Understanding the Decline in Adolescent Fertility in the United States, 2007–2012

Abstract

PurposeThe decline in U.S. adolescent fertility has accelerated since 2007. Modeling fertility change using behavioral data can inform adolescent pregnancy prevention efforts.MethodsWe used data on sexual activity and contraceptive use from National Surveys of Family Growth for young women 15–19 years of age, and contraceptive failure rates, to estimate a Pregnancy Risk Index (PRI) for the periods 2007, 2009, and 2012. Logistic regression was used to test for change over time in sexual activity, contraceptive use, and PRI. Statistical decomposition was used to calculate attribution of change in the PRI to changes in sexual activity or contraceptive method use.ResultsSexual activity in the last 3 months did not change significantly from 2007 to 2012. Pregnancy risk declined among sexually active adolescent women (p = .046), with significant increases in the use of any method (78%–86%, p = .046) and multiple methods (26%–37%, p = .046). Use of highly effective methods increased significantly from 2007 to 2009 (38%–51%, p = .010). Overall, the PRI declined at an annual rate of 5.6% (p = .071) from 2007 to 2012 and correlated with birth and pregnancy rate declines. Decomposition estimated that this decline was entirely attributable to improvements in contraceptive use.ConclusionsImprovements in contraceptive use appear to be the primary proximal determinants of declines in adolescent pregnancy and birth rates in the United States from 2007 to 2012. Efforts to further improve access to and use of contraception among adolescents are necessary to ensure they have the means to prevent pregnancy.

Examining the Role of the Pediatric Emergency Department in Reducing Unintended Adolescent Pregnancy

“…The PRI score for a woman who was not sexually active in the past 3 months or who was sexually inexperienced was set to zero. 25, 27–29 The overall PRI serves as the mean of individual PRI scores and summarizes the risk of pregnancy at the population level. A PRI of 5, for example, equates to 5 expected pregnancies per 100 adolescent females per year.…”

“…29 For the sexually experienced subgroup, we conducted similar analyses to identify sociodemographic factors associated with having an individual PRI above the PRI of 18 found in a nationally representative sample of sexually active adolescents. 29 Co-variables of interest included race/ethnicity, age category (14-17 vs 18-21), insurance type, prior pregnancy, and presentation for a potential reproductive-health concern. Chief complaints categorized as presentation for a potential reproductive health concern included: pregnancy test request, concern for sexually transmitted infection, dysuria, vaginal bleeding, vaginal discharge, lower abdominal/pelvic pain.…”

Evolution of the shape of the fertility curve: Why might some countries develop a bimodal curve?

“…However, unlike the trends seen in the former communist countries, in the United States the bimodal pattern has become ever more accentuated since the 1970s. Although teenage fertility rates in the United States have declined significantly (Lindberg, Santelli, and Desai 2016), the early mode is still evident, with a dip in hazard rates for women around age 23. Is this evidence of the polarization of American society along racial, regional, educational, and socioeconomic fault lines?…”

“Without bodily autonomy we are not free”: exploring women’s concerns about future access to contraception following the 2016 US presidential election

“…In the U.S., abortion rates have declined to a new low, with less than 1 million procedures performed in 2014 [23]. This decline is likely reflective of recent reductions in the rate of unintended pregnancy due to increased use of highly effective contraceptive methods [26–29]. …”