Where do we go from Here?
An accurate appraisal of the situation is complicated by the fact that the outcomes of sex among teenagers that are clearly negative--STDs, unintended pregnancy, abortion and too-early childbearing--are intertwined with such profoundly difficult issues as poverty, race, family structure and substance abuse. Thus, it becomes easy and tempting, for some, to dismiss early sexual activity as a phenomenon confined to teenagers in poor, inner-city areas and dysfunctional families, or as part of a hopeless tangle of social pathology.
This report shows the reality to be quite different. The transition to adulthood has been radically, and probably irrevocably, altered by major social changes. Marriage and childbearing now generally occur much later, and initiation of sexual intercourse much earlier, than they did several decades ago. Most adolescents, regardless of their race, income status, gender or religious affiliation, begin to have sex in their middle to late teens. We must deal with these facts, even if we do not like them.
And we are not alone in our quandary. Current trends in sexual behavior are hardly unique to U.S. teenagers. They mirror trends among U.S. adults, as well as teenage and adult women and men around the world. In the last 20 years, for example, the proportion of births to U.S. women in their early 20s that were out of wedlock quadrupled. (284) Indeed, it is adult women, not teenagers, who account for most unintended pregnancies, abortions and nonmarital births every year. Out-of-wedlock childbearing has also become more common worldwide, and the increase has been less dramatic in the United States than in some other developed countries, including Australia, Austria, New Zealand and Norway. (285)
So, where do we go from here? What can we--as individuals, as parents, and as a society--do to help young people avoid the negative, at times life-altering, effects of sexual activity?
When, If Ever, Are Teenagers Ready for Sex?
This is one of the most troubling questions for adults--and frequently for young people as well. The issue is difficult because there is no defining moment or event--as marriage was for earlier generations--that marks the point at which a person is considered ready for sex, or at least the point at which it is considered appropriate to have sex. Often, teenagers are simply told to wait until they are "older." Age alone, however, is no guarantee of readiness for sex, or for the assumption of many other adult responsibilities, for that matter.
For people who believe that sex outside marriage is morally wrong, the answer to the question of timing, presumably, is that unmarried people--adults as well as teenagers--should not have sexual intercourse. While this view may run counter to current trends, it is entitled to respect and support. Most adults, however, are more concerned that their children avoid the negative consequences of sex if they do begin to have intercourse. Their views on the appropriateness of teenage sex are undoubtedly affected by the maturity of the individuals involved.
Most adults are troubled by the thought of very young teenagers' having sex, which, in fact, is relatively rare. Still, there are a number of reasons why young teenagers should be encouraged to delay the initiation of sexual intercourse: Sex among young adolescents is often involuntary; it frequently involves a man who is substantially older than the woman, which may make it hard for the young woman to resist his approaches and even more difficult for her to insist that contraceptives be used to prevent STDs and pregnancy; teenagers who have intercourse at a young age tend to have relatively unstable relationships and to quickly acquire other sexual partners, which increases their risk of exposure to an STD; and biologically, young teenagers are the most susceptible to a sexually transmitted infection. Additionally, young teenagers who get pregnant are rarely, if ever, in a position to support and raise a family.
For older adolescents, it may be more appropriate--and more effective--to stress the importance of postponing sex until they are sufficiently mature to treat their partner with respect and to assume responsibility for protecting themselves and their partner from the negative consequences of sex. At a minimum, this would mean that they would not consider having intercourse until they are responsible enough to use contraceptives correctly and consistently to prevent an unintended pregnancy and the transmission of an STD.
What If Teenagers Become Sexually Active?
While we should do all we can to delay the initiation of intercourse among adolescents until they achieve a certain level of maturity, there is no clear dividing line that can be established for all young people. Furthermore, some teenagers will ignore admonitions. Many will consider themselves "ready" to have sex whether we agree or not. Thus, it is imperative that we give all adolescents, whatever their age or level of maturity, the knowledge, the means and, perhaps most important of all, strong encouragement to take the necessary steps to protect themselves from the life-altering risks of pregnancy and disease.
And they can do that. Even now, a large majority of teenagers who have sex use contraceptives to prevent pregnancy and STDs, even the first time they have intercourse. Indeed, it cannot be stressed often enough that adolescents generally use contraceptives at least as effectively as adults.
Why Do Teenagers Get Pregnant or Contract an STD?
Sexually experienced teenagers, like adult women and men, do get pregnant accidentally and acquire sexually transmitted infections. Some 3 million teenagers each year acquire an STD, which can have serious, long-term health ramifications, and more than 1 million adolescent women become pregnant, the vast majority of them unintentionally.
Teenagers tend to delay use of the most effective methods of contraception for a substantial period of time after their first act of intercourse, and like older couples, they sometimes use contraceptives incorrectly and sporadically. They also face the same dilemma: whether to choose a method, such as the condom, that protects against STDs and pregnancy, but has a relatively high failure rate in actual use, or to depend on a method, such as the pill, that offers greater protection against pregnancy and does not need the cooperation of one's partner, but provides no protection against sexually transmitted infections.
Teenagers, moreover, face a host of difficulties that do not confront adult women: lack of experience in negotiating with their partner about contraceptive use; fear of disclosure; lack of access to a source of appropriate care; and the barrage of contradictory messages about contraception and responsible behavior emanating from the media, schools, their peers and sometimes their parents.
Teenage Childbearing: Are There Two Tracks?
When adolescent women become pregnant unintentionally, the path they follow in resolving their dilemma is determined largely by their income and socioeconomic status. Young women from advantaged families generally have abortions, so they can finish their education, get a good job and establish their financial independence before they have children. Poor and low-income teenagers also frequently have abortions; more often, however, they continue their pregnancies to term and raise the children themselves. It bears repeating that more than 80% of teenagers who give birth are poor or of marginal income.
Childbearing among unwed teenagers is often cited as the cause of some of the country's most difficult problems--poverty, welfare dependence, crime, drug abuse and homelessness. About a quarter of young women who have a child as a teenager are poor later in their lives, but their poverty is as much a function of their initial economic, social and educational disadvantage as it is of becoming a teenage parent. Policymakers and others who want to reform the nation's welfare system by, among other things, denying eligibility to unwed mothers (284) should understand that while this change might cut the welfare rolls, it would not address a major underlying cause of adolescent childbearing--namely, poverty. Furthermore, such a drastic step might reinforce adverse effects of poverty for subsequent generations of children.
