Adolescent Pregnancy Prevention

Approved by Council January 2009; Revised October 2018

The American Academy of Child and Adolescent Psychiatry (AACAP) is committed to improving interventions to address the important public health issue of adolescent pregnancy in the United States.

Background
An estimated 1 in 4 girls will become pregnant at least once by age 20. Pregnancy carries with it negative physical, psychological, emotional, economic, and social sequelae for teen mothers and their children (1). The increased risks for mental health issues in pregnant adolescents include depression and increased suicidal thoughts (2). In addition, adolescent pregnancy results in enormous costs to society (an estimated $9.4 billion in 2010) (1,2). Adolescent pregnancy disproportionately affects minority racial/ethnic groups and adolescents from households where parents or guardians are of low education and/or low income (1). Pregnancy and childbirth contribute to high school dropout rates and carry a higher risk of repeat teen pregnancy (1,2).

Practical and Concrete Implications
Despite a decrease in recent years, the rate of teenage pregnancy in the U.S. continues to be higher than that in other western industrialized countries (1), underscoring the need for continued prevention efforts. The decline has been attributed to increased access to educational materials and reproductive health care (including contraception), through programmatic development and implementation. This has contributed to a reduction in the proportion of teenagers who are sexually active and an increased proportion of those sexually active teenagers using contraception (1). The most effective programs provide information about the risks of unprotected intercourse and ways to avoid unintended pregnancy, as well as modeling and practice of communication, negotiation, and refusal skills among peers and with parents (3). Full service health centers in schools where access to health care, including contraception, and education/options counseling are available have proven efficacy (4).

Recommendations
Based on this data, AACAP:

  • Endorses the development and teaching of curricula on pregnancy, parenting, and sex education throughout the U.S. school system.
  • Recommends that school systems collaborate with local and state health and education agencies to establish medically accurate and high quality comprehensive education that teaches about psychological and physical human growth and development and relationships, and encourages adolescents to make informed, responsible, and safe choices regarding sexual activity.
  • Recommends accessible health clinic programs that provide a full range of services, including confidential counseling and information regarding sexual activity and reproductive health.

Although AACAP supports parental involvement in adolescent decision-making, AACAP recognizes that many adolescents may be less likely to seek necessary health services if required to inform their parents (5). Therefore, laws that empower adolescents to obtain certain basic health care on their own, make decisions regarding reproductive health care, and ensure confidentiality are very important, as they improve access to critical health care services.

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The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.