Teenage pregnancy
Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20.[2] Pregnancy can occur with sexual intercourse after the start of ovulation, which can be before the first menstrual period (menarche) but usually occurs after the onset of periods.[5] In well-nourished females, the first period usually takes place around the age of 12 or 13.
Pregnant teenagers face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth.[7] For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age.[8] Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.)
Teenage pregnancies are associated with social issues, including lower educational levels and poverty.[3] Teenage pregnancy in developed countries is usually outside of marriage and is often associated with a social stigma.[11] Teenage pregnancy in developing countries often occurs within marriage and half are planned.[3] However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems. When used in combination, educational interventions and access to birth control can reduce unintended teenage pregnancies
In 2015 about 47 females per 1,000 had children well under the age of 20.[3] Rates are higher in Africa and lower in Asia.[3] In the developing world about 2.5 million females under the age of 16 and 16 million females 15 to 19 year old have children each year.[3] Another 3.9 million have abortions.[3] It is more common in rural than urban areas.[3] Worldwide, complications related to pregnancy are the most common cause of death among females 15 to 19 year old
Pregnant teenagers face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth.[7] For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age.[8] Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.)
Teenage pregnancies are associated with social issues, including lower educational levels and poverty.[3] Teenage pregnancy in developed countries is usually outside of marriage and is often associated with a social stigma.[11] Teenage pregnancy in developing countries often occurs within marriage and half are planned.[3] However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems. When used in combination, educational interventions and access to birth control can reduce unintended teenage pregnancies
In 2015 about 47 females per 1,000 had children well under the age of 20.[3] Rates are higher in Africa and lower in Asia.[3] In the developing world about 2.5 million females under the age of 16 and 16 million females 15 to 19 year old have children each year.[3] Another 3.9 million have abortions.[3] It is more common in rural than urban areas.[3] Worldwide, complications related to pregnancy are the most common cause of death among females 15 to 19 year old
Definition
The age of the mother is determined by the easily verified date when the pregnancy ends, not by the estimated date of conception.[14] Consequently, the statistics do not include pregnancies that began at age 19, but that ended on or after the woman's 20th birthday.[14] Similarly, statistics on the mother's marital status are determined by whether she is married at the end of the pregnancy, not at the time of conception.
The age of the mother is determined by the easily verified date when the pregnancy ends, not by the estimated date of conception.[14] Consequently, the statistics do not include pregnancies that began at age 19, but that ended on or after the woman's 20th birthday.[14] Similarly, statistics on the mother's marital status are determined by whether she is married at the end of the pregnancy, not at the time of conception.
Effects
According to the United Nations Population Fund (UNFPA), "Pregnancies among girls less than 18 years of age have irreparable consequences. It violates the rights of girls, with life-threatening consequences in terms of sexual and reproductive health, and poses high development costs for communities, particularly in perpetuating the cycle of poverty."[15] Health consequences include not yet being physically ready for pregnancy and childbirth leading to complications and malnutrition as the majority of adolescents tend to come from lower-income households. The risk of maternal death for girls under age 15 in low and middle income countries is higher than for women in their twenties.[15] Teenage pregnancy also affects girls' education and income potential as many are forced to drop out of school which ultimately threatens future opportunities and economic prospects.[16]
Several studies have examined the socioeconomic, medical, and psychological impact of pregnancy and parenthood in teens. Life outcomes for teenage mothers and their children vary; other factors, such as poverty or social support, may be more important than the age of the mother at the birth. Many solutions to counteract the more negative findings have been proposed. Teenage parents who can rely on family and community support, social services and child-care support are more likely to continue their education and get higher paying jobs as they progress with their education.[17]
A holistic approach is required in order to address teenage pregnancy. This means not focusing on changing the behaviour of girls but addressing the underlying reasons of adolescent pregnancy such as poverty, gender inequality, social pressures and coercion. This approach should include "providing age-appropriate comprehensive sexuality education for all young people, investing in girls' education, preventing child marriage, sexual violence and coercion, building gender-equitable societies by empowering girls and engaging men and boys and ensuring adolescents' access to sexual and reproductive health information as well as services that welcome them and facilitate their choices".[16]
In the United States one third of high school students reported being sexually active. In 2011–2013, 79% of females reported using birth control. Teenage pregnancy puts young women at risk for health issues, economic, social and financial issues
