Teen Childbearing Trends: Which Tide Turned When and Why?

The article by Kaufmann and colleagues¹ in this issue of Pediatrics is the latest in a rapidly growing series documenting a steady decline in the number of babies born to 15- to 19-year-old American girls since 1991.^2–4 Although the causes of this welcome turn of events have yet to be fully elucidated, everyone wants to take credit. Conservative groups say abstinence education turned the tide, while liberals claim that sex education has promoted more widespread and effective contraceptive use.⁴ In truth, both groups appear to be correct. Efforts to promote condom and contraceptive use among teens have not, as many had feared, led to more widespread teenage sexual activity.^3–8 Rather, the messages to “postpone sex” and “have safe sex if you do” appear to be not only mutually compatible but complementary. The latest vital statistics and national survey data indicate that teenagers are having less sex, using more birth control, and having fewer babies.^1–5 While the first is a new phenomenon, the latter two are not. Kaufmann and colleagues demonstrate that the convention of reporting on birth rates within the entire cohort of “15- to 19-year-old girls” has masked the steady decline in the pregnancy rate among sexually experienced teenagers in this country since the 1980s.¹ The authors note that the combination of a precipitous decline in the teen abortion rate and a rapid increase in the prevalence of teenage sexual activity inflated the birth rate in this sector of the population during the 1980s, making it extremely difficult to study trends and nearly impossible to assess the efficacy of interventions designed to prevent conceptions among the sexually active members of this population. Thus, even though the notorious inaccuracy of self-report data concerning abortion and sexual activity makes pregnancy …

Address correspondence to Catherine Stevens-Simon, MD, Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Science Center, the Children's Hospital, 1056 E 19th St, Denver, CO 80218.