55 9.2 Teenage Sex and Pregnancy

Teenage Sexual Activity

As noted earlier, teenagers are much more sexually active today than they were before the sexual revolution. About 43 percent of never-married teens ages 15–19 of both sexes have had sexual intercourse (Martinez et al., 2011); this percentage represents a drop from its highest point, in 1988, of 51 percent for females and of 60 percent for males. About three-fourths of girls in today’s sexually experienced group and 85 percent of boys in this group use contraception, most often a condom, the first time they ever have sex. In their most recent act of sexual intercourse, almost 86 percent of girls and 93 percent of boys used contraception, again most often a condom.

The birth rate for females aged 15–19 in 2009 was 39.1 births per 1,000 females. This rate represented a substantial decline from the early 1990s, when the rate reached a peak of almost 60. However, it was still twice as high as Canada’s rate and much higher yet than other Western democracies (see Figure 9.4 “Teenage Birth Rates in Selected Western Democracies (Number of Annual Births per 1,000 Women Aged 15–19)”).

If 43 percent of teens have had sexual intercourse, that means the majority of teens, 57 percent, have never had intercourse. It is interesting to examine their reasons for still being virgins. Table 9.4 “Main Reason Given for Never Having Sexual Intercourse, Ages 15–19 (%)” shows the relevant data. The top reason for both sexes is religion and morals, followed by concern about a possible pregnancy and not having found the right person with whom to have sex.

The Problem of Teenage Pregnancy

Most teenage pregnancies and births are unplanned and are part of a more general problem for all women in their childbearing years. About one-half of all pregnancies in the United States, or more than 3 million pregnancies annually, are unplanned. Approximately 40 percent of these unplanned pregnancies end in abortion, and about 10 percent end by miscarriage. Putting all these numbers together, about 1.6 million live births happen each year as a result of unplanned pregnancies (National Campaign to Prevent Teen and Unplanned Pregnancy, 2011). The cost of medical services for unplanned pregnancies and for the infants that are born from many of them cost the nation more than $11 billion annually (Gold, 2011).

About one-fifth of all unplanned pregnancies, or almost 700,000 annually, occur to teenagers; another 50,000 teenage pregnancies are planned. These two figures add to 750,000 teenage pregnancies annually, with some 400,000 births resulting from these pregnancies (Kost, Henshaw, & Carlin, 2010). Altogether, about 18 percent of women, or one of every six females, become teen mothers, and in several southern and southwestern states this percentage is as high as 25–30 percent (Perper & Manlove, 2009).

About 18 percent of teenaged girls become mothers. In several southern and southwestern states, this percentage is as high as 25–30 percent.

bradfordst219 – CC BY 2.0.

Although teenaged pregnancies (and births from these pregnancies) are far from the majority of all pregnancies, unplanned or planned, they pose special problems (American College of Obstetricians and Gynecologists, 2011; Anderson, 2011). On the individual level, pregnant teenagers are more at risk than older pregnant women for high blood pressure and anemia, and they are also more likely to experience early labor, premature birth, and low birth weight. In addition, because teenagers are more likely than adults to have STDs, pregnant teenagers are more likely than older pregnant women to have an STD while they are pregnant, either because they already had an STD when they conceived or because they contract an STD from having sex during pregnancy.

Many pregnant teenagers decide to drop out of school. If they stay in school, they often must deal with the embarrassment of being pregnant, and the physical and emotional difficulties accompanying their teenage pregnancy can affect their school performance. Once the baby is born, child care typically becomes an enormous problem, whether or not the new mother is in school. Because pregnant teenagers disproportionately come from families that are poor or near poor, they have few financial resources and often have weak social support networks, either before or after the baby is born (Andrews & Moore, 2011).

At the societal level, teenage pregnancy and motherhood are very costly in at least two important respects. First, because pregnancy and childbirth complications are more common among teenagers, their health-care expenses during and after pregnancy and childbirth are often higher than the expenses incurred by older women. Medicaid, the federal government’s national health plan for poor families, often covers much of these expenses, and the premiums that private health insurance companies charge are higher than otherwise because of their expenses when they insure the families of pregnant teenagers.

