by Geoffrey Modest<\/p>\n
2 related articles were recently\u00a0published by the CDC.<\/p>\n
1. In the United State from 1991 to 2014 the birth rate among teens age 15 to 19 hasdeclined by a dramatic 61%<\/strong>from 61.8 per 1000 to 24.2 per 1000,\u00a0with larger % decreases in ethnic\/racial minorities\u00a0<\/strong>(see\u00a0http:\/\/www.cdc.gov\/mmwr\/volumes\/65\/wr\/mm6516a1.htm?s_cid=mm6516a1_w<\/a>\u00a0).\u00a0However the birth rate remained approximately twice as high for Hispanic and non-Hispanic black teens compared to non-Hispanic white teens.\u00a0<\/strong>There are also significant geographic and socioeconomic disparities. See prior blog\u00a0<\/a> for the full assessment\u00a0.\u00a0In brief:<\/p>\n — from 2006 to 2014,\u00a0a 41% decline in birthrate\u00a0overall, to 25.4 per 1000 female teens<\/p>\n — Hispanic: decreasing to 39.8 per 1000, a 51% decrease from 77.4 per 1000<\/p>\n — Black: decreasing to 37.0 per 1000, a 44% decrease, from 61.9 per 1000<\/p>\n — white: decreasing to 18.0 per 1000, a 35% decrease\u00a0from 26.7 per 1000<\/p>\n — there is large geographic variability, for example the Hispanic birthrate in 2014 varied from 17.0 per 1000 in Maine to 58.0 per 1000 in Oklahoma; Black birthrate varied from 14.0 per thousand in New Hampshire to 54.6 per thousand in Arkansas; white birthrate varied from 4.8 per 1000\u00a0in New Jersey to 39.2 per 1000 in West Virginia. And, within states, sometimes the racial disparities remain very high: eg, in\u00a0Nebraska\u00a0the birth rate for whites was 16.2 (approx the national average) whereas the rates for black and Hispanic (42.6 and 53.9) were far above the national average for these groups.<\/p>\n –and, there was a higher birth rate in those who are unemployed, have lower levels of education\u00a0and lower incomes.<\/p>\n Commentary:<\/p>\n –as a perspective, the overall US birth rate in 2011 for 15-19 years old females was 34.0 per 1000, vs 13 per 1000 the same year in Canada. And the rate in France was 7 per 1000 and in Germany 5 per 1000.<\/p>\n so,<\/p>\n –very dramatic changes in teen birth rate, with a narrowing of the gap for racial\/ethnic minorities as compared to whites. However, as noted, the gap remains significantly discordant.<\/p>\n –And, I suspect, a large part of the geographic gap reflects access to and quality of care. And there are major concerns about the future: the trump administration\u00a0etc\u00a0are pushing for decreased Planned Parenthood (potentially leading to even less access to care\/contraception for poor and minority patients, with anticipated increases in pregnancy rates, and likely maternal and fetal death rates) and even cutbacks in maternity care.\u00a0For example, another blog<\/a>\u00a0showed that a restrictive abortion law in Texas led to an 18.2% decline in abortions; and there have been a plethora of studies linking lack of\u00a0prenatal care to poorer\u00a0outcomes.<\/p>\n –and, the overall social environment, getting worse in the trump era,\u00a0no doubt will\u00a0add\u00a0to the problem: lower incomes, cutbacks in social programs (including perhaps\u00a0health insurance),\u00a0fewer safety net programs overall,\u00a0and\u00a0social upheaval in general\u00a0(including targeting immigrants) will predictably lead to even\u00a0less access to care, less sense of hope for the future, lower self-esteem, and poorer health outcomes, including pregnancy rates.<\/p>\n ———————————————————<\/p>\n 2. Another CDC article evaluated sexual activity and contraceptive use among teens aged 15-19\u00a0in the US from 2011-2015 (see\u00a0https:\/\/www.cdc.gov\/nchs\/data\/nhsr\/nhsr104.pdf<\/a>),finding:<\/p>\n <\/p>\n –42.4% of never-married female teens (4.0 million) and 44.2% of never-married male teens (4.4 million) had sex at least once by the time of the interview; these numbers were similar to those from 2002 and 2006-2010, though\u00a0looking back to\u00a01988 there was\u00a0a decline<\/strong>\u00a0(downward trend, with p<0.05). By ethnicity\/race, from 2002 to\u00a0\u00a02011-15:<\/p>\n –Hispanic female: 37.4% in 2002, 41.2% in 2011-15; Hispanic male: 54.8% to 45.7%<\/p>\n –non-Hispanic white female: 45.1% in 2002, 44.3% in 2011-15; non-Hispanic white male: 40.8% to 42.8%<\/p>\n –non-Hispanic black female: 56.9% in 2002, 45.7% in 2011-15; non-Hispanic black male: 63.3% to 58.6%<\/p>\n –of these, the differences in females in 2011-15 were not statistically significant; though the difference\/decrease in non-Hispanic black males was significantly higher than the others<\/p>\n –assessing sexual activity by family structure at age 14: for females, a significantly lower % were sexually experienced if they lived with both parents (36.8% vs 50.8%) and for males (39.4% vs 51.9%); for males, if their mothers gave birth to first child by\u00a0age\u00a0>=20 (39.3% vs 56.7% if mothers younger). Also for males, less sexually experienced if mother had at least some college vs high school diploma or GED\u00a0(41.0%\u200b vs\u00a046.7%)<\/p>\n –by age: males more likely than females to have sex younger\u00a0(age 15-16). Though probabilities were the same by age 17<\/p>\n –partners for first sexual experience: 74.1% of females but 51.1%\u00a0of\u00a0males were \u201cgoing steady\u201d with their partner; 13% of females and 27.3% of males with \u201cjust friends\u201d\u00a0(the latter\u00a0especially true with younger teens)<\/p>\n –reasons for not having sex: most common: religion\/morals (35.3% of females, 27.9% of males), then \u201cnot found right person yet\u201d 21.7% females, 28.5% males; then \u201cdon\u2019t want to get pregnant\u201d 19.3% females, 21.2% males<\/p>\n –no change from 2002 in terms of % of teens who have had sex in past 3 months, though older teens (18-19 yo)\u00a0were\u00a0twice as likely as those 15-17.<\/p>\n <\/p>\n –female teenager use of contraception at first sex:<\/p>\n –increased from 74.5% in 2002 to 81.0% in 2011-15, though lowest in non-Hispanic black teens at 62%, and\u00a0higher in Hispanic (79%) and non-Hispanic white (87%) teens; overall, mostly using condoms (66.4% in 2002, increasing to 74.6% in 2011-15)<\/p>\n –dual protection (condom plus pill) also increased significantly from 13.1% in 2002 to 18.5% in 2011-15<\/p>\n –overall 5.8% of females had a long-acting reversible method (IUD in 2.8% or implant in 3.0%) in 2011-2015<\/p>\n –male teenager use of contraception at first sex:<\/p>\n –condom use increased from 70.9% in 2002 to 79.6% in 2006-10 and remained stable at 76.8% in 2011-2015<\/p>\n –emergency contraception use has increased significantly from 2002 (8% of female teens who ever used it) to 2011-15 (23%)<\/p>\n –no change in ever using condoms (97%), withdrawal (60%), pills (56%),\u00a0depo-medroxyprogesterone\u00a0(17%)<\/p>\n –feelings about hypothetical pregnancy (which does correlate with risk of teen birth, pregnancy risk behaviors): in 2011-15, more females would be very upset (60.5%) vs males (46.1%)<\/p>\n –teens who have\u00a0sex at an earlier age are not only less likely to use\u00a0contraceptives\u00a0at time of first sex, but also at the last sex as well.<\/p>\n <\/p>\n Commentary:<\/p>\n –although there are lots of statistics above, the report has even\u00a0lots more\u2026.<\/p>\n –it is notable that 81% of females\u00a0used contraception the first time they have sex, condoms were\u00a0used by 77% of males the first time they have sex<\/p>\n –overall trends seem to confirm some decreases in sexual activity overall and increase in contraceptive usage since 1988, aligning with the observed\u00a0decrease in teen pregnancy in the early 1990s (as above). though the contraceptive use\u00a0largely plateaued or only decreased slightly since 2002, the types and effectiveness of contraceptives used has changed<\/p>\n –there is a general trend to promote long-acting reversible contraceptives (IUDs implants) in adolescents (eg, see\u00a0https:\/\/www.acog.org\/Resources-And-Publications\/Committee-Opinions\/Committee-on-Adolescent-Health-Care\/Adolescents-and-Long-Acting-Reversible-Contraception<\/a>\u00a0), and there is dramatically increasing use of emergency contraception<\/p>\n –one important potential utility of all of these statistics is to help us clinicians and public health people\u00a0focus on teens where\u00a0the statistical predictors point to\u00a0those\u00a0at\u00a0highest risk of not using contraceptives or becoming\u00a0pregnant\u00a0(eg. family and social\u00a0situation, education, age of first sex, ethnicity\/race\u2026)<\/p>\n <\/p>\n –but, as noted in commentary after the first article, there are real concerns about the future, especially with access to high quality,\u00a0affordable care (see above)<\/p>\n<\/div>\n