Just Say Maybe

On Wednesday the U.S. Centers for Disease Control and Prevention reported that the teen birth rate in the United States increased in 2006 for the first time in 14 years, and unmarried childbearing reached a new record high: 38.5 percent of all U.S. births. (The CDC's report is based on data from the nearly 4.3 million births in the United States last year.) Between 2005 and 2006, the teen birth rate rose from 40.5 to 41.9 live births per 1,000 Americans aged 15 to 19. The increase was highest among black teens, at 5 percent. Hispanic teens had a 2 percent increase, and non-Hispanic white teens were in the middle at 3 percent. Until this year the teen birth rate had been decreasing steadily from its all-time peak in 1991.

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Why is the teen birth rate increasing again despite the $1.5 billion spent on abstinence-only sex education since 1996? And what should be done about the rise? To find out, NEWSWEEK's Karen Springen spoke with Heather Boonstra, senior public policy associate at the New York City-based Guttmacher Institute, the nation's leading reproductive-health think tank. Excerpts:

NEWSWEEK: Why do you think the teen birth rate is increasing again?
Heather Boonstra: We don't know entirely. You can't draw a straight line between whether this in truth indicates that more of these births are wanted or unwanted, whether the pregnancy rate has gone up and therefore the birth rate has gone up, or whether it means fewer young people are turning to abortion and more are giving birth instead. It may be part of a larger trend, or it may be just a blip.

If it's not just a blip, if it's real, why?
Over the time period when this group of young people has come of age, we have been funneling our federal dollars into abstinence-only programs. Since 1996 we've spent $1.5 billion on abstinence-only until-marriage programs, between state and federal dollars. If these programs talk about contraception, they only talk about it in terms of its failure rates. That is a trend we can point to. Whether or not that has impacted these rates, we don't know that. The only federal program for sex education is abstinence-only until-marriage. It's really accelerated since 2000-1. That's about the time the Bush administration came into office. They really have seen abstinence as the answer to teen pregnancy and teen birth and also to STD rates among teens. They would say that abstinence—if practiced perfectly, of course—is 100 percent effective in preventing teen birth such as this. We know that abstinence until marriage is not the norm in the United States … Very few young people are sexually active by age 15, but by age 20, 70 percent of young people are sexually active. The challenge we have had as a nation is encouraging young people to delay as long as they can because that is a protective behavior, but we also need to prepare young people for that time when they will become sexually active to prevent unintended pregnancies.

Are fewer clinics offering abortions now?
We only have data on all providers in the United States through about 2000, but it shows that the overall number of abortion providers has declined since 1982. We expect that the number of providers has certainly not increased since 2000. We just finished a new survey, but the data won't be released until January 2008.

What should U.S. health providers and elected officials do to make sure the teen birth rate doesn't continue to rise?
As to these abstinence-only programs, there's no evidence these programs work in any way to delay sexual activity or encourage young people to use contraceptives. There is very good evidence that comprehensive programs that teach abstinence but also teach about contraception are very effective at encouraging delay and encouraging young people to have fewer sexual partners and to use contraception consistently. And so if you're looking at what works to change the behaviors that then reduce unintended pregnancy, policy makers really should be looking at these comprehensive programs and how they can support those instead of these feel-good-but-lack-of-evidence programs.