Few would disagree that it would be better for everyone involved, as well as for society in general, if every child were horn into a two-parent family. That, in fact, is the aspiration of most teenagers, whatever their actual life circumstances. Surveys show that adolescents overwhelmingly want to marry and to raise their children with a spouse. (237) All too often, however, the young women who have births in their teenage years are unable to make that aspiration a reality. These young people know that they can have a better life if they get a good education that leads to a decent job, but if they cannot, or think they cannot, achieve these goals, they have little incentive to postpone childbearing. The reality is that many, if not most, of the young women who become adolescent mothers face restricted options for the future, poor prospects for finding decent jobs and little chance of marriage.
What Interventions Are Needed?
No single approach to adolescent sexuality and its consequences is appropriate for all teenagers of all ages in all circumstances and in every community. Nevertheless, it is clear that all teenagers need certain interventions if they are to avoid the negative consequences of sex. All adolescents, for example, need sex education that teaches them the interpersonal skills they will need to withstand pressure to have sex until they are ready, and that includes accurate, up-to-date information about methods to prevent pregnancy and STDs--and they need this before they begin to have sex.
But education and knowledge are not enough. Teenagers also need clear, strong messages, coming first from their parents and reinforced by the schools, the media and other sources, about the importance of making conscious decisions about whether to have intercourse; about the necessity of consistent, correct condom use to protect themselves and their partners from HIV and other STDs; and about the use of condoms or another method of contraception to prevent unintended pregnancies. Additionally, all sexually experienced teenagers, including young men, need easy access to contraceptive services and STD screening and treatment. The network of freestanding, publicly supported family planning clinics that is a major provider of confidential family planning and STD services for teenagers, especially young women, has been weakened in recent years by serious underfunding. Moreover, its future is uncertain in the face of health care reform efforts. Teenagers' access to these confidential services must be maintained and expanded, whether through a discrete clinic system or through broader health care networks.
Teenagers of all income levels also need access to abortion services. Young women who are poor or low-income are substantially less likely than their more advantaged peers to terminate their pregnancies. Surely, one reason for the difference is that most state Medicaid programs will not pay for abortions for indigent women except in very limited circumstances (but will pay for services related to childbirth). Congress took a first, but largely symbolic, step toward the restoration of Medicaid coverage when it voted, in the fall of 1993, to allow payment for abortions needed by women whose pregnancies resulted from rape or incest. (238) It must go further, however, and extend coverage to all abortions, so that women of all income levels have the same opportunity to terminate a pregnancy if they conclude that they are not in a position to bear and raise a child. Additionally, abortion must be included on the list of basic services in whatever health care reform package is ultimately adopted.Better sex education and improved access to contraceptive, STD and abortion services will not be sufficient, however, to address the root cause of early childbearing among disadvantaged teenage women who become parents. For these young women, entrenched poverty, not adolescent pregnancy, is the fundamental problem that must be addressed. Some will have the grit, the inborn talent and, somehow, the support to escape their circumstances. But for most, real change in sexual behavior and its outcomes will become likely only when their poverty is alleviated, when they--and their partners--have access to good schools and jobs, and when they develop a sense that their life can get "better."
Change Is Possible
The United States is not alone in grappling with the implications of adolescent sexual activity or unwed motherhood. However, teenage pregnancy, abortion and childbearing are larger problems in this country than in many other developed nations (Figure 55, page 76)--even though levels of adolescent sexual activity are about the same. Inmost other industrialized societies, there is greater openness about sexual relationships; the media provide positive reinforcement for using contraceptives to avoid pregnancy and STDs; and reproductive health care is better integrated into general health services, which make contraceptives more accessible to teenagers.
In the United States, by contrast, sex education is still controversial in some communities; the full panoply of contraceptives is often not readily accessible to teenagers (or to many adults, for that matter); and the media are reluctant to discuss or portray responsible sexual behavior, preferring to offer a mindless and constant display of titillating sexuality. Indeed, nothing better illustrates this country's unwillingness to confront sexual issues directly than its failure to use the national media, particularly the national television networks, to educate young people and adults alike about the importance of using protection against pregnancy and STDs, including AIDS, an invariably fatal disease. Incredibly, although the networks have agreed to run public service announcements about the importance of using condoms to prevent HIV and other STD transmission, they still refuse to accept advertising for the very same products for the purpose of preventing pregnancy, on the ground that it would offend some viewers. Americans seem to prefer bemoaning the high rates of adolescent pregnancy, abortion and childbearing to taking positive steps to address those issues. In many respects, it seems, it is adults, not teenagers, who act irresponsibly.
In an effort to develop more effective policies for helping American youth, there is much to be learned from the approaches of countries where teenagers are much less likely to experience negative outcomes of sexual behavior. We can also learn from the handful of programs, described in the previous section of this report, that have had a positive impact on teenagers' initiation of sexual intercourse and contraceptive use. These programs need to be adapted to local circumstances and widely replicated. In addition, other approaches must be tested and implemented in a variety of school systems and communities.
Many young people are managing the transition to adulthood well: They are succeeding in school, building healthy relationships with friends of both sexes, avoiding STDs and unintended pregnancy when they become sexually active, and preparing for careers. Often, however, they accomplish some of these tasks without appreciable guidance and support from their parents and other adults (who tend to be uncomfortable talking about sex with children), schools and other institutions. Inmost other aspects of life, society tries to ensure that young people have the information and skills they will need to function as competent adults. We try to give them a good education, provide job skills, instill values and establish standards of behavior. When it comes to sex, however, we say little or nothing and expect that upon reaching a magical age, young people will know how to manage such an important part of their lives. We know that avoidance is not working, not only for young women and men, but also for adults, who even m ore than teenagers experience the negative consequences of sex. So, we are paying a high price for our silence in two ways: First, many of our children are-needlessly--affected adversely by the consequences of their sexual behavior. Second, today's teenagers become tomorrow's adults, and the problems they had as teenagers do not go away, but are perpetuated into adulthood and passed on to the next generation.
