teen pregnancy

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United States Pregnancy Rates Continue to Drop

Monday, May 26th, 2014

For decades, pregnancy rates in US women have been sliding, and this is largely thanks to a steep decline in teen pregnancies, according to a new report.

The study showed that teenage pregnancies reached a historic low in 2009. For all US women between 15 and 44 years of age, the pregnancy rate in 2009 was 102.1 per 1,000 women, down 12% since 1990. The only time it has been lower was in 1997, and even then, the difference was slight. The birth rate for married women is 72% higher than for unmarried women; the abortion rate is five times higher for unmarried women than for married women, and has also dropped overall.

For women across all categories, unintended pregnancy accounts for almost all abortions, so the decline in abortion rates is closely correlated with the decline in unintended pregnancies, and this has been seen in all groups including married women. Increasing options and education are clearly beneficial for all women.

Pregnancy rates are down in every category except women over 30, the only group with a continually increasing incidence of pregnancy. Women in their 20s represent the largest group of pregnant women, but even their rates have dropped.

The data stopped at 2009 because the complete set of more recent data is not available yet, but newer statistics do suggest that pregnancy rates continue to decline, although at a slower pace than the dramatic drop from 1990 to 2009.

The recession that began in 2007 probably has had an impact. Birth rates plummeted during the Great Depression of the 1930s; a similar effect is probably taking place now. In addition, women have been having fewer children than their mothers and grandmothers, and more women are waiting until their 30s to start their families, waiting for either the economy or their personal financial situations to stabilize.

While the levelling-off of the decline in most categories may be a sign of the recession’s abating impact, the teen birth rate shows no signs of slowing its striking drop. In 2012, the teen birth rate was less than half its 1992 peak of 62 birth per 1,000 girls, making this the group with the largest decline. The data show that fewer teenagers are having sex as well as a significant increase in contraceptive use among the ones that do. The exact reasons for the decline may not be clear, but those teaching both abstinence and sexual health, including contraceptive use, are probably on the right track.

Even with the decline, the pregnancy rate in the United States is still among the highest in the industrialized countries. The countries with the ten highest birth rates worldwide are all located in Africa.

– Yvonne S. Thornton, M. D., M. P. H

Doctors Not Spending Enough Time Talking to Teens about Sexual Health

Thursday, January 16th, 2014

The sex lives of adolescents is a topic which many parents – and, apparently, doctors – would often prefer to avoid. But since almost half of high school students have had sex, we can’t pretend the sex lives of teenagers are nonexistent, nor can we neglect to teach adolescents about being responsible for their sexual health. Unfortunately, a recent study showed that only about 65% of physicians are talking to teens about sex, and when they do, the conversation lasts only an average of 36 seconds.

None of the 253 teenage patients in the study brought up sex themselves during their office visits, meaning that if the doctor did not initiate the conversation, it did not take place. The doctors were more likely to raise the topic with female patients. It may be true that girls are the ones who get pregnant, and must learn to protect themselves, but adolescent boys also need to know that they share equal responsibility when it comes to safe sex. Besides unexpected pregnancy, both girls and boys must be taught how to avoid contracting and spreading sexually transmitted infections.

And teens can’t count on learning the information they need at home or at school, either. Many sex-ed classes in schools fall short of comprehensive, and the subject is never brought up at all by many parents. For this reason, it is important for doctors to realize the magnitude of this need and be sure to talk to their adolescent patients about sex.

Parents can assist by not being present in the room during the exam – unsurprisingly, the study showed that doctors were much more likely to bring up the topic of sexual health when parents were absent. Longer visits were also more likely to include conversations about sex, one of many reasons why taking enough time with each patient and giving them individual, personal attention is so important.

Whether the doctors were uncomfortable talking about sex with teenagers, were concerned about making conservative parents angry, or were just too rushed isn’t clear. What is clear is that we can’t expect teens to make good choices if we don’t make the effort (uncomfortable as it may be) to educate them and provide them with the tools to make those good choices.

And since teens don’t bring up sex on their own during doctor appointments, it’s vital that we open up the conversation and give them a chance to ask any pressing or embarrassing questions they may have. Otherwise they will likely turn to their friends or the Internet, and there is far too much incorrect and downright dangerous information out there to neglect the job of teaching kids the facts and giving them the opportunity to talk to a trusted, knowledgeable adult about sex.

– Yvonne S. Thornton, M. D., M. P. H.

Teen Pregnancy May Be Associated With Obesity Risk in Later Life

Thursday, August 1st, 2013

Concern about the increased prevalence in teen pregnancies has raised a lot of questions societally as well as within the medical community. It is no secret that an event such as childbirth can play a large role in a woman’s health, and the potential changes that may take place are increased in a teenager, whose body is still growing and changing throughout adolescence. From very real concerns such as the potential for premature delivery to the psychological effects of becoming a mother at a very young age or giving a child up for adoption, there is much fodder for examination and research.

