1. family and parenting
2. motherhood
3. pregnancy

S.Hm..
TEENAGE
PREGNANCY:
ECONOMIC
THE
SOCIAL
AND
C^STS
T
HEARING
BEFORE
SUBCOMMITTEE
THE
EDUCATION
ON
HEALTH
AND
OF
THE
ECONOMIC
JOINT
CONGRESS
OI
ONE
COMMITTEE
UNITED
THE
HUNDRED
CONGRESS
SECOND
SECOND
STATES
SESSION
NOVEMBtR24,1992
Printedforthe
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oftheJointliconomic
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1994
PrintingOtTicc
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Congressional
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20402
102-1 150
S.Hrc.
TEENAGE
PREGNANCY:
ECONOMIC
THE
C^STS
SOCIAL
"
AND
V
....
^
?S
T~3^
HEARING
BEFORE
SUBCOiHMITTEE
THE
EDUCATION
ON
HEALTH
AND
OF
THE
ECONOMIC
JOINT
CONGRESS
Of
ONE
COMMITTEE
UNITED
THE
HUNDRED
CONGRESS
SECOND
SECOND
STATES
SESSION
NOVEMBiR24,1992
Printed
forthe use oftheJointEconomic
U.S.
GOVERNMENT
'6-6"
PRINTING
WASHINGTON:
For sale
ol
Superintendent
Documents,
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1994
PrintingOffice
Sales Office, Washington,DC
Congressional
ISBN
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BostonPublicLibrary
JOINT
[Createdpursuant
ECONOMIC
to
COMJIUITEE
Sec. 5(a) of Public Law
SENATE
PAUL
HOUSE
Maryland,
S. SARBANES,
LEE
Chairman
LLOYD
EDWARD
RICHARD
WILLIAM
STEVE
CONNIE
ROBERT
Texas
BENTSEN,
M.
Massachusetts
KENNEDY,
New
H. HAMILTON,
Indiana,
V. ROTH,
SYMMS,
MACK,
Hampshire
STEPHEN
SUBCOMMITTEE
H. SCHEUER,
A. QUICK,
York
STARK, California
K.
ARMEY,
Texas
WYLIE, Ohio
CHALMERS
P.
OLYMPIAJ.
SNOWE,
HAMILTON
New
FISH, Jr.,
Maine
York
Executive Director
F KAUFMAN,
General Counsel
Director
W. GILLESPIE, Minority
Staff
ON
EDUCATION
JAMES
Texas
HEALTH
AND
HOUSE
SENATE
BENTSEN,
PETE
New
J.SOLARZ, New York
MFUME,
Maryland
RICHARD
Florida
EDWARD
JAMES
KWEISI
Delaware
Jr.,
New
R.
STEPHEN
Idaho
C. SMITH,
OBEY, Wisconsin
DAVID
FORTNEY
Mexico
Tennessee
Jr.,
H. BRYAN, Nevada
GORE,
RICHARD
LLOYD
REPRESENTATIVES
OF
Vice Chairman
JEFF BINGAMAN,
ALBERT
304, 79th Congress]
or
REPRESENTATIVES
H. SCHEUER,
Maryland,
Chairman
JEFF BINGAMAN,
New
ALBERT
Tennessee
GORE, Jr.,
ROBERT
C. SMITH,
New
OLYMPIAJ. SNOWE, Maine
HAMILTON
New York
FISH, Jr.,
Mexico
Hampshire
(ii)
CONTENTS
WITNESSES
FOR
Tuesday,
AND
STATEMENTS
RECORD
THE
November
24, 1992
PAGE
Scheuer,Hon. James H., Chairman, Subcommittee on Education
and Health,JointEconomic
Committee:
Opening statement
.
.
Elders,
Director,Arkansas Department of Health
Joycelyn,
Walters,Hon. David, Governor of Oklahoma
11
4
12
tion,
Jane,Vice President of AffiliateDevelopmentand EducaJohnson,
Planned Parenthood
19
Burt, Martha, Senior Fellow,The Urban Institute
23
The Alan Guttmacher Institute
Rosoff,JeannieI.,President,
Faulkner,Reverend Michael J.,Minister for Youth, CalvaryBaptist
Church in New York City
....
SUBMISSIONS
FOR
THE
Walters:
41
Prepared
statement
45
Study entitled "Expendituresand
Investments:
Adolescent
Pregnancy in the South"
Ms.
Ms.
Ms.
48
Johnson:Preparedstatement
Burt: Preparedstatement
Study conducted by The Center for PopulationOptionsentided "Teenage Pregnancy and Too-EarlyChildbearing:
Public
Costs,Personal Consequences"
Rosoff: Preparedstatement
Issues in
March
Brief,
1990
Rev. Faulkner:
and
70
72
81
89
92
Studyentitled "TeenagePregnancyin
Determinants
35
RECORD
Dr. Elders: Preparedstatement
Governor
30
DevelopedCountries:
Policy
Implications"
Prepared
statement
96
107
(iii)
PREGNANCY:
TEENAGE
THE
COSTS
SOCIAL
AND
ECONOMIC
Tuesday, November
24, 1992
Congress
Subcommittee
on
of
the
United
Education
Joint Economic
and
States,
health,
Committee,
DC.
Washington,
The Committee
2359, Raymet, pursuant to notice,at 9:18 a.m., in room
H.
Honorable
Scheuer
burn House Office Building,
(Chairman of the
James
Subcommittee) presiding.
Present:
Scheuer.
Representative
Also present: William Buechner
OPENING
STATEMENT
staffmemand David Podoff,professional
bers.
OF
SCHEUER,
REPRESENTATIVE
VICE CHAIRMAN
of the JointEconomic
This is a Subcommittee
of our
Committee.
We have a broad rangingmission looking
at the economy
t
hat
it.
and
the
things
impact
country
Bill Clinton was
elected President on November
Governor
When
3, it
seemed to me that we oughtto be on the eve of a revolution in reproductive
and that at longlastthe
services and reproductive
research,
facilities,
rights,
and for a total
for
needs of young women
in our society
care
contraceptive
for theirreproductive
is longoverdue.
concern
privileges
Scheuer.
Representative
for the
itwould be helpful
the brink of thistrue revolution,
are
on
have
the
o
f
and
be
to
to
to
President,
a hearing
helpful
guidance the Congress
dent.
and to advise both the Congressand the Presiand think about this subject,
Since
we
woman
Justconsider these facts: Every 21 seconds a 15- to 19-year-old
becomes sexually
active for the firsttime. Every 64 seconds an infant is born
1986 and 1990
children. Between
children having
to a teenage mother,truly
adolescent childbearing
increased 16 percent, from 38.4 percent to 44.6 percent.
million teenagers become pregnant. Every year a
resultin the birth
million girls
become pregnant, and halfof these pregnancies
of a child,
children
children.
halfmillion
having
a
cases, 500,000
Every year
than
more
a
The vast majority
of these children are born into familiesheaded by a single
that
the type of family
mother
the most
poverty-stricken
group in America
and raise a young infant to maturitywith allof the life
is leastable to nurture
the
the rich exposure to life's
the love,the nutrition,
exciting
caring,
support,
that theyneed.
the education and skills
possibilities,
training
"
"
These women
mothers have
readyto have families. Only a third of teenage
degree,comparedto 25 percent of mothers 25
high-school
are
a
not
yet
(1)
and
Only half of pregnant teenagers know enough to seek earlyprenatal
compared to 85 percent of older mothers.
over.
care,
Many of these
and their families will spend much of their
livesin poverty. The Congressional
Budget Office recently
reportedthat half
of all adolescent mothers begin receivingAid to Families With Dependent
Children within five years after havingtheir firstchild,
while three-quarters
of
unmarried adolescent mothers will go on AFDC
within five years of their first
women
young
child.
As I said
before,a new President is going to take office on January 20, with
from the American peopleto change this Nation's direction from
sterileand empty posture relating
its utterly
and their reproducto young
girls
tive
needs to somethingmuch fuller,
much more
rich and much more
vant.
relea
mandate
have
We
present
of witnesses before us this morning who are going to
ideas for dealing
with this problem of teenage pregnancy.
some
number
a
that the hearingrecord of this morning will be broughtto President
sure
Clinton's attention. We
confident
and
take
will
that
he
it to
are
hope
heart and act on it,many of these suggestions
emanating from this morning's
I
am
witnesses.
Where
teenage
resultsfrom ignoranceof
pregnancy
ods,
familyplanningmeth-
for the new
the challenge
administration would be to help with better
channels of information for young
peopleas to where theycan seek helpin
needs.
meeting their reproductive
Where
resultsfrom lack of convenient familyplanningservices
pregnancy
and from lack of appropriatefamilyplanningtechnology,
then the challenge
is
and better institutions for familyplanningand to support the
research in order to give us a broader array of contraceptive
so
technology,
for a young girl.
that in that fullarray, there willbe somethingappropriate
to
create
more
Where
resultsfrom immaturityor a lack of responsibility,
pregnancy
find
is to
challenge
ways to support the efforts of families and social
and responsible
adults.
institutions to raise our Nation's children to be mature
teenage
the
Where
"
is to
tives
despairthat life offers no alternathen
no
job prospects, no income, no respect, no hope the challenge
for better education,job training,
provideopportunities
employmentand
teen
pregnancy
results from
"
advancement
for both young men
and women.
The Subcommittee
is very fortunate to have
here this morning
about it.
to
a
set of witnesses
distinguished
address the issue of adolescent pregnancy
and what
to
do
firstwitness is Dr. Jocelyn
Elders,Director of the Arkansas Department
of Health,and who has served Governor
Clinton in this capacityfor the
past five years.
She will then be followed by Governor David Walters of Oklahoma, who
has taken a strong interest in this subjectthroughthe Southern Governors
Our
Association's Center
Then
we
Because
day,it was
on
Adolescent Pregnancy Prevention.
willfollow with
this
hearingwas
a
panelof four
expert witnesses.
announced
not
or
planneduntil after election
round up Members
here. They are all
to come
very difficultto
back in their districtcelebrating,
I suppose,
and preparingfor the new
gressional
conand it may be because
here
the sole Member
session. Because
I am
I have retired and I am
the
be
for
that
not
re-election, may
running
"
why
reason
I
here and the Members
am
of the Committee
who
have been
back home preparingfor the new
because I am
session
are
chairing
I don't have to share time with other colleagues
this hearing,
for questioning,
elected
"
I may do some
questioningwhile you
while the questionsare fresh in my mind.
so
I do
want
at this moment
interject
to
are
allspeaking,
after each witness
or
my
deep appreciationand
enormous
admiration for the gendeman sitting
of the
at my
one
rightand at your right,
Bill
staff
Buechner.
Billhad a rightto feel that the demands
leading
experts,
his time after the election were
on
going to be a litde less than theyhad been
hectic session.
when
he and
I discussed
hearing,he was enthused,
fullof pep, vim and vigor,and he totally
agreedthat this hearingwas
and he threw himself into it with total concern
important,timelyand significant,
in
a
But
this
and dedication.
say what
pleasureit has been working with him over the
him a debt of gratitude.He has done some
past many
years.
for
his
did a cost-benefit study of the GI Bill of
He
great things
country.
eral
Rightsafter World War II which validated what an important payoffthe FedGovernment
for
and
with
men
women
providing
postsecondary
got
young
education
that it is hard
an
enormous
payoff.It is such a good investment
I
want
to
a
great
all owe
We
"
to
how
see
failto do it.
can
we
This is especially
relevant
do not have a skilled,
at a time when
we
tive,
competiviable work force that can compete successfully
in globalcommerce
with
the work forces in the developedworld. It is urgent for us to complete the
of producinga competitiveskilledwork force.
challenge
thirds of all of the jobs that are available in New
York City,rightnow,
e
ducation.
some
people
postsecondary
require
young
mission
and the
that has
Now,
been
in the past. We
had
Two
for
dent
presivery visionary
education. His name
who,
produced a report on postsecondary
At that time he recommended
that we ought to have two
was
Harry Truman.
of
education
assured,paid-for
beyond high school;in effect,that we
years
not
true
one
in 1948,
should
extend
education
our
system
from
K
through12
to
K
through 14.
kind of inflationfactor to that K through 14
Now, if you will add some
not
but a way of increasingthe demands
of societyfor skilled persons
inflation,
from 1948 to 1992
I think you could easily
had been
say, if Harry Truman
writingthat report today,he would say let'shave four years of postsecondary
"
"
education
It
was
as
an
entitlement.
Bill Buechner
who
gave
us
the
understandingof
sophisticated
what
enormous
payoffthere would be to our societyin moving in that direction.
Clinton Administration willgive deep thought to Bill
hope that tne new
Buechner's study and the enormous
for our country toward giving
potential
each young
entidement to go through 12 plusfour years of education,
an
person
from
Of
he
in
had
hand
starting
doing a costkindergarten. course,
a
benefit analysis
of the Head Start program, too. That, also,has a tremendous
from $7 to $12 back to the government
for every dollar that we
cost-benefit,
an
I
invest.
So what
our
two
he is suggestingand what I firmly
endorse is that we
restructure
education system so that it is K minus two to K plusfour. In other words,
plus 12 of elementaryand secondary
years of an enriched free-school program,
education
and four years
of
postsecondaryeducation,to give us the
skilled,
dynamic work
to
owe
I
our
to
want
All
man,
and
gratitude
tion
respect and affec-
my
He has been a trusted staff member
staff for years, and I want
to express
Committee
with the
on
hearingand
of the Arkansas
Director
as
we
Podoff.
introduce David
to
let'sget
right,
BillClinton
needs and which
urgently
BillBuechner.
the Joint Economic
on
appreciationto him.
my
country
this profounddebt of
express
for thiswonderful
I also
our
people.
young
want
force which
JoycelynElders who
Dr.
served
Department of Health for the lastfive
years.
Shaw, Arkansas, and has had a distinguished
reer
caof
Medical
from
the
Arkansas
University
graduating
of Arkansas
at the University
1960, she worked as an intern pediatrician
Dr. Elders is
native of
a
in medicine.
School in
Medical
Center.
of pediatrics
board certification
in 1976, receiving
professor
of growth in children
her
studies
in
pediatric
endocrinologist 1978. Based on
She became
as
After
a
and the
a
she has written 188
-related illnesses,
of hormone
treatment
for research
Dr. Elders has had
publication.
has been in the thick of
scholarly
background and
a
thingsin the lastfive years
cles
arti-
Director
as
of the Arkansas
Department of Public Health.
We
delightedto have
are
with
you
us.
Please take such time
as
may
you
require.
STATEMENT
JOYCELYN
OF
Dr. Elders.
Thank
you,
DEPARTMENT
DIRECTOR, ARKANSAS
ELDERS,
Chairman.
Mr.
It is
OF
real pleasurefor
a
HEALTH
me
to
be
here.
thank you for myselfand for allof the young
try
peoplein this counfor holdingwhat I consider a very important session to discuss the social
with which I have been fighting
of teenage pregnancy.
This is a subject
costs
I
want
to
long and hard
Clinton
since Governor
appointedme
as
the Director
of the
Department of Health.
Arkansas
the entire time
Clinton has stood beside me
might add that Governor
ence
around a conferof Jell-O,
from sitting
since I firstdumped him in an ocean
I
table where
Arkansas.
based
I said that
The way
school?
My
response
were
we
clinics. Then
I
was
was
were
we
going
to
reduce
in
teenage pregnancy
health education,school-
going to do that was by
at
asked, were
we
going to provide condoms
lunch
the
them
not
on
going to put
yes, but I was
plate.You can imagine that
of Jell-Oby my side.
ocean
since then Bill Clinton has had
to
swim
in that
/
speakingto
PerhapsGovernor Walters knows that. He has also testified,
the National Governors'
Conference, that he and I had been working on this
problem for
so
long that when
justto giveyou
We
are
know, the
of how
an
we
started his hair
was
black and I
was
an
bino,
al-
idea.
As you
this important investigation.
that you are holding
delighted
of
our
society,
problemof teenage pregnancy serves as a barometer
well we
are
doing and how much
we
are
investingin the future. We
know
this subject
is important. It is importantbecause
young
peopleare becomingparents before theybecome
too
many
adults.
of
our
bright
stated that
previously
You
There
than
more
million young
one
people each
year
500,000 births,400,000 abortions and
135,000 miscarriages
every year in this country. Each year in America, 1 in 10
w
ill
have
before the age of 20, and 6.7 out of 10 black girls
a pregnancy
girls
become
pregnant.
will have
over
Eighty-twopercent of these
before the age of 20.
pregnancy
a
are
are
unplanned.
We
teenage
other industrialized country in the world. In fact,our
industrialized country,
is twice as high as the next
every
rate
pregnancy
eighttimes higherthan
to
seven
behind
are
Representative
Dr. Elders.
Would
Scheuer.
No,
not
objectif I asked
you
a
you
question?
all.
at
Scheuer.
Representative
countries likeJapan.
I would
significant.
statistics that you
These
like you
to
explain
to
us
have
why
given us
are
there is such
tremely
ex-
credible
in-
an
divergencein the experienceof
Is it
various industrialized nations.
of sexual activity
varies that widely? Or is it because
societyperceivesits young people and the assistance the society
because the natural
of the way
givesthem
rate
coping with their sexuality?
in
Dr. Elders.
allthe data I reviewed and I know about, the sex activity
children
other
and
those
in
tries.
counour
people
young
From
different between
is no
In Sweden
they may
The difference is that
and
about
talking
rate
is far lower than
Yet, we
do
available for
be
active than our
people.
sexually
young
in
believe
beingopen
They
more
theyeducate their children.
it. Not
not
our
even
onlyis their pregnancy
rate
lower,but their abortion
ours.
teach
our
do
children,nor
children. I feel that
we
make
we
preventiveservices
moralize about the issue and try
to
brightyoung
peopleresponsibility.
Representative
Scheuer.
And givingthem the services theyneed.
Dr. Elders.
Making the services theyneed available where theyare.
Representative
Scheuer.
Okay. Please proceed.
morals rather than teaching
legislate
our
Dr. Elders.
Thank
you.
As you
percent of the
unplanned.Eighty-twopercent of all the
may
or
not
may
know,
82
children bom
children are
to our
children born in America, regardless,
are
Sixty-four
unplanned.
percent of
tenth gradersadmit to beingsexually
active.
Representative
Scheuer.
Those
children
are
how
our
old?
probably16, 1 would say.
women
are
active,and 86
sexually
Seventy-five percent of our 19 year-old
dren
chilSo our
of
admit
a
ctive.
19 year-old
to being sexually
our
men
percent
active as documented
by
are
sexually
by the pregnancies,as documented
transmitted
diseases.
sexually
transmitted disease
One
in six of our
every
teenagers will have a sexually
i
n
than
million.
is
three
AIDS
our
m
ost
more
rapidly
rising
teenagers.
year
Dr. Elders.
They
are
"
"
Representative
Dr.
Elders.
Scheuer.
In the heterosexual
In the heterosexual
community and obviouslyrisingmuch
in the black community in our
more
rapidly
to lose a whole
generationof young black
to
their ever-increasing
needs.
community?
poor
men
black males.
because
of
our
We
are
about
failure to
spond
re-
become
know that these children 30 percent of the women
pregnant
finishhighschool. Only 2 percent willgo on
before the age of 18
^will
never
to college.
Many of the children theyhave willbe members of what we now
that is children that are hungry. Every
call the 3-H Club. Representative,
nightin America, three and a half million children go to bed hungry.
We
"
"
homeless. We think of the homeless as the peoplethat
the alcoholicsand drug addicts. A third of those are
streets
see
on
or
we
The group in our society
children. We think that many of them are helpless.
health
have
is our children. Up
who
least
insurance
to
or
care
likely
now
are
children have no health care.
to 30 percent of school-aged
Many of them are
hugless.They have nothingto love them. Many of them end up hopeless,
with nowhere to go. I feel that because of our failureto respond,we have
Many of them
are
the
created thisproblem in
our
society.
Sixty-four
percent of the
been abused
14 who
at some
become
who
women
young
become
parents have
teen
time in theirlives.Eighty-four
percent of those lessthan
pregnant
are
abused often by somebody
sexually
in their own
home.
protect these children. Many say, well,what ifthe
who is pregis lying?Mr. Chairman, I do not feel a 14 year-old
14 year-old
nant
lie. She had to be abused by somebody.
can
do
We
not
have laws
to
children are far more
to be low-birth weight,
likely
of
lives
and requirerepeated
their
for
the
have multiplecomplications
rest
to have problemsin school
They are chidren who are twice as likely
care.
of them are far more
and many
and do poorly,
to end up themselves to
likely
know that 50 percent of the children born to
be teenage parents. In fact,
we
These
children born
to
children willthemselves be teenage parents.
in prisonbetween the ages of 17 and 35
Ninety percent of our young men
bom to teenagers who didn't know how to parent. It costs $30,000 to
were
in prisonis
build one
prisoncell,and the average cost of keepingsomeone
$35,600 dollars a
year.
often say we do
for the things
we
We
money
but
for these things,
have the money
put first.It is apparent we have not put
not
we
our
have the
children
first.
and Medicaid for
billionfor AFDC, WIC
families started by children. What we pay for with this $26 billionis for poverty,
billion
from
in
increased
1985
has
$16
ignoranceand enslavement. This
increase in the percentage of preghave seen
We
an
to $26 billionin 1991.
nancies
16 percent increase in the country, 18
in our very young
teenagers
and
WIC
percent increase in the South. In the South our outlayfor AFDC,
lion.
than 60 percent, from $3.2 billionto $5.7 bilMedicaid has increased more
In this country,
we
spend $26
"
has increased
up in poverty. Our poverty
in seven
in children from one
beingpoor in 1970 to one in five poor in 1990.
of
If theyare in Arkansas,it is one in four. If theyare minorities
regardless
Many of these children will grow
"
the minority itis one
"
in two.
This,to
me,
is a
major problem.
payers
started by teenagers in 1988 will cost taxthat familiesthat were
each
of
$16,450
justall children born to teenagers an average
with
Families
Aid
If
the
20
to
Dependent
on
next
theyare
one
over
years.
20
the
billion
next
than $37,500, or $5.9
over
Children,it will cost more
know
We
"
"
"
years.
"
make sure that we
we
can
duce
beginto address these problems and rethat we see happeningto our children?
the many things
I think we
need to look at the government
First of all,
outlayfor prevention
^Title
of teen pregnancy. We find that ifwe consider allthe programs
How
funds for familyplanninghas,in
10, Tide 20, and Title 5 and state funds
d
ecreased
than
third
the
fact,
a
more
over
past 10 to 12 years.
tion?
the effect of inflaRepresentative
Scheuer.
Does that take into account
do
spend less than
We
not
invest in
on
the
ing
spend-
care.
I feel that we
all,
of what we spend on prevention.
problemsfrom coming about. So,
of the things
that I feel we can do
2 percent
preventingtne
what must
do about it? What
we
difference?
make
to
a
First of
tion.
take into effect infla-
Scheuer.
records. That is a
adolescent pregnancy
on
Dr. Elders.
we
That is a very important figure
to have
real
two-third decrease in
dollars out of what we are
Representative
We
6673 percent, and
It has decreased
Dr. Elders.
are
some
have justsaid more
elegandy
childhood education for
invest in early
them to enter school readyto learn.
invest,as
must
than I can, in education. We have to
allof the children. We say that we want
you
know that only 18 percent of the children on
Head Start,whereas
Medicaid have any earlychildhood education,not even
tion.
childhood educa85 percent of middle- and upper-income children have early
Mr.
Chairman, I
Representative
that I am
when you
a
Head
want
you
Scheuer.
to
Justto illustratethat point,I
Start kid. You
want
you
know
to
ask how could you be a Head Start kid
when I firstcame
to Congressin 1965.
may
helpedwrite itin 1965
We
didn't call it kindergarten
or
preschoolprogram.
a
I am
but a rose of any other name
would smell as sweet.
kindergarten,
"
I had
an
pregesting
sug-
that middle-class familieshave enabled their children to benefit from
education regardless
of what they called it. So the
enriched pre-school
homes like yours and mine had educational benefits,
eduWhereas, the kids who were
theygot the experienceof good pre-school.
the
cationallv disadvantaged,
it
the kids who needed it the least,
most,
got
kids who
from
came
got it the least.
So, today,with allthe rhetoric we have heard about President Bush
education President,
lessthan 25 percent of the kids who
to be an
and the kids that urgently
needed
more
than 75
most
slot in a Head
pre-school
need
of
the
kids
who
urgently
percent
desperateeducation risk have
whereas
it the
a
ing
wantwere
a
Start program,
it don't get it.
That is not a fairor justsociety.That is a dumb society.That is a society
that cannot
best interest is. It infuriates
economic
figureout where its own
strations.
adminithat
that
after
should
be
the
12
me
reality
today
years of the lasttwo
ing
That is one of the reasons
exhilarated to be aliveand kickI am
so
in the
beginningof the Clinton
Dr. Elders.
The
I
could
certainly
not
era.
agree with you
more.
thingthat I feel we must do, we must invest in comprehensive
health education programs
in schools. I have been sayingfrom kindergarten
12th
but
the
to
grade,
peoplein prep school tellme. Dr. Elders,it has to be
from birth to 12 years.
other
8
have AIDS
and tobacco programs.
If we
had a
cigarette
programs,
h
ealth
and education program
in our school from kindergarten
comprehensive
would not need allthe specialty
to 12th grade,
It has to be age
we
programs.
and
build
and
make
it
of
educational
it a part
must
appropriate,
we
on
our
system ifwe want to make a difference.
We
Representative
I have often
Scheuer.
thoughtthat instead of havingan
tobacco
prevention drug preventionor
preventionprogram, what we
Make those kids feel good about
ought to have is a self-esteem program.
themselves and theywouldn't be destroying
their lifeprospects with drugs,
think of a better selfalcohol,tobacco,AIDS, or anythingelse. I cannot
in school and
esteem
projectthan the kind of educational enrichment starting
their
a
nd
kinds of prothe
traveling
throughout
elementary
secondaryyears,
gram
that you are discussing.
AIDS
or
Dr. Elders.
I would certainly
agree with you. I also feel that we have to
educate their parents. I also tellpeoplethat we hire electriciansto screw
in
bulbs,we get licensed plumbersto unstop our commodes, and we do
light
that
nothingto helpthe peoplewho take care of the most importantresource
children.
have,our
we
Start program, as itis presendy
constituted,
in its updated 1992 form,does spenda lot of time bringing
the parents
Representative
The Head
Scheuer.
into the education process and teaching
them how to be competent,
supportiveparents in the whole spectrum of needs that the young
have.
That is only an
additional reason
why
deeplyinvolving
parents should be made
some
ing,
nurtur-
people
kind of Head Start program
available to each kid who
needs it.
Dr. Elders.
pregnancy
I could
not
We
have been
about
talking
know
we
these programs.
The other thing,
have
we
We have allowed many
start
to
of
our
teaching
our
and that is beinga father. We
sperm
In Arkansas
more.
with Head Start,
theyare 50 percent less
teenage pregnancy. I think we allknow the realvalue of
but
prevention,
of becominga
likely
agree with you
young
have
males
feel that
young
males to
to teach them
to
be
be responsible.
theydonated a
to
responsible.
but we are going to deduct 7
legislation,
from the top of the young man's. We put their social
percent of their salary
n
umber
the
birth certificate
when the child is born so that we can
on
security
it took 12
piecesof
address that issue.
school-based
have been involved in is comprehensive
fifthof our population
is in school every day. We can
$100
provide
primaryhealth services for children in school for approximately
health
of
child.
Of
health
the
know
insurance
care.
cost
or
course,
per
you
We feelthat thishas made a very bigdifference,
for our children in
especially
Another thingwe
health services. One
poor
areas.
of our very small schools for which we received a federalfund,7
allpoor.
free lunch,so you know theywere
on
percent of the children were
The pregnancy rate was 59 percent. In three years we had no pregnancies,
no
of thisschool-based clinicprogram in our
abortions and no dropoutscjecause
In
one
program.
The other
thingthat I feel we
services
available where
must
the
beginto do, we
children
are.
must
We
make
must
tive
contracep-
improve
contraceptives,
as
child abuse where
abused.
and we must
you said previously,
8 to 10 to 12 percent of our
deal with the
young
problem of
peoplehave
been
offer our brightyoung
peoplehope for the future. The
where children who had a B or
passeda pieceof legislation
above average and were
citizens
had
their
tuition and books paid at a
good
school. It is far cheaperto pay for college
than itis to pay for
state-supported
must
we
Lastly,
hope is there. We
prisons.
For the past five years, I feel I have been
As we
alwayssay in Arkansas,when you are
there dancingwith the bear.
dancingwith the bear,you can't
sit down; you have to wait untilthe bear gets tired. I want
you to know that I
for
stand
have been lookingfor some
I am
in
new
me.
gladyou
partners to
because
havingthis opportunity,
are
it
out
to get
givesus the opportunity
new
partners.
I
pleasedBillClinton willbe the President,because I know that he understands
need to
the problem I am
about and understands what we
talking
am
do for our
viable resource,
most
children.
our
I would
like to close with an old Greek sayingwhich says, children for the
valuable resource
most
have, and when we find that
we
part are the most
there are old men
under whose shade theyknow theywill never
trees
planting
then
our
sit,
societygrows great. Today,I feel that in this conference and in
valuable resource
this Subcommittee, we
for the most
we
trees
are
planting
will ever
have
sit under. Thank
to
[The preparedstatement
the Record:]
Representative
Dr.
Scheuer.
testimony.We
are
you.
of Dr. Elders
very
starts
Elders,thank
p. 41 of Submissions
on
for
spiring
for your brilliantand in-
you
to you.
grateful
few questions.
During your five years as Director of the Arkansas
of
how
Health,
were
Department
your ideas of preventingteenage pregnancy
been affected by the Federal Government?
I have
a
Dr. Elders.
We
feel the Federal Government
has very
frequently
gotten
in the way.
I didn't know
When
I became health director,
I
allthe rules and policies.
said I was
old to learn them. So I told my departmentto make the rules
too
fitwhat I do. So, in many
respects, we bent a lot of rules to the absolute
breakingpointin order
valuable
of
One
go
up
to
to
do
of the
some
thingswe
needed
to
do for our
most
resource.
our
185
relates to Medicaid, Mr.
rulings
percent of poverty
to
Chairman.
pay for pregnant
that. But in my
women
In
our
we
society,
and children. I
not
onlygo to 29
opposedto
state, we
support that. I am
of your
of
members
for
of
told
the
I
one
familyplanning.
percent
poverty
committee
that the Medicaid rules could onlyhave been designed
by a white
male slave owner
who said that we
have
want
to
bigger,better,healthier
slaves rather than planned,
wanted children. We don't need any more
slaves
now.
I think it is for Medicaid
help.Even ifthev want
support reproductive
convinced by legislathat would help. I think I was
to write in no
abortions,
tion
in Arkansas to pass a law for fundingfor allwomen
it.
10 to 25 who want
makes
It
itwould save us billionsof dollars.
Economically,
good sense.
to
10
Representative
Scheuer.
I am
absolutely
to hear you say that.
delighted
thiswill
through
employed,I thought,
providea breakwow,
for women
in thiscountry to control theirown
I thoughtthe
fertility.
cities and states would be clamoring
to get Norplantpassed,
absolute,
an
assured
it has not happened.
to young
availability
people,but, unfortunately,
Why hasn't it happened?Is itcost?
Dr. Elders. It is cost. It costs approximately
shot. Insurances,
$500 at a single
of them are now
some
to pay.
beginning
In Arkansas,we
onlygo to 29 percent of poverty, so we didn't have the
As
soon
as
Norplantwas
Many of
money.
our
legislators
are
wanting to signon
so
that
we
can
get
for Norplant.We have over
3,000 young women
on
the waitinglist,
and you know how longtheywillstay on the waitinglist.We
willneed to send them to prenatal
time.
next
care
enough money
to
Representative
pay
Scheuer.
You
are
There ought to be
absolutely
right.
a
federal policy
addressing
Norplant.
