INNOCENTI REPORT CARD ISSUE No.3 JULY 2001

A LEAGUE TABLE OF

TEENAGE

BIRTHS

IN RICH

NATIONS This publication is the third in a series of Innocenti Report Cards, designed to monitor the performance of the industrialized nations in meeting the needs of their children. Each Report Card presents and analyses league tables ranking the performance of rich nations against critical indicators of child well-being.

Any part of the Innocenti Report Card may be freely reproduced using the following reference: UNICEF,‘A league table of teenage births in rich nations’, Innocenti Report Card No.3, July 2001. UNICEF Innocenti Research Centre, Florence.

© The United Nations Children’s Fund, 2001

Full text and supporting documentation can be downloaded from the UNICEF Innocenti Research Centre website at: www.unicef-icdc.org

The UNICEF Innocenti Research Centre in Florence, Italy, was established in 1988 to strengthen the research capability of the United Nations Children’s Fund (UNICEF) and to support its advocacy for children worldwide.The Centre (formally known as the International Child Development Centre) helps to identify and research current and future areas of UNICEF’s work. Its prime objectives are to improve international understanding of issues relating to children’s rights and to help facilitate the full implementation of the United Nations Convention on the Rights of the Child in both industrialized and developing countries. The Centre’s publications are contributions to a global debate on child rights issues and include a wide range of opinions. For that reason, the Centre may produce publications that do not necessarily reflect UNICEF policies or approaches on some topics.The views expressed are those of the authors and are published by the Centre in order to stimulate further dialogue on child rights.

UNICEF Innocenti Research Centre Piazza SS.Annunziata 12 50122 Florence, Italy Tel: (+39) 055 20 330 Fax: (+39) 055 244 817 Email general: fl[email protected] Email publication orders: fl[email protected] Website: www.unicef-icdc.org INNOCENTI REPORT CARD ISSUE No.3 JULY 2001

“In the world’s rich nations, more than three quarters of a million teenagers will become mothers in the next twelve months.” INNOCENTI REPORT CARD ISSUE NO.3

Key findings

At least 1.25 million teenagers become pregnant each year in the 28 OECD nations under review. Of those, approximately half a million will seek an abortion and approximately three quarters of a million will become teenage mothers.

The five countries with the lowest teenage birth rates are Korea, Japan, Switzerland, the Netherlands and Sweden – all with teen birth rates of fewer than 7 per 1,000.

The United States teenage birth rate of 52.1 is the highest in the developed world – and about four times the European Union average.

The United Kingdom has the highest teenage birth rate in Europe.

In 10 out of 12 developed nations with available data, more than two thirds of young people have sexual intercourse while still in their teens. In Denmark, Finland, Germany, Iceland, Norway, the United Kingdom and the United States, the proportion is over 80 per cent. In Australia, the United Kingdom and the United States, approximately 25 per cent of 15 year-olds and 50 per cent of 17 year- olds have had sex (Figure 10).

Rising levels of education, more career choice for women, more effective contraception, and changing preferences, have increased the average age at first birth in all developed countries. In 19 of the 28 nations under review, births to teenagers have more than halved in 30 years (Figure 8).

The relationship between teenage birth rates and overall birth rates varies considerably from country to country, suggesting that national differences in teenage birth rates are in large part caused by factors that affect teenagers in particular (Box 3).

Giving birth while still a teenager is strongly associated with disadvantage in later life. On average across 13 countries of the European Union, women who gave birth as teenagers are twice as likely to be living in poverty (Figure 5).

Reducing teenage births offers an opportunity to reduce the likelihood of poverty, and of its perpetuation from one generation to the next.

2 INNOCENTI REPORT CARD ISSUE NO.3

Introduction

This third Innocenti Report Card presents the most up-to- school, to become involved in crime, to abuse drugs and date and comprehensive survey so far of teenage birth rates alcohol, and eventually to become a teenage parent and in the industrialized world.And it attempts at least a partial begin the cycle all over again. analysis of why some countries have teenage birth rates that are ten or even fifteen times higher than others. Unsurprisingly, therefore, teenage births are also seen as a burden for the society that must cope with this long list of The starting point is a new league table of teenage birth negatives.That is why the issue attracts so much popular rates (Figure 1), showing the number of births per 1,000 and political interest; and that is why 15 out of the 28 15 to 19 year-olds in the 28 OECD nations under review. countries featured in this review are trying to do Figure 8 shows how those rates have changed over the last something about it. 30 years. Figure 3 presents a league table of birth rates among teenagers aged 15 to 17. How teenage births might be reduced is a question to which everyone seems to have his or her favourite answer: But why should teenage birth rates be a matter of such more sex education or less sex education; abstinence concern? Physiologically, 18 or 19 is a better age to begin education or free contraceptives in schools; dispensing childbearing than 35 (fast becoming a popular age for a ‘morning after’ pills or capping welfare benefits.And it is a first baby in the developed world).And the number of debate which is occasionally given a stir in the opposite births to teenagers is, in any case, falling steeply across the direction by a teenage mother wishing to point out that industrialized world. So why worry? having a baby at 18 did not ruin her own or her child’s life, and that her struggles and achievements ought not to The answer of course is that teenage births are today seen be categorised as feckless and irresponsible behaviour. as a problem.And they are seen as a problem because they are strongly associated with a range of disadvantages for As a contribution to the debate, this Report Card draws on the mother, for her child, for society in general, and for international experience and comparison to establish taxpayers in particular. current facts and trends, to identify some of the forces that offer young people both motive and means to delay Specifically, giving birth as a teenager is believed to be bad childbearing, and to look at what might be learnt from for the young mother because the statistics suggest that she those societies which have already succeeded in reducing is more likely to drop out of school, to have no or low the problem to unprecedentedly low levels. For although qualifications, to be unemployed or low-paid, to live in teenage birth rates are the result of a complex pattern of poor housing conditions, to suffer from depression, and to forces that differ considerably from nation to nation, a live on welfare. Similarly, the child of a teenage mother is glance at the teenage birth league (Figure 1) clearly shows more likely to live in poverty, to grow up without a father, that this is a problem that some countries have brought to become a victim of neglect or abuse, to do less well at under control and others have not.

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The teenage birth league

Figure 1 The table shows the number of births to women aged below 20 per 1,000 women aged 15 to 19 (details of the data are given on page 27). Data are for 1998, the most recent year for which comparable information is available from all countries.

2.9 KOREA

4.6 JAPAN

5.5 SWITZERLAND

6.2 NETHERLANDS

6.5 SWEDEN

6.6 ITALY

7.9 SPAIN

8.1 DENMARK

9.2 FINLAND

9.3 FRANCE

9.7 LUXEMBOURG

9.9 BELGIUM

11.8 GREECE

12.4 NORWAY

13.1 GERMANY

14.0 AUSTRIA

16.4 CZECH REPUBLIC

18.4 AUSTRALIA

18.7 IRELAND

18.7 POLAND

20.2 CANADA

21.2 PORTUGAL

24.7 ICELAND

26.5 HUNGARY

26.9 SLOVAK REPUBLIC

29.8 NEW ZEALAND

30.8 UK

52.1 USA

0102030405060 Births to women aged below 20 per 1,000 15 to 19 year-olds

4 INNOCENTI REPORT CARD ISSUE NO.3

Commentary

The league table on the left (Figure 1) In previous Report Cards, the league table birth rates are the result of a complex presents the latest internationally format has helped to direct attention to interplay of forces, and there is no one comparable data on teenage birth rates for obvious factors that might help to equation that can adequately explain or the nations of the OECD. explain the rank order. But the league predict their outcome.The attempt to table of teenage births is more opaque, analyse the teen birth league table Even at first glance, it reveals very wide and if the title were not supplied it might therefore represents a challenge. But it also differences between the 28 developed prove difficult to guess.What criterion offers a route into the heart of the issue. nations listed. Overall, the proportion of would place Korea, Japan, Switzerland young women aged 15 to 19 who give and the Netherlands in the top four Why the fuss? birth each year varies from under 3 per places? On what scale would the United For most of history, teenage pregnancy has 1,000 in Korea to more than 50 per 1,000 Kingdom stand at more than four times not been seen as a problem at all but as in the United States. Expressed another the level of Italy and three times the level something normal and desirable.Today, way, the percentage of 20 year-old women of France? Or Greece and Norway find parents, politicians and physicians warn who have already given birth ranges from themselves on a par? Or the United against it, and the governments of most of 2 per cent to 22 per cent (Figure 2). States be seen to occupy a level double the 28 countries featured in the league that of most other industrialized nations? table are trying to reduce it (Figure 4). In absolute numbers, each year sees approximately 760,000 births to teenagers This Report Card will, as usual, seek to The reason for this change is that teenage in the countries under review.Two thirds identify some of the forces that help to parenthood has come to be regarded as a of that total is accounted for by the determine these rankings. But teenage significant disadvantage in a world which United States and three quarters by the six anglophone countries, all of which are The nations of in the bottom half of the league table. Iceland, Ireland, Italy, Japan, the the OECD Republic of Korea, Luxembourg, Figure 3 breaks the league table down Mexico, the Netherlands, New Zealand, into younger and older teenagers; and it Norway, Poland, Portugal, the Slovak The Innocenti Report Cards investigate Republic, Spain, Sweden, Switzerland, shows that in the top half of the table child well-being in rich nations. The Turkey, the United Kingdom of Great births to younger teenagers are a very series draws data from the 30 Britain and Northern Ireland, and the small proportion of all teenage births. In members of the Organisation for United States of America. Economic Co-operation and the bottom half, however, births to 15 to Two member countries, Mexico and Development (OECD), the group of 17 year-olds make up a considerably Turkey, are absent from the analysis of countries that produce two-thirds of teenage births rates which is presented higher proportion of the overall teen birth the world’s goods and services. rate. Figure 3 also reveals that the 15 to 17 in this Report Card. They have been The OECD member countries are: excluded because they do not share year-old teen birth rate for the United Australia, Austria, Belgium, Canada, the low overall fertility rates that are States is higher than the overall teen birth the Czech Republic, Denmark, Finland, common to the OECD membership. rate for all other OECD countries except France, Germany, Greece, Hungary, (See sources on page 27.) the United Kingdom.

5 INNOCENTI REPORT CARD ISSUE NO.3

increasingly demands an extended Furthermore, the widely differing levels increasingly being challenged. Many education, and in which delayed of teen births in different nations, the teenage mothers have grown up with childbearing, smaller families, two- varying rates of progress in reducing some degree of poverty or disadvantage income households, and careers for them, and international disparities in the and have little in the way of educational women are increasingly becoming relationship between teen fertility and qualifications or career prospects – factors the norm. overall fertility (Box 3), also suggest that that are likely to have negative effects on this is a problem that some countries their future lives whether or not they wait Figure 5, specially commissioned for this have brought under control and others until they are in their twenties before Report Card from the University of Essex, have not. having children. Becoming pregnant UK, shows for the first time the strength while still a teenager may make these of this association between teenage Having come to be seen as a policy- problems worse (to an extent that is still parenthood and subsequent disadvantage susceptible problem, teenage births have undetermined), but not becoming across a wide range of industrialized become the subject of intense scrutiny in pregnant will not make them go away. nations. Drawing on data from the the developed countries; academics from European Community Household Panel, the United States travel to find out why Nor, to the extent that teenage pregnancy the study compares the lives of women teenage birth rates in the European per se is a problem, are the potential who gave birth as teenagers with the Union are only a quarter of those seen in solutions any less controversial. Cultural, lives of those who gave birth in their America,1 and task forces from the historical, and political differences mean twenties.And the results reveal a striking United Kingdom visit the Netherlands to that even strategies that have been shown pattern.When measured against five find out why Dutch different indicators of disadvantage – teenagers are five times less Figure 2 Number of teenage births and percentage of including poverty, unemployment, and likely to give birth than teenage mothers educational underachievement – those teenagers in the UK. Estimated Number of births percentage of who gave birth as teenagers are seen to Further afield, countries as to women aged 20 year-olds who be markedly worse off in 12 of the 13 diverse as Mexico, Russia, below 20 (1998) had a child in their teens EU countries for which data are available Vietnam and Zambia are AUSTRALIA 11,849 9 (Austria being the notable exception).A showing interest in the AUSTRIA 3,275 7 2 teenage mother in Germany, for example, ‘Nordic approach’ that has BELGIUM 2,975 4 is seen to be more than twice as likely to reduced teen births to very CANADA 19,920 10 have left school early and more than low levels across much of CZECH REPUBLIC 6,035 7 DENMARK 1,161 4 twice as likely to be living in poverty. On northern Europe. FINLAND 1,485 4 average across the 13 countries, those FRANCE 17,985 4 who became mothers while still A conflict of premise GERMANY 29,000 6 teenagers are seen to be twice as likely to In short, teenage births are GREECE 4,183 5 be living in poverty. now seen as a matter of HUNGARY 9,175 12 ICELAND 264 9 public and political concern, IRELAND 3,138 8 Looked at in more detail, the study also demanding government ITALY 11,153 3 shows significant variation between action in those societies JAPAN 17,501 2 countries in the likelihood of where teenage birth rates KOREA 5,621 1 LUXEMBOURG 111 4 disadvantage being associated with remain high. NETHERLANDS 2,823 3 teenage pregnancy (Figure 6). In Austria NEW ZEALAND 3,924 14 the likelihood of living in poverty in later But neither the problem NORWAY 1,607 5 life (poorest 20 per cent by income) is nor its solution is as POLAND 30,413 9 PORTUGAL 7,403 9 not strongly associated with giving birth straightforward as it SLOVAK REPUBLIC 6,044 12 as a teenager. But in Belgium, France, might appear. SPAIN 11,264 3 Germany and the United Kingdom a SWEDEN 1,605 3 teenage mother is seen to be twice as For example, the association SWITZERLAND 1,092 2 likely to be living in poverty.And in the between teenage births and UK 54,822 13 USA 494,357 22 Netherlands and Denmark the later-life problems may have probability is trebled. been exaggerated and is TOTAL / AVERAGE 760,185 7

