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1 This study uses neighborhoods, operationalized as census tracts, as a proxy for teenagers' local contexts. While other contexts such as peers and schools are also important for adolescent sexual behaviors and norms (), the neighborhood contains a variety of relationships and institutions in which adolescents are embedded and which frequently encompass peer relationships and schools.

2 While norms may also differ among other racial and ethnic groups besides African Americans, Latinos, and whites, this study reflects the focus in the literature on racial/ethnic cultures, as well as addressing pragmatic concerns about subsample sizes for other races, by comparing these three groups.

3 Less than 8 percent of eligible cases were missing data on any variable in the analyses of variation in norms. Missing data on any variable was negatively associated with reporting embarrassment at the prospect of a teenage pregnancy ( p < .01).

4 Compared with the earlier sample, Wave III included higher proportions of female and nonblack respondents who were in younger grades at Wave I. Wave III weights used in the analysis adjust for such patterns of nonresponse, and analyses have shown that bias from nonresponse is very low for a variety of outcomes (Chantala, Kalsbeek, and Andraca n.d.). My supplemental analyses found that compared with those who did not respond in Wave III, a higher proportion of respondents was embarrassed at the prospect of a teenage pregnancy, a lower proportion was black and a higher proportion was white, a lower proportion was poor and a higher proportion had a high household income, and respondents came from neighborhoods with lower proportions of black residents and higher neighborhood SES.

5 Because Add Health only includes a mean of seven and a median of two respondents per census tract (), accounting for the slight clustering of respondents within tracts using this method is reasonably accurate (see Harris, Kathleen Mullan , Greg J. Duncan, and Johanne Boisjoly. 2002. "Evaluating the Role of 'Nothing to Lose' Attitudes on Risky Behavior in Adolescence." Harris, Duncan, and Boisjoly 2002 Social Forces 80:1005-39. for a similar approach).

6 , Elisa Rustenbach, and Susan McHale. 2008. "Early Family Transitions and Depressive Symptom Changes from Adolescence to Early Adulthood." Booth, Rustenbach, and McHale (2008)Journal of Marriage and the Family 70:3-14. compared biological children listed in the roster of household members with respondents' reported births and found that births appeared to be somewhat undercounted in Add Health. Therefore, our count of teenage pregnancies is likely an underestimate.

7 Responses were coded into approximate years of education: no schooling = 0, eighth grade or less = 8, some high school = 10, trade/vocational/business school instead of high school = 11, high school graduate or GED = 12, trade/vocational/business school after high school = 13, some college = 14, college degree = 16, graduate/professional training = 18. The highest education levels of the mother and her spouse/partner were averaged using parent reports. If the spouse's education was missing, I substituted the teenage respondent's report of his education level, and lacking that, the mother's education stood in for both. If no parent completed the survey, the adolescent respondent's report of both parents' education levels was substituted. found 75 percent agreement between parents' and adolescents' reports of parental education levels when data for both were available.

8 Finding suitable items was difficult because among whites, African Americans, and Latinos, race/ethnicity and neighborhood SES are so intertwined that there is little overlap in the distributions of neighborhood SES indicators across these three groups. Without overlapping distributions, analysis is not meaningful ( Brewster, Karin L. 1994b. "Race Differences in Sexual Activity among Adolescent Women: The Role of Neighborhood Characteristics." Brewster 1994b American Sociological Review 59:408-24. ). Following Brewster, I included only items for which each group's (whites', African Americans', and Latinos') median fell within the 20th and 80th percentiles of each of the other two groups. This criterion led to the exclusion of four measures of neighborhood SES that did not have sufficiently overlapping distributions across racial/ethnic groups: the proportion of respondents receiving welfare income, the unemployment rate, the proportion of residents aged 25 or older without a high school degree, and the proportion of families living below the poverty line.

9 Standardized effect sizes from bivariate logistic regression analyses (not reported in tables) illustrate the relative size of the associations between individual-level racial and socioeconomic factors and embarrassment at the prospect of a teenage pregnancy. Among girls, socioeconomic factors were more important than race/ethnicity. An increase of one standard deviation in parents' education was associated with an approximately 50 percent greater likelihood of reporting embarrassment at the prospect of a teenage pregnancy. Among boys, this socioeconomic relationship was even greater at about 70 percent, but they were joined by a similarly strong negative association between African American racial identity and reported embarrassment.

10 Here and elsewhere, respondents' odds or likelihoods of reporting embarrassment at the prospect of a teenage pregnancy are based on odds ratios, which exponentiated the coefficients reported in the tables.

11 Criteria for mediation followed : The addition of the mediating variable must reduce or eliminate the relationship between the independent and dependent variables, the mediating variable must significantly predict the dependent variable, and the independent variable must significantly predict the mediating variable.

12 Was race/ethnicity or SES a more important predictor of embarrassment at the prospect of a teenage pregnancy, and was the neighborhood or individual level more important? Supplemental analyses based on Model 2 that used standardized variables to compare effect sizes found that for both genders, two predictors had the largest, roughly equally sized effects: individuals' African American race and parental education. The Hispanic and neighborhood SES coefficients were smaller, and neighborhood racial/ethnic composition was not significant.

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Predictors and Consequences of Adolescents' Norms Against Teenage Pregnancy

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1 This study uses neighborhoods, operationalized as census tracts, as a proxy for teenagers' local contexts. While other contexts such as peers and schools are also important for adolescent sexual behaviors and norms (), the neighborhood contains a variety of relationships and institutions in which adolescents are embedded and which frequently encompass peer relationships and schools.

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Journal of Epidemiology & Community Health

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Abstract

Study objective: To examine whether attitude to school is associated with subsequent risk of teenage pregnancy. To test two hypotheses that attitude to school is linked to pregnancy via pathways involving young people having "alternative" expectations or deficits in sexual health knowledge and confidence.

Design: Analysis of longitudinal data arising from a trial of sex education. Examination of associations between attitude to school and protected first sex, unprotected first sex, unprotected and protected last sex, and pregnancy, both crude and adjusting in turn for expectation of parenting by age 20, lack of expectation of education/training at age 20, and sexual health knowledge and confidence.

