The Odyssey Years

The Odyssey Years
Preventing Teen Pregnancy
Among Older Teens
September 2010
By Katherine Suellentrop
The National Campaign to Prevent Teen and Unplanned Pregnancy
1776 Massachusetts Ave, NW, Suite 200 Washington, DC 20036
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Phone: 202.478.8500 | Fax: 202.478.8588 | Email: campaign@thenc.org
The Odyssey Years: Preventing Teen Pregnancy Among Older Teens
1

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Board of Directors
Chairman
maria echaveste
diane rowland , sc.d.
The hononorable Thomas h. Kean
Senior Fellow
Executive Director
Chairman, The Robert Wood Johnson
Center for American Progress
Kaiser Commission on Medicaid
Foundation
daisy expósito-Ulla
and the Uninsured
CEO, THK Consulting
Chairman and CEO
Victoria P. sant
Chairman, The Carnegie Corporation of
d’expósito & partners
President
New York
William Galston, Ph.d.
The Summit Foundation
former Governor of New Jersey
Senior Fellow, Governance Studies
sara seims, Ph.d.
The Brookings Institution
Director, Population Program
PresidenT
ron haskins, Ph.d.
The William and Flora Hewlett
isabel V. sawhill, Ph.d.
Senior Fellow, Economic Studies
Foundation
Senior Fellow, Economic Studies
Co-Director, Center for Children and
matthew stagner, Ph.d.
The Brookings Institution
Families
Executive Director
CEO & Treasurer
The Brookings Institution
Chapin Hall at the University of Chicago
Sarah S. Brown
Senior Consultant, The Annie E. Casey
mary C. Tydings
Foundation
Managing Director
members
nancy L. Johnson
Russell Reynolds Associates
robert Wm. blum, m.d., Ph.d.
Senior Public Policy Advisor
roland C. Warren
William H. Gates Sr. Professor and Chair
Federal Public Policy and Healthcare
President
Department of Population and Family
Group
National Fatherhood Initiative
Health Sciences
Baker, Donelson, Bearman, Caldwell &
stephen a. Weiswasser
Johns Hopkins University
Berkowitz, PC
Partner
Thomas s. Chappell
Judith e. Jones
Covington & Burling
Senior Manager
Clinical Professor
Gail r. Wilensky, Ph.d.
Goodman & Company, LLP.
Mailman School of Public Health
Columbia University
Senior Fellow
Linda Chavez
Project HOPE
Jody Greenstone miller
Chairman
Kimberlydawn Wisdom, m.d.
Center for Equal Opportunity
President and CEO
The Business Talent Group
Surgeon General, State of Michigan
Vanessa Cullins, m.d., m.P.h., m.b.a.
Vice President, Community Health,
reverend Father michael d. Place,
Vice President for Medical Affairs
Education & Wellness
sTd
Planned Parenthood Federation of
Henry Ford Health System
America, Inc.
Senior Vice President
Social Mission & Ministerial
Judy Woodruff
susanne daniels
Development
Senior Correspondent
Media Consultant
Resurrection Health Care
PBS News Hour
amanda deaver
bruce rosenblum
Partner
President
Prism Public Affairs
Warner Bros. Television Group

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The Odyssey Years
Preventing Teen Pregnancy
Among Older Teens
September 2010
By Katherine Suellentrop