According to the United Nations Population Fund (UNFPA), "Pregnancies among girls less than 18 years of age have irreparable consequences. It violates the rights of girls, with life-threatening consequences in terms of sexual and reproductive health, and poses high development costs for communities, particularly in perpetuating the cycle of poverty."[15] Health consequences include not yet being physically ready for pregnancy and childbirth leading to complications and malnutrition as the majority of adolescents tend to come from lower-income households. The risk of maternal death for girls under age 15 in low and middle income countries is higher than for women in their twenties.[15] Teenage pregnancy also affects girls' education and income potential as many are forced to drop out of school which ultimately threatens future opportunities and economic prospects.[16]
Several studies have examined the socioeconomic, medical, and psychological impact of pregnancy and parenthood in teens. Life outcomes for teenage mothers and their children vary; other factors, such as poverty or social support, may be more important than the age of the mother at the birth. Many solutions to counteract the more negative findings have been proposed. Teenage parents who can rely on family and community support, social services and child-care support are more likely to continue their education and get higher paying jobs as they progress with their education.[17]
A holistic approach is required in order to address teenage pregnancy. This means not focusing on changing the behaviour of girls but addressing the underlying reasons of adolescent pregnancy such as poverty, gender inequality, social pressures and coercion. This approach should include "providing age-appropriate comprehensive sexuality education for all young people, investing in girls' education, preventing child marriage, sexual violence and coercion, building gender-equitable societies by empowering girls and engaging men and boys and ensuring adolescents' access to sexual and reproductive health information as well as services that welcome them and facilitate their choices".[16]
In the United States one third of high school students reported being sexually active. In 2011–2013, 79% of females reported using birth control. Teenage pregnancy puts young women at risk for health issues, economic, social and financial issues
Teenager
Being a young mother in a first world country can affect one's education. Teen mothers are more likely to drop out of high school.[20] One study in 2001 found that women that gave birth during their teens completed secondary-level schooling 10–12% as often and pursued post-secondary education 14–29% as often as women who waited until age 30.[21] Young motherhood in an industrialized country can affect employment and social class. Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers.
According to the National Campaign to Prevent Teen Pregnancy, nearly 1 in 4 teen mothers will experience another pregnancy within two years of having their first.[23] Pregnancy and giving birth significantly increases the chance that these mothers will become high school dropouts and as many as half have to go on welfare. Many teen parents do not have the intellectual or emotional maturity that is needed to provide for another life.[citation needed] Often, these pregnancies are hidden for months resulting in a lack of adequate prenatal care and dangerous outcomes for the babies.[24] Factors that determine which mothers are more likely to have a closely spaced repeat birth include marriage and education: the likelihood decreases with the level of education of the young woman – or her parents – and increases if she gets married.
Being a young mother in a first world country can affect one's education. Teen mothers are more likely to drop out of high school.[20] One study in 2001 found that women that gave birth during their teens completed secondary-level schooling 10–12% as often and pursued post-secondary education 14–29% as often as women who waited until age 30.[21] Young motherhood in an industrialized country can affect employment and social class. Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers.
According to the National Campaign to Prevent Teen Pregnancy, nearly 1 in 4 teen mothers will experience another pregnancy within two years of having their first.[23] Pregnancy and giving birth significantly increases the chance that these mothers will become high school dropouts and as many as half have to go on welfare. Many teen parents do not have the intellectual or emotional maturity that is needed to provide for another life.[citation needed] Often, these pregnancies are hidden for months resulting in a lack of adequate prenatal care and dangerous outcomes for the babies.[24] Factors that determine which mothers are more likely to have a closely spaced repeat birth include marriage and education: the likelihood decreases with the level of education of the young woman – or her parents – and increases if she gets married.
Child
Early motherhood can affect the psychosocial development of the infant. The children of teen mothers are more likely to be born prematurely with a low birth weight, predisposing them to many other lifelong conditions.[26] Children of teen mothers are at higher risk of intellectual, language, and socio-emotional delays.[24] Developmental disabilities and behavioral issues are increased in children born to teen mothers.[27][28] One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs.[27] Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment.[29]
Poor academic performance in the children of teenage mothers has also been noted, with many of the children being held back a grade level, scoring lower on standardized tests, and/or failing to graduate from secondary school.[20] Daughters born to adolescent parents are more likely to become teen mothers themselves. Sons born to teenage mothers are three times more likely to serve time in prison.
