Linda Bradley, MD, & M. LaVora Perry
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“We parents must repeat the message of preventing pregnancy and sexually transmitted infections to our children multiple times during the course of a month and year. Just having one ‘birds and bee’s talk’ is not enough. Our job is to impress the risks of early and unprotected sex upon our daughters’ psyches. So that when they are tempted to have sex—as they most likely will be—they hear our voices saying ‘no.’ -Linda Bradley, MD

Parents: research shows that teens are less likely to engage in sexual activity, drug use, and have emotional problems when they feel deeply loved and connected to you and their families and believe they can talk to you, without judgment, about pressing issues like sexuality.¹ And when the parents of children of color don’t ignore the realities of racism and discrimination, but rather, openly discuss these injustices within their families, their children tend to develop the inner strength to challenge obstacles, overcome them, and achieve.²

Parents, educators, mentors, counselors, and health professionals: from 1991 to 2005 teen births in the United States dropped to the lowest rate they had ever reached during the entire 65 years since the consistent documentation of these rates began.^3,4  Studies show that 86% of the decline in teen pregnancies was due to 18 to 19 year-olds using contraceptives correctly more often than before, and 14% resulted from 15 to 17 year-olds choosing abstinence more often than before.

However, we still have a long way to go to protect our young from the potentially damaging consequences of premature, uninformed, or misinformed sexual activity. In fact, even with our recent decline in teen pregnancies, among the world’s developed nations, the U.S. has the highest number of teens becoming pregnant and acquiring sexually transmitted infections.^{6, 7}

And, alarmingly, preliminary data reveal a 3% increase in teen pregnancies in the U.S. from 2005 to 2006 (up from 40.5 births per 1,000 females ages 15-19 in 2005 to 41.9 births per 1,000 in 2006).⁸ This is the first such increase in 14 years.⁸ The increase in teen births for non-Hispanic blacks ages 15 to 19 was even higher—5%—rising from a rate of 60.9 percent in 2005 to 63.7 percent in 2006. ^9,10  For this age group, this rate was higher than that of any other racial or ethnic group of young women in the U.S. ^9,10 

The recent rise in teen pregnancies is not surprising considering that the latest analysis of available data shows that the number of U.S. teens who received formal instruction about birth control methods plummeted from 87% (females) and 81% (males) in 1995 to 70% and 66% in 2002.^11,12

Compared to white teens, blacks youths received even less formal instruction about birth control methods. In 2002, fewer than half of all black teen girls surveyed and only 1 in 3 black teen males had received instruction about birth control methods when they really needed it—before they started having sex.^11,12

According to research, in the U.S., effective sex education programs for middle-school-age teens share certain characteristics including using the latest science-based evidence to create youth curriculum that really work.¹³ Such programs provide:¹³ 

• Consistent and repeated communication about the physical and emotional health benefits of abstinence

• Instruction on realistic strategies to delay and refuse sex

• Clear explanations of the importance of condoms and other contraceptives in preventing pregnancy and sexually transmitted infections including HIV/AIDS

• Accurate instruction on the correct use of condoms and other contraceptives.

But between 1995 to 2002, while fewer teens received instruction in sex education programs modeled after ones that actually prevent teen pregnancy, the number of teens who only received instruction about abstinence more than doubled to 1 in 5.¹⁴ This occurrence is despite the fact that teens around the world have been having sex throughout the ages—and never stopped.¹⁵  The difference between now and the past is that, previously, teens were typically encouraged to wed, and did.¹² Therefore, they had sex in the context of marriage.¹⁵  But today, in developed countries like the U.S., we encourage our teens to delay marriage until they are well into their twenties or beyond.¹⁵ 

Today, at a time in history when the leading cause of death of African-American young women is HIV/AIDS (as reported for 2004),¹⁶ we adults are the caretakers of the youths to whom the future belongs. Given the fact that teen sexuality is a timeless phenomenon,¹² for us to instruct our adolescents as though all of them will postpone sexual activity for a decade or more is irresponsible and even cruel. If this assessment sounds harsh, consider these findings about teens, sex, pregnancy, and sexually transmitted infections in the U.S. from Chapters 10 and 24 of TEEN SISTERS' HEALTH (Books 2 and 3):  

