Teen Pregnancy in the U.S.: Causes, Trends, and Solutions

Introduction: Teen Pregnancy as a Public Health Crisis

Teen pregnancy is one of the United States' most significant public health problems. When compared to other similarly industrialized nations with comparable healthcare systems, the United States has an alarmingly high teen pregnancy rate. In fact, if judged solely by that rate, one might assume the United States was a developing country rather than the world's leading superpower. Yet teenage pregnancy remains common in many parts of the world, which can lead people to wonder why it is considered such a significant issue in the United States. Does an anti-teen-pregnancy attitude reflect an age bias rooted more in concerns about emerging female sexuality than in the actual consequences of adolescent childbearing? The risks associated with teenage pregnancy argue against that conclusion and suggest that teen pregnancy is detrimental not only for teenage mothers, but also for their children.

Teen pregnancy is unequivocally negative for the vast majority of teenage mothers. Teen mothers are not only less likely to complete school, but also more likely to become single parents. The combination of these factors makes it unlikely that they will be able to adequately provide for themselves or for their children. Moreover, while adolescent female bodies may be capable of procreation, that does not mean they are physically ideal for it. "Common medical problems among adolescent mothers include poor weight gain, pregnancy-induced hypertension, anemia, sexually transmitted diseases (STDs), and cephalopelvic disproportion. Later in life, adolescent mothers tend to be at greater risk for obesity and hypertension than women who were not teenagers when they had their first child" (Cape Fear Teen Health Council, 2006). Viewed together, this evidence makes it impossible to conclude that teenage pregnancy is beneficial for teenage mothers as a group.

Furthermore, teenage pregnancy can have serious negative consequences for the child. Teenage mothers are far less likely to receive adequate prenatal care than older mothers, which can have a detrimental impact on the baby. Combined with the other health issues that frequently co-exist in teenage mothers, the outlook for the child can be very poor. "Children born to teen mothers suffer from higher rates of low birth weight and related health problems. Low birth weight raises the probabilities of infant death, blindness, deafness, chronic respiratory problems, mental retardation, mental illness, and cerebral palsy" (Cape Fear Teen Health Council, 2006). Moreover, these problems do not end at birth. Due to a lack of maternal resources, the children of teenage mothers often suffer lifelong consequences, including insufficient healthcare, inadequate parenting, child abuse, and neglect (Cape Fear Teen Health Council, 2006). These problems extend beyond the home as well: "children of teens are 50% more likely to repeat a grade; they perform much worse on standardized tests; and ultimately they are less likely to complete high school than if their mothers had delayed childbearing" (Cape Fear Teen Health Council, 2006).

All of society is impacted by teenage pregnancy. Every child who grows up in an inadequate home increases the burden on society. This is a particular problem in the United States, which has teen pregnancy rates far in excess of any other industrialized nation. U.S. teen pregnancy rates are "nearly double Great Britain's, at least four times those of France and Germany, and more than ten times that of Japan" (Cape Fear Teen Health Council, 2006). As a result, a significant amount of U.S. resources must be diverted to addressing the impact of teen pregnancy, placing the country in a weakened position relative to competitor nations. Teen pregnancy literally costs taxpayers billions of dollars each year and, given its cyclical nature, creates an enduring legacy of problems. "There are nearly half a million children born to teen mothers each year. Most of these mothers are unmarried, and many will end up poor and on welfare. Each year the federal government alone spends about $7 billion to help families that began with a teenage birth" (Cape Fear Teen Health Council, 2006).

Teen Pregnancy Rates: National, Racial, and Geographic Trends

When examining the problem of teen pregnancy in the United States, it is critical to recognize that the problem varies tremendously from state to state. In 2006, 750,000 women under the age of 20 became pregnant (Guttmacher, 2010). The pregnancy rate among 15- to 19-year-olds was 71.5 per 1,000 (Guttmacher, 2010). These numbers do not even include those under 15 who experienced pregnancy. Moreover, while there had been a downward trend in the U.S. teen pregnancy rate — reaching its lowest point of 69.5 pregnancies per 1,000 teens in 2005 — the rate increased in 2006 for the first time in more than a decade (Guttmacher, 2010).

