Societal assistance to teenagers in their transition to adulthood, combined with acceptance of teenage sexual relationships, clear expectations for responsible sexual behavior and access to sexual and reproductive health services leads to lower rates of teenage pregnancy (and as a result, lower rates of both childbearing and abortion) in other developed countries, according to a new study released today by The Alan Guttmacher Institute (AGI). The synthesis study, "Teenage Sexual and Reproductive Behavior in Developed Countries: Can More Progress Be Made?" by AGI researchers Jacqueline Darroch, Jennifer Frost, Susheela Singh et al. suggests that the United States could learn from the experiences of Canada, Great Britain, France and Sweden. Among the key findings:
U.S. teenage birthrates have decreased more slowly and remained higher than those of other developed countries. Despite dramatic decreases in teen pregnancy rates and birthrates in the United States over the past decade, U.S. levels of adolescent pregnancy, childbearing and abortion are substantially higher than in most other Western developed countries. The U.S. teenage birthrate of 49 per 1,000 women aged 15-19 in 2000, down roughly 20% from 1990, remains about twice as high as rates in Great Britain and Canada, and five times as high as in Sweden and France.
Differences in sexual activity and in the age at which teenagers become sexually active do not account for the wide variation between study countries in pregnancy and STD rates. While U.S. teenagers are more likely than their French, Canadian and British peers to become sexually active at a very young age (before age 15), the difference is too small to account for the overall disparities in rates. U.S. teenagers do appear to have shorter and more sporadic relationships than teenagers in other countries, however. Compared with teenagers in the other study countries, U.S. teenagers are less likely to use contraceptives, especially more effective hormonal methods. Particularly striking is the fact that only four in 10 sexually active teenagers in the United States rely on oral contraceptives or other long-acting hormonal methods--which are the most effective --compared with as many as seven in 10 sexually active teenagers in the other study countries.
Across socioeconomic levels, U.S. teenagers are the most likely to have a child by age 20. Compared with adolescents in the other countries, U.S. teenagers are more likely to grow up in disadvantaged circumstances, and disadvantage is strongly linked with having a child during the teenage years. U.S. teenagers in the highest economic group are 14% more likely than similar teens in Great Britain to have a child by age 20. In the lowest economic group, U.S. teenagers are 58% more likely than those in Great Britain to have children.
Being accepting of teenage sexual relationships and having clear expectations about responsible behavior are linked to low levels of teenage pregnancy and STDs. In the United States, where the predominant social message is that teenage sex is not acceptable, official efforts emphasize preventing youth from becoming sexually active. Other study countries are more accepting of teenage sexual relationships. Also, they have strong and clear social expectations that sexual relationships should be committed and monogamous, and that teenage partners should use contraceptives to avoid pregnancy and to prevent STDs.
Easy access to contraceptive and reproductive health services contributes to better contraceptive use and lower teenage pregnancy rates. In many countries, free or extremely low-cost contraceptive and reproductive health services that respect teen privacy are integrated into general medical care. These services are provided to the general population under the national health system, which contributes to ease of access and lends support to the notion that contraceptive use is not only acceptable, but essential. By contrast, there is no universal health insurance in the United States, many U.S. insurance policies do not cover contraceptives, and contraceptive methods are often more expensive in the United States than in other developed countries. Because of the cost and to ensure confidentiality, U.S. teenagers rely heavily on family planning clinics rather than their family doctor for contraceptive services, which marginalizes both the clinics for providing care out of the mainstream and the teenage clients for seeking those services.
Strong public support for helping youth to become responsible adults provides incentives to delay childbearing. Youth in other countries--all youth, not just those who are considered disadvantaged--receive more assistance and support, including vocational training, job placement assistance and on-the-job training, than do U.S. teenagers. In addition, paid parental leave and family support policies provide younger women with the incentive to delay childbearing, since benefits are guaranteed and are tied to salary levels at the time of pregnancy. These policies help reinforce societal norms that childbearing is best left until young couples have achieved independent adult status.
"Many in the United States consider adolescents to be too immature to make good judgments about their own behavior and to use contraceptives effectively," said Jacqueline Darroch, AGI's Senior Vice President and Vice President for Research. "However, this study shows us that in countries where youth receive social support, full information and positive messages about sexuality and sexual relationships, and have easy access to sexual and reproductive health services, they achieve healthier outcomes and lower rates of pregnancy, childbearing, abortion and STDs."
The countries included in this cross-national study are Sweden, France, Canada, Great Britain and the United States. Collaborating research teams carried out case studies in each of the five countries, using a common approach to gather information and prepare an in-depth country report using national survey data, government statistics and information on government policies and programs. The project also included two workshops, analysis of teenage pregnancy and STD levels in all developed countries, and site visits by the U.S. study team. Project funding was provided by The Ford Foundation and The Henry J. Kaiser Family Foundation.