6 INNOCENTI REPORT CARD ISSUE NO.3

to work cannot simply be transplanted. Figure 3 Birth rates for younger and older teenagers The distribution of ‘morning after’ The table shows the number of births during 1998 per 1,000 women aged 15 to 17 (dark bars) and contraception to sixteen year-olds in aged 18 to 19 (pale bars). Countries are ranked by the birth rate for 15 to 17 year-olds. No breakdown schools, for example, has recently been of teenage births by age group is available for Korea. 1.4 legalized in France but is unlikely to be JAPAN 9.2 legitimized in Ireland or Texas. 1.5 SWITZERLAND Conversely, capping welfare benefits to 11.6 unmarried mothers and launching multi- 2.2 SWEDEN million dollar teenage abstinence 13.0 2.2 campaigns is a strategy that has enjoyed NETHERLANDS 12.0 significant popular support and may be 2.5 DENMARK yielding some early signs of success in 15.6 3 2.6 the United States (Box 6), but is FINLAND 19.4 unlikely to be adopted enthusiastically in 2.9 ITALY Sweden or Iceland. 11.6 3.0 LUXEMBOURG To confound the issue further, most such 19.7 3.4 conflicts of policy and strategy have roots BELGIUM 19.6 in different value systems. If the 3.4 FRANCE underlying premise, for example, is the 18.6 social and utilitarian ideal of reducing 4.0 NORWAY teenage births because of the 24.7 4.2 disadvantages they tend to bring in their SPAIN 12.8 wake, then the solutions proposed are 5.0 CZECH REPUBLIC likely to lean towards earlier and more 31.0 comprehensive sex education, more 5.1 AUSTRIA 28.2 liberal abortion laws, and freely available 5.3 GERMANY contraception. If, on the other hand, the 25.2 underlying motive has a strong religious 5.3 GREECE dimension, including perhaps the axioms 20.4 5.8 that sex and childbearing before marriage POLAND 38.4 are wrong and that abortion is 8.2 IRELAND unacceptable, then the solutions of 34.4 choice are more likely to revolve around 9.5 AUSTRALIA abstinence campaigns, restrictive abortion 31.0 10.8 laws, reform of benefits systems, and CANADA 33.9 ambiguity at best about sex education 11.2 ICELAND and contraception. 44.6

11.4 SLOVAK REPUBLIC 48.2 Even if fought out with salvoes of 11.8 PORTUGAL statistics and surveys, many of the battles 33.5 waged around the issue of teenage births 14.1 HUNGARY are therefore conflicts not of evidence 41.8 15.4 and interpretation but of premise and NEW ZEALAND 50.7 motivation. 16.6 UK 51.8

Birth of a problem 30.4 USA It is a truism that social problems can 82.0 only be understood in context; but the 020406080100 particular difficulty of the teen pregnancy Births per 1,000 women

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Figure 4 Teenage fertility and family planning policy The different colours of the bars indicate the government’s view on fertility among women aged below 20 in each country (as reported to the UN Population Division): dark bars indicate a ‘major concern’, pale bars a ‘minor concern’, and white bars ‘not a matter of concern’. Dark type for country name indicates that the government actively intervenes to change fertility among women aged below 20. The table shows the number of births to women aged below 20, expressed per 1,000 women aged 15 to 19 as in Figure 1. (Data for 1998.)

60 UK USA ITALY OREA SPAIN JAPAN K USTRIA GREECE FRANCE POLAND SWEDEN CANADA IRELAND NORWAY ICELAND A FINLAND BELGIUM USTRALIA HUNGARY GERMANY DENMARK PORTUGAL

50 A UXEMBOURG L SWITZERLAND NEW ZEALAND NETHERLANDS CZECH REPUBLIC SLOVAK REPUBLIC SLOVAK

40

30

20

10 Births to women aged below 20 per 1,000 15 19 year-olds

0 issue is that the context has changed so of having children, placed an increasing • Divorcing sex from marriage. Sex before rapidly and radically that analysis and premium on education and knowledge, marriage and the expectation of several policy response can easily be outdated. and deepened the relative economic sexual partners before beginning a And it is a further source of turbulence disadvantage of the low-skilled. stable relationship has now become the and controversy that the world in which norm in most industrialized countries. many of today’s teenagers are growing up The result has been a socio-sexual • Lengthening span of contraception. is very different from the world which revolution that has transformed some of Average age at first sex has fallen and shaped the adolescence of most of today’s the most basic patterns of personal and average age at first birth has risen, and policy makers. family life in the industrialized nations: for many women the gap between the • Rising average age at first birth. As more two can be as much as twenty years The forces that have brought about such women enter higher education and or more. radical change are well-documented and establish careers, the average age at first include the spread of cheap, safe and • Rising levels of cohabitation. In some birth has risen to the late twenties effective contraception, the liberalization nations – Denmark, France, Iceland, (Figure 7).The age at which most of abortion law, the progress made by New Zealand, Norway, and Sweden – women begin childbearing is now women towards educational and career 40 per cent or more of births are now approaching 30 in countries such as the equality, the widespread rejection of to unmarried women (Figure 9). In Netherlands and Spain. traditional sexual codes, and the the United States, the percentage of emergence of a more sexualised society • Falling overall fertility. Changing children born outside marriage has as old taboos have fallen away and sexual preferences, the rise of opportunities increased more than eight-fold in two imagery and messages have permeated for women other than motherhood, generations.5 the information environment. Over the and the difficulties of combining same period, powerful economic careers with parenting, have seen the These are some of the more obvious and pressures have favoured two-income average number of children per woman measurable signs of the socio-sexual households, raised the opportunity costs fall from 2.5 in 1970 to 1.6 in 1998.4 transformation that has occurred in the

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Figure 5 Later life outcomes and age at first birth The table shows the percentage of mothers in each of five categories of later life outcomes, by age at birth of first child (e.g. 78 per cent of Dutch women who were teen mothers are in households with income in the lowest 20 per cent, but only 26 per cent of women who had their first child in their 20s are in this income group). On average the women were in their 30s when interviewed – see page 28 for details. The row showing the percentages for ALL COUNTRIES is a weighted average by national population sizes. Countries are ranked in ascending order of teenage birth rate.

Blue shading indicates that Less than upper Not working (inactive Neither woman nor Household income differences for individual Without partner countries are statistically secondary education or unemployed) partner working in lowest 20 per cent significant at the 5 per cent level. 15-19 20-29 15-19 20-29 15-19 20-29 15-19 20-29 15-19 20-29

NETHERLANDS 50 22 53 42 13 7 31 7 78 26

ITALY 77 52 64 54 15 3 18 5 36 20

SPAIN 80 59 70 66 20 7 27 123522

DENMARK 65 17 46 25 16 12 22 6 24 8

FINLAND 24 9 42 27 11 5 13 8 29 17

FRANCE 62 24 61 35 16 10 18 6 51 18

BELGIUM 52 22 55 27 24 8 32 7 45 19

GREECE 74 35 61 55 466630 17

GERMANY 57 24 60 36 18 10 24 5 54 21

AUSTRIA 52 23 30 31 13 12 6 4 31 24

IRELAND 73 37 69 51 42 14 46 14 41 23

PORTUGAL 92 78 37 32 15 7 8 4 26 16

UK 65 37 61 37 39 15 43 14 53 23

ALL COUNTRIES 67 34 59 41 23 19 26 8 45 21

AVERAGE DIFFERENCE 33 18 4 18 24

Figure 6 Low income and age at first birth The table shows the percentage of mothers in the poorest 20 per cent, by age of mother at first birth. Pale bars indicate mothers who had their first child aged 15 to 19. Dark bars indicate mothers who had their first child aged 20 to 29. This table graphs the data in the last two columns of Figure 5. 90 UK ITALY SPAIN

80 USTRIA GREECE FRANCE IRELAND A FINLAND BELGIUM GERMANY DENMARK DENMARK PORTUGAL

70

60 NETHERLANDS 78

50 54 53 51

40 45 41 36 30 35 31 30 29 26 26 centage of mothers with low household income r 24 20 24 23 23 22 Pe 21 20 19 18 17 17 16 10 8

0

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industrialized world in little more than very different rates today (6.6 and 21.2). and housewife with a home, a husband one generation.And it is this Similarly Norway and the United with a job, and a supportive family and transformation that is the essential Kingdom began the period with society – and a girl of today who context of the teen births issue. comparable rates, but over the last three becomes pregnant at 17 as the result of a decades Norway has seen teen births fall short-term relationship, drops out of Downward pressures by 72 per cent – almost double the 38 school, is evicted from the family home, Almost all of the forces involved have per cent drop seen in the United and attempts to bring up a child alone exerted downward pressure on teen birth Kingdom. and on welfare, in poverty and poor rates. Increasingly, young people in the housing, unsupported by partner or industrialized world have both motive But to some extent Figure 8 is deceptive. family or community in the demanding and means to delay childbearing.And the The decline in teen births that it records business of bringing up a child. results are visible in Figure 8. cannot be read in the same way as declines in, for example, disease rates or Clearly, not all teenage births in the Austria, Denmark, France, Germany, Italy, poverty levels or road deaths. For the industrialized world of the 1960s or Korea, Sweden and Switzerland have forces that have brought about the fall 1970s matched the first of these reduced their teenage birth rates by have also changed the nature of the descriptions, any more than all teenage three-quarters or more in the last 30 problem – indeed it might even be said births today match the second. But the years.The Czech Republic, Belgium, that they have to some extent created two pictures serve to illustrate two very Finland, Greece, Iceland, the Netherlands the problem. different realities which Figure 8 presents and Norway have achieved a reduction as one – two different points on a road of two thirds or more.And as Figure 8 To put the case at its most extreme, there along which most industrialized nations also reveals, the nations of the OECD is all the difference in the world between are travelling at different rates. Even have been moving at very different a teenage girl of thirty or forty years ago today, there are teenage births in every speeds. Italy and Portugal, for example, who left school at 16, married at 18 with nation that correspond more closely to had very similar teen birth rates in 1970 the blessing of family and church, had a the former description.And the (27.4 and 29.4 respectively) but have wanted baby at 19, and became a mother proportion of such births will differ from

30 Figure 7 Rising age at first birth Average age of women at birth of first child, 29 1970 to 1998.

Spain 28 Netherlands Italy Japan 27 Sweden Ireland 26 Denmark Australia 25 Finland Greece

24 Korea

Average age at first birth Norway Canada 23 Austria Portugal 22 Iceland USA 21 Hungary Czech Republic Poland 20 1970 1975 1980 1985 1990 1995 1998 Slovak Republic

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country to country. It is unlikely, for Figure 8 Teenage birth rates now and 30 years ago example, that low teenage birth rates in The pale bars show the number of births to women aged below 20 per 1,000 women aged 15 to 19 in northern Europe reflect the same balance 1970 (the basis for the ranking). The dark bars show the rates in 1998 (as in Figure 1). of forces as low rates in southern Europe.

Figure 8 must therefore be interpreted 4.6 JAPAN with caution, and with one eye on the 4.4 7.9 SPAIN degree to which the level of teenage 14.1 births in any given country may reflect 18.7 IRELAND more traditional values.And although no 16.9 2.9 one indicator can reveal the strength of KOREA 19.3 those traditional values in a given 6.3 NETHERLANDS country, Figure 9 may offer a hint by 22.6 5.5 SWITZERLAND showing the percentage of births 22.6 occurring within marriage in 27 OECD 6.6 ITALY nations. It suggests, for example, that a 27.4 9.7 significant proportion of teenage births LUXEMBOURG 27.9 in Greece and Japan may be of the more 21.2 PORTUGAL traditional kind – as 80 per cent or more 29.4 18.7 of teenage births in those two countries POLAND 29.7 are to teenagers who are married. But it 9.9 BELGIUM is also worth noting that more than 50 31.2 9.2 per cent of teenage births are to married FINLAND 32.2 teenagers in Italy, Luxembourg, Poland, 8.1 DENMARK the Slovak Republic and Switzerland. 32.4 6.5 SWEDEN 33.9 The comparison between teenage birth 9.3 FRANCE rates today and teenage birth rates of 30 36.8 11.8 years ago must therefore take into GREECE 37.0 account that the nature of what is being 26.9 SLOVAK REPUBLIC compared has changed.As a 39.4 20.2 phenomenon, teenage birth has declined: CANADA 42.1 it is as a problem that it is perceived to 12.4 NORWAY have grown. 44.6 16.4 CZECH REPUBLIC 49.0 The sexualised society 30.8 UK It has been argued that the overall effect 49.4 of the socio-sexual transformation of 26.5 HUNGARY recent times has been to bring strong 50.5 18.4 AUSTRALIA downward pressure to bear on teenage 50.9 birth rates. But not all of the forces 13.1 GERMANY involved have been pulling in the same 55.5 14.0 AUSTRIA downward direction. 58.2 29.8 NEW ZEALAND In particular the weakening of traditional 64.3 52.1 attitudes has combined with commercial USA 69.2 pressures to create more sexualised ICELAND 24.7 societies in which old taboos serve ICELAND 73.8 mainly to add to the allure of the 01020304050607080 formerly forbidden. Increasingly, sexual Births to women aged below 20 per 1,000 15 to 19 year-olds

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Figure 9 Births to married women The dark bars show the percentage of children born to women aged below 20 whose mothers were married at the time of birth. The pale bars show the percentage of children born to women of all ages whose mothers were married at the time of birth. (Data are for 1998.)