Early motherhood can affect the psychosocial development of the infant. The children of teen mothers are more likely to be born prematurely with a low birth weight, predisposing them to many other lifelong conditions.[26] Children of teen mothers are at higher risk of intellectual, language, and socio-emotional delays.[24] Developmental disabilities and behavioral issues are increased in children born to teen mothers.[27][28] One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs.[27] Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment.[29]
Poor academic performance in the children of teenage mothers has also been noted, with many of the children being held back a grade level, scoring lower on standardized tests, and/or failing to graduate from secondary school.[20] Daughters born to adolescent parents are more likely to become teen mothers themselves. Sons born to teenage mothers are three times more likely to serve time in prison.
Medical
Maternal and prenatal health is of particular concern among teens who are pregnant or parenting. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers.[8][20][32] In a rural hospital in West Bengal, teenage mothers between 15 and 19 years old were more likely to have anemia, preterm delivery, and a baby with a lower birth weight than mothers between 20 and 24 years old.[33]
Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all.[8] The Guttmacher Institute reports that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to have health issues in childhood or be hospitalized than those born to older women.[34]
In the case for Latinas and teenage pregnancy, there are barriers that prevent them from receiving any health care. That is because the Latino population is the least insured group in the Unites States [35]
Young mothers who are given high-quality maternity care have significantly healthier babies than those who do not. Many of the health-issues associated with teenage mothers appear to result from lack of access to adequate medical care.[36]
Many pregnant teens are at risk of nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals, food faddism, snacking, and consumption of fast food.[37]
Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries.[38][39] Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in developing countries each year. Young mothers and their babies are also at greater risk of contracting HIV.[7] The World Health Organization estimates that the risk of death following pregnancy is twice as high for girls aged 15–19 than for women aged 20–24. The maternal mortality rate can be up to five times higher for girls aged 10–14 than for women aged 20–24. Illegal abortion also holds many risks for teenage girls in areas such as sub-Saharan Africa.[40]
Risks for medical complications are greater for girls aged under 15, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labour is normally dealt with by caesarean section in industrialized nations; however, in developing regions where medical services might be unavailable, it can lead to eclampsia, obstetric fistula, infant mortality, or maternal death.[7][16] For mothers who are older than fifteen, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology
Maternal and prenatal health is of particular concern among teens who are pregnant or parenting. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers.[8][20][32] In a rural hospital in West Bengal, teenage mothers between 15 and 19 years old were more likely to have anemia, preterm delivery, and a baby with a lower birth weight than mothers between 20 and 24 years old.[33]
Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all.[8] The Guttmacher Institute reports that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to have health issues in childhood or be hospitalized than those born to older women.[34]
In the case for Latinas and teenage pregnancy, there are barriers that prevent them from receiving any health care. That is because the Latino population is the least insured group in the Unites States [35]
Young mothers who are given high-quality maternity care have significantly healthier babies than those who do not. Many of the health-issues associated with teenage mothers appear to result from lack of access to adequate medical care.[36]
Many pregnant teens are at risk of nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals, food faddism, snacking, and consumption of fast food.[37]
Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries.[38][39] Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in developing countries each year. Young mothers and their babies are also at greater risk of contracting HIV.[7] The World Health Organization estimates that the risk of death following pregnancy is twice as high for girls aged 15–19 than for women aged 20–24. The maternal mortality rate can be up to five times higher for girls aged 10–14 than for women aged 20–24. Illegal abortion also holds many risks for teenage girls in areas such as sub-Saharan Africa.[40]
Risks for medical complications are greater for girls aged under 15, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labour is normally dealt with by caesarean section in industrialized nations; however, in developing regions where medical services might be unavailable, it can lead to eclampsia, obstetric fistula, infant mortality, or maternal death.[7][16] For mothers who are older than fifteen, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology
Risk factors
Culture
