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Adolescent Pregnancy and Protective Behaviors Print
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Until recently, adolescent pregnancy and birth rates in the United States had been slowly but steadily declining. But 2006 data showed a three percent rise in birth rates among 15- to 19-year-old women.1 Recent research also provides evidence of adolescents’ protective behaviors, both abstinence and contraceptive use. This paper describes recent trends in pregnancy, birth, and abortion rates, and offers findings on abstinence and contraceptive use among teens.

Pregnancies and Pregnancy Rates in the United States

  • In 2004, teens accounted for about 11 percent of all the pregnancies among U.S. women, about 10 percent of the births, and just under 10 percent of the abortions.[1,2,3]
  • In the United States in 2004, there were 72.2 pregnancies per 1,000 women ages 15 through 19, including 1.6 per 1,000 teens under age 15; 41.5 per 1,000 teens ages 15 through 17; and 118.6 per 1,000 teens ages 18 and 19.2
  • Pregnancy rates in 2004 were higher among adult women than teens. For example, there were 164 pregnancies per 1,000 women ages 20 through 24; 169 per 1,000 women ages 25 through 29; and 135 per 1,000 women ages 30 through 34.[2]
  • Between 1990 and 2004, U.S. adolescent pregnancy rates declined 38 percent among 15- to 19-year-old women; 53 percent among youth under age 15; 46 percent among 15- to 17-year-olds; and 30 percent among 18- to 19-year-olds.[2]
  • Teen pregnancy rates dropped in three major ethnic groups yet remained higher for black and Hispanic teens than for whites. In 2004, among teens ages 15 through 19, the pregnancy rate was: 45 per 1,000 non-Hispanic whites; 128 per 1,000 non-Hispanic blacks; and 133 per 1,000 Hispanics.[2]
  • In one study, bisexual and lesbian teens, although about equally likely to have had sex as their heterosexual peers, had more than twice the proportion of pregnancies (12 versus five percent, respectively).[4]

U.S. Births and Birth Rates

  • In 2006, American women gave birth to 4,265,996 infants, the largest number of births since 1961. Women ages 15 through 19 accounted for about 10 percent (435,427) of the births, while women in their 20s had about 53 percent of the infants.[1]
  • Birth rates for U.S. teens ages 15 through 19 rose three percent, from 40.5 in 2005 to 41.9 per 1,000 in 2006, the first increase reported since 1991. At the same time, birth rates also rose among all age groups of adult women.[1]
  • Among U.S. teens ages 15 through 19, the birth rate was lowest among Asian and Pacific Islanders at 17 per 1,000. The rates were: 27 per 1,000 non-Hispanic whites; 55 per 1,000 American Indian/Alaska natives; 64 per 1,000 non-Hispanic blacks; and 83 per 1,000 Hispanics.[1]

Abortion in the United States

  • Pregnancies among women ages 15 through 19 are more than twice as likely to end in live birth as in abortion.[2]
  • The proportion of abortions obtained by women younger than 20 has dropped steadily since 1974. In that year women younger than 20 accounted for 33 percent of all abortions; in 1989, 25 percent, and in 2004, only 17 percent.[5]
  • The number of abortions in the United States declined by 24 percent between 1990 and 2004, down from 1.61 million to 1.22 million. In 2004, the abortion rate was 19.7 per 1,000 women ages 15 through 44 and 19.8 per 1,000 teens ages 15 through 19.[3,6]
  • Among white, black, and Hispanic teens, abortion rates fell but remained lowest for white teens. In 2004, the rate was 11 per 1,000 non-Hispanic whites ages 15 through 19, down from 33 per 1,000 in 1990. Among Hispanic teens, the rate in 2004 was 27 per 1,000, down from 39 in 1990. For non-Hispanic black teens, the 2004 rate was 47 per 1,000, down from 84 in 1990.[2]
  • As the 1990 and 2004 rates show, the abortion rate fell by two-thirds among non-Hispanic white teens, by almost a third among Hispanic teens, and by 44 percent among non-Hispanic black teens.[2]

