Building for the future: adolescent pregnancy prevention

Although almost 500,000 teenagers deliver babies every year in the United States, adolescent birth trends in the late 1990s clearly reversed the dramatic rise in rates of the previous decade. The US birth rate for teenagers in 1997 was 52.3 live births per 1,000 women age 15 to 19, a reduction of 16% from 1991. This results in part from two promising trends: Teenagers today are less likely to be sexually active, and sexually active teenagers are more likely to use contraception. Over the past two decades, a number of research studies have provided important insights that are useful for both individual clinical assessment and the development of interventions aimed at reducing the incidence of early childbearing. A number of key program factors can successfully reduce adolescent pregnancy. These include providing accurate information about the risks of unprotected intercourse and ways to avoid an unintended pregnancy; using a variety of teaching methods designed to involve the participants and have them personalize the information (with particular tailoring to appropriate age, gender, culture, and sexual experience); and providing models of and practice in communication, negotiation, and refusal skills. Resolving the problem of teenage pregnancy will require a major and coordinated effort aimed not only at adolescents themselves, but also at the political, economic, medical, educational, and religious institutions whose systems and policies profoundly influence the underlying conditions that lead to adolescent pregnancy and child-bearing.