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The Influence of American Views and Beliefs on
Teenage Pregnancy Rates in the United States
I'M ALREADY PREGNANT, SO WHAT OTHER KIND OF SHENANIGANS COULD I GET INTO?"
(JUNO, 2007)
The U.S. has always been seen as the ‘land of the free’ where opportunities wait for everyone. Nevertheless, there is one specific area of life in which there is a limit on freedom.
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Sex.
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A topic, which basically every human can identify with but which is still stigmatised beyond the pond. While priding themselves to be the ‘greatest country’ on Earth, it is shocking to see that this prude nation, which favours abstinence until marriage, is the country with the highest rate of teenage pregnancies among the developed world. Allegedly, the reason for this is stigmatisation, poor sex education in schools and a religion based society, which would rather stay silent than even dare to talk about something as sinful as the primal urge of bodily pleasure.
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While these ideas seem to represent the truth, there is reason to doubt that stereotypes truly reflect reality. One should question whether there really are that many teenage pregnancies, what sex education is truly like and whether a country like Germany is really that different from the US in terms of adolescent contraceptive use and teen pregnancy rates.
THE EVOLVEMENT OF TEENAGE PREGNANCY RATES IN THE U.S.
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When looking at the development of the number of teen pregnancies, a general tendency or trend becomes visible:
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Reasons as to why teenage pregnancies in the U.S. have decreased are not easy to pinpoint, especially as not a lot of research has been conducted in this area. However, the main possible causes of the decline are said to be delayed sexual intercourse as well as improvements in contraceptives. Between 1995 and 2012, as reported by Lindberg et al., the use of some form of birth control increased from 66% to 86% among 14 to 18-year-olds, with a tremendous rise from 11% to 37% in the implementation of multiple forms of protection during a sexual act.
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Although a general decrease of adolescent pregnancies and birth rates has taken place in all states of America, geographic, socioeconomic and racial/ethnic disparities persist. A study conducted by the U.S. Department of Health and Human Services showed that in 2017 the teen birth rates of Hispanic and non-Hispanic black teenagers were twice as high as those of non-Hispanic white adolescents. The data also indicates a correlation between adolescent birth rates and socioeconomic factors, as areas with high frequencies of teenage pregnancies also proved to have higher rates of unemployment as well as lower educational qualifications and family income. Geographic differences often correspond with the distinction between red (leaning towards Republican views) and blue (leaning towards Democratic beliefs) states, which can be seen in 2016, where teenage pregnancy rates were highest in the (predominantly red) South and Southwest.
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In conclusion, to say it in the words of Evelyn M. Kappeler, “although the teen birth rate has declined, there is still work to be done”.
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Multiple statistics indicate that these days American teenagers are significantly less likely to become pregnant than decades ago. In 1988 for instance, roughly 18 out of 1,000 14-year-olds were pregnant, whereas in 2016 this number dropped to 3 out of 1,000 equating to a decrease of 1.5% of pregnancies among this age group. Further, in 2016 merely 15 among 1,000 teenagers aged 15 to 17 were pregnant, whereas 27 years earlier it had been roughly 75 per 1,000 adolescents. This equals a decrease of 6% of pregnancies among 15-17 year-olds from 1989 to 2016. Similarly, while in 1991 still 175 out of 1,000 women aged 18 to 19 were pregnant, 2016 recorded only 60 pregnancies among 1,000 females of this age.
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Fig. 1: Trends in pregnancy rates among women aged 24 or younger, by age group, 1973-2016 (Guttmacher, 2020)
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HISTORY OF “THE BIRDS AND THE BEES” TALK IN SCHOOLS
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Regarding the history and development of sex education in the US, there is not much to tell:
The wild and free 70s opened up a formal introduction of a sexual education through the Title X Family Planning Program of the Public Health Services Act passed by Congress. After that an abstinence-only education was promoted for the next 30 to 40 years.
It was only in 2010, when new sex education programmes which favoured an evidence-based curriculum were introduced under a blue congress. These programmes are the Teen Pregnancy Prevention Program (TPPP) and the Personal Responsibility Education Program (PREP). Both were instituted under the highly discussed Affordable Care Act, often referred to as Obamacare.