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Acknowledgements
The National Campaign to Prevent Teen and Unplanned Pregnancy wishes to ac-
knowledge the Centers for Disease Control and Prevention (CDC), whose support
made this publication possible through grant number U58/CCU324968-05. The
contents of this report are solely the responsibility of the author and do no neces-
sarily represent the official views of the CDC. I also gratefully acknowledge the
input from numerous individuals who contributed their ideas and lessons learned
for working with older teens along with insightful comments that strengthened
this report. In particular I would like to thank Sharon Rodine from the Oklahoma
Institute for Child Advocacy; Shannon Flynn, Polly Edwards, and Sarah Kershner
from the South Carolina Campaign to Prevent Teen Pregnancy; Janet Realini and
Yvette Sanchez from Healthy Futures of Texas; and Andrea Kane, Kelleen Kaye, and
Bill Albert from The National Campaign to Prevent Teen and Unplanned Pregnancy.
Thank you as well to Laetitia Lemoine from the University of North Carolina – Cha-
pel Hill for her assistance identifying programs targeted to older teens and with the
charts and other aspects of the report more broadly. The findings, conclusions, and
opinions presented in this report are solely the responsibility of The National Cam-
paign to Prevent Teen and Unplanned Pregnancy and do not necessarily represent
the views of our funders or the individuals who commented on this report.
Katherine Suellentrop is the Assistant Director of Research at The National
Campaign, where she oversees the daily activities of the department’s research
projects, helps shape its portfolio, and contributes to numerous Campaign pub-
lications. Prior to joining the Campaign, Ms. Suellentrop was an Association of
Schools of Public Health Fellow with the Centers for Disease Control and Preven-
tion. Ms. Suellentrop received a Bachelor of Arts in Biology from Northwestern
University and a Masters of Public Health from Emory University.
© 2010 The National Campaign to Prevent Teen and Unplanned Pregnancy.
All rights reserved.
ISBN: 1-58671-079-6
Suggested citation: Suellentrop, K. (2010). The Odyssey Years:
Preventing Teen Pregnancy Among Older Teens. Washington, DC:
The National Campaign to Prevent Teen and Unplanned Pregnancy.
This publication was designed by Nancy Bratton Design:
www.nancybrattondesign.com

THE NATIONAL CAMPAIGN TO PREVENT TEEN AND UNPLANNED PREGNANCY

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Contents
Introduction
4
Section 1. Pregnancy and
6 Childbearing Among Older Teens


Section 2. Setting the Stage:
12 The Lives and Context of Older Teens

Section 3. Sexual and Contraceptive
22 Behavior, Knowledge, and Attitudes

Section 4. Working With Older Teens
34 and Young Adults

Conclusion
51
References
52

Appendix 1:
54 Data Sources
The Odyssey Years: Teen Pregnancy Prevention Among 18 to 19 Year-olds

