Socioeconomic disadvantage and adolescent women's sexual and reproductive behavior: The case of five developed countries

The large size of disadvantaged groups in the U.S. population, combined with disadvantaged teenagers' greater likelihood of having a child, is an important factor in explaining national differences in teenage childbearing. The proportion of the U.S. population that is poor (those whose income is less than half the median income) is at least two-thirds larger than that of the other four study countries. Onethird of American adolescents are black or Hispanic, and a large proportion of these minority groups are disadvantaged in many respects. This proportion is at least twice the proportion of racial and ethnic minorities in the populations of the other four study countries.

However, a large concentration of socioeconomic disadvantage in the U.S. population is not the only factor in the country's higher adolescent pregnancy rate. When we compared adolescents of similar status across countries, we found large differences in almost all measures of sexual behavior and disadvantage. A larger proportion of low-income 20-24-year-old women in the United States than of British women in the lowest social status group had their first child during adolescence (40% compared with 25%). Moreover, the birthrate for white teenagers alone in the United States is much higher than the rate for all teenagers in Great Britain (38 per 1,000 vs. 28 per 1,000), and the rate for all adolescents in the United States is even larger (54 per 1,000 in 1995).33

Other factors that could influence crosscountry differences in adolescent childbearing rates include differences in public perceptions of the social and economic costs of early childbearing, societal attitudes and openness regarding sexuality, and the ease of access to information and services.' In France and Sweden, there appears to be a strong and universal perception that having a child during adolescence is undesirable, while in the United States, this attitude is much less strong and much more variable across groups and areas of the country. Canada and Great Britain fall somewhere between these two situations.35

Unlike the United States, the other countries have national health care systems, facilitating adolescents' access to contraception. In addition, whereas the U.S. population is heterogeneous and spread over a large geographic area, the populations of the other four countries are concentrated in relatively small areas,* which increases accessibility to services and the likelihood that policies and programs will be implemented uniformly.

Nevertheless, socioeconomic disadvantage correlates strongly with adolescent reproductive behaviors and outcomes, and is worthy of policymakers' attention. Improving adolescents' socioeconomic status is a way to prevent their having poor reproductive health outcomes-not only unplanned or early pregnancies or births, but also STDs. While becoming a teenage mother may not have devastating consequences and may even be positive in some respects for some teenagers, it is likely to "compound the handicaps imposed by social disadvantage."36 Approaches to lowering teenage birthrates in the United States should include both reducing the numbers of young people growing up in disadvantaged conditions and helping those who are disadvantaged overcome the obstacles they face.