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Teen Childbearing Trends: Which Tide Turned When and Why?

The article by Kaufmann and colleagues1 in this issue of Pediatrics is the latest in a rapidly growing series documenting a steady decline in the number of babies born to 15to 19-year-old American girls since 1991.2–4 Although the causes of this welcome turn of events have yet to be fully elucidated, everyone wants to take credit. Conservative groups say abstinence education turned the tide, while liberals claim that sex education has promoted more widespread and effective contraceptive use.4 In truth, both groups appear to be correct. Efforts to promote condom and contraceptive use among teens have not, as many had feared, led to more widespread teenage sexual activity.3–8 Rather, the messages to “postpone sex” and “have safe sex if you do” appear to be not only mutually compatible but complementary. The latest vital statistics and national survey data indicate that teenagers are having less sex, using more birth control, and having fewer babies.1–5 While the first is a new phenomenon, the latter two are not. Kaufmann and colleagues demonstrate that the convention of reporting on birth rates within the entire cohort of “15to 19-year-old girls” has masked the steady decline in the pregnancy rate among sexually experienced teenagers in this country since the 1980s.1 The authors note that the combination of a precipitous decline in the teen abortion rate and a rapid increase in the prevalence of teenage sexual activity inflated the birth rate in this sector of the population during the 1980s, making it extremely difficult to study trends and nearly impossible to assess the efficacy of interventions designed to prevent conceptions among the sexually active members of this population. Thus, even though the notorious inaccuracy of self-report data concerning abortion and sexual activity makes pregnancy rates among sexually experienced teenagers less accurate than birth rates among teenagers, Kaufmann and colleagues show us that it is helpful to consider the former statistic. Their analysis demonstrates the importance of studying the etiologies of the concurrent trends toward decreased fecundity among sexually active teenagers and increased teenage sexual activity separately, as neither trend is difficult to understand in isolation from the other. Given the accelerated rate of adolescent pubertal development, the availability of contraceptives that enable us to separate sexual intercourse from childbearing, and the media’s fascination with our sexuality, the rapid increase in teenage sexual activity during the 1970s and 1980s is both biologically and socially understandable.9–12 Indeed, parallel decreases in the age of the sexually active proportion of the population and increases in the prevalence of teenage sexual activity have been documented around the world.13 That these rates leveled off (and even began to decline) once 75% to 80% of the population had become sexually active is also neither surprising nor difficult to understand. Similarly, the decreased fecundity of sexually experienced American teenagers can either be construed as a tribute to the success of sex education and family planning programs, the popularity of newly developed, easierto-use contraceptives among the teenagers who are at highest risk for conception, less teenage sexual activity, a by-product of the recent epidemic of sexually transmitted diseases, or a combination of these factors.4,8,10–12,14,15 Indeed, because the results of international studies prove that adolescent sexual activity need not be synonymous with adolescent childbearing,13 it is curious that the latest vital statistics reports2 have been heralded as such an enigma. Rather, from the global perspective, the enigmatic phenomenon was the rise that took place in the teen pregnancy rate during the late 1980s in this country. What we really need to try to understand and explain is not why American teenagers started to give birth to fewer babies in the 1990s but why the prevalence of out-of-wedlock births, sexually transmitted diseases, and genital carcinomas has risen in tandem with the prevalence of sexual activity among American teenagers but not among their counterparts in Europe, Scandinavia, and Japan. The answer is self-evident: American teenagers are more likely to engage in unprotected sexual activity than their European counterparts, but the reasons for this are a more complex reflection of basic differences in social values. In most western developed countries, the goal has always been to prevent sexually active teenagers from becoming the victims of sexually transmitted diseases, genital cancers, and parenthood. As a result, there is strong societal and governmental support for the use of contraceptives and, when necessary, abortion by teenagers. By contrast, in this country the goal has always been to prevent teenagers from having sex. Until the threat of death from acquired immunodeficiency syndrome became a reality, moral convictions prohibiting sex before marriage created a climate in this country that made it Received for publication Jul 15, 1998; accepted Jul 16, 1998. Address correspondence to Catherine Stevens-Simon, MD, Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Science Center, the Children’s Hospital, 1056 E 19th St, Denver, CO 80218. PEDIATRICS (ISSN 0031 4005). Copyright © 1998 by the American Academy of Pediatrics.