Teenage pregnancy health education

The progress the nation has made over the last few decades in reducing teen pregnancy has been extraordinary. Basically, teen pregnancy rates can decrease in one of two ways—if teens have less sex or become more effective contraceptive users—or through some combination of the two. The teen pregnancy rate has declined not only for the nation as a whole, but also for every state. The majority of teen pregnancies (69%) occur among 18–19-year-olds, which is hardly surprising given that they make up the majority of sexually active teens. When broken down by age, the decline in teen pregnancy among 18–19-year-olds was entirely attributable to improved contraceptive use, because the overall proportions who had ever had sex or were engaging in sexual activity did not change between 1995 and 2002. In 2014, Guttmacher researchers analyzed subsequent cycles of NSFG data and found that the decline in teen pregnancy since 2003 had little or nothing to do with teens’ delaying sex.7 Nationwide, the proportion of teens who had ever had sex did not change significantly between 2003 and 2010 (46% and 45%, respectively).
Instead, the decline in teen pregnancy in recent years can be linked to improvements in teens’ contraceptive use. Moreover, between mid-2008 and mid-2010, increasing proportions of 18–19-year-olds reported having ever had sex, and yet fewer of them became pregnant. And yet, researchers say it is not realistic to expect that an education program alone will change behaviors enough to have a measurable impact on pregnancy rates.10 For one thing, these interventions are modest. Researchers have considered whether the changing demographic makeup of the nation may be contributing to the trends in teen pregnancy and birth rates.
Related to the effects of long-standing social inequalities, researchers have also considered whether the nation’s economy or labor market conditions may have contributed to fewer pregnancies and births among teens.
Experts point to the AIDS crisis in America and the impact of AIDS education programs over the past several decades as having played a role in persuading more teens to use condoms. Changing social attitudes and family norms may also be contributing to the trend in teen pregnancy. Understanding why teen pregnancy rates have fallen goes to the heart of a number of relevant and timely public policy questions.
All adolescents, for example, need sex education that teaches them the skills they need to delay sexual initiation, while also preparing them with the information and skills needed to protect themselves and their partners when they do become sexually active. At the end of the day, the credit for the declines in teen pregnancy goes to adolescents themselves, who are making an effort to prevent unintended pregnancy.
The Data and FactsChildren born to teen parents are far more likely to live in poverty as a result of the education and employment challenges faced by their young parent while teen pregnancy can derail aspirations and positive youth development.
After years of increases in the 1970s and 1980s, the teen pregnancy rate peaked in 1990 and has declined steadily since.1 Today, teen pregnancy, birth and abortion rates have reached historic lows.
The evidence clearly indicates that more and better contraceptive use has been the main factor driving the long-term decline in teen pregnancy.