In the most recent years, Republican President Donald Trump wanted to cancel TPPP and SRAE, the Sexual Risk Avoidance Education Program and Sexual Risk Avoidance Education pre-dating 2010, which lead to five lawsuits. With Democrat Joe Biden as the president-elect it is likely that developments in this area are possible in the next couple of years.
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“DON’T HAVE SEX, CAUSE YOU WILL GET PREGNANT AND DIE”: ABSTINENCE-ONLY VS. COMPREHENSIVE SEX EDUCATION
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As seen from the political discussion surrounding the topic, inconsistency is also what dominates the American way information about sex is taught. Most prominently, there appears to be a clash between abstinence-only and comprehensive sex education.
Take a look at this infamous quote taken from the teen comedy film Mean Girls:
“Don’t have sex, cause you will get pregnant and die. Don’t have sex in the missionary position, don’t have sex standing up, kids don’t do it, promise?” [...] At your age you’re gonna have a lot of urges. You’re gonna wanna take off your clothes and touch each other. But if you do touch each other, you will get chlamydia and die.”
Although we laugh at Coach Carr’s attempt of sex education, and although we might think that this does not represent the real world, abstinence-only does exist and has been taught in the United States for quite some time. Abstinence-only sex education, as its name already hints at, teaches the idea of abstinence until marriage, omitting the endorsement of contraceptive use and a discussion of different forms of birth control. In contrast, a comprehensive sex education not only covers the topics aforementioned, but generally is a more thorough teaching method that wants to enable adolescents to make appropriate choices regarding their sex lives. Very recently, Fisher et al. discovered that sexually transmitted diseases are influenced, next to a general shortage of information and societal influences, by an absence of comprehensive sex education. In addition, receiving a more in-depth teaching increases the chance of making healthier sex choices, instead of, as some abstinence-only supporters’ argument, encouraging sexual behaviour in the first place. Following research, despite the reinforcement of stereotypes, the promotion of stigmatisation, the exclusion of minority groups and the lack of support for adolescents’ rights, abstinence-only remains a common method of sex education.
Some people have even called sex education a matter of red state versus blue state, alluding to the affiliation of abstinence-only and comprehensive sex education with social conservatives and social liberals. Talbot indicates that this division might be also connected to specific religious beliefs, which in turn influence attitudes towards sex, including first sexual contact or behaviour towards contraceptives. For example, she refers to evangelical adolescents, who predominantly refrain from having sex outside of marriage. For a more in-depth look at the role religion plays in the USA, check out this article.
The multifacetedness of sex education is not limited to two movements, but also extends to religion, political philosophies and even party interest.
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BLUE AND RED SEX - POLITICS AND SEX EDUCATION
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A recent study in this area conducted by Kantor et al. (2020) displays opinions on sex education of likely voters of either party. The study surveyed 1,001 participants deriving from different age groups, ethnicities, and educational backgrounds. Out of those participants, 54.0% identified as likely Democratic voters and 46.0% identified as likely voters of the GOP.
The study found that both groups strongly supported the teaching of sex education in high schools (82.7% overall, 73.4% Republican, 90.0% Democrat), whereas there was more of a divergence when asked about teaching sex education in middle schools (64.1% overall, 49.0% Republican, 76.8% Democrat). So, both groups support teaching sex ed, however Democratic voters favour teaching it earlier on.
Heterogeneous opinions in between the parties appeared when asked about the topics that should be discussed in sex education. The topic ‘sexual orientation’ did not achieve much support by either group (68.6% overall for middle schools, 78.9% overall for high schools) with Democrats (83.3% for middle schools, 91.3% for high schools) being significantly more in favour than Republicans (48.1% for middle schools, 63.1% for high schools). Additionally, the study demonstrated that Republicans favour the teaching of abstinence, while Democrats want sex education to teach adolescents information on birth control methods, consent or healthy relationships.
