Adolescent Pregnancy Rates in Three European Countries: Lessons to Be Learned?

Adolescent sexuality in europe: A multicentric study

Adolescent pregnancy occurs in all societies, but the level of teenage pregnancy and childbearing varies from country to country. A cross-country analysis of birth and abortion measures is valuable for understanding trends, for identifying countries that are exceptional and for seeing where further in-depth studies are needed to understand observed patterns. Birth, abortion and population data were obtained from various sources, such as national vital statistics reports, official statistics, published national and international sources, and government statistical offices. Trend data on adolescent birthrates were compiled for 46 countries over the period 1970-1995. Abortion rates for a recent year were available for 33 of the 46 countries, and data on trends in abortion rates could be gathered for 25 of the 46 countries. The level of adolescent pregnancy varies by a factor of almost 10 across the developed countries, from a very low rate in the Netherlands (12 pregnancies per 1,000 adolescents per year) to an extremely high rate in the Russian Federation (more than 100 per 1,000). Japan and most western European countries have very low or low pregnancy rates (under 40 per 1,000); moderate rates (40-69 per 1,000) occur in Australia, Canada, New Zealand and a number of European countries. A group of five countries--Belarus, Bulgaria, Romania, the Russian Federation and the United States--have pregnancy rates of 70 or more per 1,000. The adolescent birthrate has declined in the majority of industrialized countries over the past 25 years, and in some cases has been more than halved. Similarly, pregnancy rates in 12 of the 18 countries with accurate abortion reporting showed declines. Decreases in the adolescent abortion rate, however, were less prevalent. The trend toward lower adolescent birthrates and pregnancy rates over the past 25 years is widespread and is occurring across the industrialized world, suggesting that the reasons for this general trend are broader than factors limited to any one country: increased importance of education, increased motivation of young people to achieve higher levels of education and training, and greater centrality of goals other than motherhood and family formation for young women.

Background. The rate of adolescent pregnancies (15–19 years) in Slovenia have been decreasing in the last twenty years. In 1981 the birth rate was 37/1000 and the abortion rate was 24/1000. In 2000 the birth rate was 8/1000 and the abortion rate was 12/1000. The abortion rates have been perisisted around 12/1000 since 1992. Why the abortion rate among adolescents does not decrease? The comparison with European countries, in which abortion rate is low (around 5/1000) shows, that the reasons should be searched in the low prevalence of oral contraceptive (OC) use in Slovenia. In Slovenia OCs are used in only 14% of secondary-school students, but in the countries with the lowest abortion rates OCs are used in 40–60%. Therefore, the use of OCs among adolescents should be encouraged to decrease the number of unintended pregnancies. At the Center for adolescents at University Department of Ob/ Gyn in Ljubljana and in the network for sexual and reproductive health of adolescents a lot of acitivites have been carried out in the last years in the field of education of health workers and teachers, in establishing the communication between health workers and teachers and in delivering information to lay population. However, there has been no rise in the use of effective contraception. Conclusions. We determine that we need wider professional and political support to improve the accessability od adolescent service and to improve the reproductive health of adolescents

Adolescent sexuality and reproductive health: where are we in 2004?

Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Pregnancy and chlamydia infection rates among 15-19 year-old females were compared across Minnesota's 87 counties, stratified by rural/urban designations. Regression models for rural counties (n = 66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality (P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study.