100 UK USA SPAIN USTRIA FRANCE AN 99 SWEDEN CANADA IRELAND NORWAY ICELAND A FINLAND BELGIUM USTRALIA HUNGARY GERMANY DENMARK PORTUGAL A JAP 87 86 NEW ZEALAND NETHERLANDS GREECE 96

80 83 ITALY 92 ITALY 80 80 80 79 POLAND 88 73 72 72 71 SWITZERLAND 91 71 67

60 UXEMBOURG 83 63 62 L 61 60 60 SLOVAK REPUBLIC 85 SLOVAK 58 CZECH REPUBLIC 81 55 55 53 53 51 47 45 40 45 centage of births to married women 42 r 40 39 Pe 36 36 35 31

20 23 21 18 18 17 15 9 10 10 2 6 0 4 imagery and content are permeating the Among 15 year-old American girls, a most acute, these two countries are information and entertainment quarter have already had full sexual clearly not alone. Similar patterns prevail environments within which today’s intercourse; and by age 17 the proportion in Australia where even in 1992 more teenagers develop awareness, experiment is close to 50 per cent.9 than 10 per cent of 12 to 14 year-old with identity, and live out their boys were reporting that they had had aspirations towards adulthood. Available figures for the United Kingdom sex, rising to over 25 per cent for 15 tell broadly the same story. Forty years year-olds and to 50 per cent for 17 year- Unsurprisingly in such a context, sexual ago the average age at first sex was 20 for olds.12 In Iceland, the average age at first activity among teenagers has increased males and 21 for females; today it is 17 sex is now 15.4 years for both girls and (perhaps aided by a fall in the average age for both sexes.10 Among under sixteens, boys.13 In Finland, figures for 1991 show of puberty as a result of better health and the proportion who report having had that 13 per cent of 14 year-olds and 29 nutrition6). In the United States, for sex has doubled in a generation to 30 per per cent of 15 year-olds are sexually example, the percentage of all adolescents cent for males and 20 per cent for experienced, and that half have had sex who have sex by the age of 18 has females (1991). More recent statistics before the age of 18.14 doubled since the 1950s.7 Today, 85 per suggest that the number of girls having cent of American males and 77 per cent under-age sex (below 16) has doubled in In sum, the average age at first sex has of American females have had sex by the the last 10 years, and that almost 40 per fallen sharply in some parts of the age of 19.8 cent of 15 year-old girls have had full industrialized world; and in 10 of the 12 sexual intercourse.11 OECD nations for which data are But it is among younger teenagers that available more than two-thirds of young the kaleidoscope has been most Although the United States and the people have sexual intercourse while still vigorously shaken.According to some United Kingdom furnish the best in their teens (Figure 10). In Denmark, sources, for example, seven per cent of documented examples of this trend, Finland, Germany, Iceland, Norway, the American children now have sex even perhaps because it is here that the United Kingdom and the United States, before they have become teenagers. problem of teenage pregnancy is at its the proportion is over 80 per cent.15

12 INNOCENTI REPORT CARD ISSUE NO.3

Motive and means of economic and social inequality. For expectations. If she decides to have sex Such a change, all other things being the forces of change have not treated all she is likely to know about the risks and equal, could obviously have been young people equally. Indeed even the to have the kind of relationship that expected to produce significant increases attempt to prepare young people for life allows her to discuss contraception with in teenage birth rates.The fact that it has in a more sexualised society – for her partner. If despite all she finds herself not done so is testimony to the example by better sex education – can pregnant, then she is likely to feel that combined power of the already become a sphere in which relative having a baby would change her life mentioned forces that have provided disadvantage operates. But it is in the significantly and for the worse. More both motive and means to delay arena of motive, more even than of often than not she will choose to have an childbearing. means, that the unequal impact of these abortion. For all of these reasons, forces manifests itself most starkly. embracing both motive and means, ‘Motive and means’ are therefore key teenager one is unlikely to become a factors in the teenage birth equation. The different ways in which the forces of teenage mother. And they direct attention to whether and the socio-sexual transformation affect the to what extent societies have responded lives of young people are largely self- Te enager two has grown up in relative to the socio-sexual transformation by evident but may again be caricatured in a poverty. She is more likely to see herself changing the ways in which young tale of two teenagers. as a failure at school and probably has people are prepared for the beginning of little hope of further education or their sexual lives. One of the keys to Teenager one is growing up in relative anything other than an unskilled and interpreting the league table of teenage affluence. She is likely to be doing well at low-paid job. If she has sex, it may well birth rates therefore seems to be that school, has reasonable expectations of be opportunistic, unprotected, and countries with low teenage birth rates higher education and a rewarding career, possibly unwanted. She probably knows tend to be either countries that have and is likely to be surrounded by friends little about contraception, and may not travelled less far from traditional values or and family who have similarly high feel able to discuss it with her partner or countries which have embraced the socio-sexual transformation but have also Figure 10 Age at first sex The pale bars show the percentage of women who report having had sex before age 20. The dark taken steps to equip their young people to bars show the percentage of women who report having had sex before age 18. All women surveyed cope with it. By the same reasoning, those were age 20 to 24 (data for different years in the early 1990s). countries with the highest teenage birth 12 POLAND rates tend to be those that have marched 40 26 far along the road from traditional values PORTUGAL 51 whilst doing little to prepare their young 36 BELGIUM people for the new and different world 69 in which they find themselves. 53 FRANCE 73

40 This commentary will return to the issue SWITZERLAND 76 of young people’s abilities to manage the 58 GERMANY new pressures. But analysing the league 81 table of teenage birth rates exclusively in 63 USA 81 terms of the balance between traditional 50 FINLAND and modern forces, and the ability of 84 today’s teenagers to cope, ignores a major 59 NORWAY dimension of the problem to which we 84 64 must now turn. UK 87

72 ICELAND The unequal impact 88

If teenage birth rates cannot be DENMARK 71 understood outside the context of the 90 socio-sexual transformation, neither can 020406080100 they be understood outside the context Percentage of women aged 20 to 24

13 Race and place 1

insist on his using a condom. If she subsequently becomes pregnant she is less likely to seek or to receive help, and less

Is a nation’s standing in the teen rate of 30 per 1,000 is significantly likely to have an abortion.Teenager two births league table affected by the increased by the much higher rate may also be unhappy at home, and teen birth rates of its ethnic (74 per 1,000) among the Maori perhaps desperate to find a way of minority groups? community. As Maori constitute getting out and starting life on her own more than 20 per cent of the total or with her partner (though the chances Teenage births among immigrant or teenage population, the teenage are that her partner will no longer be ethnic minorities are often, though birth rate for the non-Maori around16). She is probably also vaguely not always, higher than the community falls to approximately average for their nation as a 18 – which if applied nationally aware that if she has the baby she will whole. Usually, the difference would lift New Zealand from receive some kind of financial help, reflects traditional values favouring twenty-sixth to eighteenth in the including perhaps housing and welfare early marriage and childbearing, league table of teen births. benefits.Almost certainly, she will have plus the social and economic little idea of how demanding and disadvantage commonly Geographic difference difficult bringing up a child in such experienced by such communities. Disaggregating national data is almost always useful for the circumstances will be. But she may In the UK, for example, the birth purpose of more closely informing decide that having a baby is the least rate per 1,000 teenagers in the analysis and policy. But too often unattractive alternative open to her (and 1980s was 75 for the Bangladeshi ethnic differences are used to she may be right).Teenager two is and 44 for the Caribbean draw the wrong conclusions while therefore more likely to enter the communities, as opposed to 29 for other equally important ways of statistics of teenage motherhood. whites and only 17 for the Indian breaking down the statistics are community. Similarly in the United ignored. States, the teenage birth rate is As in the earlier example, it would be approximately twice as high for In Italy, for example, the teenage untrue and unfair to suggest that all black teenagers as for white (85 birth rate in the central region of teenage girls from poor backgrounds fall as opposed to 45) and higher still the country is only 3.3 per 1,000 – into the category of teenager two, or that (94) for the Hispanic community. lower than any OECD country all girls from better-off homes conform except Korea; in the South, by At the top end of the league table, contrast, the rate is 10.0 which if to the stereotype of teenager one.An a significant percentage of teenage applied nationally would drop Italy economically poor background does not mothers in the Netherlands are from sixth to twelfth place in the preclude either success at school or a from ethnic minority groups such league table. happy and supportive home; and an as the Turkish, Netherlands affluent background is no guarantee of Antilles, and Surinamese Similarly in Canada, the teenage either – or of the ability to cope with sex communities (where the teen birth birth rates for Quebec, Ontario and relationships (teenagers in the most rates are 31, 40, and 17 and British Colombia are in the respectively, as opposed to 6 for range of 16 to 18 whereas in affluent areas of the United Kingdom the Netherlands as a whole). Saskatchewan and Manitoba the have a significantly higher birth rate than range is 37 to 38 (higher than in the average rate for the Netherlands But this ethnic factor has no any other OECD country except or France17). significant effect on national the United States). standings in the teen births league But our two stereotype teenagers table (Figure 1). Even if we use Most such methods of breaking only the birth rate among white down national data also capture, to nonetheless serve to show some of the teenagers, for example, the United some degree, the element of socio- ways in which the strong association States and the United Kingdom economic disadvantage which so between teenage pregnancy and remain firmly at the bottom of the powerfully affects teenage birth disadvantage might operate. league. rates.

The consistency of that association is The exception to this is New Zealand, where the teenage birth Source: see page 30 borne out by evidence from many developed nations, though again it is the ‘problem countries’ that tend to be best

14 INNOCENTI REPORT CARD ISSUE NO.3

documented. In the United States, for and 60 per cent of teenage abortions.18 factors include growing up in a single parent example, teenagers living in low income “The likelihood that teenagers engage in family, living in poverty and/or a high-poverty families constitute less than 40 per cent unprotected sex, become pregnant, and give neighborhood, having low attachment to of the teenage population but account birth,” concludes one US study, “is highly performance at school, and having parents for over 80 per cent of teenage births correlated with multiple risk factors.These with low educational achievement.”19

Similarly in the United Kingdom, the Figure 11 Teenage births, Percentage of Income likelihood of teenage pregnancy has been income inequality, and Teenage birth 15 to 19 year- inequality rate olds not in youth out of school index shown to be ten times higher for girls education The table shows: teenage whose parents are unskilled manual birth rates (as in Figure 1); KOREA 2.9 21.4 workers than for girls whose parents are an index of income 20 inequality where higher middle class professionals. And JAPAN 4.6 values indicate greater according to a 1995 study, the chances of inequality (the Gini SWITZERLAND 5.5 35.5 15.9 coefficient based on per a girl giving birth while still a teenager capita household income); NETHERLANDS 6.2 30.2 14.0 are significantly increased by a range of and the percentage of 15 to background factors including financial 19 year-olds not enrolled in SWEDEN 6.5 25.3 13.9 education in 1998. Dark blue adversity, emotional difficulties during denotes the worst ITALY 6.6 35.9 30.2 childhood and adolescence, low performing countries, medium blue the average educational attainment, and having a SPAIN 7.9 32.4 23.5 performers, and light blue mother who was herself a teenage the best. Where no number DENMARK 8.1 24.6 19.9 parent. Strikingly, the same study is given, the grouping has been estimated. concluded that the probability of a young FINLAND 9.2 24.6 17.9 woman with all of these problems FRANCE 9.3 32.4 12.2 becoming a teenage mother is more than

LUXEMBOURG 9.7 26.9 40 per cent, while for a young woman with none of these problems the BELGIUM 9.9 27.7 13.9 probability is less than 4 per cent.21

GREECE 11.8 35.6 22.4 Index of hope NORWAY 12.4 25.7 13.6 To this extent, therefore, the league table GERMANY 13.1 30.0 11.7 of teenage pregnancy reflects motivation as well as means; it is an index not just AUSTRIA 14.0 30.4 23.8 of success in equipping teenagers to CZECH REPUBLIC 16.4 25.8 25.1 prevent births but of success in building a

AUSTRALIA 18.4 33.7 18.4 more inclusive society; it is, in one dimension, an index of hope, of IRELAND 18.7 34.6 19.3 teenagers’ own sense of current well-

POLAND 18.7 35.8 18.6 being and future prospects.

