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Although the rate of teenage pregnancy in the United States has been declining, it remains the highest in the developed world. Approximately 97 per 1,000 women aged 15–19 — one million American teenagers — become pregnant each year. The majority of these pregnancies — 78 percent — are unintended (AGI, 1999a). Moreover, because the average age of menarche has reached an all-time low of about 12 or 13 years (Potts, 1990), and because four out of five young people have sex as teenagers (AGI, 1999a), a greater proportion of teenage girls are at risk of becoming pregnant than ever before. The consequences of adolescent pregnancy and childbearing are serious and numerous:
However, none of these initiatives can succeed without a general reassessment of the attitudes and mores regarding adolescent sexuality in the U.S. Presently, an unrealistic emphasis is placed on preventing adolescent sexual behavior, which overlooks the fact that sexual expression is an essential component of healthy human development for individuals of all ages (Freud; Maslow et al., as cited in Zimbardo, 1992). The majority of the public recognizes this fact — 63 percent of Americans believe that sexual exploration among young people is a natural part of growing up (SIECUS, 1999). An influential minority of individuals promotes unrealistic, abstinence-only education and parental consent requirements for obtaining contraception that deny American teens accurate information about and confidential access to family planning services to prevent pregnancy. However, even individuals who support parental consent and abstinence-only programs recognize the dangers of such measures. For example, in a 1998 debate over mandating parental involvement for teens using Title X-funded clinics for contraceptive services, Rep. Tom Coburn (R-OK), a radical opponent of family planning, conceded that "if we put in the [parental notice] language, some additional young women will get pregnant [and] some will get a sexually transmitted disease" because they will be deterred from seeking out services when they are no longer guaranteed confidentiality (Saul, 1999). Planned Parenthood believes that policymakers must accept the fact that teens engage in sexual behavior, and they must initiate and provide funding for various programs and interventions that will facilitate responsible sexual behavior. Medically Accurate Sexuality Education Can Help Prevent Teenage Pregnancy Medically accurate sexuality education that begins in kindergarten and continues in an age-appropriate manner through the 12th grade is necessary given the early ages at which young people are initiating intercourse — 7.2 percent of students nationwide report having sex before the age of 13, 42.5 percent by grade 10, and 60.9 percent by grade 12 (CDC, 1998). In fact, the most successful programs aimed at reducing teenage pregnancy are those targeting younger adolescents who are not yet sexually experienced (Frost & Forrest, 1995). "Balanced and realistic" sexuality education programs that encourage students to postpone sex until they are older, but also promote safer sex practices for those who choose to become sexually active, have been proven effective at delaying first intercourse and increasing use of contraception among sexually active youth. These programs have not been shown to initiate early sexual activity or to increase levels of sexual activity or numbers of sexual partners among sexually active youth (Berne & Huberman, 1999; Kirby, 1997). Sexuality education programs in the United States currently caution young people to not have sex until they are married. Of the 69 percent of school districts with a policy to teach sexuality education, 86 percent promote abstinence as the preferred or the only option for adolescents (Landry et al., 1999). A number of studies, however, have found that abstinence-only programs are ineffective because they fail to delay the onset of intercourse and often provide information that is medically inaccurate and potentially misleading (Berne & Huberman, 1999; Kirby, 1997). Medically Accurate Sexuality Education Is Supported by the Majority of Americans The vast majority of Americans support sexuality education for teenagers — 93 percent believe it should be taught in high schools, and 84 percent believe it should be taught in middle or junior high schools (SIECUS, 1999). Teenagers also express the need for medically accurate, responsible sexuality education:
