Trends in teen pregnancy rates from 1996-2006: a comparison of Canada, Sweden, U.S.A., and England/Wales.
Article Type: Report
Subject: Teenage pregnancy (Forecasts and trends)
Teenage pregnancy (Statistics)
Authors: McKay, Alexander
Barrett, Michael
Pub Date: 03/22/2010
Publication: Name: The Canadian Journal of Human Sexuality Publisher: SIECCAN, The Sex Information and Education Council of Canada Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2010 SIECCAN, The Sex Information and Education Council of Canada ISSN: 1188-4517
Issue: Date: Spring-Summer, 2010 Source Volume: 19 Source Issue: 1-2
Topic: Event Code: 010 Forecasts, trends, outlooks; 680 Labor Distribution by Employer Computer Subject: Market trend/market analysis
Product: Product Code: 9105263 Teenage Pregnancy NAICS Code: 92312 Administration of Public Health Programs
Geographic: Geographic Scope: United Kingdom; Canada; United States; Sweden Geographic Code: 4EUUK United Kingdom; 1CANA Canada; 1USA United States; 4EUSW Sweden
Accession Number: 229542649
Full Text: Abstract: This article summarizes and compares the most recent available data on ten-year teen birth/ abortion rates in Canada, Sweden, U.S.A., and England/Wales. From 1996 to 2006, the teen birth/abortion rate declined by 36.9% in Canada, 25% in the U.S.A, and 4.75% in England/Wales, and increased 19.1% in Sweden. In 2006, the lowest teen birth/abortion rate per 1,000 women aged 15-19 was in Canada (27.9) followed by Sweden (31.4), England/Wales (60.3), and the U.S.A. (61.2). With respect to teen birth rates, in 2006, Sweden (6.0), and Canada (13.7) had rates substantially lower than in England/ Wales (35.0) and the U.S.A. (41.9). Canadian interprovincial/territorial differences in teen pregnancy rates, and percentage declines from 1996 to 2006, as well as declines among women aged 15-19, 20-24, and 25-29 are examined. Potential factors contributing to trends in teen pregnancy rates are discussed.

Acknowledgement: The authors would like to thank Anna Lindam, Socialstyrelsen, The National Board of Health and Welfare, Sweden, for her assistance in locating Swedish data.

Introduction

Trends in teenage pregnancy rates are of interest to educators, health care providers, researchers and policy makers for a variety of reasons including the connection between socioeconomic factors and the incidence of adolescent pregnancy/child bearing (Bissell, 2000; Darroch, Frost, Singh & Study Group, 2001); and the use of teen pregnancy trends as indicators of adolescent sexual and reproductive health (e.g., Avery & Lazdane, 2008; SIECCAN, 2004; Weaver, Smith, & Kippax, 2005).

Teenage pregnancy has been conceptualized as a social problem requiring prevention efforts (e.g., Maynard, 1996). Other researchers have viewed teen pregnancy within the sociocultural and economic context in which it occurs, placing more emphasis on the many instances of teenage pregnancy that are not necessarily problematic, or would be less so if teen mothers received adequate social and financial support (Bissell, 2000; Bonell, 2004). From either of these perspectives, information on trends in teen pregnancy is useful for the purposes of informing public policy.

In terms of teen pregnancy rates as indicators of adolescent sexual and reproductive health, it is assumed that a majority of teenage pregnancies are unintended and that such trends therefore reflect the extent to which young women have the capacity to control their sexual and reproductive health. It is likely that declining trends in teen pregnancy rates (in contrast to stable or increasing rates) may reflect increasing levels of effective contraceptive use, greater access to reproductive health services, exposure to higher quality sexual health education, and/or a shifting of social norms in a direction that provides greater support for young women's capacity to exercise reproductive choice.

Purpose of the current article

This article compares the most recent Canadian trends in teen pregnancy (birth/abortion rates) (1996-2006) with trends in Sweden, England/ Wales and the United States over the same period. These countries were chosen for comparison because they are similar to Canada with respect to economic development, political structure, and other characteristics but also because they have generally comparable data on teen pregnancy rates that can be adapted to make such comparisons possible. While the selection of the most recent ten-year time frame for comparison is somewhat arbitrary, we think this analysis provides a useful overview for educators, health care professionals, service providers, policy makers and others concerned with adolescent sexual and reproductive health.

