Despite recent declines, the current level of births to adolescents continues to be much higher in the United States than in most other developed countries.1 Continued decreases in U.S. rates have only succeeded in moving the country's levels slightly closer to where those of most other developed countries were during the late 1990s.2 (By 2000, the teenage birthrate in the United States had declined to 49 per 1,000, as compared with late-1990s rates of 7-9 in Sweden and France, and 20-31 in Canada and Great Britain.)
Large differences in adolescent pregnancy rates were also identified in the early 1980s in a comparative study of developed countries. At that time, differences in sexual activity were not found to account for the variation in pregnancy rates; instead, the limited available information suggested that use of contraceptives, particularly the pill, by teenage women was lower in the United States than in other developed countries. Building on this body of information and using the most recent data available, we address the following questions: How large are cross-country differences in pregnancy, birth and abortion rates, and to what extent are current differences associated with variation across countries in sexual behavior and contraceptive use?
These results are part of a large-scale investigation that examined reasons for the wide variation in teenage pregnancy and birth rates among five developed countries: Canada, France, Great Britain, Sweden and the United States. Although all five focus countries have a high per capita income and are highly developed and industrialized, they differ in their extent of social and economic inequality, in their government policies and programs that address inequality, in their health care systems and their provision of services to teenagers, and in their societal attitudes concerning sexuality and adolescents. All of these factors are likely to affect adolescent reproductive behavior.
In addition to having a higher adolescent pregnancy rate, the United States has higher rates of sexually transmitted diseases (STDs) among adolescents than most other developed countries.5 The incidence of chlamydia among adolescents in the United States (1,132 cases per 100,000) is nearly twice that in Canada and Sweden (where reporting is relatively complete), five times that in England, and 20 times that in France (two countries where reporting is considered to be less complete, as it is in the United States). The annual incidence of gonorrhea among all U.S. adolescents (572 cases per 100,000) is 10 or more times the level in the other four countries.
Large differences in pregnancy and STD rates may be due to differences in the proportion of adolescent women who are sexually active and, therefore, are at risk of pregnancy and infection. Alternatively, they may be related to variation among sexually active adolescent women in the steps that they take to prevent pregnancy and STD infection, including their use of contraceptives, their choice of method and the effectiveness of their method use. While we do not have information on all of these measures, some information is available to help us assess variation in the two key factors of sexual activity and method use across countries.
Orginal Article:http://www.guttmacher.org/pubs/journals/3324401.html
By Jacqueline E. Darroch, Susheela Singh, Jennifer J. Frost and the Study Team
