Sexual Activity, Pregnancy Among Young Adolescents 'Rare,' Study Affirms

April 25, 2013 — Summary of "Sexual Initiation, Contraceptive Use, and Pregnancy Among Young Adolescents," Finer/Philbin, Pediatrics, April 2013.

"Despite substantial declines in adolescent pregnancy over the past 2 decades, teen sex remains a prominent bogeyman, as there is a broad public perception that a substantial proportion of young adolescents are sexually active," according to Lawrence Finer and Jesse Philbin of the Guttmacher Institute. This perception has been reinforced in public policy debates, including by President Obama and HHS Secretary Kathleen Sebelius in arguing that emergency contraception should not be available over the counter to people of all ages because of concerns about very young adolescents having access to the method.

While "[p]ast work has examined the sexual and reproductive behavior of adolescents 14 and younger," those studies were based on "data from the late 1990s and none of them presented information on the youngest adolescents (those 12 and younger)," Finer and Philbin noted. For the new study, the researchers used "newly available public data sets" and other information "to make updated and more precise estimates of sexual activity, contraceptive use, and pregnancy rates among the youngest adolescents as well as older teens."

Methods

Finer and Philbin examined data from the 2006 to 2010 wave of the National Center for Health Statistics' National Survey of Family Growth to determine the proportion of individuals who had had sex -- defined as "first heterosexual vaginal intercourse" -- by a certain birthday, as well as the proportion of individuals of specific ages who had had sex. In addition, for females, the researchers examined the relationship between timing of sexual debut and whether their first sexual experience was voluntary.

To look at trends over time, they also analyzed ages at first sex in the 1988, 1995, 2002 and 2006 to 2010 rounds of the NSFG. In addition, the researchers assessed birth cohorts of female respondents from 1939 to 1991 to determine the ages by which various proportions had had sex.

The researchers also determined the proportion of individuals, by age, who used contraception for the first time the same month as or before they first had sex, as well as how long it took other individuals to initiate contraceptive use.

Finally, they used NCHS data on births and Guttmacher data on abortions to calculate pregnancy, birth and abortion rates by age at pregnancy outcome for 2008.

Results

Finer and Philbin found that among women ages 15 through 24 in the 2006 to 2010 wave of NSFG, fewer than 1% had had sex by age 12, only 2% had had sex by age 13 and only 5% had had sex by age 14. Comparatively, about 2% of men in this group had had sex by age 12, 5% by age 13 and 10% by age 14.

The researchers found that sex became more common "[b]y the middle teens," with 19% of female 15-year-olds and 32% of female 16-year-olds having had sex. Similarly, about 22% of male 15-year-olds had had sex and 35% of male 16-year-olds had had sex. Twenty-six percent of both male and female adolescents had not had sex by age 20.

Finer and Philbin also reported that "sex among the youngest adolescents is much more likely to be coerced than among older age groups," with 62% of female 10-year-olds, 50% of 11-year-olds and 23% of 12-year-olds reporting that their first sex was nonconsensual. The trend diminished among slightly older adolescents, with about 7% of females who had had sex by ages 13 or 14 reporting that their first sex was nonconsensual.

In looking at historical trends, the researchers found that "at no time in the past 50 years was it the case that [at least] 10% of girls had had sex by their 14th birthday." Further, median age at first sex never dropped below 17, and the proportion of young adults who had not had sex by age 19 never dropped below 25%. The researchers also found that "members of the most recent cohorts are less likely to have had sex (by every age) than those born in the 1970s, indicating that more young people are delaying sexual initiation than in the recent past."

In terms of contraceptive use, Finer and Philbin determined that "teens who initiate sex at young ages take longer to initiate conceptive use." For example, only 52% of those who first had sex at age 12 or younger used contraceptives the first month they were sexually active. However, 80% of those who initiated sex at age 15 used contraceptives, as did 82% of those who first had sex at age 16 and 85% of those who first had sex at ages 17 or 18.

With regard to pregnancy, the researchers found that the pregnancy rate among girls ages 12 and younger was "minuscule" and the absolute number of pregnancies also was "remarkably small." They noted that the majority of pregnancies for girls ages 13 and younger ended in abortion, while pregnancies for girls ages 14 and older were more likely to end in births.

Discussion

"[T]he findings in this article indicate that sexual activity has been rare among the youngest adolescents for decades, and pregnancy is even rarer," the researchers wrote, adding that concerns about high levels of sexual activity among adolescents are "unfounded." They underscored that sexual activity among the youngest adolescents differs from that among older teens "in that it is frequently nonconsensual."

Likewise, the researchers drew a distinction between public health concerns regarding pregnancies among older and younger adolescents, noting that for younger teens, low rates of contraceptive use at first sex likely are related to a lack of "information about and access to contraceptive methods." Comparatively, sexually active 15- and 16-year-old girls "are most at risk for experiencing an unwanted teenage pregnancy, and ... are therefore most affected by restrictions, legal or practical, to using contraception," they wrote.

Conclusions

Finer and Philbin urged pediatricians and other child and adolescent health professionals to "screen for unwanted sexual activity among patients of all ages," particularly among the youngest adolescents. They also emphasized the importance of educating young adolescents about contraceptives and offering or prescribing methods before they become sexually active.

The researchers concluded, "Although the high rate of sexual coercion among young adolescents is certainly cause for concern, it should not be used as a brush with which to tar sexual activity among those older teens who are capable of both deciding to initiate sex and, based on our findings, able to initiate contraceptive use when doing so."