Methods

Calculating teen pregnancy rate measures that are comparable between countries

Differences between the four counties in their reporting of teen pregnancy-related data made it necessary to do calculations that would make comparisons between them possible. For example, variations between the four countries in the handling of fetal loss, a component of teen pregnancy rates

in Canada and the U.S.A., made it necessary to restrict our analysis to birth and abortion rates. For the purposes of this comparative study, we therefore refer to birth/ abortion rates which are based on births plus abortions per 1,000 15- to 19-year-old women in a given year.

The data sources and rationale for the necessary calculations are presented below.

Data Sources

Canada: Data for the years 1995 to 2005 were obtained by entering the appropriate inputs (i.e., live births, induced abortions, 15-19, Canada place of residence) into the Statistics Canada (n.d.a) CANSIM data Table 106-9002. Data for the year 2006 were obtained from CANSIM Table 102-4505 (Statistics Canada, n.d.b) and CANSIM Table 1069034 (Statistics Canada, n.d.c).

Sweden: The birth rate and abortion rates for Sweden were calculated from multiple data sources available from Statistics Sweden. Data on abortion rates per 1,000 women aged 15-19 for the years included in this analysis were available in the publication Aborter 2008 (Statistics Sweden, 2009a). Birth rates for Swedish teens were calculated using the number of births to females aged 19 and under for the years in question available in the publication Bilaga 1: Medieinska Fodelseregistret 1973-2008 (Statistics Sweden, 2009b) and data on the number of 15-19 year-old women in Sweden for the years 1996-2008 (Statistics Sweden, n.d.). Births to females under age 15 have been included in the numbers reported for those under 19, which inflates Sweden's birth rates in comparison to the other three countries. This inflation is likely small. In Canada, for example, the birth rate for females under age 15 was 0.6 per 1,000 in 2005 (Statistics Canada, n.d.a).

United States: Data for the U.S. for live births and induced abortions came from the National Center for Health Statistics report Estimated Pregnancy Rates for the United States, 1990-2005." An Update (Ventura, Abma, Mosher, & Henshaw, 2009) and the Guttmacher Institute report U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity (Kost, Henshaw, & Carlin, 2010).

England and Wales: Data on live births and induced abortions from England and Wales were obtained from the Office of National Statistics (2007) Conception Statistics: Conceptions for Women Resident in England and Wales, 2005 and Shrosbree's (2009) Report: Conceptions in England and Wales, 2007.

Accounting for fetal loss in teen pregnancy rate calculations

In Canada and the U.S., the teen pregnancy rate is generally calculated as the sum of live births, induced abortions, and fetal losses (i.e., miscarriages, still births) per 1000 females aged 15-19 . However, Canada and the U.S. differ in the way fetal loss data are obtained such that there are important discrepancies in fetal loss statistics between the two countries. In fact, the difference in reported rates of fetal loss between Canada and the U.S.A. is large enough that it may be reasonably concluded that the size of the difference is attributable more to differences in the way the data are collected than it is to actual differences in the percentages of teen conceptions that result in fetal loss.

Specifically, the fetal loss portion of estimated teen pregnancy rates in the U.S.A. is derived from pregnancy history data obtained from the National Survey of Family Growth, a self-report survey of women (Ventura, et al., 2009). In contrast, Statistics Canada (n.d.a.) calculates fetal loss as "... the sum of stillbirth registrations in the Stillbirth Database and cases of miscarriages, illegal abortions and unspecified abortions reported in the Hospital Morbidity Database". In other words, the Canadian fetal loss data come from medical records while the U.S. data come from a self-report survey. Not surprisingly, these quite different methods of data collection would be expected to produce different results. For example, for the year 2005 the rate of fetal loss per 1,000 females aged 15-19 in Canada was 0.5 (Statistics Canada, n.d.a.) whereas the equivalent rate for the United States was 11.1 (Ventura, et al., 2009). This kind of discrepancy explains our decision to exclude fetal loss data when comparing the teen pregnancy rates of all four countries and instead refer to birth/abortion rates. That decision is reinforced by the fact that the data available from England/ Wales (Office of National Statistics, 2007) and Sweden do not include miscarriages (i.e., fetal loss).

