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Special Focus: Surveillance for Reproductive Health Foreword

One million teenagers became pregnant in 1990; over half of these young women gave birth. After some success in reducing teen pregnancy in the early 1980s, teen pregnancy and birth rates are increasing. Today, a teenager in America is more likely than ever to become pregnant or to become a young mother.

This is a problem, as many teenage mothers are ill equipped to handle pregnancy or raise a child. Of special concern are young teens whose children are more likely to be of low birth weight or have other complications affecting their long-term growth and development.

Almost 200,000 young teenagers ages 15-17 years gave birth in 1990, and, as indicated in a companion report, many others had abortions. These teenagers are not yet prepared for the rest of their life -- how can they be prepared for parenting? They haven't finished their education, and many will not be able to do so if they become mothers. The medical, social, and economic impact of the pregnancies places an enormous burden on teenagers, their families, and society.

This special surveillance report examines the patterns of teen pregnancy and birth across the country. There are substantial differences in these patterns by state, and they have been explained to some degree. The report also examines how these differences can be magnified by differences in race and ethnicity.

Pregnancy rates in some states were double those in other states; birth rates tripled from one state to another; and there was an eightfold difference in the abortion rate when data were compared from the state with the lowest rate to that with the highest. In the state with the highest rate of pregnancy for black teenagers, one-fifth of 15- to 19-year-old black women were pregnant in 1990. Birth rates for white teenagers have been shown to be three times as high in some states as in others.

As public health practitioners at the national, state, and local levels, we need this type of detailed information to target our prevention strategies. Not all young women in all areas experience an equal risk. Many factors enable some young women to avoid an unplanned pregnancy in their teenage years. Some of these factors include self-esteem, the interpersonal skills to resist early initiation of sexual activity, appropriate and adequate health education, and access to family planning services and counseling.

The teenage years are a time of personal discovery and fulfillment. They are not years well-suited to the nurturing of a future generation. We must make it possible for every teenager to prevent a pregnancy until that personal decision is a responsible and appropriate one and in the best interest of all involved.

M. Joycelyn Elders, M.D. Surgeon General

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