The Second Decade: Understanding Adolescent Development and Sexual Health in North Carolina

The second decade of life – the one that ranges from age 10 to 19 – is a remarkable time. From the wonders of childhood to the changes of puberty and from the most awkward moments to the establishment of an adult person, the second decade matters.

During the second decade, most young people will experience puberty, a changing sense of self, new roles in their family and peer groups, first relationships, and sex. All of these experiences can be safe and healthy. Unfortunately, the second decade also carries risks — abuse, peer pressure, shame, ignorance, and a lack of resources can lead to STDs/HIV, unhealthy relationships, and unplanned pregnancy.

To encourage young people to be and stay sexually healthy, we need to understand how they grow and change in the second decade of their lives. And, we need to employ proven youth development, parenting, education, and health care strategies that grow with them.

What is it like to be age 12 in North Carolina? What about 16? Or 19?

As North Carolina has improved its teen pregnancy rates to a historic low, we have learned a lot about how young people in our state experience unplanned pregnancy or successfully avoid pregnancy. Many of these lessons-learned are painfully obvious — but they’re worth sharing:

  • Early, middle, and late adolescence are distinctly different, and deserve a more fine-tuned label than “teen”;
  • Being a sexually healthy person is very different in early, middle, and late adolescence;
  • Pregnancy results from very different sets of circumstances in early, middle, and late adolescence; and
  • Helping young people avoid unplanned pregnancy requires different tools and strategies depending on a young person’s actual age.

Teen pregnancy isn’t just one thing – and it generally doesn’t look like an episode of MTV’s 16 and Pregnant. Unfortunately, communities build on this cultural model of “teen pregnancy” and use a one-size-fits-all-teens approach to prevention. While those approaches have made an undeniable difference, communities need a bigger toolkit to make a bigger impact.

Understanding Adolescent Development and Sexual Health

Younger Adolescents (10-14)

2% of North Carolina teen pregnancies come from this age group.

Younger adolescence is a great time to provide preventative information on sexual health, relationships, and more before a young person becomes sexually active. That’s why traditional sex education programs are often geared toward this group. While it’s normal for younger teens to experiment with their own bodies, develop a curiosity about sex, form their first romantic relationships, and experience puberty, sexual intercourse is rare. In fact, most teens in this age group who have had sex report that the sex was nonconsensual and pregnancy is generally the result of something very wrong, like rape, child sexual abuse, or a relationship with a severe power imbalance.

Key Strategies: 

  • Provide medically accurate and age appropriate education on sex, sexuality, relationships, media, and pregnancy and HIV/STD prevention before younger adolescents start exploring sexual activity and developing romantic relationships. 
  • Work with adults in your community to prevent child sexual abuse and rape. 
  • Ensure romantic partners are close in age. (Girls with partners 3+ years older are more likely to have sex and to have sex without condoms or birth control.) 
  • Help young people develop a range of healthy networks, friendships, and interests. 

Middle Adolescents (15-17)

29% of North Carolina teen pregnancies come from this age group.

Middle adolescence when many teens start to explore sexual activity. However, delaying sex is still an important goal. (To state the obvious: Delaying sex is a great way to prevent pregnancy.) The average age a teen first has sex – 17.1 – falls in this stage. Dating relationships are quite common. The strength young people’s affection for their partners is genuine and shouldn’t be dismissed. Parents, schools, and communities can provide powerful guidance to help teens’ dating relationships be healthy and free of abuse.  It’s important for parents, schools, and communities to work together to address middle adolescents’ needs with a multi-pronged approach. They need healthy ways to occupy their time, support and guidance, avenues for conversation, and access to the most effective birth control methods.

Key Strategies: 

  • Parents and doctors should talk openly, honestly, and positively about sex, relationships, and birth control. 
  • Watch for markers of abusive or coercive relationships.
  • Provide healthy and engaging ways for youth to spend time.
  • Help young people choose and obtain an effective method of birth control (like an implant) before sexual activity begins.

Late Teen Adolescents (18-19)

71% of North Carolina teen pregnancies come from this age group.

Most teens are sexually active at this age, but want to delay marriage and childbearing for another 5-10 years.  Helping young people develop healthy relationships and safer sexual practices matters. Many of the best strategies for preventing pregnancy at this stage happen in a clinical setting. Older adolescents need information on and access to the most effective birth control methods, like IUDs and the implant. Parents can play a powerful role in connecting their teens to effective birth control. Similarly, medical practitioners can become good teen-friendly providers and counsel to the most effective birth control methods.  

Key Strategies:

  • Connect young people to contraceptive services. 
  • Help providers adopt teen-friendly practices. These can include offering same-day appointments, asking about sexual activity and birth control needs at every appointment, and creating a nonjudgmental environment. 
  • Encourage the use of fail-proof contraceptive methods like IUDs and the implant.