Implications of country differences in accounting for stillbirths in teen pregnancy rate calculations Canada and the U.S. include stillbirths in the fetal loss category which means that our exclusion of the fetal loss category, explained above, thus eliminated stillbirths from the teen birth/abortion rate calculations for Canada and the U.S. However, England/Wales and Sweden include stillbirths within their birth data which has the effect of slightly elevating the birth portion of the birth/abortion rates for England/Wales and Sweden compared to Canada and the U.S. However, we expect that this difference from Canada and the U.S. is minimal and will thus have had very little if any impact on the overall teen birth/abortion rate trends reported here. For example, in Canada in 2005 there were 13.3 live births per 1,000 15-19 year-old females and 0.5 per 1,000 fetal losses (miscarriages, stillbirths). If the ratios of the live birth to the stillbirth portion of fetal losses are similarly low in the other three countries, we can expect that the comparative impact of inclusion of stillbirths in the England/Wales and Sweden birth data would be slight. As Kost, Henshaw, and Carlin (2010) noted in their interpretation of teen pregnancy data in the U.S., "Stillbirths are a very small proportion of all pregnancies" (p. 21).

Results

Teen birth/abortion rate trends in Canada

Over the time period considered in this study, the teen birth/abortion rate in Canada declined in each consecutive year from 44.2 per 1,000 women aged 15-19 in 1996 to 27.9 in 2006, a decline of 36.9% (Statistics Canada, n.d.a., n.d.b., n.d.c.) (Table 1, Fig. 1). In 2006, the most recent year for which data are available for all four countries, Canada had a lower teen birth/abortion rate (27.9) than the United States (61.2), England/Wales (60.2), and Sweden (31.4). The Canadian teen birth rate decreased from 22.1 per 1,000 in 1996 to 13.7 in 2006, a decline of 38.0% and the teen abortion rate decreased from 22.1 in 1996 to 14.2 in 2006, a decline of 35.7%. Throughout this period in Canada, births accounted for about 47% of the birth/abortion rate with only slight fluctuations in an overall range of 45%-50%. The percentage of births in the birth/abortion rate was higher in the U.S.A. (65%-70%) and in England/Wales (58%-64%) from 1996 to 2006. In contrast, births in Sweden represented a low and declining contribution to birth/abortion rates over the period (30.3%-19.1%), a quite different situation than in the other countries. For example, in 2006, teen births accounted for 49.1% of the total teen birth/abortion rate in Canada compared to 68.5% in the U.S.A., 58.1% in England/Wales, and 19.1% in Sweden (Table 1).

Trends in the United States

Data on teen birth/abortion rates from the United States show an overall decline in teen pregnancies during the study period (Kost, Henshaw, & Carlin, 2010; Ventura et al., 2009) (Table 1, Fig. 1). The teen birth/abortion rate declined from 82.1 per 1,000 in 1996 to 61.2 in 2006, a drop of 25.5%. The U.S. teen birth rate fell from 53.5 per 1,000 to 41.9, a decline of 21.7% and the teen abortion rate fell more sharply, declining from 28.6 per 1,000 to 19.3, a decline of 32.5%. At both the beginning and end of the study period the United States had the highest teen pregnancy rates of the four countries under study. However, the decline in teen pregnancy rates in the Unites States from 1996 to 2006 reflects a long-term secular trend. For example, data from Ventura et al., show that the teen birth/abortion rate in the United States fell from 100.2 per 1,000 in 1990 to 61.2 in 2005, a decline of 38.9% (data not shown). Preliminary data for 2006 indicate a small increase from 2005 but data for subsequent years will be needed to determine whether this reflects a reversal of the sustained trend to decreasing birth/abortion rates in the U.S.

Trends in England/Wales

Based on data from the United Kingdom Office of National Statistics (2007) and Shrosbree (2009), the teen birth/abortion rate in England/Wales was 63.2 per 1,000 in 1996 and 60.3% in 2006, a decline of 4.7% (Table 1, Fig. 1). This decline is less than those seen in Canada (36.9%) and the United States (25.5%) over the same time period but consistent with past research showing that longer-term (e.g., 1990 to 2005) declines in teen birth/abortion rates have been less pronounced in England/Wales than in Canada and the United States (McKay, 2006). While the teen birth rate in England/Wales declined by 13.2%, the teen abortion rate increased by 9.1%.

