Reproductive Health

Adolescence marks the period between childhood and adulthood when hormonal changes transform boys and girls into young men and women able to have children of their own. Increasingly, adolescents are waiting until later to date and to have sex, and U.S. teen pregnancy and birth rates are at their lowest levels in years.[1],[2] Still, almost half of all high school students reported that they had had sexual intercourse in 2009[3] and three in ten adolescent females will become pregnant before turning 20.[4] Condom and contraceptive use is critical for adolescents to prevent pregnancy and sexually transmitted diseases. Among sexually active adolescents, male high school students were more likely to use a condom the last time they had sex than were females (69 percent vs. 54 percent).[5]

Dating and Sexual Relationships

Dating during adolescence is common and can be part of healthy development.[6] However, serious and exclusive dating relationships can lead adolescents to have sex earlier than they would have otherwise.[7]  Those who have sex at an early age are more likely to engage in risky sexual behaviors.[8],[9] Overall, the proportion of adolescents who have ever had sex has declined substantially since the early 1990s.[10] Of adolescents who have had sex, approximately one-third has had just one partner.[11] Sixteen percent has had two partners, 32 percent has had three to five partners, and 20 percent has had six or more partners.[12] Many adolescents are engaging in sexual behaviors other than vaginal intercourse: nearly one-half havehad oral sex, and just over one in 10 have had anal sex.[13]

Teen Pregnancy and Childbearing

Latest estimates reveal that more than 750,000 teen girls in the United States learn they are pregnant each year.[14] Although this number is the lowest in U.S. history, it is still higher than many other developed countries, including Canada and the U.K.[15] Teen parents face multiple risks for poor life outcomes: often, they fail to finish high school and are more likely to be poor as adults.[16] In all, one in six 15-year-old females will give birth by her 20th birthday and this number is higher for black and Hispanic adolescents. [17][18] Children born to adolescents face particular challenges—they are more likely to have poorer educational, behavioral, and health outcomes throughout their lives, as compared to children born to older parents.[19]  Teen pregnancy is an issue that many people are working to address. One of HHS Secretary Sebelius’s key priorities is to reduce teen and unintended pregnancy.

Sexually Transmitted Diseases

Adolescents account for about one-quarter of all STDs diagnosed every year, even though they make up a much smaller percentage of the sexually active population. Today, four in 10 sexually active teen girls have had an STD that can cause infertility and even death.[20]  Also, though rates of HIV are very low among adolescents, males make up more than two-thirds of HIV diagnoses among 13- to 19-year-olds.[21] STDs often have no obvious sign or physical symptom, so regular screenings are critical.[22] The most effective way to prevent STDs is to abstain from sexual activity; if teens are having sex, they should be using a condom correctly and with every sexual act. [23]

Contraceptive and Condom Use

Rates of teen pregnancy are higher in the U.S. than in other countries, in part because adolescents in the U.S. are less likely to use contraception.[24] Hormonal methods of birth control (such as the pill) and barrier methods (such as condoms) can reduce the risk of pregnancy,[25] and condom use with every sexual act can greatly reduce—though not eliminate—the risk of STDs.[26] Condom and contraceptive use among adolescents has increased since the 1990s, but many adolescents are inconsistent users: of those who had sex in the past month, almost one in four males and almost four in 10 females did not use a condom. [27]


 