Legislative acts and judicial rulings in the US in the last 2 decades have gradually broadened the rights of teenagers to obtain family planning services, abortion services, and sexual information. Despite this progress, adolescent pregnancy continues to be a major problem, and sex education for teenagers is highly inadequate. During the 1960s some progress was made concerning the rights of minors in sexual matters, but it was not until the 1970s that the courts fully recognized that mature minors had the right to obtain reproduction health services and family planning information without parental consent and that immature minors also had a right to these services, with the consent of an alternate adult, in the absence of parental consent. During the 1970s the federal government expanded its role in providing assistance for pregnant adolescents and in financing sex related programs for teenagers. In 1978 the Adolescent Health Services and Pregnancy Prevention and Care Act provided for the establishment of the Office of Adolescent Pregnancy Programs in the Public Health Service. The new office was assigned the task of coordinating the 85 federal programs aimed at helping pregnant teenagers and adolescent parents. By the late 1970s family planning services were available for most teenagers, and this improved accessibility led to a decrease in the adolescent pregnancy rate, most notably among black teenagers, and a reduction in the number of illegitimate births, especially among white adolescents. Although the courts recognized the rights of teenagers to receive sex education, progress in providing sex education programs in the public school has been minimal. Most states permit local jurisdictions to decide whether or not to provide sex education courses in their public schools. At the present time, only 31 states have policy statements concerning sex education, and only 4 states require sex education course. A recent sample survey of public high schools found that only 36% of the schools provided a course, or a course unit, in sex education, and in most of these schools, students were not required to take the course. Efforts must be made to rectify this situation in light of the extensiveness of adolescent sexual problems in the US. The proportion of young teenagers who engage in sexual activity is increasing, and the use of contraception among young teenagers is totally inadequate. In 1976 there were 780,000 premarital pregnancies among teenagers, and most teenage mothers leave school. Little is known about male adolescent sexual behavior, yet many teenagers rely on male contraceptive methods. Recent retrenchment in the financing for federal programs, and the efforts of the conservative right wing to curtail adolescent access to family planning services, threatens the progress made during the 1970s.

The birth rate among unmarried United States teens has been sufficiently high over the last several decades that large numbers of public and private agencies have implemented a range of primary prevention strategies in hopes of reducing the number of adolescent pregnancies. Prevention strategies reported in the literature have varied in philosophy, purpose, structure, and content (Orbuch, 1989). Some interventions have focused solely on education and some on getting adolescents to abstain from coital activity, whereas others have concentrated on teaching adolescents cognitive and interpersonal skills thought to decrease the chance of youthful pregnancy. This article reviews published evaluations of these primary prevention strategies with a two-fold purpose. First, it will identify prevention efforts that have been adequately evaluated and whose results have been published in peer reviewed journals, with a primary focus on those programs that have demonstrated some level of behavioral success with sexual activity and birth control use. Behavioral outcomes are focused on here because the relationship between these variables and pregnancy is clearer than the relationship of other variables, such as attitudes or behavioral intentions. Second, the applied implications of these findings will be explored. The Need for Primary Prevention The need for pregnancy prevention efforts among U.S. youth has been consistently documented since the early 1970s. Although the age of first coitus and the frequency of coitus for adolescents in our society is comparable to other Western developed countries, the pregnancy, abortion, and birth rates among our youth far outstrip these other nations (Jones et al., 1985). The most recent figures can be extrapolated to suggest that over one million teens in the U.S. will become pregnant annually in coming years (Henshaw & Van Vort, 1989). Moreover, the most recent trend has been for single mothers to keep their children rather than relinquish them through adoption (Miller & Moore, 1990). This movement significantly contributes to increases in the number of children in poverty conditions. Many of these mothers are at serious risk for giving birth to additional children while single, thereby compounding their families' life challenges. The differences in adolescent pregnancy rates between the United States and other Western countries have often been pointed out (cf. Hayes, 1987). Such disparate figures raise serious questions about why differences exist. Jones et al. (1985) compared the U.S. to six other Western nations and concluded that differences in how the problem was defined contributed to the discrepant rates in teen pregnancies. They found that teen sexual activity, although not always seen as appropriate, is accepted as inevitable in most other countries. Although the value of abstinence and postponing coitus is often stressed, policy makers in these nations believe that programmatic emphasis needs to be centered on preventing pregnancies among adolescents because of potential costs to youth, their offspring, their families, and society. The U.S., however, has yet to clearly define the focus of the problem and attempts to do so are highly politicized. Whereas there are some who take a stance similar to that found in other Western countries, others feel that the problem rests in preventing sexual intercourse from occurring among youth. Unfortunately, the discourse surrounding problem definition is rarely dispassionate. Quite the opposite, the announcement of any intended adolescent pregnancy prevention effort within a community is likely to be met with impassioned rhetoric from concerned groups of citizens who strongly believe their approach is the correct one (cf. Kenney, 1986; Kirby, Barth, Leland, & Fetro, 1991). The ramifications of this social and cultural environment on practice will be explored later in this article. BASIC RESEARCH EVIDENCE ON THE EVIDENCE OF SEX EDUCATION One source of evidence about the relationship between sex education and pregnancy prevention comes from several national probability surveys that have been intermittently conducted since the mid-1970s. …

Prevention and health promotion in school and community settings: a commentary on the international perspective

