The American Academy of Pediatrics (AAP) recently published a clinical report on the state of adolescent pregnancy in the United States. “Adolescent Pregnancy: Current Trends and Issues” can be found in the July 2005 issue of Pediatrics and is available online at http://www.pediatrics.org.

Recently the percentage of adolescents who are sexually active has decreased; however, more than 45 percent of current high school-aged females and 48 percent of high school-aged males report having had sexual intercourse. The average age at first intercourse is 16 years for males and 17 years for females.

According to the report, use of contraception by adolescents is increasing, but 50 percent of all adolescent pregnancies occur within six months of first intercourse. In 2003, almost one half of sexually active adolescents reported not using a condom the last time they had intercourse. Many adolescents who reported using prescription contraceptives indicated a gap of at least one year between the time that they first had intercourse and the time that they visited a physician to seek a prescription contraceptive.

The United States has the highest adolescent birth rate among industrialized nations. Nearly 900,000 U.S. teenagers become pregnant each year, according to the report, and four in 10 women have been pregnant at least once before 20 years of age. Approximately 51 percent of adolescent pregnancies end in live birth, 35 percent in induced abortion, and 14 percent in miscarriage or stillbirth. Twenty-five percent of adolescent births are not first births, and the risk for pregnancy increases after an adolescent has had one infant.

Significantly more adolescents who live in poverty become pregnant than do those from higher-income families. The total percentage of adolescents who live in low-income families is 38 percent; however, 83 percent of adolescents who give birth and 61 percent who have abortions are from low-income families. Similar to adolescent mothers, adolescent fathers are more likely than their peers to come from low-income families, have poor academic performance, drop out of school, and have decreased income potential.

The report indicates that in 2001, almost 79 percent of all adolescents who gave birth were unmarried, a statistic that has been rising since 1971. More than 90 percent of pregnant patients 15 to 19 years of age said their pregnancies were unplanned.

Pregnant patients younger than 17 years have a higher risk of medical complications than do older patients. Compared with adults, adolescents give birth to twice as many low birth weight infants, and the neonatal mortality rate is three times higher. Although still low, the maternal mortality rate is twice as high for adolescents. Adolescent pregnancy is associated with poor maternal weight gain, prematurity, pregnancy-induced hypertension, anemia, sexually transmitted diseases, substance abuse, and poor nutritional intake. Adolescent pregnancy also causes psychosocial problems such as interruption of school, persistent poverty, limited vocational opportunities, separation from the child’s father, divorce, and repeat pregnancy. The children of adolescent mothers are at higher risk for developmental delays, academic difficulties, behavior disorders, substance abuse, early sexual activity, depression, and adolescent pregnancy.

The AAP reports that the most successful programs to prevent adolescent pregnancy include the promotion of abstinence along with information on and dissemination of contraception, sexuality education, school-completion programs, and job training. Parents, schools, religious institutions, physicians, social and government agencies, and adolescents themselves all should be a part of successful prevention programs. Research shows that discussion of contraception does not increase sexual activity, and programs that promote abstinence along with contraception do not decrease contraceptive use.