Dr. Elders.
I certainly
think so. When I talked with Mr. Waxman, and I
also talked with Mr. Kennedy,theysaid that the governors didn'twant
it. We
about changingit from pregnancy to reproductive
health. They
were
talking
said the governors did not want it changed,but I feltwe, perhaps,
did not sell
the governors enough.
Scheuer.
Clinton's ear and
I hope you will get Governor
tion.
him the importanceof Norplant.It amounts
to reversiblesterilizaA woman
sterilized
and
her
become
can
ient.
convenat will,
at
own
timing
Representative
to
explain
Dr. Elders.
Absolutely.
Scheuer.
that is an absolute Godsend, and
It seems
to me
if
fool
available.
I would indeed say that
don't
make
it
a
we
around the world there are areas where that is justas appropriate
ica.
as in AmerRepresentative
our
societyis
In sub-Saharan
of the world where people's
duction
progoes up about VA percent a year. Food production
goes up about
1 Vi percent a year. It doesn't take a nuclear scientistto notice that there is a 2
of food the firstyear or thereafter.
percent drop in availability
Africa,you have
an
area
be as importantin the firstfew years, but by the fifteenthyear
You
around you have a 20 percent reduction in food availability.
that comes
with
heart
Somalia
which
o
f
TV
terrible
it on
tear your
see
can
now
pictures
It is the interlockableproblemcreated by an imbalance between more
out.
peopleand not enough food.
It may
I know
not
from my
planningprograms
a little
center,
hours. If you
to
women
come
Such
infinity.
experiencein over
when theyopen
in Africa,
own
20
years
up
a
of
family
scrutinizing
familyplanning
program
in
walk throughthe hot sun for hours and hours and
there around noon, the linestretchesout to the horizon,
fertility.
is theirdesire to control theirown
Somehow
the donor nations of the world,the OECD
or other,
tion
Organizaof Economic
Opportunityand Development which relatesto the wellto-do developedcountries and is located in Paris,theyhave done a shameful
wodd to provide
of the developed
the resources
familyplanning
jobin mobilizing
I think
facilities
of sub-Saharan Africa,
for the young women
especially.
could provide
the figure
is that for $6 billion or $7 billion a year, we
"
"
12
HATEMENT
Governor
OF
THE
HONORABLE
Walters.
and my
life.
Thank
DAVID
OF
OKLAHOMA
honor to participate
in thishearing,
chapterin your
you go forward in a new
It is an
you.
to you
congratulations
WALTERS, GOVERNOR
as
in our neighboring
to follow Dr. Elders. Her leadership
state has
decade. Each time I hear her I come
I
know you
as
away inspired,
It is great
spanneda
are.
David Walters,Governor of Oklahoma.
I am
day
pleasedto be here tothe lead governor to the Southern Regional
Infant
Projecton
Mortality,
which recendyauthored a report on the publicexpenditures
and investments
associated with adolescent childbearing.
The author of that report, John
is behind me.
He did a very fine job.
Schultz,
I
am
as
Scheuer. I would ask unanimous
consent
at this pointto
Record. There
put the report that you justmentioned into the Congressional
itis so ordered.
being
no
objection,
Representative
for the record
[Materialsupplied
starts
on
cord:]
p. 48 of Submissions for the Re-
The rate of babies bom to teenage mothers is raising
the publiccosts for
in the South and in the nation. Not surprisingly,
steadily
familiesstarted
these
adolescents
the
rise as well.
are
on
by
supporting
Governor
Walters.
states
spent over $5.7 billionto support familiesbegun
Included
the three largest
in that figure
are
by adolescents.
public
programs
for families in need: $2 billionfor Medicaid, $1.5 billionfor food stamps,
$2.2 billionfor Aid to Families with Dependent Children. Even in Washington,
thissounds likeand is a lotof money.
In 1981, Southern
have not begun
of remedial education,
and the day care
jobtraining
lescents,
needs of the adolescent mom.
With the recent increase in babies born to adoand
the federally-mandated
Medicaid expenses for pregnant women
the
of
families
a
nd
the
number
infants,
publicassistance,
requiring
growing
In four years, our
is skyrocketing.
gion's
repricetag for adolescent childbearing
from
billion
billion.
60
to
$5.7
$3.5
expenditures
jumped
percent,
doubled.
Some
Southern states'expenditures
actually
By
my
to
is conservative. We
estimation,the $5.7 billionfigure
estimate the
cost
totaled $219 million,
outlays
up 62 percent from $135
for drugsfor
million in 1987. Imagineifwe had these funds for prenatal
care
for parents and teachers programs, for expandingHead Start,
AIDS patients,
In
Oklahoma,
for programs
1991
for our
increasing
elderly
population.
The burden of too-early
is not justa personal
one.
parenthood
With an
less
education
work-force
and
skills,
are
teen
moms
incomplete
inadequate
than their nonparentingpeers, and consequently,
to be self-sufficient
likely
financialand medical assistance. The costs exto
more
tend
on
likely rely public
well beyond the young family
and into our public
pocketbook.
I do
or
not
to suggest that these public
mean
programs are inappropriate
nerable
vulshould be abolished. It is not in our best interests to abandon our most
I do believe,
however,that we need to take a good hard
populations.
look at our spending
priorities.
of preventionis worth a
Chairman, the familiar adage,"an ounce
dence
of
You have heard evirelevant
thisdiscussion.
is
to
pound
cure," particularly
have
that we are payingfor the pound of cure, but we
onlybegun to
Mr.
13
make wise investments in the ounce
of prevention.In the same
year that the
South expended$5.7 billionto support the consequences
of adolescent pregnancy,
lion.
investments
amounted to $110 milto prevent too-early
childbearing
ask
questionhere. You governors are
oriented. How
bottom-line
come
pretty
have
and
didn't
that
t
his
pickup on this, thought
just
governors
mayors
you
cost-benefitcalculussupporting
the enormous
evidence,
expressed,
preventive
in the field,
absent any federal leadership
for 12
and we have had none
even
Scheuer.
Representative
Let
pretty pragmaticpeople.You
me
a
are
years?
us
didn't say that it is going to pay
Why do you think governors, themselves,
there is going to be an enormous
royally,
payofffor providing
prevention
services.
Governor
Walters.
would say, in
Chairman, it is
Mr.
not
an
uncommon
problem,I
in the Federal
municipal
only
governments, but even
We
still
Government, for us not to focus clearly
on
good investments.
within our correction
to find the money
to rehabilitate
struggle
trying
prisoners
to find
struggle
systemwhen we know that it pays great dividends. We still
Start or to fund prenatal
the money
to fund Head
care, and so it is not just
isolatedto teenage pregnancy. But I think Mr. Schultz'work, in terms of developing
this report, helpingus as governors,
and hopefully
congressional
leaders and others,
focus very clearly
the fact that we spend two cents on
on
the dollarwhen itcomes
for the cost of these programs.
to prevention
not
state
and
and the other prohave torn into Medicaid,AFDC
grams
have now
can
as carefully
as we
so that we
bringgreater focus to that.
vestment
My hope is,with the new Administration and their interest in havingan inof
attitude
that
the
willbe
the
that
budget,
infecting rest
countr)''s
towards budgeting,
that we willallpay more
attention to wise investments in
the future.
I
not
am
sure
that we
The $110 million,
is virtually
as I said,
pocketchangecompared to the 5.7
and
I
billion, as justsaid,itrepresents two cents on the doUar of our expenditure
for prevention,
comparedto the cost of familiesstartedby adolescents.
outlays.
businessman,I believe in true investments that reduce long-term
schoolAnd for my money,
that would mean
that
aged
help
programs
children delayparentinguntiltheyhave completed
highschool,untiltheyare
of raising
until theyare emotionally
and financially
self-sufficient,
a
capable
of
adolescent
did
not
ten
family.Eightout
as
moms
planeariyparenthood,
Dr. Elders said.
As
a
face
onlyundesirableto the
affects
the
but
it
general
public, to
as well. I would sugyoung people directly
gest
that we have a mandate to prevent our youthfrom facing
the life-altering
and course
of unintended pregnancy.
costs
We
The
a
socialproblemthat is not
serious,
costly
"What recommendations do I have for investment
of
that could reduce the incidence
teen
pregnancy?"I am gladto
offer my own
which is groundedin research and a little
common
philosophy
and
with
few
hours
health
advisors
who
best
their
do
sense
to educate.
a
There is no singular
solution,
theycontend.
To
was
question
posedto
me,
be successful,
interventions must
be multifaceted responses to a
our
of causes
cents.
adolesand reasons
occur
why pregnancies
among
To combat ignorance,counter
and dispel
misinformation,
myths.
large number
14
communities
should provide
information about human sexuality
accurate
and
health.
reproductive
I strongly
believe that parents have the primaryresponsibility
for shaping
values and attitudesabout sexuality.
in
But theyclearly
need
of help.
are
Classroom-based health and sexuality
education programs do increase knowledge.
In Oklahoma, we
will soon
health education
implementa comprehensive
with defined learner outcomes
with segments on family
lifeand
curriculum,
health and other topics
such as AIDS prevention.
skillsto manage
their sexuality
By building
interpersonal
we
responsibly,
our
peopleto resist peer pressure, to rnake smart, healthful
empower
young
decisions. The most powerful
evidence of effectiveprograms
have comes
we
from classroom-based curriculathat pulls
students from behind theirdesk and
skills
needed to avoid sexto rehearse and practice
ual
givesthem the opportunity
pressures.
Provide health care
and family
for sexually-active
resources
teens.
planning
for public
health nurses
to discover throughin-takethat
adolescents are sexually
and not planning
active,not usingbirth control,
a
health care needs
Too often adolescents'medical and preventive
pregnancy.
It is not
are
uncommon
neglected.
clinic
Oklahoma, we are making them a priority
special
by establishing
and
who
willwork
well
with
hours,employingprofessionals
teens,
promoting
In
services to make
theyknow what is available.
ture
link students to the fuand thisis our greatest challenge,
must
we
Finally,
and givethem the sense
that theyhave other optionsbesides early
enthood.
parsure
motivated enoughto avoid
the potential
of unprotected
sexual activity.
Students who have
consequences
often fall
lost interest in school and have low expectations
for success
most
and
parenthood
trap. We need to raise their expectations
prey to the early
So many
of
our
young
parents
are
not
regaintheirinterestin learning.
We don't ask,Mr. Chairman,for more
deficit
dollars.I don't want a bigger
n
ationaldebt.
ask
for
We
I am proudto say that
or a bigger
new
priorities.
Southern States have taken great stridesto make adolescent
our
or
many
Their effortsserve as good examplesfor the
a priority.
pregnancy prevention
country.
and Tennessee,for example,employ adolescent pregnancy
Virginia
efforts.
statewide to assistcommunities in theirprevention
specialists
I mentioned Oklahoma's attempt to bringadolescents into the public
health doors. Georgiahas committed a fairportionof its maternal and child
health block grants to school-based services in hopes of advancingtheir
school'shealth status. Florida'scomprehensive
and well-funded school health
that state are givenfunding
national
communities
model;
across
program is a
West
to ensure
a
basiclevelof services
to
allstudents.
have
We in Oklahoma, as well as Georgia,Kentuckyand North Carolina,
in
establishedstate grant programs that provide
communities greaterflexibility
funds for innovative projects.
to localneeds by providing
responding
man,
cannot
we
Despiteallthese efforts,
attempt to match the need. Mr. ChairYour
need the helpof Congress to make this a national priority.
we
those
federal
in
i
nitiative
leadership creating
a
family
planning
years ago
many
has generated
unintended pregnancy, not just
health response to fight
a public
15
teens, but among
among
But
when
are
we
as
you
allwomen.
It is one
of
our
know, those TitleX funds continue
and
to achieve more
required
sources.
greatestpreventionreto buy us lessand less
more.
and the myriadof socio-healthproblems
the limited resources
facing
ity,
infantmortalcommunities, including
substance abuse,low-birthweight,
our
and HIV infection,
health community is forced to make hard
the public
choices about spending
health dollar
We
priorities. have stretched our public
./^d
far
adolescents are paying the conseas
as
possible,
unfortunately,
quences.
Tliere simplyare no federalresources
tion
to address the health informaand service needs of our childrenin adolescents.
Given
Administration and new
Congress will make
national
tion,
informathem
with
accurate
Empowering
priority.
young peoplea
accessiblehealth resources, and a sense
of their future is our greatest
for
number
of
the
to
hope
curbing
pregnancies our Nation's adolescents. It is
for
the
number of familiesstartedby young people
reducing
our
greatesthope
and it is our greatesthope for reducing
the exornot even
out of highschool,
bitant
those families.
cost associatedwith supporting
I
hopefulthat this new
am
Thank you for thisopportunity,
Mr. Chairman.
with
of The Honorable Mr. Walters,together
[The prepared
statement
starts on p. A3 of Submissions for the Record:]
tachment,
at-
Thank you for your very thoughtful
statement.
Governor
Walters.
You are the onlyelected officialon the panelthis
morning. So letme ask you a political
question.Americans tend to be very
conservative about teenage sexuality.
And frequently
theyare hostileto the
notion that teenagers are sexually
active or ought to be sexually
active,and
mation.
be
need
because theyare likely
to
active,
they
familyplanninginforsexually
Representative
How
Scheuer.
do you deal with
information and
planning
Governor
Walters.
voters
who
are
hostileto the concept of giving
family
services to
teenagers?
It is a political
risk. It is an element
Very carefully.
even
of great sensitivity
of our constituents. It is somethingthat you
among
many
tion.
simplyhave to break down the traditionalbarriersby providing
good informaDr. Elders
lotsof good information this morning. The statistics
provided
undeniable. The surveys are undeniable. The transmission of sexual diseases
is undeniable. Our pregnancy rates are undeniable. And so I think
when you counter
that
the emotion of the arguments with the simplefacts,
what we are doingapparendy
doesn't work,whether itis in the home or in the
school or in our health clinics,
that what we have done in the past needs to
gins
the
that I have dealt with" beat
change,generally public" leastthe public
the need for change.
And that,
of course, is where we start.
to appreciate
are
the need for a changebefore we can implement
to have them appreciate
incumbent
this
So
have
itis
to
really
on
us
just
any program.
type of
Southern
Infant
have
the
to
Mortality
hearing,
producedby
publications
We
have
Group, to hold
press conferences.
John came to Oklahoma, and we connected up to radio stationsallacross
the Nation and did interviews and triedto make it publicly
available
to plow
the same
for many, many years
groundthat Dr. Elders has been plowing
now
in Arkansas and doing it very, very effectively.
she needs
But she is right,
some
more
partners to dance with the bear.
16
Representative
Scheuer.
You
can't afford to sit down. You
had
a
problem
Oklahoma, and apparendyyou have surmounted the problem. Have you
in ways that have
had to changethe programs in order to gainvoter approval
preparedtheir effectiveness? What kind of compromise have you had to
in
make
to
get your
voter
mandate?
Well,I would say that we have had to do a number
i
n
tical
of differentthings order to attack the problem.And it may justbe a statisGovernor
Walters.
but we were
the onlystate in the Southern States to actually
aberration,
have a decrease in the teenage birth rates duringthe periodof time that John
studied. And we have gotten there by doinga number of differentthings.
of our counties that we espehave adolescent health clinicsin many
cially
fund. We have matchinggrants for many of our programs, as we mentioned,
unless
there
is
fund
won't
which has really
the
We
helped.
community
have found very innovative programs
strong community involvement. We
that
that have proven to be successful. We established a training
program
in
whether
we
self-esteem,
concentrates
on
bring parents or
so
principally
and train
teachers or Boy Scout leaders,
or whoever,we
bringthem together
have
had
and
that
to
some
seems
them,
impact.
We
trained over
have now
5,000 individuals who have branched out
if
have made political
would
I
around the state.
compromises because
we
say,
of the sensitivitiesinvolved,
itis that we have not been as strong as Dr. Elders
has been, as Arkansas has been in gettingschool-based clinicsestablished in
schools.
our
We
that you put the programs where the children
lotsof sense
and we have not been able to climb that
are, which would be in the schools,
wall yet and have,instead,
begun to developadolescent health clinicsin our
and making it widelyknown that those services are
county health facilities
available.
It does make
Representative
Scheuer. Are theyconveniendy
enough availableso that
almost any young person in the state willfind one?
Governor
Walters.
Not yet,to be honest with you. In our state, we have
ning,
15 out of 77 counties,so clearly
theyare not widelyavailable.We are beginI believe,
to establisha foothold
throughthe school health curriculum,
kind of the culturalacceptance of health
within the schools to provideboth
and treating
the health needs of children in schools.
education
"
"
So our comprehensive
health education program, which was
passedas part
I think willbeginto helpus provide
of a major education reform in our States,
that information that is so importantin gettingacceptance for the need for
change.
Scheuer.
Governor, you know and I know that the science
with his conof communication
of
stituents,
telecommunications,
by a politician
art
and Governor Clinton is an example. He
has been revolutionized,
of approaches
had a whole smorgasbord
to communicatingwith peopleat the
in the
Bush or other politicians
President
far more
than did
grassroots level,
into neighborhoods
meetings,his travelsby bus,his foray
years gone by: The town
of
incredible
o
f
in Washington,
connectingwith peoan
variety means
ple.
Representative
and
ness
and inventivethat we have matched this creativity
to me
seem
and try
effortsto communicate
with young women,
couples,
young
for
them
it
is
of how important
to
to them some
understanding
It doesn't
in
our
and pass
on
17
defer pregnancy to a pointin theirliveswhere it makes
that you have givenus.
sense,
the very criteria
of communicating
means
new
prospects do you see? Of these breathtaking
what
their
and
between politicians,
constituents,
possibility
politically
between
be applied
is there that these can
to improvingthe communication
that you articulated?
and these young peopleand givingthem the message
our
society
What
have
we
Rhonda
Walters,has
seen
justa glimmerof great hope in our state. My wife,
called HealthyFutures in our state, which is a revitalizedgroup
led a group
that was involved in the Robert Woods JohnsonFoundation Grant a few years
I think it has tremendous
Walters.
Governor
and
potential,
ago.
This group decided that theywere
going to attack the problem of a tooof the health issues surrounding
highpercentage of our children not beinginoculated,
And so what theydid,under my wife's
maternal and infant care.
tions
dollars. Then theywent
to the televisionstawas
to raise private
leadership,
of time,so iftheybought
and asked them to contribute a certain amount
not
at 2
ad, theyasked for three or four,in some
cases, fiveads for free,
one
in the
a.m.
morning,but duringprime time.
interestedin thisand began to become very active,and
The stations were
of allthe stations in our State. Then
have 100 percent participation
we
now
contributed and the hard private
soft
we
proceededto take both that
money
that with
to match
dollars contributed and ask the Federal Government
Medicaid dollars to help us advertise "two by two, take care of your baby
now"
"
aU kinds of jingles.
little
rock band paritywith litdekids that were
singingabout
heahhy programs. It has had a remarkable impact. We have had a 30 to 40
percent increase in the inoculationsto our state.
We
had
Young
a
women
pregnancy.
and into
"
we
Young
during
smokingand drinking
health
ments
departit is reported
coming into our
have advertised to prevent
women,
report a remarkably
the expenditure
small
without
because we spent in a
state,
changedattitude,
about a milliondollars
of additionaldollarson our part,justby beingcreative,
sues.
worked
the
It
in
works.
It
campaigns;it works on these ison
advertising.
The
our
and teachers and others now
schools,
thingthat we do not do enoughof on adolescent pregnancy prevention
hope in time that we are able to expandour program. But if
and I
is justthat,
HCFA,
or
ifthose that manage
Representative
Scheuer.
Medicaid
You
better spell
out HCFA.
If those that manFinance Authority.
aged
Governor Walters.
would also recogthose programs, which are so essentialto our health,
nize
and would
in advertising
and prevention,
the importance of investing
providethat match. If we are able to raise the funds or get contributed funds,
then we could advertiseon thisas well. Imagine ifyou had peer to peer, put a
sexual activity
of engagingin early
about the difficulties
teenager on TV, talking
of a changein theirlifecourse, I think itwould
and what it means
in terms
TV are going to do
think adults talking
have enormous
I
don't
on
impact.
Health Care
much, but
peer
do that ifwe can
it anyway, but we
to
peer
have
has
I think,
advertising,
some
won't do
encouragement
a
and
of it.
as much
nearly
And
potential.
match
some
perhaps
lotof
we
can
willdo
18
Representative
Scheuer.
with the targetgroup
Governor
we
about
How
one-on-one
peer group
involvement
about?
talking
are
It is very effective.We have funded some
grant programs
from some
communities
thathave that kind of peer-to-peer
And it is effective.It is hard to explodeit to where you are dealing
counseling.
with the great numbers of peoplethat you need to touch,and that is the
of telecommunications and advertising.
advantage
in
our
Walters.
state
it really
is goingto take a wide varithink,as I said in my testimony,
ety
of solutions. We oughtto have a table that has 20 columns in it and determine
which states do which things.There ought to be 20 different
programs that allof us can model and look to.
But I
Representative
Governor
Take from column A and column B?
Scheuer.
which ones
the most
Right.So, in determining
are
o
f
infantmortalsouthern
ity,
a
advantage having
group on
learn
from
other
mistakes.
states'
If
can
we
now
theyspintheirwheels or
spend their money doingsomethingthat doesn't work, well,we know that
and we can try to copy those things
that are most successful.
now
Walters.
which
effective,
is the
Scheuer. Assuming that President-electClinton comes
out
of
kind
w
hat
would
some
education,
postsecondary
program encouraging
kind of requirementfor those kids who benefit from govyou think of some
ernment
aid going to college?Some kind of requirementfor them to relate
basiswith teenagers
males as well as females in a one-toa one-to-one
on
one
to them the importanceof delaying
to
relationship
explaining
childbearing
where it is appropriate
and makes sense, and willena pointin theircareers
hance
theirhappiness
and lifeprospects?
Representative
with
"
"
I think the educational
the
President-electhas made is very exciting.
The idea that we offerthat kind of
educational prospects to our entire population
that investment,
and recognize
and equally
tary
is the opportunity
to pay for that or pay it back by volunexciting
services,
making availablewhat you justdescribed as an optionin that.
Governor
Walters.
would
trust
that
proposal
unteers
mandate each and every student that volthere
or
theyare working
with community law enforcement or security
or health care, it would certainly
be an attractiveoptionto make available.
I
am
not
to
sure
you
want
to
pay it back in that range, but whether
Representative
Scheuer.
We
your fine testimony.
Governor Walters.
Well, Governor,
very much
I can't thank you
enoughfor
it.
appreciate
to you
Congratulations
as
you
enter
your
next
ter.
chap-
will go ahead
we
would allwant to come
to the
eration;
FedPlanned
Parenthood
President
witness table.JaneJohnson,
of
the
Vice
Dr. Martha Burt, Senior Fellow of The Urban Institute;
JeannieRoand the Reverend Michel
soff.President of the Alan Guttmacher Institute;
Faulkner,Minister for Youth and Director of Community Outreach of the
Church in New York City.
CalvaryBaptist
Representative
with
our
Scheuer.
Thank
you. All
right.Now,
panelof four witnesses. Perhaps,
you
I want
allof you to thishearing.
to
to welcome
26
word
Rosoff.
in
13
about
been
I
have
special
Congress years,
Jeannie
say
of my congressional
service,
terms, and at the very beginning
JeannieRosoff
in the whole
but deeplyexperienced
in Washington,
was
woman
a very young
under her
of reproductive
She
took
a
nd
the
like.
matter
me
rights,
family
It is a great pleasure
for me
a
20
I
am
pleasedthat you
particularly
President had. Your
very much missed on
presence
as
a
did not have the conversion that our
advocate on family
planningwillbe
true
Hill.
Capitol
For 75 years, Planned Parenthood has been concerned with the socialand
health repercussions
of early
and unintended pregnancy. In 1989, we rededicated our commitment
tive
initiato reducing
teen
a new
pregnancy by launching
have called: First ThingsFirst. The goalof First ThingsFirst,and
we
that we believe is very much improvedby the electionof President-elect
one
Clinton,is an ambitious one, which is to reduce by half,
by the year 2000, the
number of adolescents who become pregnant and givebirthannually.
It borders
scandal in the United States that a million teenage girls
come
beundermine the
profoundly
pregnant, 500,000 givebirth.Littlecan more
of the society
than the premature, unprepared
formation of families
well-being
theiradolescence.
to get through
by youngsters who are often struggling
on
Think about it. Five hundred thousand young teen mothers a year, five
million in ten years. Let's put that number in perspective.
There are approximately
half a million persons in Seatde,Washington;
El Paso, Texas; Denver,
Colorado;Cleveland,Ohio; New Orleans,Louisiana. Imagine for a moment
that duringa one-year period,
half of these cities'productivity
slashed.
was
Half of theirbus drivers,
teachers,
doctors,
cleaners,
restaurants,
dry
taxies,
nurses,
halt.
to a
or came
stoppedfunctioning
and coming to a halt is what happensto half,
50 percent,
Stopfunctioning
of the adolescent girls
when theybecome pregnant and deliver a child. Half
of them stop functioning
in theiroccupations,
theystop goingto school. But
unlike the cities,
these youngsters are without skills,
and bizarrely
dependent,
difficult
the most
to resume
to perform
expected
occupationon the planet,
with success
parenting.
and disintegration
in these
Not onlyis there a highdegreeof dysfunction
there is the corollary
loss of two, and often more, productive
young families,
citizens. It is estimated that
$20
nearly
billionis spent
to
annually
support
familiesbegun by adolescents.
often devastatingperof too-early
costs
childbearing
are
personal
petuating
school
and
of
and
abandonment
the
tive
produchopelessness,
poverty,
work. And the cost to society
The vast resources
is far-reaching.
spent by
The
"
childtoo-early
government for the most
part are not directed to preventing
but
in
its
to
bearing,
attempting repair consequences.
The
signed
ThingsFirst that we hope the government will emulate is des
exual
because
adolescents
of
avoid the pitfallseariy
involvement,
to help
sexual involvement interrupts
and even
ends personal
developmentin
First
adolescents.
First ThingsFirst offersguidance
and materialsto
community
participating
role
include: Recognizingthe family's as priOur strategies
mary
organizations.
educators by providing
assistance to parents and caretakers in
sexuality
effectiveprograms
communicatingwith children about sexuality.
Highlighting
that involve,
educate and provide
services to adolescent men,
sexual decisionmaking
has been often neglected.
whose
role in
sign
of First ThingsFirst is itsreUance on adolescents to helpdeA centerpiece
tended
uninand implementthe programs and effortsthat can prevent the early,
Mr.
that
and
them.
chSdbearing
Ironically,
plagues
pregnancy
much
for
while
ask
find
that
does
it
not
too
Chairman,
some
apparendy
21
adolescents to performadequately
as
helpingto resolve their own dilemmas
parents, theirdemonstrated
for
potential
is effectively
ignored.
callon
the government
and the privatesector to follow our example to
that
all
assure
designedto stem the tide of adolescent pregnancy
programs
and childbearing
include an adolescent perspective.Professional expertise
is
but without the unique perspectiveof adolescents themselves,it is
critical,
doubtful that any program
succeed. Not onlyis their understanding
fresh
can
and unique, but the acknowledgment of their fundamental resourcefulness
achieves the empowerment
of them have been denied.
so
many
We
collectivehands as we
that teenagers are
note
intercourse at earlier ages, and one-third of them use
form of
initiating
no
birth control at allduringfirstintercourse. I am persuadedby the adolescents
who advise us that,with support, expectation,
and information,
adolescents
professionals
wring our
We
their own
capablenot onlyof altering
havior
behavior,but also impactingthe beof their peers and that of their younger siblings.
also promote
We
the involvement of caringadults to supplementthe nurture
and guidanceusually
available for mature
families. Unless the government
mandate parental
affects,
can
guidanceand wisdom, it is destructive of
the goal to reduce adolescent pregnancy
and childbearing
to mandate
tal
pareninvolvement in adolescent reproductive
decisionmaking.
are
of First ThingsFirst is to the recognition
that to reduce
key component
adolescent childbearing,
intervention must
beginin earlychildhood. Unless
children are nurtured and affirmed in their early
years, the chances are greatly
A
reduced that laterinterventions willbe of much
use.
Traditional programs
for involving
and servingadolescents must
be expanded,
and innovative programs begun. First ThingsFirst willdo this,
but it
also will work with communities
small children love,security,
and
to assure
proper
care.
line of allof this is that Americans must
face the reality
of adolescent
sexual activity.
of
unmarried
and
60
women
Fiftypercent
married
percent of unmen
aged 15 to 19 have had sexual intercourse.
Bottom
These
are
teen
the hard truths. For over
dressing
a decade, our
onlynational effort adhas
focused
abstinence.
I
on
solely promoting
urge
pregnancy
Congressto expand the Adolescent FamilyLife program
The
approach.
task facing
us,
importance to
Mr.
a
more
hensive
compre-
Chairman, is a tough one, but it is of fundamental
the welfare of
merits the energy and
into
resources
children and the future of
itwillrequire.
our
Nation.
It
first
child to accomplish
a
nd
emotional
turity,
maby securingan education,ootainingphysical
and developing
lifegoalsbefore assuming the responsibility
of parenthood.
Each year, the reality
of too-early
denies almost a
parenthoodcruelly
million U.S. teens
the rights
and changestheir livesforever.
to firstthings
first,
First
ThingsFirst acknowledgesthe rightof
our
every
first
things
"
We
think that American
children should reach their adulthood without
havingparenthoodin theirchildhood.
Thank
you, Mr.
Chairman.
[The preparedstatement
the Record:]
of Ms.
Johnson starts
on
p. 70 of Submissions
for
22
me
I think you
Representative
Scheuer.
justpose
questions
to
some
the whole
said it ailin tiiatlastsentence.
Let
I
should
have
done
panel. probably
thisbefore your remarks.
What have we learned in the lastdecade or two about helpingyoung people
control their fertility?
What have we learned about the diffusion and distributio
of family
information
services?
and
What
have we learned
planning
about the need for new
technologies?
contraception
What have we learned about acceptability
of the way and the means
that
services
deliver
and
have
What
learned
we
we
familyplanning
counseling?
about the way we provideincentives? Should we provideincentives?
What kind of incentives for young women,
to young
couplesto control
in order to defer childbearing?
their sexuality
In effect,
what have we learned
from 1967 to
that pieceof legislation,
since the dayswhen others put together
1970, and up to 1992? That is a periodof over two decades.
defer to
Johnson. I think what we have learned,and I will certainly
has
colleague,
Jeannie Rosoff,as you pointedout very well,
helped us
my
learn what we have learned,and prove what we have known. The one thing
that is clear,we
have known, Jeannie knew, I knew. Planned Parenthood
knew, health care providers
knew, the importance of information services,
Ms.
support.
would have been, I have no doubt, in
ifwe had not run into
edge of new technology,
health attitudesin thisadministration.
We
beingon the cutting
buzz saw of antireproductive
terms
a
of
ifwe don't prohave learned is that ifwe don't provideservices,
vide
if
don't
what
tinue
information, we
theyneed, theywillcongiveyoung people
of them
know that many
to have unintended pregnancies.We
already
willbe assistedifwe have reality-based
education in the schools and not provide
curriculathat thisAdministration supports
them disinformation,
as some
does.
What
we
availableto
that ifclinicsare availableto them, if resources
are
Norplant
them
started providing
you talked earliertodayabout Norplant.We
in our clinicsin Februaryof 1991. By the end of thisyear, we willhave
with generally
of them in adolescent women
inserted 30,000 Norplants,
many
very good results.
know
We
"
that has been more
Medicaid
this cost
because
covers
simply
It is interesting
that this is a method
income
persons
fact allstates
in some
apparendynot adequately
that itis too costly
for
lotof
really a
workingpoor.
