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1. Kost K, Henshaw SK. U.S. teenage pregnancies, births and abortions 2010: national and state trends by age, race and ethnicity. New York: Guttmacher Institute, 2014 ().

This paper examines potential explanations for recent declines in teenage pregnancy in England

The CDC Winnable Battle 2015 goal for teenage births is 30.3 per 1000 teens. The mean annual teenage birth rate in our cohort was 19.4 per 1000 teens, 36% lower than the 2015 goal. Our teenage pregnancy and birth rates reflect teens using highly effective contraception, with a high rate of LARC use in this cohort (i.e., 72% overall among teens). Although the rate of LARC use among teens 15 to 19 years of age in the United States has increased from less than 1% in 2002 to almost 5% in 2009, our study suggests that it is possible to achieve a much greater rate of use. Furthermore, teens in our cohort continued to use LARC methods longer than shorter-acting methods such as the oral contraceptive pill and DMPA injection; two thirds of teens in CHOICE were still using their LARC method at 24 months of follow-up, as compared with only one third of teens using a non-LARC method.

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shows the pregnancy, birth, and abortion rates among CHOICE participants, as compared with the 2010 rates among all U.S. teens. The rates were stratified according to age group and race. For all three outcomes within each stratum, the rates among CHOICE participants were lower than the U.S. rates. The difference between rates in CHOICE and national rates was greater for those 18 to 19 years of age and among black teens. shows the pregnancy rates among CHOICE teens, as compared with sexually experienced U.S. teens, according to age group and race. For both age groups and both races, the CHOICE rates were substantially lower than the national rates.

and family life issues reduce probability of teenage pregnancy

For this analysis, we calculated annual means and 95% confidence intervals for rates of pregnancy, live birth, and induced abortion from 2008 through 2013, because the number of pregnancies and pregnancy outcomes that occurred among teenage CHOICE participants each year was small. Each rate represents the total number of events (i.e., pregnancy, birth, or abortion) that occurred among the participants divided by the total amount of time contributed from 2008 through 2013. For a pregnancy to be considered in the analysis, the outcome of the pregnancy (i.e., birth or abortion, for the purposes of this study) had to occur before 20 years of age. This is the same approach used by the National Center for Health Statistics in calculating U.S. rates. We calculated the time contributed by each participant during which she was not pregnant. If at the last survey the participant reported she had not been pregnant since the previous contact, we subtracted 6 weeks of contributed time to account for the possibility of an early-stage and unknown pregnancy. For a participant who had a pregnancy, we subtracted the total time she was pregnant plus 1 month if she delivered, to account for postpartum infecundity. For participants who were lost to follow-up, the last date of contact was the cutoff point for outcomes and contributed time. All analyses were performed with the use of Stata software, version 11 (StataCorp).

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The primary outcomes of the study were the rates of pregnancy, live birth, and induced abortion observed among participants who were 15 to 19 years of age at any time during study participation. We compared the rates in the CHOICE cohort with the most recent available rates among all U.S. teens 15 to 19 years of age, from 2010, and hypothesized that the rates in CHOICE would be lower than the national rates. Because the U.S. rates represent all teenage girls and women 15 to 19 years of age, including those who are and those who are not sexually experienced, we also compared the CHOICE rates with the national rates reported among sexually experienced teenage girls and women in 2008 (the most recent available data). In addition, we examined rates according to age and race as secondary outcomes. All analyses of rates of pregnancy, live birth, and induced abortion; teen-years of use of contraceptive methods; and failure rates of contraceptive methods included data collected when members of the cohort were 15 to 19 years of age.

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In summary, we found that in a cohort of teenage girls and women for whom barriers to contraception (lack of knowledge, limited access, and cost) are removed and the use of the most effective contraceptive methods is encouraged, a large percentage opted to use LARC methods. The rates of pregnancy, birth, and abortion in our cohort were below both the most recent corresponding national rates and the CDC Winnable Battle 2015 goal.