Sexual Experience and Contraceptive Use Among Female Teens — United States, 1995, 2002, and 2006–2010

	MMWR Weekly Volume 61, No. 17 May 4, 2012

Sexual Experience and Contraceptive Use Among Female Teens — United States, 1995, 2002, and 2006–2010

Weekly

May 4, 2012 / 61(17);297-301

The 2010 U.S. teen birth rate of 34.3 births per 1,000 females reflected a 44% decline from 1990 (1). Despite this trend, U.S. teen birth rates remain higher than rates in other developed countries; approximately 368,000 births occurred among teens aged 15–19 years in 2010, and marked racial/ethnic disparities persist (1,2). To describe trends in sexual experience and use of contraceptive methods among females aged 15–19 years, CDC analyzed data from the National Survey of Family Growth collected for 1995, 2002, and 2006–2010 (3). During 2006–2010, 57% of females aged 15–19 years had never had sex (defined as vaginal intercourse), an increase from 49% in 1995. Younger teens (aged 15–17 years) were more likely not to have had sex (73%) than older teens (36%); the proportion of teens who had never had sex did not differ by race/ethnicity. Approximately 60% of sexually experienced teens reported current use of highly effective contraceptive methods (e.g., intrauterine device [IUD] or hormonal methods), an increase from 47% in 1995. However, use of highly effective methods varied by race/ethnicity, with higher rates observed for non-Hispanic whites (66%) than non-Hispanic black (46%) and Hispanic teens (54%). Addressing the complex issue of teen childbearing requires a comprehensive approach to sexual and reproductive health that includes continued promotion of delayed sexual debut and increased use of highly effective contraception among sexually experienced teens.
Nationally representative data on females aged 15–19 years were obtained from three survey cycles of the National Survey of Family Growth (NSFG): 1995, 2002, and 2006–2010. NSFG is an in-person, household survey conducted by CDC's National Center for Health Statistics using a stratified, multistage probability sample of females and males aged 15–44 years. The response rate for females was 76%. Survey topics included self-reported sexual activity and contraceptive use (4). Respondents who answered "yes" to ever having vaginal intercourse were considered sexually experienced.
Respondents who were pregnant, postpartum, seeking pregnancy, or who had not had sex during the interview month were excluded from analyses on contraceptives used during the interview month. The remaining respondents were classified as currently using contraception (specifying up to four methods) or not currently using contraception. Current contraceptive users were classified further by their most effective method used (according to typical use effectiveness estimates for pregnancy prevention) (3), based on the following hierarchy: 1) users of highly effective methods, including respondents who used long-acting reversible contraception (i.e., intrauterine device [IUD] or implant), pill, patch, ring, or injectable contraception (with or without dual use of condoms), or who were sterilized or had a partner who was sterilized (both were rare for teens); 2) users of moderately effective methods, including respondents who used condoms alone; and 3) users of less effective methods, including respondents who used withdrawal, periodic abstinence, rhythm method, emergency contraception, diaphragm, female condom, foam, jelly, cervical cap, sponge, suppository, or insert.
Weighted least squares regression was used to assess the significance of trends in abstinence and contraceptive use over time. Differences in bivariate proportions between racial/ethnic and age subgroups were assessed using a standard two-tailed t-test without adjustment for multiple comparisons. Comparisons are statistically significant at p<0.05. All analyses were conducted using data management and statistical software to account for the complex sample design of the NSFG.
During 2006–2010, more than half (56.7%) of female teens had never had sex (Table), reflecting a 16% increase relative to the 1995 estimate of 48.9%. The proportion of teens who had never had sex did not differ significantly across racial/ethnic groups* (whites = 57.6%, blacks = 53.6%, Hispanics = 56.2%) (Table). Although the proportion of teens who had never had sex increased for all racial/ethnic groups from 1995 to 2006–2010, this increase was greatest for blacks (34% increase) and Hispanics (29% increase) compared with whites (15% increase). During 2006–2010, 72.9% of females aged 15–17 years had never had sex, compared with 36.5% of females aged 18–19 years.
During 2006–2010, among female teens who had sex during the interview month, but who were not pregnant, postpartum, or seeking pregnancy, 59.8% used a highly effective contraceptive method during the interview month (12.0% used a highly effective method with a condom and 47.8% used a highly effective method without a condom), 16.3% used a moderately effective method (i.e., condoms alone), 6.1% used a less effective method, and 17.9% did not use any contraception (Figure). A trend toward increasing use of highly effective methods was noted from 1995 to 2006–2010. Estimates for 2006–2010 reflect a relative 26% increase in use of highly effective methods, 43% decrease for moderately effective methods, 27% increase for less effective methods, and 7% decrease for no method use compared with 1995.
During 2006–2010, white teens (65.7%) reported a higher prevalence of highly effective method use than black teens (46.5%) and Hispanic teens (53.7%) (Figure). Nonuse of any contraceptive method was significantly higher among blacks (25.6%) and Hispanics (23.7%) compared with whites (14.6%). Among whites, the use of highly effective methods increased from 48.9% in 1995 to 65.7% in 2006–2010 (34% relative increase). Smaller increases were observed for Hispanics (19% relative increase) and blacks (4% relative increase). Method nonuse among whites decreased from 18.1% in 1995 to 14.6% in 2006–2010 (19% decline); however, rates increased among blacks from 21.4% in 1995 to 25.6% in 2006–2010 (20% increase). For females aged 15–17 years, the use of highly effective methods increased from 46.0% during 1995 to 56.5% during 2006–2010 (23% increase). For females aged 18–19 years, the use of highly effective methods increased from 48.4% during 1995 to 61.8% during 2006–2010 (28% increase). Rates of nonuse among younger teens declined from 23.9% to 19.5% (19% decline) but remained relatively stable for older teens at 16.3% in 1995 and 16.9% during 2006–2010.