Second, the children of teenage mothers are at risk for several kinds of behavioral and developmental problems. The Note 9.7 “Children and Our Future” box discusses these problems further.

Trends in Teenage Pregnancy

The bad news is that there are far too many teenage pregnancies. The good news is that the rate of teenage pregnancy has declined rather dramatically since the early 1990s.

The teenage pregnancy rate is commonly expressed as the annual number of pregnancies per 1,000 women aged 15–19. In 2006, this rate was 71.5, equal to 7.15 percent of all women in this age bracket (Kost et al., 2010). Because many women in this age group either have never had sex or have not had sex in the past year, it is instructive to consider the pregnancy rate among women ages 15–19 who are sexually active. In 2006, this rate was 152.8 per 1,000, equal to 15.28 percent of all sexually active women in this age group.

As high as these rates are, and they are much higher than the rates in other Western democracies, the US teenage pregnancy rate is much lower now than it was in the early 1990s. Figure 9.5 “Pregnancy Rates for US Women Aged 15–19, 1972–2006 (Number of Pregnancies per 1,000 Women Aged 15–19)” displays this dramatic trend. Teenage pregnancy reached a peak rate of 116.9 in 1990 before falling rather steadily to its 2006 rate of 71.5, a much lower rate than existed during the early 1970s. Reflecting the decline in teenage pregnancy, teenage births, as noted earlier, also reached a record low of 39.1 births per 1,000 women ages 15–19 in 2009, as compared to its peak rate of 61.8 in 1991. Despite this dramatic decline, the US teenage birth rate remains the highest of all Western democracies. Experts attribute the decline in teenage pregnancy and birth mostly to increased contraceptive use (stemming from a combination of increased sex education in the schools and increased provision of contraceptives to teenagers) and, to a smaller extent, to reduced sexual activity among some teenagers (Kost et al., 2010).

Correlates of Teenage Pregnancy

We have already noted that teenagers from poor or near-poor families are at greater risk for becoming pregnant. In addition to social class, two other important correlates of teenage pregnancy are race/ethnicity and geography.

Figure 9.6 “Race/Ethnicity and Teenage Pregnancy, 2006 (Number of Pregnancies per 1,000 Women Aged 15–19)” displays the racial/ethnic differences for teenage pregnancy, which are rather large. The pregnancy rates for black and Hispanic teenagers are almost three times greater than the rates for non-Hispanic whites.

Large differences also exist in teenage pregnancy rates by state and the regions of the country into which the states fall. In general, the South has a higher teenage pregnancy rate than the rest of the nation (see Figure 9.7 “Teenage Pregnancy Rates in the United States, 2005 (Number of Pregnancies per 1,000 Women Aged 15–19)”), although there are individual differences by state. The South’s generally higher rate stems largely from its higher poverty rate and racial/ethnic composition. As the opening news story on Texas indicates, sex education programs emphasizing safe sex are also less common in Southern states than in many other states. The same difference holds for the provision of contraceptives by Planned Parenthood and other agencies and organizations. The lack of these two important pregnancy-prevention measures probably also contributes to the South’s higher teenage pregnancy rate.

Sexually Transmitted Diseases

In addition to pregnancy and birth, another problem associated with teenage sexual activity is the transmission of sexually transmitted diseases (STDs). This is a problem during the teenage years, but it is even more of a problem during young adulthood, when sexual activity is greater than during adolescence (Wildsmith, Schelar, Peterson, & Manlove, 2010). The STD rate in the United States is higher than in most other Western democracies. Almost 19 million new cases of STDs are diagnosed annually, and more than 65 million Americans have an incurable STD such as herpes. Although teens and young adults ages 15–24 compose only one-fourth of sexually active people, they account for one-half of all new STDs. Despite this fact, most young adults who test positive for an STD did not believe they were at risk for getting an STD (Wildsmith et al., 2010).

Teens and young adults ages 15–24 compose one-fourth of all sexually active people, but they account for one-half of new sexually transmitted diseases.

