Cairo Conference on Population and Development
Speakers: Dr. James Marks (click here for biography)
Soap Summit 1

Transcript of Proceedings
October 22, 1994

SONNY FOX: Thank you Allan. Allan came in from New York last night for the meeting, and in from Atlanta for the meeting is Jim Marks. Dr. Marks is Director of the Division of Reproductive Health Service, for the Center for Disease Control and Prevention in Atlanta, CDC. He is also an adjunct Associate Professor at Emery University School of Public Health. He has served as consultant to the World Bank, for China's 3rd and 7th Health Project. Dr. Marks.

DR. JAMES MARKS: Thanks Sonny. I'm really pleased to be here today and hope that we can enlist your help. It's becoming increasingly critical that our society deal effectively with the prevention of the undesirable consequences of sex and sexuality. It's also clear that we can't do this without your help and the help of others who frame our life's images. My role today is to take the Cairo conference, and the global perspective and to put it in the context of the U.S. This is not just a teen problem in the U.S. It is serious for all ages, however the teen part of the problem is especially serious, because of the health, education and societal consequences. And we have to get men involved responsibly if we're going to succeed. And I don't mean that to be in conflict with the issue of women's empowerment, but rather we have to have men to realize that women's empowerment is to their best interests as well. Now if I can have the first slide please.

There are about 6.5 million pregnancies in the U.S., and the last national survey of the intendedness of pregnancies was is 1988. 3.5 million were unintended. Over half of all the pregnancies in the U.S. That means if today is average, about 18,000 women will find that they are pregnant. And about 10,000 will wish they weren't. 1,000 to about 1,200 will miscarry and their immediate problem will go away. About 4,500 will decide to have an abortion. About 4,400, 4,200 maybe, who wish they weren't pregnant, will go on to deliver a baby. And that percent that's unwanted means that 1,400 of these women never, ever wanted to have this child. This is today. Tomorrow is another day. And 10,000 more women will get the same bad news, that they are pregnant.

What a lot of people don't realize is that about 90% of women are actually trying to do something to prevent becoming pregnant. Now that's in this first pie chart here. About 39 million women are potentially at risk in this country, and 90% of them are trying to avoid becoming pregnant. That may be something simple and not very effective, like withdrawal. Maybe something very effective like Norplant or Deproprevare. In about 5% of these women, the method will fail, or they won't use it entirely correctly or consistently, or their partner won't use it entirely correctly or consistently. And they will get pregnant. And they lead to almost half of the unintended pregnancies in the U.S.

Ten percent of women who claim they don't want to get pregnant are doing nothing to avoid pregnancy. And about 50% of them will become pregnant in a year's time, and they represent the other half of unintended pregnancy in the U.S.

As I said, I want to show you that this is not just a problem for teens. Here we have the proportion of pregnancies that are unintended in the U.S. Here are teens. Over 80% of pregnancies to teens are unintended. In other words, they wished that they were not pregnant then. Maybe they wanted to have a child later, when they were more settled, but this is not the time. In addition, over 80% of the pregnancies to women over forty are unintended, and the rates are also high for women over 35.

What proportion of all unintended pregnancies are due to teens? If you look at abortions and at births, the number here is about 20 to 25 percent of all unintended pregnancies occur in teenagers. Seventy-five percent occur in adult women. Why do we emphasize teens? First, as the Surgeon General emphasized yesterday, we're worse than all the other industrialized countries. This is the U.S. These are all the other countries that are industrialized, including some that we might not consider ourselves directly comparable to -- Czechoslovakia and Hungary. Half of this is births. And we have more births, on a rate basis, that is in proportion to the population, than almost every other country has births plus abortions. We have more abortions than most other countries have births plus abortions in teens. We are in terrible shape relative to where we ought to be. And, we don't have a much higher rate of sexuality, sexual experience, in our teens. In fact we have lower than some.