Medically Accurate Sexuality Education Is a Success in Other Developed Nations European countries have already demonstrated great success with responsible, medically accurate sexuality education. For example:
The rate of teenage pregnancy in the United States has been declining — between 1990 and 1996 it decreased from 117 pregnancies per 1,000 women aged 15–19 to 97 per 1,000, a drop of 17 percent (AGI, 1999a). A flawed report commissioned by the so-called Consortium of State Physicians Resource Councils, an anti-choice organization, concluded that the recent decline in adolescent pregnancy and childbearing is a result of higher levels of sexual abstinence among American teens. The authors attribute this increase in abstinence in part to abstinence-only education (Jones et al., 1999). However, this study draws its conclusions from incomplete and non-comparable data, rendering the findings invalid (AGI, 1999b). The Alan Guttmacher Institute investigated the decline in teenage pregnancy using data from the National Survey of Family Growth (NSFG), the major source of government data on population and reproductive health. The NSFG data show that the decline in teenage pregnancy rates has occurred primarily among sexually experienced teens. The fact is that sexually active teenagers are learning to use contraception more frequently and more effectively, and they account for 80 percent of the decline in teenage pregnancy rates (Saul, 1999). The Media Has an Important Role in Pregnancy Prevention Another source of teen information about sex is the media:
Easy Access to Contraception Helps Reduce the Incidence and Cost of Teen Pregnancy Easy and confidential access to family planning services through clinics, school-linked health centers, and condom availability programs has been found to help prevent unintended pregnancy. In 1995, contraceptive use among women aged 15–19 years old prevented an estimated 1.65 million pregnancies in the United States (Kahn et al., 1999). Contraceptive use is also cost-effective. The average annual cost associated with unintended pregnancy and sexually transmitted infections per adolescent who uses no method of contraception is $5,758 in the private sector and $3,079 in the public sector. Access to contraception lowers this cost. For example, the contraceptive implant costs $1,533 over five years in the private sector, saving approximately $4,225 (Kahn et al., 1999). Various studies have demonstrated that efforts to improve teenagers’ access to contraception do not increase rates of sexual activity (Kahn et al., 1999; Schuster et al., 1998; Guttmacher et al., 1997; Kirby, 1997), but do yield a number of positive outcomes. For example:
Confidentiality Attracts Teens to Contraceptive Services Forty percent of sexually active teens in need of contraceptive services turn to Title X-funded clinics (Donovan, 1998). Confidential access to contraceptive services is crucial to preventing teenage pregnancy. If teenage women are denied access to both prescription and over-the-counter methods of contraception, approximately one million additional pregnancies will occur annually (Kahn et al., 1999). In Carey v. Population Services International, the U.S. Supreme Court ruled that minors have a constitutional right to privacy that includes the right to obtain contraceptives (431 U.S. 678 (1977)). Title X requires that family planning services be provided to adolescents and that minors’ confidentiality be protected by prohibiting funded clinics from releasing information from a patient’s file without her or his consent and by enforcing a fee scale that is based on the minor’s, not the parents’, income (AGI, 1995). Some state courts have adopted "mature minor" rules that authorize minors to consent to medical treatment related to sexual activity without parental consultation or permission (Donovan, 1998; AGI, 1995). However, approximately half of all U.S. states lack legislation that explicitly guarantees teenagers’ rights to consent to contraceptive services (AGI, 1995). Increased Insurance Coverage for Contraception Will Help Reduce Teen Pregnancy Expanding insurance coverage for contraception is one way to improve teenagers’ access to contraception. Many teenagers cannot afford to pay for contraceptive methods. Pills cost $180–$300 per year; injections cost $110–$170 per year; implants cost up to $750; IUDs cost