OPINION: Abstinence, sex-ed... What really prevents teen pregnancy?

Joseph A. Puccio, MD, FAAP, is chief of the Division of Adolescent Medicine at Stony Brook University Medical Center.

The United States has long had one of the highest rates of pregnancies, births and abortions among teenagers among the Western industrialized countries. And that's a problem with deep social and economic repurcussions.

In the 1990s, to combat these rates, sex-ed programs focused on increasing teen contraception use. They seemed to work; there was a 40 percent decline in teen pregnancies between 1990 and 2005. But after that, as was reported late last month, the rates saw an uptick.

Just as some critics were proclaiming that these new statistics show that abstinence programs don't work, however, another study was released, suggesting that an abstinence-only program successfully reduced sexual activity in inner-city teens.

Now what?

The most recent study, coming out of the University of Pennsylvania, reported that an abstinence program reduced the onset of sexual activity among middle school students when compared with students who attended a health information class or one focused on safer sex.

But the students studied were very young - with an average age of 12 - and the specific program did not conform to the "abstinence until marriage" curricula that have been popular over the past 10 years. In particular, the program did not focus on moral issues, and it also addressed contraceptives when they were brought up in class discussion.

The answer to why teen pregnancy is increasing is complex. Although the rise can't be attributed solely to increased spending on abstinence-only programs, it seems likely that the decreased emphasis on contraceptives among teens who are already sexually active contributed.

The National Campaign to Prevent Teen and Unplanned Pregnancy reported that there is mounting evidence that between 2005 and 2007, older teens were having sex and not using contraception of any sort. This could be partly explained by decreasing concern about AIDS among teens. In contrast to the early 1990s - when teens were educated about HIV and the need for consistent contraceptive use - HIV education to high school students has decreased more than 15 percent since 1997.

But some of the rise in pregnancy rates among older teens may also indicate that high school students aren't receiving age-appropriate education. The University of Pennsylvania study appears to show that abstinence programs can be effective for 12-year-olds, but what about as kids mature? Too few pregnancy-prevention programs focus on older teens' social situations and relationships.

Ironically, the modest success of the pregnancy-prevention message over the past decade may also be contributing to the recent increases. After some success was achieved, the spotlight placed by parents, educators, politicians and health care practitioners became less intense - and funds for government programs and from private foundations were devoted to other initiatives. This resource shift has been compounded by recent budget cuts in these difficult economic times.

So how do we approach the problem of teen pregnancy now? These seemingly contradictory studies suggest that a reasonable approach would be to provide comprehensive sex education that focuses on abstinence as the only sure means of preventing sexually transmitted infections and pregnancy, complimented by age-appropriate information regarding contraception to prevent unwanted consequences for those teens who choose to become sexually active.

One thing is certain: We owe it to our teenagers to keep fine-tuning our approach.