[1] Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Births: Preliminary data for 2009. National Vital Statistics Reports 59(3): Hyattsville, MD: National Center for Health Statistics. Retrieved January 4, 2011, from http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_03.pdf
[2] Guttmacher Institute. (2010). U.S. teenage pregnancies, births and abortions: National and state trends and trends by race and ethnicity. Washington, DC: Guttmacher Institute. Retrieved January 7, 2011, from http://www.guttmacher.org/pubs/USTPtrends.pdf
[3] Centers for Disease Control and Prevention. (2010). Youth Risk Behavior Surveillance Survey - United States, 2009. Surveillance summaries: MMWR 2010; 59 (No. SS-5). Retrieved February 25, 2011, from http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf
[4] The National Campaign to Prevent Teen and Unplanned Pregnancy. (2011). Fast Facts: How was the 3 in 10 statistic calculated? Retrieved July 21, 2011, from http://www.thenationalcampaign.org/resources/pdf/FastFacts_3in10.pdf
[5] Centers for Disease Control and Prevention. (2010). Youth Risk Behavior Surveillance Survey - United States, 2009. Surveillance summaries: MMWR 2010; 59 (No. SS-5). Retrieved November 11, 2011, from http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf  
[6] Child Trends. (2010). Child Trends Databank: Dating. Retrieved December 1, 2010, from http://www.childtrendsdatabank.org/alphalist?q=node/151
[7] Kirby, D., & Lepore, G. (2007). Sexual risk and protective factors: Factors affecting teen sexual behavior, pregnancy, childbearing and sexually transmitted disease. Washington, DC: ETR Associates and The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved February 15, 2011, from http://www.etr.org/recapp/documents/theories/RiskProtectiveFactors200712.pdf
[8] Child Trends. (2010). Child Trends Databank: Dating. Retrieved December 1, 2010, from http://www.childtrendsdatabank.org/alphalist?q=node/151
[9] Collins, W. A., Welsh, D. P., & Furman, W. C. (2009). Adolescent romantic relationships. Annual Review of Psychology, 60, 631-652.
[10] Centers for Disease Control and Prevention (CDC). 1991-2009 high school Youth Risk Behavior Survey data. Retrieved April 27, 2011, from http://apps.nccd.cdc.gov/youthonline
[11] Martinez, G., Copen, C. E., & Abma, J. C. (2011). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth: National Center for Health Statistics. Vital Health Stat 23(31).  Retrieved November 11, 2011 from http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf 
[12] Martinez, G., Copen, C. E., & Abma, J. C. (2011). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth: National Center for Health Statistics. Vital Health Stat 23(31).  Retrieved November 11, 2011 from http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf 

[13] Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. (2011). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006-2008 National Survey of Family Growth: National Center for Health Statistics 36. Retrieved March 3, 2011, from http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf
[14] Guttmacher Institute. (2010). U.S. teenage pregnancies, births and abortions: National and state trends and trends by race and ethnicity. Washington, DC: Guttmacher Institute. Retrieved January 7, 2011, from http://www.guttmacher.org/pubs/USTPtrends.pdf
[15] Centers for Disease Control and Prevention. (2011). Preventing teen pregnancy in the US. Retrieved May 13, 2011, from http://www.cdc.gov/VitalSigns/TeenPregnancy/index.html
[16] Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: Economic costs and social consequences of teen pregnancy (2nd ed.). Washington, DC: Urban Institute Press. 
[17] Abma, J. C., Martinez, G. M., & Copen, C. E. (2010). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, National Survey of Family Growth 2006-2008. National Center for Health Statistics. Vital and Health Statistics, 23(30). Retrieved February 15, 2011, from http://www.cdc.gov/nchs/data/series/sr_23/sr23_030.pdf
[18] Welti, K. (2010). Child Trends' analysis of National Vital Statistics System birth data. Washington, DC: Child Trends.
[19] Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: Economic costs and social consequences of teen pregnancy (2nd ed.). Washington, DC: Urban Institute Press.
[20] Forhan, S. E., Gottlieb, S. L., Sternberg, M. R., Xu, F., Datta, S. D., McQuillan, G. M., et al. (2009). Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics, 124(6), 1505-1512.
[21] Centers for Disease Control and Prevention. (2010). Slideshow: HIV surveillance in adolescents and young adults. Retrieved February 14, 2011, from http://www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/slides/Adolescents.pdf
[22] Centers for Disease Control and Prevention. (2010). Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010; 59 (No. RR-12). Retrieved April 4, 2011, from http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf
[23] Centers for Disease Control and Prevention. (2010). Condoms and STDs: Fact sheet for public health personnel. Washington, DC: Centers for Disease Control and Prevention. Retrieved February 15, 2011, from http://www.cdc.gov/condomeffectiveness/latex.htm
[24] Darroch, J. E., Frost, J. J., & Singh, S. (2001). Differences in teenage pregnancy rates among five developed countries: The roles of sexual activity and contraceptive use. Family Planning Perspectives, 33(6), 244-250.
[25] Centers for Disease Control and Prevention. (2011). Unintended pregnancy prevention: Contraception. Retrieved Feb. 3, 2011, from http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
[26] Centers for Disease Control and Prevention. (2010). Condoms and STDs: Fact sheet for public health personnel. Washington, DC: Centers for Disease Control and Prevention. Retrieved February 15, 2011, from http://www.cdc.gov/condomeffectiveness/latex.htm
[27] Martinez, G., Copen, C. E., & Abma, J. C. (2011). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth: National Center for Health Statistics. Vital Health Stat 23(31).  Retrieved November 11, 2011 from http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf 

Last updated: February 25, 2014