Setting: Schools in central and southern England.

Participants: Girls of median age 13.7 years at baseline, 14.7 years at follow up 1, and 16.0 years at follow up 2.

Main results: In unadjusted analysis, attitude to school was significantly associated with protected and unprotected first sex by follow up 1, protected first sex between follow up 1 and 2, unprotected last sex, and pregnancy. Dislike of school was more strongly associated with increased risk of these outcomes than was ambivalence to school. These associations remained after adjusting for socioeconomic status and for expectation of parenting, lack of expectation of education/training, and various indicators of knowledge and confidence about sexual health.

Conclusions: Dislike of school is associated with subsequent increased risk of teenage pregnancy but the mechanism underlying any possible causal link is unlikely to involve "alternative" expectations or deficits in sexual health knowledge or confidence.

View Full Text

Previous studies report that low educational attainment predicts teenage pregnancy. However, few studies have examined the association between attitude to school and teenage pregnancy and those that have provide inconsistent findings. We have previously reported associations between dislike of school and cognitive/behavioural indicators of risk of teenage pregnancy among 13/14 year olds in baseline data from a randomised trial of sex education. After adjusting for socioeconomic disadvantage, dislike of school was associated with heterosexual intercourse, expecting heterosexual intercourse by age 16, and expecting parenthood by age 20, but not with low knowledge of contraception or low confidence negotiating sex.

From these findings, we developed an "alternative expectation" hypothesis regarding how dislike of school might increase risk of teenage pregnancy: some young people who dislike school consequently do not develop "conventional" expectations about involvement in education/training in their late teens and view parenting as an acceptable alternative. We concluded that another hypothesis, namely that some young people dislike and are disengaged from school and consequently do not develop the knowledge and confidence necessary to avoid teenage pregnancy (the "knowledge and confidence deficit" hypothesis), was not supported by our findings. However, we could not establish dislike of school as a predictor of teenage pregnancy nor explore the plausibility of each hypothesis with much certainty because we could not examine temporality and because our data provided limited information about the risk of, and no information about the occurrence of, teenage pregnancy.

Aims of this analysis

We now aim to re-examine associations between attitude to school and risk of teenage pregnancy, and explore the plausibility of our two hypotheses of causality using longitudinal data, where measurement of exposures precedes those of outcomes, and with more valid outcome measures. In this analysis, we focus only on girls because the "alternative expectation" hypothesis is particularly applicable to this group, given that women's decisions about sexual behaviour are more likely to be influenced by their future expectations about parenting.

METHODS

Data collection

We analysed baseline and two sets of follow up data from girls in two school year cohorts in 27 mixed sex comprehensive schools in central and southern England within a cluster trial of sex education, 14 in the intervention arm, and 13 in the comparison arm. Students completed questionnaires in lesson time and, where possible, questionnaires were administered and collected in by researchers. Initial data were collected in 1997 when the pupils were aged 13/14. The first follow up occurred when the participants were aged 14/15 and the second follow up when participants were aged 15/16. Questionnaires addressed demography, knowledge, attitudes, skills, behaviour, pregnancy, and views on school and sex education. Many of the questions used were based on the questionnaire used previously by Wight et al. Permission was sought from parents/carers for students to participate. The study was approved by University College London ethics committees.

Analysis

We examined several exposures. Our main exposure, attitude to school, was measured using girls' responses to the statement "I like school". Girls disagreeing or strongly disagreeing were defined as "disliking school". Those neither agreeing nor disagreeing were defined as "ambivalent". Socioeconomic disadvantage was measured using two binary indicators. The first was created from responses to a question about living accommodation. Those reporting non-privately owned accommodation were categorised as disadvantaged. The second variable was created from responses to a question about parental employment. Those indicating that no parent/guardian worked full time were categorised as disadvantaged. Both are validated indicators of socioeconomic disadvantage.

We examined expectation of parenting by age 20 using a five point ordinal variable reflecting degree of agreement with a statement about this matter. Those agreeing/strongly agreeing were categorised as expecting parenting, those disagreeing/strongly disagreeing were categorised as not expecting this, and those replying they were uncertain were categorised thus. Lack of expectation of being in higher education or training at age 20 was examined via five point ordinal scale responses to two statements on expectations of education and training. Those disagreeing/strongly disagreeing with both statements or disagreeing/strongly disagreeing with one and not answering the other were categorised as lacking expectation. Those agreeing or strongly agreeing with either item were categorised as having this expectation. Those unsure about both statements, unsure about one statement and not answering the other or disagreeing/strongly disagreeing with one statement and being unsure about the other were categorised as uncertain.

Knowledge of timing of emergency contraception was examined using a binary measure based on girls answering a question about this correctly. Knowledge of access to contraception and sexual health services was examined using a categorical indicator based on the number of correct answers from a total of four questions about these matters. Confidence in rejecting unwanted sex was examined using a categorical measure based on "easy" or "very easy" responses to a question about ease of saying "no" to this. Confidence about communicating about sex and condom use with a partner was examined using a categorical indicator based on positive responses to two questions with ordinal five point responses scales denoting easiness. All exposure measures are derived from questionnaire responses from the round of questionnaire surveying immediately prior to that from which outcomes are derived.

We examined several outcomes. Questions about girls' first experience of heterosexual intercourse (henceforth termed "sex") were asked at baseline and follow up 1 and 2. Questions about girls' last sex and pregnancy were asked at follow up 2. Questions about first and last sex were followed by questions about use of contraception in these episodes. Sex without contraception was deemed "unprotected" while sex with contraception was "protected". Students' feedback indicated they could answer questions about their experience of sex more honestly with age. Consequently if a later response contradicted earlier ones the last response was recoded.

The first aim of analysis was to examine whether attitude to school was associated with our outcomes in crude analysis and after adjusting for indicators of socioeconomic status, as in our previous analysis. The second aim was to examine the plausibility of each of our earlier stated hypotheses in explaining any association between attitude to school and our outcomes. To do this, we examined the effect on these associations of adjusting successively and specifically for each expectation variable and then for each knowledge and confidence variable. Any substantial change in the associations between dislike of school and the outcomes, after adjustment for alternative future expectations, or for indicators of knowledge and confidence would provide evidence in support of, respectively, the "alternative expectation" hypothesis or the "knowledge and confidence deficit" hypothesis.

