Teen Pregnancy Prevention Focusing on Evidence: Ineffective Abstinence-Only Lessons Being Replaced with Science

Article excerpt

DECEMBER marked a new day for sex education in America, with the elimination of federal abstinence-only funds and renewed support for evidence-based health curricula. Recent months also marked a new challenge for such efforts: For the first time in more than a decade, the U.S. teen pregnancy rate rose.

Shortly before the new year, President Barack Obama signed an appropriations bill that ended federal funding for existing abstinence-only-until-marriage programs and put a new teenage pregnancy prevention initiative in the newly funded Office of Adolescent Health within the U.S. Department of Health and Human Ser vices. Supported with more than $114 million in federal funds, the prevention initiative is being hailed by health advocates for its focus on the evidence. Of the $114 million, $75 million will go toward replicating pregnancy prevention programs that have been thoroughly evaluated and provide the strongest evidence of success, while $25 million will go to programs that show promise and innovation. There are roughly 400,000 teen births every year in the United States, with about $9 billion in associated public costs.

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"This administration and this Congress have made a historic investment in preventing teen pregnancy," said Bill Albert, chief program officer at the National Campaign to Prevent Teen and Unplanned Pregnancy. "In our view, this investment could not be more timely given the fact that the teen pregnancy rate in the United States is on the rise. I think one might say, without hyperbole, that one of the nation's great success stories of the past two decades may be in danger of unraveling. So, this investment is right on for content and right on for timeliness."

While the nation's teen pregnancy rate declined about 40 percent between 1990 and 2005, data released by the Guttmacher Institute in late January showed that the rate rose 3 percent in 2006. According to the institute, the new data is "especially noteworthy because they provide the first documentation of what experts have suspected for several years, based on trends in teens' contraceptive use--that the overall teen pregnancy rate would increase in the mid-2000s following steep declines in the 1990s and a subsequent plateau in the early 2000s." And like many other health issues, the U.S. teen pregnancy rate is checkered with disparities. In 2006, among black and Hispanic teens ages 15 to 19, there were about 126 pregnancies per 1,000 women, while among white teens, it was 44 per 1,000. Such statistics mean the United States has the unfortunate honor of having the highest teen birth rate among Western, industrialized nations.

"As a society, we have to continually redouble our efforts to sustain these kinds of (downward) trends over time," said Heather Boonstra, MA, senior public policy associate at the Guttmacher Institute, which conducts research on a range of sexual and reproductive health issues. "We can't just sit back because new teens are constantly coming into the field and we have to remain vigilant."

Factors shaping the recent rise in teen pregnancy are varied and complex, prevention advocates say, ranging from years of federal support for rigid abstinence-only programs to tempered fears of contracting HIV to less teen contraceptive use. According to the 2007 National Youth Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention, rates of teens who were sexually active and those who used a condom during their last sexual encounter remained statistically stalled from 2005 to 2007, following years of positive behavior change. Of teens who were sexually active, only about 61 percent used a condom the last time they had sex, CDC reported. According to Lorrie Gavin, PhD, MPH, a health scientist within CDC's Division of Reproductive Health, current trends point to more than just a teen pregnancy problem--"there's something else going on ... improvements in sexual risk behavior have leveled off in recent years and rates of some sexually transmitted diseases have increased. …