Teen pregnancy update.

Remember the early 1990s? When politicians, public health experts and social scientists were ringing their hands over skyrocketing teenage pregnancy rates in this country? Well, welcome to the 21st century and what experts call one of the greatest public health success stories in decades. (1)

Teen pregnancy rates declined 28 percent between 1990 and 2000. And since 1991, when teenage births peaked at 62 for every 1,000 teenaged girls aged 15 to 19, the rate has plummeted to 41--a 33 percent drop. The drop has been even greater for African-American teens, plunging more than half for those 15 to 17, and dropping 45 percent overall. (1) Meanwhile, in 2003 the birth rate among young girls ages 10 to 14 dropped to its lowest level since 1946. (21,1,3)

What's going on?

"The short answer is less sex and more contraception," says Bill Albert, senior director of communications, publications and technology for the National Campaign to Prevent Teen Pregnancy. And, indeed, national surveys bear that out, finding that fewer teens of all ages and both genders are having sex, and that more are using contraception. (22)

Other reasons include:

* Concern about HIV and AIDS. "This generation has known about AIDS all their lives, and that's had an impact on their behavior," says Mr. Albert.

* Changing attitudes about casual sex. "Many teens are simply becoming more cautious about having casual sex," says Mr. Albert.

* New forms of birth control. "Teen-friendly" contraception like Depo-Provera shots, which only need to be given once every three months, makes it easier for sexually active girls to avoid pregnancy.

* Economic growth. The healthy economy of the 1990s may have played a role by helping teens see a future, says Mr. Albert, motivating them to avoid early pregnancy and parenthood.

* More parental involvement. "There's some indication that parents have snapped out of their stupor and started to address this issue more directly with teenagers," says Mr. Albert. That's important, because studies find that teens listen to their parents more than many adults realize, he notes.

Additionally, some new local, state and national health education programs have helped, whether they espouse abstinence or birth control. One abstinence-based program is run by Christopher Kraus, JD, MTS, adolescent advocacy manager at Cincinnati Children's Hospital Medical Center.

Called "Postponing Sexual Involvement for Young Teens," or PSI, it's a national program that targets middle-school students and is often taught by high school students. Students learn how to have a relationship without sex, the risks of sex and how to find friends who won't try to make them do something they don't want to.

Results are mixed, however, with some research showing significant drops in sexually active behavior and increases in knowledge of birth control among teens taking the program vs. those who aren't, and other research showing no short- or long-term benefits. (23,24,25)

Of course, there's still plenty of room for further decline in the teen pregnancy rate, note Mr. Kraus and Mr. Albert, given that the U.S. still has the highest teenage pregnancy and birth rates among industrialized nations. Plus, preliminary teen birth data for 2004 shows a slower decline than in previous years, and a slight increase in the rate of pregnancies among girls 10 to 14.

The next step in the effort to bring teen pregnancy rates down, says Mr. Kraus, is "open discussion among adults--an intelligent compassionate discussion rather than political rhetoric that just becomes a debate."

Resources

Advocates for Youth

202-419-3420

www.advocatesforyouth.org

Offers reproductive health, relationship and self-esteem-related materials for educators, parents and teens.

Girls, Inc.

1-800-374-4475

www.girlsinc.org

Develops programs and curricula to promote adolescent health and prevent high-risk behavior; resources available for educators, parents and teens.

Planned Parenthood Federation of America, Inc.

1-800-230-7526

www.plannedparenthood.org

Offers reproductive health information and clinic locations for health care services nationwide.

References

21 Births to 10-14-year-old mothers, 1990-2002: Trends and Health Outcomes. NVSR Volume 53, No. 7, 19.

22 Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002. Centers for Disease Control. February 15, 2005.

23 Aarons SJ, Jenkins RR, Raine TR, et al. Postponing sexual intercourse among urban junior high school students--a randomized controlled evaluation. J Adolesc Health, 2000 Oct;27(4):236-47.

24 The Emory University / Grady Memorial Hospital program: Postponing Sexual Involvement. Contracept Rep. 1994 May;5(2):6-9.

25 Caron F, Godin G, Otis J, Lambert LD. Evaluation of a theoretically based AIDS/STD peer education program on postponing sexual intercourse and on condom use among adolescents attending high school. Health Educ Res. 2004 Apr;19(2):185-97.