Unintended Pregnancy

  • While about half of all pregnancies in the United States are unintended, rates of unintended pregnancy are highest among women ages 18 and 19 and 20 through 24.[7]
  • The proportion of unintended pregnancies remains highest among women under age 20. In other words, about 85 percent of teenage pregnancies are unintended compared to 50 percent  of pregnancies among adult women.[7]
  • Unintended pregnancy rates are about four times higher among women whose income is at or below the federal poverty line (112 per 1,000 women) than among women whose income is at least twice the federal poverty level (29 per 1,000).[7]

U.S. Teens Report Delaying Sex Longer than in the Past

  • In 2007, 52 percent of all U.S. high school students reported never having had sexual intercourse. The proportions who never had sex decreased as teens grew older. For example, 67 percent of students in ninth grade reported never having had sex compared to 35 percent of students in twelfth grade.[8]
  • Abstinence rates increased between 1991 and 2007 by gender and by race/ethnicity. In 1991, 49 percent of teen females in high school said they had never had sex, compared to 54 percent in 2007. Among males, the numbers were 43 and 50 percent, respectively.[8,9]
  • Fifty percent of white students said they never had sex in 1991, compared to 56 percent in 2007. Among Hispanic students, the numbers were 47 and 48 percent, respectively; and among blacks, 19 and 34 percent, respectively.[8,9]
  • In one study, only 14 percent of gay, lesbian, and bisexual high school students had never had sex, compared to 52 percent of their heterosexual peers.[10]

U.S. Teens Initiate Sex Later than Peers in Some Countries but Do Not Use Contraception as Well

  • In the United States, the typical age at first sexual intercourse is 17.5 [13] compared to 16.7 in Great Britain, 16.4 in the Netherlands, and 17.1 in France.[14]
  • Although U.S. teens report using contraception and/or condoms far more often than their peers of previous decades, they still use contraception or condoms less consistently than their peers in Europe. For example, 14 percent of sexually experienced U.S. female teens recently reported using oral contraceptives at most recent sex, compared to 26 percent of French, 55 percent of German, and 61 percent of Dutch teens. Among sexually experienced males, 73 percent of U.S. teens reported condom use at most recent sex compared to 88 percent of French, 83 percent of German, and 85 percent of Dutch teens.[8,15]
  • A study on the effect of virginity pledges found that, in early and middle adolescence, pledging delayed the transition to first sex by as much as 18 months. Pledging only worked when not more than about one-third of students pledged. Moreover, when they broke the pledge, these teens were one-third less likely to use contraception at first sex than were their non-pledging peers.[11] Said the lead researcher, "If we consider the enhanced risk of failure to contraception against the benefit of delay, it turns out that with respect to pregnancy, pledgers are at the same risk as non-pledgers. There is no long-term benefit to pledging in terms of pregnancy reduction, unless pledgers use contraception at first intercourse."[12]

Sexually Active Teens' Use of Condoms Is Up but Leveling Off

  • In U.S. studies, 70 percent of women and 69 percent of men ages 15 to 19 reported condom use at first sex.[16]
  • Among sexually active U.S. high school youth in 2007, 62 percent reported using a condom during most recent sex—a significant increase over 46 percent in 1991, but less than the 63 percent so reporting in 2005.8,9
  • In 2007, black sexually active high school students were more likely than their Hispanic or white peers to report condom use (67, 61, and 60 percent, respectively).[8]
  • In one study, fewer gay, lesbian, and bisexual high school students reported condom use at most recent sex than their heterosexual peers (51 and 58 percent, respectively).[10]

Sexually Active Youth Need Support to Use Contraception Consistently and Correctly

