as in the state of California.  In 1992, California’s teen pregnancy rate was the highest in the nation: For every 1,000 women aged 15–19 in the state, 157 became pregnant that year. By 2005, the rate had essentially been cut in half—to an all-time low of 75 per 1,000.  California’s teen pregnancy rate decline was the steepest for any state, and it was far above the national decline of 37% over the same period.

Public health experts in California credit teen pregnancy prevention efforts dating back to the 1990s for the state’s record declines.  California—the only state that never accepted federal abstinence-only dollars—has made teen pregnancy prevention a high public policy priority, with a strong emphasis on providing teens with comprehensive sex education and on fostering their access to the information and health care services they need to prevent pregnancy and protect their health.  This concerted statewide effort is still ongoing with 94% of schools providing HIV/AIDS prevention education and 96% providing sex education.

Since 1997, through a Medicaid waiver known as the Family Planning, Access, Care, and Treatment (Family PACT) program, California provides a package of contraceptive and related reproductive health services at no cost to 1.4 million adolescents and adults, males and females with incomes up to 200% of the federal poverty level.  Roughly 20% of Family PACT clients are younger than 20 and Latinos account for 52% of Family PACT’s teen clients.

Another lesson of the studies of reproductive health programs for adolescents is that the ability to choose among the most effective contraceptives is important.  Although hormonal methods, pills, rings, injectables and the patch are theoretically highly effective, under typical use conditions they frequently fail.  Among teenagers, oral contraceptives, condoms, injectables and withdrawal are the most commonly used methods [3].  While with perfect use these methods are highly effective, 9% of pill users, 18% of condom users, 6% of injectable users and a high proportion of withdrawal users will become pregnant during the first year of typical use [4].

Contraceptive effectiveness of these methods is also substantially impaired because of high discontinuation rates.  About half of condom and injectable contraception users—and almost 1/3 of pill users—will discontinue use within a year and may become non-users of contraception [4]. Long-acting reversible contraceptive (LARC) methods, such as intrauterine contraceptives and implants, have a proven record of very high effectiveness, many years of effectiveness, convenience, cost effectiveness, and suitability for a wide variety of women, including teens who have not had children.  However these methods comprise only 5.5% of contraceptive use in the U.S.  Programs that emphasize use of the LARC methods could decrease the current unacceptably high rate of unintended pregnancies among teens.
 
 

 [1] Boonstra H. The case for a new approach to sex education mounts; will policymakers heed the message? Guttmacher Policy Review | Volume 10, Number 2 | Spring 2007 available at:  http://www.guttmacher.org/pubs/gpr/10/2/gpr100202.html

Note: Much of this essay is an edited and abridged version of: Guttmacher In Brief. Facts on American teens’ sexual and reproductive health. December 2011 and other Guttmacher Institute publications available at: http://www.guttmacher.org/pubs/FB-ATSRH.html. 

Links
Websites with information on contraceptive choice for teens, adolescent pregnancy and teen sexuality can be found at:

http://www.guttmacher.org