Adolescent Reproductive and Sexual Health Facts for Policymakers

FA C T S H E E T

Susan Wile Schwarz April 2010

The reproductive and sexual health all play a role.3 In addition, adoles- needs of adolescents differ from cents are more likely to engage in those of adults.1 During adoles- risk-taking behaviors than either cence, the body undergoes signifi- younger children or adults.4 These cant developmental changes, most significant factors underline the notably puberty, the bodily changes importance of meeting the repro- of sexual maturation, and the for- ductive and sexual health needs of mation of sexual identity.2 Achiev- this age group. ing reproductive and sexual health requires more than preventing Reproductive and sexual health unwanted pregnancy and sexually – combined with mental health transmitted infections, it includes disorders and emotional problems, developing the ability to form and violence and unintentional injury, maintain meaningful relation- substance use, and poor nutrition ships with others and with one’s – form part of a complex web of own body. Psychological, social, potential challenges to adolescents’ educational, environmental, and healthy emotional and physical economic factors, among others, development.5

Facts About Sexual and Reproductive Health United States teen pregnancy, birth, Pregnancy abortion, and sexually transmitted ♦ After a 14-year decline, birth disease rates are higher than those rates for teens age 15 to 19 in most other developed countries, increased three percent in 2006 and rising.6 Factors associated with (to 41.9 per 1,000), though rates teen fertility and risky sexual be- vary by race.8 havior include socioeconomic status, parental education, community ♦ Teen mothers are more likely and peer influences, self-esteem, to drop out of school and face 215 W. 125th Street, 3rd Floor access to education, and school unemployment, poverty, welfare New York, NY 10027-4426 success, among many others.7 dependency, and other negative Ph. 646-284-9600 outcomes than women who 9 www.nccp.org delay childbearing. Sexual Activity Sexually Transmitted Diseases – Males had lower rates of chlamydia and gonorrhea than ♦ After a decade of decline, rates ♦ In 2007, chlamydia and gonor- females but showed 14.3 percent of sexual activity among high rhea rates increased for both and 3.8 percent increases respec- school students have been rising females and males age 15 to 19, tively from the previous year.22 since 2001 and vary by gender but varied by gender and race.20 10 ♦ and race. – Females in this age group had About 35 percent of 14 to 19 – Among male high school stu- the highest rates of chlamydia year olds test positive for high- dents, 73 percent of blacks, 58 and gonorrhea compared to risk human papillomavirus, a percent of Hispanics, and 44 per- any other age or sex group and virus linked to cervical cancer 23 cent of whites reported having showed 6.4 percent and 1.4 in women. had sexual intercourse in 2007.11 percent increases respectively ♦ In 2007, adolescents represented – Among female high school stu- from the previous year.21 four percent of all new cases of dents, 61 percent of blacks, 46 HIV infections in the U.S.24 percent of Hispanics, and 43.7 percent of whites reported having had sexual intercourse in Chlamydia and Gonorrhea Rates per 100,000 for 2006 and 2007 2007.12 Among Males and Females Age 15-19 2006 ♦ After over a decade of growth, 2007 rates of condom usage among CHLAMYDIA high school students have been 2007 declining since 2003 and vary by White ł 14.5% gender and race.13 2006 – Among male high school stu- Hispanic ł 5.3%

dents, 74 percent of blacks, MALES 70 percent of Hispanics, and Black ł 14.5% 66.4 percent of whites reported using a condom at last inter- White course in 2007.14 ł 5.4% – Among female high school students, 60 percent of blacks, 52 Hispanic ł 0.5%

percent of Hispanics, and 53.9 FEMALES percent of whites reported their Black ł 7.9%

partner using a condom at last 0 1,500 3,000 4,500 6,000 7,500 intercourse in 2007.15 Relationships GONORRHEA ♦ 2007 About one in five high school White ł 4.6% girls has been physically or sexu- 2006 ally abused by a dating partner.16 2.8% Hispanic Ń – Dating abuse is associated with MALES unhealthy sexual behaviors Black ł 3.9% that can lead to unintended pregnancy, sexually transmitted 2.1% diseases, and HIV infections.17 White Ń – Dating abuse occurs more fre- Hispanic 10.8% quently among black students Ń

(13.9 percent) than among FEMALES Black 4.3% Hispanic (9.3 percent) or white ł 18 (7.0 percent) students. 0 500 1,000 1,500 2,000 2,500 ♦ About 10 percent of adolescent females experience non-volun- Source: Sexually Transmitted Diseases Interactive Data 1996-2008, Selected STDS by Age, Race/Ethnicity, and Gender 1996-2008, Centers for Disease Control and Prevention. 2010. http://wonder.cdc.gov/std-std-v2008-race-age.html (accessed March 2010). tary first sex.19 Adolescent Reproductive and Sexual Health in the United States

