The good news about teenage pregnancy in the United States is that for many years, it has been declining. Yet the rate at which U.S. adolescents become pregnant remains high by any standard and is many times the rates found in other developed countries. What accounts for the difference? Drawing on data from nationally representative surveys and other sources, Jacqueline E. Darroch and colleagues find that young people in the United States begin having sex at about the same age as their peers in four other developed countries [page 244]. However, they are less likely to use contraceptives and less likely to use the most effective methods. These factors, the researchers reason, are behind U.S. teenagers' high rates of pregnancy and childbearing. The in-depth cross-national study provides a perspective that points up the need to revisit not only individual factors that influence young people's sexual and reproductive behavior, but also community and societal ones, such as attitudes toward adolescent sexuality that affect the provision of reproductive services to young people and levels of parental support or opposition to teenagers' sexual behavior and contraceptive use.
Other contributions to this issue of Family Planning Perspectives also look at the problem of teenage pregnancy in new ways. In a second article based on the same cross- national data, Susheela Singh and coauthors explore a largely overlooked question: the extent to which socioeconomic disadvantage accounts for differences among developed countries in teenagers' sexual and reproductive behavior [see article]. Not surprisingly, the researchers find that levels of adolescent childbearing are strongly related to income, education, race, ethnicity and immigrant status: Although patterns vary somewhat across countries, young women in disadvantaged subgroups generally fare worst. Disadvantage has similar associations with early initiation of intercourse but is less closely tied to contraceptive use. Once again, U.S. teenagers stand out: They are more likely than young women in the other countries to be disadvantaged and, regardless of their socioeconomic status, more likely to give birth. Thus, the authors argue, to successfully address the problem of teenage pregnancy, the United States must reduce the numbers of young people growing up in disadvantaged circumstances and help those who are disadvantaged overcome the obstacles they face.
Detailed comparisons within the United States also can throw new light on the issues surrounding teenage pregnancy. Challenging the "revisionist" notion that the consequences of teenage childbearing may not be as dire as once thought, Sandra Hofferth and colleagues use two well-established longitudinal data sets to examine the educational outcomes of women who give birth as teenagers [see article]. Unfortunately, they find, the revisionists' thinking does not hold up. In a world where educational deficits increasingly limit employment opportunities, teenage mothers are less likely to finish high school, are less likely to enter college and receive less schooling by the end of their 20s than women who postpone childbearing.
Furthermore, the detrimental effects of early sexual activity do not take long to emerge, as Lydia O'Donnell and her coauthors find [see article]. In a study of urban minority youth, those who had had sex by grade seven had increased odds of engaging in risky behavior--such as having multiple partners, having frequent intercourse and having sex while drunk or high--by the time they were in 10th grade. An important part of the solution, the researchers conclude, is to involve parents and schools in prevention efforts that address sexual initiation in early adolescence and that target youth who continue to place themselves and their partners at risk.
In a viewpoint, Douglas Kirby speculates as to what common thread ties together the diverse factors that predict risky sexual behavior among U.S. teenagers and the programs that have succeeded in reducing such behavior [see article]. Using his review of 73 studies that evaluated risk reduction programs as a jumping-off point, Kirby posits that adolescents are influenced by a group's norms regarding, among other things, sex and contraceptive use; by how closely connected they are to the group; and, importantly, by the interaction of these two factors. So what works in efforts to reduce risky behavior? The way to start, according to Kirby, is by sending clear messages and cultivating a sense of connectedness with the targeted adolescents. And while he acknowledges that the concept underlying the framework is not itself new, closer attention to it could have important implications for both research and practice.
Finally and reluctantly, we announce the departure of Michael Klitsch, executive editor of Family Planning Perspectives since 1995. Mike's connection to the journal goes back to 1980, when he joined the staff as an assistant editor. In the intervening years, Mike developed a deep commitment to the sexual and reproductive health field and a vast knowledge of the professionals working in the field. While we will miss his expertise and enthusiasm, we wish him well in his new role as senior editor/writer at EngenderHealth.