The Centers for Disease Control just reported a 44% decline in the teenage birth rate since 1990, the lowest level in almost 70 years. The decline represents an actual decrease in teen pregnancy, not an increase in abortion, and this is due in turn to two changes: more girls are delaying onset of intercourse, and a higher percentage of sexually active girls are using the most reliable forms of contraception.
By 2010, a clear majority of teenage girls (the analysis did not include boys) reported never having had sex, giving the lie to adolescent worries that “everyone is doing it.” In fact, 57% of teen girls aren’t sexually active, compared to 49% in 1995, and there were no racial or ethnic differences in age of onset. Of sexually experienced teens, 60% overall (vs. 47% in 1995) reported current use of the most reliable forms of contraception.
But winning the “Most Improved” award isn’t nearly good enough when it comes to public health issues like adolescent pregnancies. It’s a bit like going from a failing grade to a D, or feeling relieved that Hurricane Katrina was “only” a Category 3 storm. The truth is that our U.S. statistics are a comparative disaster. An analysis of girls age 15 to 19 (based on the National Survey of Family Growth) put the most recent rate at 34.3 births per 1,000 female teens. Many European rates are well below 15 births per 1,000 females, so we still have the highest rate of teenage births of any industrialized nation. Our closest competitor for this dubious distinction is Russia, a country rife with health and economic problems, including a male life expectancy below 60 years. And even so, American girls are still 25% more likely to give birth than a Russian teenager.
The real takeaway from the data is that European teenagers aren’t simply having less sex or having more abortions; they do a better job using contraception. Even within our own country, startling differences emerge when we examine state-by-state variation that suggest that our patchwork of policies about sex education may be partially to blame for our poor national average. Birth rates for teenage girls in Massachusetts, Vermont and Connecticut (less than 20 per 1,000 females) are comparable to English speaking countries such as the U.K. and Ireland. By contrast, the birth rate in many southern states is more than 50 per 1,000. It’s four times more likely that a girl in Mississippi will give birth (64 per 1,000) than a girl in New Hampshire (16 per 1,000).
It turns out that states with the highest teen birth rates overwhelmingly promote abstinence-only programming. Some provide medically inaccurate information or don’t offer sexual education at all. By contrast, the states with the lowest birth rates offer comprehensive sex education, including abstinence messages, that is either mandated by law or is included in state-level education standards. Does this mean that comprehensive sex education prevents pregnancy? It’s not so simple. There are many other possible factors, such as individual or family circumstances, religious affiliation, or access to health care.
Nevertheless, evidence has overwhelmingly discredited the effectiveness of abstinence-only sex education programs, which were the only sex ed programs eligible for federal funding until 2008, when the Obama administration and congress overturned the policy in favor of comprehensive programs that had a proven track record. A number of studies have suggested the value of these more comprehensive programs that teach abstinence alongside medically accurate information and counseling about personal decision making. A year after the federal mandate was overturned, pressure from lawmakers resulted in the reauthorization of federal dollars for abstinence-only programs so now states can choose either type.
This is unfortunate. States with disproportionately high teenage birth rates would do better to study the experience of New England and the Upper Midwest to find program models that might be appropriate for their communities. And if they still feel that sex education is more properly taught in the home than in school — a sentiment shared by many parents nationwide — they should get more serious about doing so. More than a third of sexually experienced teenagers reported receiving no information from any source before they first had sex.
A state’s level of income inequality may also play a role in birth rates. It’s not surprising that teenagers at the economic margin would be more likely than affluent teenagers to have a baby. But economists from the National Bureau of Economic Research have shown that poor girls in states with a high degree of income inequality are more likely to give birth than equally poor girls in states with greater income equality. They suggest that income inequality itself breeds a sense of hopelessness about the future that makes the long-term financial consequences of bearing a child seem less dire to a teenage girl. Teen births, the authors argue, should rightly be seen as the result of social problems, not the cause.
So before we pat ourselves on the back for the news about the teen birth rate, we need to recognize that our work is unfinished and that the national rate actually tells us very little about what’s happening on the ground. If we want to see further progress, we’ll have to learn from our successes—and our failures.