The US teen birth rate (births per 1,000 females aged 15 to 19 years) has been declining since 1991. Teen birth rates continued to decline from 17.4 per 1,000 females in 2018 to 16.7 per 1,000 females in 2019.  This is another record low for US teens and a decrease of 4% from 2018. Birth rates fell 7% for females aged 15 to 17 years and 4% for females aged 18 to 19 years.

Although reasons for the declines are not totally clear, evidence suggests these declines are due to more teens abstaining from sexual activity, and more teens who are sexually active using birth control than in previous years.

Still, the US teen birth rate is substantially higher than in other western industrialized nations, and racial/ethnic and geographic disparities in teen birth rates persist.

Disparities in Teen Birth Rates

Teen birth rates declined from 2018 to 2019 for several racial groups and for Hispanics. Among 15- to 19-year-olds, teen birth rates decreased:

• 5.2% for Hispanic females.
• 5.8% for non-Hispanic White females.
• 1.9% for non-Hispanic Black females.

Rates for non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic Asians, and non-Hispanic Native Hawaiian, and other Pacific Islander teenagers were unchanged.

In 2019, the birth rates for Hispanic teens (25.3) and non-Hispanic Black teens (25.8) were more than two times higher than the rate for non-Hispanic White teens (11.4). The birth rate of American Indian/Alaska Native teens (29.2) was highest among all race/ethnicities.

Geographic differences in teen birth rates persist, both within and across states. Although among states with low overall teen birth rates, some counties have high teen birth rates.⁶

Social determinants of health, such as low education and low income levels of a teen’s family, may contribute to high teen birth rates.⁷ Teens in certain settings are at higher risk of teen pregnancy and birth than other groups. For example, young women living in foster care are more than twice as likely to become pregnant than young women not in foster care.⁸

To improve the life opportunities of adolescents facing significant health disparities and to have the greatest effect on overall US teen birth rates, CDC uses data to inform and direct interventions and resources to areas with the greatest need.

The Importance of Prevention

Teen pregnancy and childbearing are associated with increased social and economic costs through immediate and long-term effects on teen parents and their children.

• Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school.
• The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.
• On a positive note, between 1991 and 2015, the teen birth rate dropped 64%, which resulted in $4.4 billion in public savings in 2015 alone.

Evidence-based teen pregnancy prevention programs have been identified by the US Department of Health and Human Services (HHS) Teen Pregnancy Prevention Evidence Review, which used a systematic process for reviewing evaluation studies against a rigorous standard. The Evidence Review covers a variety of diverse programs, including sexuality education programs, youth development programs, abstinence education programs, clinic-based programs, and programs specifically designed for diverse populations and settings.  In addition to evidence-based prevention programs, teens need access to youth-friendly reproductive health services and support from parents and other trusted adults, who can play an important role in helping teens make healthy choices about relationships, sex, and birth control.  Efforts at the community level that address social and economic factors associated with teen pregnancy also play a critical role in addressing racial/ethnic and geographical disparities observed in teen births in the United States.

Teen pregnancy can result in a number of negative consequences. It is necessary to understand the associated risk and protective factors in order to appropriately implement prevention efforts. Risk factors encourage, or increase, behaviors that increase the likelihood of teen pregnancy, while protective factors decrease these behaviors. These factors can occur in multiple domains, such as individual (teen’s attitude), family (poverty status), and community (available resources).

Key risk factors include living in poverty, limited maternal educational achievement, and having a mother who gave birth before the age of 20. Additional risk factors include being from a single-parent home, living in a home with frequent family conflict, early sexual activity, early use of alcohol and drugs, and low self-esteem. Lastly, a teen’s race and ethnicity can be a risk factor for teen pregnancy.

Some protective factors include open communication with parents and/or adults about accurate contraception use, parental support and healthy family dynamics, and peer use of condoms. Protective factors also include positive attitudes towards condom use, intent to abstain from sex or limit one’s number of partners, and accurate knowledge of sexual health, HIV infection, sexually transmitted infections, the importance of abstinence, and pregnancy.

Identifying these factors is important because it can help effectively guide teen pregnancy prevention program planning and implementation by focusing on the specific and varied needs of the youth in the community. 