System-level Challenges to Attaining Adolescent Sexual and Reproductive Health

Between 25 and 33 percent of – Adolescents who take health ♦ Lack of adequate insurance adolescents forgo needed care25 and risks and experience psycho- coverage. 26 many others lack access. Below logical distress are more likely – Adolescents and young adults are some of the factors hinder- to forgo health care due to con- are more likely to be uninsured ing adolescents’ use of or access fidentiality concerns despite than any other age group, to programs and services that can being among the most vulner- with 16.2 percent between help reduce the risk of sexual and able and in need of health care the ages of 13 and 17 lacking 29 reproductive health problems: services. any insurance.32 ♦ Lack of confidentiality. ♦ Lack of access and utilization to ♦ Lack of providers trained in – Inconsistent and unclear poli- preventive care. adolescent health. cies regarding adolescent pa- – Among all children and youth, – Of the 195 accredited pediatric tient confidentiality can create adolescents were the least likely residency training programs in 27 additional barriers to care. to attend preventive well- the U.S., only 27 have fellow- – While 60 percent of adolescents child visits based on medical ship programs to train clini- 30 seeking reproductive health recommendations. cians in adolescent care.33 services at family planning clin- – Adolescents’ low rates of ♦ Lack of comprehensive sexuality ics do so with parental knowl- outpatient visits put them education. edge, one in five would use no at increased risk for health – Fewer than half of all states contraception or the withdraw- complications, and high school require public schools to teach al method only if parental noti- dropouts are at even greater sex education and fewer than fication for prescription contra- risk than their non-dropout one-third require the curricu- ceptives were mandated.28 peers.31 lum to cover contraception.34

Recommendations

The newly charged federal Office of suggests that integrating health ♦ Pass legislation to enhance confi- Adolescent Health should take the promotion and disease prevention dentiality protection to improve lead in fostering cross-sector col- into youth employment and train- adolescents’ access to confiden- laboration and supporting compre- ing programs can improve health tial services. Inconsistent and un- hensive health programs, providing and employment outcomes for clear policies regarding adolescent all adolescents better access to high disconnected youth, a group with patient confidentiality can create quality services that are responsive particularly poor health status additional barriers to care.40 37 to their unique needs. Specifically, and low insurance coverage. ♦ Finance mechanisms to al- both federal and state governments ♦ Support programs that educate low foster youth to voluntarily should: and empower young people as retain state guardianship with ♦ Fund positive youth develop- peer educators and advocates. appropriate services and sup- ment and afterschool programs. Research shows that peer leaders ports up to age 25. Former foster Positive youth development pro- can be more effective than adults youth more frequently experi- grams have been found to reduce in establishing conservative ence episodes of homelessness sexual risk behaviors in adoles- norms and attitudes related to and survival sex.41 35 38 cents. High quality afterschool sexual behavior. ♦ Make contraceptives widely programming improves aca- ♦ Provide funding to establish available in venues frequented demic achievement and youths’ and expand school-based health by adolescents, including attitudes towards school, factors centers, particularly those that schools. Sexually active associated with delayed onset of 36 provide comprehensive primary adolescents in schools where sexual activity. care services. Access to on-site, condoms were available were ♦ Fund programs that bring servic- school-based health centers more likely to report having used es to youth who are disconnected increases the likelihood that ado- condoms in their most recent from school, employment, lescents will receive health and sexual encounter.42 and social supports. Research counseling services.39 Endnotes

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Blake, Susan M.; Ledsky, Rebecca; Goodenow, US Adolescents Receive Suboptimal Preventive 13. United States 2007 Among Students Who Were Carol; Sawyer, Richard; Lohrmann, David; Wind- Counseling During Ambulatory Care. Journal of sor, Richard. 2003. Condom Availability Programs Currently Sexually Active, The Percentage Who Adolescent Health 36(5): 441e1-441e7. Reported That Either They or Their Partner Had in Massachusetts High Schools: Relationships with Used a Condom During Last Sexual Intercourse, Tandon, S. Darius; Marshall, Beth; Templeman, Condom Use and Sexual Behavior. American Jour- Youth Risk Behavior Survey, Centers for Disease Amy J.; Sonenstein, Freya L. 2008. Health Access nal of Public Health 93(6): 955-962. Control and Prevention. 2008. Centers for Disease and Status of Adolescents and Young Adults Using Control and Prevention website. http://apps.nccd. Youth Employment and Training Programs in an cdc.gov/yrbss/ (accessed March 2010). Urban Environment. Journal of Adolescent Health 43(1): 30-37. 14. Ibid. 32. Total Population and Uninsured Persons Under 15. Ibid. Age 65: Percent by Selected Population Charac- 16. Silverman, Jay G.; Raj, Anita; Mucci, Lorelei A.; teristics, United States, First Half of 2007, Medical This fact sheet is supported by a generous Hathaway, Jeanne E. 2001. Dating Violence Against Expenditure Panel Survey, Agency for Healthcare grant from The Atlantic Philanthropies.