Teen Pregnancy
William P. Adelman M.D., FAAP
Assistant Professor of Pediatrics
Uniformed Services University of the Health Sciences
National Campaign to Prevent Teen Pregnancy
www.teenpregnancy.org
Teen Pregnancy
Why do we care?
U.S. Data and current trends
Should we care in the military?
What military data is available?
What works and where is the evidence?
Office Based Approach
We know lots about sex, what about sexuality?
Adult and teen perceptions
Four in Ten Girls Get Pregnant at
Least Once Before Age 20.
Source: National Campaign to Prevent Teen Pregnancy analysis of Henshaw, S.K., U.S.. Teenage Pregnancy Statistics, New
York: Alan Guttmacher Institute, May, 1996; and Forrest, J.D., Proportion of U.S. Women Ever Pregnant Before Age 20, New
York: Alan Guttmacher Institute, 1986, unpublished.
100 Teen Girls Get Pregnant Each Hour
Total: 905,000
18-19
60%
542,640
337,530
15-17
24,830
under 15
37%
3%
The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for
women aged 20-24. New York: Author.
We’re Number One
The United States has much higher pregnancy and birth rates than other
fully industrialized countries. US pregnancy rates are nearly twice as
high as rates in Canada and England and seven to eight times as high as
rates in Japan and the Netherlands.
120
100
80
60
40
20
0
United Canada Denmark England & France Japan Netherlands Norway Sweden
States (1995) (1995) Wales (1995) (1995) (1992) (1996) (1996)
(1996) (1995)
Pregnancy Rate Birth Rate
Singh, S., & Darroch, J.E. (2000). Adolescent pregnancy and childbearing: Levels and trends in developed countries. Family
Planning Perspectives 32(1), 14-23. Pregnancy rates calculated as the sum of births, abortions, and estimated miscarriages (20
percent of births plus 10 percent of miscarriages).
Each Year, Half a Million Teens Give Birth
In 1996, just over one-half of teen pregnancies to girls aged 15-19 ended in birth,
about one-third ended in abortion, and 14 percent ended in miscarriage.
miscarriage
14%
birth
56% 124,700
491,577
263,890
abortion
30%
The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for
women aged 20-24. New York: Author.
55 Teen Girls Give Birth Each Hour
Nearly one-half million teen births occurred in 1999.
Total: 484,794
18-19
64%
312,186
163,559 9,049
15-17 under 15
34% 2%
* Data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital
Statistics Reports 48(14).
Proportion of Teen Births to Unmarried
Teens, 1999*
(Births to Teens Aged 15-19)
Married
21.4%
Unmarried
78.6%
101,814
373,931
* Data for 1999 are preliminary. Ventura, S.J., & Bachrach, C.A. (2000). Nonmarital childbearing in the United States, 1940-99.
National Vital Statistics Reports 48(16). Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital
Statistics Reports 48(14).
The Consequences of Teen Motherhood
Less likely to complete high school
Dependence on welfare
Single parenthood
More likely to have more children sooner
on a limited income
More likely to abuse or neglect the child
National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Prob lem of Teen
Pregnancy in the United States. Washington, DC: Author.
Teen Mothers and High School Diploma by
Age 30
No high school
68% diploma
32%
High school
diploma
National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Prob lem of Teen
Pregnancy in the United States. Washington, DC: Author.
Risks to Children of Teen Mothers
Growing up without a father
Low birth weight and prematurity
School failure
Mental retardation
Insufficient health care
Abuse and neglect
Poverty and welfare dependence
Females more likely to be teen moms themselves
Males more likely to be incarcerated
Source: Maynard, R.A., (ed.), Kids Having Kids: A Rob in Hood Foundation Special Report on the Costs of Adolescent
Childb earing, New York: Robin Hood Foundation, 1996.
The Children of Teen Mothers Are at
Greater Risk of Abuse and Neglect
120 110
100
80 Reported child abuse
incidents per 1,000
60 51 children
Foster care placements
40 29 per 1,000 children
18
20
0
Children born to teen Children born to older
mothers mothers (age 20-21)
National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Prob lem of Teen
Pregnancy in the United States. Washington, DC: Author.
Taxpayers Spent $6.9 Billion ($2,831 Per
Teen Parent) on Teen Childbearing in 1996
Lost Tax Revenues
Public Assistance
Expenditures
$1.4 $1.0
Health Care Costs
for the Children of
Teen Mothers
Foster Care Costs
$1.7 $2.7 Criminal Justice
$0.1 Costs
National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Prob lem of Teen Pregnancy
in the United States. Washington, DC: Author.
Teen Pregnancy Rates, Girls Aged 15-19
(Pregnancies Per 1,000 Girls)
120
117.1
115
111.0
110
105
106.6
100
97.3
95
95.1
90
85
80
1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996
The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for women
aged 20-24. New York: Author.