Reported by

Crystal Pirtle Tyler, PhD, Lee Warner, PhD, Joan Marie Kraft, PhD, Alison Spitz, MPH, Lorrie Gavin, PhD, Violanda Grigorescu, MD, Carla White, MPH, Wanda Barfield, MD, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Crystal Pirtle Tyler, ctyler@cdc.gov, 770-488-5200.

Editorial Note

In 2010, the U.S. teen birth rate declined to the lowest level in seven decades of reporting and reached record lows for teens of all racial/ethnic and age groups (1). Declines since 1995 likely reflect significant increases in the proportion of female teens who were abstinent, and among sexually experienced female teens, increases in the proportion using highly effective contraception (5).
The proportion of female teens who never have had sex is now comparable across racial/ethnic groups, largely because of proportionately larger increases in delayed sexual debut observed since 1995 among black teens and Hispanic teens compared with white teens. Disparities persist, however, in the use of highly effective methods of contraception. Use of these methods remains highest among white teens, and increases over time have occurred at a greater rate among whites compared with blacks and Hispanics.
Achieving the HealthyPeople 2020 objective† of reducing teen pregnancy by 10% will require a comprehensive approach to sexual and reproductive health that includes continued promotion of delayed sexual debut and increased use of highly effective contraception among sexually experienced teens. Condoms, the method used by many teens, can provide effective protection against unintended pregnancy when used consistently and correctly; however, during 2006–2010, only about half (49%) of female teens who used a condom for contraception reported consistent use in the past month (6). Dual use of condoms with a highly effective method of contraception can provide pregnancy protection with the added benefit of preventing sexually transmitted infections, including infection with human immunodeficiency virus, which affects teens disproportionately. Given that hormonal contraception and IUDs can be obtained only from a health-care provider, yearly reproductive health visits for teens who are sexually experienced or contemplating sexual activity can facilitate discussions about the advantages of delaying sexual debut, access to contraception, and the subsequent reduction of teen pregnancy (7,8).
An analysis of data from CDC's Pregnancy Risk Assessment Monitoring System on female teens who had delivered a live infant within 2–6 months and reported that their pregnancy was unintended found that half were not using contraception when they got pregnant (9). Ways to reduce barriers to decrease teen pregnancy include encouraging teens to delay sexual debut, offering teens convenient practice hours, culturally competent and confidential counseling and services, and low-cost or free services and methods.
The findings in this report are subject to at least three limitations. First, estimates of contraceptive use are self-reported; however, NSFG was designed specifically to minimize potential sources of response error (4). Second, current use of a contraceptive method during the interview month does not necessarily reflect sustained use over time. Finally, data were not available to examine current sexual activity or contraceptive use among female teens aged <15 years, who accounted for 4,500 births in 2010 (1).
Several actions can be taken to reduce teen pregnancy further. Schools and community- based organizations can 1) provide evidence-based sexual and reproductive health education,§ 2) support parents' efforts to speak with their children about advantages of delaying sexual debut and of delaying pregnancy, and 3) connect teens to health-care providers for reproductive health services. Health-care providers should be informed that no contraceptive method is contraindicated for teens solely on the basis of age (10) and encouraged to promote highly effective contraception, preferably with the dual use of condoms. Teen pregnancy might be reduced further if health-care professionals provide culturally competent, evidence-based sexual and reproductive health counseling on the importance of correct and consistent use of contraception, and offer an array of contraceptive methods to teens who have had sex or are about to initiate sexual activity.

Acknowledgments

Gladys M. Martinez, PhD, Stephanie J. Ventura, MA, Joyce C. Abma, PhD, Div of Vital Statistics, National Center for Health Statistics; John M. Douglas, Jr, MD, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

References

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2. United Nations. Demographic yearbook 2009. New York, NY: United Nations; 2010. Available at http://unstats.un.org/unsd/demographic/products/dyb/dyb2.htm. Accessed February 28, 2012.
3. Trussell J. Contraceptive failure in the United States. Contraception 2011;83:397–404.
4. Groves RM, Mosher WD, Lepkowski J, Kirgis NG. Planning and development of he continuous National Survey of Family Growth. Vital Health Stat 2009;1(48).
5. Santelli JS, Lindberg LD, Finer LB, Singh S. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health 2007;97:150–6.
6. Martinez G, Copen CE, Abma JC. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006–2010 National Survey of Family Growth. Vital Health Stat 2011;23(31).
7. American College of Obstetricians and Gynecologists, Committee on Adolescent Health. The initial reproductive health visit. Committee opinion no. 460. Obstet Gynecol 2010;116:240–3.
8. Hagan JF, Shaw JS, Duncan PM. Bright futures: guidelines for health supervision of infants, children and adolescents. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008.
9. CDC. Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births—Pregnancy Risk Assessment Monitoring System (PRAMS), 2004–2008. MMWR 2012;61:25–9.
10. CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR 2010;59(No. RR-4).

* Persons identified as Hispanic might be of any race; persons in all other racial/ethnic categories are non-Hispanic.

† Objective FP-8, available at http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/familyplanning.pdf .

§ The Community Preventive Services Task Force recommends comprehensive risk reduction interventions. Additional information is available at http://www.thecommunityguide.org/news/2012/crrandaeinterventions.html.