What’s behind the drop in teen pregnancies?

Trends in teenaged sexuality and contraceptive use are changing, and new data is available to help pediatricians find the best approach for their patients.

The number of teenagers having sexual intercourse has declined over the last 25 years, and both pregnancies and teenaged birth rates also have dropped over the same period, according to a new report from the National Center for Health Statistics (NCHS).

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Whereas these trends might be surprising in light of the fact that overall contraceptive use has changed little, the report does show steady use of condoms as a primary form of contraception and jumps in other, newer methods such as emergency contraception.

Every year, about 750,000 teenaged girls become pregnant, and 80% of those pregnancies are unplanned, according to a 2014 policy statement on contraception for adolescents from the American Academy of Pediatrics (AAP). Those pregnancies cost $9.4 billion per year in taxpayer dollars, says NCHS, which just released its new report reviewing trends in teenaged sexual activity and pregnancy, as well as contraceptive methods and uses.

The percentage of teenagers who had sexual intercourse at least once declined in the 25-year period of 1988 to 2013. This decline was greater for male teenagers than female teenagers. According to the most recent data from 2011–2013, by age 19 years, roughly 2 of 3 never-married teenagers have had sexual intercourse. The majority of male and female teenagers used a method of contraception at first sexual intercourse. Most often used was the male condom, followed by the withdrawal method and the hormonal oral contraceptive pill.

Understanding these patterns and trends in sexual activity and contraceptive use, and their impact on teenaged pregnancy, can help provide context regarding the recent decline in the US teenaged birth rate.

NEXT: A look at teenaged mothers

The number of 15- to 19-year-old girls who became mothers dropped 58% in 2013 from its 1991 peak, according to the NCHS report, and that drop parallels a decline in teenaged pregnancies. Even with the lower pregnancy and birth rates, the NCHS says US rates are still higher than those in other developed counties.

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From 2011 to 2013, NCHS researchers say 44% of unwed teenaged girls (4.3 million) and 47% of unwed teenaged boys (4.8 million) admitted to having sexual intercourse at least one time. For females, this statistic is a 14% drop from 1988 (51%). From 2006 to 2010, the statistic was about the same, at 43%. For males, there was a 60% drop from 1988 and a 46% from 2002, but no significant difference in the years after 2002 to today.

The study showed that males were more likely to have intercourse than females in the early teenaged years, but by age 17 years, rates of intercourse are similar for both males and females. Eighteen percent of males reported having intercourse by the age of 15 years, 44% by age 17, and 69% by age 19. For females, 13% had intercourse by age 15 years, 43% by age 17, and 68% by age 19, according to the report.

Although rates of teenaged pregnancies and childbirth are declining, teenagers still have a way to go in terms of contraceptive use.

From 2011 to 2013, 79% of females and 84% of males reported using a method of contraception during their first sexual encounter. The NCHS says those figures have not changed over the time reviewed for the study. Older teenagers having sexual intercourse for the first time scored the best, according to the report. Ninety-three percent of females who were aged 18 to 19 years at their first sexual encounter used contraception, compared with 77% who were younger than age 17 years. Males scored even higher, with 99% of teenaged boys aged 18 to 19 years using contraception during their first sexual encounter compared with 82% of boys younger than age 17 years.

Although the most common form of contraception remains the condom, with 97% of females reporting condom use, the use of emergency contraception has jumped in recent years since it became available as an over-the-counter option.

Over the past decade, NCHS figures show that condom, emergency contraception, and implant use all have increased as preferred methods of contraception among teenagers. The use of withdrawal, which has a 22% failure rate, has risen as well, with 55% of teenagers stating use of this method in 2002 compared with 60% by 2013. Use of oral contraceptives, Depo-Provera, and contraceptive patches have declined, according to the report.

NEXT: What about emergency contraception?

Use of emergency contraception, or the “morning-after” pill, has risen from 8% in 2002 to 22% by 2011 to 2013, the report states. The AAP recommended in its last position paper on adolescent contraception that making emergency contraceptives available to patients as a preventive option may be more effective than having them purchase it as needed.

Next: Impact of attitude on contraception use in teen patients

Barriers to more traditional contraceptive methods, such as male condoms, have been documented in a number of studies, and teenagers may not have the means to purchase them or are embarrassed to do so. Pediatricians should counsel adolescents about their birth control options in an open and honest manner, and educate them on the resources available to them.

Whichever contraceptive method is used, employing some method in sexually active adolescents is certainly best. Female teenagers who used a method of contraception at first sexual intercourse were less likely to have had a birth in their teenaged years than those who did not use a method of contraception at first intercourse. According to the NCHS report, females who, by the age of 17 years, had not used contraception during their first sexual encounter were 5 times more likely to become a teenaged mother.

In its updated position statement for pediatricians about contraceptive use in 2014, the AAP says pediatricians play a big role in teenaged pregnancy prevention. The position statement advises pediatricians to take a developmentally targeted approach to sexual counseling using motivational interviewing practices and a nonjudgmental attitude.

Although abstinence counseling is recommended, the AAP admits that adherence to this practice is low and that pediatricians should not rely on abstinence counseling alone. Pediatricians should also work to counsel against using withdrawal as a contraceptive technique, AAP says. The position paper notes that while there are many effective contraceptive methods, and condoms may be subject to user error and usage drop-off over time, it offers a high level of protection against sexually transmitted infections. The AAP therefore recommends dual contraceptive methods that employ both a hormonal or long-acting contraceptive in addition to condoms.

The position paper also makes recommendations about oral contraceptives, Depo-Provera, and the birth control patch, noting that despite some concerns about adverse effects and adverse reactions, particularly the transdermal patch, pediatricians should continue to educate their patients about this and all other methods of birth control because they remain a safer, better option than pregnancy in adolescents.