Teen Pregnancy Rates, Racial/Ethnic Subgroups
(Number of Pregnancies Per 1,000 Girls Aged 15-19)
240
224.3
200
175.1 178.9 Non-Hispanic
Black
160 Hispanic
163.4 164.6
(any race)
120
87.3
80
66.1 Non-Hispanic
40 White
0
1990 1991 1992 1993 1994 1995 1996
Darroch, J.E., & Singh, S. (1999). Why is teenage pregnancy declining? The roles of abstinence, sexual activity and
contraceptive use. Occasional Report 1. New York: The Alan Guttmacher Institute.
Teen Birth Rates, Girls Aged 15-19
(number of births per 1,000 girls)
The teen birth rate declined steadily from 1960 through the mid-1970s, stayed fairly
constant for the next decade, then increased 24 percent between 1986 and 1991.
Between 1991 and 1999, the teen birth rate decreased 20 percent to a record low.
100
90 89.1
80 81.6
70 68.3
62.1
60
52.8
50
50.2 49.6
40
30
20
10
0
1950 1954 1958 1962 1966 1970 1974 1978 1982 1986 1990 1994 1998
Note: data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital
Statistics Reports 48(14). Ventura, S.J., Mathews, T.J., & Curtin, S.C. (1998). Declines in teenage birth rates, 1991-97:
National and state patterns. National Vital Statistics Reports 47(12).
Teen Birth Rates by Race/ethnicity, Girls 15-19
(number of births per 1,000 girls)
Teen birth rates vary substantially among the largest racial/ethnic subgroups. Between
1991 and 1999, the rate for African-American teens declined 30 percent, the rate for all
White teens declined 16 percent and the rate for non-Hispanic White teens declined 21
percent, the rate for Hispanics decreased 13 percent, the rate for Native Americans declined
20 percent, and the rate for Asian/Pacific Islanders declined 17 percent.
120
115.5
100 106.7
97.8 93.1 Hispanic (any race)
85.0
80 81.1 African American
82.2
62.1 67.7 Native American
60 53.0
49.6 TOTAL
52.8
40 45.4 44.5 White (total)
43.4
34.1 Non-Hispanic White
20 26.2 27.4 22.8 Asian/Pacific Islander
0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
Note: data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital Statistics
Reports 48(14). Ventura, S.J., Martin, J.A., Curtin, S.C., Mathews, T.J., & Park, M.M. (2000). Birth: Final data for 1998. National Vital
Statistics Reports 48(3).
Number of Teen Births, 1999*
400,000
350,000 337,323
300,000 White (total)
250,000 White (non-Hispanic)
213,223 African American
200,000 Native American
150,000 121,262 124,352 Asian/Pacific Islander
Hispanic (any race)
100,000
7,905
50,000
9,255
0
teen girls aged 15-19
* Data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital
Statistics Reports 48(14).
State Teen Birth Rates, 1998
(births per 1,000 girls aged 15-19)
Teen birth rates vary widely by state, ranging from 24.4 per 1,000 in Vermont to
73.0 per 1,000 in Mississippi.
24.4-35.8 per 1,000
36.9-42.6 per 1,000
43.1-49.2 per 1,000
51.2-61.6 per 1,000
64.3-73.0 per 1,000
Ventura, S.J., Curtin, S.C., & Mathews, T.J. (2000). Variations in teenage birth rates, 1991-98: National and state trends. National
Vital Statistics Reports 48(6).
Changes in Teen Birth Rates, 1991-98
(births per 1,000 girls aged 15-19)
Teen birth rates declined in all 50 state between 1991 and 1998; declines ranged
from 9.7 percent in Rhode Island to 37.8 percent in Vermont.
20.6-37.8% decline
17.9-20.5% decline
14.9-17.4% decline
12.7-14.7% decline
9.7-12.6% decline
Ventura, S.J., Curtin, S.C., & Mathews, T.J. (2000). Variations in teenage birth rates, 1991-98: National and state trends.
National Vital Statistics Reports 48(6).
Teen Births by Birth Order, 1999*
(births to girls aged 15-19)
Second
Total: 475,745 18% (85,455)
Third
First (14,643)
3%
78%
Fourth+
(370,749)
0% (2,148)
Not Stated
1% (2,750)
* Data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital
Statistics Reports 48(14).
Teen Pregnancy in the Military
Yes
Little data available for general
consumption
Small projects within the military
Mostly anonymous to location
No intervention studies
Large Army Community Hospital
40,000 troops
38,000 dependents age 0-18
55,000+ retirees
Dependent of Dependent
Deliveries July 2000-June 2001
134 of total 2911deliveries
4.6 % of ALL deliveries (1 in every 21)
46/1000 live births are dependents of
dependents
Teen birth rate 48-67/1000 15-19 year olds
(very conservative estimate)
Military teen birth rate same or higher than
civilian rate
What Works to Prevent Teen
Pregnancy?
“No Simple Answer”
State programs with data:
Promoting Abstinence
Providing comprehensive sexuality education
Advocating youth development
Increasing access to health service
Public awareness
Male responsibility and involvement
Economic stimulus
Sexual Intercourse in Teen Girls
25% Age 15
40% Age 16
55% Age 17
70% Age 18
The average sexually active teenager has
had 4 partners by age 18
Why DO Girls have Intercourse?
