[The Alan Guttmacher Institute: News Release] CONTACT: Susan Tew/Chris Kirchgaessner 212-248-1111 mediaworks@agi-usa.org EMBARGOED FOR RELEASE: 12:01 AM, THURSDAY, FEBRUARY 24, 2000 UNITED STATES AND THE RUSSIAN FEDERATION LEAD THE DEVELOPED WORLD IN TEENAGE PREGNANCY RATES U.S. Rate Remains Very High Despite Drop in 1990s Adolescent Childbearing and Pregnancy Declined the Industrialized World in the Last 25 Years The United States continues to have one of the highest rates of adolescent childbearing and pregnancy rates in the developed world, despite a substantial 17% decline in its teenage pregnancy rate in the 1990s, according to a new cross-country study by The Alan Guttmacher Institute (AGI). Currently, U.S. rates are akin to those in the Russian Federation and several eastern European countries, including Bulgaria, and at least four times the rates in France, Germany and Japan. The study, "Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries" by AGI researchers Susheela Singh and Jacqueline E. Darroch, reveals a widespread trend toward lower adolescent birthrates and pregnancy rates over the last 25 years across the industrialized world. Further, childbearing has declined over this period among women of all ages. The findings suggest that the possible reasons are "broad societal changes, as well as crosscutting socioeconomic, political and cultural characteristics of individual countries," including * greater importance ascribed to educational achievement and employment; * increased motivation among youth to delay sexual intercourse, pregnancy and childbearing to gain more education, job skills and economic stability before starting a family; * increased provision of sexuality education over the past decades, leading to greater knowledge of contraception, more effective contraceptive use and improved ability to negotiate contraceptive practice; and * greater social support for services for both pregnancy and disease prevention among adolescents. Indeed, a recent analysis by AGI, Why Is Teenage Pregnancy Declining? The Roles of Abstinence, Sexual Activity and Contraceptive Use, determined that at least in the United States (which, unlike other developed countries, has a strong abstinence movement), one-quarter of the drop in teenage pregnancy in the early and mid 1990s is attributable to delayed onset of sexual activity, but three-quarters is due to improved contraceptive use among sexually experienced teenagers. Authors Singh and Darroch, commenting on the large differentials between western European countries and U.S. rates, "the pragmatic European approach to teenage sexual activity, expressed in the form of widespread provision of confidential and accessible contraceptive services to adolescents, is viewed as a central factor in explaining the more rapid declines in teenage childbearing in northern and western European countries, in contrast to slower decreases in the United States." The new analysis is published in the January/February 2000 issue of the Institute's peer-reviewed professional journal Family Planning Perspectives. Part of a multiyear study supported by a grant from The Ford Foundation, it examines the levels of adolescent childbearing, abortion and pregnancy in developed countries in the mid-1990s, as well as trends over recent decades. Australia, Canada, Japan, New Zealand, the United States and all countries in Europe are included in the analysis. Data presented include * teenage birthrates for 46 developed countries over the period 1970-1995; * trend data on abortion and pregnancy rates for 25 of the 46 countries over the period of 1980-1995; and * abortion and pregnancy rates for the most recent year available for 33 of the 46 countries. Given that pregnancy consequences for younger teenagers are often of great social concern, the study also compares birthrates, abortion rates and pregnancy rates for adolescents aged 15-17 and 18-19. Data for the analysis were from various sources, including national vital statistics reports, official statistics, published national and international sources, and government statistical offices. AGI President Sara Seims, commenting further on the study findings notes: "Every country in the world is concerned about the sexual and reproductive lives of its young people. It is how each one expresses and acts upon this concern that makes the difference. In the United States, poverty and inequity clearly are behind much of our high rates of pregnancy, birth and abortion. But lack of sensitive, confidential, low-cost contraceptive services and the denial of accurate and frank information about sex and contraception, which extend from conflicted societal attitudes and a lack of openness about sex, are equally to blame. Our young people deserve better. We have a great deal to learn from the experience of our western European counterparts." ### YOUNG ADULTS BEAR THE BRUNT OF SEXUALLY TRANSMITTED DISEASES