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. 2022 Dec;35(6):676-684.
doi: 10.1016/j.jpag.2022.07.008. Epub 2022 Jul 10.

Declines in Pregnancies among U.S. Adolescents from 2007 to 2017: Behavioral Contributors to the Trend

S M Goodreau  1 , E D Pollock  2 , L Wang  3 , J Li  3 , M V Aslam  4 , D A Katz  5 , D T Hamilton  6 , E S Rosenberg  7
Affiliations

Declines in Pregnancies among U.S. Adolescents from 2007 to 2017: Behavioral Contributors to the Trend

S M Goodreau et al. J Pediatr Adolesc Gynecol. 2022 Dec.

Abstract

Study objectives: Adolescent pregnancies and births in the United States have undergone dramatic declines in recent decades. We aimed to estimate the contribution of changes in 3 proximal behaviors to these declines among 14- to 18-year-olds for 2007-2017: 1) delays in age at first sexual intercourse, 2) declines in number of sexual partners, and 3) changes in contraceptive use, particularly uptake of long-acting reversible contraception (LARC).

Design: We adapted an existing iterative dynamic population model and parameterized it using 6 waves of the Centers for Disease Control and Prevention's Youth Risk Behavior Survey. We compared pregnancies from observed behavioral trends with counterfactual scenarios that assumed constant behaviors over the decade. We calculated outcomes by cause, year, and age.

Results: We found that changes in these behaviors could explain pregnancy reductions of 496,200, 78,500, and 40,700 over the decade, respectively, with total medical and societal cost savings of $9.71 billion, $1.54 billion, and $796 million. LARC adoption, particularly among 18-year-olds, could explain much of the improvement from contraception use. The 3 factors together did not fully explain observed birth declines; adding a 50% decline in sex acts per partner did.

Conclusions: Delays in first sexual intercourse contributed the most to declining births over this decade, although all behaviors considered had major effects. Differences from earlier models could result from differences in years and ages covered. Evidence-based teen pregnancy prevention programs, including comprehensive sex education, youth-friendly reproductive health services, and parental and community support, can continue to address these drivers and reduce teen pregnancy.

Keywords: Adolescents; Contraception; Pregnancies; Sexual behavior; United States.

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Conflict of interest statement

ROLE OF THE FUNDING SOURCE AND CONFLICTS OF INTEREST

As part of the cooperative agreement model, research scientists affiliated with the funder (the US Centers for Disease Control and Prevention) contributed to the design of the study through a series of collaborative meetings. They also approved the decision to submit the manuscript for publication, and CDC staff scientists reviewed and approved the final manuscript. Those individuals who played significant roles in the scientific development of the project are listed as co-authors. The corresponding author (Steven M. Goodreau) wrote the first draft of the manuscript. The authors report no real or perceived conflicts of interest.

Figures

Figure 1:
Figure 1:. Reported method of contraception, Youth Risk Behavior Survey 2007-2017.
For full wording of each option, see Table 1.
Figure 2
Figure 2. Number of expected pregnancies averted each year (total and by associated behavior change).
Numbers are relative to pregnancies expected in the year in the absence of any behavior change from 2007-2017. “Total” represents the sum of the other three lines. Dots represent point estimates and bars represent 95% bootstrapped confidence intervals.
Figure 3:
Figure 3:. Number of pregnancies averted by age and type of behavior change, summed across years.
Numbers are relative to pregnancies expected in the year in the absence of any behavior change from 2007-2017. Dots represent point estimates and bars represent 95% bootstrapped confidence intervals.
See this image and copyright information in PMC

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