The high social and economic costs of teen pregnancy and child­bearing can have short- and long-term negative consequences for teen parents, their children, and their community. Through recent research, it has been recognized that pregnancy and childbirth have a significant impact on educational outcomes of teen parents.

• By age 22, only around 50 percent of teen mothers have received a high school diploma and only 30 percent have earned a General Education Development (GED) certificate, whereas 90 percent of women who did not give birth during adolescence receive a high school diploma.
• Only about 10 percent of teen mothers complete a two- or four-year college program.
• Teen fathers have a 25 to 30 percent lower probability of graduating from high school than teenage boys who are not fathers.

Children who are born to teen mothers also experience a wide range of problems. For example, they are more likely to:

• have a higher risk for low birth weight and infant mortality;
• have lower levels of emotional support and cognitive stimulation;
• have fewer skills and be less prepared to learn when they enter kindergarten;
• have behavioral problems and chronic medical conditions;
• rely more heavily on publicly funded health care;
• have higher rates of foster care placement;
• be incarcerated at some time during adolescence;
• have lower school achievement and drop out of high school;
• give birth as a teen; and
• be unemployed or underemployed as a young adult.

These immediate and long-lasting effects continue for teen parents and their children even after adjusting for the factors that increased the teen’s risk for pregnancy—e.g., growing up in poverty, having parents with low levels of education, growing up in a single-parent family, and having low attachment to and performance in school.

Teen pregnancy costs U.S. taxpayers about $11 billion per year due to increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers. Some recent cost studies estimate that the cost may be as high as $28 billion per year or an average of $5,500 for each teen parent. The majority of this cost is associated with teens who give birth before age 18.

Teen pregnancy prevention is a national priority. Despite declines in teen pregnancy and birth rates in the U.S., the national teen pregnancy rate continues to be higher than the rates in other Western industrialized nations. Racial and ethnic disparities remain, with higher rates of teen pregnancy for Hispanic and non-Hispanic black adolescents than non-Hispanic white adolescents. Teen pregnancy prevention is a major public health issue because it directly affects the immediate and long-term well-being of mother, father, and child. Teen pregnancy and childbirth contribute significantly to dropout rates among high school females, increased health and foster care costs, and a wide range of developmental problems for children born to teen mothers.

Addressing teen pregnancy prevention requires broad efforts that involve families, service providers, schools, faith- and community-based organizations, recreation centers, policymakers, and youth. The development and implementation of evidence-based prevention efforts require an understanding of the problem including knowledge of target populations, trends in the rates of teen pregnancy and birth, and the risk and protective factors associated with teen pregnancy. This information can be used to inform decisions—such as choosing which risk and protective factors to focus on—in order to help better guide the effective implementation of evidence-based practices to prevent teen pregnancies. Currently there are a number of initiatives being implemented through the support of the federal government and other organizations to better address the issue of teen pregnancy.

Teen childbearing can carry health, economic, and social costs for mothers and their children. Teen births in the US have declined, but still more than 273,000 infants were born to teens ages 15 to 19 in 2013. The good news is that more teens are waiting to have sex, and for sexually active teens, nearly 90% used birth control the last time they had sex. However, teens most often use condoms and birth control pills, which are less effective at preventing pregnancy when not used consistently and correctly. Intrauterine devices (IUDs) and implants, known as Long-Acting Reversible Contraception (LARC), are the most effective types of birth control for teens. LARC is safe to use, does not require taking a pill each day or doing something each time before having sex, and can prevent pregnancy for 3 to 10 years, depending on the method. Less than 1% of LARC users would become pregnant during the first year of use.

Doctors, nurses, and other health care providers can:

• Encourage teens not to have sex.
• Recognize LARC as a safe and effective choice of birth control for teens.
• Offer a broad range of birth control options to teens, including LARC, and discuss the pros and cons of each.
• Seek training in LARC insertion and removal, have supplies of LARC available, and explore funding options to cover costs.
• Remind teens that LARC by itself does not protect against sexually transmitted diseases and that condoms should also be used every time they have sex.

Problem

Few teens (ages 15 to 19) on birth control use the most effective types.