Objective. —To analyze pregnancy, abortion, and birth rates among US adolescent girls in 1980, 1985, and 1990. Design. —Retrospective analysis of trends in data on pregnancies, abortions, and births. Population. —US adolescent girls aged 13 to 19 years. Main Outcome Measures. —Pregnancy, abortion, and birth rates (with and without adjustment for sexual experience) among teenaged girls aged 15 to 19 years and girls under 15 years. Results. —Although pregnancy rates among all teenaged girls 15 to 19 years old remained fairly stable from 1980 to 1985, they increased by 9% during the last half of the decade, totaling 95.9 pregnancies per 1000 teenaged girls 15 to 19 years old by 1990. Because rates of sexual experience increased even faster, pregnancy rates among sexually experienced teens aged 15 to 19 actually declined between 1980 and 1990 by approximately 8%. Abortion rates among these teens remained stable during the 1980s, with 35.8 and 36.0 abortions per 1000 in 1980 and 1990, respectively. As with overall pregnancy rates, abortion rates among these sexually experienced teenaged girls declined during the 1980s. Between 1980 and 1985, birth rates among teenaged girls aged 15 to 19 years declined by 4%, but they increased by 18% during the latter half of the decade, totaling 59.9 births per 1000 in 1990. Among these sexually experienced teenagers, birth rates also declined between 1980 and 1985 and then increased over the next 5 years. In 1990, pregnancies and abortions among girls younger than 15 years accounted for only 3% of all adolescent pregnancies and abortions. However, the number of births among these younger adolescents increased by 15% over the decade. In that age group, trends in pregnancy, abortion, and birth rates over the decade were similar to those for older teens. However, during the late 1980s, the abortion rate declined and the pregnancy rate remained stable, resulting in a 26% increase in the birth rate. Conclusions. —Despite efforts to reduce adolescent pregnancy in the United States, pregnancy and birth rates for that group continue to be the highest among developed countries. Considering that 95% of adolescent pregnancies are unintended, increased efforts to prevent these pregnancies are warranted. ( JAMA . 1996;275:989-994)

In 2015, the birth rate among U.S. adolescents and young adults (aged 15-19 years) reached a historic low at 22.3 per 1,000 women. Despite positive trends, the United States continues to have the highest adolescent pregnancy rate among industrialized countries with data. Racial and ethnic disparities in adolescent pregnancy rates continue to exist, as do state-based differences in pregnancy, birth, and abortion rates. The American College of Obstetricians and Gynecologists supports access for adolescents to all contraceptive methods approved by the U.S. Food and Drug Administration. In the absence of contraindications, patient choice should be the principal factor in prescribing one method of contraception over another. Dual method use-the use of condoms in combination with more effective contraceptive methods to protect against sexually transmitted infections and unwanted pregnancy-is the ideal contraceptive practice for adolescents. Just as adolescents should have access to the full range of contraceptives, including long-acting reversible contraceptive methods, they should be able to decline and discontinue any method on their own, without barriers. A reproductive justice framework for contraceptive counseling and access is essential to providing equitable health care, accessing and having coverage for contraceptive methods, and resisting potential coercion by health care providers. Successful programs that resulted in measurable changes in adolescent contraceptive practices and sexual behavior have been described, but not implemented uniformly nor supported by policy improvements. More research is needed to determine which programs are most effective and which programs do not work. Continued efforts are integral to further advance positive trends.

In 2015, the birth rate among U.S. adolescents and young adults (aged 15-19 years) reached a historic low at 22.3 per 1,000 women. Despite positive trends, the United States continues to have the highest adolescent pregnancy rate among industrialized countries with data. Racial and ethnic disparities in adolescent pregnancy rates continue to exist, as do state-based differences in pregnancy, birth, and abortion rates. The American College of Obstetricians and Gynecologists supports access for adolescents to all contraceptive methods approved by the U.S. Food and Drug Administration. In the absence of contraindications, patient choice should be the principal factor in prescribing one method of contraception over another. Dual method use-the use of condoms in combination with more effective contraceptive methods to protect against sexually transmitted infections and unwanted pregnancy-is the ideal contraceptive practice for adolescents. Just as adolescents should have access to the full range of contraceptives, including long-acting reversible contraceptive methods, they should be able to decline and discontinue any method on their own, without barriers. A reproductive justice framework for contraceptive counseling and access is essential to providing equitable health care, accessing and having coverage for contraceptive methods, and resisting potential coercion by health care providers. Successful programs that resulted in measurable changes in adolescent contraceptive practices and sexual behavior have been described, but not implemented uniformly nor supported by policy improvements. More research is needed to determine which programs are most effective and which programs do not work. Continued efforts are integral to further advance positive trends.

