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Adolescent pregnancy.

Most sexually experienced teenagers try to prevent pregnancy, and most young contraceptive users succeed in doing so. Nevertheless, 1 million adolescent women--12% of all women aged 15-19 and 21% of those who have had sexual intercourse--become pregnant every year. (150)

Pregnancy Rates: Up or Down?

Over the last two decades, adolescent pregnancy rates have gone both up and down, depending on how they are calculated (Figure 30, page 41). Reflecting the dramatic rise in the proportion of adolescent women who have had sexual intercourse during this period, the rate among all teenage women aged 15-19 increased 23% between 1972 and 1990, and is now at its highest level in nearly 20 years. (151)

Pregnancy rates among all adolescent women, however, do not present an accurate picture of pregnancy levels among teenagers, because some adolescents are not sexually experienced and therefore are not exposed to the risk of pregnancy. The more important trend, therefore, is the pregnancy rate among sexually experienced teenagers. That rate has declined 19% among 15-19-year-olds in the last two decades (152)--an encouraging indication that sexually experienced adolescents are using contraceptives more effectively than did their counterparts in the past.

Age and Race as Factors

Nearly two-thirds of teenage pregnancies occur among 18-19-year-old women. (153) The proportion of sexually experienced teenagers who become pregnant increases with age, because as they get older, adolescents generally have intercourse more frequently and are more likely to be fertile and to want to get pregnant (154) (Figure 31, page 42).

* Among sexually experienced teenagers, about 9% of 14-year-olds, 18% of 15-17-year-olds and 22% of 18-19-year-olds become pregnant each year.

* The rate for 18-19-year-olds is only slightly lower than that for 20-24-year-olds.

Pregnancy rates also vary considerably by race and ethnicity. (155)

*Black teenagers have a higher pregnancy rate than their Hispanic and white peers: Some 19% of all black women aged 15-19 become pregnant each year, compared with 13% of Hispanics and 8% of whites.

*The higher rate among blacks is only partly due to the fact that they are more likely than whites to be sexually experienced. Even among those who have had intercourse, blacks are considerably more likely than whites and Hispanics to become pregnant, presumably because they are less likely to use a contraceptive or to use it effectively.

Adolescent Men

Since pregnancy data have been collected almost exclusively for women, it is easy to ignore male involvement. However, young women typically marry men who are three or more years older than they are, (156) so it is likely that the male partners of pregnant teenagers are also older than the women.

*Only 26% of the men involved in the pregnancies among women under age 18 are estimated to have been that young; 35% are aged 18-19, and 39% are at least 20. (157)

*These comparisons suggest that while 18% of 15-17-year-old women who have had intercourse become pregnant each year, only about 4% of sexually experienced men who are that young make a partner pregnant. (158)

Adolescent men may be less likely than adolescent women to be involved in a pregnancy, because many are having sex with even younger women, who are still experiencing lower fecundity in the years immediately following menarche, or because they are much less likely than young women to have sex frequently. Alternatively, the reports that higher proportions of young men than women have sex could be false.

Whatever the explanation, it cannot be assumed that the men involved in teenage pregnancies are comparable to the pregnant women. Nor can adolescent pregnancy continue to be viewed strictly as a teenage phenomenon. Age differences between partners raise concerns about how persuasive young women can be in insisting that their partners use condoms and how effective disease and pregnancy prevention programs can be if they focus only on teenagers and ignore their older partners.

Different Directions

Many of the milestones along the path to adulthood--completing education, finding full-time employment and getting married--now typically occur in the late teenage years or, more commonly, in the early 20s. On the other hand, a quarter of all young women have been pregnant by the time they turn 18, and half have had a pregnancy by age 21. (169)

* Young black women and teenagers who are poor or low-income are especially likely to become pregnant early in life.

* Typically, there is a gap of three years between first intercourse and first pregnancy among poor and low-income teenagers, compared with a gap of four and a half years among higher income adolescents.

* Similarly, blacks and Hispanics generally become pregnant less than three years after becoming sexually experienced, while whites wait more than four years. (160)

Unintended Pregnancies

Some 85% of teenage pregnancies are unintended. (161) Teenagers are not alone in experiencing high rates of unintended pregnancy, however; 55% of pregnancies among older women are unintended. As a result, teenagers account for only about a quarter of all accidental pregnancies annually. (162)

* Pregnancies among higher income teenagers are more likely to be unintended than are those among poor and low-income adolescents; among older women, by contrast, those with higher incomes are less likely to have an unintended pregnancy than are those who are poor or low-income. (163)

* Hispanic teenagers who become pregnant are somewhat more likely than blacks or whites to have wanted to get pregnant or at least not to have cared whether or not they became pregnant. (164)

