Teens with older men: A population at risk
If your next patient is an adolescent female with a partner who is six years older or more, get ready for a counseling challenge. Why? These teen-agers and their partners have a lower rate of contraceptive use, and their pregnancy rate is nearly four times the rate of those teens whose partners are no more than two years older, according to a just-published analysis of a national survey.1
Don’t expect to see the majority of teen-age females choosing older men, though. A total of 64% of sexually active females ages 15 to 17 have partners who are within two years of their age, and 29% pair with men who are three to five years older. These findings were published by researchers at the Alan Guttmacher Institute (AGI) in New York City. The institute analyzed results from the 1995 National Survey of Family Growth, a nationwide poll conducted by the federal National Center for Health Statistics in Hyattsville, MD.
The 7% of adolescent females ages 15 to 17 with partners who are at least six years older cause the greatest concern.
"What we were able to see is that if a young girl has a much older partner, she is less likely to be using contraception, even if she is at risk for an unintended pregnancy," notes Jacqueline Darroch, PhD, senior vice president at AGI and lead author of the analysis. "She is much more likely to become pregnant and more likely, in fact, to become intentionally pregnant."
Findings of note in the AGI analysis include:
• Among minors at risk of unplanned pregnancy, 66% of those with a much older partner used a contraceptive at last intercourse, compared with 78% of those whose partner was within two years of their age.
• Seven in 10 unmarried minors whose partner is much older become pregnant, compared with about one-quarter of those whose partner is three to five years older and 17% of those whose partner is no more than two years older.
• Unmarried minors whose partners are close to their own age are more than twice as likely to have an abortion when faced with an unplanned pregnancy than those whose partner is much older.
• Women ages 15 to 17 who have ever been forced to have sex are twice as likely to have a partner who is three to five years older.
Previous research on the age of young people’s sexual partners has shown only the age of fathers of babies born to teen-age women and the age of the sexual partners of young women at first intercourse.2 The new AGI study is the first to provide information about the age of the partners of women currently in sexual relationships and the partners of women who have had an abortion.
Public concern about relationships between young teens and older men has grown in recent years in response to research showing that a high proportion of babies born to teen-age mothers are fathered by adult men.2 The new analysis shows that two-thirds of sexually active women under 18 have partners close to their age.
The new findings will figure in the ongoing discussion concerning parental involvement, statutory rape, and other aspects of adolescent reproductive health care.3 Research is needed to determine the most significant reasons that some young women have relationships with older men and how their partners’ characteristics affect their reproductive behavior.
"Until we better understand why some young women have sexual relationships with much older men, and why some older men have sexual relationships with teen-age women, it will be difficult either to formulate policies that will influence their behavior or to gauge the extent to which the high pregnancy rates among these young women result from pressure from the men to have sex and to have a child, from their own desire to move quickly into motherhood and adulthood, or from difficulties in avoiding unintended pregnancy and childbearing," the AGI researchers note.
Ask the questions
It takes a high level of skill and some forethought by clinicians to approach adolescent females about their relationships with older men, says Linda Dominguez, RNC, OGNP, assistant medical director of Planned Parenthood of New Mexico in Albuquerque.
"We don’t have counseling tools or clinical tools to say Who’s your sexual partner?’" notes Dominguez. "It is something you do in conversation as a way of getting to know that patient, or if you’re in a school-based clinic situation, it may be that the school counselor or teacher has brought it to your attention."
By asking a variety of questions, clinicians can set the framework for an adolescent female to understand her hopes and plans and how they coincide with her partner’s goals, Dominguez says. Exploring contraceptive choices fit into the context of planning for the future. (See story at right for tips on questions to ask during an adolescent exam.)
References
1. Darroch JE, Landry DJ, Oslak S. Age differences between sexual partners in the United States. Fam Plann Perspect 1999; 31:160-167.
2. Landry DJ, Forrest JD. How old are U.S. fathers? Fam Plann Perspect 1995; 27:159-161, 165.
3. Saul R. Using — and misusing — data on age differences between minors and their sexual partners. Guttmacher Report on Public Policy 1999; 2:10-12.
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