Use of Long-Acting Reversible Contraception (LARC) is low.

• Less than 5% of teens on birth control use LARC.
• Most teens use birth control pills and condoms, methods which are less effective at preventing pregnancy when not used properly.
• There are several barriers for teens who might consider LARC:
  • Many teens know very little about LARC.
  • Some teens mistakenly think they cannot use LARC because of their age.
• Clinics also report barriers:
  • High upfront costs for supplies.
  • Providers may lack awareness about the safety and effectiveness of LARC for teens.
  • Providers may lack training on insertion and removal.

Providers can take steps to increase awareness and availability of LARC.

• Title X is a federal grant program supporting confidential family planning and related preventive services with priority for low-income clients and teens.*
  • Title X-funded centers have used the latest clinical guidelines on LARC, trained providers on LARC insertion and removal, and secured low- or no-cost options for birth control.
  • Teen use of LARC has increased from less than 1% in 2005 to 7% in 2013.
• Other state and local programs have made similar efforts.
  • More teens and young women chose LARC, resulting in fewer unplanned pregnancies.

What Can Be Done

The Federal government is

• Supporting efforts to prevent teen pregnancy by providing affordable family planning services.
• Developing clinical guidance for safe and effective use of birth control.
• Developing and evaluating programs in communities where teen births are highest.

Doctors, nurses, and other health care providers can

• Encourage teens not to have sex.
• Recognize LARC as a safe and effective first-line choice of birth control for teens, according to clinical guidelines for adolescents from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.
• Offer a broad range of birth control options to teens, including LARC, and discuss the pros and cons of each.
• Seek training in LARC insertion and removal, have supplies of LARC available, and explore funding options to cover costs.
• Remind teens that LARC by itself does not protect against sexually transmitted disease sand that condoms should also be used every time they have sex.

Parents, guardians, and caregivers can

• Talk with their teens about sex, including:
  • encouraging them not to have sex.
  • encouraging them to use effective birth control to prevent pregnancy, along with condoms to protect against sexually transmitted diseases.
• Visit a health care provider with the teen to learn about various types of birth control, including LARC.
• Check with their health plan(s) about coverage of preventive services. Birth control and counseling may be available for teens at no out-of-pocket cost.

Teens can

• Choose not to have sex.
• Talk openly to parents or other trusted adults and ask how they can get birth control if they choose to be sexually active.
• Talk with a health care provider to learn about the best types of birth control for them, and use it and condoms correctly every time.

In 2015, teen fatherhood occurred at a rate of 10.4 births per 1,000 men in this age group. Eighty percent of young men aged 15–19 years report that they would be very upset or a little upset if they were to get a female pregnant. When compared with other age groups, young men also are affected disproportionately by sexually transmitted infections (STI).

Young men have an important role to play in promoting adolescent reproductive health.  Their involvement in contraceptive decision-making has been shown to increase the use of effective methods of pregnancy and STI prevention.

CDC has a long history of addressing male reproductive health, convening its first male reproductive health summit, Advancing Men’s Reproductive Health in the United States, in September 2010.  More recently, CDC has supported several projects that educate and engage young men in reproductive health in innovative ways.

CDC partnered with the Office of Adolescent Health in 2015 to support implementation and evaluation of innovative approaches to educate and engage young men in reproductive health and teen pregnancy prevention efforts. More information about this cooperative agreement can be found on Grants.gov. CDC also collaborated with JSI-Denver, CAI, and Gaston Health and Human Services in 2013 to implement a pilot project to improve reproductive health services for young men and to increase young men’s use of these services.

Most teenage girls don't plan to get pregnant, but many do. Teen pregnancies carry extra health risks to both the mother and the baby. Often, teens don't get prenatal care soon enough, which can lead to problems later on. They have a higher risk for pregnancy-related high blood pressure and its complications. Risks for the baby include premature birth and a low birth weight.

If you're a pregnant teen, you can help yourself and your baby by

• Getting regular prenatal care
• Taking your prenatal vitamins for your health and to prevent some birth defects
• Avoiding smoking, alcohol, and drugs
• Using a condom, if you are having sex, to prevent sexually transmitted diseases that could hurt your baby