Aims Pregnancy rates among adolescents have declined in the US and Britain, but remain high compared to other high-income countries. This comparison examines trends in pregnancy rates, recent sexual activity and contraceptive use among women aged 16-19 in the US and Britain to consider the behavioural drivers of the decline in pregnancy rates in the two countries and the differences between them.
Methods We use data from two rounds of the US National Survey of Family Growth, conducted 2002-3 and 2011-15, and the British National Survey of Sexual Attitudes and Lifestyles, conducted 2000-2001 and 2010-2012, to examine differences between countries and over time in sexual activity and contraceptive use. We calculate pregnancy rates using national births and abortions data.
Results Pregnancy rates declined in both countries from 2001 to 2013 (US 45%, England and Wales 33%; this decline began earlier in the US and was steeper. In the later period a higher proportion of adolescents in Britain than the US reported ever having sex (GB 65% v. US 49%), sex in the last six months (59% v. 39%) and four weeks (48% v. 29%) and using highly-effective contraception (68% v. 52%). Between the two time periods there was no change in sexual activity in Britain, but in the US the proportion reporting recent sex declined. In both countries, there was a shift towards more effective contraception. IUD and implant use increased from 1% to 13% in Britain and from less than 1% to 5% between 2002 and 2013 (p<0.001). Pill, ring and patch use declined in Britain (58% to 49%, p=0.02), but did not change in the US. No method use declined only in the US (8% to 4%). Neither country had changes in condom or withdrawal use.
Conclusions In both countries, improvements in contraceptive use appear the main driver of the decline in pregnancy rates. Comparing Britain and the US shows that more sex among young people does not have to mean more pregnancies, and supports expanding comprehensive sex education programmes and youth-friendly contraceptive services in both countries.
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