The incidence of births to teenagers in the United States has declined steadily from its peak in 1991. In 2009 the birthrate for U. S. teens was 39.1 births per 1,000 females, a 37% decrease from 61.8 births per 1,000 teenage females in 1991 and the lowest rate of teen births ever recorded (Centers for Disease Control, 2011g). Even though adoles­cent birthrates in the United States have declined, the still alarmingly high rate of teen­age pregnancies and births, especially among African American and Hispanic teens, continues to be an urgent social concern. Among Western industrialized nations, the United States has the highest rate of teen pregnancy (Allen & Forcier, 2011; Akers et al., 2011). Approximately 750,000 unmarried American adolescents become pregnant each year, and 80% of these pregnancies are unintended. This adolescent pregnancy rate is as much as nine times higher than in other developed countries and two to four times higher than in several Western European nations whose age-specific levels of teenage sexual activity are comparable to those in the United States (Splete, 2011; Winik, 2008). This finding raises the obvious question of whether contraception is significantly underused or misused by adolescents in the United States. We address this issue in a later section of this chapter.

At the time of this writing, efforts are under way in Congress to reduce or eliminate federal funding for programs that focus on reducing teen pregnancy. These efforts are described in the Sex and Politics box, "U. S. Congress Considering Measures to Reduce Teen Pregnancy Prevention Programs."

As described in Chapter 10, females ages 16 and younger are currently required to obtain a prescription for EC, whereas older women can access this medication over the counter without a prescription. In November 2010 the Center for Reproductive Rights filed a legal brief charging the U. S. Food and Drug Administration (FDA) with being in contempt for not complying with a March 2009 court order to end age restrictions on EC. In passing this order the court supported evidence that there are no valid medi­cal contraindications for EC use in female adolescents (Brakman, 2011). In 2011 the FDA recommended lifting the restrictions on access to EC by teenagers 16 and younger. Unfortunately, the Obama administration overruled the FDA and elected to continue requiring EC prescriptions for teenage females 16 and younger.

Sexuality During Childhood and Adolescence