Teenage Pregnancy Declining? the Roles of Abstinence, Sexual Activity and Contraceptive Use

Why is Teenage Pregnancy Declining? The Roles of Abstinence, Sexual Activity and Contraceptive Use Jacqueline E. Darroch Susheela Singh Occasional Report No. 1 December 1999 Acknowledgments This report was written by Jacqueline E. Darroch, se- nior vice president and vice president for research, and Susheela Singh, director of research, The Alan Guttmacher Institute (AGI). The authors are indebted to Christine Bachrach, National Institute of Child Health and Human Devel- opment, and Jennifer Manlove and Kristin Moore, Child Trends, who reviewed an early draft of the man- uscript. The authors also thank Stephanie Ventura and William Mosher, National Center for Health Statistics, for their valuable comments. The advice and assistance of colleagues from AGI—Akinrinola Bankole, Patricia Donovan, Beth Fredrick, Stanley K. Henshaw, Cory Richards and Jeannie I. Rosoff—are also gratefully acknowledged. Preparation of this report was supported in part by the Educational Foundation of America and the Marion Cohen Memorial Foundation. Suggested citation: Darroch JE and Singh S, Why Is Teenage Pregnancy Declining? The Roles of Absti- nence, Sexual Activity and Contraceptive Use, Occa- sional Report, New York: The Alan Guttmacher Insti- tute, 1999, No. 1. © 1999, The Alan Guttmacher Institute Table of Contents Introduction 5 What Are the Trends? 6 What Accounts for These Trends? 8 Why Has the Pregnancy Rate Among Sexually Experienced Teenagers Declined? 10 Policy Implications 12 Figures and Table 13 References and Notes 21 3 Why Is Teenage Pregnancy Declining? Introduction The 1990s have witnessed sustained declines in teen- Clearly, it is useful for the design of policies and inter- age birthrates—a heartening development in view of ventions aimed at averting teenage pregnancy to iden- the often negative effects of adolescent childbearing on tify and quantify how these factors have affected young women and their children and the costs to soci- teenagers’sexual behavior, contraceptive use and, ulti- ety as a whole.1 Teenage births should not be the only mately, pregnancy rates. Such investigation is, how- concern, however. More than three-quarters of preg- ever, outside the scope of this effort. nancies among teenagers each year are unintended, and As a first step, however, this report presents results more than one-quarter end in abortion;2 therefore, help- of analyses that used the most current data to document ing young women avoid an unintended pregnancy is the breadth of drops in teenage pregnancy and to exam- also an important public policy goal. Here, again, the ine the contributions to these trends of changes in absti- news is encouraging: The teenage pregnancy rate also nence, the sexual behavior of those who ever had inter- dropped in the 1990s.3 course and contraceptive use. The analyses were based Nevertheless, some 900,000 Americans younger on information from the 1988 and 1995 cycles of the than 20 become pregnant every year, and the U.S. National Survey of Family Growth (NSFG) and recent teenage pregnancy rate is one of the highest in the information on rates of teenage pregnancies, births and developed world.4 Ensuring the continuation of the abortions. downward trend in teenage pregnancy is essential, and a key step is understanding the factors behind the progress already made. Declines in teenage pregnancies can be achieved through two mechanisms—changes in sexual behavior and changes in contraceptive use. Some observers have claimed that the declines are the result of increased abstinence.5 Others credit both greater abstinence and increased contraceptive use, especially condom use, among teenagers, but have not quantified their specific contributions to the falling rates.6 Broad societal factors underlie both mechanisms. Fear of HIV, changing attitudes about sexuality and availability of new contraceptive technologies may affect sexual activity and change patterns of method use among those who do have intercourse. The strong economy, with its promise of improved career oppor- tunities for young people, and welfare reform, with its constraints on the receipt of public assistance, may affect these behaviors, since greater educational and employment opportunity are linked to lower teenage pregnancy rates and birthrates. Additionally, numerous interventions have been put into place to encourage young people to delay becoming sexually active and to use contraceptives effectively when they have sex. While there is need for increased evaluation and mon- itoring of such programs, some show great promise.7 5 The Alan Guttmacher Institute What Are the Trends? Since the early 1990s, teenage pregnancy rates, hit its peak in 1991, then fell off 17% by 1996 (Figure birthrates and abortion rates have declined dramati- 3, page 15).11 The birthrate fell 13% during that