Teen Childbearing in the United States

The teen birth rate in the United States is at its lowest in nearly 70 years. Experts attribute the decline to fewer teens trying to become pregnant and to increased contraceptive use, especially of the most effective methods.

Data from the Centers for Disease Control and Prevention (CDC) revealed that, while the percentage of sexually active teenage girls has remained the same in recent years, contraceptive use has increased significantly (hormonal contraceptive use among sexually active teens went from 37 percent in 2006-2008 to 47 percent in 2008-2010). The percentage of teens using two methods (condoms plus hormonal contraceptives) went from 16 percent to 23 percent. “Bristol Palin standing up for abstinence is not what is going on here,” said Dr. John Santelli, pediatrician and adolescent medicine specialist at Colombia University. Rather, “this is probably related to better contraceptive use, including some of these newer methods such as long-acting reversible contraceptive methods and access to care.”

 

Teen Birth Rates*

  • Switzerland 4.1
  • Japan 4.9
  • Netherlands 5.3
  • Denmark 5.5
  • Sweden 5.9
  • Italy (2005) 6.8
  • Finland 8.5
  • Germany 9.1
  • Norway 9.5
  • France (2008) 10.2
  • Greece 11.6
  • Spain 12.2
  • Canada 14.2
  • Portugal 15.3
  • Australia 16.5
  • UK 25
  • U.S. (2010) 34.3

* Births per 1,000 women ages 15-19. Allbirth rates for 2009 unless otherwise noted.

The United States vs. Europe

Despite recent declines, however, the United States has the highest teen birth rate in the industrialized world, at 34.3 births per 1,000 women ages 15-19. A teenage girl who grows up in the U.S. is eight times more likely to give birth than one who grows up in Switzerland, which has one of the lowest rates of teen birth in the world. American teens are twice as likely to give birth as teens growing up in any of 19 other industrialized countries.

One likely explanation for the discrepancy in teen birth rates between the U.S. and Europe is the more open and straightforward climate around teen sexuality in European societies. “In many European countries—Switzerland in particular— sexual intercourse, at least from the age of 15 or 16 years, is considered acceptable and even part of normative adolescent behavior,” says Pierre-Andre Michaud, chief of the Multidisciplinary Unit for Adolescent Health at the University of Lausanne Hospital in Switzerland. Most parents and policymakers in Europe believe that confidential sexual health services are a fundamental right.

In Sweden, teens can access free medical care, free condoms, and oral contraceptive prescriptions without parental consent. Emergency contraception is available over the counter. Cecilia Ekéus, a nurse midwife in Stockholm with a PhD in public international health, says Swedish society teaches that sex should occur in a committed relationship “and also that teenagers should use contraceptives, be informed, and take responsibility. But in general we are open and positive and think that it’s okay.”

According to Debra Hauser, President of Advocates for Youth, “It is time that the U.S. looks to its northern European colleagues for lessons learned in adolescent sexual health promotion. In these countries, young people’s right to honest sexual health information and confidential services is respected and adolescent sexual development is recognized as normal and healthy. As a result the rates of teen pregnancy, birth, and abortion are significantly lower than in the United States.”

Barriers to Safe Sex

Of the approximately 750,000 teen pregnancies that occur each year in the U.S., 82 percent are unintended—that is, they are either mistimed by two or more years or they are unwanted regardless of the timing. Some of them end in miscarriage or abortion. Many end in live births. In 2010, there were 367,752 births to teens—77 percent of them were unintended.

The CDC identifies six factors associated with teen pregnancy:

  • Being sexually active
  • Lack of access to or poor use of contraception
  • Living in poverty
  • Having parents with low levels of education
  • Poor performance in school
  • Growing up in a single-parent family
teen_mom
Teen Mother. Photo: Vladimir Godnik/bilderlounge/Corbis

Access to contraception and information on how to use it is the most effective way to prevent pregnancy among teens who are already sexually active. But that fact doesn’t necessarily mean policies follow suit. Texas, which has the highest repeat teen birth rate in the country, is one of only four states that does not cover contraception in the State Children’s Health Insurance Program, and nearly a third of family planning clinics that contract with the state government require parental consent to obtain contraceptives. “If you’re a kid, even in college, if it’s statefunded you have to have parental consent [to get contraceptives],” said Susan Tortolero, director of the Prevention Research Center at the University of Texas in Houston.

Teens under the age of 17 in the U.S. need a prescription to obtain emergency contraception (Plan B), even though the Food and Drug Administration conceded that there is no medical justification for such a policy. “There are no medical concerns,” reported Cynthia Harper, who coauthored a study monitoring teens’ use of Plan B. “The concern is more a social, political concern about adolescents having access to these contraceptives.” The prescription requirement is a troublesome obstacle because the pills are most effective within 24 hours of unprotected sex.

Facts and Figures

 

  • Half of American teens have sex before graduating from high school.
  • A sexually active teen who does not use contraception has a 90 percent chance of becoming pregnant within a year.
  • 11 percent of all U.S. births are to teens.
  • More than a quarter of pregnancies to 15-19-year-olds end in abortion.
  • One in five teens whose parents do not know they obtain contraceptive services would continue to have sex but would not use any method if the law required that their parents be notified of their visit.
  • Only 1 percent of all adolescents who use sexual health services indicate that their only reaction to a law requiring their parents’ involvement for prescription contraception would be to stop having sex.
  • Twenty-one states and the District of Columbia explicitly allow minors to consent to contraceptive services without parental involvement. Another 25 states have affirmed that right for certain classes of minors, while four states have no law. In the absence of a specific law, courts have determined that minors’ privacy rights include the right to obtain contraceptive services.
  • Two states (Texas and Utah) require parental consent for contraceptive services in state-funded family planning programs.

 

Consequences of Teen Childbearing

Teen mothers are more likely to have pre-term and underweight babies, and less likely to receive prenatal care than older mothers. Infants born to mothers aged 15-19 are 30 percent more likely to experience injury or death than infants born to mothers aged 20-29.

Teen mothers face many education and employment obstacles. According to Advocates for Youth, “Adolescent mothers are less likely to complete their education and are more likely to face limited career and economic opportunities compared to women whose first children are born after age 20.” The Guttmacher Institute found that while “Teen mothers are now more likely than in the past to complete high school or obtain a GED…they are still less likely than women who delay childbearing to go on to college.” And according to Population Action International, “A child whose mother has no education is, on average, twice as likely to be out of school as one with an educated mother.” So the cycle of stunted education and early motherhood can be self-perpetuating.

Recent Positive Changes

For most of the past three decades, the U.S. government funded abstinence-only sex education programs at the exclusion of comprehensive, medically-accurate programs. After wasting more than $1.5 billion dollars on these failed programs, President Obama ended the majority of the funding in 2010 and redirected it to teen pregnancy prevention programs that have been proven effective. Comprehensive programs present teens with fact-based, unbiased information about reproductive health, pregnancy, contraception, and sexuality. They exclude the myths and outright lies that riddle abstinence-only programs.

Under the Affordable Care Act, health insurance plans are required to cover all methods of birth control without copays. According to Dr. Yolanda Evans, who specializes in adolescent medicine, under the law “there’s definitely a strong potential for teen pregnancy rates, which are really high in the U.S., to drop,” as teenagers are able to afford “the kind of contraception that might be the best and most effective for them.”

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