In the United States, adolescent pregnancy is largely conceptualized as stemming from sexual activity, which results in intentional or unintentional childbearing among teenagers between the ages of 12–19 years. The sexual development of adolescents and concurrent concerns over teenage pregnancy and reproductive health are inextricably linked within US culture. There are a host of factors—historical, developmental, environmental, religious, moral, social, cultural, economic, and political—which influence the degree to which adolescent pregnancy is experienced and socially accepted within the diverse cultural landscape of the USA. Whether related or unrelated to the wave of political attention, overall adolescent pregnancy rates have actually declined substantially in the USA over time, from 61.8 pregnancies per 1,000 girls age 15–19 during the late 1960s to 40.5 pregnancies per 1,000 by 2005. In contemporary US culture, these prevailing epidemiological and cultural norms have implicitly created a perceived social “picture” of adolescent pregnancy. In this chapter, we paint this picture not as prescriptive, but as a composite of the demographic, social, and cultural influences, which are commonly attributed to adolescent pregnancy in the United States. An adolescent parent in the United States is likely to be Black or of Hispanic/Latino origin, which also correlates with a likelihood of living in a low-income household or community where there is a greater concentration of teen parents. She or he is likely to be less educated and from a family in a low socioeconomic class, which irrespective of race, decreases access to preventative resources, healthcare, contraception, or abortion. As we will discuss in depth in this chapter, adolescent pregnancy rates and experiences vary greatly across geographic regions, cultural subgroups, and socioeconomic strata in the USA. The presence of diverse viewpoints and experiences related to adolescent pregnancy in the USA has multi-systemic implications for individuals, families, and communities.

Background: Evidence shows that early sexual debut “is a significant predictor of prevalent HIV infection”. With this background, this study was planned with objectives of finding the age at sexual debut and to determine mean age of sexual debut, its trend among different age groups and factors associated with it among HIV positive individuals. Methods: A Cross sectional study was conducted at Anti-Retroviral Therapy (ART) centre of a Tertiary Hospital of Gujarat region of India. Two hundred fifty patients were enrolled in the study. Age of sexual debut and associated factors like education, occupation, marital status, substance abuse and condom use at sexual debut were explored. Results: Among 250 participants, 240 (96%) had initiated sexual activity among which 133 (55.4%) were males and 107 (44.6%) were females. Mean age of sexual debut was 19.6 (±3.7) years; among males 21.2 (±3.9) years and females 17.7 (±2.2) years. The lowest age of coital debut was 14 years in males and 13 years in females. Mean age of sexual debut in the younger age group was significantly lower than among the older age group. Age of sexual debut was found to be independent of socioeconomic status, educational status and history of substance abuse; lower age of sexual debut was found to be associated with being a laborer, a migrant or female. Conclusions: Interventions for behaviour change regarding sexual health among vulnerable groups like adolescents, migrants and females need to be intensified.

Adolescents and risks: Why not change our paradigm?

Adolescent pregnancy in youth aged 10-19 years is associated with higher rates of adverse outcomes for both the mother and infant than adult pregnancy. Obesity and immature pelvic growth compound the associated risks of adolescent pregnancy. Black and Indigenous youth in the United States (U.S.) experience disproportionately high rates of adolescent pregnancy and obesity. This research project aimed to answer two questions: (1) What are the contributing risks of pelvic immaturity and obesity on adverse outcomes in adolescent pregnancy, especially in the U.S.?; and (2) Why are Black and Indigenous youth at particular risk of adolescent pregnancy and obesity in the U.S.? In this research project, I have conducted statistical analyses of biological and sociocultural factors associated with adolescent pregnancy using the CDC WONDER database, and I have used case studies and ethnographic accounts to gain insight on Black and Indigenous youth experiences with adolescent pregnancy. In this paper I examine the racial disparities in rates of adolescent pregnancy, obesity, and adverse outcomes in the U.S. My paper contributes research to a current public health issue by using an integrative biocultural approach.