Teenage pregnancy and parenthood are a national concern because of the resulting societal, economic, and educational disadvantages for teen mothers and their babies. These disadvantages lead to and exacerbate emotional stressors for teen parents and their families. Although the United States has higher rates of births to teen mothers than any other industrially developed nation, births to teen mothers in the United States have decreased since the late 1950s, with the exception of a steep increase in rates from the late 1980s until 1991, after which a steady decline has continued[1] [2] [3] [4] (Figure 155-1). Declines in birthrates have been accompanied by declines in rates of pregnancy, induced abortion, and fetal loss. From 1990 to 2000, declines occurred in the teen birthrates of all racial and ethnic groups, with the greatest decline for black teens (31%). Birthrates to European-American descent dropped 24%, and rates among Hispanic girls dropped approximately 15%. As of 2000, rates for Hispanic and black teens continued to be the highest of all population groups.[3] The future will tell if this trend continues over the next decade.

The decrease in the rates of adolescent pregnancies and births appears to be the result of several factors, including delayed initiation of sexual activity, increased use of contraception (eg, condoms) at first coitus, and a greater efficacy of hormonal contraceptive methods.[5] [6] All hormonal methods remove the act of pregnancy prevention from the act of sexual intercourse and are more effective than barrier methods, spermicides, or methods based on the periodicity of the menstrual cycle. Methods such as injectable or implantable contraception and newer hormonal delivery systems such as patches and intravaginal rings do not require the need to take a pill every day, which may be difficult for young women who may not have regular life routines. Although intrauterine devices are also available, they are not generally used in young teens or women who have never borne children.