  • Among sexually active high school students who reported using contraception in 2003: 14 percent used oral contraceptives; 49 percent used condoms only; six percent used both oral contraceptives and condoms; 11 percent relied on withdrawal; three percent, on injected contraception; two percent, on both condoms and injected contraception; two percent used an undefined method; and less than half of one percent used an undefined method and condoms. Twelve percent used no method.[17]
  • Experts say that half of all unintended pregnancies occur among contraceptive users and that 90 percent of these pregnancies result from inconsistent or incorrect use of a method rather than from method failure.[18]
  • By comparison, half of all unintended pregnancies occur among the relatively small percentage of women who use no contraception. For example, half of all unintended pregnancies among sexually active high school students occurs among the 88 percent who report using contraceptives (even if inconsistently or incorrectly) and half occurs among the 12 percent who report using no method.[17,18]
  • Studies show that women with ambivalent attitudes toward pregnancy use contraceptives less consistently and less effectively than women who have clear, firm motivation to avoid pregnancy.[19] For example in one study, inconsistent use of condoms was most common among women who felt that avoiding pregnancy was only a little important or not important compared to those who thought it was very important (77 versus 55 percent).[18]
  • Another study found that women who switched methods were at higher risk of unintended pregnancy than were women who used the same method over time, mostly due to difficulty adjusting to a new method or restarting after a period of nonuse.[19]
  • Research shows that male and female teens’ contraceptive use in their first sexual relationship was significantly associated with contraceptive use in later relationships. Conversely, males who did not use contraception during a first sexual relationship were 66 percent less likely than other males to use contraception in their current relationship. Females who did not use contraception at first sex were also less likely than other females to use contraception in later relationships.[20]
  • Males who reported engaging with their partner in more couple-like activities were almost twice as likely to have ever used and always used contraception. For females, having discussed contraception before sex was also associated with increased odds of having ever used and consistently used contraception in later relationships.[20]
  • Research suggests that many teens make decisions about whether to use contraception and/or condoms within the context of each sexual relationship. While some studies indicate more consistent use in casual relationships than in regular or main relationships, other studies indicate that, the less familiar adolescents felt with a prospective partner, the less likely they were to use contraception, possibly because they felt less comfortable discussing sex, sexual histories, and contraception.[20
  • For females, if a partner was initially a stranger to her, she was less likely to use contraception than if he had been previously known to her.20 In addition, females’ likelihood of using contraception was reduced by 20 percent for each additional partner they had ever had.[20]
  • Research also shows that males who suffered sexual abuse in the past were far less likely to use contraception than males who never suffered such abuse.[19]

Pressure, Lack of Knowledge, and Worries about Confidentiality Affect Teens’ Use of Contraception

  • In one study, eight percent of sexually experienced young women cited pressure from their partner as a factor in having sex for the first time. Seven percent cited pressure from their friends. Among young men, the percentages were one and 13 percent, respectively.[21]
  • When polled, 32 percent of U.S. teens believed condoms were not effective in preventing HIV; 22 percent believed that birth control pills were not effective in preventing pregnancy. In addition, 66 percent said they would feel suspicious or worried about their partner's past, if he/she suggested using a condom and 49 percent would worry that the partner was suspicious of them; 20 percent would feel insulted.[22]
  • In another study, 83 percent of sexually active women under age 18 indicated that mandatory parental notification would cause them to stop using some or all confidential sexual health services; 57 percent said they would stop using hormonal contraception and use condoms instead; 29 percent said they would have unprotected sex. Only one percent would stop having sex.[23]
  • Studies have shown that homophobia and violence are significant barriers to protective behaviors among lesbian, gay, bisexual, and transgender youth. These stressors damage youth’s self-esteem and may result in homelessness and a need to exchanged sex for shelter, food, and/or safety.[24]
Written by Sue Alford, MLS
© 2008 Advocates for Youth

