Teen Topics

Record low teen pregnancy — What is next step?

By Anita Brakman, MS
Director of Education, Research & Training
Physicians for Reproductive Choice and Health
New York City

Melanie Gold, DO, FAAP
Clinical Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician
University of Pittsburgh Student Health Service

A report from the Guttmacher Institute reveals the U.S. teen pregnancy rate is at its lowest level in 40 years and the teen birth rate is at the lowest point since consistent data was collected in the 1950s.1,2

In 2008, there were 67.8 pregnancies per 1,000 women ages 15-19, a 42% decrease from a peak rate of 116.9 in 1990. The declines indicate even better outcomes for the youngest female adolescents. Among females under age 15, the pregnancy rate fell 62% from 17.5 in 1990 to 6.6 in 2008.1

The most recent data on teen births from the National Center on Health Statistics is just as encouraging. The 2010 birth rate for females ages 15-19 was 34.4 per 1000, a 44% decrease compared to the peak rate of 78 in 1991 and a 64% decrease compared to the all-time peak rate of 96.3 per 1,000 seen in 1957.2

Analysis of the 2008-2010 National Survey of Family Growth (NSFG) demonstrates increased contraceptive use as the major force behind declining unintended teen pregnancy and births. While the percent of females 15-19 who reported recent sexual activity remained about the same, the number of girls reporting contraceptive use at last intercourse increased across all methods. Additionally, 23.2% of girls reported dual method use at last intercourse, an increase from 16.1% reported in the 2006-2008 survey.3 This affirms past research demonstrating the positive effect of increasing contraceptive use on teen pregnancy and birth rates.4

However, the U.S. teen pregnancy rate still is drastically high compared to other developed nations.5 Also, despite the overall decline in the United States, major disparities in teen pregnancy rates exist when comparing racial and ethnic groups.1

The Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) examines maternal attitudes and experiences in 37 states. A January 2012 report analyzing the 2004-2008 PRAMS data reveals reasons young people remain at risk for pregnancy and how providers can help .

About half of the teens with unintended pregnancies reported using no contraception at the time of pregnancy.6 The most common reason was misunderstanding how one gets pregnant and the risk of becoming pregnant after unprotected intercourse. More than 35% of girls ages 15-17 and 30% of girls ages 18-19 thought they could not get pregnant at the time they had unprotected intercourse. Fourty-two percent of Hispanic girls held this misconception, as compared to 32% of non-Hispanic blacks and 27% of non-Hispanic whites.6

Twenty-three percent of girls reported having a partner who was unwilling to use contraception. Fourteen percent of girls said they had trouble getting birth control. Eight percent reported they thought their partner was sterile. Finally, 21% reported they did not mind if they became pregnant. Ambivalence about pregnancy was reported in greater percentages among older girls.6

Consider limitations with the PRAMS data. PRAMS operates in 35 states, but adequate responses to questions about contraceptive nonuse were collected only from 19. Additionally, the data was self-reported, and girls were not asked about consistency of method use.

Providers need to provide teens with medically accurate information on how and when one can become pregnant. Providers also might wish to assist teens in condom and contraception negotiation with partners and provide more discreet methods when appropriate.

Policy solutions might help remove financial barriers to access. Providers also can improve access by prescribing lower cost methods, providing long-acting methods that are more cost effective, avoiding unnecessary procedures such as pelvic exams that might obstruct accesss, and writing prescriptions to dispense multiple months of supplies.

Addressing reasons for contraceptive nonuse with counseling and education might help bolster decreases in unintended teen pregnancy and births and alleviate disparities faced by vulnerable populations.

References

  1. Kost K, Henshaw S. U.S. Teenage pregnancies, births and abortions, 2008: National Trends by Age, Race and Ethnicity, 2012. Accessed at http://bit.ly/zINgwC.
  2. Hamilton BE, Ventura SJ. Birth Rates for U.S. Teenagers Reach Historic Lows for All Age and Ethnic Groups. NCHS Data Brief, No. 89. Hyattsville, MD: National Center for Health Statistics. 2012.
  3. Martinez G, Copen CE, Abma JC. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006–2010 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 23(31). 2011.
  4. 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(1):150-156.
  5. United Nations. 2008 Demographic Yearbook. New York; NY: United Nations; 2010.
  6. Centers for Disease Control and Prevention. Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births – Pregnancy risk assessment monitoring system (PRAMS), 2004-2008. MMWR 2012; 61:25-29.