Teen pregnancy, birth, and abortion are at all-time lows in this country. Though we don’t yet know all the factors that have contributed to these trends, two things are becoming abundantly clear: Teens haven’t stopped having sex, but they are using contraception more.
A new study from researchers at the Guttmacher Institute and Columbia University’s Mailman School of Public Health shows that while sexual activity is holding steady, contraceptive use is on the rise. The research concludes that this increase in contraceptive use is primarily responsible for the decline in teen pregnancy.
For years, educators, advocates, and politicians have debated how to best help teens avoid unwanted pregnancy, sexually transmitted infections (STIs), and other consequences of sexual activity. Some (myself included) have argued that we need to give teens information, teach them critical thinking skills, provide access to contraception, and ultimately encourage them to make responsible decisions about when to have sex and how to protect themselves. Others suggest that teens are not capable of such nuanced decision making and should instead be told to save sexual activity until they are older and either more capable of avoiding these consequences, more capable of coping with them, or married.
The findings of this study demonstrate that contraception, not abstinence, is responsible for decreasing teen pregnancy risk and that teens are capable of making responsible sexual decisions. That should be enough to put an end to “just say no” education. But, of course, the debate will go on—partly because there has not been similar success in preventing STIs among young people. In fact, STIs are on the rise across the country and across age groups.
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Teen Pregnancy Declines
In 2011, about 553,000 pregnancies occurred among young women ages 15 to 19. This translates to a rate of 52.4 pregnancies per 1,000 young women and represents a 25 percent decline from 2007. The long-term declines are even more severe: The rate dropped 50 percent from 1990, when it was 117 per 1,000. Birth rates and abortion rates among teens have also fallen during these years.
It is understandable why abstinence proponents would like to believe that a decrease in teen sexual behavior is responsible for this downward trend. After all, many schools and community-based programs spent much of the 1990s and early 2000s telling teens that sex outside of marriage had inevitable consequences—pregnancy being just one (loss of reputation and a grim future were among the many others such abstinence-only-until-marriage programs espoused). According to the Sexuality Information and Education Council of the United States, Congress invested more than one billion dollars into these programs between 1996 and fiscal year 2010. And, because of matching requirements, states added millions of dollars to this pot.
However, these programs were never found to be effective. In fact, a U.S. government-funded review of four such programs found that students enrolled in them fared no differently than their peers—they had the same number of sexual partners and similar ages of first sex. An Oxford University evaluation of 13 studies of abstinence-only-until-marriage programs found that such programs did not significantly affect the number of students engaging in vaginal sex and they failed to lower either the pregnancy or STI rates among those enrolled.
Previous research from the Guttmacher Institute examined data from 1995 and 2002 and determined that 86 percent of reduction in pregnancy risk was due to improved use of contraception and better contraceptives. The remainder of the reduction in risk was due to declines in sexual activity, but this was concentrated exclusively among younger teens.
The current study examines data from 2007 through 2012. Once again, researchers calculated a Pregnancy Risk Index, which estimated the annual risk of becoming pregnant among adolescent women based on recent sexual activity (specifically, penile-vaginal sex in the last three months), the contraceptive methods used at last intercourse, and the efficacy of these methods. They then looked at changes to rates of sexual activity and contraceptive use, or lack thereof, to figure out what was driving the reduction in pregnancy risk.
The analysis found that the rates of sexuality activity did not change significantly over time. In 2007, 31 percent of women 15 to 19 reported having been sexually active in the last three months, compared to 33 percent in 2009 and 30 percent in 2012. Other measures of sexual activity—including whether a young woman had had sex in the last year, in the last four weeks, or ever in her lifetime—also did not change significantly over those years.
What did change was the use of contraception. The percentage of teens who said they had used one or more methods of contraception the last time they had sex increased from 78 percent in 2007 to 86 percent in 2012. Teens using more than one method of contraception increased as well, from 26 percent to 37 percent. And the use of highly effective methods (the IUD, implant, pill, patch, ring, or injectable contraceptives) increased from 38 percent to 51 percent between 2007 and 2009 but did not increase further by 2012. All of these increases were considered statistically significant.
Laura Lindberg, the lead author of the study, told Rewire that one of the most important changes was in the percentage of teens who went from using no method of contraception the last time they had sex to using some form of contraception. The percentage of teens who hadn’t used contraception decreased from 22 percent in 2007 to 14 percent in 2012.
“It’s the kids who went from using nothing to using something; we’re approaching 90 percent of teens who used something the last time they had sex,” Lindberg continued.
