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APHA Scientific Session and Event Listing

Recorded presentation

John S. Santelli, MD¹, Laura Lindberg, Ph D², Lawrence B. Finer, PhD², and Susheela Singh, PhD³. (1) Department of Population and Family Health, Columbia University, 60 Haven Ave. #B2, New York, NY 10032, 212-304-5200, js2637@columbia.edu, (2) Guttmacher Institute, 120 Wall Street, New York, NY 10005, (3) The Guttmacher Institute, 120 Wall Street, New York, NY 10005

Background: Since the early 1990s, teen pregnancy rates have declined dramatically in the United States. Methods: We developed two indices: the weighted-average Contraceptive Risk Index summarizes the effectiveness of a group's contraceptive use, based on prevalence of non-use and use of each method and published contraceptive failure rates. The Overall Pregnancy Risk Index was calculated using the contraceptive risk score and the percentage of teens reporting sexual activity. We used data for women 15-19 years from the 1995 and 2002 National Surveys of Family Growth. Results: Sexual activity (past 3 months) among all teens did not change significantly over time. The Contraceptive Risk Index declined 34% overall (p<.000) and 46% among 15-17 year olds (p<.000). Contraceptive use improvement included a decline in non-use (34% to 18%) and increases in use of condoms (36% to 53%), the pill (24% to 33%), the injection (8% to 10%), withdrawal (7% to 12%), and multiple methods. The Overall Pregnancy Risk Index declined 38%, with 86% of the decline attributable to improved contraceptive use. For adolescents 15-17 years, 77% of the decline in pregnancy risk was attributable to improved contraceptive use. Among 18-19 year olds, all of the change was attributable to improved use. Discussion: The decline in teen pregnancy rates in the U.S. appear to be following patterns from other developed countries, where increasing contraceptive use was the primary determinant of declining rates. These findings challenge the U.S. government's actions to promote abstinence from sexual activity as the primary strategy to prevent adolescent pregnancy.

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