Approved by Council, January, 2009
To be reviewed 2014

As the major medical association with expertise on child and adolescent development and psychopathology, the American Academy of Child and Adolescent Psychiatry is concerned about the high rate of teenage pregnancy. The AACAP recognizes that parents have the primary responsibility for providing guidance to their children in the appreciation and understanding on their sexuality.

The Academy endorses the development of curricula in family life and sexual education throughout the U.S. school system. The Academy recommends that in communities which recognize and acknowledge the need for such services is indicated, school systems should collaborate with local and state health and education agencies to establish high quality comprehensive education about sexuality in the school. In addition, health clinic programs should be established which provide a full range of services including counseling and information regarding sexuality and reproductive health. Where such health services are provided to adolescents, these services should maintain the traditional practices regarding patient confidentiality.

The Academy documents the need for these measures with the following data:

• Each year in the United States almost 750,000 women aged 15-19 become pregnant. Adolescent pregnancy carries with it negative psychological, emotional, and economic and social sequelae for both teenage mothers and their children. In addition, it entails enormous costs to society.
• Adolescent pregnancy represents one aspect of health disparity, as it disproportionately involves poor and minority adolescents.
• The overall decline in teen pregnancies since 1990 is due to a reduction in the proportion of teenagers who are sexually active and to an increase in the proportion of those sexually active teenagers who use contraception. These behavioral changes have been attributed to the growth in high quality, comprehensive education about sexuality in schools and communities.
  Comprehensive sex education teaches about psychological and physical human growth and development and relationships, and aims at teaching adolescents to make informed, responsible and safe choices. It aims to delay the onset of sexuality activity and promote safe sexual activity among those teenagers who are already sexually active.
• Extensive research has demonstrated that the most effective programs provide information about the risks of unprotected intercourse, as well as ways to avoid an unintended pregnancy; and models of and practice in communication, negotiation, and refusal skills. Such programs also foster good parent-child communication.
• A particularly effective approach has been the location of full service health centers in schools where access to health care, including contraception, is available along with counseling.

The AACAP supports the use of comprehensive programs to prevent adolescent pregnancy. Information about and access to reproductive health care services should be a component of these programs.

The AACAP strongly supports parental involvement in adolescents’ decision-making, and recognizes that most teenagers will involve their parents in making decisions about reproductive health care. However, many teenagers will become sexually active but not seek services if they are required to inform their parents. Therefore, laws that empower adolescents to obtain certain basic health care on their own, and to make decisions regarding their own reproductive health care, and ensure them confidentiality when they receive such services are highly desirable, as they improve access to crucial health care services.