For first sex, our analysis reported odds ratios for both protected and unprotected first sex compared with no sex, using polytomous logistic regression models. Our rationale for defining both protected and unprotected first sex as indicators of risk is that it is probable that girls reporting protected first sex are more at risk of subsequent unprotected sex than those reporting no sex. To ensure all exposures were measured before outcomes, girls sexually active by baseline were excluded from this analysis.

For last sex, our analysis compared unprotected sex with protected sex among those who had sex more than once, using logistic regression. For pregnancy, our analysis considered the outcome pregnant or not by follow up 2 using logistic regression with all girls included in the analysis.

For the three category first sex outcome, the Stata 7 mlogit function was used for the polytomous logistic regression, with a robust variance estimator to account for the correlation within schools. For unprotected last sex and pregnancy, correlation between schools was accounted for using generalised estimating equations with an exchangeable correlation structure.

No significant interactions were found between trial arm and any of the exposures and so data from both trial arms were analysed together. A significant interaction was found between the survey wave and girls' attitude to school. Consequently, the analysis of the first sex outcome was undertaken in two stages, first sex by follow up 1 and first sex between follow up 1 and follow up 2, to identify any time related patterns.

The p values were calculated to describe associations between explanatory factors and the outcomes described above.

RESULTS

Baseline questionnaires were completed by 4248 girls (median age 13.7 years), follow up questionnaires by 3749 (median 14.7 years) and follow up 2 questionnaires by 3230 (median 16.0 years). Table 1 describes the sample.

First sex by follow up 1

Altogether 451 (12.95%) girls had sex between baseline and follow up 1. Of those 308 (68.29%) reported using protection and 87 (19.29%) reported having unprotected sex. Attitude to school was significantly associated with both protected first sex compared with no sex and unprotected first sex compared with no sex by follow up 1 (table 2). Dislike of school was more strongly associated with increased risk of these outcomes than was ambivalence, and was more strongly associated with increased risk of unprotected than protected first sex. These associations were not substantially changed after adjusting for indicators of low socioeconomic status (table 3), which were themselves significantly associated with increased risk of protected and unprotected first sex (table 2).

The associations between dislike of school and protected and unprotected first sex remained unchanged after adjusting for expectation of parenting and lack of expectation of education/training (table 3), both of which were themselves significantly associated with increased risk of protected and unprotected first sex (table 2). The associations between dislike of school and protected and unprotected first sex also remained unchanged after adjusting for knowledge and confidence measures (table 3). Of these, increased confidence communicating about sex was significantly associated with increased risk of unprotected and protected first sex, and increased confidence rejecting unwanted sex, higher knowledge of emergency contraception and of contraception access were significantly associated with increased risk of protected sex but not unprotected sex (table 2).

In a fully adjusted model, dislike of school, non-privately owned housing, lack of full time parental employment, confidence communicating about sex, knowledge of emergency contraception and of contraception access remained significantly associated with increased risk of protected first sex, and dislike of school, and non-privately owned housing, expectation of parenting at age 20 and confidence communicating about sex remained significantly associated with increased risk of unprotected first sex.

First sex between follow up 1 and 2

Altogether 685 (28.25%) girls had sex between follow up 1 and follow up 2. Of those, 570 (83.21%) reported using protection and 103 (15.04%) reported having unprotected sex. Attitude to school was significantly associated with protected first sex compared with no sex but not unprotected first sex compared with no sex between follow up 1 and 2 (table 2). Specifically, students who disliked school, but not those ambivalent to school, were at increased risk of protected first sex. The association between dislike of school and protected first sex was not changed by adjustment for indicators of socioeconomic status (table 3). There was a significant association between non-privately owned accommodation and protected sex (table 2).

The association between dislike of school and protected first sex was also not substantially modified by adjustment for either of our expectation variables or any of our knowledge and confidence variables (table 3). There were significant associations between expectation variables and both outcomes (table 2). All variables indicating higher knowledge and confidence were significantly associated with increased risk of protected first sex. However only higher knowledge of emergency contraception timing and increased confidence communicating about sex were associated with increased risk of unprotected first sex.

In a fully adjusted model, attitude to school, accommodation, confidence in rejecting unwanted sex, confidence communicating about sex and knowledge of emergency contraception timing remained associated with protected first sex, and knowledge of emergency contraception timing remained significantly associated with unprotected first sex.

Last sex by follow up 2

A total of 950 (34.41%) girls reported having sex more than once. Of those 793 (83.47%) reported using protection and 150 (15.79%) reported having unprotected sex. Attitude to school was significantly associated with unprotected compared with protected last sex, with dislike of school being more strongly associated with increased risk of this than was ambivalence to school (table 2). Adjusting for socioeconomic status indicators had negligible effect on the association between dislike of school and unprotected last sex (table 3). The socioeconomic variables were not themselves significantly associated with this outcome (table 4).

Adjustment for lack of expectation of education/training and for expectation of parenting each had little effect on the association between dislike of school and unprotected last sex (table 3). Both expectation of parenting and lack of expectation of education/training were significantly associated with increased risk of unprotected last sex (table 4). Adjusting for knowledge and confidence variables had no effect on the association between dislike of school and unprotected last sex (table 3). Of these exposures, only higher confidence in refusing unwanted sex was significantly associated with increased risk of unprotected last sex (table 4).

In a fully adjusted model, lack of expectation of education/training and confidence in rejecting unwanted sex remained significantly associated with unprotected last sex.

Pregnancy by follow up 2

A total of 83 (2.88%) girls reported a pregnancy by follow up 2. Attitude to school was significantly associated with pregnancy (table 4). Those girls who disliked school, but not those ambivalent to school, were at increased risk of pregnancy. The association between dislike of school and pregnancy was removed by adjusting for socioeconomic status indicators based on parental employment but not accommodation (table 3). Both these indicators of low socioeconomic status were themselves significantly associated with increased risk of pregnancy (table 4).