One of the more surprising aspects of teen pregnancy rates is that they are not directly related to teen sexual activity in the way one might expect. A more sexually active teenager does not necessarily have an increased risk of becoming a teenage mother. "The pregnancy rate among sexually experienced teenagers (those who had ever had intercourse) was 152.8 pregnancies per 1,000 women aged 15–19, reflecting the fact that the overall teenage pregnancy rate includes a substantial proportion of young people who are not sexually active" (Guttmacher, 2010). However, the three percent increase in teenage pregnancies between 2005 and 2006 was correlated with the same increase in teenage pregnancies among sexually experienced teenagers (Guttmacher, 2010), which is cause for concern.

Teenage pregnancies do not always result in teenage parents. There are three main options for a pregnant teenager: raising the child, adoption, and abortion. In 2006, the teenage birth rate "was 41.9 births per 1,000 women — 32% lower than the peak rate of 61.8 reached in 1991, but 4% higher than in 2005" (Guttmacher, 2010). The teenage abortion rate in 2006 was 19.3 abortions per 1,000 women, roughly half of the 1988 peak but 1% higher than the 2005 rate (Guttmacher, 2010). With 71.5 per 1,000 teenagers pregnant and 19.3 receiving abortions, the abortion rate exceeded 25%. It is important to note, however, that teenage abortion has declined significantly over the past two decades. "From 1986 to 2006, the proportion of teenage pregnancies ending in abortion declined almost one-third, from 46% to 32% of pregnancies among 15-to-19-year-olds" (Guttmacher, 2010). This trend has not led to a significant increase in adoptions. On the contrary, "there is an unmistakable and dramatic trend away from teenagers giving their children up for adoption" (Lachance, 2011). Combined with the overall decrease in teen abortions, the result is an increase in the number of teenagers who are parenting, even as the overall teen pregnancy rate has declined over the past two decades.

Like most social phenomena in the United States, one observes racial and ethnic differences in teen pregnancy rates. While minorities — particularly African Americans and Hispanics — have historically been far more likely to experience teen pregnancy than white teens, the racial gap does appear to be narrowing. "Among Black women aged 15–19, the nationwide pregnancy rate fell by 45% (from 223.8 per 1,000 to 122.7) between 1990 and 2005, before increasing to 126.3 in 2006" (Guttmacher, 2010). "Among Hispanic teenagers, the pregnancy rate decreased by 26% (from 169.7 per 1,000 to 124.9) between 1992 and 2005, before rising to 126.6 in 2006" (Guttmacher, 2010). Dramatic racial differences nevertheless persist: "among non-Hispanic white teenagers, the pregnancy rate declined 50% in the same period (from 86.6 per 1,000 to 43.3), before increasing to 44.0 in 2006" (Guttmacher, 2010).

Geographic location also appears to influence teenage pregnancy rates, likely because community attitudes about teenage sexuality, birth control, and sex education vary widely across the United States. Every state except one experienced declines in teen pregnancy rates from 1988 to 2000, and every state but North Dakota experienced declines from 2000 to 2005 (Guttmacher, 2010). Generally, states with the largest adolescent populations had the highest numbers of teenage pregnancies (Guttmacher, 2010). However, teen pregnancy rates were much higher in the South and Southwest than in the Northeast and Midwest. "New Mexico had the highest teenage pregnancy rate (93 per 1,000), followed by Nevada, Arizona, Texas, and Mississippi. The lowest rates were in New Hampshire (33), Vermont, Maine, Minnesota, and North Dakota" (Guttmacher, 2010). States with the highest teen pregnancy rates also tended to have the highest teen birth rates, with Texas, New Mexico, Mississippi, Arkansas, and Arizona leading in that category (Guttmacher, 2010). Abortion trends varied widely by state as well. "Teenage abortion rates were highest in New York (41 per 1,000), New Jersey, Nevada, Delaware, and Connecticut. By contrast, teenagers in South Dakota (6 per 1,000), Utah, Kentucky, Nebraska, and North Dakota all had abortion rates of eight or fewer per 1,000 women aged 15–19. More than half of teenage pregnancies ended in abortion in New Jersey, New York, and Connecticut" (Guttmacher, 2010). These state-level abortion rates may reflect personal beliefs, but they may equally reflect prevailing societal norms that make it difficult — or practically impossible — for pregnant teenagers to obtain abortions in certain regions.