Trends in Sweden

In 1996, Sweden's teen birth rate and abortion rate were each notably lower than the other three comparison countries in this study (Table 1) which is consistent with research findings in the 1970s, 1980s, and 1990s. As was the case with Canada, England/Wales, and the United States, Sweden's teen pregnancy rates showed a significant overall three-decade decline up to the mid-1990s (Darroch, Frost, Singh, & Study Group, 2001; Singh & Darroch, 2000). However, in the period covered by the current study (1996-2006) Sweden's total teen birth/abortion rate increased from 25.4 per 1,000 to 31.4, a rise of 19.1%. Thus, Sweden is the only one among the four countries considered here that had an increase the teen birth/abortion. However, if one includes the additional data for 2007 and 2008, it would appear that Sweden has had a generally stable, if slightly fluctuating, teen birth/abortion rate (30.1-32.2) since 2002.

The 19.1% rise in Sweden's teen birth/abortion rate between 1996 and 2006 is particularly notable because it occurred during a period when the teen birth rate dropped from 7.7 to 6.0 per 1,000, a decrease of 22.1%. This decline in the teen birth rate was paralleled by a 30% rise in the teen abortion rate; abortion accounted for about 70% of Sweden's teen birth/abortion rate in 1996 and about 80% in 2006. In contrast, over this period, the teen abortion rate declined by 35% in Canada and by about 33% in the U.S. The net result of these changes was that Sweden's birth/abortion rate, which was decidedly lower than Canada's in 1996 (25.4 versus 44.2) was higher than Canada's in 2006 (31.4 versus 27.9). Even given the inclusion of stillbirths in Sweden's birth data (see data sources above), this difference is notable.

[FIGURE 1 OMITTED]

Trends in teen birth/abortion rates in Canada's provinces and territories

While national measures of teen birth/abortion rates are informative, they can mask considerable variation in these rates within a country. Such differences within countries may be associated with geographic, socioeconomic, regional and ethnocultural factors that impact on teenage pregnancy. Countries that vary with respect to these factors might thus be expected to show internal variation in teen birth/abortion rates. The geographic distribution of Canada's provinces and territories makes them a good test case to look for such variability in teen birth/abortion rates and in changes in these rates over time. In this section, we compare birth/abortion rates in the provinces and Yukon in 2005 (the most recent year for which data were available) and look also at the percent decline in these rates from 1995 to 2005. Data on abortions for 2004 and 2005 were not available for the Northwest Territories and Nunavut so these rate comparisons could not be made.

Teen birth/abortion rates in Canada in 2005 (Statistics Canada, n.d.a.) varied considerably among the provinces from 22.5 per 1000 females 15-19 in Newfoundland to 42.4 in Saskatchewan (Table 2). Against a national reference point rate of 28.6 for the entire country in 2005, five provinces were 'below that level (P.E.I., Newfoundland, New Brunswick, Ontario, and Nova Scotia; 18.5-23.7) and five provinces, plus the Yukon exceeded it (British Columbia, Yukon, Quebec, Alberta, Manitoba, and Saskatchewan; 29.3-42.4). In terms of regional differences, rates were lower in Eastern Canada (and Ontario) and higher in Western Canada (and Quebec and Yukon). In all cases, birth/abortion rates were lower in 2005 than in 1995 although the percentage decline varied considerably from the relatively low declines in Quebec (! 0%), Saskatchewan (25.5%), and Newfoundland (28.3%) to the highest declines in P.E.I (48.9%), Ontario (51.5%) and Yukon (51.8%).

Comparison of trends in teen birth/ abortion rates with those for 20-24 and 25-29 year-olds in Canada

Birth/abortion rates in Canada declined between 1995 and 2005 for women aged 15-19, 20-24, and 25-29 (Statistics Canada, n.d.a.) with 15-19 year-olds showing a large 37.6% decline over this period (45.8 per 1,000 to 28.6). In contrast, birth/abortion rates for 20-24 year-olds declined 25.4% (from 104.7 per 1,000 in 1995 to 78.1 in 2005) and for 25-29 year-olds the rate declined by 13.1% (134.5 in 1995 to 116.9 in 2005) (data not shown). Overall, the declines in birth/ abortion rates from 1995 to 2005 encompassed both teens and women in their 20's. The lesser declines and greater absolute birth/abortion rates in the older age categories may reflect greater likelihood of intended pregnancy, particularly among 25-29 year-olds. For example, abortion as a percentage of birth/ abortion rates in 2005 was 46.9% for 15-19 year-olds, 35.5% for 20-24 year-olds, and 16.9% for 25-29 year-olds. Consistent with this obervation, birth rates were lowest for 15-19 year-olds at 24.3/1000 compared to 50.4/1000 for 20-24 year-olds and 97.2/1000 for 25-29 year-olds (Statistics Canada, 2009; Statistics Canada, n.d.a.) (data not shown).