"
states.
availableto lowin most
But
the
states, in
is
tragedy
have learned,
have continued to learn. But when importantorganizations
we
likeAGI, who helpus learn more, find that theydon't have access
in a situation which we
are
to the kind of resources
running up
necessary
againsta lot of problems,what we should have known, what we could nave
known better,
had a setback. But my judgmentis that we are in a new
we
ward.
forplace,in a new environment, and we have an excellent chance to move
But
we
Representative
Norplanton
Scheuer.
as
wide
a
Well,I
am
scale as you
ing
very much impressedthat you are usplant,
Northat
It is my understanding
are.
other places,China, widespread
developed in, among
I wrong?
with Norplant Jeannie,
am
experimentation
which
was
"
23
Ms.
I think it was
RosoFF.
tested in China, but
no
than in other
more
places.
Representative
Ms. RosoFF.
Scheuer.
Not
as
Is it beingused
widelyin China
now?
far as I know.
Representative
Scheuer.
that in terms of the horrendous
to me
Well,it seems
that we have documented beingproducedby early,
unwanted, outof-wedlock adolescent pregnancy,
if you calculate the cost to societyper
child
and I don't mean
the infant,
and you do a cost
I mean
the mother
benefit calculus for that $500 investment in Norplant,
that would free that
of worry about unintended pregnancy
untilshe had completed
woman
young
her education,completedher training,
had grown to maturity,
had
hopefully
husband.
and nurturing
acquireda husband, a supportive
costs
"
"
I think you would find on
that investment in Norplantwas
a
hard bottom
very
trivialto
in
society
line financialanalysis
that
the
to
comparison
savings.
of the legislation
Johnson. That has been true, really,
you talked
Title
X.
address
of
benefit of
the
issue
about,
And, again,Jeanniecan
cost
Ms.
dollars put in
familyplanning.So any failurethat we have had to pursue aggressivel
has not done anything
certainly
strong familyplanningfinancing,
for the economic well-being
of thiscountry.
Representative
Scheuer.
It has been very
deleterious for the economic
of the country.
well-being
Thank
very, very
you
much,
Ms.
Johnson.
We
are
very
for your
grateful
testimony.
willhear from Dr. Marcia Burt, Senior Fellow of The Urban Institute.
Please take ten minutes and express your views to us.
Now,
we
STATEMENT
Dr. Burt.
OF
MARTHA
BURT, SENIOR
FELLOM, THE
URBAN
INSTITUTE
facts. I am very delighted
actually
going to try to express some
the public
to hear virtually
cost of teenage pregnancy,
everybody
citing
while there were
studies from which I actually
took off that did rather
some
I
am
detailed and expensiveestimates of the
cost
of teenage pregnancies.
by the Center for Population
Optionsto developa
method that practically
anybody could use to developestimates of costs for
local jurisdictions,
I did
states
a whole, and at that time
or for the country as
In 1985, I
asked
was
the country as a whole part.
What I want
estimates
to do is describe the three different types of cost
and what are included in them. There are several graphsin my written testimony
that willmake rather clearwhat I am talking
about.
I estimated three differentkinds of
publiccosts. The firstof those is a onewelfare
Aid to Families with Dependent
dependency,
year
Children,and the programs that are tied to that. Medicaid and food stamps,
which almost 90 percent of peopleon welfare get. Actually,
the actual calculation
is that sUghtly
half of the familieson welfare whatever the current
over
of
the
mother
were
begun by the birth to a teenager.
age
cost.
It is based
on
"
"
And it is very simpleto calculate. You take the total cost of AFDC, the
total cost of Medicaid to those on AFDC,
the total cost of food stamps to
those on AFDC, multiply
by .53, and unless you have any better data for your
state or jurisdiction,
and that answer
is displayed
up with an answer
you come
Table 2, Figure2 or Exhibit 2.
on
24
In 1985, which
when I calculated it,it started out at about $16.7 billion
was
for the country as a whole. It has not gone down since then. Since 1985,
the Center for Population
has been making these calculationsevery year.
The latestcalculation,
which was
for 1990, was
and you can
$25.1 billion,
how it has gone up. The bigjump between 1989 and 1990 was, in part,
see
related to the number of people in poverty, because that will increase the
number of peopleon AFDC.
loads are pretty constant
tween
through1985 through1989, and then beand 1990, theywent
What
that
means
can
is,
expect the
you
up.
of
Another
be
well.
that
1991 figures
to
higheras
significantly
jump is
part
the increase in medical costs.
So there were
big Medicaid increases in that
1989 to 1990 inspection
as well.
Case
1989
Exhibit
The second kind of cost I calculated is a litdebit harder to explain.
of
of the differencesbetween
1 tries,
to the best
to painta picture
my ability,
birth to a
these two costs.
The second kind of cost is the cost for a single
is
who
first
birth.
that
It
a
basically
a
beginsa family,
beginsa career
teenager
of a family
that may be or may not be on welfare,
career
may or may not incur
for
builtinto that 20-yearprojection
are
costs, but the expectations
any public
additional
of
and
for
ceiving
childbearing
a certain probabilityrea certain period,
publicsupport.
The costs that are involved in these are AFDC, food stamps, Medicaid,the
administrativecosts to those programs which are not in the firstcategory, and
estimate of public
an
housingcosts and socialservices costs as well.They are
and theyare discounted back to what you
o
ver
projected
a 20-yearperiod,
would have to put aside todayin order to pay for that family.It deals only
with firstbirthsbecause that is the beginning
of the family.
There are, of course, other birthsto teenagers while theyare still
teenagers,
of havinga second childwithin a coubut that is calculated in the expectation
ple
of years and so on.
birth is in Exhibit 3. It is in thousands and not tertisingle
It
the billions. It starts at
is
not
bly impressive.
as
nearlyas impressive
about a
If you are talking
birth on average to a teen.
$13,900 for a single
the
a
bout
It
the
costs
are
are
19-year-old,
a
talking
higher. you
14-year-old,
That
costs
cost
are
of
a
lower,but thisis average.
Representative
Dr. Burt.
costs
image of
in
Scheuer.
Is that cost
That is the AFDC,
a
birth?
are
every
society?
food stamps, Medicaid,socialservices and
to
It goes up to about $18,000 by 1990.
20-yearperiod.
allhave the public
because,although
we
as low as theyare
there forever,
going on welfare and staying
teenager instandy
housingcosts, over
These
That is roughly
$14,000
Cortect,per family.
Representative
Dr. Burt.
Scheuer.
a
that is not what happensto
fact,
a
lotof them.
in any givenyear,
one-third probability
there is onlyone out of three of them that willbe on welfareduringa given
and then
out of five,
year. By the time you hit 20, you are goingdown to one
way down by the time you are 30.
In the
teen
years, there is about
a
The image of the teenage parent as the one who gets on welfare and stays
for a great
there forever is the sort of public
bugaboo,but it is not the reality
included
in
number of familiesbegun when theyare teenagers. Nevertheless,
25
mediately
testimonyis an estimate of what itwould cost iftheydo go on imand that is somewhere in the $40,000 per ily
and stay on forever,
famthe 20-yearperiod.
range over
Representative Scheuer.
Where there is a teenager who does go on welfare?
written
my
welfare and staysthere for 10 years.
from about
Let me
ask, these figures
range
$14,000 in 1985 to about $18,000 in 1990, going up to $40,000 when the
and promptlyon welfare,
and stays there
teenager does even
up reasonably
for a considerable periodof time.
Dr. Burt.
Immediately
goes
Representative
Dr. Burt.
on
Scheuer.
Right.
of $500, would you say that Norplant
would be an extremely
desirable investment
for society
to avoid these costs,
which range from $8,000 to $40,000 in a family?
that you
Dr. Burt. Right.The dark part of aU of these charts is the savings
least
the
these
is
could expect by postponingall
mother
birthsuntil
teen
at
20,
and it is about 40 percent of the totalcost. Peopledo not immediately,
once
of ever receiving
theyturn 20 without a baby,go down to a zero probability
welfare or beingsupported.
Representative
Scheuer.
At
a
cost
The peoplewho are havingbabies and usingpublic
support also have a lot
of other things
which are part of why theyare having
going on in their lives,
low-labor marof low hopes,low education,
babies in the firstplace,
in terms
ket
in
and so on, which also predict,
low school completion
even
participation,
of
the
theirlateryears, some
h
ence
40
welfare,
on
probabilitybeing
percent
issue.
But yes, in the
abstract,
Norplantwould be
a
very, very wise investment,
stuffis that theyalso cost
Norplant
a lot to
take out, and teenagers may want
them to beginwith and then five months
latermeet a wonderful man
and decide that theywant them taken out.
althoughthe feedback
on
a
lotof
A lot of family
to report back that theyare
planningclinicsare beginning
lotof
take
well
them
out
to
theyhave
as
as to put them in
gettinga
requests
side-effectsand so on.
So I think that what you need is good counseling.
into
You cannot
what theyshould
it
somebody without explaining
justpop
it
and
of
that
the
because
then
decision,
meaning
expect by
you are going to
be spendinga lotof money
to take itout, as well.
"
Representative
Scheuer.
Is the $500
cost
of
a
Norplantinsertion good
counseling?
ing
about private
docs,often no. If you are talktalking
because
about family
to have it,
clinics,
usually
planning
yes. It is critical
of the side-effectsthat may happen to
peopleoften do not recognizesome
them that theymay not like. They may not really
be thinking
in a five-year
Dr. Burt.
If you
are
stretch.
of new
there is also going to be Deprovera,
terms
technologies,
three-month
instead
of a five-year
decision. It means
decision
a
a
control in shorter perimore
frequent
ods
return, but it also givesa woman
of time.
I mean,
in
which is
more
Representative
time without the
Dr. Burt.
Scheuer.
It
givesthem control over
of taking
out Norplant.
necessity
That is right.
a
shorter periodof
26
Scheuer.
Representative
and
procedure,
Dr. Burt.
Norplantis trulya reversiblesterilization
But
it is totally
reversible?
Oh, there is no questionabout that. I think the issue is whether
it short of the fiveyears.
peoplewillreverse
Scheuer.
Representative
Let's say
a
14
woman
young
15 years old gets
or
fiveor six years of protection.
Norplantthat provides
Dr. Burt. Ifshe keepsit in.
and she has
Surelyshe
is not
And
Scheuer.
Representative
let'ssay that at 18 she decides to get married,
have
to
wants
a family.
hesitateabout taking
Norplantout for the
supportivehusband and she
a
goingto delayor
purposes of becomingpregnant.
Dr. Burt.
No, and that would
have avoided allthe
Representative
Dr. Burt.
be a very successful scenario,where you
and an unwanted pregnancy.
costs
public
Scheuer.
What
is the
cost
of
itout?
taking
About $350.
it out and
the cost of taking
most
dollars
thousand
it
the cost of Norplant the cost
to me,
seems
a
by alif a woman
has Norplant
to make, even
any calculus,
you would want
vestment
interrific
it
before
she
takes
itis
for
of
an
absolutely
a couple
out,
only
years
for society.
Representative
Scheuer.
"
Let's say, between
of
"
does invest in it,
and ifsociety
There is no questionabout that,
ics
clinit would be a very great benefit. At the moment,
a lotof family-planning
uncounselled
when
take
it
raise
out
an
to
to
are
having
person, who
money
and
it
in
So, at the
has had it put in by a private
wants
out.
doctor,comes
it is an issue. It would not be an issue ifthat public
moment,
support was
either
there to allow people
to go
way.
Dr. Burt.
Representative
Scheuer.
By
any test of
logic,
Norplantis stilla terrific
investment.
public
Dr. Burt. Absolutely.
is that we better have a
Scheuer. But what you are saying
plant
Norreevaluationof the financialprocesses by which we have been inserting
and then taking
it out at a latertime.
Representative
Dr. Burt.
Correct.
From
any vantage point of overall logicand
I don't see how you could
of
of
from the point
view
our
society,
rightness,
questiona thousand-dollar investment,with an average cost of $5,000,right?
Representative
Dr. Burt.
Right.
Representative
Dr. Burt.
Scheuer.
linedown
Scheuer. That is a prettystraight
there.
Definitely.
Representative
Scheuer. With
an
average cost of
out-of$5,000per single
wedlock birth.
is up to $18,000.
An average cost, I think,
about the
Representative Scheuer. No, no, I am talking
Dr. Burt.
Dr. Burt. The
Representative
$14
to
savings.
right.
right,
savings,
potential
Scheuer.
And plusthe single-birth
cost of anywherefrom
$40,000.
peoplewho had theirfirst
and
for cohorts
givesus the totalcohort cost,
givenyear together
Dr. Burt.
birth in
a
Exhibit
Right,right.
4 puts allthe
28
Representative
Did
Scheuer.
theyuse
Norplantin Europe?
I think since there has been
lot of attention
let me second a little
bit about what was said before. Number
to Norplant,
have learned in the last25 years we have learned
one, if you ask what we
that peopleare very strange and theyhave allsorts of strange ways and habits
and preferences,
and there is no birth control method which is acceptable
by
And I don't mean
I mean
differences,
religious
justpeople have
everyone.
fears.
Ms. RosoFF.
There
In
some
countries.
a
who will not take the pill,
some
women
even
though it has been
safe.
terrified
of
be
There
who
willbe
women
are
havingsomething
proven to
under their arm, which is tantamount
to surgery.
So, to justsay that this is a
wonderful method and everybodyshould get it,I think,is a great oversimplification.
are
For
do with removal,is very complicated.
Medicaid
the
device
under
Medicaid,
pays
get
and hopefor it and Medicaid is generous. If she is no longerin Medicaid
fully
she then has no way of gettingit out,
in a coupleof years she won't be
of
for
it out
pocket.
except paying
The other
problem,which has
if a
example,even
woman
to
can
"
"
Most
women
six months
Medicaid
on
ago
are
suddenlywealthyand
not
fees six months later The second point
capableof coughingup the surgical
that easy to take out. And not so many people
.
is that itis not
Representative
how
to
Scheuer.
insert it as know
how
You
to
mean,
not
so
many
of the technicians know
take itout.
And women
might
move
a lot around the country. You
to South Dakota
be living
York where it is very easy, and then move
in New
where it is not so easy. So the problems,I think,are much more
complex
than theyappear to be on the surface.
Yes.
Ms. Rosoff.
of fact,as you probably
know, we are engagedin a two-year
cause
that
at
question.To see one, who can get it,bestudyjustto look exactly
I think there is a triage
system that,because the device is so expensive,
and
Medicaid agencies
publichealth agenciesjustgive it to certain women,
maybe not older ones who would need it. But that is the whole problemof
As
a
matter
and
mobility
removal.
who will
There are women
of individual preferences.
also the question
because I can't stand the idea of this thing
tolerate an lUD
say I will never
hortake mones.
will say I will never
somewhere
in my body. Other women
floating
this.And justas teenagers
And I think we justhave to accommodate
And
are
not
allalike,
allmen
Scheuer.
Representative
more
research
Dr. Burt.
to
and
women
are
not
allalikeeither.
I take it that you
are
suggestingthat
we
need
increase the choices available?
And
more
options.
Representative Scheuer.
Yes.
Let's get back
to
you.
The charts and the savingsspeak
finished with the money.
for themselves. You can expect about 40 percent justfrom delaying
teenage
of
20.
reaches
leastthe
untilthe
at
woman
age
pregnancy
Dr. Burt.
I
am
also investing
in education and in job opportunity
and
job training, so on, you would reduce the probabilitie
more
and you would see much lesspublic
further,
dependency.
if we
Obviously,
creation and
even
were
29
I alsotalkfrom the pointof view of a researcherin order to try and answer
about what have we learnedabout what is effective.There are
your question
severalthings
that we have learned about the delivery
of contraceptive
ices.
servInformation is critical.
If theydon'tknow what theyneed,iftheythink
that iftheydo itstanding
up, theywon't get pregnant,then theyare not going
in for care.
to come
Representative Scheuer. Wait a minute,hold the phone.How
thatinformationto them? Is it through
the schools?
Dr. Burt.
available
means
Throughevery possible
do
where kids are,
we
get
through
schools,
Boy Scouts,Girl Scouts,throughany possible
youthactivity,
youth
Put it on TV. If you can
centers.
be able to have thisstuffon TV.
stuffon
have anti-abortion
TV,
you should
Well,I have triedvery hard for a number of
the
television
s
tations
to accept ads for condoms. They won't do
get
years
it.They will have 19,000 examples
course,
television
of sexual intera year shown on
but theydon't like to deal with the consequences
of sexual intercourse.
Representative Scheuer.
to
Dr. Burt. Absolutely,
I think we
unless you are Murphy Brown.
have
learned that availability,
comfort
and
critical.
Where
ice
are
access
you get servhas to be friendly
with teenagers,has to be used to dealing
with teenagers,
has to be closeto where teenagers are, has to be cheapor free.It has to be at
the right
time or be in school so thattheycan go during
school.
It really
is not
helpsifthe peopleare familiarto them. Even ifthe facility
ifthe staffof that facility
in the school,
tion
are involved in healtheducaliterally
classesin school,
iftheyare known people
with whom teenagersare comfortable,
will
for
If
and
told
shunted
aside
services.
to
come
are
they
they
shut up, and
so
on, you willhave
a
hard time.
Another thing
learned is that follow-up
increases
we
absolutely
drastically
the success
If
after
i
f
if
ask
them
rate.
kids, you
theyare happywith
you keep
theirmethod,that allhelps.Privacy
should be essentialso that theycan go
there without havingto telltheirparents and without allthe other kids in
school knowingwhat theyare doing.
We have also learned,
planning,
completely
separate from family
per se,
that developing
environments and peer culturesthat have a hope
protective
for the future is very effective.So, yes, you are talking
about exclusively
in
these environments. I am thinking
of one thatisa public
right
housing
project
ing
now, but there are others as wellwhere there are curriculummodels for talkabout family
lifeeducation responsibilities,
et cetera.
There are also many other opportunities,
entrepreneurs clubs,there are
and have 150
ways of tutoring,
ways to get them to stayin schooland do right
kids likeyou who willnot laughat you when you do that. You can change
ifyou givekids a protective
other
the worst environments,
even
environments,
be
that
has
of
future
is
other
kind
future.
ifthe
It
to
some
more
helps
way
realistic
out there.
so you can
say there are jobs
I think we
have learned that,
ing
of the factthatwe have had no fundin spite
forresearchinto these issues. I think it is absolutely
critical
thatthe cancellations
of majorresearchprojects,
which look at people's
sexual activity
to
find out where itwould be possible
to intervene and on what grounds
people
should go forth. If you don't have the information,
mightbe able to listen,
blind.
are
really
flying
you
76-611
0-94-2
30
allhave anecdotes. We do have some
on
pretty old research actually
tiveness.
effeclotof
research
don't
have
We
effectiveness.
on
new
a
program
program
We
Scheuer.
Representative
Thank
very, very
you
much,
Dr. Burt.
guide,pleaseproceed.
JeannieRosoff,long-time
I.
JEANNIE
OF
STATEMENT
ROSOFF,
ALAN
PRESIDENT, THE
GUHMACHER
INSTITUTE
pleasedto be here this morning. It is onlytemperedby
estingly
from coming back from Japan where I was, interthe factthat I am jet-lagged
o
f
the
talkabout
asked
subject teenage pregnancy.
to
enough,
in
The point there is that,even
though the rate of teenage sexual activity
with ailthe
Japan is onlyhalf of that in the United States,itis growingrapidly
I
Ms. Rosoff.
mention.
can
we
consequences
am
This
institution has done studies in Europe and Latin American.
much
that
worldwide. It is not so
teenage young
problemwhich is really
My
is a
own
but that theymarry much later.
and women
are
havingsex much earlier,
ten
last
if
It used to be, you are pregnant at age 17,
you hasyear of highschool,
bit and everything
the marriagea little
was
okay.It is no longerokay.
and women
to have longand expensiveeducations
We expect young men
but also
not
only men,
in order to be able to support themselves
men
"
stable marriages.So we
and that of
between the normal initiationof sexual activity
have now
a period
States and
United
for
the
think
I
marriage,which is quitelong.As a result,
the problemis as anxiety
as itis here.
for most other countries,
provoking
women
"
and
to
marry
to have
hopefully,
later,
more
transition to sexual
accept the fact that the teenage years are the
As
face.
hard
find
I
to
that
think,
This
adults,
is
ents,
parsomething
activity.
and
as
like to keep our children young
long as possible
I think we
difficult
to face.
I think thisissue is particularly
children as longas possible.
We
have
to
whether theyshould stay in
don't have that much problemdiscussing
but when it comes
to boys and
school and whether theyshould go to college,
Our children are not comfortable
and paralyzed.
become tongue-tied
sex, we
think we could be there in the
don't
about this with us, since they
talking
We
condition.
same
Scheuer.
Representative
parents
are
the
across
Are
we
more
in this country
tongue-tied
than
lengthand breadth of Europe?
tion
The pointI make about sex educaUnited
the
like
school districtsare
in Europe is also true, that most
side
their practices
and
localized
and,therefore,
vary outregionalized
States,
Ms. Rosoff.
In
that is true.
general,
very
the Scandinavian country.
The discussion of sexuality,
not
onlyamong teenagers but among human
by government. The
acknowledged
is more
beings,
open and frank and more
that
debate
of
midst
abortion,
on
a
factthat the government takes note in the
I think,is a powerful
signal
some
teenagers should be able to get contraception,
for
not
to
nant
that your government thinks it is very important
get pregyou
in your
teens.
I don't think thisis good for
in the land saying,
This is the highest
authority
think on thisissue. This
have an impact on how people
you. I think that must
have access
is also a national health system which makes sure that you really
to
a
physician.
31
I know
that I
in front of the Economic
ing
Committee, so I should be talkBut I think that there is,in this case, too much talk about
about money.
because the issue folks are focusing
and childon
money,
teenage pregnancy
bearing is teenage sexual activity.
am
"
"
It is possible
and find it pleasurable,
and
to be a teenager and have sex
about it. But, nevertheless,
its consequences
maybe also have emotional feelings
will not be long-lasting
and its consequences
be nil.However,
may
then
also get pregnant and
the choices,
are
unfortunately,
onlytwo:
you can
To have an abortion or to have a baby.
One thirdof allabortions in the United States are to girls
under 20, so it is
and unusual experience.
But mention was made thismorning about
to do with this,
well,unfortunately,
somebody who said,even ifwe don't have anything
it is one
of the most
resolutionsof teenage pregnancy.
common
And whether we want
allour remedies
to ignoreit or not, I think it makes
somewhat skewed to the portionof the population
of course,
which is usually,
the poorest and the ones
that cost us the most
and
theyusuaDyend
money,
the
babies.
up having
not
a
rare
that there is fundamental
oppositionto abortion among poor people.I know that theirrate of abortion
is quitehigh,
in some
cases
population.
They tend
goingbeyond the general
have
abortions
and
to
often,and theytend to have more
pregnanciesmore
births. For us to think simply
of thisportionof the population
in terms
more
for whom the consequences are severe
and who for the society's
consequences
That does
are
severe,
We
mean
"
and I
want
to
stress
this
"
I think is scuzzing
the whole
cannot
exist in
not
not
problem.
ifyou will,
address and segregate that population,
as iftheydid
the United States. They were
ground
backnot
exposedto the same
and the
same
as we
aspirations
are.
What's interesting
about minorityteenagers is that when theyare 14 or 15,
their aspiration
than better-offpeople,
but in fact
is higher
to go to college
which
don't
the
of
think
I
I
is very
there.
think
itis
they
problem poverty,
get
serious,and we need to address it as a poverty program, and then there is the
problemof teenage sex and how we feelabout it.
discomforts that
I acknowledge
the discomfort and particularly
the political
this creates, but I don't think solutions are possible
face this issue
untilwe
I do think that we
have found,and there is tentative research
very squarely.
which shows this,
that it is possible
under certain conditions to postpone the
initiationof sexual activity.
I think the longer
can
we
postpone it,the better.
and
for the young women
that younger teenagers
men
involved,
maybe for reUgious
reasons, for reasons
do find itharder to obtain and use contraception
well. Whatever we can gain,
whether itis six months, a year, or two years, I think thisis allto the better. I
think we should do a lot of research on this. I think it would aid the public
comfort.
I would deal with thisfor the emotional
reasons
for example,
their particular
the Japanese,
asking,
problemwith
comfortable
well,you know, nobody is untheywere saying,
teenage pregnancy, and really
of
the
house.
kids
as
out
soon
as
They are already
go to college.
We don't know what theyare doingand it is fine. It is really
when theyare
around and under foot that we really
have a concern.
iftheyfeltwhen
I think the American public
would feel a lot more
at ease
theirchildren started to have sex that theybe out of the house. But I think
I
was
32
theyare then
and
mature
take
can
care
of themselves. So I think postponing
is important.
the activity
European countries,in their sex education
sexual activity?
for deferring
have the kind of priority
concern
programs,
of fact,
Not very much. As a matter
most
Ms. RosOFF.
European countries
for
that
do
behavior
sexual
Sweden, which is earlier.
we
have the same
except
Scheuer.
Representative
We
Do
of France, England;Canada
in the middle range
are
to
seems
be
a
little
later.
because we only know about
of sexual activity
by girls,
the 11- or
It is not
is a litde under 18.
in this country, basically
girls
but theyare still
These are rarities. The numbers are too large,
12-year-old.
The
average
age
raritiesin thiscountry.
Why
Scheuer.
Representative
is the
den?
earlierin Sweof sexual activity
onset
That
I don't know. They have very free attitudesabout sex.
known
best
the
Netherlands
ples
examand
the
Sweden
two
is clear.
are
probably
of that. I think theyknow it is going to happen. They think there is
nothingwrong with it. Their parents are not upset. They have contraception
ture.
available. They think that is the thingto do,and it becomes part of the culMs. RosOFF.
The teenage sexuality?
The pregnancy is viewed
Yes, the sexuality.
Scheuer.
Representative
Ms. RosoFF.
as
as
a
catastrophe,
itis in thiscountry.
have sex with peopleyou care
about,and ifyou care about them, you protect them.
cause
bementioned
I think it is a different attitude. We
Ms. RosoFF.
it
is
in
there
is
What
is
that,
fact,
fresh
in my memory.
it is
interesting
of men
is studied as
the only country in which the teenage sexual activity
And giventhe fact that Japamuch as the teenage sexual activitiesof women.
nese
I think this is a new
in general,
kind to women
is not particularly
activity
It is viewed that
Dr. Burt.
sex
is fine. You
Jajpan,
twist.
Representative
Ms. RosoFF.
Scheuer.
I would
How
have
to
for it?
do you account
go back when the jetlagis over.
of which is in fact a questionof
have heard a lot about the problemof adolescent pregnancy and
We
cost.
hidden cost and that is the cost of
but I think there is a more
childbearing,
I
want
to
conclude
on
one
point,some
disease.
sexually-transmitted
the old fashioned ones
we
sexual transmitted disease,
and
about 20 years ago are treatable. I am
talkingabout Syphilis
Chlamydia. But a lot of the new diseases are not treatable and willhave life
cancer.
They are very often without symptoms,
particularly
consequences,
detectable and may be dormant
in women,
so
theyare not easily
particularly
As
knew
we
know, in
some
economic
for a longtime and have long-term
consequences.
do know that theyare particularly
what they are, but we
for women;
and, in
and have long-termconsequences
has
T
here
We know very little.
some
cases, for the babies that theywillbear.
been almost no research done on this topic.I think that is something
importantly
don't know
harmful to women
We
needed.
33
I
which
term
about HIV, which is obviously
the most
terribleand devastating,
talking
but the diseases most
of you never
heard of, such as chlamydia,
silentdiseases in women,
and theyhave very serious,longbasically
not
am
are
consequences.
lost. Perhaps,if our institutions are failed in
hopefulsigns.For
people,there are I think some
many
ways, I think young
in
five
the
of
the
and their
women
only
example,
proportion
young
years,
first
from
who
the
52
intercourse
at
went
use
contraception
percent
partners
as
Finally,
to
hope
I say,
is not
65 percent.
In 35 years that'sa very substantial increase. The proportionusing condoms
from
in the same
47
23
to
periodwent up
percent
percent. Forty-seven
of young women
who don't want
to get pregnant are
now
usinga contraceptive
method. So that clearly
Both the parents, the school,the
is a response.
media, somebody is doing something,and it has had effect in a very short
time.
is
The down side of this and thisgoes back to the questionof education
of
and
between
the
20
that young women,
24
we
so
women
particularly
age
about teenagers, but even
women
are
not
by
are
talking
teenagers
younger
don't
well.
of
that
It
is
and large
not
users
use
They
they
contraception.
poor
time. The methods are not easy to use,
forget.They don't use it at the right
fearfulof side-effects.
and many women
are
"
"
"
"
Therefore,I would think that there is a considerable need for improved
well. It is reas
markable.
education,not onlyfor teenagers, but the general
population
in which in
with 1800 women
In a Michiganstudy,
usingthe pill,
79 differentways of usI think,nine months of their use of the pill,
the first,
ing
the
had been found.
pill
It has to be
I assure
Now, there are not 79 ways of using the pill,
you.
hour of the day,
taken every day for 2 1 days. It has to be taken at the same
that we have failed
allbad variations,
which shows clearly
so the variations are
and the meFDA
has failed,
the schools have failed,
dia
to education the public.
failed.
has
don't quiteknow allof these reasons, but I think it needs a lotof
and research because,even
we
takingthe number of women
investigation
and
birth
the
abortion
could
reduce
we
have,including
teenage women,
There is somethingto hope about,but there is more
to be
considerably.
I think
new
now
rate
we
done.
Representative
on
Scheuer.
Mrs.
Rosoff,thank
you very much
for your
did
splen-
testifiedthismorning,as well as your years of guidanceand wise counsel.
of Ms. Rosoff,together
with attachments,starts
[The preparedstatement
of
for
Submissions
the
89
Record:]
p.
Representative
Scheuer.
Faulkner,Minister for Youth
City.Please proceed.
HATEMENT
OF
REVEREND
CALVARY
Reverend
I also serve
Faulkner.
will now
hear from the Reverend Michael
York
of the CalvaryBaptistChurch in New
We
MICHAEL
BAPTin
Thank
J. FAULKNER,
CHURCH
you,
Mr.
IN NEW
MINISTER
YORK
YOUTH,
CITY
Michael Faulkner.
AdvisoryBoard for the Board of
Chairman.
as the co-chair for the HIV-AIDS
Education of New York City.
FOR
I
am
34
middle -classfamily
here in Washington,D.C. During all
told
I
that sex
by an adult or authority
figure
growing up, was never
my
was
lactic
prophywrong, or that I should in any way exercise caution,onlyto use
in
values
this
at
area
were
shaped an earlyage by my
protection.My
As a result,
I became sexually
active at
to pornography.
peers and exposure
active in laterteen years.
an
earlyage and extremely
I
raised in
was
a
time
I do think it is necessary to share
While I am
not
proud of these things,
them as backgroundfor my material so that you willknow that my personal
convinced and convicted of the ideals I have espoused
journeyleads me even more
today.
bate,
like to beginby shapingthe debate as I see it. I do not see the dehowever unwarranted it is,as beingone onlyover the use or misuse of
the essentialelements
devices. I see the debate,rather,
on
focusing
contraceptive
of our moral concern
for the dignity
and value of each human being.
I would
evU in and of themselves.
not
are
debate whether young peopleare engagingin sexual activity.
As a minister and educator who works with young people,I can assure
you
that our young peopleare havingsex and at larger
numbers and earlierages
than ever before seen in our Nation's history.
and contraceptive
devices
Contraceptives
I
here
not
am
to
The debate should not be over whether or not young peopleare havingsex,
but
need to givethem information about contraceptives,
we
or whether or not
and where and
rather who givesthem the information about contraceptives
when the information is distributedand in what setting.
have heard the numbers and
The impact of our teen sexuality
crisis,
we
but
talked about the economy
and the end resultof the bottom line figures,
effectsof
detrimental
have
focused
what
feel
the
I
not
most
we
on
are
really
thiscountry.
lion
milone
that
think
I
it
is
this
don't
year.
young
pregnant
transmitted diseases at epidemicproportion.I
peopleare contracting
sexually
fact of this crisisis the fact that
do reel like the worst
and most
devastating
I do
not
feel like the
most
detrimental effect is the fact that over
willbecome
teenage girls
we,
as
for young
have failedto shapeand frame this argument properly
adults,
people.