* Whether an adolescent intends to become pregnant is strongly affected by whether she is married (Figure 82, page 48). Even among married teenagers, however, most pregnancies are unintended. And since so few teenagers are married, 60% of intended pregnancies among women under age 20 occur among unmarried (165)

Pregnancy rates among sexually experienced teenagers have declined substantially over the last two decades, but because the proportion of teenagers who are sexually experienced has grown, the overall teenage pregnancy rate has increased. One million young women become pregnant annually, the vast majority unintentionally. Older teenagers and adolescents who are poor or black are more likely to get pregnant than are their younger, more advantaged and white counterparts. The way in which teenagers resolve their pregnancies also differs by age, income status, race and ethnicity, and marital status.

(150.) AGI, 1993b; Henshaw, Koonin, and Smith, 1991, Table 4, p. 78; Hollmann, 1993.

In addition, each year, some 20-year-olds who conceived when they were 19 have abortions, miscarriages or births (approximately 185,000 in 1990). In this report, pregnancies are classified by the woman's age at the time of the birth, abortion or miscarriage, not by her age at the time of conception.

(151.) Henshaw, 1993.

Pregnancies among women under 15 account for fewer than 3 percent of all pregnancies among teenagers. Between 1987 and 1990, the pregnancy rate increased less than 1% for all women under 14, rose 5% for 15-17 year-old women, and climbed 8% for women aged 18-19 and 20-24

(152.) Henshaw, 1993.

Rates among sexually experienced women aged 15-17 were lower in 1990 than in any previous year for which data were collected; they were lower for 18-19-year- old women for all years except 1987, 1988 and 1989.

(153.) Henshaw, 1993.

Overall, 62% of teenage pregnancies in 1990 occurred among women aged 18-19, compared with 58% in 1972. Between 1972 and 1990, the number of pregnancies among women under age 15 remained between 28,000 and 32,000; the number among 15-17-year-olds declined from 389,000 to 363,000, while the number among older teenagers increased from 561,000 to 649,000.

(154.) AGI, 1993b; Henshaw, 1993.

The proportion of women who become pregnant is much smaller among younger teenagers than among older adolescents. Fewer than 2% of all 14-year-olds become pregnant each year, compared with 7% of 15-17-year-olds, 17% of those aged 18-19 and 20% of 20-24-year-olds.

(155.) AGI, 1993b.

Every year, 32% of sexually experienced black teenage women, compared with 26% of Hispanics and 15% of whites, become pregnant.

(156.) NCHS, 1990b, Table 1-10, pp. 1-14.

(157.) AGI, 1993d; AGI, 1993e; Henshaw, 1992, Table 1, p.86.

(158.) AGI, 1993d: AGI, 1993e: Henshaw, 1992, Table 1, p. 86; Hollmann, 1993; Sonenstein, Pleck and Ku, 1989, Table 1, p. 153.

(159.) Forrest, 1993, p. 108.

(160.) AGI, 1993b.

Because of differences in how young women resolve their pregnancies, the median gap between conception and first birth is almost five years among white women, compared with only three years among blacks and two years among Hispanics.

(161.) AGI, 1993d; Henshaw, 1992, Table 1, p. 86. Only women aged 25-34 have more intended pregnancies than unintended ones. Pregnancies ending in miscarriage are excluded from the calculations.

(162.) AGI, 1993d; Henshaw, 1992, Table 1, p. 86. Pregnancies ending in miscarriage are excluded from the calculations.

(163.) AGI, 1993d; ACT 1993e; Henshaw, 1992, Table 1, p. 86.

Among pregnant women 15-19 in 1988, 93% of higher income teenagers had gotten pregnant accidentally, compared with 83% of poor teenagers and 79% of low-income adolescents. By contrast, 35% of pregnancies among higher income women aged 25-29 were unintended, compared with 72% and 53%, respectively, among poor and low-income women in that age-group.

(164.) AGI, 1993d; AGI, 1993e; Henshaw, 1992, Table 1, p.86.

Of the 135,000 annual intended pregnancies among women under age 20, 21% are among blacks and 19% are among Hispanic teenagers. In contrast, blacks account for 29% of all unintended teenage pregnancies, but Hispanics account for only 13%.

(165.) AGI, 1993d; AGI 1993e; Henshaw, 1992, Table 1, p. 86.

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FIGURE 30

DECLINE AND RISE IN PREGNANCY RATES

Over the last two decades, the pregnancy rate among teenage women who
have had intercourse has declined; however, since proportionately more
adolescents are having intercourse, the pregnancy rate among all
teenage women has increased.