Discussion

In the study period adopted for this analysis (1996-2006), teen birth/abortion rates (a close reflection of pregnancy rates) declined substantially in Canada and the U.S.A., declined slightly in England/Wales, and increased in Sweden. Teen birth rates declined in all four countries. The trend clearly indicates a decline in teen pregnancy rates and teen birth rates in particular that is not country specific and may, in fact, reflect a broader trend occurring in Western developed countries. Research and commentary on trends in teen pregnancy have tended to focus on individual countries (for exceptions see Darroch, Frost, Singh, & Study Group, 2001; Singh & Darroch, 2000) in that country-specific social, economic, demographic, and educational factors, and health resource access, have often been emphasized as potential influences on teen pregnancy rates. While specific community and country factors of this kind have direct influence on teenage pregnancy rates, international comparative data on teenage pregnancy suggest the possibility, if not probability, that some of the key factors determining directional trends in teenage pregnancy rates are transnational.

A primary distinguishing factor between countries in the present study was the vastly higher teen birth rates in 2006 in the U.S. (41.9 per 1,000) and England/ Wales (35.0) compared to Canada (13.7) and Sweden (6.0). Similar differences in birth/abortion rates were reflected in rates in the U.S. and England/Wales that were over double those in Canada and Sweden. Differences in teen abortion rates in 2006 were slightly less pronounced but abortion as a percentage of the birth/abortion was strikingly higher in Sweden (80.9%) than in any of the other three countries.

Factors affecting trends in teen pregnancy

Anderson Moore (2008) has categorized the factors that influence trends in teen pregnancy as follows: compositional (e.g., demographic shifts, immigration patterns); distal (e.g., economic inequality, public policy, societal norms); and proximal (e.g., sexual activity, contraceptive use). A full discussion of each of these categories of factors in each country is beyond the scope of this article. Suffice it to say that with respect to interprovincial/territorial variations in teen pregnancy rates in Canada, a number of compositional factors related to geographical and ethno-cultural differences play some role in determining rates of teen pregnancy as do social and economic inequality (For discussion see Best Start, 2006; 2007). In the following two sections we will focus on proximal factors affecting teen pregnancy rates in Canada and general distal factors related to teen pregnancy in Sweden and England/Wales.

Proximal factors associated with teen pregnancy in Canada and the U.S.A

In their comparative study of teenage sexual and reproductive health in five developed countries, including Canada, Darroch, Frost, Singh and Study Group (2001) concluded that the relative lack of effective contraceptive use by sexually active adolescents, as opposed to higher percentages of teens being sexually active, was a key factor in differentiating countries with higher versus lower teen pregnancy rates. As documented above, in Canada, the teen pregnancy rate declined 36.9% during the study period of 1996-2006. Findings from the Canadian Community Health Survey (Rotermann, 2008) indicate that the percentage of 15-19 year-aids who had ever had intercourse declined from 47% in 1996/1997 to 43% in 2005. Increases in contraceptive use by sexually active teens within this time period are also evident. For example, a study of British Columbia youth found that the percentage who reported using the birth control pill at last intercourse increased from 22.5% in 1998 to 38.4% in 2003 and the percentage who reported using a condom increased from 65.3% to 74.9% (Saewyc, Taylor, Homma, & Ogilvie, 2008). In sum, the decline in the teen pregnancy rate in Canada from 1996-2006 coincided with a small decline in the percentage of youth who were sexually active and indications of a substantial increase in contraceptive use by youth who had or were having sexual intercourse.

Similar observations have been made with regard to declining rates of teen pregnancy in the U.S.A. Citing research by Santelli et al. (2007), Kost, Henshaw, and Carlin (2010) noted that

For both Canada and the United States, a correlation between declining teen pregnancy rates, small reductions in the percentages of teens who were sexually active, and substantial increases in contraceptive use among sexually active youth was apparent.