By that,I mean
be shared in
known
the context
of the long-term,
as
relationship
mutually-monogomous
of
value
The
don't
hear
that
marriage.Unfortunately,
people
young
anymore.
sex
in allof itswonder
and
beautyis meant
to
marriageand the end resultfor their familyis not somethingwe promote in a
educational setting.Young people are not hearingthat message
as
they
and how
should. They are not beingtold the truth concerningtheir sexuality
their sexuality
best be utilizedfor maximum
can
enjoyment.
Instead,the debate over this issue and the information we receive mainlv
that it will
debate is centered on the technology
take to eliminate what some
would callthe detrimental effectsof early
age
teendiseases.
transmitted
sexual activities,
eliminate pregnancies,
sexually
focuses
on
The
technology.
When
a person
give them a
says that theyare afraid of gettingHIV, we
condom. When
dom.
theybecome afraid of gettingpregnant, we givethem a conWhen
theirfear
of
a person
theylove
by someone
beingjilted
expresses
and care about and theyare afraid of the emotional scar it willleave,there is
device that we can givethem.
no
technological
36
realisticand, therefore,
let'snot talk about it,but let'sfigure
out
make thistechnology
work better for us.
a
way
to
the discussion of contraceptives
with young people;
however, it is imperativethat messages of this sensitive nature not be done in
and
a mixed
People callme old fashioned,but I believe young men
group.
ladies and gentlemenshould be separated
when talking
about intimate sexual
I
not
am
opposedto
matters.
at senior high school
opposed to thisinformation beingtargeted
because
believe
I
their
liveswhen they can
in
students,
theyare at a stage
handle the education and need to hear it. But we would go a long way to
them while conhelpingthem build the necessary self-esteem ifwe separated
traceptives
and forms are beingpassedaround the room.
I
not
am
in my youth program
called me.
ladywho participates
young
devastated. She justsat through a sex
class which was
nounced,
unanshe
could
The
who
so
not
educator,
was
a male, brought
opt out.
serted.
into the class a model of the female genitalia
device inwith a contraceptive
This model was
and
around
the
classroom.
This
passed
lady
young
others were
embarrassed to have the young men
talk about this and handle
thisin front of them, which led to a lotof discussions.
a
Recently,
She
was
track and has gone
FinaUy,letme cite an examplethat I feel is on the right
of the Emory
solve these problems.You may be aware
to helping
a longway
f
rom
families
that
asked
low-income
study
16-year-old
girls
1,000
University
Atlanta
the
of
in
education theywanted to receive. They
sex
area, what type
had
20
over
options.
to learn how to say no
to sexual
This
the
from
the
that
talked
is
is
most
about,the
pressure.
message
group
abused,the group most at risk. Yet,we continue to pump money
group most
that willreduce the risk,
rather than givingyoung peoplewhat
into technology
for.
theyneed and are asking
Eighty-four
percent said that theywanted
need
them
giving
We
to
resources
reduce what
If
a
what
would callthe
some
of early
sexual involvement.
pitfalls
ladygivesbirth out of wedlock before graduating
high school,
the statistical
chances of her actually
and completing
going on to college
heard that theyare almost nil.
degree?You have already
young
are
a
The
support these young peoplebefore theybecome pregnant by
of hope and self-esteem and self-actualization
and accomplishment.
a feeling
the standards and givingthem the
We
do this by setting
can
them the technology
those standards. Not simply
meet
to
giving
to
of self-help
about are parallel
to a
talking
programs that I am
agement
ManKenilworth
here
the
in
D.C.
Community
right
Washington,
program
Model
where peopleactually
broughtback their community and
took over
a public
housingproject.Many peoplesaid that it wouldn't work.
n't
or that theydidMany peoplesaid that the poor didn'twant homeownership,
want
theyonlywanted the Government to take care of
empowerment;
them.
success
"
"
This message was, of course, ludicrous and racist,
to say the least.Yet,that
if given an
stands as a shining
exampleof what peoplecan do, any people,
the poor and
opportunity.The young peoplein our communities, particularly
ers
those of color,
to prove to themselves and to othare
dyingfor an opportunity
need
that theycan wait,that theycan take control of their lives,
but they
37
us
as
leaders,
adults,
to support them
as
to
wait and
Thank
to
in their decisions and in their initiative
sexual involvement.
delayearly
you.
of Reverend Faulkner
[The preparedstatement
for the Record:]
Representative
Scheuer.
Thank
you
very
starts
on
p. 107
of Submissions
much. Reverend Faulkner.
You
had very fine testimony.
You have heard from the witnesses that the levelof sexual activity
around
the world is fairly
constant
at a teenage level. There are
some
regionsof the
world where it is going throughthe roof and other regionswhere it is fairly
normal. So there seems
levelof sexual activity
around the
to be a common
world. And whether we have teenage pregnancy resulting
from it seems
to
reflecthow societies differin helping
young peoplecope with theirsexuality.
in the world where there has been
you know of any societies anywhere
effectiveprogram of abstinence counseling
that has reduced the level of
sexual activity?
Do
an
And that is not around the world,that is
here in our country. In the Adanta area, as a resultof the Emory University
right
did
that
a program
study,
theyimplemented
actually giveyoung people
abstinence-based sex education. And theynoticed over
a
periodof two to
and in
three years that a drasticreduction in the number of teen pregnancies,
the number of sexual encounters
by the young peopleinvolved in the
reported
Reverend
Faulkner.
Oh,
yes.
program.
There
also another studydone in Ohio
because
I can't givethe name
of
resultof
familiarwith
there
studies
but
am
sorne
not
numerous
as a
are
it,
the Tide XX programs and funding these studies have producedsignificant
resultsin the area of the reduction of the,not justreduction of pregnancies
or
reduction of STDs, but actually
the reduction in the number of encounters
that young peopleare having.
was
"
I
"
thisproblemfrom an adult perspective.
We think of
approach
see, we
adult
in
rationale.
and we often focus on our
We
an
engaging sexual activity,
failto really
grapplewith the rationalethat a young person uses when theyare
about engagingin sexual activity.
engagingor, you know, approached
You
The motivations
differentfrom those that we think of as adults.
totally
need to get on their level and begin to deal with them
And, therefore,
we
where they are, helping
lenges
them emotionally,
helpingthem to meet the chalment.
that theyface in order to stem
the tide on their earlysexual involveare
Scheuer.
Representative
Well, I see absolutely
reason
no
why there
shouldn't be abstinence counseling
for those young peoplefor whom
that is
attractive and acceptable.
sexual activity,
nothingis lostfrom delaying
Certainly
and much may be gained.Certainly
unwanted
reduces
of
the danger
it
the
And
the
transmission
of sexually
ted
transmitto
vanishing
point.
pregnancy
t
he
ment.
talked
that
that
down
STDs
also
diseases,
about,
to vanishyou
goes
lay
So nobodycan but applaudeffortstoward counseling
young peopleto detheir sexual activity
when
time
it
in
is
their
to a
most
lives,
appropriate
when their education is completed,
where
their skillstraining
is completed,
and hopefully,
theyhave achieved a higherlevelof maturity,
marriage,with a
38
involved
concerned,loving,
supportive,
spouse.
that is very desirable.
Certainly
But there are
but
some
young peoplewho may have considered abstinence,
And
for
have
sexual
I
take
that
it
would
think
that
they
opted
activity.
you
for them we ought to have information and services to helpthem cope with
their sexuality
in ways that willnot leave them vulnerable to unwanted pregnancy,
and to sexually
transmitted diseases.Would that be a fairstatement?
Reverend
Faulkner.
say it thisway.
I think that we
livein a society
how good the information,
how desirable,
matter
no
matter
no
the
t
here
be
what age
to
choices,
matter
are
n
o
people,
going
quote, unquote,
who
from
in
deviate
that
and
ent
socioeconomic
a differor
are
strata,
goingto
go
direction.
Let
me
in which
should be one of not that this is the natural
our
approach,
though,
for
but
there
who are goingto disagree
to
are
goingto be some
sure,
way
you
go,
and not decide to take advantage
that
of,or to understand,
theycan live
and normal livesand express affectionin nonsexual ways.
healthy
think
that theyare enI
gaging
peopleare engagingin sex, and the reasons
young
in sex are differentfrom those that we mighthave heard,or think that
this is justa natural part of human growthor development.It is that,yes,
hormones are raging,
but there are nonsexual ways
so
to speak,
young people's
that we can teach young peopleto express affectionthat are very effective.
I think
And those young people and I am speaking
from my own
personal
experiand
have
I
the
whom
I
have
talked
whom
to
counseled,
enc
people
young
who have been sexually
active and then gotten into an abstinence-based program
the
because
been
much
have
encounter
at
end,
or
an
happier
group,
in the
sexual involvement is not the most
teen
pleasurable
early
experience
world for those young peoplewho are engagingin that.
"
"
with
and I sympathize
All right.I sympathize,
Representative Scheuer.
isn't
the
the pointsof abstinence training.
that
I would simply
it
lifestyle
say
of choice for allteenagers, and for those for whom
abstinence is not the answer
I take it that we
and who have sexual drives that theywant
satisfied,
and services that willenable them to
oughtto providethem with the training
be sexually
while preserving
theirhealth and preserving
active iftheyso willit,
ted
transmitand
theirlifeprospects by both avoiding
sexually
avoiding
pregnancy
diseases.
and that
It seems
that these two programs oughtto go hand-in-hand,
to me
the two
choices education and abstinence and abstinence and education
ther
and that neiand safe sex, ifyou will oughtto be two optionsin the schools,
style,
desired lifeand meet everybody's
to everybody
optionwillbe satisfactory
offered to allyoung people.
and there oughtto be optionsthat are freely
"
"
heard earlierthat only2 percent of allof the monies
that are spent for sex education are spent toward abstinence-based programs.
desirable
feel that abstinence is the best and most
You know, if we
where our
need to put our money
then we really
option for young people,
mouth is,and we really
need to beginto fund programs that are goingto promote
other
and
that
research,
are goingto promote
programs.
Reverend
You
Faulkner.
know,
as
We
because
I said before,
the realproblemin thiscrisisis adults,
thisproblemfrom our own
at what
looking
are
approaching
vantage point,
and
don't
in
not
to
want
to
our
we
lifestyles, saying young people,
you
giveup
it,no.
know, thisis what is best for you, but you know, not forcing
we
39
But I do think we need to
Nobody is going to try and legislate
morality.
desirable outcomes
tellthem that these are the most
for your life;
I mean,
statistical
the
We
will
and
that
have,
so
on.
opportunities
really
given
you
need to put our emphasisbehind those programs that will givethe best and
desirableoutcomes.
most
Scheuer.
Representative
Ms. Rosoff.
I
am
mentioned,which
very
enough.JeannieRosoff.
familiarwith the studythat Reverend Faulkner just
Fair
of fact,
we
published
and I am familiarwith it. The program, in fact,
own
journals
it,so
kids who had
but it was done with 13- and 14-year-old
was
quitesuccessful,
had sex, and among
those who hadn't had sex, in fact,
the initiation of
not
sexual activity
was
a good
postponedby 18 months, which I said was really
and desirablething.
is at
As
Emory University.
a
matter
I read my
the kids who
usually
sex
at age 13 and 14, which is undifference
sexual
O
ne
of
in
the
no
things
activity.
which the program found which was
and I think many peopledo
interesting,
of abstinence
that it was in fact possible
not
to givea message
believe,
really
and a
and have that message
work for at least a portionof that population
that the two things
of,"Ifyou are sexually
active,
use
contraception,"
message
not contradictory
were
or underminingto each other.
Among
low, there
have had
already
was
and I think I said thisin my remarks,that I think
ing
of
find
better ways
we
to
communicatingthese messages, and also findeffective.I think it is clear that,to be
out
at which age theyare the most
sexual activity
before
have
has started.
effective,
to
start
they
basically
I would
completely
agree,
need
Representative Scheuer.
Yes. In other words,they start far earlierthan
the senior year in highschool. Very much eariier.Yes, Mrs. Johnson.
of the dilemmas that parents face and we do
Ms. Johnson. I think one
and support parents in theirroles is that the parents of so many
encourage
of our current
mothers
who are in difficulty,
adolescents,
are themselves single
of them
who are frequently
also not married,and it asks an enormous
amount
And so I think
their own
in fact,
to find the strength
to repudiate,
history.
familiesare a lotof support.
"
"
also urge Reverend Faulkner to understand that our position
on
adolescents and theirbehavior and theirneeds is not based on an adult perspective.
Many of the studies that AGI has conducted are studies of youngsters,
have a lot of
their attitude,
their behavior,and their perspective.
We
faithin their ability
and theyneed to be
to influence and altertheirbehavior,
that.
given
I would
But I would
want
to
of what
giveyou the perspective
ing,
I think of thishear-
that this represents an
not.
we
can
adult view of adolescent sexual behavior. It does
investment
in determiningfrom youngsters
significant
know the enormous
that impact,and Dr. Burt talked about how we
things
altertheirbehavior with televisionand movies and music.
It represents a
"
makes a determination
justwhat a teacher says in school that ultimately
about how a youngster behaves. For example,a studyin Chicago
showed that a mother spends,
cent
with an adoleson
average, maybe 40 minutes
child and the father spends
fiveminutes a day,whereas theyspendhours
with their peers and a significant
of time watchingtelevision. So I
amount
think itis importantto understand that youngsters don't grow up in a vacuum,
and there are many things
that impacttheirbehavior.
It is not
40
Representative
Dr.
I think
Burt.
made
nie
in
However,
then
Often,
you
want
here
is
the
I
incur
not
made
is
message
the
think
that
since
and
place
being
framework
and
time
thoughtful
of
one
This
is
and
to
date
the
their
in
So
I
far
am
and
happy
very
I
and
is
how
the
end
for
to
want
specifically
not
that
the
only
of
and
proper
how
each
willing
and
to
us.
26
my
years
appropriate
of
make
young
in
facilities
congressional
and
with
perceive
we
services
my
enriching
very
thank
much
spent
are
a
experience
your
very
we
in
to
a
we,
investments
counseling,
less
spending
country,
panel
this
this
as
ready
al-
are
things.
are
and
with
active
who
those
country
this
in
those
of
realistic
I have
I think
so
this
issues.
because
of
kind
in
wisdom
your
me,
in
era,
and
them.
for
both
do
thank
these
with
of
capable
married.
be
to
tive,
ac-
basically
are
you
sexually
not-yet
to
people
to
all of
problems.
Clinton
sexuality
education
provide
the
want
shared
having
these
in
of
people's
for
you
involved
preview
of
discussion
is
sex
I
of
sexually
quite
are
part
tertibly
not
lot
the
protection
people
is
a
have
to
way
significant
a
of
Scheuer.
Representative
every
it
stinence
ab-
responsibly.
be
to
things,
programs
with
it is critical
most
married,
both
say
fact,
and
personally
moral
you
In
with
you
messages,
going
are
Jean-
that
behave
can
you
that
point
consequences.
usually
I think
the
if
effective,
And
time
grave
abstinence.
being
if
the
both
give
until
that
that
active.
within
here
to
way
programs
that, but
reinforce
to
can
preferable,
is
sexually
less
and
delay
of
of
and
abstinence
and
the
that
define
Burt.
important
very
is
or
to
message
both
giving
also
is
argument
the
denying
it
Dr.
Yes,
which
passing,
preferable,
is
the
Scheuer.
that
career
on
their
we
this
note.
This
grateful
is the
to
last
hearing
all of
you
for
that
I will
having
made
chair
it
as
a
a
very
of
Member
enriching
Congress.
I
and
satisfying
a
very
am
very
one.
Thank
you
very,
[Whereupon,
call
of
the
Chair.]
very
at
12:05
much.
p.m.,
The
the
hearing
is terminated.
Subcommittee
adjourned,
subject
to
the
41
SUBMISSIONS
FOR
OF
HATEMENT
PREPARED
THE
RECORD
M. JOYCELYN
ELDERS, M.D.
thank Repreof this honorable committee: Let me
sentative
the
social
discuss
before
costs
to
today
appear
you
for which I have been fighting
This is a subject
of teenage pregnancy.
long and hard
director of the Arkansas Department of
Clinton appointed
me
as
since Governor
Health. And, I mightjustadd, Governor Clinton has stood beside me the entire time.
this
has chosen to investigate
that this honorable committee
Both of us are delighted
Scheuer,members
Chairman
Scheuer for inviting
me
issue and
we
assistyou in your work
readyto
are
to
in any way
possible.
Consider these facts:
"
Every 21 seconds
15
a
to
19 year old
becomes
woman
active
sexually
for the
firsttime.
"
Every 64
"
Between
38.4
"
"
to
seconds
infant is born
an
to
a
teenage mother.
increased 16 percent, from
1990, adolescent childbearing
44.6 birdis per 1,000 girls
aged 15-17.
1986
and
adolescence,one
For those who givebirth during
within
two
years.
pregnancy
Every year
out
girl
teenage
nation.
What
more
a
subsequent
one
than 1 million adolescents get pregnant. This is nearly
industrialized
other
of
that
of every ten. This rate is twice
any
the nation's social and
are
in three willhave
economic
costs
of teenage
In
childbearing?
a
word, staggering.
"
is the number one
cause
those who
In addition,
prematurely.
Teenage pregnancy
for females
to
cation
terminate theiredu-
of
get pregnant priorto completion
the
of
time
level
behind
at
grade
nancy,
preghigh school are, on the average, 2 years
hood.
factor to premature motherschool failureto be a contributing
indicating
"
"
who give birth before 18 ever
completehigh
Only 50% of teenage women
school,
comparedto 96% of those who do not have childrenbefore age 20.
Of those
women
who
become
as compared to
college,
plete
mothers before the age of 20, lessthan 2% comof those who wait untilage 24 to have their
20%
firstchild.
"
"
95%
of teenage men
who become parents complete
as
highschool,
of those who do not become parents as teens.
Men
who
70%
as
"
become
those who
fathers in their teens are only50%
put fatherhood off untiltheir20's.
as
comparedto
lege
colto complete
likely
of repeating
a gradeis 40%
higherfor adolescents born to early
probability
born to older mothers.
for
adolescents
20%
to
compared
Women
who have their firstbaby as a teenager have lower status occupations,
nually
receive lower hourly
accumulative lesswork experience,
wages and earn lessanThe
childbearersas
"
than
women
who givebirthlaterin life.
the Southern Governor' s Association and the
childassociated with early
the
Conference,
expenditures
public
Legislative
billion
southern
to
In
over
states
$5.7
1991,
support
spent
bearingwere enormous.
In
a
recent
report released
by
Southern
familiesstarted by teenage mothers. This represents a 60% increase since 1987. In
1988, the U.S. spent $19.83 billionon familiesstarted by teenage mothers. Consider
these other economic facts:
"
More
than 40%
AFDC
program
of the never
married women
when theirchild is younger
younger than 25 who
than 3 spend 10 years or
enter
more
the
on
42
the program.
These young women
for almost one quarter {11%) of
account
and almost one
third (32%) of the totalcaseload.
new
entrants
Two
"
A
teen
birth
living
are
teenage mother in 1988 will cost the taxpayers $16,450 over
receive public
20 years. This is the average for all teenagers, not allof whom
assistance.
The average for onlythose who receive assistance is $37,500. The period
one
"
than 6 in familiesbegun by a
thirdsof children younger
below the poverty level.
"
family
begunby a
selected because
of 20 years was
child to adulthood.
the
publicwill likely
support
than
more
All the familiesbegun by adolescents havingtheirfirstbabyin 1988 will cost
United States $5.98 billionover the next 20 years.
When
I
agreedto
accept the
appointmentas directorof
the Arkansas
the
Department
the major health problemin my state which I
out
worn
was
my state
goingto impact.This has not been an easy job.I have literally
I
could
the
and
down
to listenabout the
to
car
talking
highways
get
driving
anyone
up
problemof teen pregnancy in our state.
of Health,I chose
The
firsttime I
teen
as
appearedbefore
commented,
legislator
until you became
state
pregnancy
"Dr.
our
a
committee
at our
legislative
a problemof teen
didn'thave
health director.
we
Elders,
That justillustratesthe importance of
the public
on
educating
state
one
capitol,
pregnancy
in this
this issue. But
once
be readyto present a planand implementthat plan.
you must
you get them educated,
When I travelaround the
I believe that I have educated my state about our problem.
think
health
what
is
the
and
ask
care
state
problemwe have,
biggest
they
today
people
"teen
pregnancy."
theytellme
Now
we
are
readyfor our plan.
The issue of
teen
rates
are
our
many
poverty
unwed
not
is much likethe chicken and the egg. I am
sure
highbecause of the number of unwed mothers or ifwe have
pregnancy
mothers because
our
poverty
rates
are
so
if
so
high.
cent
the statisticswhich reflectthe economic costs of adolesmotivations
has
indicatethe
been
done
r
esearch
to
However, little
childbearing.
which prompt a young girl
to chose to bear a child.
I have reviewed with you
ual
there is no choice.The pregnancy may be the resultof sexmany,
what
know
is
child
their
the
to
even
within
is
too
Often,
abuse,even
family.
young
all
could
I
the
their
day
telling
spend
you
body as
happeningto
pregnancy
progresses.
gency
horror stories about twelve and thirteen year olds who present in labor in the emerof a stomach ache.
of our hospitals
rooms
complaining
But for some,
there is a conscious choice to have a child,someone
theycan hold
ray
who willlove them. They chose to become pregnant because of the arand someone
of services which we make availableto them. These services are importantand I
would not advocate cuttingthem out for any reason.
But, you must understand that
who has repeated
substandard
below
in
for a poor, young girl
housing,
living
poverty,
of lifefor her. A
an
means
improvedquality
a pregnancy
gradesin school,
one
or more
food
c
ollect
AFDC,
into public
mother can move
stamps and receive
housing,
single
have
herself
to go to school
and her child.She may no longer
WIC food vouchers for
limited
vision,she
ifadequatechild care is not available.In her eyes, with her grossly
for too
Clearly,
success.
overnight
these
children any hope for success
to motivate them to delay
we
enting?
paroffering
Are we
avoid
need
tools
them the
facing
Are we
to
they
offering
parenting?
and 86% of men
effortsto promote abstinence,
75% of women
the reality
that despite
active by age 19?
are
sexually
for me. As director
This is why combatting
teen
pregnancy has been so challenging
for
I can
of a health department,
care
provideprenatal
teenagers who get pregnant.
be
But, to keep them from getting
pregnant, there are many others areas which must
feelthe
heat.
fixed.It is in some
of these areas where you really
beginto
becomes
Are
an
44
Health
on
the
Care
Access,
that he
statement
clinics that when
get
can
held
B
for
than
who
should
$20,000
need
be
society needs
opportunities
the perspective of
is the world's
America
million
12
hair
and
I
children
mothers.
They
the
hungry
albino!
an
until
The
heat
in school-based
clinics
the
of the
last minutes
critical minds,
educated,
be
to
health
state
a
wealthiest
members
are
was
condoms
made
school-based
on
and
dren
chil-
our
develop fully.
to
today and
heard
discuss
with
you
this
director.
today, our
But
nation.
of
live in poverty.
Many
of what
I call the 5-H"
who
long
should
be guaranteed. All children with
is
good citizenshipand whose
family income
at
stateguaranteed free tuition and books
appreciate the opportunity
I
from
dark
funding for
this committee,
so
exhibit
supported colleges.Our
Again,
had
of
heat
higher education
above
or
average
less
issue
he
issue
chaired
facing the
entire
department's appropriation bill
my
It was
the last bill to pass.
session.
legislative
Opportunities
a
The
been
up
1991
6.
I had
started
we
hot.
pretty
who
Clinton,
Governor
and
Americans
poorest
children
these
were
the
are
born
to
teen
the homeless
the
helpless
the
hugless, and
the
hopeless.
children, who
The
thread
to
which
resulted
what
I
am
sure
But,
you
you
you
a
often
I have
in
that the
we
so
next
Band-Aids
make
can
the
even
lem.
probbiggest dog
of the
biggest nation.
this dance
of the
out
by the magnitude
fleas
committed
the
even
hand
to
surgery.
often, overwhelmed
enough
in
me
President
or
will continue
we
care,
hanging by a very slender
society
problems in our
fed,
homeless,
poorly
poorly
are
the
address
compared
attacking the problem
been
dancing with that bear for
willing to join
are
mind,
transform
and
bear.
Until
being poorly housed
is major
I do
feel Hke
just keep
I have
future.
in children
the patient needs
uncomfortable
with
only hope for the future,
our
their
lacking adequate health
and
educated
when
hope
any
have
are
for
at
United
the
of
teenage
federal
States
has
to
dancing
delighted that
also pleased to tell
pregnancy
five years.
level. I am
over
a
I
demonstrated
am
commitment
to
dancing with that bear also.
children
The
to
this
ago
not
cause,
I would
like
of
A
society
to
Thank
grows
sit.
you.
nation
are
crying for
our
help. It
is time
to
become
committed
just concerned.
that I've have
they'llnever
our
close
with
forgotten who
great
when
my
favorite
I borrowed
old
men
saying which
I stole from
someone
so
long
it from:
plant
trees
under
whose
shade
they know
45
PREPARED
Good
STAnMENT
morning, Mr. Chairman.
to
pleased
OF THE
I
am
HONORABLE
DAVID
WALTERS
David Walters,Governor
be here
of Oklahoma.
I
todayas the lead governor to the Southern Regional
Projecton
which recently
authored a report on the publicexpenditures
and
Mortality,
am
fant
In-
vestments
in-
associatedwith adolescent childbearing.
Within the lastfew years, the rate
of babies born to teenage mothers has been increasingsteadily
in a majorityof states
the South and the nation. Not surprisingly,
the public
associated with
across
costs
t
hese
adolescents
familiesstarted
the
rise
well.
supporting
are
on
as
by
In 1991, southern
states
$5.7 billionof federal and state
collectively
spent over
familiesbegun by adolescents.Included in that figure
the three
are
families-in-need:
for
billionfor
billionfor
$
2
Medicaid;
largest
$1.5
public
programs
Food Stamps; and $2.2 billion for Aid to Families with Dependent Children
funds
support
to
(AFDC).
the $5.7 billionfigure
isconservative. We haven't even
estimation,
begun to
talk about the remedial education,jobtraining,
and day care needs of the adolescent
By
my
mother.
With the recent
increase in babies born to adolescents,the federally-mandated
Medicaid expansionsfor pregnant women
and die growing number of
and infants,
families requiring
the
adolescent
for
is skychildbearing
publicassistance,
rocketi
pricetag
In four years, the region's
jumped 60%, from $3.5 billion to
expenditures
doubled. In Oklahoma, 1991
Some southern states'expenditures
$5.7 billion.
actually
out
laystotaled $219 million,
up 62% from $135 million in 1987.
The burden of too-early
With an incomplete
is not justa personal
one.
parenthood
work force skills,
less
education and inadequate
teen
moms
are
likelyto be selfsufficientthan their non-parenting
and
to rely
on
more
consequently,
likely
peers,
financialand medical assistance. The costs extend well beyond the young family
public
and into our public
pocketbook.
should
I do not mean
or
to suggest that these public
programs are inappropriate
be abolished. It is not in our best interests to abandon our most
vulnerable populations.
I do believe,
however, that we need to take a good hard look at our spending
priorities.
Mr. Chairman, the familiaradage*"an ounce
of preventionis worth a pound of
relevant to this morning'sdiscussion. You have heard evidence
cure,"is particularly
that
we
are
payingfor die pound of cure, but
of prevention.
In the same
ounce
in die
support the consequences
to
amoimted
too-early
childbearing
In
for every
fact,
pocketchange.
ments
onlybegun to make wise investthe
lion
bilthat
South
$5.7
expended
year
of adolescent pregnancy, investments to prevent
that is
to $110 million.Compared to $5.7 billion,
we
have
dollar we spend in the South to support the
one
of
familiesstarted
long-termcosts
onlytwo cents is expendedto preby adolescents,
vent
the initial
pregnancy.
As
a
businessman, I believe in shrewd investments diat reduce long-term
outlays.
that would mean
youthdelayparentmoney,
ing
programs that helpschool-aged
untiltheyhave completedhighschool,
and
and are emotionally
self-sufficient,
are
did
of
of
adolescent
out
ten
not
financially
moms
capable raisinga family.
Eight
plan
social problemdiat is not onlyundesirable
We face a serious,costly
earlyparenthood.
affectsas well. I would sugbut to the young peopleit directly
to the general
public,
gest
mandate
have
of
from
the life-altering
course
we
to prevent our
a
youth
facing
unintended pregnancy.
For my
The questionwas posedto me, "What recommendations do I have for investments
that could reduce the incidence of teen pregnancy?"
I am gladto proffer
losophy
phimy own
which is groundedin research,common
hours
with
and
long
sense,
my health
advisorswho do theirbest to educate me. There is no singular
solution,
theycontend.
To be successful,
multifaceted
interventions must
be a
our
response to die multitude
of reasons
why pregnancies
occur
among adolescents.
46
"
combat ignorance,
and dispel
counter
misinformation,
myths,communities
and reproductive
information about human sexuality
should provideaccurate
health.I strongly
believe that parents have the primaryresponsibility
for shaping
but theyclearly
values and attitudes about sexuality,
in need of help.
are
Classroom-based health and sexuality
education programs do increase knowledge.
"
skillsto
interpersonal
By building
To
our
The
young
most
their sexuality
we
power
emresponsibly,
manage
sions.
peopleto resistpeer pressure, to make smart, healthfuldecifrom
powerfulevidence of effectiveprograms we have comes
students from behind theirdesks and gives
curriculathat pulls
classroom-based
skills
needed
them the opportunity
to rehearse and practice
to
avoid sexual pressures.
"
for sexually-active
Provide health care and family
teens. It is
resources
planning
health nurses
in-takethat adolescents
for public
not
to discover through
uncommon
a
are
active,not usinga birth control method, and not planning
sexually
needs
health
adolescents'
medical
and
Too
are
care
often,
preventive
pregnancv.
In Oklahoma, we are making them a priority
ne^ected.
special
by establishing
who work well with teens, and promoting
clinichours,employing
professionals
services to make sure theyknow about what is available.
"
and
Finally,
link students to the future
this is our greatest challenge,
must
we
that theyhave other optionsbesides earlv parenthood.
and givethem the sense
of our young parents are not motivated enough to avoid the potential
So many
of unprotected
intercourse. Students who have lost interest in
consequences
often fallprey to the early
for success
school and have low expectations
most
and regaintheirinterest in
their
We
need
raise
to
parenthood
expectations
trap.
learning.
proud to
of our southern states have taken great stridesto
say that many
for
Their effortsserve
make adolescent pregnancy prevention
as exemplars
a priority.
the country.
I
am
West
and Tennessee,for example,
ists
employadolescent pregnancy specialVirginia
statewide to assistcommunities
efforts.
in theirprevention
Oklahoma's attempts to bringadolescents into the publichealth
block grant to school-based
doors. Georgiahas committed a fairportionof its MCH
Florida'scomprehensive
of
theirstudents'health
status.
services in hopes
enhancing
that
national
communities
and well-funded school healthprogram is a
model;
across
allstudents.
state are givenfunding
to ensure
a basiclevelof services to
I mentioned
We
to
have esand North Carolina,
tablished
in Georgia,Kentucky,
in
that
communities
ing
respondflexibility
state grant programs
provide
greater
funds for innovative projects.
localneeds by providing
in
Oklahoma, as well as
cannot
we
Despiteallthese efforts,
attempt
to
match the need. Mr. Chairman,we
Your leadership
in creating
need the helpof Congressto make thisa nationalpriority.
health
has
those
federal
a
i
nitiative
public
generated
a
family
planning
many
years ago
all
X
Tide
those
as you know,
resources.
women.
our
greatestprevention
and
funds continue to buy us less and lesswhen we are required
to achieve more
and the myriadof socio-healthproblemsfacing
our
Given the limited resources
more.
and HIV
infant mortality
substance abuse,low birthweight,
communities, including
the public
health community is forced to make hard choices about spending
infection,
nately,
And unfortuhealth dollar as far as possible.