period, cally; pregnancy and abortion rates have reached their while the abortion rate among these young women lowest points since they were first measured in the began to drop in the late 1980s and was 36% lower in early 1970s, and birthrates are similar to those that pre- 1996 than it had been a decade earlier. vailed between the mid-1970s and mid-1980s.8 Even among teenagers 14 and younger, who have The decreases in pregnancy and abortion rates have always had very low rates, pregnancy became even less been especially steep. In 1986, some 107 pregnancies common in the early 1990s. Some 13 pregnancies occurred per 1,000 women aged 15–19; by 1990, that occurred per 1,000 females in this age-group in 1996, rate had climbed 11% to 117 per 1,000 (Figure 1, page a reduction from rates of about 17 per 1,000 from the 14).9 Within the next six years, however, the rate fell by mid-1980s until 1993.12 a striking 17% to 97 pregnancies per 1,000 teenagers, The small proportion of teenagers who are married 9% less than the 1986 rate. (4% of women aged 15–19 in 199613) have also regis- The teenage birthrate followed a similar trend, tered very substantial declines in their rates. Between although the recent decrease has been less rapid. From 1990 and 1996, the pregnancy rate among married a level of 50 births per 1,000 women aged 15–19 in women aged 15–19 dropped 19%, from 535 to 432 per 1986, the rate rose rapidly to 62 per 1,000 in 1991, an 1,000, and the birthrate fell 18%, from 420 to 344 per increase of 24%. The next five years saw a turnaround, 1,000. These changes reflect both that married and in 1996, 54 births occurred per 1,000 teenage teenagers are becoming less likely to conceive and that women—a rate still higher than that in 1986, but 12% teenagers who become pregnant out of wedlock are lower than the peak reached in 1991. becoming less likely to marry before their baby is born. A somewhat different pattern is seen in the teenage While abortion rates have consistently been very low abortion rate, which varied little during the 1980s and among married teenagers, they dropped 43% between then began a steady decline. By 1996, the rate was 29 1988 and 1996, from 31 per 1,000 to 18 per 1,000.14 abortions per 1,000 young women—31% lower than Trends among unmarried teenagers have followed a teenagers’ abortion rate a decade earlier. somewhat different pattern (Figure 4, page 15).15 While pregnancy rates declined 14% between 1990 Declines Are Widespread and 1996, the birthrate increased steadily between An examination of the data for various subgroups of 1986 and the early 1990s, leveled off and then declined teenagers reveals that with little exception, the trends 8% between 1994 and 1996. Still, the rate was 33% in pregnancy rates have followed the same general pat- higher in 1996 than a decade earlier. At the same time, tern across the board, regardless of young women’s the abortion rate among unmarried teenagers declined age, marital status, race or ethnicity. 31%. Thus, the rise in the birthrate reflects the decreas- Among 18–19-year-olds, the pregnancy rate climbed ing likelihood not only that unmarried pregnant 8% from the late 1980s until 1991; by 1996, the preg- teenagers will marry before they give birth but also that nancy rate had dropped to 12% below the peak level they will end their pregnancies by abortion. (Figure 2, page 14).10 The birthrate followed a similar Non-Hispanic white teenagers have historically had pattern, falling 9% between 1991 and 1996. The abor- lower rates than black adolescents or Hispanic young tion rate among these oldest teenagers hovered around women of any race, a trend that continued in the 1990s. 60 abortions per 1,000 women through much of the Furthermore, their rates dropped during this period 1980s, began a gradual decline in 1990 and had fallen to (Figure 5, page 16); pregnancy and abortion rates fell 45 per 1,000 by 1996, roughly a 25% drop. more steeply than birthrates (24% and 41% vs. 12%).16 Likewise, for 15–17-year-olds, the pregnancy rate Through much of the 1990s, black teenagers had the 6 Why Is Teenage Pregnancy Declining? highest rates. However, all three rates dropped by about 20% between 1990 and 1996 (Figure 6, page 16).17 Because the birthrate declined more steeply among black than among white teenagers, the gap between these two groups narrowed. By contrast, rates among Hispanic teenagers increased through the early 1990s (Figure 7, page 17).18 The pregnancy and abortion rates declined slightly after 1993, but the birthrate remained stable through 1994 and then declined 5%. As a result, His- panic teenagers now have the highest birthrate. U.S. teenagers are not the only age-group whose rates of pregnancies, births and abortions are on the decline. Rates for women in their early 20s, while higher than those for teenagers, follow the same general patterns.

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