The association between dislike of school and pregnancy was not changed by adjusting for either expectation variable or for any of the knowledge and confidence variables (table 3). Expectation of parenting and lack of expectation of education/training were both significantly associated with increased risk of pregnancy (table 4). Of the knowledge and confidence variables, only increased confidence in rejecting unwanted sex was significantly associated with pregnancy.

In a fully adjusted model, all exposures other than knowledge of emergency contraception timing and knowledge of contraception access remained significantly associated with pregnancy.

DISCUSSION

Dislike of school was comparatively common and was associated with increased risk of all outcomes except unprotected first sex between follow up 1 and 2, and these associations remained after adjusting for socioeconomic status. In interpreting our findings some caution should be applied as the number of associations examined may have produced a small number of false positive results. None the less, our findings support our earlier suggestion that dislike of school may predispose girls to risk of teenage pregnancy.

Adjusting for expectation of parenting by age 20 and for lack of expectation of education/training at age 20 had little effect on the associations between dislike of school and our outcomes. These "alternative" expectations were themselves associated with increased risk of all outcomes, although lack of expectations regarding education/training was comparatively rare.

Adjustment for our knowledge and confidence measures also had minimal effects on the association between dislike of school and our outcomes. Our knowledge and confidence measures were not as consistently associated with outcomes as was dislike of school. Where there were associations, increased knowledge and increased confidence were each associated with increased risk of pregnancy. It is probable that these associations result from confounding by factors such as overall social confidence, which we did not attempt to adjust for in this paper but will explore in subsequent analyses.

Because adjustments for the variable discussed above did not affect the association between dislike of school and our outcomes our findings do not seem to provide support for our "alternative expectation" hypothesis or for our "knowledge and confidence deficit" hypothesis as explanations of the relation between disliking school and increased risk of teenage pregnancy, although we cannot rule out the possibility that increased knowledge and confidence are independently related to increased risk of teenage pregnancy.

It is possible that the lack of support for the alternative expectation hypothesis may be an artefact of limitations in our measures. It might be that fewer girls reported low expectations about future education/training than reported disliking school because of a reluctance to be negative about the future compared with the present. This might explain the limited extent to which expectation of education/training confounds the associations between dislike of school and some of our outcomes. Nevertheless, our findings do suggest that "alternative" expectations may be important risk factors for teenage pregnancy.

In conclusion, this study supports the suggestion made in our earlier paper that dislike of school may be an important determinant of subsequent risk of teenage pregnancy. It also supports the notion that lack of expectation of education/training and positive expectations about becoming a parent in one's late teens might influence risk of teenage pregnancy.

However, while the study contributes to debates about the determinants of teenage pregnancy, we are able to make limited suggestions about the possible causal processes involved. Further research is needed here, particularly on the factors underlying dislike of school and lack of future expectations about education/training that might predispose to risk of teenage pregnancy. Research suggests that these factors are likely to involve a complex interplay between individual and school factors.

Despite these limitations, our findings suggest that, in the absence of increasing school students' satisfaction with school and expectations about future education/training, interventions to reduce teenage pregnancy and improve sexual health will only be of limited effectiveness. Our findings should encourage the development of interventions to increase young people's satisfaction with schools and expectations about future education/training, along with randomised trials to assess the effects of these. If such interventions were to prove effective, these trials should also shed more light on possible causal processes.

View Abstract

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The effect of dislike of school on risk of teenage pregnancy: testing of hypotheses using longitudinal data from a randomised trial of sex education

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Study objective: To examine whether attitude to school is associated with subsequent risk of teenage pregnancy. To test two hypotheses that attitude to school is linked to pregnancy via pathways involving young people having "alternative" expectations or deficits in sexual health knowledge and confidence. Design: Analysis of longitudinal data arising from a trial of sex education.

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Teenage pregnancy and perinatal mortality

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In the general population teenage pregnancies present an elevated rate of perinatal mortality compared with pregnancies of women in their twenties. In two large-scale university hospital studies (one American, one Danish), the teenage pregnancies showed lower perinatal mortality than those of any other age group.

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Prescription birth control is available through your doctor or a women's health clinic.

Intrauterine device (IUD)

An intrauterine device (IUD) is a device a doctor implants in your uterus. The procedure is well tolerated, and hospitalization isn't required. The IUD prevents pregnancy by various mechanisms. It has a 99 percent rate of effectiveness, according to Planned Parenthood.

IUDs are sold under the following brand names:

Birth control implant

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This is a very small plastic stick that's inserted under the skin of your arm. Implants stay in place for up to three years. They have a 99 percent rate of effectiveness.

Other methods

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Alesse, Apri, Enpresse, Loestrin, Ortho-Novum, Yasmin, and many more (pills)

Depo-Provera (shot)

Ortho Evra (patch)

The diaphragm and cervical cap (FemCap) are devices you place in your vagina when you're going to have sex. They block sperm from entering your uterus. The effectiveness of these devices is 71 to 88 percent.

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Teenage Pregnancy: Signs, Effects, Diagnosis, and Prevention

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Teenage pregnancy occurs in a woman 19 years of age or younger. A woman can get pregnant if she has vaginal sex with a man at any age after she's begun having regular monthly periods. Discover how pregnancy affects the health of teen mothers and their babies.

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The US teen birth rate (births per 1,000 females aged 15 to 19 years) has been declining since 1991. Teen birth rates continued to decline from 17.4 per 1,000 females in 2018 to 16.7 per 1,000 females in 2019. This is another record low for US teens and a decrease of 4% from 2018. 1,2 Birth rates fell 7% for females aged 15 to 17 years and 4% for females aged 18 to 19 years. ²

Although reasons for the declines are not totally clear, evidence suggests these declines are due to more teens abstaining from sexual activity, and more teens who are sexually active using birth control than in previous years. 3, 4

Still, the US teen birth rate is substantially higher than in other western industrialized nations, 5 and racial/ethnic and geographic disparities in teen birth rates persist. 1,2

Disparities in Teen Birth Rates

Teen birth rates declined from 2018 to 2019 for several racial groups and for Hispanics. 1,2 Among 15- to 19-year-olds, teen birth rates decreased:

5.2% for Hispanic females.