CANADA 20.2 31.7 22.0 Pursuing this theme, Figure 11 shows the PORTUGAL 21.2 38.2 23.8 teenage birth rate of 28 OECD nations alongside two common indicators of ICELAND 24.7 20.3 ‘inclusiveness’. For each country, it HUNGARY 26.5 25.0 24.6 tabulates the teenage birth rate, the

SLOVAK REPUBLIC 26.9 26.2 degree of income inequality, and the percentage of 15 to 19 year-olds not NEW ZEALAND 29.8 37.0 28.3 enrolled in education (using light blue,

UK 30.8 36.6 30.5 medium blue and dark blue to indicate whether a country is in the top third, USA 52.1 40.6 25.8 middle third or bottom third under each

15 INNOCENTI REPORT CARD ISSUE NO.3

indicator).And although Figure 11 to explain different levels of teenage teenage births reflect causality or merely demonstrates association rather than births in developed nations, what do they correlation. cause, it nonetheless reveals a clear have to say about current attempts to tendency for less inclusive societies to reduce those rates? In an attempt to answer this question, have higher teenage birth rates. research has for the most part First, the fact that disadvantage and concentrated on statistical methods of In sum, adding this dimension of disaffection seem to be major factors controlling for pre-existing factors in disadvantage to our view of the teenage represents a fundamental challenge to all order to remove them from the birth league table means that a country’s such attempts.And it forces a return to equation. standing in that table may in some the question touched on at the degree be explained by: beginning of this report.Are teenage Figure 12, for example, summarizes the births a cause of the disadvantages in results of one such attempt in the United a) A combination of how far a particular later life that are summarized in Kingdom.And it concludes that, even if country has travelled down the road Figure 5? Or do they merely stand proxy the effects of economic disadvantage are from traditional values and to what for a complex of pre-existing cancelled out by looking only at those extent that society has prepared young disadvantages that are the real reason who grew up in poverty during the people for this new world (of which behind later-life problems and that would 1960s and 1970s, the chances of those the key practical test is the effective be largely unaffected by delaying women still living in poverty today are use of contraception), and childbearing by a few years? In other almost doubled by having had a baby b) What proportion of teenagers are words, would even a successful national while still a teenager. Reviewing such strongly motivated to avoid early programme to reduce teenage births evidence, a report by an expert working parenthood because they feel that they really make much difference if all it group in the United Kingdom have an expectation of reasonable achieved was a delay in beginning concludes: “Whatever the extent to which education and employment, and of childbearing while leaving untouched teenage birth results from hardship and being included in the opportunities the underlying disadvantages which deprivation, it also contributes to such and advantages of living in an predispose young people towards teenage outcomes.After taking into account the effects economically advanced society. births? of education and social class, women who give birth in their teens are more likely to live in a Cause or correlation? Clearly, the answer depends on whether poor area of the country, are less likely to own If these are some of the factors that help the negative outcomes associated with their own home, and are less likely to be in paid work, than those who did not.An Figure 12 Later life outcomes and age at first birth in the UK interpretation of these findings that has logical This table shows the effects in the UK of teenage birth and childhood poverty (net of other childhood appeal takes account of the fact that if young factors) on the odds of having no qualifications, low household income (bottom 25 per cent of distribution), and claiming benefits at age 33. women and their partners defer parenthood, Always relative to the probability for a woman who had her first child aged 23 to 32 and who did not they will have greater opportunities for experience childhood poverty, the figure shows the probabilities of experiencing each later life training, jobs, and financial betterment.”22 outcome: dark bars for a woman who had a child as a teenager and who did not experience childhood poverty, pale bars for a woman who had a child as a teenager and who experienced clear childhood poverty, and white bars for a woman who had her first child aged 23 to 32 and who Overall, the results of most such studies experienced clear childhood poverty. have tended to agree that although many of the problems experienced by teenage NO mothers are indeed the result of pre- QUALIFICATIONS existing social and economic factors, there is still a substantial degree of LOW HOUSEHOLD INCOME disadvantage that can be directly attributed to the fact of having given birth while still a teenager. CLAIMING BENEFITS But the extensive use of statistical

0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 controls, which cannot entirely take into Probability relative to that of a woman with a first birth at age 23 to 32 and no childhood poverty account subtler and less measurable

16 INNOCENTI REPORT CARD ISSUE NO.3

factors such as parental attitudes, means fortunes of teenagers who gave birth Unfortunately, such approaches have that these results have not necessarily with those of teenagers who became themselves been subject to been accepted as conclusive. pregnant but miscarried. In both these methodological or sampling problems cases it may reasonably be assumed that (such as the under-reporting of More recent research has attempted to most of the background factors, miscarriages or their possible attack the problem by exploiting ‘natural including unmeasurable influences, were independent effects). Not least, all studies experiments’. One pioneering study, for probably similar.23 Pre-existing of long-term disadvantage suffer from the example, compared the later-life circumstances can therefore be largely obvious and inevitable drawback of being outcomes of sisters in cases where one cancelled out of the equation, enabling able to draw conclusions only about the sister had given birth as a teenager and researchers to focus on the degree of past. Looking at the long-term effects of the other not. Other studies have disadvantage that can be said to be teenage pregnancy on mothers and attempted to compare the subsequent caused by teenage birth. children requires following the fortunes

Sexual health 2

The problems associated with the sexual conduct need not be value Among teenagers in the United increasing sexual pressures on young free,” says Roger Ingham, Director of Kingdom, half of under 16s and a people are wider than the risks of the Centre for Sexual Health third of 16 to 19 year-olds use no pregnancy and the consequences of Research at the UK’s Southampton contraception at first sex, and a childbearing. University, “Sex and relationship quarter of all teenagers believe that education can and must be based on the pill protects against STDs. Partly For many, the pressure to become values of respect and mutuality, as a result, the incidence of involved in sexual activity at too whether or not these are located gonorrhoea among British teenagers early an age brings emotional and within specific religious or cultural rose by 45 per cent between 1995 psychological anxieties. Others live frameworks.” and 1997. with the fear or the reality of sexually transmitted infections, including TBRs and STDs In the United States, where a similar AIDS. In particular, sex education needs to proportion (over 40 per cent) of help young people protect sexually experienced teenagers say Still others are victims of unwanted themselves against the dangers of that they do not use contraception sex. A quarter of American sexually transmitted diseases every time they have sex, the picture teenagers report that their first (STDs). And the kind of sex is also worrying. Every year some 3 experience of sex was unwanted, and education which has helped produce million American teenagers contract seven per cent say that it was some of the world’s lowest teenage a sexually transmitted infection actually involuntary. In New Zealand births has also brought low and (about 1 in every 4 sexually a study of women born in 1972 also declining rates of sexually experienced teenagers). found that 7 per cent said that first transmitted infections, including Approximately a quarter of all new sex was not only unwanted but HIV/AIDS. cases of HIV/AIDS are diagnosed in forced upon them. young people under the age of 22. In Sweden, for example, the number Preparing young people to live in an of STDs has fallen by 40 per cent in Much of this burden of disease increasingly sexualised society the early 1990s. In the Netherlands arises from ignorance of the risks. In therefore needs to be about more (where the so-called ‘double Dutch’ one act of unprotected sex with an than just contraception – and to be method of using both contraceptive infected partner, a teenage woman directed equally at both sexes. In the pill and condom is widely used) the has a 1 in 100 chance of contracting Netherlands, for example, sex level of sexually transmitted HIV, a 1 in 3 chance of contracting education concerns itself with infections is low and falling. genital herpes, and a 1 in 2 chance sexually transmitted infections, the of contracting gonorrhoea. balance of gender power, managing In the two countries with the highest relationships, and coping with teenage birth rates in the OECD, by pressures from partners and peer contrast, STDs are a matter of groups. “A more open approach to increasing concern. Source: see page 30

17 INNOCENTI REPORT CARD ISSUE NO.3

of those who became pregnant 20 or 30 least, not compounding the handicaps imposed considerable social and financial years ago. But the world has moved on by social disadvantage.”26 difficulties.27 Even in the case of Italy, since the 1970s and 1980s. Recent where widespread poverty in the south decades, for example, have seen a sharp Meanwhile, the less elusive implications undermines the idea of an inclusive increase in the job market’s demands for of high teenage birth rates should not be society, it may be that the continuing skills and qualifications; and in the case overlooked. Even where the incentive to hold of more traditional values in the of the United States a spate of welfare avoid pregnancy may not be particularly south helps to keep teenage birth rates reforms that have severely limited the strong, it is known that most teenage lower than its poverty rate might lead benefits available to unmarried mothers in the two countries with the one to expect. mothers.24 In such a dynamic highest teenage birth rates – the United environment there is an obvious danger States and the United Kingdom - neither Other top ten countries, such as the in applying lessons from the past to the wished nor intended to become Netherlands, Sweden, Denmark, Finland present or the future. pregnant. Most of those teenagers say and France, have travelled far down the that they did not know enough about road from traditional values but have As for the impact on the children of either contraception or the demands and achieved a rapid fall in teenage birth rates teenage mothers, the balance of difficulties of childcare, and that they by being fully exposed to the forces that evidence points to similar conclusions. wish that they had waited before starting have tended to make early childbearing a A major US study titled ‘Kids Having a family. Enabling young women to disadvantage, by being relatively inclusive Kids’ reports that, “Even given the exercise such choices, thereby giving societies, and by making conscious and differences in the mother’s characteristics and them more control over their own lives, apparently successful efforts to prepare the policy environment in which the children is in itself a powerful justification for the and equip their young people to cope were raised, delaying childbearing from ages attempt to lower teenage birth rates. with a more sexualised society. 16 to 17 until ages 20 to 21 would increase the probability that the children would Top and bottom Still others, like Switzerland (and even graduate from high school by about 9 per Given such arguments, what does perhaps the Netherlands where Calvinist cent.The probability of the daughters giving international comparison have to say traditions are still powerful in some areas) birth as a teen would fall by about 22 per about the approaches that are most likely may have achieved low teenage birth cent.The probability that the daughters to be effective? And what, if anything, rates by an uneasy combination of both would give birth out of wedlock as a teen can be learnt from those countries that factors. Switzerland, for example, has a would fall by about 10 per cent.And the have already achieved low levels of long history of school-based sex probability of being economically inactive as teenage pregnancy? education28 but also retains a strong grip young adults would decrease by about on traditional values.As Figure 9 shows, 19 per cent.”25 Of the top ten countries in the league more than 60 per cent of Swiss teenage table, all except Italy and Switzerland births are to teenagers who are married, The current consensus therefore seems could be described as ‘inclusive societies’ a higher proportion than in most to be that the importance of teenage as judged by the degree of income northern European nations. births as a cause of subsequent problems equality (Figure 11). In addition, Korea, has tended to be exaggerated, but that it Japan, Italy, and Spain would appear to Looking to the bottom half of the league still represents a significant problem. “It enjoy a top ten position not because of table, it may be that high teenage birth is much too early to conclude that policy changes in the sexual education of young rates in countries such as the Czech efforts to reduce teenage pregnancy and people but more probably because Republic, Hungary, Poland, Portugal, and childbearing are misguided,” concludes an traditional values remain a significant the Slovak Republic include a significant overview of research into this question influence. In Korea particularly, the proportion of more traditional teenage by Saul Hoffman of the University of extremely low teenage birth rate is likely births (as suggested by Figure 9 showing Delaware, US. “Reduction of early to be, at least in part, a reflection of the that a relatively high proportion of parenthood,” he argues, “will not eliminate fact that pre-marital sex and pregnancy teenage births in such countries are to the powerful effects of growing up in poverty tend to incur strong social disapproval, married teenagers). and disadvantage. But it represents a that contraceptive advice is intended for potentially productive strategy for widening married couples, and that teenage girls At the bottom of the table are countries the pathways out of poverty or, at the very who find themselves pregnant face such as New Zealand, the United

18 Teen births versus overall fertility 3

When judged against levels in much ‘motives and means’ for teenagers to Denmark, the Netherlands and Korea of the rest of the world, fertility delay childbearing may vary are the opposite. These are countries among all women of childbearing age markedly across the industrialized that manage to keep their teenage is very low in each of the 28 OECD nations in ways that are not strongly birth rates much lower than would be countries considered in this Report connected to the factors that affect expected from fertility levels among Card. In every case it is below the fertility among all women. all women. Despite having overall ‘replacement level’ required to keep fertility that is quite high by OECD a country’s total population constant. The graph compares the actual teen standards, Denmark succeeds in Nevertheless, these overall fertility birth rates in the OECD countries coming eighth in the teenage birth rates do vary substantially across (the bars) with the rates that would league. The Netherlands is in fourth the 28 countries – by a factor of be expected on the basis of each place, two places above Italy, despite nearly two to one. Are countries with country’s overall fertility rate (the a substantially higher level of overall high teen births those where women diamonds). The ‘expected’ rates are fertility. of all ages have greater numbers of not to be seen as the levels that the children? OECD countries ‘should’ have. For Portugal and Switzerland have the example, the fact that Iceland has an same fertility rate and hence the On the one hand the level of teenage expected rate equal to its actual rate same ‘expected’ teen birth rate, 14 births in a country may reflect many does not mean that Icelanders per 1000. But their actual rates of the influences on fertility among should be content with their record differ sharply – 18 countries come women of all ages – the on teenage births: twenty-third place between them in the teenage birth opportunities for women to work and in the teenage birth league (see league. There must be factors that the general availability of Figure 1). push teenage births up in Portugal contraception and abortion. If so, and down in Switzerland which have teenage fertility and overall fertility The US, the UK, Hungary and the little to do with the factors would be strongly related and there Slovak Republic stand out as having influencing the overall level of would be nothing particularly special teen birth rates that are much higher fertility in the two countries. The UK to any country about the factors than would be expected on the basis and France or Canada and Belgium affecting births among its teenagers. of their levels of overall fertility. New provide similar contrasts. Zealand, Portugal, Poland and the On the other hand a country’s Czech Republic are also countries teenage birth rate may be only where the actual rate is significantly weakly related to overall fertility. The higher than the predicted one. Source: see page 31

Teenage birth rates and overall fertility The bars show actual teenage birth rates (as in Figure 1), while the diamonds show the teenage birth rates expected on the basis of each country’s total fertility (the basis for the ranking).

