Teens improve contraceptive use, but more women at risk for pregnancy

What do new contraceptive trends mean for your practice?

Just-released information from the National Survey of Family Growth offers family planning clinicians a mix of good and bad news: While sexually active teens are more likely to be using contraception, many teens are uninformed about birth control choices.1 The research also indicates that the number of women ages 15-44 at risk of pregnancy but using no method of contraception rose from 7.5% in 1995 to 10.7% in 2002.2

While this 3.2% rise may appear small in numbers, it translates into potentially large problems with unintended pregnancy, says James Trussell, PhD, professor of economics and public affairs and director of the Office of Population Research at Princeton (NJ) University. In 1994, the last year for which data are available, the small minority (7.5%) of women using no contraception contributed almost half (47%) of the 3 million unintended pregnancies in the United States,3 he reports.

"What we have witnessed is a 43% rise in that small minority, which would lead, everything else held constant, to an 18% rise in unintended pregnancies," he explains.

The National Survey of Family Growth (NSFG) is conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics in Hyattsville, MD, with researchers collecting information on several topics, including contraception, infertility, pregnancy outcomes, and births. (See the accompanying snapshot for an overview of the latest findings.) Since the survey is so large and is known for its accuracy, reproductive health experts see the newly reported increase as a worrisome trend.4

What factors may be impacting women’s nonuse of contraception? Declining insurance coverage, increasing costs of contraceptives, and the inability of publicly funded family planning services to keep up with inflation all could be contributing to the decline, says Sharon Camp, president and chief executive officer of the New York City-based Alan Guttmacher Institute (AGI).

Camp also points to the increase in abstinence-only sex education and what she terms "government-sponsored misinformation" as possible contributors to a lack of knowledge or misconceptions about the effectiveness, safety, and side effects of the various contraceptive methods available, particularly among teens and young adults. (For an overview of challenges to information on reproductive health, check AGI’s review, "Top 10 Ways Sexual And Reproductive Health Suffered in 2004" on the organization’s web page, www.guttmacher.org.) Among older women, a mistaken belief that they are unable to become pregnant may be influencing their contraceptive decision making, she surmises.

Are teens better off?

What do the survey findings show when it comes to teens? Information from the NSFG indicates good news on the adolescent front:

  • The proportion of never-married females ages 15-17 who had ever had sexual intercourse dropped from 38% in 1995 to 30% in 2002. At ages 18-19, 68% had had intercourse in 1995, compared with 69% in 2002.
  • For male teens, the percentage of those who were sexually experienced dropped in both age groups: from 43% to 31% at ages 15-17, and from 75% to 64% at ages 18-19.
  • Teens are more likely to use contraception when they begin having intercourse (79% in 1999-2002, up from 61% in the 1980s).
  • Teens are more likely to have used contraception at their most recent intercourse (83% in 2002, up from 71% in 1995). At their first premarital intercourse, teens were most likely to choose condoms for birth control; 66% reported using a condom when they became sexually active.1

However, the survey results also highlight some troubling developments:

  • Many teens are not learning about birth control in school; one-third of teens report having received no formal instruction about contraceptive methods before age 18.
  • Half of young women ages 18-19 and about one-third of men of similar age, said they had talked with a parent about birth control before they turned 18.1

"Although more teens are delaying first sex, and those who are sexually active are more likely to use contraceptives than they were previously, the fact that so many teenagers lack the information and services they need to protect themselves from unintended pregnancy and sexually transmitted infections is particularly alarming," says Camp. "As more schools move towards abstinence-only-until-marriage education that talks about contraception only in the context of its failure rates, family planning providers may increasingly find themselves on the front lines as teens’ primary source of medically accurate information about consistent and correct contraceptive use."

Is mandatory notice OK?

When it comes to obtaining contraceptives, one in five teenagers would have unsafe sex if their parents had to be notified before they could receive prescription birth control at a family planning clinic, according to just published nationally representative data.5

Results from the new study show that many teens — three in five — had parents who already knew about their clinic visit, usually because teens told them or their parents suggested it. But among those adolescents whose parents were unaware of their visit, 70% said they would stop coming to the clinic, and one-quarter said they would continue to have sex but would rely on withdrawal or not use any contraception if parental notification were mandated. Just 1% of all teens surveyed said they would stop having sex.5 Researchers surveyed more than 1,500 women younger than 18 who were seeking sexual health services, including contraceptives, at family planning clinics in 33 states.

Texas and Utah now require parental consent for state-funded family planning services, and a similar restriction is in place in one Illinois county (McHenry), where research has found an increase in teen birthrates while other counties experienced declines.6 In 2004, bills to impose new requirements for parental consent for adolescents seeking contraception were introduced in Congress and several states, including Kentucky, Minnesota, and Virginia.

While the rate of teen pregnancy has dropped over the last decade, about 850,000 teenagers still get pregnant each year, with most such pregnancies unintended, according to the AGI, which performed the new study. Forcing parental involvement could drive teen pregnancy rates up, reproductive health experts contend.

Research shows that family planning clinics can play an important role in fostering parental/ teen communication.7 National research conducted in 1999 found that 43% of agencies had one or more educational program to improve parent-child communication.8

The practices and educational programs provided by many family planning clinics are intended to improve parent-child communication around sexual health issues, explains Rachel Jones, PhD, senior research associate at AGI and lead author of the study. Some clinics incorporate this issue in one-on-one counseling sessions with teen clients, such as offering to help teens come up with strategies for talking to parents about sex and birth control, she notes.

"Formal educational programs — which can be directed at teenagers, parents, or both — often provide skills and information to improve communication around sexuality issues," states Jones. "Notably, educational programs are often labor-intensive, require a physical space to hold classes, and cost money, so clinics are less likely to be able to provide this resource to clients and community members."

References

1. CDC National Center for Health Statistics. Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002. Hyattsville, MD; 2004.

2. CDC National Center for Health Statistics. Use of Contraception and Use of Family Planning Services in the United States: 1982-2002. Hyattsville, MD; 2004.

3. Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect 1998; 30:24-29, 46.

4. Connolly C. More women opting against birth control, study finds. The Washington Post, Jan. 4, 2005:A01.

5. Jones RK, Purcell A, Singh S, et al. Adolescents’ reports of parental knowledge of adolescents’ use of sexual health services and their reactions to mandated parental notification for prescription contraception. JAMA 2005; 93:340-348.

6. Zavodny M. Fertility and parental consent for minors to receive contraceptives. Am J Pub Health 2004; 94:1,347-1,351.

7. Jones RK, Boonstra H. Confidential reproductive health services for minors: The potential impact of mandated parental involvement for contraception. Perspect Sex Reprod Health 2004, 36:182-191.

8. Finer LB, Darroch JE, Frost JJ. U.S. agencies providing publicly funded contraceptive services in 1999. Perspect Sex Reprod Health 2002; 34:15-24.