Teen Pregnancy In The United States: A Work In Progress

Dr. David J. Holcombe
Dr. David J. Holcombe

Significant progress has been made in reducing teen pregnancy in the United States over the last two decades.  The number of births per 1,000 teens between 15 and 17 years of age dropped by 67% from 1991 (51.9/1,000) to 2012 (17/1,000).  Proportionally, the greatest drop occurred in the 15-year-olds (70%) as compared to the 16- (65%) and 17-year-olds (61%).  While good news, the rates of teenage pregnancy remain high in the U.S. (31.3/1,000 live births), when compared with other industrialized countries (24/1,000 in the U.K. and only 4/1,000 live births in the Netherlands). Teen births are particularly high in Louisiana at 45.1/1,000 births, although better than Arkansas and Mississippi at 50/1,000 live births.  Among all U.S. teens that become pregnant, there remains significant difference between races, with Hispanics (25.5/1,000 teens) and African-Americans (21.9/1,000) several times higher than whites (8.4/1,000) and Asians (4.1/1,000).


The declines in teen pregnancies in the U.S. are attributed to a combination of decreased sexual activity (23%) and changes in contraceptive methods (77%).  The latter included an increased use of highly effective contraceptive choices such as LARCs (Long-Acting Reversible Contraceptives), which include both intra-uterine devices (IUDs: Paragard or Mirena and Skyla) and implantable devices (Nexplanon).  Even though most sexually active teens (92%) used some form of contraception, it is generally one of the least effective methods, including condoms, which are used imperfectly.


Most young teens (15-17 years of age) that become pregnant are still in high school, but only 38% of these go on to complete their secondary education.  Over 80% of teens who become pregnant had not received adequate sex education in school and around 25% had never spoken to their parents about any form of contraception, including abstinence.  That being said, among sexually active teens, over half (58%) had visited a healthcare provider for reproductive health services.  Despite this fact, over 80% of teen pregnancies are still unintended, substantially higher than the surprising 50% rate among all U.S. women (which is higher than the estimated 40% rate or less among women in other developed countries).


So what can be done about reducing teen pregnancy even further?  Parents, guardians and caregivers can talk to teens about sexuality, including contraception, keep teens out of high risk situations (unsupervised parties with alcohol consumption), and be very aware of social media influences on adolescents.  Increased use of LARCs (Long-Acting Reversible Contraception), including intrauterine devices and implantable rods (in the upper arm) would go a long way to decreasing unintended pregnancies, especially in teenagers whose complicated lives distract them from correct use of other less effective methods.


Healthcare providers should encourage delayed sexual activity in adolescents, but also offer open, honest, convenient, confidential and respectful services to teens.  The substantial risks of STDs (including HIV), especially in Louisiana (which ranks in the top 4 states for STDs and HIV rates), should be stressed, with recommendations for safe sex practices among sexually active teens.  Adolescents themselves should speak openly to parents, healthcare professionals and educators and recognize their responsibilities to prevent unintended pregnancies and STDs, both of which can be life-altering experiences.