August 2017

The teen birth rate in 2015 dropped another 8%, reported the Centers for Disease Control and Prevention.[1] The 22.3 births per 1,000 teen women aged 15 to 19 years represent another historical low over more than four decades. And the birth rate (0.2 births for 1,000) for teen girls aged 10 to 14 years is the lowest on record. The declines were seen across all race and ethnicity groups. As the birth rate dropped steadily over time, teen use of contraception rose. But there is always a ‘but.’

Over the longer term, the decline in the birth rate for 15 to 19 year olds is dramatic. More than 25 years ago, in 1991, the pregnancy rate per 1,000 was 61.8. The newly reported rate is down by 64%. A decade ago, in 2007, the rate was 41.5/1,000, which was 46% higher than the recent 22.3/1,000 rate reported by the CDC. When the CDC analysts examined rates for teens aged 15 to 17 and aged 18 to 19, both groups had declining rates. The younger group’s birth rates had fallen by 74% since 1991 and 54% since 2007. The older group’s birth rates fell 57% and 43% respectively. All states reported declining rates since 2007, and state rates by race and Hispanic ethnicity declined or remained the same. Nonmarital birth rates also declined, by 9%, in stark contrast to nonmarital birth rates among all age groups over 30, which were at an all-time high.

To what do we owe these remarkable successes? Is it a decrease in the percentage of teens who report being sexually experienced? That is a toss up. Over the longer term, a smaller proportion of teens were sexually experienced compared with those about 25 years earlier, in 2011 to 2015. However, the shorter term led to no significant decline, with similar percentages reporting sexual experience in 2002 and in 2006 to 2010.

One thing we know: the lower birth rates were not a result of increased abortions. From 2004 to 2013, the adolescent abortion rate decreased 46%, a drop greater than for any other age group.[2] Given the challenges of abortion surveillance, more recent figures are difficult to find.

What about contraceptive use? Were teens more likely to use birth control or to select a long-acting reversible method? In the short term, the percentage of teen couples using condoms, the most commonly used method among teens, remained stable, although since 2002 the percentage bumped up a few points. Virtually all sexually experienced female teens (99.4%) reported having used some method of contraception; that level of use has been sustained over the longer run—97.7% in 2002 and 96.2% in 1995. [3]

Did teens select more highly effective methods over any of these time periods? That, too, is a toss up. From 2002 to 2011-2015, reliance on withdrawal rose by 5%, from 55% to 60% of teen females reporting ‘ever use.’ During that same time period, use of IUDs and implants rose from under 1% in 2002 to 5.8% in 2011-2015. The dramatic increase in use of emergency contraception (from 8% to 23%) raises questions. EC has not been effective in reducing pregnancy rates in the population of reproductive-age women in general. Might teens be a different story?

Source: Abma JC, Martinez GM. Sexuality activity and contraceptive use among teenagers in the United States, 2011-2015. National health statistics report 2017; no 104. Hyattsville MD: National Center for Health Statistics, 2017.

In any event, teen pregnancy rates dropped from 116.0 to 57.4 pregnancies per 1,000 teen females between 1990 and 2010.[4] Over that span, remarkable decreases in sexual experience and increases in contraceptive use played major roles. In more recent years, noted in this article, percentages of teens reporting sexual experience shifted slightly downward and percentages of teens using contraceptives have stayed stable with some shifts in types of methods.

For most of American, these markers of teen sexual and reproductive health are encouraging. Family planning providers have played a critical role, along with parents, schools, teens themselves, and occasionally policy makers. Let’s keep it up! But ‘most’ of America is not all America. Researchers recently identified ‘hot spots’ where the teen birth rates are high.[5] In some hot spots the rates were 40% to 50% higher than the national rate. One, an urban area with 40 surrounding counties, has a rate 87% higher. When the researchers adjusted for county poverty and high school diploma rates, a risk factor for teen pregnancy, the rates dropped somewhat but it was clear that the higher risk for teen pregnancy was “most likely not associated” with poverty or education level.

Poverty-adjusted top 10 high teen birth rate clusters (population greater than 100,000)

High school diploma-associated top 10 high teen birth rate clusters (population greater than 100,000)

The researchers’ conclusion: “One would postulate that access to contraception may be a factor in these hot spots and represents an area of further study.” Indeed, many of the regions in which the hotspots reside appear to be in “contraceptive deserts” as designated by the National Campaign to Prevent Teen and Unplanned Pregnancy. In these contraceptive deserts, the number of public clinics with the full range of methods is not enough to meet the needs of the county’s population. See the maps, especially the one showing the scarcity of sites with IUDs and implants, in this link https://thenationalcampaign.org/deserts.

Although not all hotspots reside in contraceptive deserts, access may still be an issue, perhaps the public clinic did not have a full array of methods as Planned Parenthood does or teens were not informed about the contraceptive provision in the Affordable Care Act. Also, the social values can play a role. For example, in the small areas with less than 100,000 teens (not shown in this article), all the top 10 hotspots are Native American reservations. Some of the hot spots listed in the tables above have large populations of Hispanic teens, and Hispanic women tend to have higher birth rates.

We need to find ways to better provide services and education to more at-risk teens who don’t want to be at risk, whether they live in hotspots, are poor or less educated, or for some other reason do not use contraceptives to protect against an unwanted pregnancy.

Source: Abma JC, Martinez GM. Sexuality activity and contraceptive use among teenagers in the United States, 2011-2015. National health statistics report 2017; no 104. Hyattsville MD: National Center for Health Statistics, 2017.

[1] Martin JA, Hamilton BE, Osterman MJK, et al. Births: final data for 2015. National vital statistics report; vol 66, no 1. Hyattsville, MD: National Center for Health Statistics. 2017.

[2] Jatlaoui RC, Ewing A, Mandel MG, et al. abortion surveillance—United States, 2013. MMWR 2016;65(12):1-44.

[3] Abma JC, Martinez GM. Sexuality activity and contraceptive use among teenagers in the United States, 2011-2015. National health statistics report 2017; no 104. Hyattsville MD: National Center for Health Statistics, 2017.

[4] Office of Adolescent Health, US Department of Health and Human Services. Trends in teen pregnancy and childbearing. Accessed 7/22/17 at https://www.hhs.gov/ash/oah/adolescent-development/reproductive-health-and-teen-pregnancy/teen-pregnancy-and-childbearing/trends/index.html

[5] Amin R, Decesare JZ, Hans J, Roussos-Ross K. epidemiologic surveillance of teenage birth rates in the United States, 2006-2012. Obstet Gynecol 2017;129:1068-77.