U.S. teen pregnancy rates decline due to improved contraceptive use
Abstinence promotion alone won't stem unintended pregnancy rate
Results of a new analysis of national data indicate that 86% of the recent drop in U.S. teen pregnancy rates is the result of improved contraceptive use, while 14% of the decline can be attributed to teens waiting longer to start having sex.1
Between 1995 and 2002, U.S. teen pregnancy rates declined by almost one-quarter.1 While the news is good for those who advocate adolescent health, family planning experts are questioning the value of the federal government's funding of abstinence-only-until-marriage programs that prohibit information about the benefits of condoms and contraception. Since 1996, more than $1 billion in federal- and state-matching funds have been committed to abstinence-only programs, according to the Sexuality Information and Education Council of the United States in New York City.2
"We need to redouble our efforts on contraception and get rid of curricula that limit information on contraceptive use," states John Santelli, MD, MPH, department chair and professor of the Heilbrunn Department of Population and Family Health at Columbia University in New York City and lead author of the new research. "The problem is a strongly held belief system that giving information on contraception leads to having sex."
The new analysis was performed by Santelli and researchers at the Guttmacher Institute, a research, policy analysis, and public education organization. They looked at information from the National Survey of Family Growth (NSFG), a nationally representative survey that offers comprehensive information about adolescent females. The scientists used data from the 1995 and 2002 cycles of the survey to develop two indexes:
- the contraceptive risk index, which encompassed the overall effectiveness of contraceptive use — including nonuse — among sexually active teens;
- the overall pregnancy risk index, which looked at the contraceptive risk index score and the percentage of individuals reporting sexual activity.
According to the new research paper, most of the decline in teen pregnancies can be attributed to more sexually active teens using contraceptives, using more effective methods, and using dual methods. When researchers looked at results by age, they found that delays in sexual activity played a greater role than improved contraceptive use for younger teens ages 15-17, while among those ages 18-19, the decline in the risk was due entirely to improved contraceptive use.1
What's the message?
While most states require public schools to teach some form of sex or sexually transmitted disease (STD)/HIV education, there are differences in what types of information are presented, according to the Guttmacher Institute. Most states provide guidance on how abstinence or contraception should be handled when included in a school district's curriculum. Such guidance is "heavily weighted toward stressing abstinence; in contrast, while many states allow or require that contraception be covered, none require that it be stressed."3
Santelli and fellow researchers again looked to the NSFG to look at the scope of sex education among adolescents.4 They found that from 1995 to 2002, formal instruction about birth control methods fell for adolescent males and females, from 81% to 66% in teen males and from 87% to 70% in adolescent females. While education about contraception dipped, more teens reported receiving instruction only about abstinence; for adolescent males, the number grew from 9% to 24% and, in females, it rose from 8% to 21%.4
Concern about abstinence-only education programs has been heightened since 2004, when a congressional staff analysis of 13 of the most commonly used curricula uncovered misleading information in 11 of the programs.5,6 The 11 programs, in use by 69 organizations in 25 states, included such statements as:
- A 43-day-old fetus is a "thinking person."
- HIV, the virus that causes AIDS, can be spread via sweat and tears.
- Condoms fail to prevent HIV transmission as often as 31% of the time in heterosexual intercourse.5,6
Findings from the analysis, prepared at the request of Rep. Henry Waxman (D-CA), led to an October 2006 legal opinion released by the Government Accountability Office's general council office. The opinion states that the Department of Health and Human Services should ensure that abstinence education material prepared and used by groups receiving federal funding include accurate information on sexually transmitted infections and the effectiveness of condoms.7
On tap: 'Prevention first'
Look for action in the current congressional session on comprehensive sexual education, says Heather Boonstra, senior public policy associate at the Guttmacher Institute's Washington, DC, bureau. Senate Majority Leader Harry Reid has introduced the Prevention First Act bill (S21), which calls for federally funded programs to provide medically accurate information, as well as seeks more funding for Title X programs.
"It is a real answer to the abstinence-only move," she says of the proposed legislation. "It recognizes the need for medically accurate information."
On the House side, there may be hearings conducted on the issue, says Boonstra. "There is a drumbeat going," she states. "There are hopes that adjustments can be made."
What can providers do?
Family planning clinicians have been effective in delivering prevention messages, notes Santelli. The fact that more teens are choosing dual methods for protection against HIV and pregnancy is heartening, he observes.
"We wrote some of the first articles in the early 1990s on dual use,8 and I used to hear, 'Teens won't use condoms,'" recalls Santelli. "Clinicians have done a good job."
What can providers do to see that teens get the information they need when it comes to pregnancy and HIV prevention? The Society for Adolescent Medicine has issued a position statement calling for "a comprehensive approach to sexual risk reduction including abstinence as well as correct and consistent use of condoms and contraception among teens who choose to be sexually active."9 The organization also is calling for current funding for abstinence-only programs to be replaced with funding for programs that offer comprehensive, medically accurate sexuality education.9
"Messages on abstinence are important, but messages on contraception are just as important," says Santelli.
- Santelli JS, Lindberg LD, Finer LB, et al. Explaining recent declines in adolescent pregnancy in the United States: The contribution of abstinence and improved contraceptive use. Am J Public Health 2007; 97:150-156.
- Sexuality Information and Education Council of the United States. 15% Boost for Ineffective Abstinence-Only-Until-Marriage Programs in President Bush's Proposed FY 2007 Budget. Press release. Feb. 7, 2006. Accessed at: www.siecus.org/media/press/press0123.html.
- Guttmacher Institute. Sex and STD/HIV Education. Fact sheet. Jan. 1, 2007. Accessed at: www.guttmacher.org/statecenter/spibs/spib_SE.pdf.
- Lindberg LD, Santelli JS, Singh S. Changes in formal sex education: 1995-2002. Perspect Sex Reprod Health 2006; 38:182-189.
- Connolly C. Some abstinence programs mislead teens, report says. Washington Post, Dec. 2, 2004; A01.
- U.S. House of Representatives. Committee on Government Reform — Minority Staff Special Investigations Division. The Content of Federally Funded Abstinence-Only Education Programs. December 2004.
- HHS should ensure abstinence education material used by federal grantees contains accurate information on condoms, STIs, GAO legal opinion says. Kaiser Repro Health Report, Oct. 16, 2006. Accessed at: www.kaisernetwork.org.
- Santelli JS, Davis M, Celentano DD, et al. Combined use of condoms with other contraceptive methods among inner-city Baltimore women. Fam Plann Perspect 1995; 27:74-78.
- Society for Adolescent Medicine. Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine. J Adolesc Health 2006; 38:83-87.