Distal factors affecting teen pregnancy trends in Sweden and England/Wales

During the study period, the trend in Sweden's teen pregnancy rate was characterized by a declining birth rate and an increasing abortion rate. In light of this, several qualitative research studies have examined Swedish female teenager's attitudes and perceptions regarding sexual health topics including abortion (Ekstrand, Larsson, Von Essen & Tyden, 2005; Thorsen, Aneblom, & Gemzell-Danielsson, 2006). These studies found that young women viewed access to abortion as a right and as an acceptable option for a teenager dealing with an unwanted pregnancy. The young women in these studies did not, however, endorse abortion as a method of birth control but rather saw it as a "painful necessity" when an unwanted pregnancy occurred. The young women in both studies were highly critical of the sexual health education provided in Swedish schools. Ekstrand et al. note that in the early 1990's sexuality education was removed as a core subject in the Swedish school system and instead integrated into other subject areas. In response to "negligence in contraceptive use" on the part of Swedish teenagers, the authors make a number of recommendations including higher quality sexuality education in the schools.

In recent years, research and commentary on teenage pregnancy in the U.K., and England specifically, has focused on England's ten-year national Teenage Pregnancy Strategy launched in 1999 (Social Exclusion Unit, 1999) which sought to halve the teen pregnancy rate in England by 2010. Research suggests that the national strategy had some effect in reducing teenage pregnancy among socioeconomically disadvantaged subpopulations (Wilkinson, French, Kane, et al., 2006) and in influencing young people's use of contraceptive services (e.g., increasing young women's use of school-based clinics and young men's use of general practice and family planning clinics) (French, Mercer, Kane et al., 2007). Although it appears that the goal of a 50% reduction in teen pregnancies has not been reached, examination of teen birth/abortion data from England/Wales during the study period examined here indicates that the ratio of births to abortions among teens has changed significantly. In other words, while the overall teen pregnancy rate remained stable, birth rates declined and abortion rates increased. Thus, while the government's goal of significantly reducing the rate of conceptions among teens in England has not been achieved, the teen birth rate (the outcome with greater socioeconomic and demographic implications) has dropped. It should be noted that the trend towards lower birth rates and higher abortion rates among teens was already in place in England/Wales prior to the launching of the national strategy in 1999.

Lawlor and Shaw (2004) have cautioned that selective reporting of international trends and making comparisons using selective time periods can unduly shape political and media discourse concerning teenage pregnancy. They cite the experience of England in the 1990's where such selective reporting was used to support the contention that England's teen pregnancy rate was relatively high in comparison to some other countries. We are aware of the need for such caution in interpreting the current analysis. In 2006, Canada's teen pregnancy rates was relatively low in comparison to the United States and England/ Wales, but if other countries had been chosen for this comparative analysis the relative placing of Canada as a high or low teen pregnancy country might have been different. For example, although we did not locate sufficient data to include them in the current analysis, if birth rates alone are examined, for the year 2006, a number of countries had birth rates per 1,000 for 15-19 year-old women lower than Canada's 13.3 per 1,000 including Sweden (6.0) but also Japan (5.1), Denmark (5.9), Germany (10.1) and France (7.8-2005 data) (United Nations, 2008).

Policy and practices implications of teen pregnancy trends in Canada

In the past, the perception that teen pregnancy rates were high and/or rising has provided social/ political motivation and rationale to initiate new teen pregnancy prevention efforts or to strengthen existing programming. Since the mid-1970's, there has been a secular decline in the teen pregnancy rate in Canada and this trend, as reported here, has continued in the most recent 10-year period for which data are available. What are the implications for policy and practice of declining teen pregnancy rates? As documented above, the decline in Canada's teen pregnancy rate that occurred during the study period coincided with a substantial increase in contraceptive use by sexually active teens. The implication of this association is clear: a reduction or neglect of access to sexual and reproductive health education and services for youth is likely to halt or reverse the current trend in teen pregnancy rates. Research has consistently shown that well-developed sexual health education programming that targets contraception and safer sex practices can have a positive impact on adolescent behaviour (SIECCAN, 2010). Maintaining and enhancing access to broadly-based sexual health education and related services is essential for continued improvement in indicators of sexual health among Canadian youth.

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Weaver, H., Smith, G., & Kippax, S. (2005). School-based sex education policies and indicators of sexual health among young people: A comparison of the Netherlands, France, Australia and the United States. Sex Education, 5, 171-188.

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Alexander McKay (1) and Michael Barrett (1)

(1) The Sex Information and Education Council of Canada (SIECCAN), Toronto, ON

Correspondence concerning this article should be addressed to Alexander McKay, Ph.D., SIECCAN, 850 Coxwell Avenue, Toronto, ON M4C 5R1. E-mail:alex@sieccan.org.
... almost all of the decline in the pregnancy
   rate between 1995 and 2002 among 18-19
   year-aids was attributable to increased
   contraceptive use. Among women aged
   15-17, about one-quarter of the decline
   during the same period was attributable to
   reduced sexual activity and three-quarters
   to increased contraceptive use (p. 4).