Regarding pregnancy and 15 to 19 year old girls, in 2002…

• Girls who started having sex before they were 15 years old were almost twice as likely to get pregnant as those who waited until they were older (46% more likely compared to 25%).¹⁷ 

• More than 1 out of 3 girls (31%) who had sex got pregnant.¹⁷ 

• Girls who used birth control the first time they had sex were much less likely to have a baby by the time they were 20 years old than girls who didn’t use birth control the first time they had sex (43% less likely compared to 27%).^17,15 

• 4 out of every 7 teen girls who got pregnant had their babies; 2 out of 7 got abortions; and 1 out of seven had a miscarriage.¹⁹

In 2006…

• Preliminary data indicates that Teen girls ages 15 to 19 had 435,427 babies.¹⁰ And of these infants, almost one fourth—103,692—were born to non-Hispanic Black mothers.¹⁰

Regarding sexually transmitted infections (STIs)…

• Over 65 million people may have an incurable STI.^21,22

• Every year, 1 out of every 4 teens catches an STI.^21,23

• 1 out of every 2 sexually active young people will catch an STI by the time she or he is 25 years-old.^21,24

• Even though only about 1 out of 4 sexually active people are teens or young adults, about 2 out of 4 people who got STIs in 2000 were 15 to 24 years-old.²⁵

And from Chapter 18’s “Doctor’s Visit”…

“Today, my heart broke into pieces. I had to tell a nineteen year-old, a young woman whose entire life is ahead of her, that she has HIV.

“I know many people live long and productive lives with this virus. But I prayed that my daughter will never have to hear the news I gave my patient.” –Dr. Linda

Although teenage sexuality, and avoiding its pitfalls, is, by necessity, a pivotal topic in TEEN SISTERS' HEALTH, it isn’t the only one. In this book, we explore issues relevant to a to a young woman of color’s whole being—her body, her mind, and her spirit. From embracing her heritage to rejecting societal stereotypes; from fitness to nutrition, from higher education to wealth-building, from community involvement to environmental stewardship, and much more. Coming from two distinct faith traditions ourselves—Christian and Buddhist—in this book, we endeavored to respect the backgrounds and beliefs of every girl.

We set out to write TEEN SISTERS' HEALTH in a reader-friendly style based on scientific findings and human experiences like the ones presented in this rationale. Our goal in creating this book was simple but not easy: to help each young woman who reads these pages cultivate a fulfilling life of no regrets.

Girls can rely on TEEN SISTERS' HEALTH to empower them with the knowledge they need to make educated decisions and smart choices. We offer it in support of your efforts to maintain caring, honest, and open lines of communication with your daughters, students, mentees, clients, and every young woman in your life.  

Linda Bradley, MD  
M. LaVora Perry  

REFERENCES
¹“Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health,” Resnick MD et al. Journal of American Medical Association, 1997;278:823-32. JAMA.AMA.ASSN.org. September 13, 2007. PubMed.gov. PMID: 9293990 Cited in “Parent-Child Communication: Promoting Sexually Healthy Youth,” Nicholas Lagina, August 2002. AdvoatesForYouth.org. September 13, 2007. Retrieved at http://www.advocatesforyouth.org/publications/factsheet/fsparchd.htm. And http://www.advocatesforyouth.org/publications/factsheet/fsparchd.pdf

² Phinney JS, Chavira V. “Parental Ethic Socialization and Adolescent Coping with Problems Related to Ethnicity,” . Journal of Research on Adolescence, 1995; 5:31-53. Cited in “Parent-Child Communication: Promoting Sexually Healthy Youth,” Nicholas Lagina, August 2002. AdvoatesForYouth.org. September 13, 2007. Retrieved at http://www.advocatesforyouth.org/publications/factsheet/fsparchd.htm. And http://www.advocatesforyouth.org/publications/factsheet/fsparchd.pdf  

³“Births: Preliminary Data for 2005. Health E-Stats,” Hamilton BE, Martin JA, Ventura SJ. Released November 21, 2006. United States Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics (NCHS). Last reviewed January 11, 2007. CDC.gov. July 19, 2007. Retrieved at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths05/prelimbirths05.htm  

