Teens Need Comprehensive Reproductive Health Care, Sex Ed
The US continues to have the highest rate of teen pregnancy of any industrialized nation. The birth rate among US teens ages 15-19 was 42.5 (per 1,000) in 2007, marking a 5% increase since 2005. Births to adolescents had declined 34% from 1991 to 2005. The spike in teen births was observed across racial lines, with the exception of Hispanic teens, who experienced a 2% decrease in births.
Experts believe the increase is partly due to abstinence-only sex education programs combined with decreased contraception education and decreased contraceptive use among teens. "Abstinence works for some teens, but the idea that most teens will wait to have sex indefinitely is rigid and impractical," said Richard S. Guido, MD, chair of ACOG's Committee on Adolescent Health Care.
According to the Centers for Disease Control and Prevention, 66% of female teenagers have had sex at least once by the time they reach 12th grade. "The data show that a large portion of teens are having sex. Abstinence-only programs inadvertently disenfranchise sexually active teens, leaving them at risk for pregnancy because they haven't been taught how to effectively avoid it," Dr. Guido added. A sexually active teen who does not use contraception has a 90% chance of becoming pregnant within a year.
ACOG supports comprehensive sex education that provides scientifically accurate information about sexuality, sexually transmitted diseases (STDs), contraception, and preventive health care; promotes abstinence from sexual intercourse for adolescents; aims to increase effective use of contraceptives, including latex condoms, by sexually active adolescents; and involves the teen's parent or guardian.
"The US Food and Drug Administration's recent decision to make emergency contraception (EC) available without a prescription to women younger than age 18 is a positive development in the fight against teen pregnancy," said ACOG President Douglas H. Kirkpatrick, MD. "Emergency contraception is safe and effective for adolescents and women of all ages, and there is no scientific or medical reason to impose an age restriction on its over-the-counter availability. Easy access to EC, and all other forms of contraception, is critical in preventing unintended pregnancies and subsequent abortions among adolescents," Dr. Kirkpatrick added.
In addition to an increase in teen births, rates of STDs, such as gonorrhea and chlamydia, are highest among girls ages 15-19. ACOG recommends that sexually active teens be screened annually for these diseases. In most instances, STD testing can be performed with a urine sample in teens, and no pelvic exam is necessary. "Exposure to STDs can cause short-term damage to an adolescent's reproductive system and jeopardizes her future fertility. Therefore, access to a full spectrum of confidential reproductive health services-including family planning and services for the prevention, diagnosis, and treatment of STDs-is imperative," Dr. Guido said.
Ob-gyns can help educate teens and their parents about sexual health, abstinence, contraception, and STD prevention. ACOG recommends that a teen first visit an ob-gyn between the ages of 13 and 15. "Getting acquainted with an ob-gyn in the early teens facilitates the development of a trusting relationship between a teen and her doctor. This age is an excellent time to discuss pregnancy prevention and sexually transmitted infections, whether a teen has started having sex or not," Dr. Kirkpatrick noted. "The goal is to boost a teen's comfort level, so if she starts having sex, has questions about her reproductive health and development, needs advice on birth control, or has any other kind of problem, there is a reliable and knowledgeable source that she can consult," he added.
Parental involvement also makes a difference in teen attitudes toward sexuality and pregnancy. A recent survey by The National Campaign to Prevent Teen and Unplanned Pregnancy found that parents are more influential than peers, the media, teachers, and sex educators when it comes to a teen's decisions about whether to have sex. "Most parents don't think their kids listen to what they say, but that's simply not true. Parents need to be upfront and vocal about what's acceptable and what's not for their family," Dr. Kirkpatrick said. The survey also found that teens and parents would like to receive more comprehensive sex education that provides more information on both abstinence and contraception, rather than a focus on one or the other.
"After the second consecutive increase in teen births, it's becoming clear that this is more than just a one-year blip-it's a societal failure that must be swiftly and continuously addressed," Dr. Guido noted. "We don't want to see all the strides in teen pregnancy prevention erased because we continued to cling to programs that don't work. We need to reevaluate how we equip our teens to care for and protect their reproductive health."
ACOG encourages ob-gyns, parents, and teens to participate in The National Day to Prevent Teen Pregnancy and to use it as an opportunity to engage individuals and communities in the dialogue about teen sexuality and pregnancy. More information is available at http://www.thenationalcampaign.org.
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.
American College of Obstetricians and Gynecologists
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