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Collection: Teen Pregnancy: Going... Going...

Back to the Future

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More than 80 percent of teen pregnancies are accidents. A girl with other hopes and dreams—or maybe a girl who is floundering, who hasn’t even begun to explore her hopes and dreams—finds herself unexpectedly slated for either an abortion or 4,000 diapers. Given the shame and stigma surrounding abortion in many American subcultures, that can seem like a choice between the proverbial rock and hard place. The exciting news that launched this Sightline series is that teen pregnancy is in decline across the United States and across all major ethnic groups. Fewer and fewer young women are facing hard decisions after the fact.

All the same, America continues to have the highest teen pregnancy rate of any developed country, and Canada looks stellar only when compared to the States. Even in Cascadia, which is better off than most regions, several thousand babies are born each year to girls between the ages of 15 and 17, and thousands more to young women aged 18 or 19 (e.g., Oregon 2012, Washington 2012, British Columbia 2010). Across the United States, almost 1,000 infants are born to teens each day. And approximately 30 to 50 percent of teen girls who give birth will experience a rapid repeat pregnancy within 24 months, which multiplies medical complications and the risk of lifelong poverty.

Economic Inequality

Early unplanned childbearing widens the gulf of income inequality. Pregnancy often compels girls to drop out of school, and fewer than 40 percent of those who give birth before graduating go on to complete high school by age 22. In a survey of high school dropouts aged 19–35, only 17 percent held full-time jobs, and half of those employed said they had no opportunity to advance beyond their current position. By age 25, even those who do work full time earn 30 percent less than their peers who completed high school and 60 percent less than college graduates. Their loss of productivity and income has been called a permanent recession.

Racial Justice

Early unplanned childbearing also widens racial disparities. Birthrates for black and Hispanic teens are more than double that of their white peers and quadruple the rate for Asian/Pacific Islanders. Since the birthrate is highest among Latinas, some people assume that early childbearing is simply a cultural norm. But a wide-ranging survey of US Hispanics found that Hispanic parents had other dreams for their daughters, and so did the girls who ended up pregnant. In the words of one advocate, Ruthie Flores, “There’s a big disconnect between pregnancy rates and what Latina families want and value.”

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Stand by Me

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No one birth control method fits everyone, but today young women have better options than ever before. Across the United States, from New York to South Carolina to Texas to Oregon, health advocates and providers are scrambling to get the word out about long-acting yet easily reversible contraceptive methods that are now approved for use by teenagers and well liked by most who use them. (See this earlier Sightline series, Twenty Times Better Than the Pill.)

Some of the energy has gone into creating youth-friendly information sources online such as Bedsider, followed by SexEtc, SafeAndEffective, and StayTeen. Other energy is targeted at bringing age-appropriate sexual health information and services to teens wherever they may congregate and whenever they may have contact with the health care system.

The Family Doctor

The American Congress of Obstetricians and Gynecologists recommends that any contact between a young person and a medical provider be treated as an opportunity to invite conversation about family planning and top-tier long-acting reversible contraceptive methods specifically. Sexually active young people face a high pregnancy risk but may be reluctant to seek out sexual health services, especially if this could involve a parent’s insurance company. They do see doctors for everything from sports physicals to acne to chronic medical conditions such as diabetes, however.

School-Based Clinics

One of the mechanisms for improving teen health broadly is a trend toward school-based health clinics that bring practitioners to kids rather than vice versa. Reproductive health and mental health make up a large portion of the service mix at most high school clinics. Multnomah County, home to Portland, created its first school-based health clinic 30 years ago with the goal of reducing teen pregnancy, which is the number one reason that girls drop out of high school. Today almost every public high school in the city has one, and students at Benson Polytechnic, a school with a high poverty rate, are lobbying for one of their own.

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Say Anything

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A young woman sits in an examining room, waiting for her medical provider.

The provider arrives and picks up the chart. “I see you’re here to talk about family planning,” she observes. “What did you have in mind?” The young woman scans her memory: “What does my sister use? What about my friends? What have I seen on TV?”As we know from the work of psychologist and Nobel Prize winner Daniel Kahneman, author of Thinking, Fast and Slow, the preference she expresses is likely to be shaped by familiarity—whatever jumps to the front of her mind.