⁴“Explaining Recent Declines in Adolescent Pregnancy in the United States : The Contributions of Abstinence and Improved Contraceptive Use. Santelli JS, Lindberg LD, Finer LB, Singh S. American Journal of Public Health 2007;97(1):150–156. PubMed.gov. PMID: 17138906. Cited in “Adolescent Reproductive Health: Home: Teen Pregnancy,” United States Department of Health and Human Services Centers for Disease Control and Prevention. Content Source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Page last modified: 6/6/07. CDC.gov. August 1, 2007. PubMed.gov. August 1, 2007.  PMID:17138906. Retrieved at http://www.cdc.gov/reproductivehealth/AdolescentReproHealth/index.htm. And Cited in “U.S. Teen Pregnancy Rates are Down Primarily Because Teens are Using Contraceptives Better,” Guttmacher Institute, News Release, Friday, December 1, 2006. Guttmacher.org. September 13, 2007. Retrieved at http://www.guttmacher.org/media/nr/2006/12/01/index.html  

⁵“Differences in Teenage Pregnancy Rates Among Five Developed Countries: The Roles of Sexual Activity and Contraceptive Use” Jacqueline E. Darroch, Susheela Singh, Jennifer J. Frost and the Study Team, Guttmacher Institute, Family Planning Perspectives, Volume 33, Number 6, November/December 2001, Table 2: “Birth, Abortion and Pregnancy Rates and Abortion Ratio, by Country, According to Age-group, Mid-1990s,” p. 246. Guttmacher.org. July 15, 2007. Retrieved at http://www.guttmacher.org/pubs/journals/3324401.html. And http://www.guttmacher.org/pubs/journals/3324401.pdf.

⁶“Adolescent Pregnancy and Childbearing: Levels and Trends in Developed Countries” by Singh S and Darroch JE, Guttmacher Institute, Family Planning Perspectives, Volume 32, Number 1, January/February 2000, Table 5: “Adolescent Birth, Abortion and Pregnancy Rates and Abortion Ratio, by Age-group, According to Country,” p. 19. Guttmacher.org. July 15, 2007. Cited in “Differences in Teenage Pregnancy Rates Among Five Developed Countries: The Roles of Sexual Activity and Contraceptive Use” by Jacqueline E. Darroch, Susheela Singh, Jennifer J. Frost and the Study Team, Guttmacher Institute, Family Planning Perspectives, Volume 33, Number 6, November/December 2001. Guttmacher.org. July 19, 2007. Retrieved at http://www.guttmacher.org/pubs/journals/3324401.html. And http://www.guttmacher.org/pubs/journals/3324401.pdf. And (original) at http://guttmacher.org/pubs/journals/3201400.html And http://guttmacher.org/pubs/journals/3201400.pdf  

⁷“Sexually Transmitted Diseases Among Adolescents in Developed Countries,” Panchaud, C., Singh, S., Feivelson, D., & Darroch, J. E., Family Planning Perspectives, 2000, Volume 32, Number 1, January/February 2000, Table 2: “Annual Reported Rates for Sexually Transmitted Infections Among Adolescents, by Gender, and in the Total Population; Ratios of Infection Rates Among Adolescents to Rates Among Selected Groups; and Percentage of all Infections that Occur Among Adolescents and Young adults; All by Type of Infection and by Country," p. 28 Guttmacher.org. July 19, 2007. Retrieved at http://www.guttmacher.org/pubs/journals/3202400.html And http://www.guttmacher.org/pubs/journals/3202400.pdf  

⁸“NCHS ( National Center for Health Statistics) Releases Preliminary Birth Data,” Bill Albert, Tel: 202-478-8510; Jessica Sheets, Tel: 202-478-8523. December 5, 2007, The National Campaign to Prevent Teen and Unplanned Pregnancy. TheNationalCampaign.org. December 6, 2007. Retrieved at http://www.thenationalcampaign.org/resources/birthdata.aspx. Citing, “Figure 1: Birth rates for teenagers by age: United States , final 1980–2005 and preliminary 2006” in “Births: Preliminary Data for 2006,” p.1, and “Table 2. Births and birth rates, by age, race, and Hispanic origin of mother: United States , final 2005 and preliminary 2006,” p. 7. National Vital Statistics Reports, Brady E. Hamilton, Ph.D.; Joyce A. Martin, M.P.H.; and Stephanie J. Ventura, M.A., Volume 56, Number 7, December 5, 2007. United States Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Vital Statistics. TheNationalCampaign.org. December 6, 2007. Retrieved at http://www.thenationalcampaign.org/resources/pdf/NCHS_birthdata.pdf