IN DEVELOPED COUNTRIES Rates of Gonorrhea and Chlamydia Among Teenagers Extremely High in the United States and the Russian Federation, Compared with Other Developed Countries In all but a few developed countries, teenagers and young adults aged 20-24, particularly young women, are disproportionately affected by sexually transmitted diseases (STDs). They account for more than one-fifth (and often more than one-third) of reported cases of syphilis, gonorrhea and chlamydia, according to a companion study to the cross-country analysis of teenage pregnancy rates also appearing in the journal. "Sexually Transmitted Diseases Among Adolescents in Developed Countries," by AGI researchers Christine Panchaud, Susheela Singh, Dina Feivelson and Jacqueline E. Darroch, reports that the incidence of the three STDs has generally decreased over the last decade, but rates remain quite high among adolescents in some countries. For the analysis, supported by a grant from The Henry J. Kaiser Family Foundation, data on the current incidence and recent trends of STDs among teenagers and young adults were obtained for 16 developed countries from official statistics, published national sources or scientific articles, and unpublished government statistics. The incidence of syphilis among teenagers is quite low in most developed countries (rates of less than seven cases per 100,000 teenagers). In fact, syphilis rates among teenagers declined in most countries between 1985 and 1990. However, syphilis rose dramatically in the Russian Federation in the 1990s and remains at a very high level there (211 per 100,000), as well as in Romania (58 per 100,000). Reasons for the STD epidemic in the Russian Federation include disruption and deterioration of health care service provision and increased sexual activity among adolescents. The reported incidence of gonorrhea among teenagers is also quite low (15 or less per 100,000) and declining in the majority of developed countries. However, it is substantial in some countries--Canada, England and Wales, and Romania (ranging from 59 to 77 per 100,000)--and exceptionally high in the Russian Federation and the United States (nearly 600 per 100,000). Reported incidence of chlamydia is extremely high among adolescents (between 563 and 1,132 cases per 100,000), and is highest in Denmark (1,081) and the United States (1,132). It is much higher among young women than among young men, largely because young women have more regular contact with medical providers and are more likely to be screened. While the rate of chlamydia declined overall in the 1990s in seven of the 10 countries with trend information, it appears to be increasing in some countries, including the United States. These increases, as well as the high incidence in some countries, are at least partly a reflection of more active screening programs. The authors note that differences in sexual behavior alone cannot explain why there is such variation among countries in the incidence of the three STDs, because there is little variation in sexual activity levels among teenagers in the countries examined. The analysts suggest that the comparatively high rate of STDs among U.S. youth may reflect both that some teenagers have difficulty in accessing good-quality medical care for diagnosis and treatment, and that the United States has less-widespread and less-intensive prevention policies than most European countries. According to the researchers, their findings suggest some broad priorities in efforts to reduce risky behavior and the incidence of STDs among young adults: raising awareness among the general population, policymakers and health care providers about the problem of STDs among youth; increasing prevention efforts, especially for the socially and economically disadvantaged; and implementing well-designed education programs and behavioral interventions, particularly before teenagers initiate sexual relationships. They also note several other policy approaches that have been shown to affect STD incidence: * implementing active screening, partner notification and partner referral practices; * providing comprehensive services including health education and direct STD services that are integrated into other types of health care (such as family planning); and * adapting STD facilities to the specific needs of youth. In sum, the authors suggest, "Declines in STDs in some countries, in particular the Nordic countries, offer hope that it is possible to reduce the burden of STDs through a combination of information and education programs, partner notification and active screening strategies, better access to STD health care, and programs promoting behavioral change." ### The Alan Guttmacher Institute is a nonprofit organization focused on reproductive health research, policy analysis and public education, with offices in New York City and Washington, D.C. copyright 2000, The Alan Guttmacher Institute.