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Teens are heading in wrong direction: Likely to have sex, but not use contraception

June 18, 2009

Between 2003 and 2007, the progress made in the 1990s and early 2000s in improving teen contraceptive use and reducing teen pregnancy and childbearing stalled, and may even have reversed among certain groups of teens, according to the study "Changing Behavior Risk for Pregnancy Among High School Students in the United States, 1991-2007," by John S. Santelli, MD, MPH, professor and chair of the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health in conjunction with researchers at Guttmacher Institute. Between 1991 and 2003, teens' condom use increased while their use of no contraceptive method declined, leading to a decreased risk of pregnancy and to declines in teen pregnancy and childbearing. The new findings, published in the July 2009 issue of the Journal of Adolescent Health, paint a very different picture since 2003.

Using data from young women in grades 9-12 who participated in the Youth Risk Behavior Survey, the authors estimated teens' risk of becoming pregnant based on their sexual activity, the contraceptive method they used and the effectiveness of that method in preventing pregnancy. The authors found no change in teen sexual activity between 2003 and 2007, but did find a small decline in contraceptive use.

"After major improvements in teen contraceptive use in the 1990s and early 2000s, which led to significant declines in teen pregnancy, it is disheartening to see a reversal of such a positive trend," says Dr. Santelli. "Teens are still having sex, but it appears many are not taking the necessary steps to protect themselves from unwanted pregnancy or sexually transmitted infections."

Previous research by the Mailman School of Public Health and Guttmacher Institute showed that contraceptive use was a key factor in reducing teen pregnancy rates in the 1990s, despite little significant change in teen sexual activity. The authors suggest that the recent decline in teen contraceptive use since 2003 could be the result of faltering HIV prevention efforts among youth, or of more than a decade of abstinence-only-until-marriage sex education that does not mention contraception unless it is to disparage its use and effectiveness.

This reversal in contraceptive use is consistent with increases in the teen birth rate in 2006 and 2007 as reported by the Centers for Disease Control and Prevention (CDC), and may well portend further increases in teen pregnancies and births in 2008. The authors recommend reinvigorated efforts at both the state and national levels to promote contraceptive use among teens through medically accurate sex education and increased access to health services, to effectively address the problem of teen pregnancy. The Western European experience in reducing teen pregnancy and childbearing-with rates that are far lower than in the United States-suggests that efforts to improve teen contraceptive use are warranted.

Columbia University's Mailman School of Public Health