We can and must do better.
(284.) Moore, 1993, Table, p. 2.
(285.) Ferguson, 1993, Table 2, p. 639.
(286.) Murray, 1993.
(287.) Bezilla, 1988, p. 35; Crimmins, Easterlin and Saito, 1991, Table 1, p. 119.
(288.) P.L. 103-112 (Oct. 21, 1993).
(289.) Jones et al., 1986.
Alan Guttmacher Institute (AGI), "Polities of Sex Halts Youth Survey," Family Planning Perspectives, 23:197, 1991.
AGI, tabulations of data from the March 1992 Current Population Survey, 1993a.
AGI, tabulations of data from the 1988 National Survey of Family Growth, 1993b.
AGI, tabulations of data from the 1990 Youth Risk Behavior Survey, 1993c.
AGI, tabulations of data from the 1988 National Maternal and Infant Health Survey, 1993d.
AGI, tabulations of data from the 1987 AGI Abortion Patient Survey, 1993e.
AGI, tabulations of data from the 1987 National Survey of Families and Households, 1993f.
AGI, tabulations of data from the 1988 National Health Interview Survey--Child Supplement, 1993g.
AGI, tabulations of data from the 1988 National Survey of Adolescent Males, 1993h.
Anderson, E., Street Wise, University of Chicago Press, Chicago, 1990.
Anderson, J. et al., "HIV/AIDS Knowledge and Sexual Behavior Among High School Students," Family Planning Perspectives, 22:252-255, 1990.
Aral, S. O. and M. E. Guinan, "Women and Sexually Transmitted Diseases," in K. K. Holmes et al., eds., Sexually Transmitted Diseases, McGraw-Hill, New York, 1984, pp. 85-89.
Atwater, E., Adolescence, third ed., Prentice-Hall, Englewood Cliffs, N.J., 1992.
Axinn, W. G. and A. Thornton, "Mothers, Children, and Cohabitation: The Intergenerational Effects of Attitudes and Behavior," American Sociological Review, 58:233-246, 1993.
Bachrach, C. A., K. S. Stolley and K. A. London, "Relinquishment of Premarital Births: Evidence from National Survey Data," Family Planning Perspectives, 24:27-32, 1992.
Bachu, A., "Fertility of American Women: June 1990," Current Population Reports, Series P-20, No. 454, 1991.
Barth, R. P. et al., "Enhancing Social and Cognitive Skills," in B. C. Miller et al., eds., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif., 1992, pp. 53-82.
Bennett, J., Acting Deputy Assistant Secretary for Population Affairs, Memorandum to Regional Health Administrators, Washington, D.C., June 25, 1993.
Berger, D. K. et al., "Influence of Family Planning Counseling in an Adolescent Clinic on Sexual Activity and Contraceptive Use," Journal of Adolescent Health Care, 8:436-440, 1987.
Bezilla, R., ed., America's Youth 1977-1988, The Gallup Organization, Princeton, 1988.
Billy, J. O. C. et al. "The Sexual Behavior of Men in the United States," Family Planning Perspectives, 25:52-60, 1993.
Blum, R. W. and M. D. Resnick, "Adolescent Sexual Decision-Making: Contraception, Pregnancy, Abortion, Motherhood," Pediatric Annals, 11:797-805, 1982.
Bloom, D. et al., LEAP: Implementing a Welfare Initiative to Improve School Attendance Among Teenage Parents, Manpower Demonstration Research Corporation, New York, 1991.
Bongaarts, J. and R. Potter, Biology and Behavior: An Analysis of the Proximate Determinants, Academic Press, New York, 1983.
Brindis, C. D., Adolescent Pregnancy Prevention, Health Promotion Resource Center, Stanford Center for Research in Disease Prevention, Palo Alto, Calif., 1991.
Britton, P. O., D. De Maruo and A. E. Gambrell, "HIV/AIDS Education: SIECUS Study on HIV/AIDS Education for Schools Finds States Make Progress, but Work Remains," SIECUS Report, 21(2):1-8, 1992/1993.
Bumpass, L. L., "What's Happening to the Family? Interactions Between Demographic and Institutional Change," Demography, 27:483-498, 1990.
Bumpass, L. L. and J. A. Sweet, "National Estimates of Cohabitation," Demography, 26:615-625, 1989.
Cassell, C., Swept Away, Simon & Schuster, New York, 1984.
Cassese, J., "The Invisible Bridge: Child Abuse and the Risk of HIV Infection in Childhood," SIECUS Report, 21(4):1-7, 1993.
Cates Jr., W. and K. M. Stone, "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part I," Family Planning Perspectives, 24:75-84, 1992a.
Cates Jr., W. and K. M. Stone, "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part II," Family Planning Perspectives, 24:122-128, 1992b.
Center for Population Options, Teenage Pregnancy and Too-Early Childbearing: Public Costs, Personal Consequences, Washington, D.C., 1992.
Centers for Disease Control and Prevention (CDC), "Current Tobacco, Alcohol, Marijuana and Cocaine Use Among High School Students--United States, 1990," Morbidity and Mortality Weekly Report, 40:659-663, 1991a.
CDC, "Perceptions About Sexual Behavior: Findings from a National Sex Knowledge Survey--United States, 1989," Morbidity and Mortality Weekly Report, 40:255-259, 1991b.
CDC, Division of STD/HIV Prevention 1991 Annual Report, Atlanta, 1992.
CDC, Division of STD/HIV Prevention 1992 Annual Report, Atlanta, 1993.
CDC, "Characteristics of Women Receiving Family Planning Services at Title X Clinics--United States, 1991," Morbidity and Mortality Weekly Report, 43:31-34, 1994.
Chadwick, B. A. and T. B. Heaton, ads., Statistical Handbook of the American Family, Oryx Press, Phoenix, 1992.
Chamie, M. et al., "Factors Affecting Adolescents' Use of Family Planning Clinics," Family Planning Perspectives, 14:126-139, 1982.
Chapin, J., American College of Obstetricians and Gynecologists, personal communication, June 23, 1993.