Finally, the study consulted participants on their opinions about state funded teen pregnancy prevention programmes (TPPP and PREP). Both the majority of Democrats (87.9%) and Republicans (56.3%) expressed that they were pro supporting federally funded programmes. Nevertheless, there is a difference of more than 30% of support between the likely voters of either group. Most surveyed (74.4%) answered that “programmes should focus on both ‘encouraging teens to postpone sex and providing teens with information about birth control and protection from sexually transmitted infections’“. Slight differences could only be found on whether these programmes should only focus on making teens delay sex, which was favoured more by Republicans or whether they should also offer information on birth control strongly supported by Democrats.
As we mentioned before and as is visible from this study, views on sex education seem to correlate with party affiliation.
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"THEY WERE TALKING IN HEALTH CLASS ABOUT HOW PREGNANCY CAN LEAD TO … AN INFANT”: TEEN’S OPINIONS ON SEX ED AND PREGNANCY PREVENTION PROGRAMS
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This quote is taken from the 2007 film Juno, which covers an American teenager’s unplanned pregnancy. While it indicates that the character did receive a sex education class in school, it also shows that apparently this Health class was ineffective as the character Juno ends up pregnant anyway.
What becomes clear through the film is that nowadays youth should also be included in the conversation on sex education and teen pregnancy prevention programs as they are the ones whom decisions and opinions are being made about.
A survey of interviews of adolescents about their opinions on the matter was conducted by Fisher et al. in 2020. 41 participants aged 13-22 from a mid-sized US city were asked about their knowledge of current prevention activities, behaviour of youth seeking information, personal opinions on how to address teen pregnancy and STIs. Among the 41 participants, a great variety of ethnicities was included as well as homeless teens and former wards of the state.
The results of the survey give an interesting insight into the teen’s opinions:
Most teens named school’s sex education classes as the main source of information, while acknowledging that there was not enough class time or classes offered in general. Additionally, they noted that there was great divergence in what schools were allowed to teach and what teenagers really wanted to learn. Furthermore, the study found that sex education in schools tends to be highly ineffective as most teens surveyed were unable to recall what they had learned there. This seems to coincide with Juno’s experience in the film named above.
Regarding information seeking, the youth highlighted that teens tend to only seek information once they are confronted with an issue. The main reason for this, according to the teens is stigmatisation of the topics which leads to shame and embarrassment.
Personal views on sex education strongly included that more discussion in the school environment, peer-to-peer talks as well as discussion of the topics at home and in the media was desirable. Additionally, teens wanted sex education to be more comprehensive and more accurate. Moreover, the adolescents suggested that sex education should be started earlier and that adults who are not teachers should be trained to provide advice for those in need. Other ideas included STI testing in school, offering separate classes for boys and girls as well as providing condoms.
With regard to the delivery of information, adolescents wished that it should be truthful not belittling, that peer-educators should be introduced and that potentially incentives might increase the number of those attending. New technology was seen as the best approach for providing private and confidential information.
The study clearly shows that teens do have strong opinions and ideas about sex education and teen pregnancy prevention programs. What becomes obvious is that teens prefer to be acknowledged as mature when it comes to these topics and that they do not feel that the stigmatisation of the topic aids in their seeking for help and information.
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EAST SIDE, WEST SIDE: TEENAGE PREGNANCY OUTSIDE THE U.S.
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“In recent years, the United States has had the highest rate of adolescent pregnancy of any of the world’s developed nations.”(Santelli)
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“Despite substantial declines over the last two decades, USA continues to have the highest teenage birth rate of any industrialised country.” (Simpsa)
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What these quotes taken from research articles have in common is the observation that teenage pregnancies are more prominent in the United States than in other industrialised countries. Additionally, both lack information on some other countries.
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In comparison to Germany, who has a lower adolescent pregnancy rate according to Guttmacher, the U.S. taboos adolescent sexuality, which also explains its execution of sex education. Instead of a nationwide implementation, sex education appears to be taught rather inconsistently amidst American schools. This is different in Germany, where according to the Federal Centre for Health Education (BZgA), 93% of adolescents polled are taught sex education at school and 80% admitted that this is their main source of information about all kinds of questions regarding sex. However, similarly to the U.S., young people belonging to disadvantaged groups often stated that their school did not cover sex education extensively.