References:
  1. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2006. National Vital Statistics Reports 2007; 56(7):1-18; http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf; accessed 7/24/2008.
  2. Ventura SJ, Abma JC, Mosher WD et al. Estimated pregnancy rates by outcome for the United States, 1990-2004. National Vital Statistics Reports 2008; 56(15):1-24; http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_15.pdf; accessed 7/23/2008.
  3. Strauss LT, Gamble SB, Parker WY et al. Abortion surveillance, United States, 2004. Morbidity & Mortality Weekly Report, Surveillance Summaries 2007; 56(SS-9):1-33.
  4. Saewyc EM, Magee LL, Pettingell SE. Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference? Family Planning Perspectives 1999; 31:127-31.
  5. Henshaw SK and Kost K. Trends in the Characteristics of Women Obtaining Abortions, 1974-2004. New York: Guttmacher Institute, 2008.
  6. Jones RK, Zolna MRS, Henshaw SK et al. Abortion in the United States: incidence and access to services, 2005. Perspectives on Sexual & Reproductive Health 2008; 40:6-16.
  7. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual & Reproductive Health 2006; 38:90-96.
  8. Eaton DK, Kann L, Kinchen S et al. Youth risk behavior surveillance, United States, 2007. Morbidity & Mortality Weekly Report 2008; 57(SS-4):1-138; http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf; accessed 6/11/2008.
  9. Eaton DK, Kann L, Kinchen S et al. Youth risk behavior surveillance, United States, 2005. Morbidity & Mortality Weekly Report 2006; 55(SS-5):1–108.
  10. Blake SM, Ledsky R, Lehman T et al. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health 2001; 91:940-46.
  11. Bearman PS, Brückner H. Promising the Future: Virginity Pledges as They Affect Transition to First Intercourse. New York: Columbia University, 2000.
  12. Bearman P. [Letter; quoted with permission]. New York: Columbia University, 2002.
  13. Guttmacher Institute. Facts on Young Men’s Sexual & Reproductive Health [In Brief] New York: Author, 2008; http://www.guttmacher.org/pubs/fb_YMSRH.pdf; accessed 8/7/2008.
  14. IPPF European Network, the SAFE Project. Sexuality Education in Europe. Brussels, Belgium: Author, 2006; http://www.euro.who.int/Document/RHP/SexEd_in_Europe.pdf; accessed 7/7/2008.
  15. Godeau EC, Gabhainn SN, Vignes C et al. Contraceptive use by 15-year-old-students at their last sexual intercourse: results from 15 countries. Archives of Pediatrics & Adolescent Medicine 2008; 162:66-73.
  16. Mosher WD, Martinez GM, Chandra A et al. Use of contraception and use of family planning services in the United States: 1982-2002. Advance Data 2004; #350:1-36.
  17. Santelli JS, Morrow B, Anderson JE et al. Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003. Perspectives on Sexual & Reproductive Health 2006; 38:106-111.
  18. Frost JJ, Darroch JE. Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspectives on Sexual & Reproductive Health 2008; 40:94-104.
  19. Frost JJ, Singh S, Finer LB. Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual & Reproductive Health 2007; 39:90-99.
  20. Manlove J, Ryan S, Franzetta K. Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships. Perspectives on Sexual & Reproductive Health 2004; 36:265-275.
  21. Kaiser Family Foundation & YM Magazine. National Survey of Teens: Teens Talk about Dating, Intimacy, and Their Sexual Experiences. Menlo Park, CA: The Foundation, 1998.
  22. Kaiser Family Foundation. Safer Sex, Condoms, and ‘The Pill’: A Series of National Surveys of Teens about Sex. Menlo Park, CA: The Foundation, 2000.
  23. Reddy DM, Fleming R, Swain C. Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. JAMA 2002; 288:710-714.
  24. Savin-Williams RC. Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: association with school problems, running away, prostitution, and suicide. Journal of Consulting & Clinical Psychology 1994; 62:261-269.
This publication is part of The Facts series.
 
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