Brian Rosner – New Friends at CU – CC BY 2.0.

In any one year, 15 percent of young adults ages 18 and 26 have an STD. This figure masks a significant gender difference: 20 percent of young women have had an STD in the past year, compared to 10 percent of young men. It also masks important racial/ethnic differences: 34 percent of young African Americans have had an STD in the past year, compared to 10 percent of Asians, 15 percent of Hispanics, and 10 percent of whites.

Three types of sexual behaviors increase the risk of transmitting or contracting an STD: having sex with at least three partners during the past year, having a sex partner with a known STD, and not using a condom regularly. About 17 percent of sexually active young adults have had at least three partners during the past year, and 8 percent have had a partner with a known STD. Three-fourths of unmarried sexually active young adults do not use a condom regularly. Combining all these risk factors, 39 percent have engaged in one risk factor in the past year, 14 percent have engaged in at least two risk factors, and the remainder, 48 percent, have engaged in no risk factors (Wildsmith et al., 2010).

Reducing Teenage Pregnancy and Helping Teenage Mothers

Teenage pregnancies cannot occur in either of these two situations: (1) Teenagers do not have sex, or (2) they use effective contraception if they do have sex. If we could wave a magic wand or turn the clock back to before the 1960s, it might be possible to greatly reduce the number of teenagers who have sex, but that day is long past. Teenage sex increased during the 1960s and 1970s and, despite some slight declines after HIV and AIDS became a worldwide problem during the 1980s and 1990s, remains much more frequent than before the sexual revolution. Most sexual behavior researchers believe that pleas for abstinence, as well as sex education programs that focus solely or almost entirely on abstinence, do not help to reduce teen sex and pregnancy (Ball & Moore, 2008).

If this is true, they say, then the best strategy is to use a harm reduction approach. We first encountered this term in Chapter 7 “Alcohol and Other Drugs”’s discussion of illegal drugs. A harm reduction approach recognizes that because certain types of harmful behavior are inevitable, our society should do its best to minimize the various kinds of harm that these various behaviors generate. In regard to teenage sex and pregnancy, a harm reduction approach has two goals: (1) to help reduce the risk for pregnancy among sexually active teens and (2) to help teenage mothers and their children.

Helping Teen Mothers

Because teen pregnancies occur despite the best prevention efforts, the second goal of a harm reduction approach is to help teens during their pregnancy and after childbirth. This strategy has the immediate aim of providing practical and emotional support for these very young mothers; it also has the longer-term aims of reducing repeat pregnancies and births and of preventing developmental and behavior problems among their children.

To achieve these aims, ECI programs have again been shown to be helpful (Ball & Moore, 2008). Another type of program to help teen mothers involves the use of second-chance homes, which are maternity group homes for unmarried teen mothers (Andrews & Moore, 2011). One of the many sad facts of teenage motherhood is that teen mothers often have nowhere to live. A teen mother’s parent(s) may refuse to let her and her infant live with them, either because they are angry at her pregnancy or because they simply do not have the room or financial means to house and take care of a baby. Or a pregnant teen may decide to leave her parents’ home because of the parents’ anger or because they refuse to let her continue seeing the child’s father. In another possibility, a teen mother may begin living with the father, but these unions are typically unstable and often end, again leaving her and her child without a home. As well, many teen mothers were runaways from home before they became pregnant or were living in foster care. Because of all these situations, many teen mothers find themselves without a place to live.

Second-chance homes provide many kinds of services for pregnant teenagers and teen mothers, many of whom are unable to continue living with their own parents.

Teresa Rodríguez – cynthea y kabeer jr – CC BY-ND 2.0.

In second-chance homes (which, depending on the program, are in reality one large house, a set of apartments, or a network of houses), mothers and children (as well as pregnant teens) receive shelter and food, but they also receive important services, such as childrearing help, educational and vocational counseling and training, family planning counseling, and parenting classes. Although rigorous evaluation studies do not yet exist of the effectiveness of second-chance homes, they do seem to offer a valuable resource for teen mothers and their children (Andrews & Moore, 2011).