On one level, the answer is simple: Pregnancy rates have fallen either because teens are having less sex in the first place or because more teens who are sexually active are using contraceptives and using them more effectively.
The researchers concluded that the vast majority of the decline in teen pregnancy—86%—was the result of improvements in contraceptive use, including increases in the use of individual methods, an increase in the use of multiple methods and a substantial decline in nonuse.6 The remaining 14% of the decline could be attributed to a decrease in sexual activity.
Delaying first sex played a greater role for younger teens, accounting for 23% of the decline in pregnancy among 15–17-year-olds. But just how these behaviors are linked with teens’ race or ethnicity, educational achievements or family income is difficult to sort out. For instance, an adolescent who has a child is likely to have a hard time finishing high school, which is often followed by decreased economic opportunities and earnings in future years.14 But living in poverty or having a low level of education could also increase the risk that a young woman will become pregnant in the first place. Whereas the age composition of the teenage population has been roughly consistent since the early 1990s, the racial and ethnic composition has changed.15 Latina adolescents—a group with high rates of pregnancy and births—make up an increasing share of the teenage population. In the early 1990s, a handful of highly visible people living with HIV—such as sports figure Magic Johnson, mother and activist Elizabeth Glaser, and teenager Ryan White—helped raise public awareness of HIV, and of the need for AIDS research and public education to address the epidemic. There are many complex societal forces that may help explain the drop in teen pregnancy, birth and abortion rates—and the sexual behaviors and contraceptive use patterns that underlay them. By the end of the Bush administration, the era of abstinence-only education—a decade or so during which the federal and state governments spent well over $1.5 billion on education programs focused solely on promoting abstinence29—appeared to be over. Expansions in public and private health insurance under the Affordable Care Act mean that more teens are gaining coverage for contraceptive services.
The question now is whether society will do its part by adopting policies that support and equip young people with knowledge, skills and services to stay healthy. Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, 104(S1):S43–S48.
Finer LB and Philbin JM, Sexual initiation, contraceptive use, and pregnancy among young adolescents, Pediatrics, 2013, 131(5):886–891.
Finer LB and Philbin JM, Trends in ages at key reproductive transitions in the United States, 1951–2010, Women’s Health Issues, 2014, 24(3):e271–e279.
Martinez G, Copen CE and Abma JC, Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006–2010 National Survey of Family Growth, Vital and Health Statistics, 2011, Series 23, No.
Kearney MS and Levine PB, Media Influences on social outcomes: the impact of MTV’s 16 and Pregnant on teen childbearing, NBER Working Paper, 2014, No. American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care, Long-Acting Reversible Contraception Working Group, Committee opinion no. There is some good news though- from 2009-2012, based on Berkshire Health Systems and Berkshire Regional Planning Commission data from local hospitals, the Berkshire County teen birth rate declined 50% - thanks in part to the work this community is doing with the Face the Facts - reduce teen pregnancy coalition.Face the Facts-reduce teen pregnancy -- including Berkshire United Way and representatives from business, education, health care and local social service agencies -- knows there is still more to do! What is more, teen pregnancy rates have fallen in all 50 states and among all racial and ethnic groups.

Yet, substantial disparities remain among states: Maine, Massachusetts, Minnesota, New Hampshire and Vermont have consistently had the lowest teen pregnancy rates (28–37 per 1,000 in 2010), whereas Arkansas, Louisiana, Mississippi, New Mexico, Oklahoma and Texas have had the highest (69–80 per 1,000).
Nonetheless, wide disparities in pregnancy rates by race and ethnicity persist, with rates among both black and Hispanic teens remaining twice as high as among their non-Hispanic white peers. The quality and quantity of evaluation research have improved dramatically over the last decade, and there is now clear evidence that comprehensive sex education programs can change the behaviors that put young people at risk of pregnancy.10 Such programs have been shown to delay sexual debut, reduce frequency of sex and number of partners, increase condom or contraceptive use, or reduce sexual risk-taking. All else held constant, therefore, researchers would have expected substantial increases in the teen pregnancy and birth rates, rather than declines.
Considering that teen pregnancy has been consistently declining despite fluctuations in the economy, it appears that the economy may not be a major driver behind the drop in rates.
Declines in pregnancy among teens parallel those among 20–24-year-olds, suggesting that later childbearing may be the “new normal” for adolescents, as well as for young adults. In the early 2000s, however, that began to change, as the standard of care regarding Pap tests and pelvic examinations shifted.25 Around that time, various medical groups—from the World Health Organization (WHO) to the American Cancer Society to the American College of Obstetricians and Gynecologists (ACOG)— updated their clinical recommendations to enable teens and young women to access hormonal contraceptives more quickly and easily without a pelvic exam or Pap test.
The research shows that adolescents need more comprehensive education, not less, and increased access to contraceptive services, not less. Deconstructing why teen pregnancy rates have fallen over the last several decades nonetheless matters, so that future programs, policies and practices can be shaped to help advance—rather than hinder—these positive trends. They are the elements of a society's organization and process that affect the overall distribution of disease and health. At the request of the Obama administration, Congress also provided roughly $185 million for medically accurate and age-appropriate sex education programs. Examples include education, housing and the built environment, transportation, employment opportunities, the law, and the justice system. The health care and public health systems are also social determinants of health.Health EquityHealth equity is achieved when everyone has an equal opportunity to reach his or her health potential regardless of social position or other characteristics such as race, ethnicity, gender, religion, sexual identity, or disability. 4Teens in child welfare systems are at increased risk of teen pregnancy and birth than other groups. For example, young women living in foster care are more than twice as likely to become pregnant compared to those not in foster care.

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