Why Have Teens Gotten Better at Birth Control?
This study can’t tell us exactly what changed to spur this positive trend of contraceptive use. We don’t yet know whether teens have gotten more information, increased access, more motivation, or all three.
We do know, however, that in recent years, public health experts have paid a great deal of attention to the issue of teen pregnancy and to contraceptive use. Some of this can be traced back to the new generation of IUDs and contraceptive implants, which are safe for teenagers. In the past—after the Dalkon Shield, an early IUD, left many women infertile—IUDs were recommended only for women who had already given birth and did not plan to have any more children. And issues with the removal of the original contraceptive implant called Norplant caused it to go off the market. But with research proving the safety of new models, public health experts and medical providers alike became focused on these two so-called long-acting reversible contraceptive (LARC) methods due to their their incredibly low failure rates.
Once these LARCs are inserted by a health-care provider, both IUDs and implants are all but guaranteed to prevent pregnancy for three to five years without any action on the part of the user. Teens—whom many fear will forget to take their pills or leave the condoms in the drawer—will be protected no matter what. Some even declared this to be the magic bullet for teen pregnancy prevention. In that view, if all women under 19 had a LARC method, unwanted teen pregnancy could become a thing of the past.
But Lindberg says LARCs aren’t the only reason for the recent drop in teen pregnancy, because the use of these methods ticked up only slightly in the data she and her colleagues looked at—from 1 percent of women who’d been sexually active in the last three months in 2007 to 3 percent in 2012. In contrast, the percentage of sexually active women who used the pill increased from 26 percent to 35 percent. Still, the national conversation that started with public health experts’ excitement about LARCs and the attention paid to teen pregnancy—the Centers for Disease Control and Prevention (CDC), for example, declared it to be a “winnable battle”—may be at least in part responsible for the change in teen behavior. Lindberg believes we need to keep this up.
She told Rewire: “Both the long-term and the more recent declines in teen pregnancy have been driven by teens’ responsible contraceptive behavior. Continuing to give teens the information and access they need for good contraception use will remain key in supporting reduced teen pregnancy rates.”
What About STI Rates?
Clearly, though, staying the course is not enough, because it looks like we may have traded one public health concern for another. STIs among young people are actually on the rise. As the CDC points out, young people ages 15 to 25 are a relatively small portion of the sexually active population, but in 2014 they accounted for almost two-thirds of all reported cases of chlamydia and gonorrhea.
Lindberg points out that our national conversation about teen pregnancy prevention did not emphasize the importance of preventing STIs. She says, “In general, we have a hard time keeping our eyes on both prizes even though you think they’d go together.” In the 1980s and 1990s, the conversation focused on STIs due to the growing HIV epidemic and the fear of this deadly STI, which we knew little about. As HIV became more manageable and was no longer a death sentence, some turned their focus to teaching a vision of morality through abstinence-only-until-marriage programs, while others started a national conversation about teen pregnancy and contraception.
What was lost in both approaches was the importance of condom use. Condoms are the only method of contraception that also provide protection against STIs, but their efficacy rates for preventing pregnancy do not match that of LARCs because there’s high potential for user error (such as not putting the condom on soon enough, taking it off too early, or forgetting it entirely). As for abstinence-only-until-marriage programs, they went out of their way to undermine young people’s confidence in condoms, going as far as comparing sex with a condom to Russian roulette or jumping out of an airplane with a faulty parachute.
Given this environment, we cannot be surprised that condom use among young people has suffered. The Youth Risk Behavior Surveillance System, conducted by the CDC’s Division of Adolescent and School Health, found that condom use declined from 63 percent in 2005 to 57 percent in 2015.
Where to Go from Here
While I do not expect the debate of teens and sex to end anytime soon, I think the path is clear. This research confirms that young people are capable of making responsible decisions about contraception and that if we focus our efforts on helping them prevent pregnancy, they do it.
This study also shows that today’s young people are willing to use more than one method at the same time. The percentage of sexually active young women using two or more methods increased from 26 in 2009 to 35 in 2012.
Let’s embrace this willingness by giving teens the information they need about LARCs, other hormonal methods (such as the pill, the patch, or the ring), and condoms. Let’s simultaneously set our sights on addressing teen pregnancy and STIs. And, most of all, let’s make sure teens understand that doubling up on contraception is the best way to do that.
But, please, let’s not go back to telling teens not to have sex and ending the conversation there. They’re too smart for that.