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Something the U.S. and Germany have in common is their choice of sex education topics, as birth control methods, STDs, puberty and healthy relationships are taught at most German schools as well. Surprisingly, sexual orientation tends to also be a left-out topic in a lot of German schools.
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Although there are no recent numbers available publicly, the most current statistics being from 2011 (cf. Cygan-Rhem and Riphahn), the pregnancy rate in Germany appears to be below the European average and is definitely lower than in the United States. Regional differences within the adolescent pregnancy rate are not limited to the United States however. While one of the main forces behind teenage pregnancies in the U.S. appears to be the division of its nation in red and blue states—including their distinctive values and norms—fertility rates also seem to differ considerably in Germany, particularly between East and West Germany. West German adolescent birth rates have dropped since 1990, but East Germany recorded a positive trend of teenage pregnancies at that point in time. Nevertheless, the figure also shows that from 2010 onwards there was a downward trend in East Germany again. In 2010 at least, 6 out of 1,000 West German teenagers, and 14 out of 1,000 East German adolescents gave birth to a child. In contrast, as we have seen before, the United States still had higher numbers six years later. Overall, it is indicated that the German reunification and East Germany’s disadvantaged status contributed to its higher pregnancy rate and the slow downward trend starting from 2010 onwards.
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According to the National Center for Health Statistics, American female teenagers aged 15 to 19 tend to contracept with a condom (97%), followed by withdrawal (65%) and the pill (53%). The next best methods are fertility awareness (11%) and long-acting reversible contraception (LARC) (20%). In contrast to that, as reported by Oppelt, the pill is the most used form of birth control among German teenagers (70%), followed by the condom (48%) and the vaginal ring, implant and three-month injection (4%). Some German teenagers even stated that their favourite method to contracept is a combination of the pill and a condom.
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Following Guttmacher, access to contraceptives varies across all American states. For instance, Georgia allows all minors to make use of contraceptive services, whereas Florida has stricter rules determining which adolescent is allowed to employ them. Even among those states sharing either Georgia’s or Florida’s view, differences might occur. For example, while underage girls in Florida can get contraceptives due to health reasons, marriage, parent’s wish or pregnancy prevention, South Carolina only allows it in cases of marriage or if the person is 16 years old. Even though Georgia grants those services to all minors, there are states like New York or Wyoming, who in addition offer confidential contraceptive care.
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In contrast to the United States, most teenagers have easy access to different contraceptive methods in Germany. In 2015, 96% of those teenagers polled by the Federal Centre for Health Education stated that they used some form of contraception during their last sexual intercourse. One of the possible reasons behind this high percentage is that underage girls can get prescriptions for contraceptives without involving their parents if necessary. Another cause might be that prescription-only contraceptives are covered by medical insurance until the age of 22, which ensures that, due to the construct of a ‘compulsory insurance’, potential financial difficulties do not arise. This is not the case in the United States though. As a consequence, medically insured women might have access to free forms of birth control, but those people uninsured have to pay high prices for the doctor’s visit to obtain a prescription as well as the contraceptive.
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Fig. 2: Minors' Access to Contraceptive Services (Guttmacher, 2021)
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CONCLUSION
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Although the numbers of teenage pregnancies are declining, the United States still remains at the top of that list, indicating that this stereotype is accurate. While recent numbers are hard to find, more American teens get pregnant today than their German counterparts six years ago. Additionally, the sex education question, which is strongly connected with politics and regulations seems to negatively influence teen pregnancy rates in the United States. The lack of access to and price of contraception also impacts American teens in this area. Overall, the stigmatisation of sexual intercourse among teens seems to be the dominating force influencing sex education and acceptance of contraceptive use, which puts American teens in higher risks of getting pregnant than German ones. What recent surveys show is that especially American teens are wishing for more acceptance and information from adults.
SOURCES
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“Adolescent Pregnancy and its Outcomes Across Countries.” Guttmacher Institute, August 2015, www.guttmacher.org/fact-sheet/adolescent-pregnancy-and-its-outcomes-across-countries#. Accessed 24 December 2020.
