Teen birth rate in U.S. through a wider lens

ATLANTA - The rate of teen births in the United States is at its lowest level in almost 70 years. Yet the sobering context is that the teen pregnancy rate is far lower in many other countries.

The most convincing explanation is that contraceptive use is much higher among teens in most Western European countries.

Last week, U.S. health officials released new government figures for 2009 showing 39 births per 1,000 girls ages 15 through 19 - the lowest rate since records have been kept on this issue.

That's close to the teen birth rate for Romania, Turkey, and Bulgaria in 2007, the latest numbers available from the World Bank, which collects a variety of data gauging international development.

But it is dramatically lower around Western Europe and in some countries elsewhere. In Britain, it's 24 per 1,000 girls, and in Ireland, 16; Italy, 5; France, 7. Canada's rate is under 13; Sweden's, under 8; Japan's is about 5, and the Netherlands, close to 4.

The disparity has existed for decades. Several experts say the reason mostly has to do with more realistic approaches to birth control.

Birth control is less expensive and easier for teens to get in many other developed countries than in the United States. And teachers, parents and physicians tend to be more accepting of teenage sexuality and more likely to encourage use of contraception, said Sarah Brown, chief executive of the Washington-based National Campaign to Prevent Teen and Unplanned Pregnancy.

In an attempt to spark interest in condoms, the Philadelphia Department of Public Health is currently holding a contest to design a wrapper for a sort of Philadelphia brand condom. (More details: http://go.philly.com/condom/)

New York, which pioneered the contest idea, gives out 41 million condoms a year.

Both cities are particularly concerned about sexually transmitted diseases - Philadelphia has some of the highest rates in the country - but teen births are also a worry.

The hazards of teen pregnancy include higher dropout rates and possible health and other problems for young mothers and their kids.

There are few comprehensive studies of why teen birth rates vary from country to country. And experts say there probably is not one overarching explanation. For example, the reason for a low teen birth rate may be different in the Netherlands, where prostitution is legal, than in Japan, which has a more conservative culture about sex and sex education.

Some countries may have predominant social values that discourage teenage sex, but abstinence-only education programs - a hot topic in the United States - are generally not considered a major reason for other countries' lower teen birth rates.

"Not at all," said Cecilia Ekeus, an international public health researcher at Stockholm's Karolinska Institute.

"We're working the opposite way," she added, describing Sweden's comprehensive sex education and easy teen access to birth-control pills and condoms (Stockholm has its own brand as well).

Experts say teen births can be lower when:

Teens have less sex.

Teens use contraception correctly and often.

A larger proportion of pregnant teens has an abortion.

But do those explain the international differences?

There is no evidence teens in Europe are having less sex than American teens. They may be having more.

Most international comparisons of abortion rates are considered to be somewhat unreliable and the overall patterns are unclear, although they may help explain low rates in specific countries such as Sweden, where abortions are common and do not require parental consent.

There's much more consensus that birth control is the key to a lower teen birth rate.

Studies indicate that 80 percent of sexually active teen girls in Sweden and 88 percent in England and France use contraception. In the United States, it's about 61 percent.

And in some European countries they are more likely to use longer-lasting forms of birth control, such as the IUD, experts said.

Other explanations? Perhaps race and ethnicity, said Monique Chireau, who researches adolescent pregnancy at Duke University.

The U.S. teen birth rate for whites (26 per 1,000) is much lower then for blacks (59) and Hispanics (70), she said.

"There are distinctions between different ethnicities," and the U.S. whites are more comparable to countries with more homogenous white populations, Chireau said.

Factors like proportions of teens who are married in each country, proportions living in poverty, and other demographics also should be considered, experts said.

Cultural expectations have a lot to do with it, too.

In Sweden, for example, teen motherhood is so far outside the norm that young moms often are assumed to have other problems like a psychiatric diagnosis or drug addiction, said Ekeus, of the Karolinska Institute.