Can More Progress Be Made? Teenage Sexual and Reproductive Behavior in Developed Countries

There is a strong consensus in the United States that teenage pregnancy and birth levels are too high. Despite dramatic decreases in teenage pregnancy rates and birthrates in the United States during the past decade, this country still has substantially higher levels of adolescent pregnancy, childbearing and abortion than other Western industrialized countries. In this project, collaborating research teams carried out case studies for five countries: the United States, Sweden, France, Canada and Great Britain.

Differences in levels of sexual activity among the countries are too small to account for the wide variation in teenage pregnancy levels. Most measures indicate less -- not more -- exposure to sexual intercourse among teenage women and men in the United States than in the four other countries. However, US teens are the most likely to have intercourse before age 15 and, on average, appear to have shorter and more sporadic sexual relationships. The researchers found that less contraceptive use and less use of hormonal methods are the primary reasons US teenagers have the highest rates of pregnancy, childbearing and abortion. US teens are less likely to use any contraceptive method than young women in other study countries.

More sexual partners, a higher prevalence of infection, and, probably, less condom use contribute to higher teenage STD rates in the United States. US teenagers have more sexual partners than teenagers in the other study countries, especially France and Canada. This increases their risk of contracting an STD, including HIV. Moreover, while sexually active US teens are more likely than their counterparts in other countries to rely on condoms as their main contraceptive method, data suggest they are less likely than teenagers in Great Britain and probably Canada to use condoms in addition to a hormonal method. Thus, American teenagers who are sexually active are more likely to be exposed to the risk of STDs and may be less likely to use condoms. Higher levels of STD infection in the United States population as a whole than in other study countries suggest that another contributing factor is the greater prevalence of both viral and untreated bacterial STDs among their partners.

Social and economic well-being and equality are linked to lower teenage pregnancy rates and birthrates. The philosophy that individuals are responsible for their own welfare and that the government should stay out of people's lives as much as possible, especially in the areas of health and social policy, contributes to widespread inequity in the United States. One-fifth of US women of reproductive age have no health insurance. Also, because public services are primarily for the disadvantaged, their use carries a stigma in many communities. Other study countries, especially Sweden and France, have stronger social welfare systems and are committed to reducing economic disparity. Governments there provide or pay for basic services, such as health care, for everyone. Public services are considered a right, and no stigma is attached to their use.

Comprehensive sex education, not abstinence promotion, is emphasized in countries with lower teen pregnancy rates. There the focus is on preventing HIV, STDs and pregnancy; on contraceptives and where to obtain them; and on respect and responsibility within relationships. "Extremely vocal minority groups in the United States pressure school districts not to allow information about contraception to be provided in sexuality education classes, and substantial federal and state funds are directed to promoting abstinence for unmarried people of all ages, particularly for adolescents. Some 35 percent of the school districts that mandate sexuality education require that abstinence be presented as the only appropriate option outside of marriage for teenagers and that contraception either be presented as ineffective in preventing pregnancy and HIV and other STDs or not be covered at all," the authors wrote. Also, in the United States, media is used less to promote positive sexual behavior. In the other study countries, contraceptive services and reproductive health care are generally more integrated into regular medical care. US teens have greater difficulty obtaining contraceptive services than do adolescents in the other study countries.

The authors concluded, "Where young people receive social support, full information and positive messages about sexuality and sexual relationships, and have easy access to sexual and reproductive health services, they achieve healthier outcomes and lower rates of pregnancy, birth, abortion and STDs."

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