Rates of teenage pregnancies are higher in societies where it is traditional for girls to marry young and where they are encouraged to bear children as soon as they are able. For example, in some sub-Saharan African countries, early pregnancy is often seen as a blessing because it is proof of the young woman's fertility.[40] Countries where teenage marriages are common experience higher levels of teenage pregnancies. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities than in cities.[47] Many teenagers are not taught about methods of birth control and how to deal with peers who pressure them into having sex before they are ready. Many pregnant teenagers do not have any cognition of the central facts of sexuality.[48]
Economic incentives also influence the decision to have children. In societies where children are set to work at an early age, it is economically attractive to have many children.[49]
In societies where adolescent marriage is less common, such as many developed countries, young age at first intercourse and lack of use of contraceptive methods (or their inconsistent and/or incorrect use; the use of a method with a high failure rate is also a problem) may be factors in teen pregnancy.[50][51] Most teenage pregnancies in the developed world appear to be unplanned.[51][52] Many Western countries have instituted sex education programs, the main objective of which is to reduce unplanned pregnancies and STIs. Countries with low levels of teenagers giving birth accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality.[53]
Other family members
Teen pregnancy and motherhood can influence younger siblings. One study found that the younger sisters of teen mothers were less likely to emphasize the importance of education and employment and more likely to accept human sexual behavior, parenting, and marriage at younger ages. Younger brothers, too, were found to be more tolerant of non-marital and early births, in addition to being more susceptible to high-risk behaviors.[54] If the younger sisters of teenage parents babysit the children, they have an increased probability of getting pregnant themselves.[55] Once an older daughter has a child, parents often become more accepting as time goes by.[56] A study from Norway in 2011 found that the probability of a younger sister having a teenage pregnancy went from 1:5 to 2:5 if the elder sister had a baby as a teenager.[57]
Sexuality
See also: Adolescent sexuality
In most countries, most males experience sexual intercourse for the first time before their 20th birthday.[58] Males in Western developed countries have sex for the first time sooner than in undeveloped and culturally conservative countries such as sub-Saharan Africa and much of Asia.[58]
In a 2005 Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported "being in a relationship where they felt things were moving too fast sexually", and 24% had "done something sexual they didn’t really want to do".[59] Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex.[60][61] The increased sexual activity among adolescents is manifested in increased teenage pregnancies and an increase in sexually transmitted diseases.
Role of drug and alcohol use
Inhibition-reducing drugs and alcohol may possibly encourage unintended sexual activity. If so, it is unknown if the drugs themselves directly influence teenagers to engage in riskier behavior, or whether teenagers who engage in drug use are more likely to engage in sex. Correlation does not imply causation. The drugs with the strongest evidence linking them to teenage pregnancy are alcohol, cannabis, "ecstasy" and other substituted amphetamines. The drugs with the least evidence to support a link to early pregnancy are opioids, such as heroin, morphine, and oxycodone, of which a well-known effect is the significant reduction of libido – it appears that teenage opioid users have significantly reduced rates of conception compared to their non-using, and alcohol, "ecstasy", cannabis, and amphetamine using peers.[50][59][62][63]
Early puberty
Main article: Precocious puberty
Girls who mature early (precocious puberty) are more likely to engage in sexual intercourse at a younger age, which in turn puts them at greater risk of teenage pregnancy.[64]
Lack of contraception
Main article: Birth control
Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information.[60][65] Contraception for teenagers presents a huge challenge for the clinician. In 1998, the government of the UK set a target to halve the under-18 pregnancy rate by 2010. The Teenage Pregnancy Strategy (TPS) was established to achieve this. The pregnancy rate in this group, although falling, rose slightly in 2007, to 41.7 per 1,000 women. Young women often think of contraception either as 'the pill' or condoms and have little knowledge about other methods. They are heavily influenced by negative, second-hand stories about methods of contraception from their friends and the media. Prejudices are extremely difficult to overcome. Over concern about side-effects, for example weight gain and acne, often affect choice. Missing up to three pills a month is common, and in this age group the figure is likely to be higher. Restarting after the pill-free week, having to hide pills, drug interactions and difficulty getting repeat prescriptions can all lead to method failure.[66]
In the US, according to the 2002 National Survey of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than older women to use contraceptives (18% of 15–19-year-olds used no contraceptives, versus 10.7% for women aged 15–44).[67] More than 80% of teen pregnancies are unintended.[68] Over half of unintended pregnancies were to women not using contraceptives,[67] most of the rest are due to inconsistent or incorrect use.[68] 23% of sexually active young women in a 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who did not use a condom, while 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor.[60]
