- Douglas Kirby and B. A. Laris
- Child Development Perspectives, (2009)
Historically, teenage pregnancy rates in the US and UK are higher than those of other developed nations. A third of girls in the US become pregnant before they reach the age of 20 (National Campaign to Prevent Teen Pregnancy, 2006). Earlier research found 82 per cent of these teen pregnancies were unintended. Consistent with this high teen pregnancy rate is the high teen birth rate (40 births per 1,000 for 15- to 19-year-old females in 2005.
These teen pregnancies and births generally have negative consequences for those involved, especially when the girls are younger than 18 (Hoffman, 2006). Girls in this group are less likely to complete high school or attend college and are more likely to have large families and be single parents.
Teen sexual activity also leads to high rates of sexually transmitted disease (STD). Although young people aged 15 to 24 represent 25 per cent of the sexually active population in the US, they account for about half of all new cases of STDs. In addition, about one-third of all sexually active young people become infected with an STD by 24.
Although most sexually experienced teenagers report that they use contraception, especially condoms and oral contraceptives, some of the time (Suellentrop, 2006), many teenagers do not use contraceptives correctly and consistently, and so expose themselves to risks of pregnancy or STD. Accordingly, many schools, youth organisations and adolescent reproductive health professionals have developed a variety of education programmes to reduce unintended pregnancy and STD among young people.
The programme studied had to be a curriculum- and group-based abstinence, sex or STD/HIV education programme (as opposed to an intervention limited to spontaneous discussion, one-on-one interaction, or broad school, community, or media awareness activities). It also had to focus primarily on sexual behaviour (as opposed to a variety of risk behaviours such as drug and alcohol use, violence, and sexual behaviour), target adolescents of middle school or high school age, and be implemented in the US.
In terms of evaluation, the research had to have a sample size of at least 100. It also had to include measures of programme impact on one or more sexual behaviours (for example, number of sexual partners, use of condoms or contraception, and frequency of unprotected sex), pregnancy rates, birth rates or STD rates.
For those behaviours that can change quickly, impact had to be measured for at least three months; for those that change less quickly, impact had to be measured for at least six months.
Of all 55 programmes, 15 per cent focused only on reducing teen pregnancy, 45 per cent only on preventing STD/HIV, and about 40 per cent focused on both.
Of those studies that measured impact on one or more sexual behaviours, 41 per cent delayed the initiation of sex, 31 per cent decreased the frequency of sex (which includes returning to abstinence), and 40 per cent cut the number of sexual partners.
Of the studies that measured the use of condoms and other forms of contraception, 42 per cent reported an increase in condom use and 40 per cent, an increase in contraceptive use.
Across all 55 studies, 64 per cent had a significant positive impact on one or more of the relevant sexual behaviours or outcomes and 38 per cent had a positive impact on two or more behaviours.
Programmes that were effective gave a message about behaviour - for example: ‘‘You should always avoid unprotected sex", "If you have sex, always use protection against pregnancy and STD.'' However, programs that encouraged abstinence alone had little evidence that they affect sexual behaviour
Effective curricula incorporated multiple activities designed to improve each of the mediating factors. These activities, geared to the students' gender, age, and level of sexual experience, got young people actively involved and helped them personalise the information. They included games to increase students' knowledge, role-playing exercises to improve their skills to say no to sex or to insist on using condoms or contraception, and anonymous voting activities about what sexual behaviours are right for them to change perception of peer norms. The activities also had young people describe situations that might lead to unintended, unwanted or unprotected sex and then had them describe strategies for avoiding them.
Implications for practice
- Policymakers and educators should implement programmes with strong evidence that have been shown to be effective with adolescent populations similar to those being targeted. These programmes include curricula found to be effective in both school and community settings.
- Select and implement widely programmes that incorporate the 17 key characteristics of programmes that have been effective with populations similar to those being targeted. These 17 characteristics are outlined in the paper and include: addressing multiple sexual psychosocial risk and protective factors affecting sexual behaviour (e.g. knowledge, perceived risks, values, attitudes, perceived norms, and self-efficacy); employing instructionally sound teaching methods that actively involve the participants; and employing activities, instructional methods, and behavioural messages that were appropriate to culture, developmental age, and sexual experience.
- If implemented broadly with fidelity, programmes with evidence of success can contribute to further reductions in teen pregnancy and STDs.