Cheng, T. L. et al., "Confidentiality in Health Care: A Survey of Knowledge, Perceptions, and Attitudes Among High School Students," Journal of the American Medical Association, 269:1404-1407, 1993.
Cooksey, E. C. "Factors in the Resolution of Adolescent Premarital Pregnancies," Demography, 27:207-218, 1990.
Crimmins, E. M., R. A. Easterlin and Y. Saito, "Preference Changes Among American Youth: Family, Work, and Goods Aspirations, 1976-85," Population and Development Review, 17:115-133, 1991.
Daley, D. and R. B. Gold, "Public Funding for Contraceptive, Sterilization and Abortion Services, Fiscal Year 1992," Family Planning Perspectives, 25:244-251, 1993.
Dawson, D. A., "The Effects of Sex Education on Sexual Behavior," Family Planning Perspectives, 18:162-170, 1986.
Donovan, P., Our Daughters' Decisions: The Conflict in State Law on Abortion and Other issues, AGI, New York, 1992.
Donovan, P., Testing Positive: Sexually Transmitted Disease and the Public Health Response, AGI, New York, 1993.
Dryfoos, J. G., "School-Based Health Clinics: Three Years of Experience," Family Planning Perspectives, 20:192-200, 1988.
Dryfoos, J. G., Adolescents-at-Risk Prevalence and Prevention, Oxford University Press, New York, 1990.
Edwards, L. E. et al., "Adolescent Pregnancy Prevention Services in High School Clinics," Family Planning Perspectives, 12:6-14, 1980.
Effler, P. et al, "High Prevalence of Chlamydia in Female Adolescents Reporting Only One Lifetime Sex Partner," paper presented at the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Anaheim, Calif., Oct. 11-14, 1992.
Eisen, M. and G. L. Zeilman, "A Health Benefits Field Experiment: Teen Talk," in B. C. Miller et al., eds., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif., 1992, pp. 220-264.
Elam, S. M., L. C. Rose and A. M. Gallup, 25th Annual Gallup/Phi Delta Kappa Poll of the Public's Attitudes Toward the Public Schools, conducted for Phi Delta Kappa International, Bloomington, Ind., Oct. 1993.
Emans, S. J. et al., "Adolescents' Compliance with the Use of Oral Contraceptives," Journal of the American Medical Association, 257:3377-3381, 1987.
Federer, L., Youth Indicators, 1991. Trends in the Well-Being of American Youth, Office of Educational Research and Improvement, Washington, D.C., 1991.
Ferguson, J., "Youth at the Threshold of the 21st Century: The Demographic Situation," Journal of Adolescent Health, 14:638-644, 1993.
Food and Drug Administration, Fertility and Maternal Health Drug Advisory Committee vote, Washington, D.C., May 20, 1993.
Forrest, J. D., "Timing of Reproductive Life Stages," Obstetrics and Gynecology, 82:105-111, 1993.
Forrest, J. D. "Thirtysomething and Beyond," paper presented at the Center for Population Research, National Institute of Child Health and Human Development and The Rockefeller Foundation Conference on Opportunities in Contraception: Research and Development, Bethesda, Md., February 1992.
Forrest, J. D., R. B. Gold and A. M. Kenney, The Need, Availability and Financing of Reproductive Health Services, AGI, New York, 1989.
Forrest, J. D., A. I. Hermalin and S. K. Henshaw, "The Impact of Family Planning Clinic Programs on Adolescent Pregnancy," Family Planning Perspectives, 13:109-116, 1981.
Forrest, J. D. and J. Silverman, "What Public School Teachers Teach About Preventing Pregnancy, AIDS and Sexually Transmitted Diseases," Family Planning Perspectives, 21:65-72, 1989.
Forrest, J. D. and S. Singh, "The Sexual and Reproductive Behavior of American Women, 1982-1988," Family Planning Perspectives, 22:206-214, 1990.
Frost, J. J., "The Availability and Accessibility of the Contraceptive Implant from Family Planning Agencies in the United States, 1991-1992," Fancily Planning Perspectives, 26:4-10, 1994.
Furstenberg Jr., F. F., J. Brooks-Gunn and S. P. Morgan, "Adolescent Mothers and Their Children in Later Life," Family Planning Perspectives, 19:142-151, 1987a.
Furstenberg Jr., F. F., J. Brooks-Gunn and S. P. Morgan, Adolescent Mothers in Later Life, Cambridge University Press, New York, 1987b.
Furstenberg Jr., F. F., K. Moore and 3. Peterson, "Sex Education and Sexual Experience Among Adolescents," American Journal of Public Health, 75:1331-1332, 1985.
Gambrell, A. E. and L. M. Kanter, "The Far Right and Fear-Based Abstinence-Only Programs," SIECUS Report, 21(2):16-18, 1992/1993.
George H. Gallup International Institute, The Religions Life of Young Americans: A Compendium of Surveys on the Spiritual Beliefs and Practices of Teen-agers and Young Adults, Princeton, 1992.
Grady, W. R. et al., "Condom Characteristics: The Perceptions and Preferences of Men in the United States," Family Planning Perspectives, 25:67-73, 1993.
Greeley, A. M., R. T. Michael and T. W. Smith. "A Most Monogamous People: Americans and Their Sexual Partners," National Opinion Research Center, Chicago, 1989.
Haffner, D. W., "1992 Report Card on the States: Sexual Rights in America," SIECUS Report, 20(3):1-7, 1992.
Hanson, S. L., "Involving Families in Programs for Pregnant Teens: Consequences for Teens and Their Families," Family Relations, 41:303-311, 1992.
Hardy, J., Johns Hopkins University School of Medicine, personal communication, May 19, 1992.
Harlap, S., K. Kost and J. D. Forrest, Preventing Pregnancy, Protecting Health. A New Look at Birth Control Choices in the United Stales, AGI, New York, 1991.
Harris/Scholastic Research, Hostile Hallways: The AAUW Survey on Sexual Harassment in America's Schools, American Association of University Women Educational Foundation, Washington, D.C., 1993.
Hayes, Cheryl D., ed., Risking the Future: Adolescent Sexuality, Pregnancy and Childbearing, Vol. 1, National Academy Press, Washington, D.C., 1987.