Portrayal of Teen Pregnancy in Popular Culture

Perhaps one of the most alarming dimensions of teen pregnancy today is that it is receiving increasing attention in popular culture — but not always negative attention. For years, the prevailing tendency was to stigmatize teenage mothers, which often led to their ostracism from mainstream society. Pregnant teenagers were once even prohibited from attending the same schools as other students. There has since been a welcome trend toward greater compassion, since ostracizing teenage mothers only served to intensify the negative consequences of teen pregnancy. However, in recent years popular culture has focused on teen pregnancy in ways that many believe glamorize it.

The film Juno centered on a pregnant 16-year-old and her decision to carry the baby to term and place it for adoption. Because the title character was portrayed sympathetically and positively, many viewers felt the film promoted the idea of teen pregnancy as a manageable, even attractive, situation. Certain aspects of the film do not align with reality for most pregnant teens. For example, the character is notably self-possessed and benefits from strong family support (Jayson, 2008). In reality, most pregnant teenagers belong to otherwise high-risk groups and are unlikely to possess the resources or composure depicted in the film. While some parents do support their pregnant teenagers, many pregnant teens receive little or no family support at all. This does not mean Juno is entirely unrealistic, but it portrays a reality that applies to only a very small percentage of pregnant teenagers.

Even more disconcerting than Juno is the popular reality television series Teen Mom and the programming it has spawned. Following teenagers who become pregnant during high school, the series does portray some of the genuine hardships of teen parenthood. However, despite the fact that most of the young women featured are not exemplary parents and have done little to distinguish themselves otherwise, they have been welcomed into celebrity culture. The result is that teenage parenting may be perceived as glamorous, even if the show's content does not explicitly glamorize it. Teen pregnancy could be seen by some viewers as a pathway to fame and fortune. While most adults might dismiss this reading given the very real problems portrayed on the show and covered in tabloids, the concern is that teenagers lack the adult judgment required to interpret these messages critically. Indeed, one of the core problems with teen pregnancy is that teenagers have not yet fully developed the cognitive faculties of adults; expecting them to parse complex or contradictory media messages may be beyond many teenagers' abilities.

Other figures in popular culture have experienced teenage pregnancy with an apparent absence of lasting consequences. When Jamie Lynn Spears became pregnant as a teenager, her situation diverged sharply from that of the average teen mother: she had the financial resources to manage a pregnancy and a family willing to help raise the child. Similarly, teenage mothers such as Bristol Palin, who built a public profile around being an unwed teenage mother, do not represent the reality that most teenagers will face if they become pregnant. The fact is that any figure sufficiently public for her pregnancy to enter popular culture is so far removed from the circumstances that plague most teenage parents that she cannot serve as a realistic model for the average teenager.

Conclusion

Teen pregnancy may be one of the most confounding health problems facing modern Americans. Unlike other health conditions associated with pleasurable behaviors, there is no reduction in pleasure associated with using contraceptives, and yet sexually active teenagers frequently fail to do so. This reflects an underlying societal attitude that is critical of both contraceptive use and emerging female sexuality. Individually, a maternity nurse may not be able to change broad societal attitudes toward contraceptive use or adolescent sexuality. However, change does not need to be large to be meaningful. Preventing pregnancy in a single sexually active teenage girl can make a real difference in that girl's life and in the lives of her future children.