 Sexually exper-
 All women ienced women

1972 95 254
1973 96 250
1974 99 247
1975 101 243
1976 101 235
1977 105 241
1978 105 240
1979 109 246
1980 111 247
1981 110 242
1982 110 238
1983 109 230
1984 108 223
1985 109 221
1986 107 212
1987 107 206
1988 111 208
1989 115 207
1990 117 207

Source: Births, 1972-1990: National Center for Health Statistics,
"Advance Robert of Final Natality Statistics," Monthly Vital Statistics
Report, Vols. 23-41, Supplements, 1974-1993. Abortions, 1973-1988: S. K.
Henshaw and J. Van Vort, eds., Abortion Factbook, 1992 Edition:
Readings, Trends, and State and Local Data to 1988, AGI, New York, 1992,
Table 1, pp. 172-173; 1972, 1989-1990: S. K. Henshaw, U.S. Teenage
Pregnancy Statistics." AGI, New York, 1993. Sexual experience data: E.
F. Jones et al., Teenage Prenancy in Industrialized Countries, Yale
University Press, New Haven and London. 1986, Table 3.5, p. 47; J. 0.
Forrest and S. Singh, The Sexual and Reproductive Behavior of American
Women, 1982-1988," Family Planning Perspectives, 22:206-214,1990, Tables
1 and 3, pp. 207 and 208.

Notes: births, abortions and miscarriages. Miscarriages are estimated
as 20% of births and 10% of abortions. Sexually experienced women:The
sexually experienced population was estimated by interpolating from
sexual behavior data for 1971,1976,1982 and 1988. Data were extmpolated
for 1989 and 1990 using the 1982-1988 trend.

Note: Table made from line graph
FIGURE 31

RISE WITH AGE

The oldest sexually experienced teenagers are the most likely to become
pregnant.

Pregnancies per 1,000 sexually experienced women, 1990


14 and younger 93
15-17 184
18-19 222
20-24 233

Sources: Births: National center for Health Statistics, "Advance Report
of Final Natality Statistics, 1990," Monthly Vital Statistics Report,
Vol. 41, No. 9, Supplement, 1993, Table 2, p. 18. Abortion, 1990: S.K.
Henshaw, "U.S. Teenage Pregnancy Statistics," AGI, New York, 1993.
Sexual activity data: 14 and younger: AGI tabulations of data from the
1990 Youth Risk Behavior Survey; 15-24: J.D. Forrest and S. Singh, "The
Sexual and Reproductive Behavior of American Women, 1982-1988," Family
Planning Perspectives, 22:206-214, 1990, Tables 1 and 3, pp. 207 and
208.

Notes: Pregnancy: Pregnancies are defined as the sum of births,
abortions and miscarriages. Miscarriages are estimated as 20% of births
and 10% of abortions. Sexually experienced women: The sexually
experienced population was estimated using the 1982-1988 trend. To
estimate sexual experience for women under 15 years of age, data from
the Youth Risk Behavior Survey (YRBS) were used. Because the YRBS
reports higher levels of sexual activity than the National Survey of
Family Growth (NSFG), YRBS estimates were deflated on the basis of the
radio of YRBS to NSFG figures on proportions of 18-year-old women who
have had intercourse.

Note: Table made from bar graph
FIGURE 32

DO THEY WANT TO GET PREGNANT?

Pregnancies among married teenagers are about five times as likely as
those among unmarried teenagers to be intended.

 Pregnancy outcomes Pregnancy outcomes
 among married women among unmarried women
 aged 19 and younger, aged 19 and younger
 1988: 180,000 1988: 716,000

Abortion 17% 50%
Intended birth 33% 7%
Unintended birth 50% 43%

Sources: Number of births: National Center for Health Statistics,
"Advance Report of Final Natality Statistics, 1988," Monthly Vital
Statistics Report, Vol. 39, No.4, Supplement, 1990, Table 2, p. 16.
Distribution of intended and unintended births: AGI tabulations of data
from the 1988 National Maternal and infant Health Survey.

Abortions: S. K. Henshaw, L M. Koonin and J. C. Smith, "Characteristics
of U.S. Women Having Abortions, 1987," Family Planning Perspectives,
23:75-81, 1991, Table 3, p. 77; S. K. Henshaw, "Abortion Trends in 1987
and 1988: Age and Race," Family Planning Perspectives, 24:85-87, 1992,
Table 1, p. 69.

Note: Pregnancies do not include miscarriages. The 1987 distribution of
marital status among women having abortions was applied to the 1988
number of abortions.

Note: Table made from pie chart
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Date:Jan 1, 1994
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