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Teenage pregnancy

by Heather Dryburgh
Health Reports, Vol. 12, No. 1
Statistics Canada, Catalogue 82-003

During the last quarter century, there has been an overall decline in the teenage pregnancy rate in Canada, perhaps reflecting the availability of contraceptives, and the increased awareness of the risks of unprotected sex brought about by the AIDS epidemic.¹ Nevertheless, in 1997, an estimated 19,724 women aged 15 to 19 gave birth, and a slightly larger number in this age range—21,233—had an abortion.

The social stigma that once attended out-of-wedlock pregnancy may have diminished; however, the risks of serious health consequences remain for babies born to mothers still in their teens. Children of teenagers are more
likely to have low birth weights, and to suffer the associated health problems.²

Pregnant teens themselves are also at greater risk of health problems, including, for example, anemia, hypertension, renal disease, eclampsia and depressive disorders.^3,4 As well, teenagers who engage in unprotected sex are putting their own health at risk of sexually transmitted infections.¹

Teenage pregnancy also has economic consequences. Childbearing may curtail education and thereby reduce a young woman’s employment prospects in a job market that requires ever higher levels of training.^8,9 In addition, recessions in the early 1980s and 1990s meant that to maintain an adequate standard of living, dual earning became the norm in many Canadian households.¹⁰ But teenagers who give birth, particularly at ages 15 to 17, are likely to be single. Consequently, most teenage mothers lack a partner to contribute to the household income.³

This article focusses on recent trends in pregnancy rates and outcomes (live birth, induced abortion or fetal loss) for 15- to 19-year-olds (see Methods and Definitions).

Short-term trends
In 1997, an estimated 42,162 pregnancies of women aged 15 to 19 ended in birth, abortion or miscarriage. The number of pregnancies had declined steadily since 1994, when the estimated total was 46,753 (Appendix Table A) (see Sexual activity and contraceptive use).

At the same time, the teenage pregnancy rate dropped, and by 1997, it stood at 42.7 pregnancies per 1,000 women aged 15 to 19. The decrease in the teenage pregnancy rate in Canada began several years later than that in the United States^3,12 (Chart 1). Nevertheless, the US rate remains about double the Canadian rate¹³ (see International comparisons).

Chart 1 Teenage pregnancy rates, by age of women at end of pregnancy, women aged 15 to 19, Canada and United States, 1974 to 1997 Data sources: References 5,6,7; Health Statistics Division; Canadian Vital Statistics Data Base; Canadian Institute for Health Information; Alan Guttmacher Institute

Older teens are more likely than younger teens to be sexually active.⁸ This is reflected in much higher pregnancy rates at ages 18 to 19 than at ages 15 to 17: 68.9 versus 25.5 per 1,000 Canadian women in the respective age groups in 1997. Nonetheless, even at ages 18 to 19, the pregnancy rate was well below that of women aged 20 to 24 (100.6 per 1,000; data not shown).

Teenage pregnancy rates tend to be higher in the North and the Prairie provinces than in other regions (Chart 2). In 1997, the rate in the Northwest Territories was 123.3 pregnancies per 1,000 and over 60 per 1,000 in the Yukon and in Manitoba. On the other hand, rates in Newfoundland and New Brunswick were less than 35 per 1,000 (Appendix Table B).

Chart 2 Teenage pregnancy rates, women aged 15 to 19, by province and territory, 1997 Data sources: Health Statistics Division; Canadian Vital Statistics Data Base; Canadian Institute for Health Information

 

Abortion now most common outcome
In the past, more teenage pregnancies ended in a live birth than in an abortion. However, in 1997, with the decline in live births to teens, abortion became the most common outcome of teenage pregnancy (Chart 3). This had been the case for younger teens in most years since 1993.

Chart 3 Percentage distribution of outcomes of teenage pregnancy, women aged 15 to 19, Canada, 1974 to 1997 Data sources: References 5,6,7, Health Statistics Division; Canadian Vital Statistics Data Base; Canadian Institute for Health Information

 

This shift at the national level was influenced by changes in the three most populous provinces—Ontario, British Columbia and Québec—where abortions constituted the majority of pregnancy outcomes in 1997 (Appendix Table C). By contrast, in the other provinces and territories, most teenage pregnancies ended in a live birth (Chart 4) (see Access to abortion).