60 UK USA ITALY OREA SPAIN JAPAN K USTRIA GREECE FRANCE POLAND SWEDEN CANADA IRELAND NORWAY ICELAND A

50 FINLAND BELGIUM USTRALIA HUNGARY GERMANY DENMARK PORTUGAL A UXEMBOURG L SWITZERLAND NEW ZEALAND NETHERLANDS

40 CZECH REPUBLIC SLOVAK REPUBLIC SLOVAK

30 25 25 22 23 21 19 18 19 19 19 17 18 20 15 16 16 13 14 14 14 12 12 13 11 11 12 8 8 9 10 Births to women aged below 20 per 1,000 15 19 year-olds 0

19 INNOCENTI REPORT CARD ISSUE NO.3

Kingdom, and the United States – all Figure 13 Birth and abortion rates less inclusive societies as measured by The table shows the number of births (dark half of bar) and of abortions (pale half of bar) to women high levels of income inequality and the aged below 20, expressed per 1,000 women aged 15 to 19. (Data are for 1996.) proportion of older teenagers not in education (Figure 11). It appears likely, 3.9 7.1 JAPAN therefore, that a larger proportion of 7.7 3.9 NETHERLANDS young people in these countries may be less than strongly motivated to delay 7.5 4.9 SPAIN childbearing.At the same time, the 6.6 6.7 ITALY United Kingdom and the United States are also societies that have experienced 12.2 1.3 GREECE the socio-sexual transformation, 9.9 5.2 BELGIUM including the sexualisation of the information environment, but without 13.0 5.3 GERMANY making commensurate changes to 9.8 9.6 FINLAND prepare young people to cope with the new pressures. Contraceptive advice and 9.4 13.2 FRANCE services may be formally available, but in 8.2 15.4 DENMARK a ‘closed’ atmosphere of embarrassment and secrecy. Or as one British teenager 7.7 17.7 SWEDEN puts it, “it sometimes seems as if sex is 13.6 18.3 compulsory but contraception is illegal.”29 NORWAY

20.1 12.4 CZECH REPUBLIC Summing up many such interviews with young people, the UK government’s 21.5 20.6 ICELAND

Social Exclusion Unit concludes, “The 30.5 13.1 SLOVAK REPUBLIC universal message received from young people is that the sex and relationships education 20.1 23.9 AUSTRALIA they receive falls far short of what they would 22.3 22.1 CANADA like to equip them for managing relations as they grow into adulthood.”30 29.6 21.3 UK

33.4 22.5 NEW ZEALAND These factors may go a long way towards explaining the lowly position 29.9 30.2 HUNGARY of the United Kingdom and the 55.6 30.2 USA United States in the league table of teenage births. 020406080100 Combined number of births and abortions to women aged below 20 per 1,000 15 to 19 year-olds. Dutch lessons As far as policy issues are concerned, it Figure 13, however, shows the danger of several northern European nations have therefore appears to be the northern treating the northern European countries achieved low teenage birth rates partly by European countries that hold the key to as a homogeneous group. relying on relatively high levels of lowering teenage birth rates in abortion. In Denmark, two thirds of modernized societies. (Unless one argues By adding the teenage abortion rate to teenage pregnancies are terminated. In that a large-scale return to traditional the teenage birth rate, Figure 13 serves as France and Norway the termination rate sexual values is desirable and realistic, an approximate teenage conception rate is about 60 per cent; in Sweden 70 per although this would presumably have to (with no allowance made for the small cent.The ‘Nordic model’ is therefore, at include a return to the very different number of miscarriages or for the fact its present stage, far from being an ideal. economic and media environments that abortion may be under-reported in To some extent the level of abortion may which sustained such values.) some countries).And it shows that reflect the acceptability of terminating

20 INNOCENTI REPORT CARD ISSUE NO.3

pregnancies in a given society; but associated with shame or embarrassment” and socio-sexual revolution. Even using the abortion is no one’s first choice, and in which “the media is willing to carry approximate teenage conception rate therefore must also be seen as a measure explicit messages designed for young people (adding together the birth and abortion of failure to educate and equip young about contraceptive services”.The result is rates, as in Figure 13), the Nordic people to use contraception effectively. that using contraceptives, as one teenage countries have achieved significantly survey respondent put it, “is as ingrained lower rates of teenage pregnancy than The Netherlands, on the other hand, not as not going through a red light.”31 the countries at the bottom of the league only has one of the lowest teenage birth table.The teen conception rate in rates in Europe but also one of the ‘Openness’ about sex and contraception, Finland, for example, is only one third lowest teenage abortion rates in the commented on by many observers of the that of the United Kingdom and one developed world. Netherlands, is obviously difficult to fifth that of the United States. capture in statistics (although one study This is a remarkable achievement, has concluded that teenage boys in the Sweden, in particular, has attracted summed up by the position of the Netherlands are two to three times more international attention for its radical Netherlands in Figures 8 and 13.Whilst likely to discuss contraception with their policies, beginning in 1975 with a major experiencing the same socio-sexual sexual partners than teenagers in the review of the school sex-education transformation as other advanced Western United Kingdom, and that parents are curriculum. Recommendations of economies, the Dutch have managed to twice as likely to discuss sex with their abstinence and sex-only-within-marriage reduce teenage births by 72 per cent in children32). But it appears to be a were dropped, contraceptive education 30 years (Sweden and Denmark have significant element in the Dutch was made explicit, and a nation-wide achieved very similar reductions but have achievement.Whereas contraceptives and network of youth clinics was established teenage abortion rates that are contraceptive advice appear to be just as specifically to provide confidential approximately four times higher).And as freely available in many other OECD contraceptive advice and free it is clear that this is an achievement that countries, the atmosphere surrounding contraceptives to young people. In the springs not only from the particularities contraception is markedly different in the same year, abortion law was reformed to of culture or history but from conscious Netherlands. One Europe-wide study of allow termination of pregnancy on policy, it is to the Netherlands that most ‘what works’, for example, has concluded demand and without charge. Over the attention has been directed in the search that “the spirit in which sex education is next two decades, Sweden saw its for ‘what works’. offered and delivered appears to be more teenage birth rate fall by 80 per cent. important than the specific approach According to a recent study published by In general, studies of the Dutch adopted.”33 the US based Population Council, this experience have concluded that the was the result of a pragmatic approach underlying reason for success has been Other telling indicators of openness and which sees teenage sexual activity the combination of a relatively inclusive of teenagers being more in control, “neither as desirable nor undesirable, but as society with more open attitudes towards particularly when compared with inevitable – this being the case, teenagers’ use sex and sex education, including countries where teenage births are much of contraceptives is viewed as highly desirable contraception.This has paved the way for more common, are that young people in because it will prevent both childbearing and sexual relationships to be discussed at an the Netherlands have a higher average abortion.”35 early age – before barriers of age at first intercourse, lower levels of embarrassment can be raised and before subsequent regret, higher levels of Similarly pragmatic policies have been sex education can be interpreted as contraceptive use and effectiveness, and pursued by the other Nordic countries, sending a signal that the time has come report more discussion and forward and with similar results. to start having sex.According to the planning between partners.34 conclusions of a 1994 international In 1998, the Family Planning conference under the title of ‘Can we The Nordic approach Associations of Denmark, Norway, learn from the Dutch?’, for example, Similar conclusions might also be drawn Sweden and Iceland attempted to distil young people in the Netherlands “feel from Sweden, Norway, Denmark and the lessons from this experience into a comfortable discussing sexuality in a warm, Finland – all countries which have ‘Nordic Resolution’, urging that young mutually supporting atmosphere” in which achieved low levels of teenage births people should have the same rights to “requests for contraceptive services are not despite being in the vanguard of the sexual and reproductive health care as

21 INNOCENTI REPORT CARD ISSUE NO.3

married couples, that they should have send the wrong message to the young, society to make to the young; and that affordable and high quality sexual health pay no regard to moral welfare, recent abstinence education campaigns services, including contraception, that encourage sexual activity at too early an are achieving some success (Box 6).They they should have the right to age and of too casual a nature, and might also add that welfare provision for confidentiality in discussing contraceptive threaten to undermine the basic family unmarried teenage mothers is an services, and that they should be able to values on which society ultimately encouragement to irresponsible opt for abortion without needing depends.They may also argue that childbearing. parental consent.36 abortion represents the deliberate taking of a human life and is a moral wrong To this, the advocates of the Dutch or Opponents of the Dutch and Nordic that cannot be justified on pragmatic Nordic approaches might reply that their approaches, operating from a different grounds; that abstinence is the countries have the lowest teenage birth moral premise, argue that such policies appropriate recommendation for adult rates in the world, that there has been no

Emergency contraception 4

Emergency contraception, sometimes upheld the objections of protesters opposition spokesperson Dr. Liam called the ‘morning after pill’, is who argued that dispensing hormonal Fox. “It can only increase the risk of essentially a high-dose of a regular contraceptives without prescription worsening the current epidemic of oral contraceptive taken in the form was against the law. Six months sexually transmitted diseases and of two pills taken 12 hours apart and later, in December 2000, parliament could result in repeated and within 72 hours of unprotected sex. It made emergency contraception legal unsupervised exposure of young girls offers 95 per cent protection against again after a debate in which the to this powerful drug.” (see Box 5) pregnancy becoming established and French education minister described is on sale over-the-counter in France, the policy as “a gesture of help for The second accusation levelled at Norway, Portugal and the United those living in a painful moment of emergency contraception is that it is Kingdom (and as of December 2000 isolation and fear.” abortion by another name. has been licensed for use by prescription in all nations of the In the United Kingdom, the In Italy, where the emergency European Union except Greece and government is trying to make contraception pill Norlevo was Ireland). emergency contraception more licensed to be sold in pharmacies on widely available and has licensed prescription in September 2000, the Its advocates believe that it is an over-the-counter sales. The health ministry has announced that invaluable ‘last stay’ against persistence of the name ‘morning use of the drug does not constitute unwanted pregnancy and that it can after pill’ is unfortunate, says a abortion. Condemning the decision, drastically reduce the number of government report, following a the Vatican argued that “blocking the women seeking abortion. In the survey finding that fewer than half of implantation in the uterus is the same United States, where emergency 16 to 21 year-olds knew that there as suppressing it. Morally, it’s the contraception is not available without was a 72 hour ‘window of same thing as surgical abortion.” The prescription, the President of the opportunity’ for emergency Irish Medicines Board agreed, and Planned Parenthood Federation of contraception. has refused a license. America has argued that “this is a safe drug that could prevent more Irresponsible Supporters counter that emergency than a million and a half unintended Opponents are equally fervent in contraception actually prevents pregnancies a year and reduce the condemning the promotion of abortions by offering women an number of abortions by about emergency contraception to young alternative. In the UK, 70 per cent of 800,000 if it were widely used.” people. women seeking an abortion said that they would have used emergency In France, emergency contraception “Making the morning after pill contraception instead if they had has been sold over-the-counter since available to all girls over 16 in this known how to get it. 1999 and was made available in way sends the wrong message about schools in December of that year. In the need for responsible sexual July 2000, the Supreme Court activity,” says the United Kingdom’s Source: see page 31

22 Finland: 5 waking up to the pill further fall in the average age at first sex for the last two decades,37 that they have low and still declining abortion rates, and that the prevalence of AIDS and sexually Opponents of ‘morning after’ surveys in the late 1980s and early transmitted infections has fallen sharply contraception (Box 4) have argued 1990s. (as opposed to the rising levels of that it will encourage irresponsible infection in other countries (Box 2)). sexual activity and that there is a The study concluded: They might also add that concerns over danger of what is essentially a “Emergency contraception has not high-dosage drug being used become a contraceptive choice sending the wrong messages to young repeatedly by young people who replacing conventional methods people about sex would be better come to rely on it as a substitute among adolescents. Our results directed towards the media and the for conventional contraception. suggest that easy access to advertising industry rather than towards contraceptive services (including parents, school and clinics attempting To examine this proposal, emergency contraception) and responsible sex education. researchers in Finland surveyed intensive sex education have not the use made of emergency increased adolescent sexual contraception by teenagers since activity. The proportion of sexually Such battles have characterized much its introduction in the late 1980s. experienced teenagers in our study recent discussion on teenage birth rates. The results of the survey, involving was not higher than in Finnish But whereas there are some dimensions over 20,000 Finnish girls in the mid studies in the late 1980s or early of the debate which might eventually be 1990s, are shown in the two 1990s when emergency settled by the accumulating evidence (for tables. contraception was not widely example the potential of abstinence used.” The study also compared the education and welfare reform to reduce proportion of teenagers who were Note: The school health care teenage birth rates (Box 6)), the heart of sexually experienced (13.3 per system in Finland advises the matter remains a conflict of premise cent of 14 year-olds, 28.8 per cent teenagers on all aspects of sexual and principle that is unlikely to be of 15 year-olds, and 51.5 per cent health, including emergency resolved by analysis of league tables. of 17 year-olds) and found that contraception. there had been no significant change since the equivalent Source: see page 31 Contraception the key Overall, any examination of different levels of teenage births in the Use of emergency contraception by teenagers in Finland industrialized nations must conclude by (percentage of teenage girls who had ever used emergency contraception) re-emphasizing the central role played by contraception. Contraceptive behaviour Girls aged:14 15 17 All ages may be strongly influenced by %%%% motivation; but it is through the ability % ever used 2.1 6.3 15.1 6.6 % never used 93.6 91.5 83.5 90.5 to manage contraception successfully, % not knowing often over an extended period of time, what emergency contraception is 4.3 2.2 1.4 2.9 that motives, attitudes, and decisions find Total 100.0 100.0 100.0 100.0 practical expression.