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Introduction
Despite a 39 percent decrease in the teen pregnancy
This report:
rate and a one-third reduction in the teen birth rate
since the early 1990s, recent data suggest that prog-
– documents the importance of increasing the focus
ress has stal ed. Between 2005 and 2006 both the
on older teens within teen pregnancy prevention
teen pregnancy and teen birth rate increased for the
efforts,
first time since the early 1990s [1, 2]. Teen birth rates
continued to increase in 2007 (data on teen pregnancy – provides a detailed portrait of their characteristics,
rates are not available beyond 2006) before declining
attitudes, and behavior that any such efforts will
slightly in 2008. Teen birth and pregnancy rates in the
need to address, and
United States remain among the highest of all indus-
trialized countries and it remains the case that three in
– summarizes the experiences and lessons learned
10 girls in the United States get pregnant by age 20.
by those in the field who have worked with
These trends are worrisome because the majority of
older teens.
teen pregnancies in this country are unplanned, are to
unmarried mothers, and are associated with serious
In addition to trends in teen pregnancy and birth
hardship for both child and parent.
rates, this report provides detailed new information
on older teens’ knowledge, attitudes, behavior, and
Older teens (ages 18–19) account for the vast
expectations related to relationships, sex, and con-
majority of teen pregnancies and births, and their
traception. The final section of this report includes
trends have been more discouraging than for
lessons learned and examples from organizations
younger teens overall. Compared to their younger
who have actively sought to increase pregnancy
peers, older teens experienced smal er declines in
prevention efforts among this age group, and takes
teen pregnancy and birth rates through 2005, and
a closer look at strategies that have been developed
recent increases in their teen birth rates are larger.
and found to effectively change behavior related to
Yet, few efforts have addressed teen pregnancy pre-
teen pregnancy prevention among older teens.
vention specifical y among this age group. This lack
of attention may be due to the chal enges reaching
Why Care About Pregnancies and Births
this group, lack of political and/or community will
to address pregnancy prevention among this age
to Older Teens?
group, and limited evidence of effective programs
for teens in this age group.
Fully eight in ten pregnancies to older teens are
unplanned, and the vast majority of births to older
Approximately two-thirds of all teens are to unmarried women. In fact, in 2008 there
were nearly 250,000 births to unmarried older teen
teen pregnancies and births are women—83 percent of all births to 18–19 year-olds
[3]. Pregnancy and childbearing among older teens is
to older teens.
closely linked to a host of other critical social issues,
including poverty and income disparity, overall child
4
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Key Facts
– Many older teens have con-
– Pregnancy rates for older
cerns about the side effects
– Working with and reaching
teens are more than three
of various contraceptive
older teens requires a slight-
times the rate for younger
methods. They also tend to
ly different strategy than
teens.
underestimate the potential
one used for younger teens.
benefits of contraception,
Some states and communi-
– Approximately two-thirds
including its effectiveness for
ties have focused on this
of all teen pregnancies and
preventing pregnancy.
population and have impor-
births are to older teens.
tant lessons learned that are
– Children born to older teen
helpful for those interested
– The majority of older
mothers fare worse than
in including older teens in
teens have had sex, and
those born to mothers in
teen pregnancy prevention
approximately half are
their early twenties.
work.
currently involved in a
sexual relationship.
– While older teens are techni-
– While few programs have
cally adults, few report that
been developed that focus
– Most teens use some form of
they have reached adult-
specifically on 18–19 year-
birth control, but many do
hood as they define it—most
olds, there are evidence-
not use it very well.
older teens are still attend-
based programs that have
ing school and many still live
been developed for young
– Older teens are aware of a
at home with their parents.
adults more broadly that
wide variety of birth control
– Romantic relationships are
have been found to ef-
options, but misinformation
an important aspect of older
fectively change behavior
and misperceptions about
teens’ lives and might influ-
among older teens.
these options are wide-
ence the type of contracep-
spread.
tive methods that they use,
as well as their consistency
of contraceptive use.
well-being, and education to name just a few. While
more likely to be incarcerated and spend more time
the risks tend to be more severe for young teen
in prison compared to sons of mothers age 20–21,
mothers, they remain significant for older teen moth-
and daughters of older teen mothers are more likely
ers as well [4]. For example, compared to children
to become mothers themselves compared to daugh-
of mothers age 20–21, children born to older teen
ters of mothers age 20–21 [4]. While older teen
mothers are more likely to be placed in foster care or
mothers are more likely than younger teen mothers
to have a report of abuse or neglect in the first five
to graduate from high school, they are still less likely
years after birth. Children of mothers age 18–19 are
than their peers who delay childbearing until after
also slightly less likely to graduate from high school
their teen years to have a high school diploma or
themselves compared to their peers who are born
GED [6]. In addition, they are much less likely to pur-
to mothers age 20–21. Other research suggests that
sue post secondary education as compared to their
the children born to 18–19 year-old mothers also
peers who delay childbearing a few more years [4].
fare worse than children born to older mothers on
Taken together, research makes clear that although
early educational indicators such as cognition and
older teen mothers might technically be adults, teens
knowledge, language and communication, social
themselves and their children fare better when moth-
skills and emotional well-being, and physical and mo-
ers are slightly older. These outcomes improve further
tor development [5]. Sons of mothers age 18–19 are
if the pregnancy was wanted and welcomed.
The Odyssey Years: Preventing Teen Pregnancy Among Older Teens
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Section 1. Pregnancy and
Childbearing Among Older Teens
Key Facts
age 15–17. Between 1991 and 2006, the pregnancy
rate for girls age 18–19 decreased 30 percent [2].
– Pregnancy rates for older teens are more
During the same time period, the pregnancy rate
than three times the rate for younger teens.
among girls age 15–17 decreased 47 percent (Chart
1) [2]. However, for the first time since 1991, the
– Approximately two-thirds of all teen births
pregnancy rate for older teens increased 4 percent
and pregnancies are to older teens.
between 2005 and 2006 [2].
– The vast majority of pregnancies and births
Pregnancy rates among older teens and their trends
to older teens are to unmarried teens.
over time differ by race/ethnicity (Chart 2). In 2005
(the most recent year for which these data are avail-
able by age and race/ethnicity), the pregnancy rates
The vast majority of all teen pregnancies and births in
among Hispanic and non-Hispanic black older teen
the United States occur to older teens.a In fact, more
girls (210 and 203 per 1,000 respectively)b were more
than six in ten pregnancies (64 percent) and fully
than double the pregnancy rate among non-Hispanic
two-thirds of births (67 percent) to girls under age
white older teens (79 per 1,000) [7]. The declines
20 are to older teen girls—accounting for nearly half
in the teen pregnancy rate among older teens also
a million pregnancies and more than 300,000 births
vary according to race/ethnicity. Between 1991 and
each year [2, 3].
2005, the teen pregnancy rate among older non-
Hispanic black and non-Hispanic white teens declined
substantially (falling by 36 percent and 40 percent re-
Pregnancies
spectively). However, the teen pregnancy rate among
older Hispanic teens decreased only 19 percent dur-
In 2006, most pregnancies to older teens resulted
ing that same period [7].
in a live birth (60 percent); less than one-third (26
percent) resulted in an abortion, and 15 percent
Pregnancy rates to older teens also vary considerably
resulted in a miscarriage [2]. The pregnancy rate is
by state (Figure 1) [2]. In fact, the pregnancy rate
higher for older teens than for younger teens and
among older teens in the state with the lowest rate is
has decreased less among older teens than among
younger teens in the past two decades. In 2006, the
pregnancy rate for 18–19 year-olds was 122.3 (per
1,000) compared to 38.9 (per 1,000) among younger 12 percent of girls age 18–19
teen girls [2]. Put another way, approximately 12
percent of girls age 18–19 became pregnant in 2006
became pregnant in 2006 alone.
alone compared to approximately 4 percent of girls
a Data on birth rates are available through 2008, and data on pregnancies are available through 2006.
b Pregnancy data for American Indian and Alaska Natives and Asian and Pacific Islander teens are not available. Note that 2006 data are not
available by race/ethnicity and age group.
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Chart 1. Teen Pregnancy rates by age Group, 1990–2006
200
15–17
18–19
15–19
150
100
50
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Source: Guttmacher Institute (2010). U.S. Teenage Pregnancies, Births and Abortions:
National and State Trends by Race and Ethnicity. New York, NY: Author.
Chart 2. Pregnancy rates among Teens age 18–19 by
race/ethnicity, 1990–2005
Hispanic
Non-Hispanic Black
350
Non-Hispanic White
300
Total
250
200
150
100
50
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Source: Ventura, S.J, Abma, J.C., Mosher, W.D., and Henshaw, S.K. (2009). Estimated
Pregnancy Rates for the United States, 1990-2005: An Update, National Vital Statistics
Reports, 58(4).
The Odyssey Years: Preventing Teen Pregnancy Among Older Teens
7

