ONE IN THREE TEENS GET NO FORMAL EDUCATION ABOUT BIRTH CONTROL

Even When They Do, Many Do Not Get It When They Need It Most:
BEFORE They Start to Have Sex
The proportion of U.S. teens who had received any formal instruction about birth control methods declined sharply between 1995 and 2002, while the proportion who had received only information about abstinence more than doubled to more than one in five, according to “Changes in Formal Sex Education: 1995–2002,” by Laura Duberstein Lindberg et al., published in the December 2006 issue of Perspectives on Sexual and Reproductive Health. Only 66% of males and 70% of females received formal instruction about birth control in 2002, compared with 81–87% in 1995. Black teens were even less likely than whites to have received any instruction about birth control methods

While the vast majority of Americans support a comprehensive approach to sex education that encourages young people to delay sexual activity but also provides medically accurate information about contraception, these findings suggest that schools have retreated from this approach. The authors analyze data from the 1995 National Survey of Adolescent Males and the 1995 and 2002 National Surveys of Family Growth to examine changes in adolescents’ reports of the sex education they have received from formal sources such as schools, churches and other community groups. They find dramatic shifts in the type of information teens receive and when they receive that information.

In fact, many teens receive information about contraception and abstinence too late—after they have begun to have sex. In 2002, slightly more than half of sexually experienced males and six in 10 such females had received any instruction about birth control methods before they first had sex, down from 61% of males and 72% of females in 1995; one-quarter of each had not received information about abstinence in 2002, either. Again, black teens were at greater disadvantage—only one in three sexually experienced black males and fewer than half of sexually experienced black females had received instruction about birth control methods before they first had sex.

“Other research has clearly shown that improving contraceptive use reduces teen pregnancy. Yet instead of providing teens with the information they need to protect themselves, our results show that we are retreating from talking about contraceptive use and instead focusing on unrealistic approaches that try to convince teens to abstain from sex until marriage,” says lead author Laura Duberstein Lindberg. “As a result, young people are increasingly unlikely to receive medically accurate information in schools, and many do not get that information when they need it most—in time to protect themselves from unintended pregnancy and sexually transmitted diseases”

These findings complement earlier Guttmacher research showing that four in 10 sex education teachers do not teach their students about contraceptives at all, or teach that contraceptives are ineffective. The lack of information on birth control is not surprising in light of the federal government’s billion-dollar investment over the past decade in unproven abstinence-until-marriage programs that do not provide medically accurate information about contraception. To ensure that public dollars are being put to good use, the authors call for the reversal of these policies and for evaluations of the impact of abstinence-only education on teens’ knowledge, behavior and outcomes.

Also in this issue of Perspectives on Sexual and Reproductive Health:
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Many birth control pill users in France use the pill inconsistently, according to “Social, Demographic and Situational Characteristics Associated with Inconsistent Use of Oral Contraceptives: Evidence from France,” by Caroline Moreau et al. Twenty percent of women surveyed missed at least one pill during the month prior to the interview, and 7% missed two or more pills; 10% missed at least one pill without using contraceptive backup during subsequent intercourse. Inconsistent use was more common among women with small children and those who do not have a daily routine for taking the pill, situations in women’s lives that can or will change over time. The authors recommend that physicians help patients choose the contraceptive method best suited to the context of their lives in order to ensure consistent and long-term contraceptive use.
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New findings from the 2002 National Survey of Family Growth suggest that both young women and young men who start having sex before age 16 with an older partner have an increased likelihood of being involved in a teenage birth, according to “Young Teenagers and Older Sexual Partners: Correlates and Consequences for Males and Females,” by Jennifer Manlove et al. An estimated two million women and 800,000 men aged 18–24 first had sex before age 16 with a partner at least three years their senior. The authors suggest that parents, service providers and communities work to help teens understand appropriate age differences between partners and to negotiate decisions about whether to have sex and use birth control with their partners, even when the partners are older.
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Latina teenagers in the United States have high pregnancy rates and birthrates, but researchers, policymakers and program planners do not really understand why. “Acculturation and the Sexual and Reproductive Health of Latino Youth in the United States: A Literature Review,” by Aimee Afable-Munsuz and Claire D. Brindis, examines 17 studies that investigate the impact of various measures of acculturation—language, culture, area of residence and the length of time a teen’s family has spent in the United States—on sexual and reproductive health outcomes.
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Washington State’s experience with integrating emergency contraception into its health care and social service systems shows that state agencies and local partners can effectively work together to expand women’s options for preventing unintended pregnancy, according to “Expanding Access to Emergency Contraception Through State Systems: The Washington State Experience,” by Marian Weldin et al. The Washington State Departments of Health and of Social and Health Services reached out to state and local groups and communities for help in educating the public about unintended pregnancy and available resources, with the thought that communities were best positioned to know what would work locally. Making emergency contraception widely available takes time and persistence, according to key individuals in the process, so it is essential to keep emergency contraception on the agenda at all levels while building on small successes.