Table 1
Birth, abortion, and combined birth-abortion rates per 1,000 women
aged 15-19, Canada, Sweden, U.S.A., England-Wales, 1996-2006

             1996   1997   1998   1999   2000   2001   2002   2003

Canada

Birth        22.1   20.0   19.8   18.6   17.0   16.0   14.9   14.4
Abortion     22.1   21.6   21.6   20.5   20.1   19.4   18.4   17.1
Total        44.2   41.6   41.4   39.1   37.1   35.4   33.3   31.5

Sweden

Birth         7.7    7.1    6.4    6.7    7.1    6.6    6.7    6.2
Abortion     17.7   17.8   18.5   19.0   21.2   22.7   25.5   25.0
Total        25.4   24.9   24.9   25.7   28.3   29.3   32.2   31.2

USA

Birth        53.5   51.3   50.3   48.8   47.7   45.3   43.0   41.6
Abortion     28.6   27.1   25.8   24.7   24.0   22.6   21.3   20.7
Total        82.1   78.4   76.1   73.5   71.7   67.9   64.3   62.3

Eng/Wales

Birth        40.3   39.6   40.5   38.7   37.9   36.3   36.4   35.8
Abortion     22.9   23.0   24.6   24.3   24.6   24.5   24.2   24.1
Total        63.2   62.6   65.1   63.1   62.5   60.8   60.6   60.0

             2004   2005   2006     2007       2008

Canada

Birth        13.6   13.3   13.7
Abortion     16.3   15.3   14.2
Total        29.9   28.6   27.9 *

Sweden

Birth         5.9    5.9    6.0      5.8      5.7
Abortion     24.4   24.3   25.4     24.8     24.4
Total        30.3   30.2   31.4     30.6     30.1

USA

Birth        41.1   40.5   41.9
Abortion     19.8   19.1   19.3
Total        60.9   59.6   61.2 *

Eng/Wales

Birth        36.2   35.9   35.0     26.2
Abortion     24.2   24.2   25.2     35.3
Total        60.3   60.1   60.2     61.5 *

Sources: Statistics Canada. (n.d.a.). Table 106-9002-Pregnancy
Outcomes. By age group, Canada, provinces and territories,
annual, CANSIM (database); Statistics Canada. (n.d.b.). Table
102-4505-Crude birth rate, age specific and total fertility rates
(live births), Canada, provinces and territories, annual, CANSIM
(database); Statistics Canada. (n.d.c.). Table 106-9034
--Induced abortions in hospitals and clinics, by age group and
area of residence of patient, Canada, provinces and territories,
annual, CANSIM (database); Statistics Sweden. (n.d.). Population
by marital status, age, and sex. Year 1968-2009. Statistka
Centralbyran. Statistics Sweden. (2009a). Aborter 2008;
Statistics Sweden. (2009b). Bilaga 1: Medicinska Fbdelse
registret 1973-2008; Guttmacher Institute. (2010). U.S. Teenage
Pregnancies, Births and Abortions: National and State Trends by
Race and Ethnicity. Office of National Statistics. (2007).
Conception Statistics: Conceptions for Women Resident in England
and Wales, 2005; Shrosbree, E. (2009). Report: conception in
England and Wales, 2007. Health Statistics Quarterly, 41, 66 68.
* = preliminary data.

Table 2
Birth-abortion rates, 15-19 year-old women, Canada, provinces,
and Yukon, 1995 and 2005, percentage decline

                        1995   2005   % Decline

Canada                  45.8   28.6     37.6%
Newfoundland            31.4   22.5     28.3%
Prince Edward Island    37.0   18.9     48.9%
Nova Scotia             43.2   23.7     45.1%
New Brunswick           40.4   22.6     44.1%
Quebec                  36.0   32.4     10.0%
Ontario                 47.4   23.0     51.5%
Manitoba                63.9   40.5     36.6%
Saskatchewan            56.9   42.4     25.5%
Alberta                 53.7   33.0     38.5%
British Columbia        45.3   29.3     35.3%
Yukon                   65.1   31.4     51.8%

Source: Statistics Canada. (n.d.a.). Table 106-9002-Pregnancy
outcomes, by age group, Canada, provinces and territories,
annual, CANSIM (database).
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