⁹“Births: Preliminary Data for 2006,” National Vital Statistics Reports, Brady E. Hamilton, Ph.D.; Joyce A. Martin, M.P.H.; and Stephanie J. Ventura, M.A., Volume 56, Number 7, December 5, 2007, p. 2. United States Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Vital Statistics. TheNationalCampaign.org. December 6, 2007. Retrieved at http://www.thenationalcampaign.org/resources/pdf/NCHS_birthdata.pdf

¹⁰“Table 2. Births and birth rates, by age, race, and Hispanic origin of mother: United States, final 2005 and preliminary 2006” in “Births: Preliminary Data for 2006,” National Vital Statistics Reports, Brady E. Hamilton, Ph.D.; Joyce A. Martin, M.P.H.; and Stephanie J. Ventura, M.A., Volume 56, Number 7, December 5, 2007, p. 7. United States Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Vital Statistics. TheNationalCampaign.org. December 6, 2007. Retrieved at http://www.thenationalcampaign.org/resources/pdf/NCHS_birthdata.pdf

¹¹“Changes in Formal Sex Education: 1995-2002,” Laura Duberstein Lindberg, John S. Santelli and Susheela Singh,  Perspectives on Sexual and Reproductive Health, December 2006,  Volume 38, Number 4. The Alan Guttmacher Institute. Guttmacher.org. September 15, 2007. Retrieved at http://www.guttmacher.org/pubs/journals/3818206.html

¹²“One in Three Teens Get No Formal Education About Birth Control: Even When They Do, Many Do Not Get It When They Need It Most: BEFORE They Start to Have Sex,” Rebecca Wind, Alan Guttmacher  Institute News Release, Tuesday, November 28, 200e. Guttmacher.org. September 16, 2007 Retrieved at http://www.guttmacher.org/media/nr/2006/11/28/index.html. Citing “Changes in Formal Sex Education: 1995-2002,” Laura Duberstein Lindberg, John S. Santelli and Susheela Singh,  Perspectives on Sexual and Reproductive Health, December 2006,  Volume 38, Number 4. The Alan Guttmacher Institute. Guttmacher.org. September 15, 2007

¹³Emerging answers: Research Findings on Programs to Reduce Teen Pregnancy, p. 10, Kirby, D National Campaign to Prevent Teen Pregnancy. Washington,, DC, 2001. TheNationalCampaign.org. September 13, 2007. Retrieved at http://www.teenpregnancy.org/resources/data/pdf/emeranswsum.pdf

¹⁴"The Case for a New Approach to Sex Education Mounts; Will Policymakers Heed the Message?” Heather D. Boonstra, Guttmacher Policy Review. Spring 2007, Volume 10, Number 2. Guttmacher.org. September 16, 2007.Table: “More Getting Less,” p. 3 (of PDF), Table “Not Soon Enough,” p. 4 (of PDF). Tables’ Source: Perspectives on Sexual and Reproductive Health, 2006. Guttmacher.org. Retrieved at http://www.guttmacher.org/pubs/gpr/10/2/gpr100202.html. And http://www.guttmacher.org/pubs/gpr/10/2/gpr100202.pdf  

¹⁵“Teen Pregnancy: An American Dilemma,” David Popenoe, Ph. D, Rutgers University, Department of Sociology, Testimony before the House of Representatives, Committee on Small Business, Subcommittee on Empowerment,” Washington, DC, July 16, 1998. Marriage.Rutgers.edu. July 19, 2007. Retrieved at http://marriage.rutgers.edu/about.htm  