We have stretched our public
priorities.
federal
adolescents are payingthe consequences. There simply
resources
are no
to address the health information and service needs of our childrenand adolescents.
response
to
unintended
fighting
It is one
of
pregnancy
-
not
justamong
teens, but among
But
hopefulthat thisnew administrationand new Congresswillmake young people
health
accessible
a national priority.
Empoweringthem with accurate information,
the number of
of the future is our greatest hope for curbing
a sense
resources, ana
started
the number of families
by young
pregnanciesto our nation's adolescents,
I
am
47
people
not
supporting
Thank
out
even
high
school,
and
the
exorbitant
public
costs
associated
families.
those
you
of
for
this
opportunity.
I would
be
glad
to
entertain
your
questions.
with
48
AnACHMINT
TO
THt
HONORAtU
MR.
WALTIItS'
nATIMINT
MtlPAMD
EXPENDITURES
AND
INVESTMENTS
Adolescent
Prepancy
in the South
Soutktrn
Soalbin
Mortality
Infant
on
Ri^ional
Project
Cmtir
on
AMndnt
Priptnn
Prnimion
1992
49
EXPENDITURES
INVESTMENTS
Adolesctm
in
Pregnancy
tbt South
Note
Author
the
from
bill each
publics
is the
Hhat
adolescents?
It is
attachinga price tag
who
leaders
state
hope
advocates
to
greater
dollars
being expended
public funds
each
adolescent
on
to
are
the billions of
of
investments
in the
adolescents
among
for
argument
Of
what
pregnancy,
pregnancies
prevent
put prevention
compelling
a
of
the interest
childbearing,
tell half the story.
they only
for adolescent
year
made
being
are
expenditures
Public
prevention, but
to
appropriate
public spending
by
that
surmise
public agencies.
to
fiscally-responsible
policy-makers to
prompt
attention
funds
started
are
who
childbearingmight pique
policy and
costlyremediations.
Ijefore
families that
question of advocates
adolescent
to
set
the exorbitant
By exposing
for supporting
year
often-asked
an
first place?
The
Southern
Center
Adolescent
on
regionalanalysisof
a
pregnancy
for the purpose
initiatives.
Recognizing
crosses
for
estimates
health, and
what
to
efforts
state
and
health
to
adolescent
pregnancy
This
a
is not
southern
civic
draw
attention
parents
desiringto
states
initiatives
completed
Infant
to
both
surveys
to
John J. Schlin
September,
the
1992
determine
to
should
be; directed
reproductive
to
the
agencies and
state
for this
state
are
by
used
for
designated specifically
not
are
spending
those
and
combat
and
to
and
the poor
does
not
from
them
here
programs
becoming
provide guidance
management
is the
capture
entities,
the countless
their assistance
differential between
sexual
commitment
states'
policiesand appropriations.
of its
parents.
for
youth.
of programs
myriad
includingreligiousin.stitutions.
youth organizations;
their
immeasurable.
and
agency
telephone
to
.Meg
state
featured
communiry-based
responded
analysisof
an
that prevent
programs
invaluable
Kelly Thompson
Mortalityfor
were
designated by
by-pass
education,
state
used
funding
or
gauged by
as
Investments
staff is indebted
Center
thanks
are
criteria
and
but
sponsored by non-public
hospitals,and
groups,
contributions
The
prevention
Expenditures and
What
funds
programs,
importantly,the exemplary
Most
from
initiatives
policy,program,
prevention
funding
and
prevention.)
adolescent
serve
stimulatingprevention
first pregnancies; direaly related
federal
prevention
pregnancy
is to
Its purpose
and
The
prevent
rigorous, scientific study, but rather
adolescent
that
to
instances,
some
localities for at-risk
to
include.
conducted
adolescent
to
pregnancy
information
Several
responsiblesexualitymanagement;
(In
purpose.
adolescent
requested
the Center
administrators.
service
that seek
initiatives
for
responsibility
related
funding
state-sponsored primary prevention
human
[the Center)
Prevention
and
of assessing the state's role in
that
boundaries,
agency
Pregnancy
policies,programs,
state
LaPone
in
representatives
information
of the Southern
collectingdata.
who
requests.
Special
Regional Project
on
50
SPECIAL
INITIATIVES
Community
Grants
State
48,000
Federal
Louisiana
SCHOOL
School
State
Health
of
dedicates
school
and
HEALTH
Services
Department
Hospitals
PUBUC
health
Title
Health
V
MCH
Block
70,000
and
federal
funds
personnel
services
administration.
HEALTH
SERVICES
Family
Planning
Family
Case
State/Federal
3,073,000
Planning
Management
Federal
funds
Title
dedicated
are
to
family planning
case
program
management
V
MCH
Block
to
prevent
first pregnancies
Maryland
$5,682,000
total
comprehensive
school
Teacher
health
Training
Annual
CDC/DOE
wellness
state
education
conference
teacher
personnel,
for
workshops
health
nurses
Fedeml
and
dedicated
funds
in
15
support
counties
funds
state
to
training
state's
Services
federal
school
for
framework.
Health
and
the
teaching
curriculum
School
State
are
school-based
one
clinic
HEALTH
Family
SERVICES
Planning
High-Rlsk
Planning
SPECLU.
Adolescent
Grants
Family
Program
INHTATIVES
for
Campaign
Children
Our
Incentive
Community
State
141.000
one
community-based
early
PUBUC
$3,284,000
TOTAL
COMPREHENSIVE
to
690,000
of
Department
Education
Grant
Miscellaneous
Grants
Department
funds
conlerence.s
annually
adolescent
initiatives
-i
pregnancy
for
health
teen
high-nsk
and
"
school-based
prevention
students.
grants
100.000
52
adolesceni
sexuality
teachers,
Male
Involvement
Funds
state
position
parents.
Program
family planning
stimulate
to
involvement
and
for
counselors
public
Adolescent
health
and
by
local
public
state
leaders,
with
8,"'00
over
information
resources.
total
comprehensive
school
$4,903,000
health
Training
State
101,000
CDC
PUBUC
HEALTH
Family
Health
State/Federal
Scene
Cotnmuniry-based
and
teen
SPECIAL
18,500
SERVICES
Planning
Teen
unavailable
health
Carolina
Teacher
Block/
funds
one-day
link
health
community
South
MCH
Communirv
conferences
students
V
agencies.
Health
Coordinated
and
Title
16,000
schools
in
Conferences
staff
X
male
activities
health
Title
staff
2,287,000
State
comprehensive
family planning
36,000
Medicaid
360,000
clinic
EVrriATIVES
Teen
Companion
Program
Medicaid
Tennessee
pubuc
total
health
Family
State
a
State/Fedei^l
Title
dedicates
federal
health
V
MCH
4.022,000
Block
245,000
funds
commumry-based
adolesceni
SPECIAL
$4,619,000
services
Planning
Clinic
Teen
to
2,100,000
comprehensive
clinic
DVmATIVES
Adolescent
Pregnancy
State
320,000
Prevention
Initiative
Teen
The
health
Theatre
PG-I3
Hlavers
related
peer-to-pcer
Male
Kunds
20,000
Title
.X
12.000
theatre
siatf
for
a
community-based
familv
male
education
involvement
X
information
through
Involvement
suppon
Title
provide
planning
program
53
Texas
comprehensive
health
school
Health
Education
School
Based
Specialist
Clinic
Coordination
PUBUC
HEALTH
SERVICES
Family
Planning
Adolescent
Primary
Clinics
Care
Family
Teen
SPECLU.
Planning
Clinic
X
120,000
Theatre
Title
Male
Involvement
State
51,000
State
27,000
Male
Teen
Education
Initiative
Initiative
Title
Virginia
SCHOOL
Teacher
training
eight
components
health
program.
School
DFSC/CDC/State
Health
tf"
integrate
ol
a
.school
Services
Personnel
HEALTH
Family
MCH
Block
150,000
$5,425,000
HEALTH
Training
Statewide
V
TOTAL
COMPREHENSIVE
SPECLU.
739,000
Teen
Health
PUBUC
X
INTTIATIVES
Hispanic
West
Title
SERVICES
Planning
INITIATIVES
Community
Organization
Conununity
Grants
the
200,000
54
Southern
The
Center
Adolescent
The
on
is
Prevention
the
Delaware,
Arkansas,
house
clearing-
a
Projea
Infant
on
and
Mortality
Southern
the
by
funded
is
from
grant
generous
report
do
Mississippi,
of
Suite
Carolina,
"Washington,
p)ositions
of
Southern
Governors'
Virginia,
Virgin
in
The
the
tories
terri-
included
not
because
study
readily
not
were
of
Disiria
and
this
$10.00
West
available.
the
all
or
of
portions
the
this
report
be
may
Legislative
Southern
without
reproduced
Conference,
or
the
prior
Carnegie
Corporation
p"ermission,
vided
pro-
of
the
New
the
and
is
source
York.
cited
as
Adolescent
Pregnancy
in
and
E)ipenditures
Investments
Southern
Adolescent
Prevention:
D.C.
South:
the
(1992),
Center
on
Pregnancy
'Washington,
St.,
N.W.
200
202/624-5897
Tennessee,
Islands,
Any
Association,
South
Rico,
Texas,
data
constitute
not
Capitol
North
were
in
views
N.
Oklahoma,
New
this
444
Missouri,
Columbia
Corporation
The
Maryland,
Virginia.
Carnegie
York.
Louisiana,
Puerto
Conference.
Center
Kentucky,
Carolina,
Southern
the
Legislative
a
sf"on-
Association
Governors'
The
is
the
by
sored
and
J. Schlitt
Georgia,
Coordinator
Regional
Southern
the
Pregnancy
Prevention
John
Florida,
of
function
assistance
on
Columbia,
of
District
technical
and
Center
Adolescent
Alabama,
encompasses
Pregnancy
Southern
region
Project's
DC.
20001
55
For
every
SI. 00
spent
on
two
assistance
public
and
are
Hhere
of
types
costs
associated
with
adolescent
public programs
dedicated
Jbr families begun
as
the
to
of
prevention
funds
and
adolescents,
the
South
directed
pregnant
parenting
cents.
adoles-
the
For
spends
an
estimated
of this
as
2t
on
primary
expenditures,
from
prevention
the
prevent
resulting
in
a
speaks
who
contend
The
Souths
ent
differ-
tax
activity
pregnancy
by
being
committed;
that
unproteaed
every
SI. 00
public
that
for
spent
curb
to
intercourse);
deal
exfDenditures
the
of
consequences
begun
adolescents,
spends
programs
reduce
too-early
childbearing.
on
fiscal
on
estimated
primary
cost
southern
more
than
might
be
billion
the
cost
state-specific
for
public
failing to
This
figure
make
includes
prevention
[see
pregnancy.
estimates).
of
federal
funds
state
table
considered
estimated
in
of
prevention
adolescent
states
an
2c
and
Expenditures
childbearing
South
S5.7
pregnancy
1991,
year
by
the
an
greater
give
for
programs
families
with
budgets,
primary
to
adolescent
sexual
for
who
government
prevention
In
pregnancy.
(early and
tool
agency
attention
already
are
larly
particu-
leaders
spending
port
sup-
reveals
dollars
financial
a
policies, balance
and
begun
adolescents
direaed
to
the
be
to
public
set
cent
adoles-
issues.
bill
families
found
prompting
tax
in
child-
Advocates
[sersuasive
place
no
invested
and
impact
those
that
have
have
the
high
a
adolescent
bearing.
report
that
pays
pregnanc7
ed
support-
to
too,
for
price
consequence,
This
provide
evidence
suggest
public,
fewer
yield
data
which
pregnancies,
sexuality
other,
are
might
by adolescents,
cost
compelling
prevention
also
being
the
attention
greater
publicly
dollars
to
resp"ec-
each
investments
to
as
and
investments
cents
adoles-
families.
these
tively. Distinaly
of adolescent
efforts
fewer
referred
be
that
primary
and
purpose
report,
shall
costs
to
begun
pregnant
inappropriate,
unintended
to
for
programs
and
primary
cies
pregnan-
adolescents
among
is
but
funds
pregnancy;
for
parenting
PUBLIC
investments.
three
for
outlays
the
largest public
EXPENDITURES
This
different
with
adolescent
it5
southern
purpose
to
minimal
of
state
in
.sonal
has
contrast
around
costs
and
argument
federal
include
not
of
to
child-
.^s
thai
related
to
Children
IS2
per-
child,
years
on
of
are
national
suggest
data
that
S3%
receiving
public
a.ssistance
when
a
IS 15
single
estimates
begun
was
billion],
stamps
families
to
billion),
2
These
cost
based
which
to
mea.sured
families
ftxKi
year
Aid
Dependent
(S2.0
.Medicaid
billion!.
economic
impact
with
typically
broadened
recent
Families
the
lescent
ado-
serve
familie.s-in-need:
and
the
her
with
by public expenditures
prevention.
is
been
within
investmenLs
pregnancy
The
framed
and
for adolescent
resources
adolescent
adolescent
childbearing
to
associated
beanng,
tant
exorbi-
public expenditures
related
Hhe
Its
draw
the
to
analysis
consequences
prevention
states.
is to
attention
nancy
preg-
which
programs
associated
costs
and
in
the
examines
report
teenager
were
the
mother
56
EXPENDITURES
PUBLIC
RELATED
TO
CHILDBEARING
ADOLESCENT
FY
AFDC
Food
1991
Total
Medicaid
Stamps
Alabama
$
45,426,000
48,360,000
23,556,000
Aritansas
$
31,156,000
23,892,000
42,839,000
97,887,000
Delaware
$
21,643,000
18,677,000
28,585,000
68,905,000
117,342,000
Florida
$301,075,000
198,863,000
295,951,000
795,889,000
Georgia
$196,381,000
137,045,000
202,578,000
536,004,000
Kentucky
$118,791,000
19,597,000
128,504,000
266,892,000
Louisiana
$112,055,000
122.187,000
100,773,000
335,015,000
Maryland
$229,234,000
79,931,000
140,131,000
449,296,000
65,482,000
102,876,000
220,054,000
51,696,000
Mississippi
$
Missouri
$127,942,000
73,201,000
126,729,000
327,872.000
N.Carolina
$181,718,000
79,100,000
197,010,000
457,828,000
Oklahoma
$100,452,000
53,945,000
64,697,000
219.094,000
60,004,000
45,151,000
173.258.000
S. Carolina
$68,103,000
Tennessee
$158,520,000
123,850,000
143,487,000
425,857,000
Texas
$278,927,000
251,131.000
224,876.000
754.934,000
Virginia
$123,424,000
69,326,000
91,956,000
284.706,000
70,599,000
67,720,000
202,180.000
West
Virginia
$63,861,000
Regional
^~~~~"~~
Total
2,210,404,000
^^^^~~~"
1,495,190.000
"
"
"
"
2,027,419,000
"
^^^^
5,733,013,000
57
Public
The
have
costs
does
dnrmaticaliy
risen
because
take
not
and
estimates
last
were
(iay
and
mother
term
total
1991,
and
has
Medicaid,
EDUCATION
AND
SERVICES
too,
the
over
Hompre
health
school
years.
has
long been
regarded
WIC.
PUBLIC
school
as
essential
INVESTMENTS
special education,
foster
HEALTH
SCHOOL
els
lev-
payment
stamps,
last four
by
pregnancy.
COMPREHENSIVE
the
include
housing
meals,
and
steadily
targeted
adolescent
reducing
at
and
initiatives
number
increased
have
subsidies,
subsidized
1981
food
and
be
has
across
and
region;
special
the
for AFDC,
might
begun
adolescents
Between
infant.
cents
adoles-
sen'ices
adolescents,
eligible for
families
increased
by needy
families
region.
1986;
public support
the
her
that
costs
incurred
the
increasing
potential long-
Other
compiled for
for
care
been
of
job training,
for
15-17
since
public health
child-
among
aged
remedial
education,
faaors:
bearing
with
of
combination
a
several
parenting,
including
when
1987,
to
public
associated
adolescent
is
it
into
other
account
costs
since
figure
billion
$57
conservative
of
p)onent
care.'
the
cent
adolestion
preven-
pregnancy
ments
invest-
Btates'
paradigm.^
in
prevention
of
adolescent
nancy
preg-
parenthood,
60%,
Public
have
costs
risen
are
1987,
since
skills, and
when
estimates
refleaed
were
for
compiled
last
the
the
in
S3. 6 billion.
upfront
young
information,
need
people
dramatically
funding
sexuality
their
manage
School
responsibly.
facilitate
that
local
programs
have
promising
impact
health
and
1991,
total
efforts.
prevention
costs
For
had
increased
60%,
the
from
up
of
purpose
this
on
Southern
S3. 6 billion.
the
report,
students'
increasing
Center
of
knowledge
largest
increases
Icxjked
the
exp)eriencing
states
at
a
broad
tion,
reproduc-
sexuality and
of
were
state-sfxjnsored
that
initiatives
(110%),
skills
for
have
sexual
responsible
sion-making,
deci-
potential for preventing
( 108%),
Tennessee
human
range
building
Florida
to
resources
policies,
and
programs,
1987
Between
region.
To
primary
successfully delay early
Trends
Spending
increased
costs
an
com-
supporting
North
(96%),
Carolina
Delaware
adolescent
(92%),
pregnancy,
health
including
and
parents
and
sexuality
as
and
educators,
for
Ccnier
Options.
and
nancY
in^
the
was
health
only
costs,
family planning,
tures
expendi-
whose
state
Surveys
Although
reveal
that
establish
are
legislative and
minor
Health
J
(
1991
to School,
1
Bnniiinii
Mortahty
Proiect
state
on
to
activity
the
increase
can
in
three
areas:
knowledge
attributed
generally
that
p"ersonal
hensive
compre-
responsibility for well-
Intant
be
foundation
is concentrated
stresses
Southern
state,
Regional
from
differences
a
agency
of
Schlitt.
can
programs
state
DC
there
2
school
programs.
health
unchanged.
services.
life
and
Comprehensive
options
remained
sequences,
con-
l-Ah ctJitK)n,
Washington
and
personnel
chittthear-
personal
health
services,
TeenaneprvK-
too-eariy
Public
Alabama
pro\id-
with
ing linkages
PopuUtion
1992
(90%).
Virginia
West
1
tion,
sexuality educa-
human
school
health.
58
AL
SCHOOL
LIFE
SERVICES
DIRECTIVES
EDUCATION
FOR
POLICY
PREVENTION
TRAINING
POLICY
None
None
None
None
Curricula
Mandate:
one
AK
HEALTH/FAMILY
HEALTH
grades
Mandate:
and
high
TEACHER
HEALTH
unit.
grades
one-half
and
K-8
school
high
PREGNANCY
K-8
unit
a
5-6
for
training
districts
in
law
State
mandates
of
services
year.
school.
school
per
distria;
nurse-student
DE
Mandate:
grades
K-12
required;
46 teacher
bullet
see
in
trainings
for
92
1991-
school
2800
personnel.
FL
Mandate:
grades
K-12
Mandated
human
sexuality
Variety
education
grades
K-12.
across
KY
Mandate:
for
30 hours
and
grades
K-8
school
unit.
Local
option.
high
1
sexuality
Human
is included
required
tion
educa-
see
training
events
mandates
see
See
bullet
None
competency.
defines
State
None
None
MD
of Health
units
Education
required
for
Mandate:
and
Health
None
teacher
topics
by
training
are
grades
K-8.
required;
None
conference
for
teacher
for
option;
health
education
Local
NC
Mandate:
education
state
health
option.
Mandate:
grades
but
not
funded
but
not
funded
state.
K-9
None
None
None
None
Authorized,
Beginnmg
learner
outcomes
'93.
Family
Life
school
year
grades
1-12.
to
schools,
for
are
provided
but
not
SC
Mandate:
grades
K-8.
required:
see
bullet
Mandate:
grades
K-12.
required;
see
bullet
dated.
man-
and
AIDS
HIV/
See
Family
See
None
description of
required.
Written
health
services
None
training
700
in
state
1991-92
.\uthonzed,
life education
request;
K-12.
serving
bullet
served
grades
health
topics workshops
466
personnel in
teacher
Mandate:
state
no
attached
was
None
TN
TX
standards
health;
curriculum
by
OK
school
Authorized,
by
education
is avaibble.
curriculum
MO
shops
work-
trainer
for
and
adopted
agencies
funding
the
Train
None
state-
sive
comprehen-
health
State
for
health
curriculum
adopted
for
nurses.
request.
personnel;
Wellness
bullet
see
training
Local
be
to
mandate
no
graduauon.
school
MS
essential
services
school
Physical
units;
as
provided;
Two
one
teacher
aruiually
bullet
health
lA
is 1:1,000
ratio
per 40
bullet.
nurse
nurse
suggested
serving
state
teachers
1,000
GA
of
the
law
State
the
licensed
a
by
by
teachers
bullet
E,s.scntial health
for
Mandate:
grades
K-10
WV
Mandate:
grades
K-12
required:
required:
see
bullet
See
see
bullet
Statewide
funded
not
1991-92.
mandated;
VA
but
state
bullet
no
."er\'iccs
state
funding
implementation.
None
teacher
to
integrate
of
school
training
8 components
health
program
.Mandated
ratio;
funded;
student-nurse
health
see
personnel
bullet
state
60
of
benefits
sexual
ment,
involve-
school
the
of
methods
In
The
of
grant
Education's
the
staff,
of
benefits
relate
health
responsibility of
family planning, and
the
to
of
effeaiveness
topics, many
states
have
funds
to
support
Virginia's
West
"
ing
address-
state
risk
all health
including
behaviors,
sexual
ty.
activi-
inclusion
of
too-early
implications
of
The
adolescent
and
fertilitycontrol;
in
recognizing
prevention
pregnancy
state-sponsored
of
resp)onsibility
activities
parenthood
and
the
significance
of
family
planning.
The
programs.
and
have
states
ing
followstrated
demon-
Sexuality
Human
a
significant
Education
in
ing
supporting
Tangible
is
education
health
apparent
sponsor
human
for
support
when
sexuality
training.
tion
educa-
State
Policy
health
and
school
the
Among
health
components,
health
services
least
the
received
of
amount
from
has
tion
atten-
ment.
govern-
state
southern
educators:
.states
states
and
Health
Six
"
health
into
curricula.
Services
.sexuality
human
infusing
in
topics
probably
toward
commitment
Tra
p"ersonnel
health
comprehensive
Health
for
interested
School
regarding
philosophy
staff
the
on
agency's
education
Cancer
provides
Council,
existing
greatly
depends
the
state-
5700,000
at
Texas
health
the
training
Project,
school
of
methods
evaluating
and
sexuality
Health
development
pregnancy;
human
van
teacher
School
Texas
via
the
analyzing
include
The
funded
education
health
education
training.
health
for
framework
across
mobile
a
provide
and
a
in
state
health
the
cators
edu-
travel
to
the
two
health
full-time
specific
comprehensive
contraception.
"
While
used
funds
Education
funds
State
of
Department
and
very
Carolina's
South
"
al
profession-
categorical
teenage
activity, the
sexual
life education
sequences
con-
the
of
family
state's
mandate.
materials.
health
the
involvement,
ing
implement-
in
the
trative
adminis-
development,
sexual
postponing
assisting
schools
support
state
agencies
thereby
education,
including
understanding
include
16
the
education
service
and
have
fiscal
health
for
objeaives
learning
regional
prevention
provided
family life education
federal
programs
trainers
of
each
in
family
for
salaries
life education
and
HIV/AIDS
State
to
revenue
limited.
Schools
Free
Communities
Virginia
Board
years
state
fund
to
tion
instruc-
been
recent
Drug
pregnancy
prevention.
"
health
have
various
of
training
personnel
provide
of
pregnancy,
teenage
and
funds
effects
the
for
ing
postpon-
In
1991.
code
Governor
having
no
regulating
school
Miller
health
earmarked
report
Georgia's
services;
seven
5500,000
states
authorize
the
61
provisionof essential
services
but do
provide
for
funding
tives
adolescen
and contraceptive
public
health services
table].While school
the prevention
providerof school
health services, are
by
supportedprimarily
states
paradigm
because theylink young
sonnel
people to health per-
grant funds for health
to
service
In
represents the region's
investment of
largest
and federal funds
state
toward adolescent
pregnancy
and
educators,
sexually
fact,family
planning
counselors,
"
federal block
designate
services
active adolescents.
vitalpart of
a
are
the dominant
local funds, some
providing
on
counseling
family
planning
SERVICES
(see
implementation
nurses,
focus
HEALTH
PUBLIC
not
prevention.
With adolescents
providers and medical
"
personnel. Three
have made
states
significant
a
financial commitment
to
school health services
Delaware
and West
mandate
Virginia
school
nurse
including
a
ratio
in West
Virginia;
per number
of teachers in
capacityfor supporting
160 school health
considered
state
are
state
employees;their
throughstate funds.
providingfamily
resources
planning
includes
state
and
from
source
tion
appropria-
allocated for expanded
Daly. .M (1W2)
Glance.
,
41
school-based
services
Facts At A
to
18 years of
Child Trends
0-94-3
age.'For
the risk of
unmtended
populationas
an
agency
of
25%
an
access
and
to
family
planningservices for
to
sites,publicize
delivery
programs, implement
aggressivefollow-up,
no
contraception,the risks
great.
care
e.stablishnontraditional
active
.sexually
use
health
provide.service outreach,
pregnancy
adolescents who
concerted effortsto
adolescents. Effons
for the
is significant;
state
fX)pulations.
Wishinpon. DC
76-611
high-risk
the region have
and increase
are
cents
each of these adoles-
are
for
family
of
improve the delivery
thought
be sexually
active by
|S9 million]is
K.. Snyder. N
vary
to source,
than half of all
(S5.7million]for basic
additional
seek
identifiedthis high-risk
services.
While the estimates
funding
health services;
an
at
unintended
and have made
priority
adolescents
districtprograms
pregnancy
across
to
access
an
planning.Many state
publichealth agencies
to improve
designed
health code establishes
Moore.
public
Center examined
and
counseling,
alladolescents
risk of
adolescents. The
more
1
Not
to
Florida'sschool
the foundation for
alone total over
567,000,000(see table].
health education,
salaries are funded
"
of sexual
involvement, and for
adolescents'
jjersonnelin each
s family
state
clients,
planning
and federal family
counseling
planning
and contraceptive
for this popuresources
lation
for encouraging the
health initiatives
Delaware). The nearly
nearly30%
representing
of the South
enormous
postponement
grams,
pro-
nurse
specific
(perstudents
agencies have
adolescent
respKDnsible
sexuality
management,
and p)ersonnel:
"
Public health
care.
Many of the
prevention initia-
sensitive
and hire .staff
to
adolescents have
been
enhanced
greatly
62
STATE
FEDERAL
AND
FOR
RESOURCES
PLANNING
FAMILY
FY
1990
AL
AR
DE
FL
GA
KY
lA
MD
MS
MO
NC
OK
sc
TN
TX
VA
WV
South
1
Escinaied
bv
2
GoJd
Dalev
FamUy
cbenis
3
and
Planmng
heahh
state
f
1992).
agency
admmisnuton
Funding
PuNk
Pier^tectUMX 23(5).
$67,716,000
$47,721,000
$19,995,000
29%
p
of Contraceptive.
204-211;
and
repona
Stenlization
of
adolescents
Block
Grant,
and
as
Abortion
a
Services.
pcnreraage
of
Fwcal
Year
I9W,
family pianntng
served
Fedeial
funds
comprise
Tide
X
Medicaid.
Tide
V
MCH
and
Tide
XX
Socol
Services
BlocJc GnmL
63
by
states'
of
federal
dollars
and
state
grant
toward
adolescent
tion
demonstra-
planning
commitment
with
care
program
Prevention
Initiatives
communities
seven
primary
Primary
in
large propwrtions
evidenced
As
services.
of
expenditures
growing
"
With
5500,000
in
Oklahoma
"
allots
related
combined
and
state
of
$280,000
funds,
federal
funds
State
public health
of
Department
Health
around
by adolescents,
to
the
Arkansas'
families
to
and
state
begun
federal
lion's
share
public
the
enhance
ship
partner-
a
state
local
and
resources
to
dedicated
are
health
to
with
of
clinics
programs
forged
has
by the
high-risk youth.
delivery
the
serving
quences
conse-
adolescents.
to
of young
education
agencies
to
people's sexual
20
create
based
Reaching
SPECIAL
health
the
f)eople
young
centers
before
across
activity.
school-
they become
INITIATIVES
state.
while
sexually aaive,
"
The
Georgia
is
of
Department
Resources
Human
Hhere
among
of
nearly SI million
federal
Maternal
Child
Health
Grant
annually
school-based
its
to
social
and
program
that
adolescent
providers
counties
be
must
the
across
"
The
state.
Kentucky
State
of
Department
dedicates
12
of
its Maternal
Child
Block
survey
and
planning.
Adolescents
who
to
lack
that
instruction
family
The
hours
a
variety
that
planning, Maryland
strategies
appropriated
implementing
million
of
for
state
a
S2
enue
rev-
family
communities
adolescent
and
of
states
to
pregnancy
childbearing:
break
traditional
delivery
of services.
programs
innovative
in
efforts
are
that
delay the
to
of sexual
among
"
are
ation
initi-
activity
high-risk youth.
South
Carolina
Services
Care
they
statewide
s
of Social
Departments
help
reduce
innovative
the
for
initiatives
states
that
represent
.services.
following
reflect
of
expanded
family planning
in
from
Two
created
These
health
or
after-school
a
variety of barriers
will
hour
an
reproduaive
state
face
accessing
than
Infant
on
programs
from
society
revealed
adolescents
have
greater
a
Regional
Projea
motivation
Youth,
High-Risk
Mortality].
delay early parenthood,
require
primary
a
the
Pregnancy
Among
family
of
Prevention
Southern
education
commitment
facilities
Following
than
they contend,
toward
school-based
care
broader
cent
adolesissues
(see Schlitt, J. (1992).
Adolescent
sexuality
Health
Grant
adolescent
"
Health
nearly S.5
million
and
human
public
treat
Primary
prevention
pregnancy
14
how
to
sexuality
researchers,
the
not
institutions
health
in
centers
exception,
norm,
tion
preven-
advocates,
and
Block
belief
increasing
commits
logical, is the
seemingly
an
and
Health
Financing
teamed
establish
up
an
to
after-
64
school
prevention
for
program
eligible youth.
the
Teen
links
Called
sexual
to
help
through
campaign
The
variety
and
way."
and
through
lesson
and
an
nity
opportu-
di.scuss
explore
the
campaign
s
private
the
funding
its
serve
fulfill
of
range
well
as
community
as
including
training workshops,
responsibility
assessments,
health
programs,
guides,
resource
and
West
etc.
Virginia and
Tennessee
have
unique
and
taken
approach
Georgia
annual
Sl.l
state
appropriation
local
health
dedicated
full-time
solely
coordinating
in
guishing
distin-
adolescent
initiatives;
nity
commu"
Kentuck-y
state
activities.
community-
to
adolescent
pregnancy
ments
depart-
staff
based
participation of the
to
agencies
for
Organization
an
million
resources:
health
employ
provides
ties
communi-
students.
Community
health
conferences.
