Teen Pregnancy-So what PowerPoint Presentation

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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

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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

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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and Forrest, J.D., Proportion of U.S. Women Ever Pregnant Before Age 20, New York: Alan Guttmacher Institute, 1986, unpublished.

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542,640 337,530 24,830 Total: 905,000 The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: Author. 100 Teen Girls Get Pregnant Each Hour

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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. 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).

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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. The Alan Guttmacher Institute. (1999). Special report: U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: Author. 491,577 124,700 263,890 Each Year, Half a Million Teens Give Birth

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Nearly one-half million teen births occurred in 1999. * Data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital Statistics Reports 48(14). 312,186 163,559 9,049 Total: 484,794 55 Teen Girls Give Birth Each Hour

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* 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). 373,931 Proportion of Teen Births to Unmarried Teens, 1999*(Births to Teens Aged 15-19) 101,814

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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.

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Teen Mothers and High School Diploma by Age 30 68% 32% National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Problem of Teen Pregnancy in the United States. Washington, DC: Author.

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Risks to Children of Teen Mothers 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. 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

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The Children of Teen Mothers Are at Greater Risk of Abuse and Neglect 110 51 29 18 National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Problem of Teen Pregnancy in the United States. Washington, DC: Author.

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Taxpayers Spent $6.9 Billion ($2,831 Per Teen Parent) on Teen Childbearing in 1996 $2.7 $1.0 $1.4 $1.7 $0.1 National Campaign to Prevent Teen Pregnancy. (1997). Whatever Happened to Childhood? The Problem of Teen Pregnancy in the United States. Washington, DC: Author.

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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, Girls Aged 15-19(Pregnancies Per 1,000 Girls)

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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. Non-Hispanic Black Hispanic (any race) Non-Hispanic White Teen Pregnancy Rates, Racial/Ethnic Subgroups (Number of Pregnancies Per 1,000 Girls Aged 15-19)

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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. 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, Girls Aged 15-19(number of births per 1,000 girls)

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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. Hispanic (any race) African American White (total) Non-Hispanic White Asian/Pacific Islander Native American TOTAL 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). Teen Birth Rates by Race/ethnicity, Girls 15-19(number of births per 1,000 girls)

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* Data for 1999 are preliminary. Curtin, S.C., & Martin, J.A. (2000). Births: Preliminary data for 1999. National Vital Statistics Reports 48(14). Number of Teen Births, 1999*

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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 birth rates vary widely by state, ranging from 24.4 per 1,000 in Vermont to 73.0 per 1,000 in Mississippi. State Teen Birth Rates, 1998(births per 1,000 girls aged 15-19)

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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. 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)

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(370,749) (2,148) Total: 475,745 (85,455) (14,643) (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 Births by Birth Order, 1999*(births to girls aged 15-19)

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Teen Pregnancy in the Military Yes Little data available for general consumption Small projects within the military Mostly anonymous to location No intervention studies

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Large Army Community Hospital 40,000 troops 38,000 dependents age 0-18 55,000+ retirees

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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

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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

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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

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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

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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”

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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

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A sexually active teen who does not use contraception has a 90 percent chance of pregnancy within one year

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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

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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

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Office Techniques to Reduce Teen Pregnancy Promote communication about sexuality issues between parent and child All Men Are Pigs (optional)

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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.

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“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?” Important Not important Adults Teens 94.5% 4.7% 93.3% 6.6%

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“Kids in your community are 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? Question for adults: Please react to the following statement:

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Agree net Agree strongly Agree somewhat Disagree net Disagree somewhat Disagree strongly Adults 63.0% 36.0% 27.0% 32.8% 18.6% 14.2% Agree net Disagree net 32.8% 63.0%

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“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? Question for teens: Please react to the following statement:

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Agree net Agree strongly Agree somewhat Disagree net Disagree somewhat Disagree strongly Teens 85.1% 57.2% 27.9% 14.6% 10.7% 3.9% Agree net Disagree net 85.1% 14.6%

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Teens should not be sexually active, but teens who are should have access to birth control (or “protection.”)Teens should not be sexually active and should not have access to birth control (or “protection”)It’s okay for teens to be sexually active, as long as they have access to birth control (or “protection.”) “Which of the following comes closest to your view?” Adults Teens 73.0% 15.0% 11.6% 56.3% 18.4% 25.0%

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“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.” Suppose a parent or other adult tells a teenager the following:

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“Do you think this is a clear and specific message or do you think this is a confusing or mixed message?” Adults Teens 70.6% 28.3% 74.7% 24.3% Clear and specific message Clear and specific message Confusing or mixed message

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“When it comes to teens’/your sexual decision-making, which of the following is most influential? Would you say…” Parents Friends The media Teachers and sex educators Brothers and sisters Religious organizations Adults Teens 31.7% 50.0% 7.5% 3.5% 3.0% 2.9% 38.3% 31.7% 3.6% 6.8% 7.4% 9.1%

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“Other than teens themselves, who do you think is most responsible for fixing the problem of teen pregnancy? Would you say…” Parents and adults The media Schools The government Religious organizations Adults Teens 85.0% 6.8% 3.7% 1.8% 1.2% 63.3% 14.5% 13.5% 5.4% 2.1%

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“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.