One study has even suggested that there is a potential association between adolescent pregnancy and obesity later in life. However, it is important to note that this association is still vague at best, and researchers have yet to uncover a cause for this heightened obesity risk.   While it is possible that the associations between adolescent pregnancy and obesity is caused by the physiological changes that take place in the female body (and in particular the adolescent female body) during pregnancy, there are also many factors –primarily psychological and sociological—to take into consideration in order to determine the underlying cause of this association.  I believe that these young women, obese or not obese, gain so much weight when they are pregnant that obesity is the result of the pregnancy and they cannot lose the weight postpartum, given the additional responsibilities of raising a child.

Demographically speaking, adolescent mothers are more likely to be from a racial minority, to have lived in poverty, or to have attained a lower educational level than many of their peers. Four out of five black women are either overweight or obese.  It is highly likely that at least part of the association between adolescent pregnancy and weight gain is due to this “crossover”, as women of these demographics are also those most likely to be classed as overweight or obese. This is part of the difficulty in determining whether or not there are other physiological factors to take into account.

My take on the conclusions of this study and the entire situation of pregnant adolescents  and future obesity is that these young women are looking for acceptance and have very low self-esteem.  Their feelings are exploited by their male counterparts, who have a biological imperative to be intimate and not be rebuffed. Consequently, sexual intercourse is a form of being “accepted” and “loved”, only to find out later that the girl is pregnant, has gained excessive weight during the pregnancy and is now alone being responsible for a new life.  Her old habits (no exercise and cheap fast food) with a low or nonexistent income lead to her obesity and that of her child.  Then, it becomes a vicious cycle.

Regardless of the reasons for the prevalence of overweight and obese women among those who were pregnant as teenagers, studies like these highlight the importance of increased contraceptive aid and sexual education among female adolescents. At present, it seems that the primary association between these two groups of women, i.e.,  those who become pregnant as teenagers and those who are classed as overweight or obese in adulthood,  is a lack of education or awareness about their bodies.

– Yvonne S. Thornton, M. D., M. P. H.


Why Aren’t Teens Getting Screened?

Thursday, November 15th, 2012

Teen pregnancy is consistently a major social problem in the United States. While teen pregnancy has been on the decline over the past few decades, it is still an issue and more than 34% of girls will have a baby by the time they’re twenty years old. For that reason, the results of a recent study might be surprising to you. The study showed that when receiving care in the emergency room, only 19% of teen girls across the country were tested for pregnancy. Even those with abdominal pain were given other tests, and some doctors didn’t even bother asking whether or not the girls were sexually active.

Not testing for pregnancy can be extremely dangerous. Of the girls who complained about abdominal pain, 28% were given tests that included radiation.  With that said, although there is stark hysteria when it comes to inadvertent exposure to radiation from diagnostic imaging, a chest X-ray or an X-ray of the abdomen would not harm the growing embryo or fetus.  There is no evidence that suggests that there is increased fetal risk of malformations, growth restriction or abortion from a radiation dose of less than 5 rads.  Most diagnostic imaging procedures using radiation are calculated to be in millirads (one-thousandth of a rad).  Case in point, a chest X-ray exposes the fetus to only 0,07 mrad which is exceptionally small and without any significant risk to the fetus at any gestational age.   Nevertheless, not checking for pregnancy in teenage girls can result in not diagnosing an ectopic pregnancy, which carries with it an increased risk of death to the teenage mother.   Moreover, many medications could also be extremely harmful to a growing fetus.   When shown the results of the study, a few doctors claimed that their resistance to giving a pregnancy test was partly because few teen girls come to the ER alone. When a large number of family members are present, ER doctors don’t want to offend the people in the room. These doctors are almost always strangers to ER patients, so they don’t know the family history or teen’s background.

While you’re probably not an ER doctor, you can still learn from this study and apply it to your own life. Especially if you have a teen daughter, you should always make sure that she receives a pregnancy test before undergoing any other procedures in the emergency room. If the doctor doesn’t offer one as part of his or her diagnosis, bring it up and have your daughter tested. Your teenager might look at you in utter disgust, but the temporary hatred you elicit from your teen is preferable to the potential misdiagnosis and misguided plan of care formulated, which was based on an incomplete evaluation because a pregnancy test was not done.

As an obstetrician, my credo is that any young woman from 12-56 is pregnant until proven otherwise.  Emergency room doctors are trained to test for pregnancy in adult females, so it might slip their mind to test teen girls who come in. However, teen pregnancy is a serious issue, so if you have any control in the situation, always make sure your teen is tested for pregnancy before any other procedures are conducted.

 – Yvonne S. Thornton, M. D., M. P. H.