"
and
materials,
adolescent
to
themes
state
teacher
including
male
"
wide
a
special
activities,
needs
could
youth.
to
Programs
organizing
community
community
determine
to
maintain
undertake
a
The
among
used
are
process
tion
collabora-
of
instruction
teachers
with
grant
prompts
needs,
plans give
to
and
coalitions,
television
ads,
tive.
cost-prohibi-
ration,
collabo-
best
Classroom
posters.
the
and
were
to
how
form
resources
staff tfiat
agencies
Funds
efforts
by providing
youth-serving agencies.
a
augment
to
strengthening
public
media,
radio
prevention
linkages between
ing
promot-
time
programs
local
coordination,
including billboards,
prime
grant
The
abstinence
of
grants,
stimulate
go
State
or
heretofore
you
message
delivered
is
money,
organizations
can
responses
needs.
and/or
all the
sexual
local
also
when
greater
provide
community-based
the
"You
go
communities
in developing
flexibility
incentive
Our
across
farther
don't
seed
grant
provide
programs
for
adolescent
Maryland
advises
that
state
gies
strate-
to
family
for
children
state
prevention,
Virginia and
Maryland's
Campaign
pregnancy
around
resources
of
aspea
comprehensive
"
life education
program,
which
one
adolescent
pregnancy.
media
and
Children
to
community
and
categorical
programs
address
preventing
combination
A
grant
funds
identifying local
and
most
southem
provide
organization
mentoring.
"
Community
Grants
necessary
Four
facilitate
activity and
education
is
creating effective
states
early
parenthood
solutions
programs.
with
delay
Pregnancy
Prevention
Unlike
adult
people
young
to
able
undesir-
developing
indisputably
and
companions
in
prevention
initiative
peer
them
and
the
statewide
Adolescent
childbearing as
Companion
Program,
and
pregnancy
Medicaid-
prevention
variet\-
revenue
of
combines
and
federal
a
65
block
dollars
grant
sponsor
investment
special prevention
and
initiatives
Center
North
fund
for
grant
and
Service
$1.4
on
Oklahoma
funds
made
of
local
to
community
to
adolescent
some
cent
adoles-
have
prevention
which
the
initiatives,
establishment
task
community
force
used
for
public
youth
the
and
It
spending
to
of
adolescent
prevention:
REGION'S
resources
FINANCIAL
to
be
some
states
Aal
planning
grant
is
source?
Are
Hor
of
expenditure
How
and
investment
figures,
financial
than
prevention
contrasting
do
to
special
prevention
measured.
pregnancy
programs
the
family
roof.
of
Use
block
services
Title
X
funds
family
for
initiatives
is
sporadic.
adolescent
make
meaningful
others?
total, the
of
state
figures
across
states,
investments
capita
were
per
computed
tures
expendiasing
censu.s
10-19
year
data
for
with
childbearing?
In
the
in
state.
adolescent
source
figures
associated
states'
commitment
the
with
compare
predominant
making
investments
greater
purfKjse
and
planning
To
the
social
(Title
Security
funding
under
child
grant
prevention
not
the
'What
and
Social
is the
for
related
projects.
block
to
dedicated
prevention?
funding
states
fund
to
the
federal
pregnancy
are
of
It is
'What
the
that
maternal
health
V
states'
patterns
COMPUTING
INVESTMENT
intent
sense
awareness.
revenue
looking beyond
The
are
should
Center's
a
state
innovative
may
accordingly.
create
block
matched,
programs
emphasized
estimates
evenly
suggesting
a
educational
comp"onents
and
of
tion
informa-
that-these
enough
federal
and
are
missed.
be
cannot
include
must
and
been
initiatives.
categorical grant
funding
pregnancy
state
across
distribution
activities,
program
and
is
the
and
pregnancy
prevention
agencies
implement
school
grants
was
all
state
largest
spread
between
include
to
f)onion
The
services
[6l%], with
public health
direaed
effort
every
the
up
various
and
by
remaining
community
While
provides
$250,000
the
[i.e. non-administrative).
basis;
"
the
being
down
breakstate!.
planning
make
repon.
primary
to
prevention
to
Family
eates
delin-
A
sp)ending
state
for
[see
1992
year
dollar
be
must
dedicated
tive
competi-
a
table; appendix
that
was
fiinding
to
state
to
for
million
fiscal
featured
criterion
SI 10
the
a
this
prevention
twiched
source
programs
included
Grant
prevention
pregnancy
affix
to
and
The
Social
adolescent
projects
requested
throughout
is direaed
local
the
state
Block
money,
pregnancy
federal
dollars,
state
amount
program,
of
comprised
funds
of
agencies
Carolina's
million
states'
mating
$738,000
a
communities;
"
Che
to
lnve,stment
North
For
olds
in
each
example:
Carolina
s
was
In
approxi-
funds
and
in
federal
adolescent
investments
55,148,000;
totaled
divided
by
66
estimated
an
918,000
adolescents
North
aged
$560.
The
$8.50.
Souths
the
$3-20;
the
reflects
the
Divided
the
investment
South.
its
states
in
Low
figures
representative
make
states
beyond
high
figures reflea
commitment
providing
resources
of
planning;
capita
greater
per
are
minimal
investments
family
is
than
higher
which
to
by
90,000
neighboring
a
nearly
health
financial
per
of
number
state's
adolescents,
capita
to
among
estimated
the
INVESTMENTS/
CAPITA
commitment
school
much
PER
SOUTH
per
range
personnel.
the
AND
INVESTMENT
appears
high
million
to
EXPENDITURES
THE
is
anomaly
regional
$5
PUBLIC
IN
Delaware's
figure, $65,
an
PREGNANCY
is
investment
capita
ADOLESCENT
f"er
investment
capita
be
10-19,
Carolina's
to
prevention
nities.
commu-
1
.\4e"iicaid. AFDC.
repotted
2
3
state
Pnmary
Based
the
and
human
on
Census.
1991
Pood
service
preveniKin
informauon
program
of
by
program
collected
state
census
Scamp
and
(i e
costs
fnim
for
expenditures
Medicaid
state
estimates
famiUes
begun
by adolescents;
based
on
FY
1991
dau
as
aftenctes.
schooJ
health,
of
departments
for
males
and
public health,
health,
females
speaal
educatuxi,
aged
uhI
iniiian\es,
human
10-19-. Population
etc
I. based
oo
FY
1992
services
Estimates
Branch.
Dumu
68
APPENDIX
STATE
INVESTMENTS
PREGNANCY
CDC
DFSC
"
DOE
-
SSBG
-
Title
for
Centers
-
X
Federal
HIV/
Education
U.S.
Department
of
Education
Title
XX
Social
Services
family planning
to
Title
Refers
X
Family
prevention
Free
Schools
grant
and
Communities
Grant
program
of
federal
Social
XX
funds,
Services
typically, Title
Block
Grant,
V
Medicaid.
Planning.
appropriations
state
to
Title
Grant,
AIDS
Drug
Block
combination
any
Block
and
-
Control
of
MCH
State
Disease
Department
Refers
-
PREVENTION
U.S.
Federal
-
ADOLESCENT
IN
Alabama
health
pubuc
services
Family
Planning
Adolescent
Proiect;
area
Care
Primary
Children
Hospital-based
large metropolitan
serves
and
professional
provides
development
providers
Youth
"
adolescent
to
the
across
health
state.
Delaware
total
COMMlEHENSrVE
State
Training
held
teacher
year
HEALTH
SCHOOL
Teacher
-t6
health
trainings
for
Annual
additional
$5,728,000
2800
wellness
120
in
teachers
and
conference
school
CDC/DFSC
education
1991-92
schtxil
nurses.
attracts
personnel.
30.000
69
School
State
Health
law
teacher
40
per
funded
one
units;
through
federal
nurse
nurses
are
and
stale
appropriations.
school-based
Four
clinics
with
supported
federal
are
and
funds
state
PUBUC
Serrkcs
mandates
HEALTH
SERVICES
Family
SPECIAL
Planning
INmATIVES
of
Evaluation
the
school-based
state
health
s
initiative.
Florida
comprehensive
school
School
Health
School
"
Basic
"
Supplemental,
Health
grants
fund
49
statewide
projects
HEALTH
Family
Program
high-risk
school-health
PUBUC
health
Services
SERVICES
Planning
Georgia
comprehensive
school
Teacher
Training
School-Based
State
Department
Resources
funds
federal
school-based
health
Care
Primary
Hutnan
dedicates
high
health
middle
to
clinics
in
districts.
Kentucky
$4,473,000
total
school
comprehensive
Adolescent
School-Based
Primary
PUBUC
and
seven
HEALTH
Family
Health
health
Title
V
MCH
BliKk
-i70.000
Services
SERVICES
Planning
State'Federal
3.365.000
70
STATEMENT
PREPARED
OF
JANE
JOHNSON
Good morning.I am Jane Johnson,Vice President of AffiliateDevelopment and
Education for the Planned Parenthood Federation of America (PPFA) I have spent
children and families.I am trained as a
my lifetryingto improve the lives of women,
social worker. Prior to my 23 -year association with Planned Parenthood, I was
selor.
a counI
managed
social service
Wisconsin
Oklahoma,
bama,
in Michigan,Alahospitals
departmentsat teaching
and
York
New
worked
City.I
welfare in
in chUd
Georgia.
I
appearingtodayon behalf of
am
the 169 Planned
Parenthood
than 30,000 volunteers and staffwho
more
affiliatesthroughout
the country, the one
and above all,the more
our
organization,
erate
op-
mill ion-
than 1.6
contribute to
each year. I want
who are served by our affiliates
and men
million adolescent women
lescent
to speak about the issue of adoto thank you, Chairman
Scheuer,for the opportunity
of
cans.
Amerithe
risks
health
ancl
and
the
it
to
well-being
young
poses
pregnancy
plusindividualswho
Before I go any further with my statement, I want
to thank you, Mr. Chairman,
Your
for the dedication you have givenover the years to the issues of family
planning.
Hill.
missed
much
willbe
advocate
on
true
Capitol
as
a
very
presence
Parenthood has been concerned with the social and health
In 1989, we rededicated our commitment
of earlyand unintended childbearing.
repercussions
For 75 years, Planned
reducingteenage pregnancy
goalof First ThingsFirst is an
to
First.The
of adolescents who
2000, the number
It borders
a
by launching
ambitious
become
scandal that in the United
on
one:
pregnant
new
initiative
-
First
Things
reduce by half,
by the year
and givebirth annually.
to
become
States,a million teenage girls
undermine the
profoundly
pregnant each year, and 500,000 givebirth.Littlecan more
of families by
formation
of a society than the premature, unprepared
well-being
theiradolescence.
to get through
youngsters who often are themselves struggling
mothers a year, five million in ten years. Let's put
teen
half a million persons each in
There
that number in perspective.
are
approximately
that
New
Orleans.
Cleveland
El Paso, Denver,
and,
Imagine for a moment
Seattle,
of
their
h
alf
in
half of these cities'productivity
cut
half,
was
duringa one year period,
tioning
bus drivers,doctors,nurses, teachers,
taxis,restaurants, stoppedfuncdry cleaners,
Think
or
about
came
it.500,000
to
a
halt.
and coming
Stop functioning
to
a
lescent
halt,is what happensto half,50%, of the ado-
theybecome pregnant and delivera child.Half
of them stop functioning
in their "occupations
theystop going to school. But unlike
these youngsters are without job skills,
the cities in our imagining,
dependent,and
the most
difficult
parenting.
occupationon the planet,
bizarrely
expectedto assume
lies,
famithese
in
and
disfunction
there
riskof
Not onlyis
disintegration
young
a high
It
is
mated
esticitizens.
often
loss of two, and
there is the corollary
productive
more,
families
to support
that nearly
begun by
20 billiondollars are spent annually
in the United States when
girls
adolescents.
often devastating perpetuating
of too-early
are
costs
childbearing
personal
work. And the
of school and productive
and the abandonment
poverty, nopelessness,
The vast resources
is far-reaching.
cost
to society
spent by government for the most
but in attemptingto repair
childbearing,
too-early
part are not directed to preventing
The
-
-
itsconsequences.
First
ThingsFirst is designedto helpadolescents avoid
the
sexual
of early
pitfalls
development
personal
ends
and even
because sexual involvement interrupts
involvement,
of
in promoting First ThingsFirst are a number
in adolescents. JoiningPPFA
individualsand organizations.
weU-known
and respected
ganizations
offers
First ThingsFirst
community orguidanceand materials to participating
include:
Our strategies
71
role
Recognizing the family's
"
to
educators
primary sexuality
as
that involve,educate, and
effective programs
Highlighting
"
tance
by providingassis-
parents and caretakers in communicating with children about sexuality.
adolescent
role in sexual decision-
whose
men,
making often
provideservices to
neglected.
has been
A centerpieceof First ThingsFirst is its reliance on adolescents to helpdesign and
unintended pregnancy
and efforts that can
prevent the early
implement the programs
that plaguesthem.
and childbearing
much
for adolescents
ask too
not
for helping
to
potential
resolve their own
and
call on the government
that all programs
designedto
We
bearing include
adolescent
an
find that it does
while some
Ironically,
apparently
strated
perform adequatelyas parents, their demon-
to
dilemmas
is
ignored.
effectively
our
example and
follow
the private sector
to
the tide of adolescent
stem
perspective.Professional
pregnancy
expertiseis
sure
as-
and childbut
critical,
the unique perspective broughtby adolescents themselves, it'sdoubtful that
succeed. Not only is their understandingfresh and unique, but the
can
any program
so
acknowledgment of their fundamental resourcefulness achieves the empowerment
without
of them
many
have
been
denied.
that teens
are
collectivehands as we
note
initiating
them
birth control duringfirst
no
use
intercourse at earlierages, and that one-third of
intercourse. I am
persuadedby the adolescents who advise us that,with support and
behavior but also
their own
information, adolescents are capablenot onlyof altering
siblings.
of impacting the behavior of their peers, and that of their younger
wring
professionals
We
our
also promote
the involvement of caring adults to
families.Since we cannot
guidanceavailable from mature
We
and
supplementthe nurture
mandate
a
ffection,
parental
to the goalof reducingadolescent pregit is counterproductive
nancy
parentalinvolvement in adolescent reproductive
childbearingto mandate
guidanceand wisdom,
and
decisionmaking.
that to reduce adolescent
of First Things First is the recognition
key component
children are nurtured
Unless
childhood.
intervention must
beginin early
childbearing,
A
and affirmed in their earlyyears, die chances
will be of much use.
for
Traditional programs
innovative
programs
begun.
are
tions
reduced that later intervengreatly
be expanded, and
must
willwork with
also
but
it
this,
and servingadolescents
involving
First
Things
First vnH do
and proper care.
small children love,security
married
of adolescent sexual activity.
Fiftypercent of unface the reality
Americans
must
had
sexual
have
course.
inter15-19
of
unmarried
and
60
aged
men
women
percent
in 1979, 56
Teenagers are having sex for the firsttime at younger ages
communities
to
assure
-
-
had experienced
intercourse; in 1988, 72
percent of urban,unmarried females aged 17
white
the
1980s
in
sexual activity
was
among
percent. Most of the increase in female
and
ethnic
families
narrowingpreviousracial,
teenagers and those in higherincome
active women
differences. Six in 10 sexually
aged 15-19 report having had
economic
-
two
or
more
These
teen
sexual partners.
the hard truths. For
are
pregnancy
Adolescent
us
is
a
has focused
on
-
decade, our onlynational effort addressing
promoting abstinence. I urge Congress to replacethe
over
a
ing
comprehensiveapproach.The task facFamilyLife program with a more
children
tough one, but it is of fundamental importance to the welfare of our
and the future of
our
nation. It merits the energy
and
resources
it will
require.
Things First acknowledgesthe rightof every child to accomplishfirstdiings
oping
and emotional maturity,and develfirst by securingan education,attaining
physical
of parenthood.Each year, the
lifegoals Before assuming the responsibilities
to firstthings
of too-early
parenthooddenies almost a million U.S. teens access
reality
lives
their
forever.
and
first, changes
First
-
-
12
STAnMEHT
PREPARID
The
Economic
Joint
of
impact
There
programs.
most
teenagers
infants
health,
health
who
being
future
and
infants
and
Many
teens
from
school
have
the
for
have
babies
before
but
the
are
and
pregnancy
which
can
families
of
compelling
to
of
in
who
society
to
reason
their
costs
measured
be
mothers
costs
monetary
human
identify
dollars
their
too-early
and
first
may
also
parenting
education
be
and
assures
gaining
while
childbearing
are
approaches
implement
of
the
lescents
adowell-
ers'
moth-
completion.
result
of
young
alienation
their
fection
disaf-
mothers
will
programs
the
When
recognized,
they
prevent
public
support
to
still teenagers.
can
also
are
add
*
Any
opinions
to
the
expressed
Urban
herein
Institute
are
or
its
solely those
officers
or
of
the
funders.
author
and
should
not
teens
be
full
another
babies.
having
for
caring
experience.
public
that
to
own
the
young
and
there
But
through
spent
a
work
childbearing.
birth
of
with
that
their
immediate
school
high
on
difficulties
pregnancy
of
many
the
jeopardize
depend
may
First,
parenting
responsibilities
and
experiencing
teenage
the
had
of
which
Their
pregnant.
the
work
the
ment
govern-
babies.
care
Third,
affects
poverty
Fourth,
school
already
were
getting
school,
future,
the
difficulty completing
more
These
costs,
compete
prospects
take
not
compromised.
is
children.
with
do
other
effective
provide
discuss
to
me
and
having
teenagers
to
their
anci
poor,
their
about
asked
federal
by
teenagers
they carry
very
of
children
who
from
babies
are
has
Congress
incurred
care
many
BURT*
R.
themselves
enough
Second,
the
chances
small
economic
of
U.S.
to
reasons
many
mature
birth
give
the
MARTHA
expenditures
on
children.
young
the
so
are
not
are
and
of
Committee
childbearing
teenage
OF
tributed
at-
from
73
Types Of
Cost Estimates
The
cost
I willshare with
figures
you
todayare based on a method I developed
ager
of faniilies
begun by a firstbirth to a teen-
for calculating
costs
sector
public
and
a locallevel.'After reviewingallavailablemethods
a national or
much
the
from
more
chose
the pragmatic
was
theirapplications,
adapted
approachI
undertaken by researchersat the Urban Institute and elsewhere, I
complexanalyzes
developedthe estimates for 1985; estimates for subsequentyears were calculatedby
in 1986
at
either
.
the Center for Population
Options.'
The size of cost estimates for teenage childbearing
dependvery much on what is
takes. Three approaches
are
and on which approach
one
included in the calculations,
whole
annual
cohort
birth
costs.
and
h
ere:
costs,
single
single
presented
year costs,
the differencesin these three approaches.
Exhibit 1 illustrates
mates
be considered a "slicein time." It estibirth
families
the totalpublic
begunby a teen
outlayin a givenyear for aU
relevantgovernment programs. The mothers in
who receive assistance through
these families may be of any age duringthe year in question;that is,a 30 year
old mother whose oldest child is 13, a 22 year old mother whose oldest child is
baby
old mother would allbe counted,since each had her first
6, and a 17
Costs
SingleYear
"
thisapproach
can
--
year
as
teenager.
a
the
these families
the cost of supporting
through
What CostsAre Included In thismethod,
relevantpublic
threebiggest
prc^jams are estimated:
~
Familieswith
"
Aid
"
Medicaid;
Food Stamps.
"
to
DependentChildren (AFDC);
be considered a "corridor(or tunnel)in
thisapproach
can
20 years of supporting
a family
the
calculates
It
over
family.
cost
one
of
the
various
use
birth
to
government
programs.
a teenager through
begunby a
who has her firstbaby as a
of a woman
career
It asks what the childbearing
the
will
cost
publicby the time her firstbaby
teenager in a particular
year
for a firstbirth to
done separately
calculations
The
are
adulthood.
cost
reaches
and
aged
a teenager
15-17,
aged
a teenager
a teenager
aged 14 or
SingleBirth
"
Costs
--
time" for
younger,
18-19.
thatany family
the probability
The method takesintoconsideration
Gm" Are Included:
each
of the 20
benefits
i
n
related
and
willreceiveAFDC
birth
program
begunby a teen
in "today's
the projected
costs to arriveat a figure
Italsodiscounts
of the projectioa
WxU
years
Itinckdesestimatesof costs for.
dollars."
"
AFDC;
"
Medicaid;
"
Food
"
Stamps;
subsidizedhousing;
Publicly
Socialservices;
"
Family Planning
Public Costs of TeenageChildbearing."
perspectives.
Burt, "Estimating
Much Docs It
How
and
Haffner,
D.
M.R.
Burt
Childbearing:
Teenage
18(5), 1986, 221-226;
1986
DC: Center for Population
Options,
localcosts. Washington,
Cost? A manual forestimating
A Review of Recent
M.R
Burt and F. Levy,"Estimates of Public Costs for TeenageChildbearing:
Studies and Estimates of 1985 Public Costs." Chapter10 in S.L Hofferth and CD. Hayes (eds.)
'
M.R
the
Risking
DC:
Future: Adolescent Sexuality.
Pregnancy,and
National
Volume
Childbearing.
II.
Washington
Academy Press,1987.
^
DC
Public Sector Costs. Washington,
RF. Wertheimer and K. Moore, Teenage Childbearing:
of Government Expenditures
Consequenton
"An Analysis
Urban Institute,
1982; SRI International,
TeenageChildbirth. Menlo Park,CA: 1979.
Public
Childbearing:
See Center for Population
"TeenagePregnancyand Too-Early
Options,
for
Center
DC:
Options,
6th
edition.
Population
Personal
Washington,
Costs,
Consequences,"
'
1992.
74
Program administrativecosts.
"
"
Whole
this approachestimates the 20-yearcosts of
Annual Cohort Costs
the entire cohort of familiesbegunby a firstbirth to a teenager in a givenyear.
--
it multiplies
the
Thus
or
younger
same
For
Birth
Single
Cost of 20 years of support for a mother
14
of that age during
a givenyear, does the
by allthe firstbirthsto girls
for teens aged 15-17 and 18-19. It then adds the results together
tain
to obthe cost of the entire annual cohort.
allthe first
birthsto
example,
teenagersin 1985
371,000)are
(approximately
one
hort,
co-
"corridor
in time"thatwillend only
one
m 2004. ITie 1986 cohortwillbegin
begin
thisone ending
in 2005. Thus many cohortsor "corridors"
another"corridor,"
existat the
and
same
more
time,withcohortmembers being
or
lessadvanced toward the end of their20
started.
on when they
depending
year projection,
Costs Not Covered
of the projections,
because
familiesbegun
use
among
evidence that
by a firstbirth to a teen. I mention them here because there is some
dren
likelihoodthan other chilchildren in familiesbegunby a teen birth may have a higher
which these costs would accrue.
The types of
of needingthe programs through
for
services for which this may be true in some
degreeare: treatment
as-yet-unknown
child protective
services and fostercare or other out-ofdiseases;
sexually-transmitted
needs/mental
education or special
home placement;
education;
special
compensatory
homelesshealth services;
and emergency
services relatedto homelessness or potential
such as emergency food,shelter,
or health care.
ness
Several types of
no
adequatedata
public
oudayare
exist on
which
EstimatingPotential SavingsTo
Year
Single
to
covered
not
base
an
by any
of
expectation
Be Gained
From
DelayingBirths To
Teens
Cost
itis also possible
to estimate the
cost estimates,
the government would save ifevery teenager who haa a babyhad postponed
from the fact
that birth untilshe was at least20 years old. The majorsavings
come
the age of 20 are
that women
20 and older who did not have childrenbefore reaching
who had
AFDC
and other government programs than are women
lesslikely
to rely
on
the calculationof net savings
theirfirstchild as a teenager. The assumptionunderlying
is that any teenager who manages to postpone a birthto the age of 20 or laterwill
In addition to these three types of
amount
as
the same
(and hence government expense)
rates of welfare dependency
experience
who wait untiltheyare 20 or older to have children.
observed in other women
and receiving
chances of needing
waited to have children would experience.
But waitinguntil20 or later to have children does not reduce the chance of
tional
and often poor educabackgrounds
needingwelfare to zero. Given the impoverished
who have babies as teenagers, theyrun a considerablerisk
attainment of women
Thus delaying
a
if theypostpone childbearing.
of eventual welfare dependencyeven
nate,
elimibirthuntila woman
to reduce,but not entirely
is beyondher teen years is likely
welfare. The net savings
willat some
the riskthat a woman
time need to rely
on
of delaying
these firstbirthsdependson the differencebetween
to the government
thisdifference
In research conducted at the Urban Institute,
these two probabilities.
of
T
hat
costs.''
of
in
result
in
40
projection
to
a
was
public
projected
savings
percent
Having a babyas
welfare (AFDC)
40 percent
a
teenager increases
beyondwhat
is used
savings
Estimated Costs And
a
woman
a
woman's
who
here.
in allthe calculations
reported
Potential
Savings
birthto
familiesbegunby a first
Exhibit 2 shows the single
year cost of supporting
for
1985
the
six
the
three
through
public
years
biggest
teenager through
programs
for
These figures
dollarsof theiryear; theyare not adjusted
in the current
1990.
are
inflation.
a
Wertheimer
and Moore, Public Sector Costs.
76
the
increase
at
an
age
and
attraction
Teens
support
reliable
of
1
types:
a
real
solutions
and
affordable
lie
where,
else-
teenagers.
poor
) accessible
discussion
unprejudiced
make
The
teenagers.
to
two
about
difference;
health
they
and
of
sexual
family
behavior
life options
2)
and
holding
behave
if
responsibly
investing
and
programs,
contraception,
decisions,
responsible
options,
curricula
and
activity
making
can
care
planning
sexual
for
peers
so
education
sexuality
and
facts
care
family
of
are
to
and
Expanding
through
to
to
more
early childbearing.
the
adults
contraceptive
active.
timing
than
know
both
born
available
clear
enough
young
must
refer
I
promise
from
children
opportunities
including
services,
choices
to
the
opportunities
planning
for
costs
changing
in
The
human
greatly
through
the
other
access
be
to
doing
improving
and
have
choose
and
in
more
schools
they
experience
and
ally
sexu-
reach
out-
more
and
content
mechanisms
are
all
essential.
But
do
teenagers
that
will
in
job
support
of
knowledge
have
a
require
a
major
and
education,
public
to
take
the
jobs
assure
efforts
real
and
job
At
of
family
to
access
for
the
youth
It
training.
able
to
the
same
expanded
suggests
perceived
pay
fertility and
likely
most
health
investment-in
will
also
enough
time,
to
ejdiortation
opportunity
maintain
and
teens
The
without
structures
a
make
the
to
in
care,
require
opportunities.
that
will
planning
their
controlling
options
societal
in
assistance.
advantage
intervention
changing
to
or
for
motive
life
Expanding
development,
to
but
not
motive.
teens
of
amount
no
a
to
support
have
babies
a
in
without
will
children
of
opportunity
have
on
their
grams,
pro-
investment
family
experience
if
act
child-supportive
societal
younger
can
difference
the
will
considerable
last
do
in
course
re-
need
ade
dec-
little,
pact.
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81
AnACHMENT
TEENAGE
TO
MS.
BURTS
PREGNANCY
PUBUC
PREPARID
TOO-EARLY
AND
COSTS,
PERSONAL
minute
another
every
teenager became
time.
giving birth for the secorxl, third or more
had
Report
mother.
a
CHILOBEARING:
CONSEQUENCES
Summary
In 1989
CTATEMEHT
Every
Nearly one-fourth
minutes
46
of these
adolescent
an
14
women
young
old
years
or
was
younger
child.
a
babies
Altogether,517,989
represents
itthe
making
15-17
have
America
highest since
risen
19
the
were
bom
were
increase
8 percent
an
1974:
highestamong
in 1989,
teenagers
birth rate, defined
for teens
58.1
since
percent
to
in the teen
15-19
Even
1986.
developed
and
these
the
488,941
the number
for teens
1.4
before
from
up
as
under
Increases,
before.
year
of births per
1
Birth rates
15.
adolescent
countries, despite similar proportions of
teens
among
who
in
rates
pregnancy
teens
This
.000 individuals.
sexually
are
experienced.
There
is broad
pregnancies
has
been
who
Center
This
social
for
the human
when
begun
federal
to
the
rDother
costs,
Vermont
and
varietyof
measures
described
in
briefly
CPO
believes
socicry for
people and
young
reap
that
ESTIMATED
The
help
to
the
In programs
for them,
COSTS
costs
cities
two
much
and
long-
with
remain
it
result
arxJ
consequerrces,
invisible to
to translate
of the nation's
America's
in
pdicy-rrakers
of the last six years
the attention
it costs
of
Nevertheless,
real solutions.
health
term
study for each
that commands
nxire
help them
with
TEENAGE
bear
Baltimore
can
and
the burden
states
seven
taxpayers
San
and
of
leaders.
to
support
supporting families begun
Rorida, Kansas,
-
Francisco.
New
States
too-early childbearing,and
be
cost
Mexico,
have
some
Ohio.
initiated
of these
a
are
done.
reducttons
inlerebt, at
avoid
their families
also
to
and
short-term
on
payment,
OF
-
pregnancy
However,
to
fonvard
rrxive
century.
goal.
reduction
teenager.
avoid
exact
of the
the turn
parenting: what
teen
estimated
and
-
to
a
form
a
local governments
has
"qukik fixes" focused
FEDERAL
of
a
teens
report.
benefits
enormous
was
Wyoming
brief while, and
a
impact of
state and
CPO
by too-early chikjt)earing.
Oregon.
conducted
too-early childbearinginto
economk:
by
national
nation, calls for the
disadvantaged young people often
for diminishingpublk: resources.
claims
the
for the
parents arxj their children, too-early childbearingcan
teen
Population Options (CPO) has
realities of
In additton
For
opportunity, in short-
However,
stress.
study estimates
families
will
galvanize the political
educatior^l
and
negotiate competing
must
The
difficult to
is an important
chiidt)earing
agenda
health
by nearly one-third
18
paying the price.
are
ecorxxnic
enrKJtional and
under
and
pregnancy
Administration's
adolescents
among
teens
preventingteenage
Bush
the
2000.
enormously
America's
in lost
that
consensus
People
Healthy
a
pregnancy
are
later iime.
and
likelyonly
to
defer
Rather, investment
parenthood
before
they
YEAR
1990
payment
in Amenca
are
by
s
ready will
for all Americans,
CHILDBEARING
FOR
FISCAL
teenage childbearingare
the U.S.
conceptualized in three ways: SingleYear Costs, the amount
while the ntother
was
a
singleyear on behalf of ail families in whk:h tfie first birth occurred
arrraunt
teenager Single Birth Costs, the average
taxpayers will spend as a result of a single teen birth over
the next 20 years; and
Single Cohort Cost, the amount
taxpayers will sperxl over the next 20 years on all
costs
spends
teen
n"ntpr
i^nier
in
a
births in
ft^ir
ror
KDpulation
Cations
a
given year.
^^^^
Vermont
202/347-5700
Avenue.
fax
N.W.
202/347-2263
Suite 210
Washington,
DC.
20006
USA
82
Costs
based
of Single Year
on
are
and
Food
(AFDC), Medicaid
Stamp payments
Estimates
conservative
as
IN
it does
estimate,
SINGLE
U.S.
THE
1990,
1989
mother
In her
was
COST
YEAR
(Table I). CPO
billon, from
U.S.
the
20s,
Infants
foster
would
saved
have
biith to
40
Children
Dependent
that
began
is
costs,
with
with
family support
(WIC) supplemental
a
actually
food
a
such
program,
care.
BILUON,
$2S
that If every
associated
Chldren
day
with
to families
administrative
as
commonly
or
Famllas
to
gtven year
a
weH
as
and
care
OVER
WAS
estimates
in
made
public costs
Women,
the
are
payments
other
special education,
meals,
school
direct
irwiude
not
subsidies,
job training,housing
subsidized
includes
figure, which
The
birth.
teen
of Aid
percentage
a
that
mother
had
calculated
of the
percent
alaming
an
up
teen
a
16
percent,
been
delayed
expenditures,
or
$3.5
or
untH
the
$10.02
bUkxi.
BEGUN
FAMILY
EACH
OF
THE
BY
$18,133
delayed unti
of families
the
BY
mother
a
20
over
after
a
ESTIMATED
COST
FOLLOWING
20
YEARS
IS 7.15
multiplyingthe Single
much
IN
would
public assistance,
be around
birth would
TAXPAYER
THE
(Single Birth Costs. Table
20
potentialsaving
average
actually receive
teen
COST
WILL
1990
AGE
three
be
the
limas
$7,253.
average
the
Since
Birth
were
only one-third
arrxxjnt
Single
AVERAGE
AN
il).If the birth
each
to
Costs,
famPy
or
$54,399
OVER
THE
years.
