Although teen pregnancy rates have declined considerably over the past few decades in the United States and in most of the other 20 countries with complete statistics, the teen pregnancy rate is still highest in the United States (57 per 1,000 15–19-year-olds), followed by New Zealand (51) and England and Wales (47). The lowest rate was in Switzerland (8 per 1,000), followed by the Netherlands (14), Slovenia (14) and Singapore (14). Rates were higher than the highest rates mentioned above in some former Soviet countries with incomplete statistics and in developing countries in Sub-Saharan Africa and Latin America for which estimates could be made.

In the first known assessment of teen pregnancy, birth and abortion rates across a range of countries and regions, a new study, “Adolescent Pregnancy, Birth, and Abortion Rates Across Countries: Levels and Recent Trends,” by Gilda Sedgh et al., examines rates among 15–19-year-olds and among 10–14-year-olds in all countries for which recent information could be obtained, as well as trends for the mid-1990s when available. The study relies on data from countries’ statistical reports and from the United Nations Statistics Division.

Among countries with reliable evidence, the researchers found exceptionally low teen pregnancy, birth and abortion rates in Switzerland (8, 2 and 5 per 1,000 15–19-year-olds, respectively), where long-established sex education programs, free family planning services and low-cost emergency contraception are widely available, and sexually active teens are expected to use contraceptives. By contrast, the United States’ rates of teen pregnancy, birth and abortion (57, 34 and 15 per 1,000 15–19-year-olds, respectively) were among the highest. The authors note that U.S. teens face low societal acceptance of teen sexuality, inconsistent provision of sex education, and socioeconomic inequalities that underlie higher teen pregnancy rates among the most disadvantaged groups.

The analysis found that the proportion of teen pregnancies that end in abortion varies widely across the 21 countries, even though legal abortion is available on broad grounds in all of them. For example, nearly 70% of teen pregnancies end in abortion in Sweden, compared with just 17% in Slovakia and 26% in the United States. The authors note that while all of these countries have liberal abortion laws, differences in access to and attitudes about abortion may contribute to these varying outcomes.

“A teen’s decision to end a pregnancy seems to be driven in large measure by her future aspirations and her hopes of achieving them,” says study author Gilda Sedgh. “However, a teen’s ability to actually obtain an abortion might depend on whether services are available and affordable and whether she has support to do so.”

The authors also found that, in countries with high teen pregnancy rates, a smaller proportion of those pregnancies end in abortion than in birth. As a result, the difference between countries’ teen birth rates is even greater than the already large difference in teen pregnancy rates between these countries. For example, the United States’ teen pregnancy rate is seven times that of Switzerland, while the birth rate is 15 times as high.

“The long-term decline in teen pregnancy rates in many countries is great news,” says study author Gilda Sedgh. “Yet it is clear that far more needs to be done to bring down the comparatively high rates in countries like the United States and England and Wales so that they are on par with those in countries like Switzerland and the Netherlands.”

The study also looked at pregnancy, birth and abortion rates among 10–14-year-olds and found that they are far lower than those among 15–19-year-olds. Among countries with reliable evidence, the highest pregnancy rates among 10–14-year-olds were in Hungary and the United States, while the lowest was in Switzerland. The highest birth rate among this age-group was in Romania, followed by the United States, while the lowest, again, was in Switzerland.

Teen pregnancies have long been associated with poor social and economic conditions and future prospects for teens. The researchers hope that tracking country-specific estimates of pregnancy, birth and abortion among teens can inform policy and programmatic responses to teen pregnancy and help monitor progress toward reducing incidence. They recommend further research to examine the circumstances that lead to teen pregnancy, especially unintended pregnancies, and how those circumstances can be best influenced to reduce rates more broadly.

Adolescent Pregnancy, Birth, and Abortion Rates Across Countries: Levels and Recent Trends,” by Gilda Sedgh, Lawrence B. Finer, Akinrinola Bankole, Michelle A. Eilers and Susheela Singh, is currently available online and will appear in a forthcoming issue of the Journal of Adolescent Health.