In particular, those countries that have Number of times emergency contraception used by teenage girls been in the forefront of the socio-sexual revolution are today reliant on some Girls aged:14 15 17 All ages combination of contraception and Once 61.8 62.9 66.4 64.6 abortion to bridge an unprecedented gap Twice 16.2 16.7 17.6 17.1 between average age at first sex and Three or more 6.4 4.3 4.9 4.9 Missing data 15.6 16.1 11.1 13.5 average age at first birth.And what Total 100.0 100.0 100.0 100.0 determines the position of such countries in the league table of teenage birth rates is not any significant difference in the

23 USA: why teen births are falling 6

The United States sits at the bottom But their supporters believe that the United States, the Alan Guttmacher of the league table of teen births – national debate on such issues had Institute concluded: “These findings with a rate more than twice as high already changed the climate. And as suggest that the best strategy for as most other industrialized the second half of the 1990s began continuing the declines in teenage countries. But its present level of and the teenage birth rates pregnancy levels is a multi-faceted teenage births represents a sharp continued to fall, The Consortium of approach. Programs and policies drop from the peak years of the early State Physicians Resource Councils should aim at encouraging teenagers 1990s. As this report goes to press, pronounced that “the evidence points – particularly those at the youngest new figures (April 2001) show that to sexual abstinence, not increased ages – to postpone intercourse, and the decline is continuing. A further 3 contraceptive use, as the primary at supporting sexually experienced per cent fall has brought the teenage reason for the decline.” youths who wish to refrain from birth rate to 50.5 per 1,000 in 1999. further sexual activity. At the same This is still more than twice the Is abstinence increasing among US time, it must be recognized that most European average, but it represents teenagers? According to two young people become sexually active a fall over the 1990s of 20 per cent. different surveys, the answer during their teens, and sexuality appears to be ‘yes – slightly’. education and information should Since the good news began to filter also prepare them to adequately through from the national statistics, The latest Youth Risk Behaviour prevent pregnancy and sexually the hunt has been on to identify the Survey has found that the proportion transmitted infection if and when they reasons for the decline and the of female high school students who do have sex.” policies that might sustain it. But it is report having had sex has declined a hunt that has tended to ride off in from 51 to 48 per cent (1991 and America’s parents seem to agree. two different directions. 1997). And the National Survey of Most want to see sex education in Family Growth finds that the schools expanded and three-quarters Abstinence proportion of all teenage girls who say it should include contraceptive For some time, a significant section report having had sex has declined education. of public and political opinion in the from 52.6 to 51.5 per cent between United States has argued that sexual 1988 and 1995. As for the debate on welfare reform, abstinence is the only appropriate the jury is still out. Stricter limits to sex-education message for Contraception benefits were introduced only in unmarried teenagers. Contraceptive Others have been quick to challenge 1996 and it will be some time before advice, the argument runs, carries these conclusions. The 1.3 their effects, if any, on teenage the inevitable subtext that it’s all percentage point decline in the pregnancy rates can be analysed. right to start having sex. And since proportion of all teenage girls who 1996, more than US$400 million in report having had sex is not Standing back from these particular federal and state funds has been statistically significant, say debates, teenage pregnancy rates in spent on ‘abstinence only’ campaigns researchers at New York’s Alan the United States, as in the rest of in America’s schools. Today, one in Guttmacher Institute. Furthermore, the industrialized world, are also three US high schools has an even the reported decline would only influenced by a wide range of other abstinence-only policy on sex account for about 25 per cent of the factors including fear of HIV/AIDS education. decline in the teenage pregnancy and sexually transmitted infections, rate (see Sources). Most of the fall, improvements in contraceptive At the same time, it has also been they argue, is attributable to a fall in technologies, and the state of the argued that welfare payments to the pregnancy rate among teenagers economy and of career prospects for unmarried mothers encourage who do have sex. And as there young people. teenage pregnancy. And since the appears to have been no change in mid 1990s different states have the frequency of intercourse among introduced new limits and conditions sexually experienced teenagers, the on benefits to unmarried mothers. decline can only have been caused by more or more effective These specific campaigns and contraception. reforms took the field too late to be credited with the fall in teenage Summing up its inquiry into why births in the first half of the 1990s. teenage birth rates have fallen in the Source: see page 32

24 INNOCENTI REPORT CARD ISSUE NO.3

number or age of teenagers involved in Finally, it should be noted that Motivation is a less tractable issue. In the sexual activity but the level of effective contraception is essentially in contention main, the incentive to avoid early contraception and the degree of recourse with abortion and that, all other things parenthood stems from a stake in the to abortion. being equal, abortion tends to recede as future, a sense of hope, and an contraception advances. In South Korea expectation of inclusion in the benefits In France, for example, the proportion of over the last 30 years, for example, total of living in an economically advanced under-eighteens who give birth has been fertility has been reduced from 4.5 to 1.5 society. Building that sense of inclusion more than halved in the last 20 years births per woman – largely by a where it is now absent is a task that while the average age at first sex has combination of contraception and requires action on a much broader front. remained stable for many years,38 as has abortion. But while the percentage of Such action, however, is required not the number of abortions.This has only Korean women aged 15 to 44 using only to reduce teenage births but for its been made possible by an increase in contraception has risen from 25 per cent own sake – and for the sake of contraceptive use and effectiveness. In to almost 80 per cent over the period, the attempting to resolve at a fundamental 1970, for example, about 50 per cent of abortion rate has been more than level many of the other major problems French women used no form of halved.43 that confront today’s industrial societies contraception at first sex. By 1993 that and that are the subject of the Report figure had declined to 16 per cent.39 And with the rise in the use and Card series. Similarly, it is not the difference in the effectiveness of contraception of recent average age at first sex or fewer abortions decades, abortion rates are now stable or that gives the United Kingdom a higher falling in most industrialized nations. From rate of teenage births than other the mid-70s to the mid-90s abortion rates European nations but lower rates of in Denmark, Finland, Italy, and Japan have contraceptive use (only about 50 per cent dropped by 40 per cent to 50 per cent. of under-sixteens and two thirds of 16 to Smaller but still substantial declines have 19 year-olds in the United Kingdom use been seen in France, Germany, and the contraception at first sex40). United States. In most other developed nations, rates have been stable over the last The point may be made more 20 years.44 Only Canada and New graphically by imagining the effect of Zealand appear to be showing slight removing modern contraceptives from increases. the scene altogether. In the United States alone, it has been estimated that this Conclusion would result in a trebling in the annual This commentary has stressed throughout number of teenage births from today’s that success in lowering teenage birth rates 494,000 to approximately 1,650,000. is a matter of both motivation and means. Even if teenagers responded to this unlikely scenario by having less frequent The ‘means’ involve not only the degree sex, or using rhythm or withdrawal of availability of contraception but also the methods, the decline in contraceptive use kind of sex education which enables and effectiveness would result in an extra young people to make informed and 1 million pregnancies, 400,000 abortions, mutually-respectful choices, including the and 120,000 miscarriages every year.41 choice to delay having sex or to insist on Arguments in favour of abstinence safe contraception.And the evidence from education must therefore take into countries that have already achieved low account that the prevalence of sexual rates of teenage birth suggests that it activity among US teenagers would have ought to be within the power of all to decline by more than 80 per cent to governments in the developed world to prevent the same number of pregnancies ensure that sex education of this kind is as are today prevented by modern available to all their young people within contraceptive methods.42 the relatively short term.

25 INNOCENTI REPORT CARD ISSUE NO.3

Notes

1 The weighted average, or 5 The percentage of children Planning Queensland, 2000 20 B. Botting, M. Rosato, and total teenage birth rate, for the born outside marriage in the available at R. Wood, ‘Teenage mothers European Union is 13.3 per US has increased from 4 per www.fpq.asn.au/teenpreg.html. and the health of their 1,000 – about a quarter of the cent in 1940 to 33 per cent in children’, Population Trends, US figure of 52.1 as given in 1995. H. Boonstra, ‘Welfare 13 ‘Country Profiles’, 93, Autumn 1998. Cited in The Figure 1. Law and the Drive to Reduce International Planned Social Exclusion Unit, ibid. ‘Illegitimacy’’, The Guttmacher Parenthood Federation, 2 The ‘Nordic approach’ refers Report on Public Policy, The developed with support from 21 K. Kiernan, ‘Transition to to The Nordic Resolution on Alan Guttmacher Institute, the UN Population Information Parenthood: Young mothers, adolescent sexual health and New York, December 2000, Network (POPIN), available at young fathers – associated rights, drawn up by (chart p.8). www.ippf.org. factors and later life associations working in the experiences’, Welfare State field of sexual and reproductive 6 ‘Reducing teenage 14 E. Kosunen, A. Vikat, M. Programme, Discussion paper health in Denmark, Iceland, pregnancy’, Fact Sheet, Rimpellä, H. Huhtala, WSP/113, London School of Finland, Norway, and Sweden, Planned Parenthood ‘Questionnaire study of use of Economics, 1995. Cited in The Helsinki, October, 1998. Full Federation of America, 2000, emergency contraception Social Exclusion Unit, ibid. (p. text available at available at among teenagers’, British 19). www.sexogsamfund.dk/ www.plannedparenthood.org. Medical Journal, Volume 319, uk_sider/nordisk%20reso.html. library/TEEN-PREGNANCY/ 10 July 1999. 22 K. Wellings, ibid. Further discussion on use of reducing.html. The Nordic Resolution found in 15 ‘Sharing responsibility: 23 S. D. Hoffman, ‘Teenage news item, IPPF, 26 March 7 J. G. Khan, C. D. Brindis, women, society & abortion childbearing is not so bad 1999, New York, available at D. A. Glei, ‘Pregnancies world-wide’, The Alan after all – or is it? A review of www.ippf.org. averted amongst U.S. Guttmacher Institute, 1999. the new literature’, Family teenagers by the use of Planning Perspectives, 3 H. Boonstra, ‘Welfare Law contraceptives’, Family 16 In the UK, 50 per cent of Volume 30, No. 5, and the Drive to Reduce Planning Perspectives, the partners of teenage September/November 1998. ‘Illegitimacy’’, The Guttmacher Volume 31, No. 1, mothers have left after one Report on Public Policy, The January/February 1999. year. I. Allen, S. Bourke 24 H. Boonstra, ibid. Alan Guttmacher Institute, New Dowling, Teenage Mothers: York, December 2000. 8 ‘Trends in sexual activity Decisions and outcomes, 25 R. A. Maynard, ibid. and contraceptive use among Policy Studies Institute, 1988. 4 These figures refer to the teens’, Research Brief, Child Cited in The Social Exclusion 26 S. D. Hoffman, ibid. (unweighted) average values of Trends, Washington D. C., Unit, ibid., (p.24). the total fertility rates for OECD USA, 2000. 27 Kyu-Taik Sung, ‘Teenage countries (excluding Mexico 17 The Social Exclusion Unit, pregnancy and pre-marital and Turkey) calculated from 9 ‘Trends in sexual activity Teenage Pregnancy, The birth in Korea: issues and data drawn from the sources and contraceptive use among Stationery Office Ltd, UK, June concerns’ in M. Rosenheim cited in Box 3 for 1998 and teens’, ibid. 1999 (p.25). and M. Testa (eds.) Early from Eurostat, Demographic Parenthood and Coming of statistics – Data 1960-99, 10 K. Wellings, ‘Promoting 18 ‘Sex and America’s Age in the 1990s, New Luxembourg 1999 (pp.102-3) the health of teenage and Teenagers’, The Alan Brunswick, N. J: Rutgers except Australia, Canada, lone mothers – setting a Guttmacher Institute, New University Press, 1992. Czech Republic, Hungary, research agenda’. Report of York, 1994. Japan, Korea, Poland, New the UK Health Education 28 F. Narring, P-A Michaud, Zealand, USA from United Authority Expert Working 19 R. A. Maynard, ‘The study, and S. Vinit, ‘Demographic Nations, Demographic Group, 1999. the context, and the findings in and Behavioural Factors Yearbook Historical Supplement brief’, in R. Maynard (ed.), Associated With Adolescent 1948-1997, 2000; the Slovak 11 The Independent, August Kids Having Kids: Economic Pregnancy in Switzerland’, Republic from UNDP, Slovak 10, 2000. Costs and Social Family Planning Perspectives, Republic – Human Consequences of Teen Volume 28, No. 5, Development Report 1995 12 ‘Teenage sexuality, Pregnancy, Urban Institute September/October 1996. (1996) for 1970. Pregnancy, Abortion & Press, 1997. Contraception’, Family

