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Sexual Behaviors and Health

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Sexual development is central to adolescence. For more information, visit:

What is Sexual Health?

Understanding Sexual Development

Romantic Relationships in Adolescence

Adolescent Pregnancy and Parenthood

For statistics relating to adolescent sexual health, visit Demographics: Sexual Health.

Communities can provide the supportive context youth need to avoid unplanned pregnancies or succeed as young parents. By providing services, opportunities, and supports, communities foster positive youth development. By ensuring access to youth-friendly health care, they promote well-being. And by promoting comprehensive sex education, they give youth the knowledge and skills they need to navigate relationships and take control of their sexual and reproductive lives.

This is a tall order for any community -- especially those that are under-resourced and those where stigma against sex and sexuality runs high. However, the consistent decline in pregnancy rates suggests that this can be done.

How do environmental factors affect adolescent pregnancy?

Sex is a normal part of the teen years: in the U.S., two out of three people have sex before the age of 19. But sex is a complicated part of life, connected not only to family, relationship, and individual issues, but also to myriad social and economic pressures and policies. Consider how these pressures can weave through young people's lives:
  • Social stigma against teen sexuality has affected Caroline in significant ways. Caroline's mother is uncomfortable talking to her about sex, and is embarrassed to ask anyone how to have that conversation. Because they fear potential objections from parents, Caroline's high school prohibits condom demonstrations in sex education classes as a matter of school policy. Caroline and her boyfriend Max want to use protection, but they don't know how. When the condom breaks, Caroline's friends tell her about emergency contraception, but she lacks access to public transportation and is unable to get to a clinic or pharmacy in time. She doesn't want to go to a health center in any case because of confidentiality concerns: it's a small town, and the odds are she will see someone she knows there.
  • At 16, William is feeling the pressure of masculine gender norms: he is teased relentlessly for being a virgin. He would rather be working or doing something that will set him up for the future, but there are no jobs and nothing interesting to do where he lives. To pass the time, he and his friends just hang out and get high at the end of the school day. There's one girl who seems to like him, so he might as well get it over with. Among the guys, peer norms hold that condoms make sex less pleasurable; condom use is rare in his crowd, and no adults offer a different narrative to challenge that norm. In fact, no one seems to be paying attention at all.
  • Homophobia, violence, and poverty have all contributed to the toxic stress that accompanies 15-year-old Ti through life. Identifying as queer, Ti sees no need for contraception, and doesn't even consider going to the free clinic. But she has learned it's not safe to be gay, so she covers her tracks by having boyfriends. Ti's school and neighborhood have no resources to provide her with opportunities to develop her talents and plan for the future. She lives one day at a time and prides herself on being a survivor. Kicked out of her family's home, she uses sex to meet basic needs for food and shelter.


These stories suggest many points at which interventions -- from parent education to vocational opportunities to food and shelter -- could change the trajectory of teens' lives. When it comes to adolescent pregnancy, the power of influences beyond the individual or couple involved has been well-researched: hundreds of risk and protective factors for adolescent sexual health have been identified. Together, they suggest many pathways toward empowering youth to care for their health and plan the futures they desire.

Because the causes of adolescent pregnancy are so complex, researchers and funders recommend that comprehensive plans be developed and implemented at the community level. Every sector has a role to play in supporting a community's youth. Three overarching strategies can make a significant difference through:

  • Positive Youth Development
    Positive youth development has been linked to decreases in adolescent pregnancy and to better adolescent sexual health. This section describes positive youth development principles and practices.
  • Evidence-Based Programming
    Comprehensive sexual health education allows youth to build the knowledge and skills -- such as refusing sex and using a condom correctly -- that they need to protect their health and promote their well-being. This section focuses on how to prepare for successful implementation of evidence-based programs in adolescent sexual health.
  • Access to health care
    Youth-friendly, confidential sexual health care is fundamental to pregnancy prevention.
It's also important to note that poverty is central to many of the risk factors for youth. To support young people, it is critical to address the burden of poverty carried by under-resourced neighborhoods, and activate the strengths and resources within these communities.

Support for Young Families

Prevention, of course, is not the end of the story: thousands of teens become parents each year. It's safe to say that in most communities in the U.S., adolescents who are parents are rarely supported in their own development. Coping with the pernicious effects of stigma, they face obstacles in completing their education and building the connections and competencies that support self-sufficiency and a healthy adulthood. At the same time, they must work to ensure the well-being of their children: finding safe housing and childcare, getting to health care appointments, and securing income.

When connected to supportive opportunities, young people who parent can meet their own developmental challenges while raising their children.

Resources: Focus on Disparities

Adolescent pregnancy and parenting rates have declined dramatically since 1991. However, some groups remain disproportionately affected by unintended pregnancy, HIV, and STDs. To achieve health equity, the social determinants negatively affecting these groups must be addressed. See below for information and resources.

Youth of color

Rural youth

Lesbian, gay, and bisexual youth

Youth in foster care

Homeless and runaway youth

Additional resources

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