Abstract

PIP: The proportion of adolescents who report having sexual intercourse has increased steadily since the 1970s. The proportion of females aged 15- 19 years reporting such activity increased from 26.6% in 1970 to 51.5% in 1988, with the percentage of 15 year olds rising from 4.6% to 25.6% over the period. Data from the 1988 National Survey of Adolescent Males indicate that 64% of males aged 15-18 years had sexual intercourse at least once. Adolescents, however, tend to delay using contraception until 1 year after the initiation of sexual intercourse. Youths seen at family planning clinics have cited being afraid of their parents finding out about their visit, fear of pelvic exams, and fear of health consequences from the pill as reasons for their delay. This degree of sexual intercourse without contraception has led to annual pregnancies for more than 1 million women under age 20. Approximately 50% bear their children, while 40% abort their fetuses. Births to these young mothers increase their risk of delivery-related mortality and subsequent long-term economic and educational underachievement. The children born to these mothers also share similar risks in addition to the possibility of being born underweight and bearing infants themselves as teenagers. Teenage pregnancy and childbearing therefore comes at great social and public economic costs. Medical practitioners, counselors, policymakers, and the general public must realize, however, that teenage sexuality and its consequences are not the most alarming of social ills in the US. Of greater concern is the failed continuation of declines in the rate of adolescent childbearing began in the 1970s and the recent increase among younger adolescents. Central to these trends is the continually declining age of initial sexual intercourse among youths and the particular tendency among younger adolescents to delay using contraceptives. 18% of US adolescents have sexual intercourse before reaching age 15 and 66% do so by age 19, yet only 33% of those who are sexually active use contraceptives. Despite similar levels of sexual activity across countries, the US has higher rates of adolescent pregnancy, births, and elective abortions than Canada, France, the Netherlands, Great Britain, and Sweden. US efforts to prevent unwanted pregnancies among youths are therefore comparatively weak. Pediatricians are in a good position to speak out about the realities of adolescent sexuality, educate youths about their sexuality, and promote adolescents' access to contraceptives. Pediatricians are also well- situated to encourage discussion of these issues with their young male clients who generally avoid seeking contraceptives in traditional family planning settings.