26 INNOCENTI REPORT CARD ISSUE NO.3

Sources

29 The Social Exclusion Unit, 35 G. Santow and M. Figure 1. Data for European calendar year in which the ibid. Bracher, ‘Explaining trends in countries are from Eurostat, birth occurred (which is equal teenage childbearing in NEW CRONOS Demographic to the difference between the 30 The Social Exclusion Unit, Sweden’, Studies in Family database 2000. Data for other year of birth of the child and ibid. (p.37). Planning, Population Council, countries are as follows: USA the year of birth of the 1999 30[3]169-182. from S. Ventura, J. Martin, S. mother). To ensure 31 The quotations cited in this Curtin, T. Mathews, M. Park, comparability, the data for paragraph are from L. 36 The Nordic Resolution, Births: Final data for 1998, Germany were multiplied by Jacobson, C. Wilkinson and R. ibid. National Vital Statistics Reports 1.34, which is the average Pill (1995), ‘Teenage 48(3), National Center for ratio of teenage birth rates Pregnancy in the United 37 The Nordic Resolution, Health Statistics, Hyattsville, based on the two different age Kingdom in the 1990s: The ibid. Maryland, 2000 (pp.25 and definitions across other Implications for Primary Care’, 93); Canada from Statistics European countries for which Family Practice, Volume 12, 38 H. Kafé, N. Brouard, Canada, Health Statistics at a rates on both bases are No. 2, pp. 232-36, and from E. ‘Comment ont evolués les Glance, 1999; Australia from available. Jones, J. Forrest, N. Goldman, grossesses chez les Australian Bureau of Statistics, S. Henshaw, R. Lincoln, J. adolescents depuis vingt Cat. 3301.0, Births 1999, 2000; The two OECD countries not Rosoff, C. Westoff, and D. Wulf, ans?’, Population et sociétés the Slovak Republic from included in the table are Teenage Pregnancy in 361, 2000. Statistical Office of the Slovak Mexico and Turkey. Both have Industrialized Countries: A Republic; Japan from Statistics total fertility rates that are Study Sponsored by the Alan 39 H. Kafé, N. Brouard, ibid. and Information Department, above the ‘replacement’ level Guttmacher Institute. New Ministry of Health and Welfare for any country’s population, Haven, CT: Yale University 40 The Social Exclusion Unit, and from Statistics Bureau, conventionally taken as 2.1. Press, 1986. For further ibid. Management and Coordination The total fertility rate measures discussion see J. Micklewright Agency, Government of Japan, the number of children that a and K. Stewart, The Welfare of 41 J. G. Khan, C. D. Brindis, Japan Statistical Yearbook woman can be expected to Europe’s Children, The Policy D. A. Glei, ‘Pregnancies 2000; New Zealand from give birth to in her lifetime Press, Bristol, 2000 (chapter averted amongst U.S. Demography Division, given prevailing age-specific 6). teenagers by the use of Statistics New Zealand; birth rates. The replacement contraceptives’, Family Belgium from National Institute level of total fertility is the level 32 R. Ingham and G. van Planning Perspectives, for Statistics; Korea from required for a country’s Zessen, ‘From cultural contexts Volume 31, No. 1, National Statistical Office, population to stay constant to interactional competencies: January/February 1999. Republic of Korea. (ignoring migration). The A European Comparative World Health Organisation study’. Paper presented at 42 J. G. Khan, C. D. Brindis, Data refer to 1998 except: estimates total fertility to have AIDS in Europe, Social and D. A. Glei, ibid. Canada, France, Spain (1997), been 2.8 in Mexico in 1998 Behavioural Dimensions, 1998. Italy (1996), Belgium (1995). and 2.5 in Turkey (The World Cited in The Social Exclusion 43 S. Henshaw, S. Singh, T. Data for Netherlands are for Health Report 1999, Annex Unit, ibid (pp. 35 and 40). Haas, ‘Recent Trends in 1998 except for the number of Table 2). Mexico’s teenage abortion rates world-wide’, births to women aged less birth rate was 85.2 in 1995 33 Reducing the rate of Family Planning Perspectives, than 16 which is for 1994. Data and 92.1 in 1970 while teenage conceptions – An Volume 25, No. 1, March for Japan are for 1998 except Turkey’s rate was 50.0 in 1997 international review of the 1999. for the number of births to and 81.1 in 1967 (United evidence: data from Europe, women aged less than 15 Nations, Demographic Health Education Authority, UK 44 S. K. Henshaw, S. Singh, which is for 1997. (Data for Yearbook 1997, 1999). This 1999. T. Haas, ibid. Japan refer to Japanese source labels the 1995 Mexico nationals in Japan only.) rate as ‘unreliable’ and the 34 R. Ingham, ‘Education and 1997 Turkey rate as debate: For and against – Age refers to age of mother at ‘provisional’. Doctors should advise birth of the child (age in full adolescents to abstain from years at the time of the event). Figure 2. The years to which sex’, British Medical Journal, In Germany, age of mother is data refer are as in Figure 1 Volume 321, 16 December reported as the age that the and the sources are also the 2000, UK. woman will attain during the same, except for the USA

27 INNOCENTI REPORT CARD ISSUE NO.3

(National Center for Health Slovak Republic, the teenage Data for 18 to 19 year-olds mothers who gave birth for the Statistics Variations in Teenage birth rate for 1995 and 1998 were available only for 1994 in first time aged 20 to 29 is Birth Rates, 1991-98: National respectively was multiplied by Australia and rates were much larger, an average of State Trends, National Vital five. adjusted proportionally to a 763 women per country. Statistics Reports 48(6)). Total 1998 basis in line with Household income is teen births in Germany have Second, to take into account movements in the birth rates equivalised by the OECD been estimated by multiplying repeat teen births (the for all women aged below 20 scale. Further details of the the reported figure (21,668) by possibility of a teenager in the two years. Because of a analysis (including results that 1.34 (see the note on German having more than one child), difference in reporting of age allow for differences in the data in Figure 1). The OECD these percentages where (see note on German data in current age of former teen total including Mexico and reduced by one-eighth (the Figure 1), data for Germany mothers and of other mothers) Turkey would be 1,347,936. rate of repeat births in the were multiplied by 1.55 (age are contained in R. Berthoud This draws on data for Mexico UK), except for the US where 15 to 17) and 1.31 (age 18 to and K. Robson, ‘The (1998) and Turkey (1997) the reduction was one-fifth. 19). Data are missing for Outcomes of Teenage given in Instituto Nacional de The incidence of repeat teen Korea. Note that for all Motherhood in Europe’, Estadística, Geografía e births is given for the UK in countries, births to women Innocenti Working Paper 86, Informática, Indicadores Social Exclusion Unit, Teenage aged under 15 are not available from the UNICEF Sociodemográficos de México Pregnancy, The Stationery included in Figure 3 (whilst Innocenti Research Centre (1930-2000) (p.46) and UN Office, June 1999 (p.12 which they are in Figure 1). website http://www.unicef- Demographic Yearbook cites K. Wellings et al, icdc.org. The paper is also Historical Supplement 1948- Teenage sexuality, fertility and Figure 4 draws on United available as a Working Paper 1997, 2000. life chances, report prepared Nations Population Division, of the European Panel for the Department of Health Global Population Policy Analysis Group at ISER, The estimated percentage of using data from the National Database, 1999 (2000). University of Essex (see 20 year-olds who gave birth in Survey of Sexual Attitudes and http://www.iser.essex.ac.uk). their teens was calculated in Lifestyles, 1996) and for the Figures 5 and 6 are based on two steps. First, birth rates US in C. Dailard, ‘Reviving analysis of data from the Figure 7. Council of Europe, (expressed as percentages) Interest in Policies and European Community Recent Demographic were summed for women Programs to Help Teens Household Panel (ECHP), Developments in Europe 2000 aged 15 in 1994, 16 in 1995, Prevent Repeat Births’, The 1996 (wave 3), undertaken for (p.77), except Canada from 17 in 1996, 18 in 1997 and 19 Guttmacher Report on Public the UNICEF Innocenti Statistics Canada, USA from in 1998. Different years were Policy, III (3), The Alan Research Centre by Richard National Centre for Health used for some countries: Guttmacher Institute, June Berthoud and Karen Robson Statistics, Australia from France – 1993 for births to 15 2000). of the Institute for Social and Australia Bureau of Statistics, year-olds, 1996 for 16/17 year- Economic Research (ISER), 3301.0 Births, Australia 1999 olds, 1997 for 18/19 year-olds; Figure 3. Sources are as University of Essex, UK. The (p.38), Japan from Ministry of Germany – 1996 for 15 to 17 Figure 1 except Australia sample analysed is of women Health and Welfare, Korea year-olds (multiplied by 1.34 (Australian Bureau of who had their first (or only) from National Statistical Office. to correct for different age Statistics, Cat. 4119.0.00.001, child aged 15 to 19 or 20 to NB Australia: ‘1985’ is 1986, definition); Italy – 1996 for Australia’s Children (2000) for 29, and whose oldest child still ‘1990’ is 1993, ‘1995’ is 1996; ages 17 to 19; Spain – 1997 ages 15 to 17 and S. Singh living with them was aged less Korea ‘1985’ is 1987. for ages 18/19; Switzerland – and J. Darroch ‘Adolescent than 16. The women were 1998 for ages 18/19. For pregnancy and childbearing: interviewed for the ECHP an Figure 8. Eurostat, NEW Australia, Canada, Japan, levels and trends in developed average of eight years after CRONOS Demographic Korea, Poland, New Zealand countries’, Family Planning their first child was born. The database 2000, except and the USA, the sum of the Perspectives 2000, 32(1): 14- sample of former teenage Australia, Canada, Hungary, teenage birth rates from 1994 23 for ages 18 to 19), Belgium mothers ranges from 32 Germany, Ireland, Japan, New to 1998 was taken (Canada – (Eurostat, NEW CRONOS women in the Netherlands to Zealand, Poland, Portugal, 1997 instead of 1998, Japan Demographic database 2000) 223 in Greece, with an Spain, UK, USA from UN and Poland – 1997 rate and Canada (Statistics average size of 103. (The Demographic Yearbook estimated from 1996 and Canada, Annual Demographic sample size in Luxembourg Historical Supplement 1948- 1998, Korea – 1996/97 rates Statistics 1999, 2000 (pp. 49 was too small for this country 1997, 2000, the Slovak estimated from 1995 and and 179)). Data refer to the to be included in the analysis.) Republic from the Statistical 1998). For Belgium and the same years as for Figure 1. The size of the samples of Office of the Slovak Republic,

28 INNOCENTI REPORT CARD ISSUE NO.3

and Korea from National difference in age reporting countries). The years to which and that for the Slovak Statistical Office, Republic of (see notes to Figure 1), data the data refer are 1998 for Republic assumes a value Korea, Statistical Yearbook for teenagers in Germany Hungary, Poland, the Slovak equal to that for the Czech 1997 (p.70). Data for 1970 were multiplied by 0.94. Republic, 1997 for New Republic. differ from those for 1998 as Zealand and USA, 1996 for follows: data are tabulated by Figure 10. France, Germany, Belgium, Czech Republic, Figure 12 draws on J. year of registration rather than Poland, UK and the USA: Into Greece, Ireland, Korea and Hobcraft and K. Kiernan occurrence in Australia, New a New World: Young Women's Portugal, 1995 for Austria, ‘Childhood Poverty, Early Zealand, Ireland; Canadian Sexual and Reproductive Canada, Finland, Italy, Motherhood, and Adult Social data do not include Lives, The Alan Guttmacher Norway, Sweden and the UK, Exclusion’, Centre for Analysis Newfoundland; UK data refer Institute, New York, 1998, 1994 for Australia, France, of Social Exclusion to Great Britain (i.e. they Appendix Table 3, cols. 7–10 Germany, Luxembourg and CASEpaper 28, London exclude Northern Ireland) and (data for the UK are for Great the Netherlands, 1992 for School of Economics, 1999 a weighted average has been Britain). All others: M. Bozon Denmark, Japan and (Table 9) cited in Social taken for England and Wales and O. Kontula, ‘Initiation Switzerland and 1990 for Exclusion Unit, Teenage (weight equals 0.9) and sexuelle et genre: Spain. The shading for Iceland Pregnancy, The Stationery Scotland (weight equals 0.1). comparaison des évolutions assumes income inequality at Office, June 1999, which Data for Germany are a de douze pays européens’, the level of the OECD notes ‘The analyses of the weighted average of figures Population, 1997, 52 average. Shadings for Japan effects of teenage motherhood for the Federal Republic of (6):1367–1400, Table 2. (Data and Korea have been and of childhood poverty on Germany (weight equals 0.75, compiled and cited in Sharing assigned on the basis of adverse adult outcomes are data multiplied by 1.34 to Responsibility: Women, values given in D. Jacobs, drawn from logistic regression adjust for differences in age Society and Abortion ‘Low inequality with low models, which control for both reporting – see note on Worldwide, The Alan redistribution? An analysis of of these factors and for a wide German data in Figure 1) and Guttmacher Institute, 1999.) income distribution in Japan, range of other potential Former German Democratic Data come largely from South Korea and Taiwan childhood factors, including Republic (weight equals 0.25). national surveys on sexual compared to Britain’, Centre family type, contact with the attitudes and lifestyles for Analysis of Social police, father's and mother's Figure 9. Eurostat, NEW conducted between 1989 and Exclusion CASEpaper 33, interest in schooling, mother's CRONOS Demographic 1993. London School of Economics, and father's school leaving database 2000, except USA 2000 (Figure 1). age, parental housing tenure, from National Center for Figure 11. The data on grandfathers' and father's Health Statistics, Variations in income inequality refer to the Data on the percentage of 15 social class, personality Teenage Birth Rates, 1991-98: distribution by individuals of to 19 year olds not in attributes (aggression, anxiety, National State Trends, National per capita household income education are taken from and restlessness), and test Vital Statistics Reports 48(6), and come from various OECD, Education at a Glance scores’. Australia from Australian sources: European – OECD Indicators, 2000 Bureau of Statistics, 3301.0 Community Household Panel edition (p.135). Belgium refers Figure 13. The source for Births, 1999 (p.31), New (ECHP) microdata for wave 3 to the Flemish community abortion data is Health For All Zealand from Demography (Greece, Ireland, Portugal), J. only. The shading for Japan is Statistical Database 2000, Division, Statistics New Flemming and J. Micklewright, estimated from the results of a WHO Regional Office for Zealand, Canada from ‘Income Distribution, linear regression for other Europe, Copenhagen. Statistics Canada. Japan from Economic Systems and OECD countries of the Exceptions are France (Institut Statistics and Information Transition’, Innocenti percentage of 15 to 19 year National d’études Department, Ministry of Health Occasional Paper No. 70, olds not in education on the démographiques), Greece and Welfare, the Slovak 1999 (Czech Republic), upper limit of the age range in and Hungary (Eurostat, NEW Republic from the Statistical UNICEF Innocenti Research which over 90 per cent of the CRONOS Demographic Office of the Slovak Republic. Centre MONEE project population are enrolled (data database 2000), Japan and Data are missing for Korea. (Hungary, Poland, the Slovak drawn from the same OECD the Netherlands (United Data for teenagers for Canada Republic), UN WIDER World source). The shading for Nations, Demographic and Japan refer to women Income Inequality Database Luxembourg assumes a value Yearbook 1997, 1999), aged 15 to 19. The years to (New Zealand), and equal to the average for Australia (Sharing which data refer are as in Luxembourg Income Study contiguous countries Responsibility: Women, Figure 1. Because of (LIS) microdata (all other (Belgium, Germany, France) Society & Abortion Worldwide,

