Let’s start with a quiz.   

Since the 1990s the rate of teen pregnancy in the United States has:
A. declined by about a third.
B. stayed about the same.
C. increased by a third.

The group of unmarried women in the U.S. most likely to have used an effective method of contraception the last time they had sex is:
A.  teenagers.
B. women in their twenties.
C. women in their thirties.

The group with the highest number of unplanned pregnancies in the United States is:
A. women in their twenties.
B. teenagers.
C. women in their thirties.

The answer to all three questions is “A”: the rate of teen pregnancy has, indeed, dropped by a third; teenagers are most likely to have used an effective method of contraception;  and the group with the highest number of unplanned pregnancies in the United States today is women in their twenties.

If you’re like most Americans surveyed, it’s likely you got all three wrong.

Now, after a year of focus groups and consultations among the Hewlett Foundation, public opinion researchers, and a broad range of experts on reproductive health, those three answers have emerged as central to a new effort to reduce the nation’s rate of unplanned pregnancy.

In a bid to reduce unplanned pregnancy in the United States, and with the support of the Hewlett Foundation, the National Campaign to Prevent Teen Pregnancy has expanded its mission (and its name) to include people in their twenties.

The new National Campaign to Prevent Teen and Unplanned Pregnancy-“the National Campaign,” for short- has turned its efforts to these young adults, who account for more than half of the three million unplanned pregnancies that occur each year in the United States. By comparison, teenage girls now account for only 21 percent.

Sarah Brown, chief executive officer of the National Campaign, is quick to say that the new work does not mean the organization she leads has completed its work with teenagers. Despite the decline, the United States still has the highest rates of teen pregnancy and birth among comparable countries. The U.S. teen birth rate is one and a half times higher than the teen birth rate in the United Kingdom which in turn is the highest in Europe. So the Campaign has set itself a new goal: to reduce the teen pregnancy rate by another one-third between 2006 and 2015.  

Of course, in the case of teens, it’s clear to the public that pregnancy and teenagers are a bad combination. The issue is less transparent when the discussion is about people in their twenties.

“First we need to explain the magnitude and consequences of the problem,” Brown says of this broadened mission.

Key among those consequences is the fact that about half of all women who have an unplanned pregnancy choose to have abortions, making women in their twenties the most amply represented age group among the 1.3 million abortions that occur in the country each year, she says. So reducing unplanned pregnancies will reduce abortions.

Women who have an unplanned pregnancy also are at far greater risk of poverty, of starting prenatal care late, and of having a low birth weight baby.

 “It doesn’t do well for mother or child and it doesn’t need to be that way,” Brown adds.  “Seventy-five percent of all unplanned pregnancies are among people under 30. So if we can make progress on these two decades of life, we really have hit the majority of the problem.”

The reasons for high levels of unintended pregnancies among women in their twenties has much to do with societal changes that make that decade of life more unsettled than a generation ago, Brown and those who have studied the age group say.

Among the findings of a research project that social scientist William Galston of the Brookings Institution conducted on “20-somethings,” with funding from the Foundation, is that the number of young adults deferring marriage has risen steadily since 1970.

Getting married, achieving financial independence, and moving away from their  parents’ homes, all are being deferred later and later, the research shows. As New York Times columnist David Brooks noted in a recent column on what he called “the odyssey years,” in 1960 roughly 70 percent of thirty-year-olds had achieved these things. By 2000, fewer than 40 percent of thirty-year-olds had done so.

Alexandra Robbins, co-author of Quarterlife Crisis: The Unique Challenges of Life in Your Twenties adds, “because marriage and other traditional hallmarks of adulthood have been delayed, there are simply more years available to this generation in which to have an unplanned pregnancy.

“Thirty years ago, I’d venture to say that many if not most twenty-year-olds were planning their pregnancies,” she says. “Today, that’s not the case. More single years equals more sex equals more unplanned pregnancies.”

Robbins also observed that the problem is compounded by less education and outreach about the consequences of unplanned pregnancy to that age group, a thought echoed by Brown.

“People say its fine to tell teenagers what to do, but it’s not okay to tell someone who is 28 what to do,” Brown says. “But we tell people all the time what the best recommendations are on auto safety, and diet and exercise and dental flossing. Why not say it about unplanned pregnancy? This has as many consequences as those other things. It’s not telling them what to do. That puts it crudely; it’s telling them what’s in their own best interest.”

And while some of the lessons learned working to reduce teen pregnancy are expected to be helpful to the National Campaign in addressing its broadened mission, the new work will require new approaches.
While teenagers can be reached through schools, young adults in their twenties aren’t so conveniently convened. Brown talks not just of reaching out to community colleges, but potentially trying to address the group in such novel settings as through avatars in the online role-playing world, Second Life, or through blogs and other online venues.

 “People thought we were crazy when we said our goal was to reduce teenage pregnancy by a third,” Brown says. “Social scientists said, “you’re nuts. You’ll never do it. And it’s happened.

“You do it through a lot of hard work and talking to a lot of people. We have to find way to make it not okay to have an unplanned pregnancy. We have to make it not cool.”