Now consider an alternative scenario: A young woman sits in an examining room, waiting for her medical provider. The provider arrives and picks up the chart. “I see that you’re here to talk about family planning,” he observes. “When do you think you might like to have your first baby?” As the conversation opens up, he follows with other questions: “What would you like to do before then? How big a deal would it be if you experienced an unexpected pregnancy? Ideally, how often would you like to get your period?”

In this scenario, the young woman finds herself having a very different conversation because rather than focusing on the surface question, a choice among contraceptive technologies, the provider has asked about what lies underneath: What is the young woman really after? What are her dreams and plans? How does this seemingly small, concrete decision about birth control relate to the life she wants to live?

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Bring It On

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When Plan B emergency contraceptives became available without a prescription, I sent my teenage daughter, Marley, and her friend Amanda out to do a little research. Was the medication available in our local pharmacies? What would happen if they asked for help?

Most of the drugstores the girls visited in their meander through Seattle’s Capitol Hill neighborhood kept the medication behind a counter or locked up because it’s so expensive (close to $50 for a single dose). But the pharmacists and retail staff were friendly and eager to help, and the girls came back reporting that the excursion had been fun.

I wish I could say that Marley and Amanda’s experience was typical, but for most teens reality is far different. Capitol Hill is the heart of Seattle’s queer community. It hosts a broad array of immigrants, artists, and homeless young people. The pharmacists there are a flexible, forward-thinking lot—a contrast to some of those in more conservative and rural communities, who have refused to even fill prescriptions for birth control.

On top of that, Marley and Amanda themselves are atypical—girls who have been subjected to years of conversations about reproductive health at the dinner table, thanks to my work in the field. Many teens would have been mortified by the assignment: Ask an adult about birth control? Forget it! Besides, pregnancy is something that happens to other girls, not us.

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Dazed and Confused

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Can a girl get pregnant if she has sex standing up?
Will my boyfriend be able to feel my IUD?
What are dental dams, and why do people use them for sex?
Does everybody shave or trim down there?
If a guy pays for dinner, what does a girl owe him?

If the goal of school is to help kids become healthy, prosperous adults who contribute to thriving communities, then one of the most leveraged classes they can take is sex ed.

Teen pregnancy is both an effect and a cause of poverty. It can erect insurmountable obstacles for a young woman who may dream of a better life. Of girls who give birth while in high school, fewer than half graduate, and only 2 percent complete a college degree by age 30. Two-thirds receive public assistance in the first year after giving birth—and half are living in poverty three years later. The girls hit the hardest are often those already fighting an uphill battle: black and Latina girls born into impoverished families and hardscrabble communities.

Percentage of Teen Mothers Living in Poverty, by Race, Ethnicity. From The National Campaign to Prevent Teen and Unplanned Pregnancy.
Percentage of Teen Mothers Living in Poverty, by Race, Ethnicity. by The National Campaign to Prevent Teen and Unplanned Pregnancy (Used with permission.)

Negative impacts of teenage childbearing persist even after accounting for the fact that many teen moms faced challenges before they got pregnant. New media love to tell stories about the exceptions to the rule, the determined young women who fight their way through the obstacles and end up flourishing. Such women provide crucial inspiration for girls who have given birth and need both hope and role models for how to forge ahead.

But the fact is that when girls get pregnant before they’re ready, the odds are stacked against them.

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Party Time! Excellent!

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Oh what fun, by all.consuming, cc.
Oh what fun by all.consuming used under CC BY-ND 2.0

Public health officials, educators, and parents of teens have reason to party! According to a new report from the Guttmacher Institute, American teen pregnancy rates are lower currently than they were back in 1975 when top 40 dance music included “Kung Fu Fighting” and “The Hustle.”

For decades, health and education advocates have been frustrated by US teen pregnancy rates that are the highest in the developed world. Between 2010 and 2013, over a million babies were born in the United States to girls between the ages of 15 and 19. Nearly one in five was a repeat birth, and approximately 80 percent were unintended.

Research tells us that kids do best when moms are ready. Young women who delay childbearing into their 20s have fewer pregnancy complications and healthier babies. They’re more likely to complete high school and college, and to end up financially secure. In the long run, their children tend toward better mental health, fewer learning disabilities, and fewer run-ins with the criminal justice system. Some of the high incidence of such problems among teen mothers and their offspring may be due to which girls get pregnant young, rather than the timing of their pregnancies per se. Also, some of the negative impacts could be mitigated by better services. Even so, a reduction in teen pregnancies is a good thing.

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