Henshaw, S. K., "The Accessibility of Abortion Services in the United States," Family Planning Perspectives, 23:246-252,263, 1991.
Henshaw, S. K. "Abortion Trends in 1987 and 1988: Age and Race," Family Planning Perspectives, 24:85-86, 1992.
Henshaw, S. K., "U.S. Teenage Pregnancy Statistics," AGI, New York, 1993.
Henshaw, S. K., L. M. Koonin and 3. C. Smith, "Characteristics of U.S. Women Having Abortions, 1987," Family Planning Perspectives, 23:75-81, 1991.
Henshaw, S. K. and K. Kost, "Parental Involvement in Minors' Abortions Decisions," Family Planning Perspectives, 21:196-207,213, 1992.
Henshaw, S. K. and A. Torres, "Family Planning Agencies: Services, Policies and Funding," Fancily Planning Perspectives, 26:52-59,82, 1994.
Henshaw, S. K. and J. Van Vort, "Teenage Abortion, Birth and Pregnancy Statistics: An Update," Family Planning Perspectives, 21:85-88, 1989.
Henshaw, S. K. and 3. Van Vort, "Abortion Services in the United States, 1987 and 1988," Family Planning Perspectives, 22:102-108, 1990.
Hofferth, S. L., tabulations of data from the 1982 National Survey of Family Growth, 1986.
Hofferth, S. L., "Social and Economic Consequences of Teenage Childbearing," in S. L. Hofferth and C. D. Hayes, eds., Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing, Vol. II, National Academy Press, Washington, D.C., 1987, pp. 123-144.
Hofferth, S. L. and C. D. Hayes, eds., Risking the Future: Adolescent Sexuality, Pregnancy and Childbearing, Vol. II, National Academy Press, Washington, D.C., 1987.
Hofferth, S. L., J. R. Kahn and W. Baldwin, "Premarital Sexual Activity Among U.S. Teenage Women over the Past Three Decades," Family Planning Perspectives, 19:46-53, 1987.
Hoffman, S.D., tabulations of data from the 1987 Panel Study of Income Dynamics, 1993.
Hoffman, S.D., E. M. Foster and F. F. Furstenberg Jr., "Reevaluating the Costa of Teenage Childbearing," Demography, 30:1-13, 1998.
Hollmann, F. W., "Estimates of the Population of the United States by Age, Sex, and Race," U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 1095, 1993.
Howard, M. and J. B. McCabe "Helping Teenagers Postpone Sexual Involvement," Family Planning Perspectives, 22:21-26, 1990.
Howard, M. and J. B. McCabe, "An Information and Skills Approach for Younger Teens: Postponing Sexual Involvement Program," in B. C. Miller et al., eds., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif., 1992, pp. 83-109.
Institute for Health Policy, Substance Abuse: The Nation's Number One Health Problem, Brandeis University, Waltham, Mass., 1993.
Jones, E. F. et al., Teenage Pregnancy in Industrialized Countries, Yale University Press, New Haven and London, 1986.
Jones, E. F. and J. D. Forrest, "Contraceptive Failure Rates Based on the 1988 National Survey of Family Growth," Family Planning Perspectives, 24:12-19, 1992.
Kalmuss, D. S. and P. B. Namerow, "The Mediators of Educational Attainment Among Early Childbearers," paper presented at the National Institute of Child Health and Human Development Conference on the Outcomes of Early Childbearing, Bethesda, Md., May 18-19, 1992.
Kates, N., "Buying Time: The Dollar-a-Day Program," John F. Kennedy School of Government, Harvard University, Cambridge, Mass., 1990.
Kenney, A. M., S. Guardado and L. Brown, "Sex Education and AIDS Education in the Schools: What States and Large School Districts Are Doing," Family Planning Perspectives, 21:56-64, 1989.
Kestelman, P. and J. Trussell, "Efficacy of Simultaneous Use of Condoms and Spermicides," Family Planning Perspectives, 23:226-232, 1991.
Kidman, C., "Non-Consensual Sexual Experience & HIV Education: An Educator's View," SIECUS Report, 21(4):9-12, 1993.
Kirby, D., Sexuality Education: An Evaluation of Programs and Their Effects, Network, Santa Cruz, Calif., 1984.
Kirby, D. and C. Waszak, "School-Based Clinics," in B. C. Miner et al., ads., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif. 1992, pp. 185-219.
Kirby, D. et al., "The Effects of School-Based Health Clinics in St. Paul on School-Wide Birthrates," Fancily Planning Perspectives, 25:12-16, 1993.
Kirby, D. et al., "School-Based Programs to Reduce Sexual Risk Behaviors: A Review of Effectiveness," Public Health Reports, 109:339-360, 1994.
Kominski, R. and A. Adams, "Educational Attainment in the United States: March 1991 and 1990," Current Population Reports, Series P-20, No. 462, 1992.
Korenbrot, C. C. et al., "Birth Weight Outcomes in a Teenage Pregnancy Case Management Project," Journal of Adolescent Health Care, 10:97-104, 1989.
Kost, K. and J. D. Forrest, "American Women's Sexual Behavior and Exposure to Risk of Sexually Transmitted Diseases," Fancily Planning Perspectives, 24:244-254, 1992.
Ku, L., F. L. Sonenstein and J. H. Pleck, "The Association of AIDS Education and Sex Education with Sexual Behavior and Condom Use Among Teenage Men," Family Planning Perspectives, 24:100-106, 1992.
Ku, L., F. L. Sonenstein and J. H. Pleck, "The Dynamics of Young Men's Condom Use During and Across Relationships," paper presented at the National Institute of Child, Health and Human Development Conference on Behavioral Research on the Role of Condoms in Reproductive Health, Bethesda, Md., May 10, 1993.
Lapham, S. and J. del Pinal, Persons of Hispanic Origin in the United States, 1990, U.S. Bureau of the Census, Population Division, Ethnic and Hispanic Statistics Branch, Washington, D.C., 1993.
Leitman, R., E. Kramer and H. Taylor, "A Survey of Condom Programs," in S. E. Samuels and M. D. Smith, eds., Condoms in the Schools, Henry J. Kaiser Family Foundation, Menlo Park, Calif., 1993.