¹⁶“Deaths, Percent of Total Deaths, and Death Rates for the 15 Leading Causes of Death in 10-year Age Groups, by Race and Sex: United States”, 2003. LCWK2. Last reviewed June 4, 2007 . CDC.gov. July 29, 2007 . http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs/lcwk2_10.htm. And http://www.cdc.gov/nchs/data/dvs/lcwk2_2003.pdf. Cited in “Fact Sheet: HIV/AIDS Among African Americans,” United States Department of Health and Human Services Centers for Disease Control and Prevention. Content Source: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. Last Modified June 28, 2007 . CDC.gov. July 30, 2007 . http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm

¹⁷“Pregnancy Among Sexually Experienced Teens,” Science Says, The National Campaign to Prevent Teen Pregnancy. All statistics for 2002 were generated with data from the National Survey of Family Growth (NSFG) Cycle 6, a periodic national survey of fertility-related issues conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services (HHS.gov). NSFG data sets on CD-ROM are available free of charge from NCHS: visit www.cdc.gov/nchs/nsfg.htm.TheNationalCampaign.org. August 3, 2007. Retrieved at http://www.teenpregnancy.org/works/pdf/Science_Says_23.pdf  

¹⁸"Teenagers in the United States:Sexual Activity, Contraceptive Use, and Childbearing, 2002: A Fact Sheet for Series 23, Number 24” United States Department of Health and Human Services Centers for Disease Control and Prevention. National Center of Health Statistics. Source of data---The 1988, 1995, and 2002 National Surveys of Family Growth (NSFG), and the 1988 and 1995 National Survey of Adolescent Males (NSAM), United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. CDC.gov. August 3, 2007. Retrieved at http://www.cdc.gov/nchs/data/series/sr_23/sr23_024FactSheet.pdf  

¹⁹“Trends in Pregnancy Rates by Outcome,” Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Recent trends in teenage pregnancy in the United States, 1990-2002. Health E-stats. Hyattsville , MD : National Center for Health Statistics. Released December 13, 2006. CDC.gov. August 3, 2007. Retrieved at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/teenpreg1990-2002/teenpreg1990-2002.htm  

²⁰“Births: Final Data for 2004,”National Vital Statistics Reports, Vol. 55, No. 1. Table 2. “Live births by Age of Mother, Live-birth Order, and Race of Mother: United States , 2004,”p.36. September 17, 2007. Retrieved at http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_01.pdf  

²¹“STD/STI Statistics: Fast Facts,” American Social Health Association. Last updated October 9, 2006. ASHASTD.org. September 17, 2007. Retrieved at http://www.ashastd.org/learn/learn_statistics.cfm  

²⁴Our Voices, Our Lives, Our futures: Youth and Sexually Transmitted Diseases. Cates JR, Herndon NL, Schulz S L, Darroch JE. (2004). Chapel Hill, NC: University of North Carolina at Chapel Hill School of Journalism and Mass Communication. Cited in “STD/STI Statistics: Fast Facts,”  American Social Health Association. Last updated October 9, 2006. ASHASTD.org. August 6, 2007. Retrieved at http://www.ashastd.org/learn/learn_statistics.cfm  

²²“Sexually Transmitted Diseases in America: How Many Cases and at What Cost?” American Social Health Association. (1998). Research Triangle Park, NC. Cited in “STD/STI Statistics: Fast Facts,”  American Social Health Association. Last updated October 9, 2006. ASHASTD.org. August 6, 2007. Retrieved at http://www.ashastd.org/learn/learn_statistics.cfm  

²³Sex and America's Teenagers, Alan Guttmacher Institute, 1994. Cited in “STD/STI Statistics: Fast Facts,”  American Social Health Association. Last updated October 9, 2006. ASHASTD.org. September 17, 2007. Retrieved at http://www.ashastd.org/learn/learn_statistics.cfm  

²⁵“Sexually Transmitted Diseases Among American Youth: Incidence and Prevalence Estimates,” 2000. In Weinstock H, Berman S, Cates W, Jr. (2004). Perspectives on Sexual and Reproductive Health, 36, 6-10. Cited in “Facts on Sexually Transmitted Infections in the United States .” Guttmacher Institute. August 2006. Guttmacher. July 12, 2007. Retrieved at http://www.guttmacher.org/pubs/fb_sti.html

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