up to $450 (PPFA, 1998). Many private insurance plans do not provide adequate coverage for contraception — no U.S. health care policy pays for condoms (Berne & Huberman, 1999), half of all fee-for-service plans do not cover any reversible methods of contraception and only one-third cover the pill, only 39 percent of traditional health maintenance organizations (HMOs) cover all five methods of prescription contraceptives, and seven percent do not cover any of them (Dailard, 1999). Countries with lower rates of teenage pregnancy — the Netherlands, Germany, and France — also have liberal contraceptive coverage for contraceptive pills and devices, including free contraceptive services for teenagers (Berne & Huberman, 1999). If passed, the federal Equity in Prescription Insurance and Contraceptive Coverage Act (EPICC) being debated by Congress would require all health insurance plans with a prescription drug benefit to cover contraception. Still, sexually active women will remain unprotected: one-quarter of women of childbearing age, and one-third of children under age 18, do not have private insurance (Dailard, 1999; Campbell, 1999). Poor and Low-Income Teens Most in Need of Contraceptive Coverage Public funding for family planning could significantly help poor (family income is at or below the federal poverty level) and low-income (family income is between 100 and 199 percent of the poverty level) teenagers aged 15–19, who account for 73 percent of young women who become pregnant, even though they make up only 38 percent of all women in that age group (AGI, 1998). Poor teenagers are more sexually experienced than those of higher incomes, yet they use contraception less frequently and less successfully, and they have higher rates of pregnancy (AGI, 1998). Among women aged 15–19, 60 percent of poor women are sexually experienced, versus 53 percent of low-income and 50 percent of higher income adolescents (AGI, 1998). Nearly 60 percent of poor and low-income teenagers use some method of contraception the first time they have sex, versus 75 percent of higher income teens. Likewise, 78 percent of poor and 71 percent of low-income teenage women use contraception on an ongoing basis, versus 83 percent of higher income teens (AGI, 1998). When faced with an unintended pregnancy, many poor and low-income teens are likely to view early childbearing as a positive, desirable choice (Brindis, 1999), becoming pregnant with the misguided hope of improving their lives (Gordon, 1996). Medicaid, Title X, and the State Children's Health Insurance Program (CHIP) are three government programs that subsidize contraceptive services for poor and low-income adolescents. Publicly funded family planning is cost-effective — every dollar spent on publicly subsidized family planning services saves $4.40 on costs that would otherwise be spent on medical care, welfare benefits, and other social services to women who became pregnant and gave birth (Donovan, 1995). Of 15–19-year-olds obtaining contraceptive services, 63 percent use a publicly funded source (Forrest & Samara, 1996). Four in 10 sexually active teenagers who need contraceptive services rely upon clinics funded through Title X (Donovan, 1998). Despite these outcomes, public funding for family planning is decreasing — funding for Title X dropped 61 percent between 1980 and 1998 when inflation is taken into account (Dailard, 1999). Poor teens who cannot afford the full cost of contraception must rely upon cheaper but less effective methods (Donovan, 1995), such as periodic abstinence and withdrawal. Poor and High-Risk Teens Need Programs Aimed at Preventing Pregnancy Although youth development programs for poor teens, such as academic tutoring, job training and placement, mentoring, and youth-led enterprise programs, have been found to significantly reduce teenage pregnancy rates (Kirby, 1997), few adolescent pregnancy prevention programs directly address the problem of poverty (Brindis, 1999). Lesbian, bisexual, and abused teens, as well as teens who are sexually involved with older partners, are more likely than other teens to experience pregnancy, and they may need specialized programs to address their specific risk behaviors and to help them obtain services. Pregnancy among lesbian and bisexual adolescents is 12 percent higher than among heterosexual teens. Lesbian and bisexual teens are also more likely to engage in frequent intercourse — 22 percent versus 15–17 