THE RECENT DEBATE about the pregnancy rate among adolescents in Australia has led to increased interest in the most successful way to prevent unintended pregnancies, and in the potential contribution of sex education with young people in schools. We address these questions in the light of the available evidence on effective sexual health education, and current Australian policy and practice.
Teenage pregnancy and its outcomes
In Australia in 1995 there were 43.6 pregnancies per 1000 young women aged 15-19 years, and this rate had been stable for the previous 10 years. This is relatively low in comparison to the same age group in the USA (83.6 per 1000), and is comparable to other Western developed nations like New Zealand (54 per 1000), England (47 per 1000) and Canada (45.4 per 1000). Overall in Australia in 1995, there were 19.8 births and 23.8 terminations per thousand young women aged 15-19 years. The vast majority of the births (88%) were to single women, and at least some of them were probably the result of planned and wanted pregnancies.2
Many studies have demonstrated that there are negative associations between early childbearing and social, economic and health outcomes, both for the mother and for society. For young women, the social, emotional and physical consequences of early motherhood can present a considerable burden, including an increased risk of antenatal complications and mortality, failure to complete schooling, socioeconomic disadvantage and maternal depression. The children of teenage mothers have been found to have increased rates of health problems, physical injury, behavioural and cognitive difficulties and educational underachievement.2-4
These problems are not only a consequence of teenage parenting, as teenage pregnancy is associated with economic and social disadvantage.2,5 In Australia and other similar countries, births to teenagers are higher in disadvantaged and remote areas than in urban or affluent areas.3
Accurate data is collected on the number of terminations in South Australia, Western Australia and the Northern Territory, but SA is the only state that publishes these data. In the period 1995-1999, a little over half of all teenage pregnancies in South Australia ended in a termination.6 These factors have led to calls for improved interventions, including sexual health education, to reduce the number of pregnancies.
Success of interventions to prevent teen pregnancy
Few programs have proven successful in preventing unintended pregnancy in teenagers. Those that have been evaluated and have shown longterm positive effects have been social interventions that start early to address social disadvantages. The Children's Aid Society-Carrera Program in New York worked with 600 disadvantaged adolescents aged 13-15 over a 3-year period. Half were assigned to a control group and half received an intervention that involved a comprehensive youth development program including a "job club", tutoring and homework help, family life and sex education, self expression through the arts, and individual sport activities. The control group received a less intensive after-school program typically run for disadvantaged youth by the Children's Aid Society. After 3 years the control group were twice as likely as the intervention group to report a birth.7 Furthermore, the girls in the intervention group were less likely to be sexually active or to have been pregnant. This program was offered to both boys and girls, and the changes were all noted in the girls; no effect was noted on the behaviour of the boys.4
A few other longer-term interventions have also been shown to have some impact on preventing teenage pregnancy. An evaluation of day care programs for pre-schoolers aimed at families from lower socioeconomic areas in the USA showed lower rates of teenage pregnancy to be among its long-term beneficial effects, particularly when programs with parents were included. …