29 INNOCENTI REPORT CARD ISSUE NO.3

Box 1 Box 2 Race and place Sexual Health

The Alan Guttmacher Institute, their own country for abortion Data for the United Kingdom Discussion of teenagers as 1999), Canada (Statistics when it is not readily available are from: R. Berthoud, victims of unwanted sex in the Canada, Health Statistics at a at home (e.g. from Ireland to ‘Teenage births to ethnic US draws on K. A. Moore et al., Glance, 1999), New Zealand the UK). (National statistics for minority women’, Population ‘A statistical portrait of (Demography Division, women of all ages in France, Trends 104, Office for National adolescent sex, contraception, Statistics New Zealand), and Italy, Japan and Spain have Statistics, The Stationary and childbearing’, National the USA (The Alan been judged to be more than Office, London, June 2001. Campaign to Prevent Teen Guttmacher Institute, US 20 per cent incomplete – see The data are based on the Pregnancy, Washington D. C., Teenage Pregnancy Statistics: A.Bankole, S.Singh, T.Haas, Labour Force Survey of 13 1998 and cited in Facts in Brief: With Comparative Statistics for ‘Characteristics of women who consecutive years (1987-99), Teen Sex and Pregnancy, Women Aged 20-24, 1999). obtain induced abortion: A and refer to women aged up Revised 9/1999, The Alan The data refer to 1996 except worldwide review’, to 30 who had had a child in Guttmacher Institute available at for Australia (1995-96), International Family Planning their teens. The peak years for (http://www.agi-usa.org/pubs/ Belgium (1995), and the Perspectives 25(2) 1999. observations were in the mid fb_teen_sex.html). Roger Netherlands (1992). NB the 1980s. Data for all other Ingham discusses value birth rates in the figure refer to countries in this box refer to systems in sex education in R. the same year as abortion 1998. Data for the United Ingham, ‘Education and debate: rates, so they do not States are from: S. Ventura, J. For and against – Doctors correspond with the rates in Martin, S. Curtin, T. Mathews, should advise adolescents to the main league table. Data M. Park, Births: Final data for abstain from sex’, British for Japan refer to Japanese 1998, National Vital Statistics Medical Journal, Volume 321, nationals in Japan only. For Reports 48(3), National Center 16 December 2000, UK. Data abortions in France, age of for Health Statistics, on the fall in sexually mother is reported as the age Hyattsville, Maryland, 2000. transmitted diseases (STDs) in that the woman would attain Data for the Netherlands are Sweden are drawn from The during the calendar year in from: NISSO Fact Sheet, Nordic Resolution on which the abortion occurred. Teenage mothers in the adolescent sexual health and The abortion rate has been Netherlands, Utrecht, April rights, drawn up by multiplied by 1.36 to correct 2000, compiled by E. associations working in the field for this (the ratio of teenage Evenhuis, available at of sexual and reproductive birth rates in France in 1996 http://www.nisso.nl/ health in Denmark, Iceland, according to the two age nfactstiene.htm. Data for New Finland, Norway, and Sweden, definitions, age at birth and Zealand are from Demography Helsinki, October 1998, age attained during the year Division, Statistics New available from of birth). Data are missing for Zealand, Demographic Trends www.sexogsamfund.dk/uk_sider Austria, Ireland, Korea, 2000 (2001). Data for Italy are /nordisk%20reso.html. Data on Luxembourg, Poland, from ISTAT, Nascite: STDs among British teenagers Portugal, Switzerland. caratteristiche demografiche e are drawn from Social Exclusion sociali. Anno 1996, 2000; Unit, Teenage Pregnancy, The Since abortions occur well ISTAT, Popolazione e Stationery Office Ltd, June before birth would have movimento anagrafico dei 1999, (p. 49). Information on occurred the data include comuni, Anno 1995, 1997; use of contraception among US abortions undergone by ISTAT, Popolazione e teenagers is drawn from teenagers who would have movimento anagrafico dei ‘National Survey of Teens on turned 20 years old when comuni, Anno 1996, 1998. Dating, Intimacy, and Sexual giving birth were they not to Data for Canada are from Experiences’, conducted for the have aborted. Note also that Statistics Canada, Annual Henry J. Kaiser Family abortions may be Demographic Statistics 1999, Foundation, California, and YM underreported, especially in (2000) p.180. Magazine by Princeton Survey countries with restrictve Research Associates, 1998. The abortion laws, and that chances of contracting HIV and national statistics often contain other STDs are taken from figures for abortions for non- Social Exclusion Unit, ibid nationals who travel outside (page 6).

30 INNOCENTI REPORT CARD ISSUE NO.3

Box 3 Box 4 Box 5 Box 6 Teen births versus Emergency Contraception Finland: waking up to USA: why teen births overall fertility the pill are falling

The ‘expected’ teenage birth Information on licensing of the The discussion and tables The 1999 US teenage birth rates are the predicted values ‘morning after pill’ in the draw on E. Kosunen, A. Vikat, rate of 50.5 per 1,000 is from the results of a linear European Union is given in M. Rimpellä, H. Huhtala, calculated from information in regression for the teenage the British Medical Journal, ‘Questionnaire study of use of S. Ventura, J. Martin, S. Curtin, birth rate on total fertility: Volume 321, 25 November emergency contraception F. Menacker, B. Hamilton, slope parameter = 19.1 2000 (p.1306). The statement among teenagers’, British Births: Final data for 1999, (t-statistic = 2.6), by the President of the Medical Journal, Volume 319, National Vital Statistics constant = –14.1 Planned Parenthood 10 July 1999. Reports vol. 49 no. 3. (t-statistic = –1.2), Federation of America, New Hyattsville, Maryland: National R2 = 0.20. The source for the York (Gloria Feld) is available Center for Health Statistics, data on total fertility is at www.ippf.org (statement 2001. The fall during the Eurostat, Statistics in Focus made December 5, 2000). The 1990s (20 per cent) is the (theme 3 – 10/2000) except statement by the French percentage change over 1991- Australia from Australian education minister (Ségolène 99, while the 3 per cent fall is Bureau of Statistics, 3301.0 Royal) is taken from H. the percentage change from Births, 1998, Canada from Boonstra, ‘Promoting 1998 (the year to which the Statistics Canada, Japan from contraceptive use and choice: US data refer in Figure 1). The Japan Statistical Yearbook France’s approach to teenage value of 50.5 differs from the 2000, New Zealand from pregnancy and abortion’, The published rate of 49.6 cited in Demography Division, Guttmacher Report on Public the National Vital Statistics Statistics New Zealand, Policy, vol. 3, no. 3, The Alan Report since it includes births Belgium from Eurostat, Guttmacher Institute, June to women aged under 15 (as Demographic Statistics – Data 2000. Dr. Liam Fox, UK in Figure 1). (The 49.6 rate 1960-99, (p.102) and Korea opposition spokesperson at relates to births to15 to 19 (calculated from fertility rates the time this Report Card goes year-olds rather than to all of 5-year age groups) from to press, is quoted in an women aged under 20.) National Statistical Office, article ‘Quietly, Britain Eases Discussion of abstinence-only Republic of Korea, Statistical Access to Morning-After policy on sex education in US Yearbook 1999 (p.124). The Contraception’, International schools draws on H. years to which the data relate Herald Tribune, January 16, Boonstra, ‘Welfare Law and are the same as for Figure 1. 2001. The Vatican comment the Drive to Reduce (Total fertility data are on emergency contraception ‘Illegitimacy’’, The Guttmacher provisional for Belgium, is found in the Kaiser Daily Report on Public Policy, The France, Italy, Spain.) Reproductive Health Report, 1 Alan Guttmacher Institute, October 2000, cited in news New York, December 2000, item from the International and C. Dailard, ‘Sex Planned Parenthood Education: Politicians, Federation available at Parents, Teachers and Teens’, www.IPPF.org. The Irish The Guttmacher Report on Medicines Board’s decision to Public Policy, The Alan refuse a licence for Guttmacher Institute, New emergency contraception pill York, February 2001. The is cited in the British Medical quotation from The Journal, Volume 321, 25 Consortium of State November 2000 (p.1306). Physicians Resource Councils Discussion of whether or not is taken from J.M. Jones, et al. emergency contraception may (1999), ‘The Declines in prevent abortion in the UK can Adolescent Pregnancy, Birth be found in Social Exclusion and Abortion Rates in the Unit, Teenage Pregnancy, The 1990s: What Factors Are Stationery Office Ltd, June Responsible?’ N.p.: The 1999, (page 54). Consortium of State Physicians Resource Councils.

31 INNOCENTI REPORT CARD ISSUE NO.3

Acknowledgements

The data on abstinence from 211.8). This represents a This publication was written Carlos Bovagnet (Eurostat, the Youth Risk Behaviour decline of 2.7 per 1,000 – as and produced by Peter Luxembourg), Bruce Bradbury Survey and the National opposed to the actual decline Adamson, Giorgina Brown, (Social Policy Research Survey of Family Growth and in the teenage pregnancy rate John Micklewright and Anna Centre, University of New the discussion of frequency of of 10.3 per 1,000. Therefore Wright of the UNICEF South Wales, Sydney), Roger intercourse among sexually only about a quarter of the Innocenti Research Centre, Ingham (Centre for Sexual experienced teenagers come decline in teenage pregnancy drawing in part on the Health Research, from J. Darroch and S. Singh, can be attributed to a fall in contributions of other people Southampton University), ‘Why is teenage pregnancy the proportion of sexually (none of whom is responsible Michaela Kreyenfeld (Max declining? The roles of experienced teenagers. for the way in which his or her Planck Institute for abstinence, sexual activity and work has been used). Demographic Research, contraceptive use’, Occasional Information on the views of Rostock), Jany Rademakers Report No. 1, The Alan parents on sex education in In particular, Richard Berthoud (Netherlands Institute of Social Guttmacher Institute, New schools was taken from R. and Karen Robson (Institute Sexological Research, York, December 1999. (This is Saul, ‘Teen Pregnancy: for Social and Economic Utrecht), Gerry Redmond also the source of the Progress meets politics’, The Research, University of (UNICEF Innocenti Research quotation on The Alan Guttmacher Report on Public Essex), carried out the Centre). Guttmacher Institute’s Policy, Vol. 2, No. 3, The Alan analysis of data from the findings.) Guttmacher Institute, New European Community Design and layout by Their conclusion that most of York, June 1999. Household Panel on the Garry Peasley. the fall in teenage pregnancy outcomes of teenage (both pregnancies that lead to motherhood in Europe (drawn Administrative support at the births and pregnancies that on in Figures 5 and 6). UNICEF Innocenti Research end in abortion) is attributable Centre was provided by Cinzia to a fall in the pregnancy rate The following people kindly Iusco Bruschi. among teenagers who do provided data for their have sex is based on the countries: Jan Broum (Czech following argument. The teen Statistical Office, Prague), pregnancy rate for 1988 Frantisek Burdan and Peter (111.4) combined with the Heidinger (Statistical Office of proportion of teenagers the Slovak Republic, sexually active in that year Bratislava), Yoko Kanegae (52.6 per cent) yields a (Ministry of Health and pregnancy rate among Welfare, Tokyo), Jung-ah sexually active teenagers of Kwon (National Statistical 211.8 per 1,000 (111.4/0.526). Office, Seoul), Jeanne By 1995, the overall teenage MacDonald (Statistics pregnancy rate had fallen to Canada, Ottawa), Jean-Luc 101.1 per 1,000 and the Stroobant (National Institute proportion of sexually active for Statistics, Brussels), Irene teenagers had reportedly Tang (Statistics New Zealand, fallen to 51.3 per cent, yielding Christchurch), Stephanie a pregnancy rate among Ventura (National Center for sexually active teenagers of Health Statistics, Hyattsville), 197.1 (101.1/0.513). But if the Sabrina Voorham (Statistics pregnancy rate among Netherlands, sexually experienced Voorburg/Heerlen). teenagers had remained at the 1988 level of 211.8 per 1,000 Comments, information and then the lower proportion of help in other forms were sexually active teenagers in provided by Ana Betrán 1995 would have produced an (World Health Organization, overall teenage pregnancy Geneva), Dana Blumin rate of 108.7 (0.513 times (OECD, Paris), François-

32 Previous issues in this series: Innocenti Report Card,No.1 A league table of child poverty in rich nations

Innocenti Report Card,No.2 A league table of child deaths by injury in rich nations

The next Innocenti Report Card will compare Educational inequality in the nations of the industrialized world.

Design and layout: Miller, Craig & Cocking Limited Printed by:Tipografia Giuntina Innocenti Report Card, No.3 A league table of teenage births in rich nations

This third Report Card presents the latest internationally comparable data on teenage births in 28 nations of the industrialized world.

ISSN: 1605-7317 ISBN 88-85401-75-9