ABSTRACT
In spite of the current declines, the US continues to have the highest rate of teen pregnancy in the developed world. 8 Data suggest that the current US
rate is approximately two times the rate in Europe and Canada and eight times the rate in the Netherlands and Japan. 1 The reason for these regional variations is the subject of much research and debate. Strict moral and traditional values have been suggested as the reason for low teen pregnancy rates in areas like Japan and Singapore. Some suggest that the large minority population of the US is the etiology of its higher teen pregnancy rate. Although the minority population in the US has higher rates of teen pregnancy, non-Latina whites represent a larger proportion of the adolescent population and therefore have a greater absolute number of births. 8 – 10 Rates and age of first sexual intercourse are similar across the developed world and therefore cannot account for variations in pregnancy rates across countries. 11 Furthermore, the misconception that teens in the United States view pregnancy as a means of obtaining public assistance benefits is inconsistent with the lower pregnancy rates observed in some European countries that provide greater access and excellent public assistance benefits to pregnant teens. 9 The major difference between the US and the rest of the developed world is in policy related to teenage pregnancy, sexual education, adolescent sexuality, contraception, and reproductive health services. Access to comprehensive reproductive health services is a problem for many teens around the globe. Worldwide, 13-14 million children are born to women less than 20 years old; 12 90 % of these births occur to adolescents living in the developing world. 13,14 The adolescent pregnancy rate ranges from a high of 143/1000 in sub-Saharan Africa to 4-8/1000 in Singapore. 13,14
For many teens in the US and across the globe, pregnancy and childbirth have long-term consequences that last well beyond the expected 40-week
gestational period. Pregnant teens around the world face similar challenges of poverty and decreased educational and employment opportunities. Lack of access to confidential care, abortion services, and contraception are major obstacles. These challenges are not insurmountable. Adolescent pregnancy remains an important issue because of the medical, financial, psychosocial, and political impact that it has on the teen, her child, and society. A comprehensive care plan to end the cycle of poverty, decreased opportunities, poor maternal and fetal outcomes, and repeated pregnancies involves several key issues ( Table 16.1 ).