percent of heterosexual or unsure teens (Saewyc et al., 1999). Teenagers who have been raped or abused also experience higher rates of pregnancy — in a sample of 500 teen mothers, two-thirds had histories of sexual and physical abuse, primarily by adult men averaging age 27 (Males, 1993). Among women younger than 18, the pregnancy rate among those with a partner who is six or more years older is 3.7 times as high as the rate among those whose partner is no more than two years older. Adolescent women with older partners also use contraception less frequently — one study found that 66 percent of those with a partner six or more years older had practiced contraception at last intercourse, compared with 78 percent of those with a partner within two years of their own age (Darroch et al., 1999). Some states are enacting or more rigorously enforcing statutory rape laws to curb teenage pregnancy among women with older partners by deterring adult men from becoming sexually involved with minors. However, experts assert that statutory rape laws will not reduce rates of teenage pregnancy, but will discourage teens from obtaining reproductive health care out of fear that disclosing information about their partner will lead to a criminal charge (Donovan, 1997). Pregnancy Prevention Programs Must Address the Role of Young Men Young men are often overlooked as a group that plays an important role in reducing teenage pregnancy. A study of high school students in North Carolina found that 14.7 percent of sexually experienced teenage men had been involved in a pregnancy in 1997 — a 38 percent increase from 1995 (DuRant, 1999). Sexuality educators and reproductive health care providers must therefore present pregnancy prevention as the job of both partners to foster responsible sexual choices among young men and women. Because young men who have unprotected intercourse also tend to engage in other risk behaviors such as fighting, carrying a gun or other weapon, attempting suicide, smoking cigarettes, drinking alcohol, and using drugs (DuRant, 1999), programs designed to address these behaviors should optimally include a pregnancy prevention component. Preventing Teenage Pregnancy Calls for Changes in Attitudes about Sexuality A shift in attitudes towards teenage sexuality must occur in the U.S. to facilitate the development of appropriate policies and programs to reduce teenage pregnancy. Presently, sexual activity, rather than the pregnancies that can result from it, is seen as the problem requiring intervention. Teaching young people that premarital sex is a moral failure does not prevent pregnancy — studies show that those with fearful and negative attitudes about sexuality are less likely to use contraception when they have sex than those who believe they have a right to decide to have sex (Reiss, 1990). Recognition that sexual expression is a crucial component of teenagers’ development will help guarantee teenagers the right to honest, accurate information about sex and access to high quality reproductive health services that will empower them to express their sexuality in safe and healthy ways. Lower teenage pregnancy rates will follow as a natural outcome. AGI — Alan Guttmacher Institute. (1995). Issues in Brief: Lawmakers Grapple with Parents’ Role in Teen Access to Reproductive Health Care. New York: Alan Guttmacher Institute _____. (1998). Issues in Brief: Teenage Pregnancy and the Welfare Reform Debate. New York: Alan Guttmacher Institute. _____. (1999a, accessed 1999, October 5). Facts in Brief: Teen Sex and Pregnancy [Online]. www.agi-usa.org/pubs/fb_teen_sex.html _____. (1999b, April 29). Memorandum, "Consortium of State Physicians Resource Council Report." New York: Alan Guttmacher Institute Annie E. Casey Foundation. (1998). When Teens Have Sex: Issues and Trends. Baltimore, MD: Annie E. Casey Foundation. Berne, Linda & Barbara Huberman, eds. (1999). European Approaches to Adolescent Sexual Behavior and Responsibility. Washington, DC: Advocates for Youth. Brindis, Claire. (1999). "Building for the Future: Adolescent Pregnancy Prevention." Journal of the American Medical Women's Association, 54(3), 129–132. Campbell, Jennifer A. (1999, October). "Health Insurance Coverage 1998." Current Population Reports, P60-208. Carey v. Population Services International, 431 U.S. 678 (1977). CDC — Centers for Disease Control and Prevention. (1998). "Youth Risk Behavior Surveillance — United States, 