Teenage pregnancy is defined as a teenaged or underaged girl (usually within the ages of 13–19) becoming pregnant. The term in everyday speech usually refers to women who have not reached legal adulthood, which varies across the world, who become pregnant.
The average age of menarche (first menstrual period) in the United States is 12 years old, though this figure varies by ethnicity and weight, and first ovulation occurs only irregularly until after this. The average age of menarche has been declining and continues to do so. Whether fertility leads to early pregnancy depends on a number of factors, both societal and personal. Worldwide, rates of teenage pregnancy range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea.
Pregnant teenagers face many of the same obstetrics issues as women in their 20s and 30s. However, there are additional medical concerns for younger mothers, particularly those under 15 and those living in developing countries. For mothers between 15 and 19, age in itself is not a risk factor, but additional risks may be associated with socioeconomic factors.
Data supporting teenage pregnancy as a social issue in developed countries include lower educational levels, higher rates of poverty, and other poorer "life outcomes" in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. For these reasons, there have been many studies and campaigns which attempt to uncover the causes and limit the numbers of teenage pregnancies. In other countries and cultures, particularly in the developing world, teenage pregnancy is usually within marriage and does not involve a social stigma.
Among OECD developed countries, the United States and United Kingdom have the highest level of teenage pregnancy, while Japan and South Korea have the lowest.
Global incidence
Main article: Global incidence of teenage pregnancySave the Children found that, annually, 13 million children are born to women under age 20 worldwide, more than 90% in developing countries. Complications of pregnancy and childbirth are the leading cause of mortality among women between the ages of 15 and 19 in such areas. The highest rate of teenage pregnancy in the world is in sub-Saharan Africa, where women tend to marry at an early age. In Niger, for example, 87% of women surveyed were married and 53% had given birth to a child before the age of 18.
In the Indian subcontinent, early marriage sometimes means adolescent pregnancy, particularly in rural regions where the rate is much higher than it is in urbanized areas. The rate of early marriage and pregnancy has decreased sharply in Indonesia and Malaysia, although it remains relatively high. In the industrialized Asian nations such as South Korea and Singapore, teenage birth rates are among the lowest in the world.
The overall trend in Europe since 1970 has been a decreasing total fertility rate, an increase in the age at which women experience their first birth, and a decrease in the number of births among teenagers. Most continental Western European countries have very low teenage birth rates. This is varyingly attributed to good sex education and high levels of contraceptive use (in the case of the Netherlands and Scandinavia), traditional values and social stigmatization (in the case of Spain) or both (in the case of Italy and Switzerland).
The teenage birth rate in the United States is the highest in the developed world, and the teenage abortion rate is also high. The U.S. teenage pregnancy rate was at a high in the 1950s and has decreased since then, although there has been an increase in births out of wedlock. The teenage pregnancy rate decreased significantly in the 1990s; this decline manifested across all racial groups, although teenagers of African-American and Hispanic descent retain a higher rate, in comparison to that of European-Americans and Asian-Americans. The Guttmacher Institute attributed about 25% of the decline to abstinence and 75% to the effective use of contraceptives. However, in 2006 the teenage birth rate rose for the first time in fourteen years. This could imply that teen pregnancy rates are also on the rise, however the rise could also be due to other sources: a possible decrease in the number of abortions or a decrease in the number of miscarriages, to name a few. The Canadian teenage birth has also trended towards a steady decline for both younger (15–17) and older (18–19) teens in the period between 1992–2002.
Causes of teenage pregnancy
In some societies, early marriage and traditional gender roles are important factors in the rate of teenage pregnancy. 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. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities compared to the rate in cities.
In societies where adolescent marriage is uncommon, young age at first intercourse and lack of contraceptive use may be factors in teen pregnancy. Most teenage pregnancies in the developed world appear to be unplanned.
Adolescent sexual behavior
See also: Adolescent sexualityAccording to information available from the Guttmacher Institute, sex by age 20 is the normal age across the world, and countries with low levels of adolescent pregnancy accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality.
However, in a 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". Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex. 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 to teenage pregnancy are cannabis, alcohol, and amphetamines, including "ecstasy". 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 cannabis, alcohol, and amphetamine using peers. Amphetamines are widely prescribed to treat ADHD – internationally, the countries with the highest rates of recorded amphetamine prescription to teenagers also have the highest rates of teenage pregnancy.
Contraception
Main article: birth controlAdolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information.
In the United States, according to the 2002 National Surveys of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10.7% average for women ages 15 to 44). More than 80% of teen pregnancies are unintended. Over half of unintended pregnancies were to women not using contraceptives, most of the rest are due to inconsistent or incorrect use. 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.
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.
In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly or forget to take oral contraceptives. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users. Reversible longer term methods such as intrauterine devices, subcutaneous implants, or injections (Depo provera, Combined injectable contraceptive), require less frequent user action, lasting from a month to years, and may prevent pregnancy more effectively in women who have trouble following routines, including many young women. The simultaneous use of more than one contraceptive measure further decreases the risk of unplanned pregnancy, and if one is a condom barrier method, the transmission of sexually transmitted disease is also reduced.
Age discrepancy in relationships
According to the conservative lobbying organization "Family Research Council," studies in the US indicate that age discrepancy between the teenage girls and the men who impregnate them is an important contributing factor. Teenage girls in relationships with older boys, and in particular with adult men, are more likely to become pregnant than teenage girls in relationships with boys their own age. They are also more likely to carry the baby to term rather than have an abortion. A review of California's 1990 vital statistics found that men older than high school age fathered 77 percent of all births to high school-aged girls (ages 16–18), and 51 percent of births to
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