Teen birth rate rises for first time in 14 years — What lies behind the change?

It's time to redouble efforts to stem adolescent pregnancy. Preliminary birth statistics released by the Centers for Disease Control and Prevention indicate the U.S. birth rate rose by 3% between 2005 and 2006 among females 15-19 after dropping 34% between 1991 and 2005.1

According to the report, prepared by the National Center for Health Statistics, the birth rate for ages 15-19 rose from 40.5 live births per 1,000 females to 41.9 births per 1,000 in 2006. This increase follows a 14-year downward trend in which the teen birth rate fell by 34% from its all-time peak of 61.8 births per 1,000 in 1991.

The increase raises several important questions, says Bill Albert, deputy director of The National Campaign to Prevent Teen and Unplanned Pregnancy in Washington, DC. Why did the rate increase?" he asks. "Is the increase the beginning of a trend or a statistical anomaly, and, of course, what can be done to reverse the increase and continue to drive down rates of teen births?"

Throughout the 1990s, teen sexual activity in the United States decreased and contraceptive use improved, says John Santelli, MD, MPH, professor and chair of the Heilbrunn Department of Clinical Population and Family Health and professor of clinical pediatrics at Columbia University in New York City. In an estimate of trends in use and nonuse of effective protection among adolescents from 1991-2003, analysts found that condom use increased significantly, from 46.2% in 1991 to 63% in 2003.2 The percentage of teens reporting use of withdrawal or no method steadily declined, from 32.6% to 18.8%.2

However, an analysis of data from the 2005 Youth Risk Behavior Survey indicates a deterioration in contraceptive use, says Santelli.3 For the very first time in almost 20 years, analysts saw a small decrease in condom use for young women, and they noted an increase in nonuse of birth control.

Complacency sets in?

Does the increase signal just an increase or the start of a trend? It does represent a reversal in the downturn of births among adolescents, observes Anita Nelson, MD, professor in the Obstetrics and Gynecology Department at the University of California in Los Angeles (UCLA) and medical director of the women's health care programs at Harbor-UCLA Medical Center in Torrance.

Complacency may have become the enemy of progress when it comes to lowering teen pregnancy rates, says Albert. Fourteen consecutive years of declines in the teen birth rate may have led to complacency and may have diverted attention, resources, and funding to other pressing issues, he observes. "The birth rate is up among women of all ages — women in their teens, 20s, 30s, and 40s — and among all racial and ethnic groups, which suggests that a broader set of forces may be at play," Albert notes.

Improvement in teen birth rates in the 1990s may have come as a result of an emphasis on condom use, heightened by concerns about HIV, observes Santelli. Today's teens may not see HIV in the same light and may not be as consistent in using protection, he notes.

Less contraceptive use?

In the United States, there were 441,832 teen births in 2006. Compare this number to 50,752 teen births in the United Kingdom for 2004 and 2,549 in the Netherlands for 2006.3 For Santelli, who wrote an editorial for the online version of the British newspaper, The Guardian, the major behavioral difference between European and U.S. teenagers is better use of contraceptives among European adolescents. Rates of sexual activity are similar among the two groups, but European teens report a higher use of oral contraceptives and use of the "Double-Dutch" method — simultaneous use of condoms and hormonal methods, states Santelli.3

I think the problem is that we're a pretty anti-contraceptive society," Santelli comments. "To the Europeans, if you want to talk about responsibility as an adolescent, you talk about not getting pregnant and you talk about contraception," he says. "People are very open about that, and that is the social norm."

America as a society is much different, Santelli points out. The social norm promoted to teenagers may be more along the lines of "don't get a disease, and you shouldn't have sex anyway," he observes.

I think in a society where sexuality is expected and understood and seen as normal, it's much easier for people to use contraception," Santelli comments. "I think we haven't gotten there yet."

Abstinence-only debated

Release of the new data has reignited debate about abstinence-only sex education programs, which receive about $176 million a year in federal funding.4 Findings from a 2007 analysis of four abstinence-only education programs indicated that such programs do not keep teenagers from having sex. Such programs neither increase nor decrease the likelihood that if teens do have sex, they will use a condom, the analysis concludes.5 A 2006 paper concludes there is no evidence base for providing "abstinence-only" or "abstinence-until-marriage" messages as a sole option for teenagers. The report finds abstinence-only programs demonstrate little evidence of efficacy in delaying initiation of sexual intercourse.6

In contrast, a new report released by the National Campaign to Prevent Teen and Unplanned Pregnancy showed that a growing number of sex education programs that support abstinence and the use of contraception for sexually active teens have demonstrated positive effects in delaying first intercourse, improving contraceptive use, and preventing pregnancy or sexually transmitted among teens.7 Two-thirds of sex education programs examined in the National Campaign report that focused on abstinence and contraception had a positive effect on teen sexual behavior. None of the programs that discussed abstinence and contraception hastened the initiation of sex or increased the frequency of sex among adolescents.7

What is the next step?

What needs to happen in light of the new report? In the upcoming weeks, the National Campaign to Prevent Teen and Unplanned Pregnancy and others will try to determine what might account for the rise in the teen birth rate, says Albert.

At the same time, we will redouble our own efforts to shine a spotlight on the importance of continuing to focus on teen pregnancy," states Albert. "We will also encourage colleagues nationwide to use this sobering news to intensify their own programs and outreach to policy-makers, practitioners, the press, parents, and, of course, teens themselves."

If you are a family planning clinician who is working with an adolescent population, don't let frustration cloud your efforts in helping teens make wise decisions about their reproductive health, says Santelli.

People who work in family planning are primarily responsible for those big declines up until 2005," Santelli observes. "We saw birth rates drop by a third among teenagers and even higher among the younger teens, so people who have been doing this work, even though they're not getting rewarded, clearly were the people responsible for that decline."

References

  1. Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2006. Natl Vital Stat Rep 2007; 56: 1-18.
  2. Anderson JE, Santelli JS, Morrow B. Trends in adolescent contraceptive use, unprotected and poorly protected sex, 1991-2003. J Adolesc Health 2006; 38:734-739.
  3. Santelli J. Knocked up. The Guardian. Accessed at: commentisfree.guardian.co.uk.
  4. Stein R. Teen birth rate rises in U.S., reversing a 14-year decline. Washington Post, Dec. 6, 2007:A01.
  5. Trenholm C, Devaney B, Fortson K, et al. Impacts of Four Title V, Section 510 Abstinence Education Programs. Princeton, NJ: Mathematica Policy Research; 2007.
  6. Santelli J, Ott MA, Lyon M, et al. Abstinence and abstinence-only education: A review of U.S. policies and programs. J Adolesc Health 2006; 38:72-81.
  7. Kirby D. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy, 2007.