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Bode, Heidrun, and Angelika Heßling. Jugendsexualität 2015: Die Perspektive der 14- bis 25-Jährigen. Ergebnisse einer aktuellen Repräsentativen Wiederholungsbefragung. Germany, Bundesministerium für Gesundheit, Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung), 2015, www.forschung.sexualaufklaerung.de/fileadmin/fileadmin-forschung/pdf/Jugendendbericht%2001022016%20.pdf. Accessed 25 December 2020.
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Crump, James. “The Contraceptive Pill: How it differs in the US and UK.” Independent, May 2020, www.independent.co.uk/news/world/americas/contraceptive-pill-us-uk-costs-reproductive-rights-america-a9500631.html. Accessed 25 December 2020.
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Cygan-Rehm, Kamila, and Regina T. Riphahn. “Teenage Pregnancies and Births in Germany: Patterns and Developments.” Applied Economics, vol. 46, no. 28, 2014, pp. 3503-3522. Taylor and Francis Online, doi.org/10.1080/00036846.2014.932045. Accessed 24 December 2020.
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Fisher, Christopher M., et al. “Adolescent Perspectives on Addressing Teenage Pregnancy and Sexually Transmitted Infections in the Classroom and Beyond.” Sex Education, vol. 20, no. 1, 2020, pp. 90–100. Taylor and Francis Online, doi:10.1080/14681811.2019.1618257. Accessed 16 December 2020.
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Juno. Directed by Jason Reitman and Diablo Cody, performances by Elliot Page (formerly Ellen Page), Michael Cera, Jennifer Garner and Jason Bateman, Searchlight Pictures, 2007.
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Kappeler, Evelyn M. „Adolescent Health and Teen Pregnancy in the United States: A Progress Report.” Public Health Reports, vol. 130 no. 3, June 2015, pp. 196-198. PubMed Central, doi: 10.1177/003335491513000304. Accessed 21 December 2020.
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Kantor, Leslie, et al. “Support for Sex Education and Teenage Pregnancy Prevention Programmes in the USA: Results from a National Survey of Likely Voters.” Sex Education, vol. 20, no. 3, 2020, pp. 239–51. Taylor and Francis Online, doi: 10.1080/14681811.2019.1652807. Accessed 16 December 2020.
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Kramer, Alisha S. “Framing the Debate: The Status of US Sex Education Policy and the Dual Narratives of Abstinence-Only Versus Comprehensive Sex Education Policy.” American Journal of Sexuality Education, vol. 14, no. 4, 2019, pp. 490–513. Taylor and Francis Online, doi:10.1080/15546128.2019.1600447. Accessed 16 December 2020.
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Lindberg, Laura et al. “Understanding the Decline in Adolescent Fertility in the United States, 2007-2020.” Journal of Adolescent Health, vol. 59, no. 5, April 2016, pp. 577-583. ScienceDirect, doi.org/10.1016/j.jadohealth.2016.06.024. Accessed 21 December 2020.
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Mean Girls. Directed by Mark Waters and Tina Fey, performances by Lindsay Lohan, Rachel McAdams, Tim Meadows, Ana Gasteyer, and Amy Poehler, Paramount Pictures, 2004.
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Oppelt, Patricia G. et al. “Situation of Adolescent Contraceptive Use in Germany.” Geburtshilfe und Frauenheilkunde, vol. 78, no. 10, 2018, pp. 999-1007. PubMed, doi: 10.1055/a-0684-9838. Accessed 25 December 2020.
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Santelli, John S. et al. “Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use.” American Public Health Association, vol. 97, no. 1, January 2007, pp. 150-156. PubMed, doi: 10.2105/AJPH.2006.089169. Accessed 23 December 2020.
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Sipsma, Heather L., et al. “Impact of Social Service and Public Health Spending on Teenage Birth Rates Across the USA: An Ecological Study.” BMJ Open, vol. 7, no. 5, 2017, pp. 1-6. PubMed, doi:10.1136/bmjopen-2016-013601. Accessed 16 December 2020.
Talbot, Margaret. “Red Sex, Blue Sex: Why do so many evangelical teenagers become pregnant?” The New Yorker, 2008, www.newyorker.com/magazine/2008/11/03/red-sex-blue-sex. Accessed 26 December 2020.
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