Leridon, H., Human Fertility: The Basic Components, J. F. Helzner, trans., University of Chicago Press, Chicago, 1977.
Lester, G. H., "Child Support and Alimony: 1987," Current Population Reports, Series P-23, No. 167, 1990.
Levenson, P. M., J. K. Morrow Jr., and B. J. Pfefferbaum, "A Comparison of Adolescent, Physician, Teacher, and School Nurse Views," Journal of Adolescent Health Care, 5:254-260,1984.
Louis Harris and Associates, Sexual Material on American Network Television During the 1987-88 Season, survey conducted for Planned Parenthood Federation of America, Jan. 26, 1988.
Makinson, C., "The Health Consequences of Teenage Fertility," Family Planning Perspectives, 17:132-139, 1985.
Marini, M. M., "Sex Differences in Earnings in the United States," Annual Review of Sociology, 15:343-380, 1989.
Marsiglie, W. and F. L. Mott, "The Impact of Sex Education on Sexual Activity, Contraceptive Use and Premarital Pregnancy Among American Teenagers," Family Planning Perspectives, 18:151-162, 1986.
Martin, T. C. and L. L. Bumpass, "Recent Trends in Marital Disruption," Demography, 26:37-51, 1989.
MeKinney, D. H. and G. L. Peak, School-Based and School-Linked Health Centers: Update 1992, Center for Population Options, Washington, D.C., 1994.
McLaughlin, S. D., D. L. Manninen and L. D. Winges, "Do Adolescents Who Relinquish Their Children Fare Better or Worse Than Those Who Raise Them?" Family Planning Perspectives, 20:25-32, 1988.
Moore, K. A., Facts at a Glance, Child Trends, Washington, D.C., 1993.
Moore, K. A., C. W. Nerd and J. L. Peterson,
"Nonvoluntary Sexual Activity Among Adolescents," Family Planning Perspectives, 21:110-114, 1989.
Moore, K. A., C. W. Nord and J. L. Peterson, tabulations of data from the 1987 National Survey of Children, 1993.
Moore, K. A. and T. M, Steif, Changes in Marriage and Fertility Behavior: Behavior Versus Attitudes of Young Adults, Child Trends, Washington, D.C., 1989.
Morrison, D. R. and A. J. Cherlin, "The Divorce Process and Young Children's Well-Being: A Prospective Analysis," paper presented at the annual meeting of the Population Association of America, Denver, May 1, 1992.
Moscicki, A. et al., "Differences in Biologic Maturation, Sexual Behavior, and Sexually Transmitted Disease Between Adolescents with and Without Cervical Intraepithelial Neoplasia," Journal of Pediatrics, 115:487-493,1989.
Moscicki, A. et al,, "Human Papillomavirus Infection in Sexually Active Adolescent Females: Prevalence and Risk Factors," Pediatric Research, 28:507-513,1990.
Mosher, W. D., "Infertility Trends Among U.S. Couples: 1965-1976," Family Planning Perspectives, 14:22-27, 1982.
Moss, A. J. et al., "Recent Trends in Adolescent Smoking, Smoking-Uptake Correlates, and Expectations About the Future," Advance Data from Vital and Health Statistics, No. 221, 1992.
Murray, C., "The Coming White Underclass," Wall Street Journal, Oct. 29, 1993.
Nathanson, C. A., Dangerous Passage: The Social Control of Sexuality in Women's Adolescence, Temple University Press, Philadelphia, 1991.
National Center for Health Statistics (NCHS), Vital Statistics of the United States, 1965, Vol. I--Natality, U.S. Government Printing Office, Washington, D.C., 1967.
NCHS, "Advance Report of Final Natality Statistics, 1988," Monthly Vital Statistics Report, Vol. 39, No. 4, Supplement, Aug. 15, 1990a.
NCHS, Vital Statistics of the United States, 1986. Vol. III--Marriage and Divorce, U.S. Government Printing Office, Washington, D.C., 1990b.
NCHS, Vital Statistics of the United States, 1988. Vol. II--Mortality. Part A, U.S. Government Printing Office, Washington, D.C., 1991.
NCHS, "Advance Report of Final Natality Statistics, 1990," Monthly Vital Statistics Report, Vol. 41, No. 9, Supplement, Feb. 25, 1993a.
NCHS, "Advance Report of Final Natality Statistics, 1991," Monthly Vital Statistics Report, Vol. 42, No. 3, Supplement, Sept. 9, 1993b.
Nicholson, H. J. and L. T. Postrado, "A Comprehensive Age-Phased Approach: Girls Incorporated," in B. C. Miller et al., ads., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif., 1992, pp. 110-138.
Oakley, D., tabulations of data from the University of Michigan Feb. 1987-Apr. 1989 survey on initial clients at three family planning clinics, Detroit, 1993.
Olsen, J. A. et al., "The Effects of Three Abstinence Sex Education Programs on Student Attitudes Toward Sexual Activity," Adolescence, 26:631-641, 1991.
Opinion Research Corp., "Teen Sexual Attitudes," prepared for CBS/Good Housekeeping, Jan. 5,1993.
Ostergard, D. R., "The Effect of Age, Gravidity, and Parity on the Location of the Cervical Squamocolumnar Junction as Determined by Colposcopy," American Journal of Obstetrics and Gynecology, 129:59-60, 1977.
Osterman, P. Getting Started: The Youth Labor Market, MIT Press, Cambridge, Mass., 1980.
Paone, D. and W. Chavkin, "From the Private Family Domain to the Public Health Forum: Sexual Abuse, Women and Risk of HIV Infection," SIECUS Report, 21(4):13-16, 1993.
Philliber, S. and J. P. Allen, "Life Options and Community Service: Teen Outreach Program," in B. C. Miller at al., eds., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif., 1992, pp. 139-155.
Pleck, J. H., F. L. Sonenstein and L. C. Ku, "Adolescent Males' Condom Use: Relationships Between Perceived Cost-Benefits and Consistency," Journal of Marriage and the Family, 53:733-745, 1991.