5.8% for non-Hispanic White females.

1.9% for non-Hispanic Black females.

Rates for non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic Asians, and non-Hispanic Native Hawaiian, and other Pacific Islander teenagers were unchanged.

In 2019, the birth rates for Hispanic teens (25.3) and non-Hispanic Black teens (25.8) were more than two times higher than the rate for non-Hispanic White teens (11.4). The birth rate of American Indian/Alaska Native teens (29.2) was highest among all race/ethnicities. 1

Birth Rates for Females Aged 15 to 19 Years, by Race and Hispanic Origin of Mother: United States, 2018 and 2019

Data source: Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1-50.

Geographic differences in teen birth rates persist, both within and across states. Although among states with low overall teen birth rates, some counties have high teen birth rates. ⁶

Social determinants of health, such as low education and low income levels of a teen's family, may contribute to high teen birth rates. ⁷ Teens in certain settings are at higher risk of teen pregnancy and birth than other groups. For example, young women living in foster care are more than twice as likely to become pregnant than young women not in foster care. ⁸

To improve the life opportunities of adolescents facing significant health disparities and to have the greatest effect on overall US teen birth rates, CDC uses data to inform and direct interventions and resources to areas with the greatest need.

The Importance of Prevention

Teen pregnancy and childbearing are associated with increased social and economic costs through immediate and long-term effects on teen parents and their children.

Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school.¹⁰

The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.¹¹

On a positive note, between 1991 and 2015, the teen birth rate dropped 64%, which resulted in $4.4 billion in public savings in 2015 alone.¹²

Evidence-based teen pregnancy prevention programs have been identified by the US Department of Health and Human Services (HHS) Teen Pregnancy Prevention Evidence Review, which used a systematic process for reviewing evaluation studies against a rigorous standard. The Evidence Review covers a variety of diverse programs, including sexuality education programs, youth development programs, abstinence education programs, clinic-based programs, and programs specifically designed for diverse populations and settings. In addition to evidence-based prevention programs, teens need access to youth-friendly reproductive health services and support from parents and other trusted adults, who can play an important role in helping teens make healthy choices about relationships, sex, and birth control. Efforts at the community level that address social and economic factors associated with teen pregnancy also play a critical role in addressing racial/ethnic and geographical disparities observed in teen births in the United States.

References

1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1-50.

2. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2018. Natl Vital Stat Rep. 2019;68(13):1-47.

3. Santelli J, Lindberg L, Finer L, Singh S. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health. 2007;97(1):150-6.

4. Lindberg LD, Santelli JS, Desai S. Understanding the decline in adolescent fertility in the United States, 2007-2012. J Adolesc Health. 2016:1-7.

5. Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health. 2015;56(2):223-30.

6. Romero L, Pazol K, Warner L, et al. Reduced disparities in birth rates among teens aged 15 to 19 Years-United States, 2006-2007 and 2013-2014. MMWR Morbid and Mortal Wkly Rep. 2016;65(16):409-414.

7. Penman-Aguilar A, Carter M, Snead M, Kourtis A. Socioeconomic disadvantage as a social determinant of teen childbearing in the US Public Health Rep. 2013;128(suppl 1):5-22.

8. Boonstra HD. Teen pregnancy among women in foster care: a primer. Guttmacher Policy Review. 2011; 14(2).

9. National Campaign to Prevent Teen and Unplanned Pregnancy, Counting It Up: The Public Costs of Teen Childbearing 2013. Accessed March 31, 2016.

10. Perper K, Peterson K, Manlove J. Diploma Attainment Among Teen Mothers. Child Trends, Fact Sheet Publication #2010-01: Washington, DC: Child Trends; 2010.

11. Hoffman SD. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Washington, DC: The Urban Institute Press; 2008.

12. Power to Decide. Progress Pays Off. Accessed January 10, 2019.

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Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children.

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What are the causes of teenage pregnancy?

The causes of teenage pregnancy include a lack of access to sexual and reproductive health education and services. The expectations of communities on girls to become mothers early can be a cause along with sexual violence.

Child marriage is a key factor - approximately 90% of births to teenage mothers in developing countries occur within marriage.

Factors such as parents' income and girls' education also contribute. Girls who have received a low amount of education are 5 times more likely to become a mother than those with higher levels of education.

In addition, the unique risks faced by girls during emergencies increase the chances of them becoming pregnant.

What are the effects of teenage pregnancy?

Global problem with dangerous consequences - Key statistics

7.3 million girls become pregnant before 18 each year.

2.5 million girls aged 15 or younger give birth each year.

Pregnancy and childbirth complications are the second highest cause of death for girls aged 15 to 19.

Half of pregnancies among girls aged 15-19 living in developing regions are unintended.

Every year, 3 million girls undergo unsafe abortions.

Where is teenage pregnancy most common?

Data: WorldBank*

How is Plan International helping girls?

We firmly believe that girls' bodies are their own and they must have the ability to make their own decisions about them.

By raising girls' awareness of sexual health, protecting them from abuse and connecting them with education and health services, we support the key decisions they make about their futures and bodies so they can avoid teenage pregnancy.

In addition, we are calling on governments to strengthen national health systems, implement sex education in and out of schools, provide affordable, safe contraception and address the root causes of teenage pregnancy.

In Nicaragua, the country with the highest rate of teenage pregnancy in Latin America, we're educating young people about sexual health and encouraging open discussions about the issue.

Campaign for girls
RAISE AWARENESS AND TWEET THIS
"#TeenagePregnancy increases when girls are denied the right to make decisions about their sexual health. https://plan-international.org/teenage-pregnancy" Tweet this

"Every year, 7.3 million girls become pregnant before they turn 18. #TeenagePregnancy #BecauseiamaGirl https://plan-international.org/teenage-pregnancy" Tweet this

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The causes of teenage pregnancy include a lack of access to sexual and reproductive health education and services. The expectations of communities on girls to become mothers early can be a cause along with sexual violence. Child marriage is a key factor - approximately 90% of births to teenage mothers in developing countries occur within marriage.

