Increased use of birth control, and, some say, other wide-ranging variables such as abstinence-only education and a poor economy, are playing key roles in driving the US teen birthrate to a record low, according to new data from the Centers for Disease Control and Prevention.
The CDC's National Center for Health Statistics reported in November that the rate declined 9 percent from 2009 to 2010, with 34.3 births per 1,000 teens ages 15 to 19. That marks the largest single-year drop since 1946-47 – and the lowest level ever reported in the United States.
Teenage birthrates have tracked a relatively steady downward trend since 1991, when the rate was 61.8 births per 1,000 teens. (The rates were 52.2 in 1981, 64.5 in 1971, and 88.6 in 1961.)
In a world dominated by an increasingly image-oriented and sexualized culture, what's afoot? What accounts for this abundance of caution? The answers depend upon whom you ask.
Take Elizabeth Reis and daughter Leah Reis-Dennis. They each used the word "embarrassing" to describe their first talk about birth control, which Elizabeth initiated about a month into Leah's relationship with a high school boyfriend.
But that unease quickly gave way to relief. Ms. Reis knew that her daughter, then 16 and a high school student in Eugene, Ore., was on the pill and being careful, and Ms. Reis-Dennis benefited from her mother's knowledge and support. Perhaps most important, they learned there was clear agreement between them – a baby was not an option.
Advocates for birth control, sex education, and reproductive health rights point to that kind of parent-child dialogue as a reason for the change in the teen birthrate. They say parents are no longer in ready denial about their teen's sexual activity. Young people, too, are educating themselves about their options.
Currently 26 states and the District of Columbia allow minors to consent to contraceptive services without a parent's approval. Another 20 states allow some minors – those who have health issues, or are married, pregnant, or deemed mature – to do the same. But it's education and communication that make the difference, advocates say. And teens are listening.
"I've always planned on living an adventurous and mobile life," says Reis-Dennis, now a junior at Harvard University in Cambridge, Mass. "Pregnancy is something that is a huge responsibility that I know I'm not ready for." She adds: "I would really encourage parents to bring up the conversation. Even if they think their teenager doesn't want to hear it."
Increasing numbers of teens are seeking out birth control, according to a Guttmacher Institute analysis of CDC data from the National Survey of Family Growth. Among sexually active teens, 37 percent used hormonal contraceptives between 2006 and 2008. Between 2008 and 2010, that number rose to 47 percent.
Advocates also note an uptick in "dual use" protection – teen boys are using condoms and their female partners are on birth control. Almost one-quarter – 23.2 percent – of 15-to-19-year-olds in the National Survey of Family Growth embraced both methods between 2008 and 2010, according to Guttmacher, which promotes sexual and reproductive health through research. That's up from 16.1 percent over the prior two-year period.
Those who press for expanded birth-control access for teens were disappointed, however, when Health and Human Services Secretary Kathleen Sebelius decided Dec. 7 to keep the emergency contraceptive pill known as Plan B One-Step unavailable to anyone younger than 17, without a prescription. The issue has been politically contentious, pitting parental rights against teen access to emergency contraception.
Behind the trend in lower birthrates for teens (and a decline in abortions, too) is "more effective" sex education, says Leslie Kantor, vice president of education for the Planned Parenthood Federation of America. "Whether it's in the public school system or community-based venues, we've really learned over the last 20 years what kinds of programs help young people to really change their behavior."
Supporters of abstinence-only education look at these studies, however, and see numbers that back their approach.
The share of teenagers who have had sex is also on the decline, the National Survey of Family Growth shows. In 1988, 51.1 percent of girls ages 15 to 19 were sexually active; between 2006 and 2010, that figure fell to 42.6 percent. For boys in the same age group, 60.4 percent were sexually active in 1988, compared with 41.8 percent in the latest study.
"The one thing we know for certain is more teens are waiting to have sex, which tells us this is a message that's resonating with them," says Valerie Huber, executive director of the National Abstinence Education Association in Washington.
While the Bush administration endorsed abstinence-focused policies, President Obama has placed a higher premium on sex education programs, devoting $155 million in the 2011 budget to evidence-based teen pregnancy prevention efforts. Ms. Kantor, of Planned Parenthood, hopes that funding will pay dividends in coming years with a continued decline in the teen birthrate.
Some experts suggest that another variable may be in play – the economy. During tough fiscal times, the birthrate tends to drop across age groups. In 2007, more than 4.3 million babies were born in the US, according to the Pew Research Center. That number hovered around 4 million in 2010.
"In a tighter economic context, people are maybe more attentive to the costs involved in childbearing," says Dr. Lawrence Finer of Guttmacher Institute.
Getting pregnant too young has emotional and long-term financial costs, of course. Reis, an associate professor of women's and gender studies at the University of Oregon in Eugene, says she broached the matter not only with her daughter but has talked with her students, too. One promising freshman she knew dropped out of college after getting pregnant and having a child. Her parents had never discussed the merits of birth control; abstinence was their only directive.
Reis hoped to ensure that scenario would not play out with Leah.
"Just because we're having the conversation doesn't mean you have to have sex," she told her teen. "I just want you to be prepared."