NEW YORK (Reuters Health) - A relatively high degree of poverty and a lack of access to jobs, education and healthcare leave American teens more vulnerable to getting pregnant and having children than teens in many other developed nations, according to researchers.

``The fact (is) that at each level of income, education and among white teens, those in the US have higher levels of teenage childbearing than do teens in other developed countries,'' said Dr. Susheela Singh, director of research at the Alan Guttmacher Institute in New York.

Singh and her team conducted a country-by-country case study analyzing adolescent sexual behavior, contraceptive use, and pregnancy and abortion rates in France, Canada, Great Britain, Sweden and the US.

In the latest edition of Family Planning Perspectives, Singh's team reports that the five countries have very different economic profiles. Seventeen percent of the US population lives at the bottom half of the income range, compared with 8% to 9% in France and Sweden, and nearly 11% in Canada and the UK.

At all levels of educational achievement, US women had the highest rates of childbearing in adolescence. Compared with their British peers, the poorest American teens are almost 80% more likely to have a child by the age of 18, and almost 60% more likely to have a child by age 20. Richer American teens were 36% more likely to have a child by the age of 18 than the wealthiest UK teens, and 14% more likely by age 20.

The investigators found that in the US and UK, low-income teens were less likely to use contraceptives than higher-income teens, and that black and Hispanic American teens were less likely to use contraceptives than white teens.

Observing that US adolescent pregnancy and birth rates are the highest of all the studied countries, the researchers conclude that the problem is at least partly a function of American poverty. They note that the percentage of the population living in poverty is at least two-thirds larger in the US than in any of the other four countries.

This problem, Singh and colleagues add, is compounded by the unique absence of a national healthcare system in the US. Other factors include a large, diverse US population distributed across a broad geographic area. The other four countries are much smaller, they point out, making access to services easier and policy implementation more uniform.

And while in France and Sweden there appears to be a general perception that adolescent motherhood is undesirable, the authors note, attitudes in the US are generally less disapproving and can vary dramatically among different groups and across geographic areas.

Singh and her colleagues suggest that government-initiated programs designed to broaden the educational and job opportunities of low-income youth would go a long way toward reducing both unplanned pregnancies and sexually transmitted diseases. The researchers point out that social policies along these lines are much more common in Europe and Canada than in the US.

``While the larger proportion of the US population that is poor, disadvantaged and belonging to race/ethnic minorities, compared to other developed countries, contributes to our higher teen childbearing levels, it's not the only reason,'' Singh told Reuters Health.

``Differences in alternative opportunities and hence in motivation to delay motherhood, differences in access to prevention and in the social context surrounding both of these, are some of the factors that further help explain why teen childbearing is higher in the US,'' she added.

SOURCE: Family Planning Perspectives 2001;33:251-258.

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