Finally. THE
which
20s. the
birth
teen
receiving public assistance
MOTHER
REACHES
CHILD
in her
was
with
begun
TEENAGE
A
THAT
TIME
is available.
data
as
$2.86
Costs
Birth
OF
by
FAMIUES
ALL
the
BEGUN
(Single Cohort
BILLION
of first births
number
By delaying those
births, CPO
WITH
Cost, Table
to teens,
estimates
the
A
TEEN
BIRTH
III.) This figure is calculated
394,1 19
federal
in 1989.
latest year
the
could
government
save
billion.
1985
-
1990
Single
TABLE
Six Year
Trend
in
Single Year
Costs
Costs
Year
I
Attributable
to
Teenage
Childbearing
(in billions)
YEAR
SINGLE
COST:
Aid
1986
1987
1988
1989
1990
S8.32
$949
$9.87
$10.07
$10.43
$11.23
$3-42
$2.82
$2.97
$3-23
$344
$398
$491
$5.62
$6.43
$6.53
$7.68
$984
$16.65
$17.93
$1927
$1983
$21.55
$2505
Families
to
with
1985
dent
DepenChildren
(AFDC)
Food
Stamps
Medicaid
The
Center
for
Population Options, 1992
j
by
for
as
84
TEEN
PREGNANCY
Since
1986,
the
Policy Initiatives
atxjut
t)een
TEENS
between
of
use
PLANNING
forced
be
PREVENTING
1986
teen
and
the
Is saved
PREGNANCY
tt^
for
that
would
every
available
otherwise
birth.
be
Yet
by
CHILDBEARING
delivery. This results
future
health
greater ttian for
tfie increased
In
of the
over
one
medical
maternal
Only
(compared
85
to
54
all teens
to
compensate
HEALTH
ttian
with
pregnancy,
to
delay
or
who
of teens
THE
fias
an
and
on
gave
14
the
is 60
received
in 1989
percent
medical
prennature
present
percent
contributes
forego prenatal care
birth
MOTHER.
15
age
for
federal
total
serious
impact
under
the
dramatically
TEEN
cervical traun\a
and
30-34), and
for women
have
sufferingfrom
of
for mothers
mortalityrate
just in
spending
cutbacl"s,
FOR
RISK
women
of all ages.
1990
states
for federal
hypertension, toxemia,
percent
percent
older
Guttmacher
Alan
to women
FY
most
AFDC
urgent
more
the
the
choosing
now
nutrition programs
Whfle
1980.
by
altogether
in Medicaid,
even
federal
TEENS
FOR
limitingminors'
sen/ices
study by
and
access
is overturned
wore
tjecomes
inflation, tfie
since
Teenagers' tenderx:y
20s.
welfare
SIGNIRCANT
associated
The
should
A
over
Despite this
improved
laws
Wade
v.
F"ay billions
to
prevention
care,
for
third
higher risk
costs
teen.
risl" of pregnancy.
first trimester
in the
A
much
a
pregnancy-induced
individual
in their
women
health
higher
at
Olegal and
expect
in 1988
DIFRCULT
to atxxtlon
access
of American
1 970.
to
enacted
If Roe
be
teens,
adjustments
to
access
reversed.
MORE
have
states
lose
for medical
REPRESENTS
During pregnancy,
teenagers are
complications, including anemia,
37
fail due
now
spent to provide contraceptives
funds
needed
after
has
COST-EFFECTIVE.
IS EXTREMELY
of federal
dollar
to
percent in
to
trend
wBI
could
their own
spending for contraceptive services
sperwling has not l(eptpace with inflation.
state
TOO-EARLY
care
less
actually decreased
hias
abortion
any
become
In reduced
intercourse,
sexual
28.6
BECOMING
ARE
states
give birth,tfien U.S. taxpayers
followir"ga
years
Increased
and
In some
Shoiid
nrxMhers.
had
currentlyenforced.
all are
not
have
(31.9 percerrt)of ninth-grade
continued
The
Already
tnore.
girlswll
of 20, three-fourths
age
from
up
rates
abortion.
SERVICES
them
abortion
birth
Eightyusing
not
teenagers
resulted
one-third
having
report
arvj
PREGNANT.
to
have
the
Neariy
intercourse,
pregnancy
need
that
in anxieties
faled.
they reach
boys
legalizationof
although
With
have
BECOME
occur
childt^earing.
behavior,
abortion.
of ail adolescent
last decade
time
sexual
ABORTION
they
t)ecome
costs.
TEEN
found
contraceptives
and
had
having
abortion,
to
Stamp
Food
Institute
will
teens
rTK"re
sexual
over
-
of Ave
percent
sexually active.
are
Court, explicitly
or In effect, teens
abortion
43
the
the
By
males
AND
wfwn
time
at a
Supreme
two
and
1970
to confidential
access
$4.40
ACTIVE.
contraceptives
FAMILY
OBTAIN
and
estimated
an
IN TEN
out
and
pregnancy
adoiescerrt
ONE
three
'lust-say-r)o*
messages
on
reported
1 5-1 9
prevent teenage
-
and
percent
nearly half (48.7 percent) of ninth-grade
and
arxj
of 20,
age
of American
Increase,
BOTH
the
SEXUALLY
86
19M"
about
WOMEN
unintended,
are
Clearly,ttie strategiesof
once.
half of aU females
TO
By
effort to
amtiivalence
TEENAGED
pregnancies
ARE
and
girls and
to
MILLION
ONE
In societai
up
THE
phiosophicai, theological arxJ politicalconflicts
altematlvely rely
and
females
In
arxJ
of these
at least
pregnant
services
caught
FOR
in the
losing ground
been
contraception.
of
MORE
has
OVER
YEAR
percent
form
U.S.
have
rdes
parental
EVERY
two
IMPERATIVES
PREVENTION:
received
to
prenatal
late
or
no
prenatal care.
TOO-EARLY
most
this
bom
to teens
weight
Even
of older
mothers.
The
under
A
pregnancy
to tfie number
18
of low
were
is
HEALTH
SIGNIRCAf^
paid by
tfie infants
of Infants bom
(2,500 grams
for
costs
Population Options,
and
1992
lrx:rease
the
txjrdens
on
TO
One
CHILD.
THE
The
t"irthweights.
infant
In 1989,
of the
mortality rate in
over
10
percent
or
less) birth
(1,500 grams
tiian
Infants
of
rate
rehospitaiization
higher
illness and
disability
greater risi" of chronic
less)
have
mothers
birth weight infants of teen
a
Lengthy hospitalstays, painful procedures and
medical
RISK
themselves.
at low
or
normal
high personal
Center
of teen
strongly related
Is
country
of iDabies
exact
REPRESENTS
CHILDBEARING
heart-rerxJingcosts
an
or
very
low
inadequate
health
care
system.
85
ARE
MOTHERS
TEEN
TO GRADUATE
UKELY
LESS
FROM
SCHOOL
HIGH
than their childless peers to have the education and skillsneeded
Eightypercent of teen mothers drop out and only 56 percentever
beginsparentingin her
wfK)
povertylevel,and povertyrates
ARE UNUKELYTO
MOTHERS
TEEN
RECEIVE
CHILD SUPPORT.
who
a woman
of meinled teen mothers
even
mothers
alone
living
were
had
incomes
Two-thirds of
A
woman
below
the
teens 15-19,and
parenting
publk:assistance.
of teen
the age of tfiefather is known, almost one-third of fathers
to be unskilled and/or unemployed.
ifthe father is okJer he is likely
Even
themselves.
likely
twice the national average.
or
father Is not kJentHied.
less
waits untilshe is 20 to
the likelihood that theywillneed
younger, are unmarried, Increasing
form of chid support from the father Is extremelyrare. Furthermore, In many cases
almost allteens 14
are
economicallyindependent.
graduatefrom highschool.
half the lifetimeearningsof
makes
1986, 81 percentof young mothers
her firstchikj. In 1985 and
have
federal
Any
teens
Teen
to become
Where
are
births the
teenagers
In the short mn. marriage appears to
RATES OF POVERTY.
chidbearing,sirx:efewer married teens receive publicassistance.
for benefrts in many
to FY 1991 two-parent families were
Ineligible
prior
to have completed
states. Even wtien teenagedgirls
many, their husbands are almost three times less likely
highschool, and have higherunemployment rates than their male peers. One survey showed that 40
EVEN
MARRIED
TEENS
FACE
HIGHER
povertyassociated with
This is misleading,
however, because
teen
percent of the husbands
mothers
reduce the
mothers
TEEN
face
of young
not
were
high-paying
jobs.Furthermore, many
skilledor have
rates than women
higherdivorce
NEED
MOTHERS
tfieythemselves
HELP
to term
to carry a pregnancy
faced with the awesome
DEVELOPING
who
and
highschool graduates,
are
early
marriages
of these
wait untilthey are
PARENTING
are
to be highly
unlikely
short-lived. Married teen
older to have
children.
SKILLS. Over 90 percentof teens who
also ctxx"se to raise the chiW themselves.
Teens
who
choose
parentare suddenly
the livesarxl characters of their chikjren,at a time when
of shapir^g
responsibility
overwhelming and confusingphysk:aland emotional developmental
social supportsystem. Not or^yis their own
or no
development
parents have little
in the midst of
are
tasks. Too often teen
affected
but that of their chikJren is alltoo often negatively
Interrupted
by peirenthood,
Guidingtfie growthand development of
and passingon
generatkjn
the next
as
well.
the collective wisdom
of the
Importanttasks of any society.We owe a productiveand healthyfuture to allour
chikjren. Educatksn arxJ services can
help teens avoid becoming parents until they are ready. Many
and assist parenting
teens
aro
childbearing
programs
beingImplementedIn states to preventtoo-early
culture is one
of the most
-
and young men
both young women
these and other efforts must overcome
-
futures for themselves and their children. But
brighter
funds, politk^al
agendas and years of counterproductive
to achieve
lack of
The urgentneed to reduce the heavy burden on taxpayers from too-early
chPdbearingmust
pdteies.
and reject
those that do not
that are effective in reducing
teen Ijirths
to adopt polteies
poltey-makers
TEENAGE
CHILDBEARING:
Teenage pregnancy
exacts
SEVEN
a
STATES
AND
TWO
move
work.
CITIES
tollat the state and local levels as well
as
at the national level. Estimated
costs
Mexico, Ohio,Oregon,Vermont, Wyoming. Baltimore and San
the
thrust into sharp relief
the extent of these costs. The numbers
Francisco were calculated to highlight
in those individualstates and cities.
toU exacted by too-early
chikjbearing
budgetary
of teen
for Florida,
Kansas, New
chikjbearing
costs and potential
savingsreportedfor these states and citiesvary widelyand are not meant to be
have a much greaternumt"er of AFDC
participants
compared with each other. Some of these jurisdictkans
AFDC, Medicakj and
than others. In additkxi,teeruge birthrates vary among
the states and cities. Lastly,
food stamp payments vary from state to state; therefore,a locality
provkJIngpayments at a higherpercent
but willalso
of poverty level than another kxallty
win have highercosts associated with teen childbearing,
provkJemore completelyfor those families in need.
The
The Center for
76-611
PopUatkxiOpttons,1992
0-94-4
86
The
a
bWion
that
The
teenager.
federal
and
the
than
that
The
funds
local
-
by
dtles.
Federal
the
total
figures for
Most
jurisdictionIs
each
state
biUlon
The
two
cities
when
included
for
Population Option*,
do
1902
to support
city reported
not
earlier
Single Yev
of the
year
-
here
weU
as
state
report, however,
famlles
represent
as
other
Medicaid
directlyfund
required by the
in this
provide services.
Center
and
described
city governments
portion of Medicaid,
estimate
an
sperxJs each
government
part of the $25.05
revenue.
norvfederai
do
for each
caloiated
number
$25.05
plan, is
are
Coet
those
examples
often
of
equivaJent of the
when
locales'
the
mother
A
was
allocations
originatingfrom
monies
services.
rrxye
the
-
begun
of
state
local contribution
provided by
counties
city-county consolidations
to
87
STATE
A
adolescent
of
survey
many
of these
states
Class
focuses
on
Increased
Too
of their
teenage
a
and
in Rorida.
for
Series
schools, covering
a
pregnancy;
Project
example,
human
(TIPS)
Is
of
range
Oregon,
innovative
some
emphasizing
program
Program
Impact
middle
Ohio,
Mexico,
themes
l(ey to forestallingtoo-early
a
for
Young
to
plan
is cited In most
and
the
Mexico,
a
Rrst
sexuality
six weel(,
six
related
to
topics
Men
is
Program
future
a
Male
weei"
male
up
in
a
are
Reproductive
on
technical
high
women.
young
provides
In those
New
capacity
served.
now
the
the
develop
them
the
expand
urxjerstand
rural
component
of Northem
Wyoming's
Involvement
located
program
opportunities aridhelps
with
to
Coordinator
Involvement
beefing
eight
an
critical
a
to
all counties
helping them
men,
young
programs,
provided funds
that
so
as
Parenthood
potential fathers, focusing solely
exclude
on
statewide
a
prevention
for
efforts
focus
cities
Planned
for adolescents.
services
family planning
and
states
Vermont.
activities
outreach
provide
to
of the
In
rates.
Oregon's legislaturehas
teens.
place
pregnancy
men
young
Teen
in three
pregnancy
prevention
pregnancy
In New
actions.
to
statewide
programs
to state-funded
Leadership
out
coordinated
involvement
teenage
clinics
family planning
often
Male
arxj
mentors
Battinrvye's
sidlis.
contracaptiva sarvicaa
to
effort to lower
Courx;!
Health
Is
New
Kansas,
common
early Intervention
providing
area,
Implemented
England specificallyreaches
of local
that
reveals
pregnancy.
accasa
corx^erted
In Rorida.
programs
Francisco
middle-s(^HX}l-aged
children,
address
urtan
an
program
preventing teenage
of any
understand
decision-maidng
educational
session
in
San
and
cities
and
boys
and
Information
Experts
twists.
programmatic
prevention
pregnancy
Baltimore
Wyomirtg,
Vermont
INITIATIVES
PREVENTION
LOCAL
AND
consequences
assistance
Rorida's
projects.
school
that
motivation
empowers
delay
to
sexual
activity.
Prevention
of
Young
and
men
services
projects are
Teen
wtio
women
wiU
that
pregnanciea
repeat
for
designed
Force
Tasi"
reducing repeat pregnancies
counseling
Pear
with
any
prevention
San
Francisco's
peer
All teens
and
need
referral.
A
enrolled
Parents
are
and
esteem
state,
The
17
and
that
Center
school
the
primary
are
and
their
diseases
help parents
the
to
of
information.
New
Mexico's
sl"ills arxJ
prevention
community-based
a
program.
Govemor's
Wyoming's
teenagers.
and
prevention strategy.
any
the
mentoring
projects
aimed
at
to
the
arxJ
high
School-based
health
compreiiensive
teen
school-linked
or
health
both
to reduce
and
and
male
topics
teen
parenting.
of birth
female,
control
parenting.
services.
care
efforts
the
covering
of teen
consequences
on-site
parenting teens,
schools
adolescents
to reach
successful
sexuality,pregnancy
teenage
involves
Program
middle
effective ways
most
of its most
some
dinJc
clinics
in many
In Baltimore
attracts
and
states
counseling
Including contraceptive
all
youth,
both
not
educators
Two
their
Population Options,
chPdren
of their
pilot projects
emphasis
at"stlnence.
polish
of the
one
approach
services.
with
teen
tlx"se
useful.
parents;
and
care
sexuality
very
promoting
for
and
births
management
that
Counselors
visit both
studerrts
as
discovered
discussion
Peer
mall-lsased
unique
in school
communication
10
high
is noted
-
has
wtx)
health
to
access
provides
those
Teen
trainers
sexually transmitted
methods,
cities
arxJ
teens
Ohio
peer-to-peer
a
innovath/e
counselors
among
messages.
third
establishing case
on
In Vermont,
teens.
and
of
need
Fully half
births.
parenting
second
piece
rrrathers
adolescents.
teaching
teens
utitzed
have
pregnancy
as
-
arxl
prevent
focusing
is
and
subsequent
already-pregnant
to
fathers
become
unwanted
delay
Initiative,wortcs
Pregnancy
Pregnancy
them
help
already
essential
is another
teens
among
have
Is
Baltimore
sex
1992
on
and
so
focus
free
and
Parents
and
communication
that
programs
on
improving parent-child
hosts
education
In Kansas
young
communication
Children
improve
people
between
the
ages
of
sl"ills,
building self-
Tallcingevents,
sl"ills.
parent-child
funded
by
the
88
Lastly, madia
pregnancy
14
with
on
the
"Your
television,
arxl
radio
The
of the
proportions
a
The
a
copy
for
Center
to
and
In many
of the
cities included
report
the
range
incidence
1025
Options.
Vermont
1992
forever."
-
the
Public
the
posters, billboards, rap
In nx^vie
Campaign
toll-free
theaters
for
Our
and
a
and
teen
and
number
the
on
songs
Children,
10
announcements
hotline
promoted
teenage
of
ages
service
material
a
of
problem
between
featured
report have
a
governor's
of govemn"ent
top levels
The
sefverttyof
at children
parent
blitzed
the
a
radio,
speakers
city with
parents.
of
Ave.,
that
recommended
of teenage
including a complete
Population Options,
Population
In this
in the
life
your
program.
and
the
targeted
announcements
children
communities.
fuU
In Kansas
media
middle-scfxxil
change
printed
other
public service
blueprintfor reducing
for
and
of
awaranaaa
campaign
sex
campaign
Indicatingconsensus
pregnancy,
provide
states
about
abstinence-based
targeted
messages
For
billboards
public
statewide
a
decisions
newspapers,
high scfKJol
In
Center
ran
public awareness
parcel. Baltimore's
Most
Incraaaa
to
Ohto
popUar.
message
brochure.
ads
campaigna
are
mayor's task force
parenthood
strategies emerging
chBdbearing
listingof
NW,
or
teenage
sources
Suite
210,
In the
of data
is
from
on
adolescent
reaching
these
crisis
bodies
U.S.
and
Washington,
citations,
D.C.
20005.
send
$8 to the
89
STATEMENT
PREPARED
OF
JEANNIE
ROSOFF
pendent,
JeannieRosoff,President of The Alan Guttmacher Institute (AGI), an indefor
and
education
nonprofit
analysis public
corporation research,policy
on
health. I want
issues relating
to reproductive
to thank you. Chairman
Scheuer, and
the Subcommittee
Education and Health of the JointEconomic
on
Committee, for
the opportunity
make
this statement
the scope of the adolescent pregto
regarding
nancy
I
am
need for national attention to
problemin the United States and the compelling
the issue of adolescent pregnancy
prevention.
Adolescence has never
been an easy time of life.
lent
The adolescent years are a turbutime when
with
take
s
kills
developingpersonal
people
increasingly on the
young
t
asks
and
of
adulthood.
But the general
task of
seemingly
confusing
responsibilities
be
the
the
into
adulthood
transition
allthe
making
onlycommon
aspect to
may
young
peoplewe label"adolescent." Despitethe fact that we tend to think of alladolescents
the same, adolescents are a very diverse group
the variances in age, living
as
arrangements,
education and economic status are but a portionof the listof differences
that are present in the very diverse group that we liketo labelwith the oneterm
lescent."
"adoboth developmentally
and legally.
Young peopledevelopat differentrates
And in most
is often very differentfrom a 17 year-old.
DevelopmentaUy,
a 14 year-old
the law treats a 14 year-old
when it comes
and a 17 year-old
states
to her
differently
health decisions for herself.Because of the diversity
to make
ability
reproductive
within the adolescent population no matter
what the question there will never
be
that will embrace the concerns
of them all.And the questionof how
justone answer
best to handle the issue of adolescent sexuality
and pregnancy prevention
is no exception.
--
-
--
-
the teen years are a transition time into sexFor the majorityof Americans
ual
today,
This is a reality
that many American adults find hard to face. Some recent
activity.
data suggest that adolescent sexual activity
but at a high
to plateau,
may be starting
level:50 percent of unmarried women
and 60 percent of unmarried men
aged 15-19
the past 20 years (the onlyperiodfor
have had sexual intercourse. In addition,
over
which we
the trend has
have national data on sexual activity
of adolescent women)
been toward earlier initiation of sex, but later marriage.
As a result,
women,
young
and young men
active
also,spend a longertime than theirelders did beingsexually
before marriage.
unintended
of
STDs
This period
and
both
is especially
i
n
terms
risky
tion
in meetmg needs for educato our
challenges
society
pregnancy, and presents special
and services.
from their sexual activity
that are very
these
deal
with
and
neuver
theymust matry
consequences
prevent
their way througha health care
and education system that is often unresponsive
their needs. Too
to
often,the focus on their age has been used to deny
adolescents needed services,
turallyand culrather than a reason
to develop
ageappropriate
their
needs.
adolescent-specific
They need
appropriate,
programs to address
from us in order to thrive.It is the responsibility
of parents and of our societyas
more
for these transitions and to helpthem throughthem as suca whole to prepare
teens
cessfully
We do thismuch more
when it comes
as possible.
to education and
readily
these responsibilities
much lessoften
and much lesswell
employment;we fulfill
when it comes
values and means
to preparmg
sponsibly
to deal reyouthwith the knowledge,
with theirsexual activity.
Today'syouth are
adult in nature, but
to
facingconsequences
to
-
-
The consequences
and either the
of unprotected
sexual activity pregnancies
abortions or largely
out-ofwedlock births that result have been with us since time
immemorial. What is most
shockingis not that these problemsare stillwith us, but
the extent to which theyexist in our society.
than one million teenage
Each year, more
females
come
befivewho
and
active
in 10 women
in
15-19
one
one
are
sexually
aged
least
four
willbecome
in
at
once.
pregnant. By age 18, one
pregnant
teenagers
unintended. Nearlyone in five teenagers who exEightin 10 teenage pregnancies
are
perience
a premarital
pregnant againwithin a year.
pregnancy become
-
--
-
-
90
while thisheaiiiig
addition,
may focus on the problemof adolescent pregnancy,
unfortunate fact that the risks from unprotected
it is importantnot to overlook me
HIVIAIDS.
transmitted diseases,
sexual intercourse also include sexually
including
Adolescents
STh annually.
in six teens
contract
an
one
resent
repNearly3 million teens
In
--
--
Certain types of STDs, such as chlamyclia
least20 percent of allSTD cases.
and cervicalcancer, respectively.
and human
virus,can lead to infertility
papilloma
While the numbers are lower than for other STDs, the statisticsfor adolescents and
of the estimated 1 million Americans with HIV,
HIVIAIDS
are
certainly
alarming,
ties
the ages of 13 and 24. Persons in theirtwenbelieved
be
between
to
are
over
75,000
with
the
and
infected
of
HIV
make up the largest
latency
p
eriod
persons,
portion
share of persons with
that a large
10 years itis reasonable to assume
of approximately
at
contracted the virus while adolescents.
AIDS
it is importantto say that what really
today's
distinguishes
Despitethe statistics,
to which theyare
tryingto be responof sexually
active youthis the extent
sible
generation
of teenage women
Between
1982 and 1988, the proportion
about their sexuality.
method at firstintercourse
who reported
theyor their partner used a contraceptive
using condoms increased from 23
52 percent to 65 percent and the proportion
rose
active and tryingto
sexually
currently
percent to 47 percent. Among those women
method. But while
avoid unintended pregnancy, 79 percent are using a contraceptive
diat
fact
tive
acunfortunate
remains
one
the
sexually
these developments
are
promising,
teenage
woman
teenage
women
in five uses
will become
no
method
and
-
pregnant within
as
a
many
as
nine in ten
year if theycontinue
tive
acsexually
to
have
sex
without contraceptives.
do use contraception,
active adolescent women
when sexually
Moreover, even
active and who
Most teens who are sexually
face some
degreeof uncertainty.
theystill
all
other reversible
condoms. These and
eitheron the pill
or on
rely
use
contraceptives
and the
availablecontraceptive
(Norplant)
implants
methods,except fbr the recently
stration
Adminiand
Food
the
which
Drug
approved
by
was
just
(Depo-Provera)
injectable
next
and should become availableearly
ongoingattention from
year, require
tiveness
the effecof allages, but especially
the user. Among women
among
younger women,
if
achieved
could
be
what
that
much
lower
they
methods
with
these
are
rates
tive
effecthe
methods
that
most
the
are
In
and
addition,
used consistently correctiy.
were
the pill do
and DepoProvera,
or
even
for pregnancy prevention likeNorplant
offer
that
methods
while
the
from STDs and HIV,
offer protection
any proonly
tection
not
that have the highest
likethe condom
from STDs and HIV
are die methods
-
--
-
-
failurerates
indeed.
problems,
user
among
allusers,
adolescents.These
especially
are
very serious
use
failurebrings
to the issue of contraceptive
us
The issue of contraceptive
user
the
f
or
itis
need
better
education,
education. Adolescents
contraceptive
and sexuality
cient
insuffiof
in
out
and ineffectiveuse of contraceptivesproblemsborn, part,
nonuse
active adolescents vulnerable to
that make sexually
information and education
education,user failurerates can be
With contraceptive
of health problems.
a number
But the current state of affairsis one where thiskind of education may not
improved.
cation
eduon
sexuality
availableto teens in need. In spiteof increased emphasis
be readily
half of young women
aged
over
by parents, schools and other organizations,
able
availand
information
sex
there
little
reproduction
on
that
is
a
ccurate
too
15-19 say
but
education programs vary widely,
of sexuality
and intensity
The content
-
-
today.
the totaltime devoted to instruction is 39 hours between grades7
schools,
with
and 12,
just5 hours spent on birthcontrol and 6 on STDs.
tion
of information and educaclinicshave served as a major source
Familyplanning
than older women
Teens are much more
likely
about contraceptive
use.
to teens
in
those surveyed
for
their
care.
c
linics
Among
contraceptive
to rely
on
planning
family
62 percent of die women
the 1988 National Survev of FamilyGrowth, for example,
visitin the past year had gone to a clinic,
planning
aged 15-19 who had made a family
of^
aged 20-24. The prtmary reason young
women
compared with only42 percent
doctor is that doctors are too
than
for usinga clinicrather
a private
women
in
most
give
92
AHACHMENT
March
TO
MS.
ROSOFFS
PREPARED
CTATEMENT
1990
The
ISSUES
Alan
in
An
Independenl. Nonprofit
Corporation for
Research, PolicyAnalysis
and
BRIEF
$4.40
Is Saved
The
Cost-Benefit
health
subsidized
One
Fa^
useful
about
offered by puWiciy
tool
at
that
time
a
of
which
that is.a
analysis"
-
to calculate
attempts
from
back
is a
that
help women
of
publicly
is
States
Over90
source.
about
-
dized
subsiputslicly
a
percent of these
million
4. 1
are
reimbursed
nor
the
neither
people
these
services
4.5
who
who
able
million
the
and
them
by
The
show
Alan
a
year.
are
fect,
per-
ence
experi-
women
New
Guttmacher
support
an
obtain
Institute
for
average
unintended
(AGI)*
of government
family planning
of
1.2
ices,
serv-
tional
million addi-
pregnancies
could
been
not
through
Service
also make
providing
help
to
of
purpjose
these
related
also
reproductive
These
exception, these
concluded
well as
cervical
pregnancy
medical
health
primary
care
for
of
ies
stud-
large numbers
abortions) are
averted
familyplanning efforts,
lab
result, for every
a
and
care
welfare
studies
each
key data
at the time,
such
obtained
sexual
as
based
on
research
as
well as
of variables
comp)letely from
in the
actual
that had
inadequately measured
of
estimates
used
on
private
calculations
recent
more
of the variatjies
ceptive
contra-
from
AGI
new
of
on
contraceptive
put"liclysubsidized
physicians. The
many
including data
of overall
care
are
lack
by
important variables
and
use
quite
now
limited
was
dollar
costs.
by
are
old, and
ices.
serv-
been
or
the eariier
lier
ear-
ures
meas-
either
left out
analyses.
high blood
screening for breast
cancer
as
These
tended
unin-
offer a range
that
fore,
pregnancies (and, there-
extent
activity,
contraceptive
including basic
screening
as
Most
counseling; gynecdogt-
cal examinations,
pressure
that,
include contraceptive Information
and
and
of
familyplanning programs,
programs
attempts
appropriated for contraceptive services,
is saved
in
considerably more
tions
appropria-
is the
such
by
years,
and
services.
avoid
the
be
Child Health
women
not
family planningprograms.
by subsidized
Act, Medicaid
some
familyplanning
While
methods
several
do
averted
for
several
including Title X
Social Services Block Grants
for
and
might
the Maternal and
states now
tests
planning
that
-
are
Over
use.
without
have
subsidized
them
Putjiic Health
calculations
that, in the absence
been
otherwise
programs,
and
approximately 430,000 unintended
pregnancies
Almost
pregnant.
years, family
have
to
federal
20
pregnancies
contraceptives
use
there have
to evaluate
such
ily
fam-
on
is difficult,
since
they
contraceptive
welfare
eligiblefor
of money
amount
pregnancies
-
t}ecause
occur
births and
who
by Medicaid.
Because
be
to
events
women
care,
services
would
For almost
additional
privatephysicians
to
go
law
fiave to be
the
services
at unintended
rely on
-
family planning clinics; an
400,000
social
services ifthey t"ecame
people
in
one
in the United
itfrom
funds that othenArise would
in
family planning;
services.
infertility
the savings to be calculated comefrom
Background
a
obtains
of $4.40
average
by
contraceptivemettxid each
steriliyear (exclusiveof contraceptive zation)
uses
an
avoij
available, almost
women
saves
sion
proviing
includ-
by putslicexpenditures
planning
provide contraceptive
who
services
data
to
in natural
basic
Measuring
saved
ing
Accord-
these calculations, every public
to
to the
pregnancies.
four
in abortion.
end
other
to the most
women
would
and
important since, according
who
which
at
the
ally
each yearamong
least four In 10 of
to occur
-
and
spent to provide medical
Evaluatingthe impact
subsidized familyplanning
recent
women
diseases:
contraceptive methods,
instruction
ifany
ceptive
expenditures for contra-
services
unintended
every
expected
of
study
what
savings eventually accrue
taxpayer
be
these
services
concem
high federal budget deficits
"cost-benefit
202
transmitted
be particularly dollar spent
may
NW
202 296-4012
223-5756
$1 Spent...
of
family planning providers.
evaluative
Avenue.
20036
Telephone
for Each
services
Education
Massacfiusens
Washington. DC
the
are
to assess
many
ways
of the educational
and
tive
preven-
value
Public
2010
Publicly
Family Planning Services
Funded
There
^C7
Guttmacher
Institute
(Pap
smears);
testingand testingfor sexu-
"J.D.
Forrest
and
S.
Savings nesulting
from
Singh,
"Public-Sector
Expenditures
traceptive
tor Con-
Services," FamilyPlanning PerspecI7M3,
22:6.
1990.
93
The
Alan
Guttmacher
Institute
FACTS
An
in
lor
Research
ftjticvAnalysis
PuOIh:
and
Education
F.fTh Avenue
111
New
BRIEF
YorK
fax
212
Massachusetts
Fax
in the
Behavior
97%
of
"
50%
of unmarried
women
of sexual
Levels
old
and
women
Teeiugos
"
had
In
27%.
Hispanics and
of
More
of
19, 75%
at age
CONTRACEPTIVE
"
at younger
had
15 had
aged
In
ages:
in 1988,
17
have
had
and
45%
59%,
are
sexual
in female
aged
women
"
than
any
of
of
66%
"
used
"
In
"
a
an
1979
schools
"
too
late and
that
average,
secondary
education
and
Most
1 /5
condom
causes
"
to teach
2 of those
61/2
hours
hours
focus
on
on
have
is limited
pregnancy
a
year
on
"
sex
by
to
no
conclusive
evidence
programs
factors,
state
that
or
sex
and
as
some
"
local level.