The National Longitudinal Study of Adolescent Health surveyed 1027 students in the US in grades 7–12 in 1995 to compare the use of contraceptives among Whites, Blacks, and Hispanics. The results were that 36.2% of Hispanics said they never used contraception during intercourse which is a high rate compared to 23.3% of Black teens and 17.0% of White teens who also did not use contraceptives during intercourse[69]
In a 2012 study, over 1,000 females were surveyed to find out factors contributing to not using contraception. Of those surveyed, almost half had been involved in unprotected sex within the previous three months. These women gave three main reasons for not using contraceptives: trouble obtaining birth control (the most frequent reason), lack of intention to have sex, and the misconception that they "could not get pregnant".[70]
In a study for the Guttmacher Institute, researchers found that from a comparative perspective, however, teenage pregnancy rates in the US are less nuanced than one might initially assume. "Since timing and levels of sexual activity are quite similar across [Sweden, France, Canada, Great Britain, and the US], the high U.S. rates arise primarily because of less, and possibly less-effective, contraceptive use by sexually active teenagers."[71] Thus, the cause for the discrepancy between rich nations can be traced largely to contraceptive-based issues.
Among teens in the UK seeking an abortion, a study found that the rate of contraceptive use was roughly the same for teens as for older women.[72]
In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly, forget to take oral contraceptives, or fail to use the contraceptives they had previously chosen. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users.[62] Long-acting contraceptives such as intrauterine devices, subcutaneous contraceptive implants, and contraceptive injections (such as Depo-Provera and combined injectable contraceptive), which prevent pregnancy for months or years at a time, are more effective in women who have trouble remembering to take pills or using barrier methods consistently.
According to Encyclopedia of Women's Health, published in 2004, there has been an increased effort to provide contraception to adolescents via family planning services and school-based health, such as HIV prevention education
Culture
Rates of teenage pregnancies are higher in societies where it is traditional for girls to marry young and where they are encouraged to bear children as soon as they are able. For example, in some sub-Saharan African countries, early pregnancy is often seen as a blessing because it is proof of the young woman's fertility.[40] Countries where teenage marriages are common experience higher levels of teenage pregnancies. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities than in cities.[47] Many teenagers are not taught about methods of birth control and how to deal with peers who pressure them into having sex before they are ready. Many pregnant teenagers do not have any cognition of the central facts of sexuality.[48]
Economic incentives also influence the decision to have children. In societies where children are set to work at an early age, it is economically attractive to have many children.[49]
In societies where adolescent marriage is less common, such as many developed countries, young age at first intercourse and lack of use of contraceptive methods (or their inconsistent and/or incorrect use; the use of a method with a high failure rate is also a problem) may be factors in teen pregnancy.[50][51] Most teenage pregnancies in the developed world appear to be unplanned.[51][52] Many Western countries have instituted sex education programs, the main objective of which is to reduce unplanned pregnancies and STIs. Countries with low levels of teenagers giving birth accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality.[53]
Other family members
Teen pregnancy and motherhood can influence younger siblings. One study found that the younger sisters of teen mothers were less likely to emphasize the importance of education and employment and more likely to accept human sexual behavior, parenting, and marriage at younger ages. Younger brothers, too, were found to be more tolerant of non-marital and early births, in addition to being more susceptible to high-risk behaviors.[54] If the younger sisters of teenage parents babysit the children, they have an increased probability of getting pregnant themselves.[55] Once an older daughter has a child, parents often become more accepting as time goes by.[56] A study from Norway in 2011 found that the probability of a younger sister having a teenage pregnancy went from 1:5 to 2:5 if the elder sister had a baby as a teenager.[57]
Sexuality
See also: Adolescent sexuality
In most countries, most males experience sexual intercourse for the first time before their 20th birthday.[58] Males in Western developed countries have sex for the first time sooner than in undeveloped and culturally conservative countries such as sub-Saharan Africa and much of Asia.[58]
In a 2005 Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported "being in a relationship where they felt things were moving too fast sexually", and 24% had "done something sexual they didn’t really want to do".[59] Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex.[60][61] The increased sexual activity among adolescents is manifested in increased teenage pregnancies and an increase in sexually transmitted diseases.