Girls use sex to find love; Boys use love to
get sex (All men are pigs)
3of 4 girls and over ½ of boys report that
girls who have sex do so because their
boyfriends want them to have sex.
8 of 10 girls wish they had waited until they
were older to have sex
Why Do Girls NOT have
intercourse?
#1 “Against my religious or moral values”
#2 “To avoid pregnancy”
#3 “Fear of contracting a sexual infection”
#4 “Have not met the right partner”
What Protects Against Teen Sexual
Debut and Teen Pregnancy?
Two parent families (22% vs 44% of 16 yr
olds are sexually active)
Strong emotional attachment to parents
School connectedness
Lack of free time
Access to contraception
A sexually active teen who does
not use contraception has a 90
percent chance of pregnancy
within one year
The Paradox of Teen Sex
Half of all teenage pregnancies occur within
6 months of the onset of sexual activity
Most Teenagers look to the physician for
protection against pregnancy
Average time from onset of sexual activity
to presentation to the physician for
contraception is 9.5-14 months
Office Techniques to Reduce
Teen Pregnancy
Normalize history to include sexuality by
the 6th grade—Teaches OK to discuss with
the doctor before onset of activity
Promote Abstinence—congratulate smart
decisions
Offer a safe environment for comprehensive
discussion of sexuality and contraception
BEFORE onset of sexual activity
Office Techniques to Reduce
Teen Pregnancy
Promote communication about sexuality
issues between parent and child
All Men Are Pigs (optional)
What Do Teens and Parents Think?
Some survey results
The majority of slides in this presentation are from the
National Campaign publication, With One Voice:
America’s Adults and Teens Sound Off About Teen
Pregnancy. The publication has results from a
nationally-representative survey of over 1,000 adults
over age 20 and 1,000 young people aged 12-19
conducted in January and February 2001. The other
results are from various nationally polling of young
people aged 12-17 conducted in 2000. For complete
results, please visit the National Campaign’s website —
www.teenpregnancy.org.
“How important do you think it is
for teens to be given a strong
message from society that they
should abstain from sex until they
are at least out of high school?”
Teen
Adults
s
Important 94.5% 93.3%
Not important 4.7% 6.6%
Question for adults:
“Kids react to community are
Please in your the following statement:
getting a clear message from the
adults in their lives that teen
pregnancy is wrong.” Would you
say you agree strongly, agree
somewhat, disagree somewhat, or
disagree strongly with that
statement?
Disagree net
32.8%
63.0%
Agree net
Adults
Agree net 63.0%
Agree strongly 36.0%
Agree somewhat 27.0%
Disagree net 32.8%
Disagree somewhat 18.6%
Disagree strongly 14.2%
Question for teens:
Please react to the following statement:
“I’m getting a clear message from the
adults in my life that teen pregnancy is
wrong.” Would you say you agree
strongly, agree somewhat, disagree
somewhat, or disagree strongly with
this statement?
Disagree net
14.6%
85.1%
Agree net
Teens
Agree net 85.1%
Agree strongly 57.2%
Agree somewhat 27.9%
Disagree net 14.6%
Disagree somewhat 10.7%
Disagree strongly 3.9%
“Which of the following comes closest to your
view?”
Adults Teen
Teens should not be sexually s
active, but teens who are should 73.0% 56.3%
have access to birth control (or
“protection.”)
Teens should not be sexually 15.0% 18.4%
active and should not have access
to birth control (or “protection”)
It’s okay for teens to be sexually 11.6% 25.0%
active, as long as they have
access to birth control (or
“protection.”)
Suppose a parent or other adult
tells a teenager the following:
“I feel very strongly that not having
sex at all during your middle and high
school years is your best option and
the right thing to do. I also think it is
important for you to receive
information about birth control or
protection. But, again, I think not
having sex is your best option.”
“Do you think this is a clear and specific
message or do you think this is a
confusing or mixed message?”
Confusing or
mixed message
28.3% 24.3%
70.6% 74.7%
Clear and
Clear and
specific
specific
message
message
Adults Teens
“When it comes to teens’/your
sexual decision-making, which of
the following is most influential?
Would you say…”
Teen
Adults
s
Parents 31.7% 38.3%
Friends 50.0% 31.7%
The media 7.5% 3.6%
Teachers and sex educators 3.5% 6.8%
Brothers and sisters 3.0% 7.4%
Religious organizations 2.9% 9.1%
“Other than teens themselves, who
do you think is most responsible
for fixing the problem of teen
pregnancy? Would you say…”
Teen
Adults
s
Parents and adults 85.0% 63.3%
The media 6.8% 14.5%
Schools 3.7% 13.5%
The government 1.8% 5.4%
Religious organizations 1.2% 2.1%
“Have you had a helpful
conversation with your
parents about sex?”
More than one-third of teens say
they have not had even a single
helpful conversation with their
parents about sex.