The health and social consequences for the individual teen who bears a child are much worse than they are for adult women. They have higher rates of medical complications of pregnancy, and maternal morbidity. There's a higher need for hospitalization. Higher rates of prematurity and low birth-rate babies. They are less likely to earn a high school diploma, and very much less likely to get a college education. They're not likely to catch up.

The second reason is that teens have a harder time of it, if they have unintended pregnancy. Third, the trends for teens in this country are worsening. This is average age, or the age at sexual inter-course, now the average age, we're at about 50% of teenage women will have been sexually active by, is just after their seventeenth birthday. About 17 years 4 months, on average. In 1960 it was about 19 years 4 months. We're having sex earlier. This is coupled with the fact that our marital age has gone up, so that whereas in 1960 the average of marriage was at 20, it's now at 23 or 24. So the average teen is having sex for 5 more years before they're married than they were 30-35 years ago.

What's happened? These are the trends in birthrates by the three different age groups. Ten to 14 year-olds, they've had a 30% increase since 1980. Fifteen to 17 year-olds, they've had about a 20% increase. And 10-19 had about a 10% increase.

The societal impact of teen pregnancies, as you might expect, is also going up. The Center for Population Options estimated in the six years, 1985-1990, that the total social services cost for families that were started with a teen birth, was 120 billion dollars. That's aid to families with dependent children, Medicaid, food stamps. It excludes other welfare costs, and the annual costs increase substantially. In the latest figures that I've seen now say it's about 30 billion dollars for 1992. And while many of these teens were from poor families, and some would have needed public assistance anyway, their estimate is that about 40% of these costs could have been prevented had the birth been delayed until age 20.

Increasingly, also, in the education realm, is that in 1960 a high school graduate could expect to earn a reasonable living. There were lots of jobs in factories, construction, things like that. We know that since 1970 in this country, the average income for a high school graduate has fallen 25% when adjusted for inflation, so that even if they struggle through to complete their high school education, they will be much less able to support themselves than they would have 30 years ago.

The third point that I wanted to raise with you is that we need to get men involved. Not many people realize that there are many more teen mothers than there are teen fathers. About 500 thousand of the one million teen pregnancies that occur each year end in a live birth. All of those are teen mothers, but there are only about 200 thousand teen fathers. What does this mean? It means that on average, the partner for a teen mother is older, and often substantially older. And this is the proportion -- if the mother is 15 or younger -- the father is six or more years older about 20% of the time. This is often a very predatory kind of sex, especially if the girl is at the younger of these age ranges. In fact, in one study, they looked at whether the girls had a history of being forced to have sex, and if they started having sex before age 15, 60% of them give a history of having been forced at sometime to have sex. Again, this is not sort of the consentual sex, mutually affectionate, that we're used to thinking of.

In fact, also, in studies that we've done, about 6% of women will tell a stranger in an interview that they've been beaten in the year before they've had their baby. And that rate is highest when the pregnancy is unwanted. It is also higher among teens. That is also low in that we know that when they are talking to someone that they know, their doctor or somebody like that, there is a higher rate that give that history.

I've outlined some of the serious problems facing us, and I don't want to leave you without some hopeful signs, and there are a few. Although the rate of sexual experience is increasing, the pregnancy rate among those who are sexually experienced has declined somewhat. Why is that? There's evidence that there is increasing use of contraception by teens, and as you can see, this is in 1982, the national survey, about 23% give a history of condom use at first intercourse, vs. 48% in 1988. The other methods don't change very much: the pill about the same; withdrawal a little less. There is evidence that there's some improvement in the use of contraception, and obviously if it's condoms, that's probably partly because they're getting the message regarding HIV. And I also know that in this next week there will be data released that will show that for the first time since 1986, a slight decline in the rate of teen births for 15 to 17-year olds.

You and others in the media have been critical players in raising the consciousness about HIV and AIDS. And we need your help here. The problems are serious and they're deep-seated. There are small programs that have been shown to delay onset of sexual activity, or to decrease rates of pregnancy in teens. They are not as effective as they might be. They are not as effective as they would be if the other messages society gave them were consistent. And we would like your help in doing that. Thank you very much.