1997." Morbidity and Mortality Weekly Report, 47(SS-3), 1–89. Dailard, Cynthia. (1999). Issues in Brief: U.S. Policy Can Reduce Cost Barriers to Contraception. New York: Alan Guttmacher Institute. Darroch, Jacqueline E., et al. (1999). "Age Differences Between Sexual Partners in the United States." Family Planning Perspectives, 31(4), 160–167. Donovan, Patricia. (1995). The Politics of Blame: Family Planning, Abortion and the Poor." New York: Alan Guttmacher Institute. _____. (1997). "Can Statutory Rape Laws Be Effective in Preventing Adolescent Pregnancy?" Family Planning Perspectives, 29(1), 30–34 & 40. _____. (1998). Issues in Brief: Teenagers’ Right to Consent to Reproductive Health Care. New York: Alan Guttmacher Institute. DuRant, Robert H. (1999). North Carolina Adolescent Males: Linking High Risk Behaviors. Chapel Hill, NC: Adolescent Pregnancy Prevention Coalition of North Carolina. Forrest, Jacqueline Darroch & Renee Samara. (1996). "Impact of Publicly Funded Contraceptive Services On Unintended Pregnancies and Implications For Medicaid Expenditures." Family Planning Perspectives, 28(5), 188–195. Frost, Jennifer J. & Jacqueline Darroch Forrest. (1995). "Understanding the Impact of Effective Teenage Pregnancy Prevention Programs." Family Planning Perspectives, 27(5), 188–195. Gordon, Courtney P. (1996). "Adolescent Decision Making: A Broadly Based Theory and Its Application to the Prevention of Early Pregnancy." Adolescence, 31(123), 561–584. Guttmacher, Sally, et al. (1997). "Condom Availability in New York City Public High Schools: Relationships to Condom Use and Sexual Behavior." American Journal of Public Health, 87(9), 1427–1433. Jones, Jeffrey M., et al. (1999). The Declines in Adolescent Pregnancy, Birth and Abortion Rates in the 1990s: What Factors Are Responsible? N.p.: The Consortium of State Physicians Resource Councils. Kahn, James G., et al. (1999). "Pregnancies Averted Among U.S. Teenagers by the Use of Contraceptives." Family Planning Perspectives, 31(1), 29–34. Kirby, Douglas. (1997). No Easy Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy. KFF — Kaiser Family Foundation. (1999, accessed November 4). Many Teens in the Dark about Sexual Health: Press Release [Online].www.kff.org/content/1999/1548/teenfindings.htm. Kunkel, Dale, et al. (1999). "Sexual Messages on Television: Comparing Findings from Three Studies." The Journal of Sex Research, 36(3), 230–236. Landry, David J., et al. (1999). "Abstinence Promotion and the Provision of Information About Contraception in Public School District Sexuality Education Policies." Family Planning Perspectives, 31(6), 280–286. Luker, Kristin. (1996). Dubious Conceptions: The Politics of Teenage Pregnancy. Cambridge, MA: Harvard University Press. Males, Mike. (1993). "School-Age Pregnancy: Why Hasn’t Prevention Worked?" Journal of School Health, 63(10), 429–432. Potts, D. Malcolm. (1990). "Adolescence and Puberty: An Overview." In John Bancroft and June Machover Reinisch, eds., Adolescence and Puberty (pp. 269–279). New York: Oxford University Press. PPFA — Planned Parenthood Federation of America. (1998). The Facts about Birth Control. New York: Planned Parenthood Federation of America. Reiss, Ira L. (1990). An End to the Shame: Shaping Our Next Sexual Revolution. Buffalo, NY: Prometheus Books. Saewyc, Elizabeth M., et al. (1999). "Sexual Intercourse, Abuse and Pregnancy Among Adolescent Women: Does Sexual Orientation Make a Difference?" Family Planning Perspectives, 31(3), 127–131. Saul, Rebekah. (1999). "Teen Pregnancy: Progress Meets Politics." The Guttmacher Report on Public Policy, 2(3), 6–9. Schuster, Mark A., et al. (1998). "Impact of a High School Condom Availability Program on Sexual Attitudes and Behaviors." Family Planning Perspectives, 30(2), 67–72 & 88. SIECUS — Sexuality Information and Education Council of the United States. (1999, accessed November 11). Public Support for Sexuality Education Reaches Highest Level: Press Release [Online]. www.siecus.org/media/press/press0005.html. Zimbardo, Philip G. (1992). Psychology and Life, 13th ed. New York: HarperCollins. Media Contacts New York:212/261-4660 Washington, DC: 202/785-3351 Public Policy Contact Washington, DC: 202/785-3351 Fact Sheet Published by the Katharine Dexter McCormick Library Planned Parenthood Federation of America 810 Seventh Avenue, New York, NY 10019 212-261-4779 Current as of February 2000 |
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