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Figure 1. Pregnancy rates among Teens age 18–19 by
state, 2005
Nearly one-quarter
of births to older
teens are to teens
who already have
62–80 per 1,000
81–99 per 1,000
one child.
100–118 per 1,000
119–137 per 1,000
138–156 per 1,000
Source: Guttmacher Institute (2010). U.S. Teenage Pregnancies, Births and Abortions:
National and State Trends by Race and Ethnicity. New York, NY: Author.
less than half that of the state with the highest rate
Chart 3. Proportion of Pregnancies that
(62 per 1,000 in New Hampshire compared to 155
are Unplanned by age Group, 2001
per 1,000 in Nevada). The difference in pregnancy
rates between states is due in part to differences in
percent
the racial/ethnic composition across states in addition
100
to other factors such as educational opportunities,
89%
poverty, and policies related to reproductive health
80%
80
and family planning.
60%
60
The vast majority of pregnancies to older teens—
fully eight in ten—are unplanned, accounting for
43%
nearly half a million unplanned pregnancies each
40
32%
year (Chart 3) [8]. That so many pregnancies among
this age group are unplanned is in direct opposi-
20
tion to the wishes of older teens. In addition, in a
nationally representative survey of unmarried young
0
15–17
18–19
20–24
25–29
30+
adults age 18–29, 81 percent of 18–19 year-olds
report that it is very important to avoid pregnancy
right now, and 94 percent agree that pregnancy is
Source: Special Tabulations of data from Finer, L. and Henshaw, S. (2006).
something that should be planned [9]. Given that the
Perspectives on Sexual and Reproductive Health, 38(2):90-96.
pregnancy rate among older teens is so high and that
the overwhelming majority of these pregnancies are
unplanned there is clearly an opportunity and need
8
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