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York: Alan Guttmacher Institute, 1986, unpublished.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 Problem 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 Problem 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 Robin Hood Foundation Special Report on the Costs of Adolescent
Childbearing, 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 Problem 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 Problem 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
85.0 Hispanic (any race)
80 81.1
82.2 African American
62.1 67.7
60 53.0 Native American
49.6
52.8 TOTAL
40 45.4 44.5
43.4 White (total)
34.1
26.2 22.8 Non-Hispanic White
20 27.4
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?”
Adults Teens

Important 94.5% 93.3%

Not important 4.7% 6.6%

Question for adults:
Please react to the following statement:
“Kidsin
“Kids inyour
yourcommunity
communityarearegetting
gettingaa
clearmessage
clear messagefrom
fromthe
theadults
adultsinintheir
their
livesthat
lives thatteen
teenpregnancy
pregnancyisiswrong.”
wrong.”
Wouldyou
Would yousay
sayyou
youagree
agreestrongly,
strongly,agree
agree
somewhat,disagree
somewhat, disagreesomewhat,
somewhat,or or
disagreestrongly
disagree stronglywith
withthat
thatstatement?
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’mgetting
“I’m gettingaaclear
clearmessage
messagefromfromthe
the
adultsin
adults inmy
mylife
lifethat
thatteen
teenpregnancy
pregnancyisis
wrong.” Would
wrong.” Wouldyou yousay
sayyou
youagree
agree
strongly,agree
strongly, agreesomewhat,
somewhat,disagree
disagree
somewhat,or
somewhat, ordisagree
disagreestrongly
stronglywith
with
thisstatement?
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 Teens

Teens should not be sexually active, but 73.0% 56.3%

teens who are should have access to birth
control (or “protection.”)

Teens should not be sexually active and 15.0% 18.4%

should not have access to birth control
(or “protection”)

It’s okay for teens to be sexually active, 11.6% 25.0%

as long as they have access to birth
control (or “protection.”)
Suppose a parent or other adult tells a
teenager the following:

“I“Ifeel
feelvery
verystrongly
stronglythat
thatnot
nothaving
havingsexsexatatall
all
duringyour
during yourmiddle
middleand
andhigh
highschool
schoolyears
yearsisis
yourbest
your bestoption
optionand andthe
theright
rightthing
thingtotodo.
do. II
alsothink
also thinkititisisimportant
importantfor
foryou
youtotoreceive
receive
informationabout
information aboutbirth
birthcontrol
controlororprotection.
protection.
But,again,
But, again,IIthink
thinknot
nothaving
havingsex
sexisisyour
yourbest
best
option.”
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 specific
Clear and specific
message
message

Adults Teens
“When it comes to teens’/your sexual
decision-making, which of the following
is most influential? Would you say…”

Adults Teens
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…”
Adults Teens
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.