Polit, D. F., "Effects of a Comprehensive Program for Teenage Parents: Five Years After Project Redirection," Family Planning Perspectives, 21:164-169, 187, 1989.
Polit, D. F. and J. R. Kahn, "Early Subsequent Pregnancy Among Economically Disadvantaged Teenage Mothers," American Journal of Public Health, 76:167-171, 1986.
Rabin, J. M., V. Seltzer and S. Pollack, "The Benefits of a Comprehensive Teenage Pregnancy Program," American Journal of Gyuecologic Health, 6(3):66-74, 1992.
Ralph, N. and A. Edgington, "An Evaluation of an Adolescent Family Planning Program," Journal of Adolescent Health Care, 4:158-162, 1988.
Randall, T., "Adolescents May Experience Home, School Abuse; Their Future Draws Researchers' Concern," Journal of the American Medical Association, 267:3127-3131, 1992.
Reiss, I. L. "Sexual Pluralism: Ending America's Sexual Crisis," SIECUS Report, 19(3):5-9, 1991.
Roper, W. L., H. B. Peterson and J. W. Curran, "Commentary: Condoms and HIV/STD Prevention--Clarifying the Massage," American Journal of Public Health, 83:501-503,1990.
Saluter, A. F., "Marital Status and Living Arrangements, March 1991," Current Population Reports, Series P-20, No. 461, 1992.
Saracco, A. et al., "Man-to-Woman Sexual Transmission of HIV: Longitudinal Study of 343 Steady Partners of Infected Men," Journal of Acquired Immune Deficiency Syndromes, 6:497-502, 1993.
Schachter, J., "Why We Need a Program for the Control of Chlamydia Trachomatis," New England Journal of Medicine, 320:802-804, 1989.
Shafer, M. and R. L. Sweet, "Pelvic Inflammatory Disease in Adolescent Females," Adolescent Medicine: State of the Art Reviews, 1:545-564, 1990.
Silverman, J. and A. Torres, Barriers to Contraceptive Services, AGI, New York, 1987.
Singh, S., J. D. Forrest and A. Torras, Prenatal Care in the United Stales: A State and County Inventory, Vol. 1, AGI, New York, 1989.
Smith, T. W., "A Methodological Review of Sexual Behavior Questions on the 1988 and 1989 GSS," GSS Methodological Report, No. 65, National Opinion Research Center, Chicago, 1988.
Sonenstein, F. L., J. H. Pleck and L. C. Ku, "Sexual Activity, Condom Use and AIDS Awareness Among Adolescent Males," Family Planning Perspectives, 21:152-158, 1989.
Sonenstein, F. L., J. H. Pleck and L. C. Ku, "Levels of Sexual Activity Among Adolescent Males in the United States," Family Planning Perspectives, 23:162-167,1991.
Steinberg, L. "Jumping Off the Work Experience
Bandwagon," Journal of Youth and Adolescence, 11:183-205, 1982.
Stipp, H., "New Ways to Reach Children," American Demographics, Aug. 1993, pp. 50-56.
Stout, J. W., and F. P. Rivara, "Schools and Sex Education: Does It Work?" Pediatrics, 83:375-379, 1989.
Tanfer, K., tabulations of data from the 1991 National Survey of Men, 1993.
Thomson, E., S. S. McLanahan and R. B. Curtin, "Family Structure, Gender and Parental Socialization," Journal of Marriage and the Family, 54:368-378, 1992.
Torres, A. and J. D. Forrest, "Why Do Women Have Abortions?" Family Planning Perspectives, 20:169-176, 1988.
Trent, K. and S. J. South, "Sociodemographic Status, Parental Background, Childhood Family Structure, and Attitudes Toward Family Formation," Journal of Marriage and the Family, 54:427-439, 1992.
Trudell, B. and M. Whatley, "Sex Respect: A Problematic Public School Sexuality Curriculum," Journal of Sex Education and Therapy, 17:125-140, 1991.
Udry, J. R. and J. O. G. Billy, "Initiation of Coitus in Early Adolescence," American Sociological Review, 52:841-855, 1987.
U.S. Bureau of the Census, "Poverty in the United States: 1987," Current Population Reports, Series P-60, No. 163, 1989.
U.S. Bureau of the Census, "United States Population Estimates, by Age, Sex, Race, and Hispanic Origin, 1980-1988," Current Population Reports, Series P-25, No. 1045, 1990.
U.S. Bureau of the Census, "Marital Status and Living Arrangements: March, 1990," Current Population Reports, Series P-20, No. 450, 1991.
U.S. Bureau of the Census, Statistical Abstract of the United States: 1992, U.S. Government Printing Office, Washington, D.C., 1992.
U.S. Congress, Office of Technology Assessment, Adolescent Health--Vol. II: Background and the Effectiveness of Selected Prevention and Treatment Services, U.S. Government Printing Office, Washington, D.C., 1991.
Upchurch, D. M. and J. McCarthy, "The Timing of First Birth and High School Completion," American Sociological Review, 55:224-234, 1990.
Vincent, M. L., A. F. Clearie and M. D. Schluchter, "Reducing Adolescent Pregnancy Through School and Community-Based Education," Journal of the American Medical Association, 257:3382-3386, 1987.
Wallace, H. M., J. Weeks and A. Medina, "Services for Pregnant Teenagers in the Large Cities of the United States, 1970-1980," Journal of the American Medical Association, 248:2270-2273, 1982.
Walter, H. J. and R. D. Vaughn, "AIDS Risk Reduction Among a Multiethnic Sample of Urban High School Students," Journal of the American Medical Association, 270:725-762, 1993.
Warrick, L. et al., "Educational Outcomes in Teenage Pregnancy and Parenting Programs: Results from a Demonstration," Family Planning Perspectives, 25:148-155, 1993.
Wasserheit, J. N., "Epidemiological Synergy: Inter-relationship Between Human Immunodeficiency Virus Infection and Other Sexually Transmitted Diseases," Sexually Transmitted Diseases, 19:61-77, 1992.
Wilson, W. J., The Truly Disadvantaged, University of Chicago Press, Chicago, 1987.