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1. Approximately 90% of births to girls aged 15-19 in developing countries occur within early marriage where there is often an imbalance of power, no access to contraception, and pressure on girls to prove their fertility.

2. Factors such as parental income and the extent of a girl’s education also contribute. Girls who have received minimal education are 5 times more likely to become a mother than those with higher levels of education. Pregnant girls often drop out of school, limiting opportunities for future employment and perpetuating the cycle of poverty. In many cases, girls perceive pregnancy to be a better option than continuing their education

3. The unique risks faced by girls during emergencies increase the chances of them becoming pregnant. Factors include the desire to compensate for the loss of a child, reduced access to information and contraception, and increased sexual violence.

4. For many adolescents, pregnancy, and childbirth are neither planned nor wanted. In countries where abortion is prohibited or highly restricted, adolescents typically resort to unsafe abortion, putting their health and lives at risk. Some 3.9 million unsafe abortions occur each year to girls aged 15-19 in developing regions

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Question 16: 67.5% of participants said that there are not enough Government resources available for teen parents and/or single teen moms. The Federal government is supporting efforts to prevent teen pregnancy by providing affordable family planning services. Developing clinical guidelines for safe and effective use of birth control. Developing and evaluating programs in communities where teen births are highest.
-Teen parents also have significant economic burdens related to being in school and raising a child. Due to this, they are often in need of government assistance including Supplemental Nutritional Assistance Program (SNAP formerly Food Stamps) benefits, TANF, and Children's Health Insurance Program (CHIP).
-1)     Pregnancy Resource Centers

A Pregnancy Resource Center, also known as a Crisis Pregnancy Center, focuses on the pregnant teen as well as their unborn child. Some of their services may include free pregnancy tests, parenting classes, prenatal development classes, counseling, life coaching, and free supplies such as diapers, baby wipes, etc. These centers give you full information on what to expect in labor and delivery and beyond. These centers respect you as a person and will be there for you regardless of what you decide to do. They may even provide post-abortion counseling if needed. Some centers have programs for dads as well. These centers perform these services free of charge. Click here for more information.

2)     Maternity Homes

A maternity home is a place a pregnant teen can go if they are at risk for homelessness or if they need a place to stay far away from their community where they will be loved, supported, cared for, and not judged. Maternity Homes, also known as Maternity Housing, may provide such things as housing, support, pregnancy resources, addiction counseling, and spiritual counseling. Click here for more information.

3)     Mentoring and support services:

There are many resources for teen moms including Young Lives, a division of Young Life, which is a faith-based ministry dedicated to supporting teen moms and giving them direction in this difficult time of life. They are not connected to anyone's church and you do not need to be a Christian to participate in their services.

T.O.P.S (Teen Outreach Pregnancy Services)

According to the TOPS website,

“TOPS is an Arizona non-profit organization that provides healthy pregnancy, childbirth, and parenting education and support to families of all ages …”

4)     Extended family

Have you ever thought about reaching out to a distant relative for help? A grandma, a grandpa, an aunt, uncle, cousin, or even older sibling may offer help, guidance, and advice that you never dreamt of. Perhaps they went through a similar circumstance when they were your age. Perhaps they have experience on how to navigate these troubled waters. They may be able to take you in for a few months till you deliver. They may even be willing to adopt your child, should you choose to go down that road.

Lastly and perhaps, most controversial, have you considered… the father’s family? I know: there are many cases where you cannot or would not ever think of reaching out to that side of the family. But if you do have a good relationship with your boyfriend and if his family are good, upstanding citizens, what do you have to lose? After all, they may be able to provide a place for you to stay during tough times and may even care for your child on a short-term or long-term basis. This may also ensure that the father stays actively involved in his child’s life; the child is also his responsibility. His family is also an extended family.

In any event, there are places to go when a teen has a crisis pregnancy. Think outside of the box! There is hope. There is not only one choice… there is a multitude of choices. Choose one that is right for you AND your baby.

Are you considering placing a child for adoption? Not sure what to do next? First, know that you are not alone. Visit Adoption.org or call 1-800-ADOPT-98 to speak to one of our Options Counselors to get compassionate, non-judgmental support

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Question 15: 51.8% said that in their opinion, they have received enough education on sex in school allowing them to be confident in their decision-making. I am glad to see and hear that the majority have been exposed to this strong and important issue. What is concerning is that 26.5% said that they don't think they were given enough educational meetings on sex. Abstinence-only education sometimes encourages students to abstain from sex without ever telling them what sex is. When comprehensive sex education is taught in schools, it may encourage teens to make more informed decisions before participating in alternative sexual behaviors.  Ontario Premier Doug Ford made good on his promise to cancel the lessons, which sparked protests when it was implemented in 2015.

-The curriculum was objected to by many who said it was age-inappropriate and dismissed family values.

Similar protests over sex ed have happened around the world.

Ontario, Canada's most populous province, introduced a new sex-ed curriculum in 2015 in an attempt to modernize the program in light of many changes to Canadian society and the growth of social media and sexting.

- The explosion of social media and the constant use of mobile phone ownership led to the rise of cyber-bullying, cyber-exploitation, and sexting.
-Sex education in Canada varies greatly by province, and the discussion of when children need to
learn about sexual health is always a controversial topic in the media. In 2010, the Sex Information
and Education Council of Canada released a document that delves deeply into the statistics and
reasons for comprehensive sex education, but not specifics per province. To clarify the lack of
consistency across the country, examples are listed below (from 2015), highlighting the two ends of
the spectrum regarding age (other provinces fall between the two extremes).

