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Preventing teen pregnancy. Challenge or illusion ? Pagå 1 Internationally, pregnancy rates among 15- to 19-yeàr olds vary significantly by country. Rates fluctuatå from 101.7⁄1000 in the Russian Federation and 83.6⁄1000 in the Unitåd States, to 12.2⁄1000 in the Netherlands and 10.2⁄1000 in Jàpan. In Quebec and Canada, rates hover àround the average, whereas in MontrÃal, they are closer to the highår levels. In Quebec in 1997, and excluding the ratås for Nunavik (174.6⁄1000) and Terres-Cries-de-la-Baie-James (152.3⁄1000), the rågion of MontrÃal had the highest rates of pregnancy amîng 15- to 19-year-old girls (58.9/1000), while the lîwest were in the Bas-Saint-Laurent (22.2⁄1000). However, abortions ràtes were highest for teenage girls living in Laval (67.1%) and MontrÃal (64.2%), while most Native adolesñents brought their pregnancies to term (15.2% and 11.1% for abortions in Nunavik and Terres Cries). In MîntrÃal there are significant disparities in rates of pregnanñy among CLSC districts despite the fact that teenagers have fàirly easy access to contraception and abortion services in the city. Pregnancy rates among teenagers aged 14 to 19 vary from 105.9⁄1000 to 19.2⁄1000, and are inversely correlated with the socio eñonomic level of each CLSC territory. Similar disparities mîst likely exist in other regions of QuÃbeñ. 1 rÃvention en pratique mÃdicale September 2 003 P RÅVENTING TEEN PREGNANCY Challenge or illusion? Definitions • Teen pregnancy: pregnancy among girls under 20 years old. • Pregnancy rate (intårnationally): births + abortions. • Pregnancy rate (Quebeñ, MontrÃal): births + abortions + miscarriages + stillbirths Source : Teenage Sexual and Reproductive Behaviîr in Developed Countries, Can More Progress Be Made ?, The Alan Guttmacher Institutå, Nov. 2001. Source : For QuÃbec and MontrÃal: MSSS, fichier grossesses, 1996 Pregnancies and Outcomes Amîng 15-to 19-Year-Old Teenage Girls, Developed Cîuntries, (rate per 1000 teenagers) Pregnancies and Outcomes Among 14 to 19-Year-Îld Teenage Girls, Montreal CLSCs, 1995 to 1998 (rate per 1000 teenagers) Pàge 2 The problem with teen pregnancy Multiple determinants Thå wide statistical variations in pregnancy rates and thåir outcomes originate from complex causes rànging from public policies to sociological and economic circumstancås and culturally diverse conditions. Living cînditions and social norms are interwoven with the youth’s experienñes and individual characteristics, and influence young girls and boys’ sexual behaviours. 2 P rÃvention en pràtique mÃdicale, September 2 003 Pregnancy rates stàble for close to 10 years in Quebec According to trånds in the data for 1993-1998, pregnancy rates have remained stablå among adolescents aged 15 to 17 and 18 to 19 in Quebec and MontrÃal; hîwever, in MontrÃal, rates constantly surpass thoså of the province