New options needed for
dealing with teen pregnancy

When unmarried teens engage in consensual sex, this pleasurable, private behavior can become a painful, public scandal. If the girl is very young, the man or boy can be charged with statutory rape. If the couple does not use a condom, they may be exposed to sexually transmitted diseases. One quarter of HIV infections occur in people under age 20. If the couple does not use an effective contraceptive in addition to a condom, the girl may become pregnant. She is then faced with the difficult decision of whether to terminate the pregnancy, to bear but not rear the child or to bear and rear the child herself-often forcing mother and child into a marginal life of grinding poverty.

Most teens can recite these dangers, but adolescence is a time of presumed invincibility. So in this country, most teens choose to explore the pleasures while ignoring the downside of unprotected intercourse. Despite similar proportions of sexually active, unmarried teens, the United States has twice the abortion and child birthrates of other Western countries. Why is this? What are other countries doing that we are not?

While we cannot answer these questions definitively, it appears that other cultures do a better job of educating their children about the consequences of sexual activity, and they provide their sexually active youth easy access to contraceptive and preventive health services. Both strategies have been found to reduce the incidence of premature and unprotected intercourse. When tried experimentally in this country, these strategies have had the same salutary effect.

However, most of our youth do not receive early sex education, and most sexually active youth do not have the opportunity to obtain contraceptives in their schools or wherever they "hang out." The result is that only one out of five adolescents use contraception every time they engage in sex. That means that by age 18, six out of 10 teens have taken one or more chances in the high stakes of "sexual roulette." Those who lose are faced with an unintended pregnancy or a sexually transmitted disease or both. About 29,000 Georgia teens become pregnant each year. And they are not the only ones affected-families are put under tremendous stress, while society bears a financial burden for attendant health and welfare costs. In 1991, Georgia's public expenditures related to adolescent childbearing amounted to more than $500 million for Aid to Families with Dependent Children, food stamps and Medicaid alone.

Society bears a moral burden as well. A 1995 national public opinion poll revealed that 87 percent of American adults feel that something is fundamentally wrong with the country's moral condition. In their minds, the most salient symptom of moral decay is teen-age pregnancy, a consequence of premature sex unaccompanied by commitment. That view bears some examination in light of the fact that teen-age childbearing rates are actually lower now than they were during the 1950s-a time many view nostalgically as one of higher moral values and stronger family norms than we have today.

Part of the difference between then and now is that couples who "got into trouble" in the 1950s often married before the girl gave birth. While many of these marriages did not last, the subsequent divorce and rearing of children by only one parent were not viewed as morally decadent as unwed childbearing. Today pregnant teens are far less likely to marry, even though unwed childbearing is still viewed with alarm by many in our society. As our society becomes more reliant on higher education and technical training to establish economic independence, the interruption of education by unintended pregnancy carries a harsher life penalty as well. While all societies have established cultural norms and taboos around what is considered acceptable sexual behavior, those norms in our multicultural society are constantly undergoing challenge and change.

Our cultural stresses are reflected in the views our media provide of sex. Thousands of sexually overt scenes play out on TV and movie screens each year, in stark contrast to our traditional cultural norms of modesty and abstinence outside of marriage. As a nod to those traditional norms, however, few scenes include adult discussions of the possible consequences, and contraception ads are thought to be taboo. Through these mixed messages, our youth come to understand that it's okay to be "swept away," but it's not okay to take the consequences of unmarried sex into account.

Traditionalists in our society accept the need for sex education, as long as it teaches only abstinence. However, one of the surprising findings of an Institute of Medicine report is that adolescent sex education that teaches abstinence only has no effect. Sex education that teaches abstinence in the context of maturation and includes information and access to contraception for teens who do become sexually active has been demonstrated to postpone the initiation of sexual experimentation and to increase the likelihood that teens will use contraception the first time. Unfortunately, Georgia's teens cannot benefit from this approach, which is known to work, because Georgia law prohibits contraceptive counseling and distribution where it is most needed-in schools.

In its current session, the Georgia State Legislature will be deciding on several proposed initiatives to reduce teen pregnancies. Most of these are designed to increase contraceptive availability in out-of-school clinic sites and to improve sex education within schools. All such initiatives deserve our support. Additionally, we in the Emory community may wish to respond to the Institute of Medicine committee's call to search for common ground on which our multicultural society can establish and maintain moral balance for ourselves and for our children.

Carol Hogue is a Jules and Dean Terry Professor of Maternal and Child Health professor
and director of the Women's and Children's Center at the Rollins School of Public Health.

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