Vital signs: teen pregnancy--United States, 1991--2009.

BACKGROUND In 2009, approximately 410,000 teens aged 15-19 years gave birth in the United States, and the teen birth rate remains higher than in other developed countries. METHODS To describe U.S. trends in teen births and related factors, CDC used data on 1) teen birth rates during 1991-2009 from the National Vital Statistics System, 2) sexual intercourse and contraceptive use among high school students during 1991-2009 from the national Youth Risk Behavior Survey, and 3) sex education, parent communication, use of long-acting reversible contraceptives (LARCs), and receipt of reproductive health services among teens aged 15-19 years from the 2006-2008 National Survey of Family Growth. RESULTS In 2009, the national teen birth rate was 39.1 births per 1,000 females, a 37% decrease from 61.8 births per 1,000 females in 1991 and the lowest rate ever recorded. State-specific teen birth rates varied from 16.4 to 64.2 births per 1,000 females and were highest among southern states. Birth rates for black and Hispanic teens were 59.0 and 70.1 births per 1,000 females, respectively, compared with 25.6 for white teens. From 1991 to 2009, the percentage of high school students who ever had sexual intercourse decreased from 54% to 46%, and the percentage of students who had sexual intercourse in the past 3 months but did not use any method of contraception at last sexual intercourse decreased from 16% to 12%. From 1999 to 2009, the percentage of students who had sexual intercourse in the past 3 months and used dual methods at last sexual intercourse (condoms with either birth control pills or the injectable contraceptive Depo-Provera) increased from 5% to 9%. During 2006-2008, 65% of female teens and 53% of male teens received formal sex education that covered saying no to sex and provided information on methods of birth control. Overall, 44% of female teens and 27% of male teens had spoken with their parents about both topics, but among teens who had ever had sexual intercourse, 20% of females and 31% of males had not spoken with their parents about either topic. Only 2% of females who had sexual intercourse in the past 3 months used LARCs at last sexual intercourse. CONCLUSIONS Teen birth rates in the United States have declined but remain high, especially among black and Hispanic teens and in southern states. Fewer high school students are having sexual intercourse, and more sexually active students are using some method of contraception. However, many teens who have had sexual intercourse have not spoken with their parents about sex, and use of LARCs remains rare. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE Teen childbearing is associated with adverse consequences for mothers and their children and imposes high public sector costs. Prevention of teen pregnancy requires evidence-based sex education, support for parents in talking with their children about pregnancy prevention and other aspects of sexual and reproductive health, and ready access to effective and affordable contraception for teens who are sexually active.