Role of drug and alcohol use
Inhibition-reducing drugs and alcohol may possibly encourage unintended sexual activity. If so, it is unknown if the drugs themselves directly influence teenagers to engage in riskier behavior, or whether teenagers who engage in drug use are more likely to engage in sex. Correlation does not imply causation. The drugs with the strongest evidence linking them to teenage pregnancy are alcohol, cannabis, "ecstasy" and other substituted amphetamines. The drugs with the least evidence to support a link to early pregnancy are opioids, such as heroin, morphine, and oxycodone, of which a well-known effect is the significant reduction of libido – it appears that teenage opioid users have significantly reduced rates of conception compared to their non-using, and alcohol, "ecstasy", cannabis, and amphetamine using peers.[50][59][62][63]
Early puberty
Main article: Precocious puberty
Girls who mature early (precocious puberty) are more likely to engage in sexual intercourse at a younger age, which in turn puts them at greater risk of teenage pregnancy.[64]
Lack of contraception
Main article: Birth control
Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information.[60][65] Contraception for teenagers presents a huge challenge for the clinician. In 1998, the government of the UK set a target to halve the under-18 pregnancy rate by 2010. The Teenage Pregnancy Strategy (TPS) was established to achieve this. The pregnancy rate in this group, although falling, rose slightly in 2007, to 41.7 per 1,000 women. Young women often think of contraception either as 'the pill' or condoms and have little knowledge about other methods. They are heavily influenced by negative, second-hand stories about methods of contraception from their friends and the media. Prejudices are extremely difficult to overcome. Over concern about side-effects, for example weight gain and acne, often affect choice. Missing up to three pills a month is common, and in this age group the figure is likely to be higher. Restarting after the pill-free week, having to hide pills, drug interactions and difficulty getting repeat prescriptions can all lead to method failure.[66]
In the US, according to the 2002 National Survey of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than older women to use contraceptives (18% of 15–19-year-olds used no contraceptives, versus 10.7% for women aged 15–44).[67] More than 80% of teen pregnancies are unintended.[68] Over half of unintended pregnancies were to women not using contraceptives,[67] most of the rest are due to inconsistent or incorrect use.[68] 23% of sexually active young women in a 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who did not use a condom, while 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor.[60]
The National Longitudinal Study of Adolescent Health surveyed 1027 students in the US in grades 7–12 in 1995 to compare the use of contraceptives among Whites, Blacks, and Hispanics. The results were that 36.2% of Hispanics said they never used contraception during intercourse which is a high rate compared to 23.3% of Black teens and 17.0% of White teens who also did not use contraceptives during intercourse[69]
In a 2012 study, over 1,000 females were surveyed to find out factors contributing to not using contraception. Of those surveyed, almost half had been involved in unprotected sex within the previous three months. These women gave three main reasons for not using contraceptives: trouble obtaining birth control (the most frequent reason), lack of intention to have sex, and the misconception that they "could not get pregnant".[70]
In a study for the Guttmacher Institute, researchers found that from a comparative perspective, however, teenage pregnancy rates in the US are less nuanced than one might initially assume. "Since timing and levels of sexual activity are quite similar across [Sweden, France, Canada, Great Britain, and the US], the high U.S. rates arise primarily because of less, and possibly less-effective, contraceptive use by sexually active teenagers."[71] Thus, the cause for the discrepancy between rich nations can be traced largely to contraceptive-based issues.
Among teens in the UK seeking an abortion, a study found that the rate of contraceptive use was roughly the same for teens as for older women.[72]
In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly, forget to take oral contraceptives, or fail to use the contraceptives they had previously chosen. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users.[62] Long-acting contraceptives such as intrauterine devices, subcutaneous contraceptive implants, and contraceptive injections (such as Depo-Provera and combined injectable contraceptive), which prevent pregnancy for months or years at a time, are more effective in women who have trouble remembering to take pills or using barrier methods consistently.
According to Encyclopedia of Women's Health, published in 2004, there has been an increased effort to provide contraception to adolescents via family planning services and school-based health, such as HIV prevention education
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