Winter, L. and L. Breckenmaker, "Tailoring Family Planning Services to the Special Needs of Adolescents," Family Planning Perspectives, 23:24-30, 1991.
Wu, L. L. and B. C. Martinson, "Family Structure and the Risk of a Premarital Birth," American Sociological Review, 58:210-232, 1993.
Zabin, L. S., "School-Linked Health Services: The Johns Hopkins Program," in B. C. Miller et al., eds., Preventing Adolescent Pregnancy, Sage Publications, Newbury Park, Calif., 1992, pp. 156-184.
Zabin, L. S., M. B. Hirsch and J. A. Boscia, "Differential Characteristics of Adolescent Pregnancy Test Patients: Abortion, Childbearing and Negative Test Groups," Care, 11:107-113, 1990.
Zabin, L. S. et al., "Evaluation of a Pregnancy Prevention Program for Urban Teenagers," Family Planning Perspectives, 18:119-126, 1986.
Zellman, G. L., "Public School Programs for Adolescent Pregnancy and Parenthood: An Assessment," Family Planning Perspectives, 14:15-21, 1982.
Zelnik, M. and Y. J. Kim, "Sex Education and Its Association with Teenage Sexual Activity, Pregnancy and Contraceptive Use," Family Planning Perspectives, 14:117-125, 1982.
Zierler, S. et al., "Adult Survivors of Childhood Sexual Abuse and Subsequent Risk of HIV Infection," American Journal of Public Health, 81:572-575, 1991.
FIGURE 55 AN INTERNATIONAL PERSPECTIVE ON TEENAGE PREGNANCY The United States, compared with many other industrialized countries, has high adolescent pregnancy rates. Pregnancies per 1,000 women aged 15-19 and younger, 1988 Births Abortions United States 44 97 Czechoslovakia 22 71 Hungary 26 70 New Zealand 15 47 England & Wales 19 46 Iceland 13 45 Canada 16 40 Norway 22 40 Sweden 24 35 Finland 15 27 Denmark 16 25 Netherlands 4 10 Japan 6 10 Sources: United States: Birthrate--National Center for Health Statistics, "Advance Report of Final Natality Statistics, 1988," Monthly Vital Statistics Report, Vol. 39, No. 4, Supplement, 1990, Table 3. Abortion rate--S. K. Henshaw, "Abortion Trends in 1987 and 1988: Age and Race," Family Planning Perspectives, 24:85-86, 1992, Table 1, p. 69. Czechoslovakia: Number of births--United Nations, Demographic Yearbook, 1990, New York, 1992, Table 11, p. 335. Number of abortions-Vydava Ustav zdravotnickych inofmacia statistiky, Zdravotnicka Statistika CSSR, Potraty, 1988, Prague, 1989, Table 64, p. 35. Total women 15-19- Population data for women aged 15-19 were interpolated from United Nations, Demographic Yearbook, 1987, New York, 1989, Table 7, p. 246; United Nations, Demographic Yearbook, 1989, New York, 1991, Table 7, p. 190. Hungary: Birthrate--Council of Europe, Recent Demographic Developments in Europe, 1991, Strasbourg, 1991, Table H-3 p. 119. Abortion rate- Ferenc Kauraras, "In Your Part of the World: Survey of Central and Eastern Europe (Part I)," Entre Nous, No. 14--15, 1990, pp. 13-14. Table 1, p. 14. New Zealand: Birthrate--United Nations, Demographic Yearbook, 1990, New York, 1992, Table 11, p.336. Number of abortions--Abortion Supervisory Committee to Parliament, "Report of the Abortion Supervisory Committee, for the Year Ended 31 March 1990," Wellington, New Zealand, Table 2, p. 4. Total women 15-19--Interpolated from United Nations, Demographic Yearbook, 1989, New York, 1991, Table 7, p. 198; United Nations, Demographic Yearbook, 1987, New York, 1989, Table 7, p. 246. England and Wales: Number of births-Office of Population Censuses and Surveys, "Birth Statistics, 1988," London, 1990, Table 3.1, p. 28. Number of abortions--Office of Population Censuses and Surveys, Abortion Statistics, 1988, Series AB, No. 15, London, 1989, Table 3, p. 6. Tolal women 15-19--Office of Population Censuses and Surveys, Key Population of Vital Statistics, London, 1990, Table Al, p. 83. Iceland, Norway, Sweden, Finland and Denmark: Birthrates and abortion rates--Nordic Medico-Statistical Committee, Health Statistics in the Nordic Countries, 1966-1991, Copenhagen, 1991, Table 5.a, p. 121. Canada: Birthrate--Statistics Canada, Selected Birth and Fertility Statistics, Canada, 1921-1990, Ottawa, 1993, Table 10, p.46. Abortion rate-Statistics Canada, "Therapeutic Abortions, 1988," Health Reports, 2(1), Supplement, Ottawa, 1990, Table 6, P. 25. Netherlands: Birthrate--Council of Europe, Recent Demographic Developments in Europe, 1991, Strasbourg, 1991, Table NL, p.158. Number of Abortions--J. Rademakers, Abortus in Nederland 1987-1988, Stimezo-Onderzoek, Utrecht, 1990, Tables 2.1 and 2.2, pp. Band 10. Total women 15-19-- United Nations, Demographic Yearbook, 1989, New York, 1991, Table 7, p.192. Japan: Birthrate--United Nations, Demographic Yearbook, 1989, New York, 1991, p.321, Table 11. Abortion rate--Kuno Kitamura, "Every Child Should Be a Wanted Child," Integration, Dec. 1991, Table 2, p. 42. Total women 15--10--United Nations, Demographic Yearbook, 1989, New York, 1991, Table 7, p.184. Note: Pregnancies are the sum of births and abortions and do not include miscarriages. For New Zealand and Japan, the numerator is births and abortions among all women aged 19 and younger. In all other cases, the numerator is births and abortions among women aged 15--19. The denominator is women aged 15--19. Note: Table made from bar graph
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||adolescent sexuality and politics|
|Publication:||Sex and America's Teenagers|
|Article Type:||Statistical Data Included|
|Date:||Jan 1, 1994|
|Previous Article:||Organized responses to adolescent sexual and reproductive behavior.|