• British Columbia and Manitoba require children to know the proper name for body parts in
kindergarten, while PEI and New Brunswick wait until Grade 6.
• Sexual orientation is taught in Ontario, Saskatchewan, and Nova Scotia in Grade 3, but
Newfoundland only teaches LGBT awareness in grade 9 (Manitoba has no clear agenda.)
• Information about STIs and prevention are taught in Nova Scotia starting in Grade 5 but New
Brunswick avoids the topic until Grade 10.
• Birth Control is taught in Grade 6 in BC and in Grade 9 in Nova Scotia and Saskatchewan.
Nova Scotia teaches STI prevention in Grade 5 but waits until high school for birth control, and some
provinces refuse to discuss gender identity and LGBT concerns at all. Even if the topic is mandated
for the province, no studies have looked at what teachers are actually telling their students in a class.
Overall, sex education in Canada is very inconsistent, similar to the lack of consistency to women’s
reproductive rights in the country, which is likely a reflection of stigma and sexuality restrictions. Even
though the question of abortion would undoubtedly arise in school classrooms, provincial websites
often do not indicate whether it is included in birth control discussions

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Question 14: (Short Answer) " Do you believe that society is responsible for teen pregnancy? Why or why not?"
-There were many different responses to this question. 43/83 (a little more than half) participants agreed to society being responsible for teen pregnancy, Many responses stated that they were unsure or "on the fence" since it comes down to how responsible the individuals are and being accountable for their actions. Peer pressure was frequently brought up in the responses and how society puts a lot of pressure on people regarding their sexual activity. I do believe that teen pregnancy is a result of one's irresponsible choices by not using protection. Sex at a young age has been normalized in today's society and people feel the need to lose their virginity before knowing the harsh consequences. There are many other circumstances that come into play like sexual assault and rape that is beyond a young women's control. Society is lacking in spreading awareness and information and for shaming teen moms and shining a negative view on them. There are many factors that come into play, not just society. One major factor that needs to be held more accountable and responsible is properly educating boys and not just girls on what the word "NO" means. Giving consent, and proper contraception use is an important element.

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Question 13:  92.8% of participants agreed to this statement. Having one on one conversations with teen parents will enlighten teen on the difficulties that come with having a child at a young age. It will also allow the teen parents to speak up and share their stories and make them feel less isolated.  Spreading the word on this issue will open conversations and decrease the stigma associated with teen pregnancy. These programs should occur in every highschool or provide access in every community.

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Question 12: 69.5% said that sex is permitted before marriage in their culture and 30.5% said that it is NOT permitted in their culture. I was just curious about how culture affects the knowledge and/or influences in one's decisions with sex and contraception. Aspects of sexuality that are influenced by culture include values, such as decisions regarding appropriate sexual behaviors, suitable partner or partners, appropriate age of consent, as well as who is to decide what is appropriate.

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Question 11: 26.5% of participants said that on a scale from 1-10, 5 is where teen pregnancies stand in Canada. It occurs but not as frequently as other countries. While the national rate rose just slightly from 27.9 per 1,000 teens to 28.2, four provinces have seen much more staggering increases between 2006 and 2010: Teen pregnancy rates, for women aged 15 to 19, jumped by nearly 40 percent in New Brunswick, nearly 36 percent in Newfoundland, more than 17 percent in Nova Scotia and 15 percent in Manitoba.

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Question 10: I was very surprised seeing that the majority (91.5%) said that the morning-after pill or Plan B (Levonorgestrel) is not enough to prevent pregnancy, due to the popularity of the name and the common use of this pill. It is used as backup contraception to prevent pregnancy when taken within 72 hours after unprotected sex or when birth control fails. Levonorgestrel is a progestin. Progestins are hormones used in many birth control pills. Although levonorgestrel and similar emergency contraception pills contain a higher dose of levonorgestrel than birth control pills, they work in a similar way to prevent pregnancy, mainly by stopping the release of an egg from the ovary. If you've had unprotected sex multiple times in the last 24 hours, you only need to take Plan B once. If you take Plan B within three days, it can reduce the risk of pregnancy by 89 percent. If you take it within 24 hours, it can reduce the risk of pregnancy by about 95 percent. Knowing this information is crucial for adolescents entering the adult world.

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Question 9: 48.2% said that they agree that schools and parents are doing enough to educate adolescents on teen pregnancy and the dangers of having a child at such a young age.  Cooperating with parents is one of the best ways to provide the kids with the necessary information and education, but working closely with doctors such as the experts from the Worldwide Pediatrics Group can help come up with a program that will educate the kids and ensure they have a happy and healthy childhood.

In addition to this, schools can adopt an inclusive way to this issue and help in four distinct ways:

1. All schools should enforce programs that involve support, tutoring, education, and recreation as these programs can help decrease high-risk behavior among teens and prevent teen pregnancy in schools.

2. Schools should promote values that include academic success, self-worth, and connectedness to reduce the chances of high-risk behavior among teenagers.

3. Schools should try to implement programs that promote positive youth development. These programs should be able to support resilience in children and provide more information about the following topics:

Connectedness – feeling safe, establishing direct relationships with other people and kids, and feeling like you’re part of a distinct group

Confidence – having great self-esteem in addition to knowing you have control over your life

Character – feeling competent about what options are out there and what is attainable, making good career choices, leading a healthy life, and having meaningful relationships with your family, friends and fellow classmates.

Generally, schools should be required to prepare students for prosperous futures, striving to foster young and competent people who are able to make healthy life choices. All this can be done by including appropriate character education in the school curriculum, providing attentively crafted learning activities in the lesson plans, and promoting nonscholastic and out of school activities and programs

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Question 8: I am thankful to see that the majority of people have gotten this important issue on sex and unprotected sex at school. Sexuality education has positive effects, including increasing young people's knowledge and improving their attitudes related to sexual and reproductive health and behaviors. Sexuality education – in or out of schools – does not increase sexual activity, sexual risk-taking behavior, or STI/HIV infection rates. Comprehensive sex education doesn't encourage kids to have sex. Just like abstinence-only programs, good comprehensive programs teach students that abstinence is the only surefire way to prevent pregnancy and STDs.
The more kids know, the more likely they are to say "No." Teenagers aren't stupid. When a teacher tells them that only abstinence can protect them from the dangers of STDs and pregnancy, they know they're being lied to. At the very least, they know they're being misled.

Giving adolescents an accurate picture of the risks of different types of sexual behavior can help them make informed decisions about sex.

