What Does New Research on Adolescent Brain Development Tell Us About Designing Adolescent Reproductive Health Services?

By Christine Cupaiuolo — November 15, 2010

by Karin Ringheim | Population Reference Bureau

A recent NPR story on the biological basis for the sometimes confrontational, erratic and seemingly irrational behavior of adolescents reminded me of my own experiences in raising adolescents (and gratitude that this particular stage of life is now behind me).

As Garrison Keillor recently reminded us, to be a parent is to live a life of constant silent prayer — prayer that everything will turn out all right. We know that adolescents don’t always exercise the best judgment, and now, at least, we have a better sense of why this is the case.

The Teen Brain – A Work In Progress

The physical evidence gathered from Magnetic Resonance Imaging (MRI), according to Harvard researchers Frances Jensen and David Urion, shows that the adolescent brain is only about 80 percent as developed as an adult brain.

In adolescence, the brain’s frontal lobe, responsible for such important functions as reasoning, planning and judgment, is not as well-connected to the rest of the brain by myelin, or “white matter,” as it is in an older individual. Because of the immaturity of their brains, adolescents are less capable than adults of rational thought processes.

White matter grows substantially over the course of adolescence, providing insulation that increasingly enables nerve signals to flow freely from one part of the brain to another. When the frontal lobe is fully connected to the rest of the brain, around age 25, the brain is more capable of “connecting the dots,” processing complex notions — such as that actions have consequences.

Brain development from age 5 to 20 / Source: Paul Thompson, professor of neurology, UCLA School of Medicine

Death and Disability Rates Double During Adolescence

If parents did not already intuit this, the difficulties that adolescents have in controlling their emotions and behaviors lead to a doubling in rates of death and disability during adolescence as compared to rates among younger children.

According to Ronald Dahl, Staunton Professor of Psychiatry and Pediatrics at the University of Pittsburgh Medical Center, increased risk-taking, sensation-seeking and reckless behavior lead adolescents to higher rates of traffic and other accidents, substance abuse, suicide, eating disorders, depression, violence and risky sexual behaviors.

Although Dahl does not promote a mechanistic view of biology as destiny, he does note that the life trajectories established in youth can have a major impact on later life, and it is best to alter these trajectories in a positive direction while one can.

Youth Reproductive Health: A Politically Charged Issue


Adolescents who become unintentionally pregnant or become infected with HIV are certainly in for a life-altering experience, and usually not one that will be advantageous.

For at least 15 years, reproductive health advocates have called for “youth friendly services” to enable youth who are, or intend to become sexually active, to obtain the information and services they need to remain healthy.

The concept of reproductive health services for adolescents has been, and remains politically controversial. In 2004, ideologues charged that the Global Health Conference, an international gathering of health professionals held annually in Washington D.C., would be a platform that year to advocate for youth reproductive health services, instigating a last-minute withdrawal of federal funding for the conference from the U.S. Department of Health and Human Services, the Centers for Disease Control (CDC) and the U.S. Agency for International Development (USAID).

While the conference proceeded with funding from other donors, the action had a chilling effect on some federal grantees, who swept their websites clean of any potentially damaging information. U.S. programs for youth in developing countries supported under the President’s Emergency Plan for AIDS Relief, PEPFAR, were firmly grounded in the “ABCs” — Abstain, Be faithful, use Condoms, even as domestic research showed that abstinence-only programs had no long-term health benefits.

Meanwhile, in some African countries, one in five young women is HIV positive and as many as one in two has been pregnant. In South Africa, 22 percent of young women attending antenatal care are both pregnant and HIV positive. These astounding statistics have largely been unmoved by the infusion of PEPFAR and other funding for proscriptive youth reproductive health information and services. And politically shaped policies in the United States help maintain pregnancy, birth and abortion rates among adolescents that are the highest in the developed world.

An Evidence-Based Practice

How should societies respond to the knowledge that adolescents may not be capable of obeying our pleas to “just say no,” “abstain until marriage,” or “always use a condom”?

Adolescents are capable of understanding, if not fully controlling, their own immature thought processes. They need realistic, truly “youth-friendly” tools and resources to help them make better decisions and remain healthy and safe.

If, based on brain research, adults come to view adolescence less as a period of self-centered disobedience and more as a period of innate vulnerability, we will do a better job of providing youth with comprehensive, compassionate services and education. We will do whatever we can to help them navigate this vulnerable period without becoming pregnant or HIV-positive, or undergoing an unsafely performed abortion, and if such outcomes occur, we will aim to minimize the harmful life-altering consequences.

Our obligation is to protect as best we can, those who by virtue of their not-fully-realized intellectual capacity, are less able than we previously assumed to look out for themselves.

Karin Ringheim, Ph.D., M.P.H., is a senior policy adviser at the Population Reference Bureau

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