Chart 4 Percentage of teenage pregnancies ending in abortion, women aged 15 to 19, Canada, provinces and territories, 1997 Data sources: Health Statistics Division; Canadian Vital Statistics Data Base; Canadian Institute for Health Information 1997

 

The percentage of teenage pregnancies ending in an abortion is strongly weighted by trends among 18- to 19-year-olds, who account for the majority of teenage pregnancies (64% in 1997). Even in 1997, live births still slightly outnumbered abortions among older teens, but with the decline in live births, the percentage opting for abortion had risen from 43% in 1995 to 48% two years later. Among girls aged 15 to 17, 54% of pregnancies ended in an abortion in 1997 (Appendix Table C).

Abortion rates stable from 1994 to 1997
Although the teenage pregnancy rate decreased, the abortion rate per 1,000 women aged 15 to 19 was stable between 1994 and 1997. Therefore, with fewer teenagers giving birth or experiencing fetal loss during this period, a greater proportion of all teenage pregnancies ended in abortion (Chart 5).

 

Chart 5 Teenage abortion rates, by age of women at end of pregnancy, women aged 15 to 19, Canada, 1974 to 1997 Data sources: References 5,6,7; Health Statistics Division; Canadian Vital Statistics Data Base; Canadian Institute for Health Information

 

The abortion rate was much higher for older teens, even though pregnant 15- to 17-year-olds were more likely than pregnant 18- to 19-year-olds to have an abortion. The higher abortion rate at ages 18 to 19 reflects the higher number of pregnancies among older teens. The 1997 rate at ages 18 to 19 stood at an estimated 33.1 abortions per 1,000 women; at ages 15 to 17, the rate was 13.9 per 1,000.

Hospital and clinic patients differ
In provinces with access to both hospital and clinic abortions, teenagers are more likely to use hospitals (Table 1). However, based on an analysis of data from Ontario and Alberta, the only provinces that provide detailed information about patients in both hospitals and clinics, the characteristics of women using these establishments differ in some ways.

 

Table 1 Percentage of teenage abortions performed in hospitals and clinics, by province, 1997 Data source: Health Statistics Division Note: Prince Edward Island, Saskatchewan, the Yukon and Northwest Territories do not have abortion clinics.

 

Clinic abortions were more likely to occur earlier or later in the pregnancy. In 1997, 40% of teenagers who had clinic abortions were less than 9 weeks pregnant, whereas this was the case for 25% of those who had hospital abortions (Table 2). The percentage of abortions performed at 17 or more weeks was over 5% in clinics, compared with less than 2% in hospitals. Also, compared with those who went to a hospital, a higher proportion of teenagers who had a clinic abortion had had at least one previous induced abortion: 24% versus 18%. Regardless of whether they went to a clinic or hospital, the vast majority (96%) of Ontario and Alberta teenagers who had an abortion in 1997 were single; fewer than 3% were living common-law, and just 1% were married.

 

Table 2 Characteristics of teenagers obtaining abortions in hospitals and clinics, Ontario and Alberta,† 1997 Data source: Health Statistics Division Note: Data may not add to totals because of rounding. † Ontario and Alberta were the only provinces providing detailed data on patients in both hospitals and clinics. ‡ Separated, divorced and widowed have too few cases to be reported. -- Amount too small to be expressed.

 

Live births
Fewer teenagers are becoming pregnant, and as noted above, fewer of those who do are giving birth. In 1997, live births to teenagers numbered 19,724, and the birth rate for 15- to 19-year-olds reached an all-time low of 20 births per 1,000 (Chart 6). Rates declined among both younger and older teens.

Teenage birth rates were relatively high in the Prairie provinces and the territories, and low in Québec, Ontario and British Columbia (Appendix Table B).

 

Chart 6 Teenage live birth rates, by age of women at end of pregnancy, Canada, women aged 15 to 19, 1974 to 1997 Data sources: References 5,6,7; Health Statistics Division; Canadian Vital Statistics Data Base; Canadian Institute for Health Information

 

Fetal loss
Since 1974, it has been estimated that fewer than 10% of teenage pregnancies have ended in fetal loss (miscarriage or stillbirth; see Definitions). However, fetal loss is underreported. While counts of
stillbirths are virtually complete, it is difficult to estimate miscarriages because they may not come to the attention of the medical care system (see Estimating miscarriages).

Concluding remarks
In recent years, teenage pregnancy in Canada has declined. At the same time, the abortion rate for teenagers has stabilized. As a result, the proportion of teen pregnancies that end in an abortion has increased, exceeding live births for the first time.

Pregnancy rates are higher for older teens than younger teens. Abortion is the most common outcome for pregnancies among women aged 15 to 17. Older teens, however, are still more likely to have a live birth.

Teenage pregnancy rates tend to be high in the North and the Prairie provinces and low in the Atlantic region. However, in every province and territory, except Québec, Ontario and British Columbia, the majority of teenage pregnancies end in a live birth rather than an abortion.

 

References
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