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Question 7: I am relieved that the majority of participants have gotten information on sex-ed and the rules of contraception. I do think that 100% of the participants should have agreed to choose yes since it's such an important topic that needs to be addressed and open to conversation and questions. One of the biggest problems with abstinence-only education is that it denies teenagers the chance to learn about acceptable options other than abstinence. Given that no form of sex education has been shown to effectively convince teenagers not to have sex, this is a significant problem. Over the past 20 years, numerous studies have consistently demonstrated that teaching comprehensive sex education in schools doesn't have the downside most people are afraid of. In other words, providing condoms in schools doesn't encourage adolescents to start having sex earlier, or even more often.
Part of staying healthy is seeking appropriate health care. As boys age, many of them stop going for preventative health care. This limits the opportunities they have to be screened for, among other things, STDs.

A study in Pediatrics found that parents who talk to their male children about sex are more likely to have boys who go to the doctor. It's all about setting a good example.

One of the biggest risk factors for not seeking care is holding traditional views about masculinity. It's important that young men learn early that taking care of their health is one of the most "manly" things they can do

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Question 6: 50.6% of participants agree that teen pregnancies occur by mistake and 25.3% say that irresponsibility plays a role. These young females have not yet reached adulthood and the causes of teenage pregnancy vary greatly. Teenage pregnancy may be linked to things such as lack of education and information about reproduction, peer pressure, and early engagement in sexual activity.

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Question 5: 90.4% of participants said that abortions are what end in unwanted pregnancies. Ending a pregnancy is a common decision that millions of people make - every year a quarter of pregnancies end in abortion.

And regardless of whether abortion is legal or not, people still require and regularly access abortion services. According to the Guttmacher Institute, a US-based reproductive health non-profit, the abortion rate is 37 per 1,000 people in countries that prohibit abortion altogether or allow it only in instances to save a woman’s life, and 34 per 1,000 people in countries that broadly allow for abortion, a difference that is not statistically significant.

When undertaken by a trained health-care provider in sanitary conditions, abortions are one of the safest medical procedures available, safer even than childbirth.

But when governments restrict access to abortions, people are compelled to resort to clandestine, unsafe abortions, particularly those who cannot afford to travel or seek private care.

-I personally am pro-choice, women should have a right to what is done to their bodies and the decisions that effect them.

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Question 4: 93.6% of participants agreed to the statement on teen parents and the stigma and isolation they have to face on a daily basis.
-I am very glad to see that the majority said yes and see how truly hard it is taking care of a child and trying to block away the negative comments and arguments against them and there choices.

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Question 3: (short answer question) "What do you think the prevailing feelings amongst teen moms are?"
-Gathering all of the different answers from all that were willing to state their opinion on this question, I saw a significant pattern of the prevailing feelings of stress, shame, and anxiety.
-Answers stated that the feeling of regret and guilt came up less frequently but still seen and agreed upon.
-Parents want the best for their children and don't want them being burdened with the responsibilities that come with having a child. They want their children to fulfill their academic goals and have a better life than they did when they were their age.
-Teenage pregnancy can be a crisis for your teen and your family. Common reactions might include anger, guilt, and denial. Your teen might also experience anxiety, fear, shock, and depression. Ask what your teen is feeling and talk about what's ahead. Your teen needs your love, guidance, and support now more than ever.

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Question 2: 65.1% (54) participants were female and 33.7% of participants were males. Having a greater number of females participating in my survey gives me a clear understanding of the knowledge of teen females and teen pregnancy and their opinions. Having male participants complete my survey made me excited to learn how much sex-ed knowledge was given to the opposite sex and how they felt about the quantity and quality of what they received.

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Rethinking Teenage Pregnancy Prevention | Juliana Marquez Salej | TEDxColegioAngloColombiano

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Question 1: 68.7% of participants are the ages between 16-17 gives me a clearer understanding of the demographic being used and how my target audience goals were met

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LINK:
Participants: 83

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Hi, my name's Sophia Gatzos I am a grade 12 student and I am doing my ISP on Teen Pregnancy to see how much knowledge and understanding you hold about this important issue and topic. -If you have any questions or concerns, please contact me on my school email at 349163741@gapps.yrdsb.ca.

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Teens and how there are many causes behind teenage pregnancy and to highlight the support programs that are available around Canada

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If these factors are present in a teenage girl’s environment, then her risk of pregnancy is greater because she does not have access to resources that could prevent pregnancy from occurring.

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1. The causes: Approximately 90% of births to girls aged 15-19 in developing countries occur within early marriage where there is often an imbalance of power, no access to contraception, and pressure on girls to prove their fertility.

2. Factors such as parental income and the extent of a girl’s education also contribute. Girls who have received minimal education are 5 times more likely to become a mother than those with higher levels of education. Pregnant girls often drop out of school, limiting opportunities for future employment and perpetuating the cycle of poverty. In many cases, girls perceive pregnancy to be a better option than continuing their education

3. The unique risks faced by girls during emergencies increase the chances of them becoming pregnant. Factors include the desire to compensate for the loss of a child, reduced access to information and contraception, and increased sexual violence.

4.  For many adolescents, pregnancy and childbirth are neither planned nor wanted. In countries where abortion is prohibited or highly restricted, adolescents typically resort to unsafe abortion, putting their health and lives at risk. Some 3.9 million unsafe abortions occur each year to girls aged 15-19 in developing regions

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1. Focusing on the top four causes of teen pregnancy and connect them all together through their relating outcomes

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There could be many outcomes to having a teen pregnancy. Many are due to the lack of knowledge of sex-ed and how to use protection. Other possibilities are linked to rape and sexual assault, being against/ or not being able to get an abortion. The influence around you when you’re growing up has an impact on what you think is right or wrong and how you deal with circumstances like getting pregnant and what choices you have to make.

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-My sisters’ boyfriend’s mom had him when she was 16 and shared her story with me which I’m thankful for because I learned a lot from hearing her situation and how hard it was to be going to school and taking care of a newborn child. I feel like teen pregnancy isn’t talked about as much as it should and I want to learn more details about the topic and view other people’s stories.

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-Teen pregnancy: female adolescents becoming pregnant between the ages of 13-19. These young females have not yet reached adulthood and the causes of teenage pregnancy vary greatly