"
last time
however,
likely,
more
1 in 5 use
method.
no
had
Hispanic
6%
to
women
of teenage
11%
during the first
aged
women
among
"
failure
contraceptive
with
older
contraceptive
any
15-19
aged
men
sex.
likely than
more
usmg
a
to 58%.
of
they
are
women
experience
"
Each
year
15-44.
in the short
term.
50%
In
than
more
as
highest pregnancy
in England and
and
in Sweden;
as
null ion
one
15-19
aged
women
in
an
1987,
abortion
the
age
and
teenage
15-19)
and
By age
"
in
1987, the
in
rates
Wales,
7 times
the
France
as
high
teenagers (1,014,620 in 1987)
are
sexually active
1 in 5 who
more
in 1 987
resulted
14%
miscarriage.
twice
were
72
the
those
among
pregnancy
and
90,
189
teenagers
in
(pregnancies
rate
109, and
rates
than
conceived
estimated
pregnancy
have
18, 1 in 4 (24%)
and
an
was
Minority teenagers
once
high
as
of teeiuge pregnatKies
"
"
3 times
the
high
as
"
"
pregrant.
women
"
of
one
twrice
"
Canada;
36%
education
sexually active earlier or later.
have
specificsex education
programs
to
approaches contribute
greater delay in
at least
53%
compared
world
1 in 10
including
become
sexually active,
eiv-
1980$
in the Netherlands.
of a few
teenagers becoming
21%
and
teenagers have
become
education
many
the
PREGNANCY
US.
western
tion
contracep-
prevention.
teenagers' sexual activityat the
found
teenagers
that
pregnancy
almost
contraceptive
a
use
are
nonusers:
from
pregriant while
TEENAGE
the subject.
on
only
relationshipbetween
the
In-depth studies
shown
spent
offer
vs.
sex.
provided
prevention
teenage
Studies
than
is
it is often
(65%
had
during
use
women
They
1988"
the
of use,
year
and
Measuring
lack of data
"
schools
ttunk
most
thattheir
diseases.
of sexually transmitted
largeschool districts in the United States support
education
in their public schools,
yet 1/3 of the states
of the largerschool
districts
do not require or eiKXJurage
the
their schools
and
but
little time
too
fewer
"
states
sex
and
"
education,
sex
On
sex
"
offer
report
teenage
of white
and
pillusers
teachers
juruorandsemorhighschool
active
general,young
EDUCATION
Nearly
they
to 47%).
black, 54%
tjecome
SEX
in 1982
increased
has
condom
in
doubling
contraceptive
a
than
dom
men
aged 15-19 used a consexually active unmarried
those
the last time
they had intercourse, and among
aged
condom
than doubled
in metropolitan areas,
use
more
between
2 or
sextial partners.
at first intercourse
a
used
protection the first time
no
in 1982.
up from 71%
other age group
to be
"
57%
17-19
was
report having had
used
sexually
method
48.
activity in the 1980s
15-19
23%
of
79%
"
Proportions
intercourse.
first time
1 /3
yet
(from
in
livii\g
72%.
"
15-19
aged
lOsexually active
more
subjects.
surveyed in 1988
they had intercourse
women
Contraceptive use
tirelybecause of
"
in
intercourse;
aged
men
intercourse;
the
48%),
those in higher income
families,
teenagers and
income
differences.
the previous radal, ethnic and
narrowing
these
USE
teenage
method
white
among
6 in
of
15-year-
intercourse.
of utunarried
had
of age: 27%
year
of uiunarried
the first time
of whites
the iiKiease
about
teeiugers' knowledge
aged
men
considerably by race and ethnicity
of blacks, 60%
of
81%
15-19-year-old men,
57%
women
among
"
had
wonwn
had
unmarried
among
Most
each
33%
at least once;
for
sex
56%
1979,
areas
have
been
sho%vn to effectively
provide
programs
about reproduction and contraception and thus increase
information
activity levels vary
Sexual
"
with
and
have
men
having
are
metropolitan
"
of
86%
of unnuirried
60%
intercourse
of urunarried
1982, 19%
1988,
and
activity increase
have
men
Sex education
unmarried.
are
202223-5756
intercourse.
15-year-oldwomen
unmarried
15-19
aged
men
women
sexual
had
have
15-19
of
99%
296-4012
States
United
"
and
"
NW
20036
202
Reproductive
Acnvmr
SEXUAL
"
and
Avenue.
DC
Wasfwngton,
Sexual
254-5656
254-9891
212
2010
10OO3
Yorv
New
Telephone
Telephone
Teenage
^ionD^^(l!
inaepeoaeni.
CorpwatKxi
will
4 in 10 (44%)
do
a
birth,
per 1,000
15-17.
aged
rate of white
agers
teen-
respectively.
become
will
in
pregnant
so
by
age
at least
20.
94
of white
21%
"
of nonwhites
63%
become
8
10
in
repeat
a
CA
AK
(151),
lowest
"
the
munber
rate
rose
within
Within
2
unintended
arc
half
about
TX
95
the
1980,
in
"
1985
Wl
4
"
the
(73).
10
in
the
will
and
Latin
United
in the
66%
91%
births
7 in
10
"
The
teenage
"
The
53.6"
was
occurred
increase
Of
"
blacks,
4
"
Nearly
1 /4
"
Less
10
in
have
were
first births
to
teenagers.
bom
1988,
to
23%
birth
give
teenagers.
aiHl
Oi
preiutal
inadequate
their
who
20
age
either
care,
because
or
pregnancy
under
women
they
because
have
they
The
OF
experieiux
heal
baby
will
prenatal
care,
Teenage
mothers
her
"
the
late
care
and
children
More
"
child
at
age
aivj
17
dependent
"
Public
"
The
will
more
age
economic
their
ai"d
welfare
Babies
billion
"
Children
bom
over
spent
services
to
the
over
of teenage
20
billion
families
to
in
teenagers
next
$21
in
begun
%viU
1989
OH,
ND,
factsheet
1989
by
cost
SMa.
UT,
WV,
are
at
greater
DM,
CT,
WY.
WI,
for
family
in
The
irKlude:
the
for
National
ences'
Sci-
of
Academy
National
by
Plan-
Centers
Options,
Population
the
coiulucted
published
/or
the Future.
INSTITUTE:
for AmmaK
Poml
Tummg
A
129
1W1.
Hadlh:
Prr)UiSm%
Nm
A
lot
74
IWO.
teenage
Sinh
at
pp,
$1100.
Onicfs
Omirol
Tod"y
first
30.
1989.352
198S-19W.
Ptripnlwa.
UucmIioh
Srt
Tacldng
n
Sdmb
Amthas
Todtf, 1999,
24
pp..
1986. 310
MiotrMjmilCniirtna.
Prcgnmcym
(Yaie
Prrjnsiicv
Mr
m
pp,
S119S
SSO.OOckithliound.
Press).
Uniwmty
TV
S6U".
UsilaJ
Sojpr of fV
imJ
Pn*bm
fespomo.
Sl""f
1 9*9,
"
English
in
(nd
in
Porfniilof
A
1990,97
Ifcf AiitmoB.
pp.. $20
00.
$28.00
for
SpMUsh.
PtisiiKlivo,
Fmi/y PUnmtig
individuals.
firoiM;
7iiii""m"B"'s
/Uo(""criitt,
avmilabic
sufeacription: $38.00
1-yw
for
inttilutions,
poor
support.
mothers.
taxpayers
risk of lower
On
m
pp.. (20.00.
SMtt
Ktimdiictiot
Usn:
$12a00
for
Mnw,
Include
Pkaac
discounts
copies
are
Pnrptmls
Lffakrm
Momhirr
1 -ynr
10%
Additional
$6
HolM
00
$100
uubtutians.
lor
for
subscription: $60.00
of
your
of
this
order
for
factsheet
nut
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intellec-
TNs
"Facts
in
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and
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individuals^
orders
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available
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was
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poasibW
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individuals.
years.
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consent
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government
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choosing
72pp."15.00.
school
their
disproportiofutely
for
assistance
high
by
having
parental
obtain
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papcfbound
payforthedeliverycostsofatleastl/2ofthebirths
funds
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mandatory
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births.
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abortion.
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pp.. S30i)0.
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have
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who
have
"9.00.
tage
disadvan-
unintended
women
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mothers
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on
of tf"e
tiiis age
INFORMATION
THE
of later
result
and
less educated
graduating
now
1 /2
younger
or
become
who
Teenagers
are
and
delay childbearing
who
those
of nonmarital,
yet only
she
that
a
women
visits.
of socioeconomic
risk
than
as
to
in
in
lifestyle factors.
other
generally
levels
mothers
before,
ever
lives
are
higher
teenage
than
"
They
20s.
their
until
complications,
and
greater
at
are
their
throughout
th
nutrition,
poor
15-19
RadmpimTttr^giPrtpwKyframFunilyPUantmg
likelihood
the
greater
are
year
of abortions
about
MO,
this
in
Risking
MORE
FROM
CHILDBEARJNG
EARLY
mother,
the
younger
the
for
Umttd
"
have
MN,
Health
for
Prmntmg
CONSEQUENCES
they
DATA
data
report
receive
medical
that
is about
problems.
minor
a
MI,
Control,
Abortum
few
too
birth
start
ratio)
given by teenagers
financial
for
Persptcttves.
first births.
give
1 JIXO
per
considerably
is
likelihood
the
each
aged
women
concern
Guttmacher
Disease
FOR
of
33%
average,
(36),
States
lives, feeling that
OF
Alan
rung
among
adoption.
"
(73)
number
total
often
are:
ME,
of the
Most
The
tlieir babies
place
of
most
effect
SOURCES
The
1977.
Center
who
in
95 J.
between
Hispanics.
not
are
of abortions
(abortion
United
the
4%
about
currently
states
N4A,
were
end
406,790.
their
LA,
teenagers
teougers
to
of teenagers
in
were
18
whites
the
in
child, aivd
a
15-19)
since
mothers
nuscamages)
minorities
abortion
in
1987
in
"
abortion
an
in
aiul
nonwhites
among
10
of all babies
10%
than
in
highest
the
was
20
reasons
laws
10%
whites.
year,
change
in
for
three
have
and
minorities,
among
increased
15-17
first birth
their
2
Every
The
pregnattcies.
aged
maternal
themselves.
parents
(number
rate
among
pregnancy
was
"
1 5) and
rate
a
age
"
1988,
whites
to
women
and
43.7,
rate
entirely
whites,
In
age
births
unplanned
1/100
aged
1988
having
women
Among
births.
under
those
to
from
per
whites,
teenagers
the
1988;
and
1986
Guatemala,
in
lower
of teenage
daughters
(excluding
among
of all abortions
group
"
result
(births
among
for
10
2 in
blacks.
to
birthrate
birthrate
10
in
end
of the
54%
"
teenagers
to
( 1 0358
488,941
unmarried
births
the
of
"
1988
totaled
those
to
were
5 in
pregnancies
all teenage
births
teenage
and
Brazil
in
10
Canada,
in
wonwn
child.
first
of
1/2
About
"
20, 1 in 9
age
3 in
States,
their
had
have
By
America's.
as
under
Canada's
between
halfway
is
rate
15-19)
the
than
end
26%
"
teerugcchildbearing
US.
the
teenage
abortion
teenage
aged
higher
1987, 109.
CHIUJBEARING
The
prob-
ily
primar-
size.
pregnancies
teenage
women
same
"
become
mothers,
single parenthood,
inevitable,
likely to
more
While
"
1980s.
off in the
in
of
larger family
aiKl
problems,
of older
abortion.
pregnancy
and
111
effects
chiklren
ABOR-nON
were
with
(70),
teenage
are
anK"ng
states
leveled
but
1970s
was
(128);
the
than
it is not
Although
"
teenagers.
m
(67), SD
and
10
in
rates
(62), lA
the
rate
pregnancy
9
"
), AZ
(131
pregnancies
gradually dunng
of
and
education
than
more
years,
behavior
acMevcownt,
of wtU-ajnOoi
lema
pregnancy
married
among
pregnancy
MN
(60),
of teenage
iimtaiii:
and
and
are
(132),
ND
were
the
In 1972,
premarital
a
year.
a
highest teenage
GA
come
be-
tual
o* whMn
41"
t"ecause
experience
and
(144),
rates
The
wiU
latnagB*
18, and
pregnancy.
tewiagers
with
States
"
who
pregnancies
teenage
unmarried
""wority
a^e
20.
age
again
pregnant
have
31%
"
by
of
by
once
5 teenagers
1 in
Nearly
"
least
at
""%
and
teenagers
pregnant
by
a
grant
from
The
Sophia
Fund.
only
volume
95
AGI
new
ma|or
tour
had
study
aga
amounts
icaa
cortracepttves from
otjtain
who
women
publicly supported
various
of the
rates
in actual
methods
and
probable
behavior
of health
sen/ices
i such
supplies,
providing famSy
of
the
on
hand,
of
hand
one
in
few
those
for
stamps
W1C)
and
Infants wfw.
under
law, would
be
the
for
hmd
Almost
and
of current
temrw
eligible for
such
in the
ices;
serv-
a
(and
one
In three
most
effective
lUD)
obtains
dized
and
four
in every
one
wtio
each
the
methods,
it from
pSI
In
savings
lic
pub-
clinics
planning
Famty
planning
key
the
of
source
remain
Of the 4.5
for
care
help
mMion
women
services
each
Major Findings
These
yield the following
calculations
90
~Slno*
less tftan 10
major findings;
4.5
million
contraceptives
who
rely on
of
users
are
percent
ing
receivover
year,
and
Because
"
Under
"
protable
receiving
behavior,
an
of
of
average
unintended
disproportionately
are
year.
scenarios
three
the
additional
million
a
1 .2
unmarried,
ices
serv-
poor
not
tfuin
women
publicly
funded
516,000
"
and
of
spend
a
million
for contraceptive
total
Ifthese
the
ure
fail-
tfiat would
short-term
be
to
mettiods
allother
the
use
tfiese
since
rates
are
women
switch
to
do
H thay stop
not
their overall
similar
to
because
Important
cUenta
wfw
not
able,
avail-
ditures
expen-
required by law
"
nirtg
Publldy
of
those
reversible
services
family
furxled
allow
substantial
pregnancies,
to
prevent
birtfisand
ttwy
II
t"assd
unin.
infornia-
on
methods
woman
birth control
th*
of dinic
large number
III (resulting
unintended
million
3.1
million
plan-
on
a
nancies)
preg-
to
us*
to
be
unrealistic,
would
result
clinic.
in
an
pregrurfdes)
women
affected
but
the
sexually
of subsidiisd
A fourth
additional
assumed
would
alt would
While
active.
scenario
iHuttrates
what
before
used
contraceptives
this
contribution
about
women
family planning
unintended
of
rrana
information
methods
or
(especislly
sterilization
of the
(which
pill
prsscription method
1.7
baaad
to
came
scenario
ods.
meth-
tinue
concon-
admittedly
the
corwaceptivs
total
sarv-
bers
num-
unlntervjed
abortions.
wtio
Pattam
miffion
1.1
taking
ices to the prevention
of women
incoma
piU users). Pattern
are
addWorMl
an
tinue
nually.
an-
ab-
laval
Mrvicat.
was
oontracaptlve
a
that
using
women
mair
In
risk of unlntandad
tama
another
usa
conlraoeptlva
highly effective
most
of contraception,
aach
ally.
gener-
$400
services
were
tend
pregnancy
governments
approximately
services
additional
births
abortions.
state
However,
of
including
uninterxled
addKional
Federal
absence
services,
additional
509,000
and
occur
in tfw
batiava
I
publicty
uaing
contracaptiv*
what
waa
would
appioxi-
additional
*n
pragnanciaa)
tton atMut
In
American
do
additionaJ
at
(utMidizad
uM
At
Pattam
pragnanciat
unman
of ttM
and
pragnancy
have
they
of contraceptive
hiave higher rates
cies
pregnan-
young,
nonwhite.
and
to
to
coniidcrad.
woman
would
prevMaf*
iimilarty
con-
ivailabl*
iptctrum,
in an
that
wlul
utctty
longar
no
unlntandad
aaaumad
"anoa
predid
twfuvtoral
800,000
mataly
and
pregnarv:ies
unintended
day.
to-
If put"licly funded
"v*r*
ratutt
(ratultlng In
contraceptive
publldy sutjsidized
433,000
abortkxis
States
caid.
Medi-
by
women
of unintended
of po*sibilitl"t wa*
of Itw
fundad
ies;
dirt-
private
to
go
reimbursed
further
rates
and
to
do
might
ring*
tandad
providers
approximately
experience
who
the
would
United
in the
twt"ich would
States
United
inthe
publicly funded
doctors
ible
revers-
and
It i" ^potsibK
"
did
The
"
de-
and
services
effectivelyand
woman
on*
ices.
serv-
planning
famBy
percent rely on
actually
Improving
practice contracep-
ttie number
experienced
funds
counselirig woUd
and
couples
more
reduce
yaar)
subsidized
half of
measured
have
and
Expanding
more
tton
h"f
women
cortiaceptK/e
seeking subsidized
services.
contraceptive
on
tures
expendi-
resulting from
fialfof
and
servues,
dollars,
In constant
.
spending
over
1960, total govemmert
famly
for
"vwy
provider.
"
for
account
trmocptivt Mivtcat
the
computing
"
metliod
no
the
or
sut3Si-
publicly
a
only
risk of
of the
either
uses
is well
eight percent
pregnancies
year
use
all atxxtkxu.
wtw
women
method
contraceptive
uses
States.
United
use
pregnancies
related educatkin
provision of iannly
ttie
actual
at
proviskxi of cortracepdve
crttl-
remains
be
the
athou^
about
-
women
Skxe
study:
new
low
women
pregnancy
uninterxjed
ices,
serv-
corKluslons
subsidy
to
these
-
of
number
dined.
the
from
planning services
care
of contraceptkin
for specialized
following major
Public
"
unintended
source
small
an
the
tfiat can
normal
In adcStlon,
ices
serv-
needs
more
rates
with
obtained
prcvid-
referral
ttBt accrue
planning
theoretically and
a
Inv
substantial
between
gap
ceptive
contra-
and
and
providers
callyimportant
(AFDC,
to women
the
failure
docunented.
In addition
related
The
done.
to be
contraceptive
needed.
be drawn
may
tions
abor-
two-year
a
services
social
and
The
pediatric
period after chOdbirtlv
(Medicaid)
other
that
states
sen/ices) and,
abortion
wtien
care
(and
childbirth
and
the
on
medical
providing
pregnancy
health
care
to
serv-
ings
large sav-
benelts
famSy
to note
educational
counseling
as
otfier
pianrung
and,
and
ices
serv-
public-sector
the
calculating
"
of
cortraceptlve
low-cost
variety of
a
well
as
these
the
to
cunenlty beir"goffered,
levels
receive.
may
-
or
health
portant
were
unavailable:**
costs
care
subsidized
tures.
expendi-
important
often their only
are
free
to
of
scenarios
three
under
services
of
publicly funded
to
access
which
-
from
achieved
putjlldy furxtod
to
care
ers
conditions
under
experience
continued
It Is
arxJ eoorx;TTiic
taxpayer
makir"g visits for
ttiat women
women
welfare
and
in health
sodal
plarv
prevention
-
resUtkig
the
arxj
use
tions
births, aborthese
miscarriages
and
a
pregnarx^ies by cortracep-
mlrterxled
However,
estimate
to
use
on
of famly
area
Impact
nirtg program
savings
on
analysis focuses
crucial
but
tive
contracep-
of unintended
the number
would
data
avaiaUe
using newly
"
failure
AGI
new
tive
Medicaid;
through
reimbursed
cians
private ptiysl-
or
The
narrow
either
programs,
dlnics
famly planning
relative
Finally,despite
o(
characteristics
and
number
amal
ara
that resUt
ImpBcaUonsforPubecPoBcy
to determiiw
Growth
FamBy
of
Survey
provide
to
apart
"
tor "wy
National
the
from
data
using
"
food
$1-8
of $4.40
doHarspem
steps:
the
""nga
aawingt
would
Cafcutetfcyn
The
of unlntandad
nationally.
The
Copyright
Th*
Alwi
199a
Qulknaclwr
tnamul*.
pregnancy
96
in
Countries:
Developed
Policy Implications
Pregnancy
Teenage
and
Determinants
By Elite
F
Richard
Lincoln. Jeannie
Darroch
Jones. Jacquetine
ColJman.
Sorren
Formt.
Rosoff. Charles
t.
F.
Stanley
Deirdre
Wesloffand
Ilemhstc.
K.
u//
W
Introduction
artiHr
This
chUdbeanng
of jdolescent
bv
The
insicht
some
article
Catot
and
that
allhuiiidi adolescent
Andre^^-
been
dnlininic
have
in
and
in the
'
the
I'nited
and
block
between
L'niled
(for whom
tended)
than
Abortion
it
rales
Two
for which
"|ueslions
major
abortion
L'niled
rales
Slates
L'niled
ITm
37.Country
other
The
two
F
JtHw^dvn-tt-d(hr%tiHh
wbilr
tuM^
Kormr
o
"4"
those
for
PTr^Klr*il
""
i\CI"
rather
than
en
in the dozdata.*
l^uvdur
k
RK-lunI
1
RuMjff
B
ihe
with
37
data
and
thai
Hrmiw*
birthrates
birthrates
and
"
States
pul"-
designed
documented
survey
be
as
the
of
and
have
ihe
uniform
a
national
icy,
pol-
policies lend
benefit
thus,
L'niled
this varuble.
on
those
and
benefits
(Because
represented
countries.^ and.
not
og-
m
indKnilmg
Eumpean
most
in
the
L'niled
Slates
fit this pattern.)
Analysis of the relationshipbetween
fertil-
of information,
areas
prevalence
have
not
not
'Austnla.
such
Deviirv
leaves
less liberal than
would
a""
ment
supple-
to
Srnof
"
does
lh"- proportion
rmpkiied
developmentt
fact, L'.S. maternity
In
"
force
birthrate.
was
avMK-ialiun
and
inlerpreli*d
of maternity
it
to
and
positive relationship between
a
teenage
nan-
lie taken
u*rms
positive
a
labor
mull
iTinc-luvne.
chikJhearing
jor
ma-
t-arxird
lu
brnad
m
a
l)e-
iiflh"are
ihe
have
than
only
socioeconomic
is
rrMilts.
sa
resiihsof
rather
(a variable
There
levels
to
anolv
arulf
The
ihe
tially,
ini-
attempted.
was
fiH-lh"d"iloe" and
bi\
teenage
level of
"
basis
described
nculture
highly
for the quantitative
country-level
a
of ihev
of the
the
for 42
from
ihr
analysis found
found
acceptable
an
obtained
ACI
inadequately
were
Measures
selected
From
the
by
are
were
was
reasofuble
rates.
variables
cause
be-
for only 13
it
seeemed
it
for pregiuncy
data
chosen
However,
rales
so
plained
ex-
Birthrates
61)
were
available
were
are
and
urrerxoiiiim'd
analysis
suggestive
The
"*"r-
rfLlmavhips
\arulil"*s
appendix
are
iithrr
i"r
pLiiiiim:
pairuisr
analysis presented here
and
18
rales
(page
rates
countries.
conducted
The
"
iironi/alHm
for famiK
and
of the
between
cific
age-speage
on
multivariate
in the
i"f t-oi-h
(.'.. and
indepeiKlriit xarulilt*
results of the
for the
selected
girls under
appendix
that
assume
lished
TV
and
t-mliavw
countn
dependent
two
ihr
lo
\\'a.vhingt"Hi.I)
in
pfots
scnplions
tries,
coun-
study,
each
variate
multi-
countries
cumublive
were
pregiuitcy
analysts
jl
And
dertakings:
un-
they
1"-19.
the
that abortion
proxy
coun-
U^rTDch
Luiroln
Ptndrnl
young
no."
say
family pbnning
in each
ate
for
abortion
of the
by
in
\uoculr
^unlrt
Difwtw
jrjnnw
Is
sex
time,
should
Scatter
pregnancy
five selected
variables
study
fertility correlated,
J^niurluv
and
of teenage
in
women
in
L'.S.
devefoped
Hn^jirh
brntw
4
possible
that
same
in the
between
Analysis
birthrates
upun"hrhlh"4nrlrs
inklnulr
Hr*#M"rh
Bt-M-jA^i
Drpiitx
\
vhf
CulTiftjrKrr
\Lin
the
responsible
vices
of
Stales?
States
dependent
3T-country*
independent
Eler
all
tell them
countries
tile
as
gap
unm-
higher
other
in
number
devefoped
37
studies
case
to
that
distinct
two
can
than
suggested
much
so
than
the
L'nited
invoK'ed
fertilihi in
and
of buths
teenage
are
adolescent
cents
adoles-
are
the
of these
agency
rates
quantitative bivanale
teenagers.
there
of
worst
TV
and
countnes
analyses of ihe factors associated
its antecedents
among
were
Why
comparuuiu.
arid
older
higher
adolescents
among
countries
so
these
also
of
pregnancy
in
study
.ACI
Ihe
presumably,
among
u
The
adverse.* what
for reducing
and
the
majorirt-
great
and.
ore
than
leeiugers
or
the
of wedlock
out
and
useful
and
The
ytMinger
the
and
included
pregiuncies
experience
conceptions
the
higher
Slates
radio
unintended.^
ofien
the
if only
in
rates
countries.
among
he
leeiuge
of while
even
the
other
greater
is
might
teenage
are
adolescent
States
rates
still much
ore
the
countnes
are
the
most
Slates
from
fower
developed
However,
ofihe
must
they
large differential within
a
considered,
Slates
in
with
as
L'niled
learned
have
fertilityis still
of other
between
teenagers.
are
L'niled
is
States
be
of Western
the
in
majonty
There
Stales,
countnes
teenage
higher
great
countnes.
those
L'niled
Europe,
cofuiderably
whites
the
in
L'nited
their consetjuencrs
reported
Foster
the
in
fertilityrates
irtuojly all the
northern
than
triesi* .And. sinir
Westoff. O-
F.
D-
inherited
.
music,
age
teen-
especiallylacton
by Charles
rord
v
of
.
icim
be siibjeet to policy changes.
I9S3
A
to
have
.
Movies,
romantic,
exciting, titillating
Yet, at
that good
people get the message
girls
Institute
deteimmants
hehavnr.
worlds
taken
under-
was
purpose
the
mto
reprodut-tne
thai mieht
mam
s
"[U.S.] teenagers
ctrni-
and
nmntries.
Cultmacher
Alan
study
a
prejcnancy
developed
in
The
(ACI).
results of
the
summarizes
study
paratixe
sex
Briinum.
Auttna.
fiullsrw.
Cbiir.
Cin^fj.
cation
eduCuba.
ClPctwfiDvalitt.
Drnmsri
ihr
F"deni
of
RiTublK
.
UuU
Wi^ioD
PriiMT^m
nrf
k^n-n
jrrcrjiHiilK
ihi* KtrtU
i"
"4
Dtm-tor
GoUnun
Nucrrn
r
Dr|i"ir\
B
i"
Hr^rjrch
^ iiUrr
TW
tllrnt:
.BlniMli^la^
KtniiHiilitn
til
(Mh^
Difrrhir
I nnrr%rt\
PublK-^um.
ot
the
llll"li"liiianl
itf ^
f
ilil""
tlimiilMilMW
^
LvM"
Ourin
IWmwti
%tr"-
each
within
AC)
contraceptive
services
attitudn
"n"hl
leMmt
that
sexual
kU"mrfCm*"M*"n
TKrvlvA
was
sent
to
the availabilityof
country,
for
have
minors
a
on
social
ado-
pubic
eird
"v.
activity.
The
pubtir
albirs
the
and
bearing
Gcmuny.
questionnaire
officvr
AAi
M".
American
embwsy
in
each
(oreign eountry
Cieal
SfMi.
l
and
t^an.
aMri
S-idia
S"Mn.
Re-
OvraocTVic
Wain
Hon"
corad-
jnd.
Konx.
Huno-
Nrlhrrlaadi.
dw
tt/brnd. fmtmd.
Notny.
iW
Itak.
Cemun
Crrrre.
ScmUnd).
IvhL
Smmpan.
L'SM.
(England
Bntam
vpanlrly.
InWd.
Zf^nd.
of the
the
Flnianii. Frmcr.
Puma
imnerUni
aari TaaMlava
Hn
T^ann.
Nr"
Rooaihr
97
Prtgitaacy
Tttnt*
Dtvtiafti
m
Cntt\
tn
adolescent
high
FIgura
1. BiiliM
20, by
"ronian'(
1,000
par
uMinlilaa,
caaa-amdy
aga,
with
mi
regard
of the
one
Bum
1
par
with
.000
low
of the
100
tility
rate
United
much
"zed. and
the
than
higher
higher
that
countries
U.S.
those
developed
less
than
rates
found
number
a
in
The
The
where
falls be-
ies
U.S.
of Romania
those
tween
the
relatively high adolescent
United
perience
United
that
of other
has
country
at
fbr
age
about
low
small
benefits
the
bottom
the
and
a
a
been
buis
about
openneis
of four
female
the
nudit"
(defined
sex
media
items:
of nudity
eitent
the
on
of
presentatioo
public
on
more
available,
it is
additional
the
ity and
or
ed
with
likely that
variables
is not
to
adolescent
analysis would
fertilityin the
have
retained
multivanale
tance
in the
them
deserve
1. 2 and
and
each
countries
ate
general culturdevel-
economic
the
imesligators'
countries,
adolescent
to
ex-
it
some
pregnancy
by single
rates
apparent.
fi\e
of
year
U.S.
shows,
is
teenage
much
are
pregnancy
exceptional
The
age.
Stales
I!W1
countries.
and
rales
United
The
1
Figure
lor the United
3 present,
of the
abortion
bivariate
impor-
of
stage
related
position of the
theu-
m
that for these
data
birthrates,
of
and
States
it was
young
available.
were
Figures
some
among
different, the
of
lower
and
Sutes.
the
on
rales
the first phase of the project,
apparent
eco-
Their
activity
finally,ftom
the Neih-
chosen
United
very
Can-
"
considerably
are
the United
assocut-
be
to
in
stud-
case
States
France,
were
"
sexual
badcground
crucial
al least
found
of the
people
relatively
information
complete
measures
for the
considerations:
that
similar
States
better
no-
education
United
Wales.
Sweden
penencewith
nomicl^der.
Had
that
was
the
pregnancy
believed
countries
of the
runp
and
opment;
distributed
is
also
relatn^ely
the
on
selected
to
and
of three
than
al
of its income
is
Studlaa
England
adolescent
bet, the
most
Casa
addition
in
basis
that it is less open
than
It
scores
contraceptive
five countries
erlands
general pattern
birthrates, and
teenage
on
n
one
of the United
schools,
ex-
of these.
matters
proportion
families
that
In
fits the
fertUity
teenage
and
13 countries
sex
States
the 37 countries
among
the
consis-
were
mamage.
none
Stales
sexual
with
to
hat
Sutes
United
high
in
if the
countries,
leaves
minimum
about
U nited
United
probably
u
the low rating
openness
that the
ada.
pionatalisifertilitypolicy, high
a
low
The
birthrate
Stales
levels of maternity
United
The
Hungary.
also suggest,
of the
with
tent
would
States
rate
and
on
data)
high
very
the
of the
any
are
underlying
Country
youn-
teenagers,
The
Sules.
of much
inconsonance
applies particularlyto (ertilityamong
ger
there
of
availability
the
considerably
are
countries.
of
modem-
United
(the highest of
table
low
observed
those
comparably
arc
the
religiosity
reported Rx
which
States
ex-
fer-
teenage
a
of
factor
one
is
countries
has
States
it
than
level
for
assocated
Although
fertility.
rates
States
development.
bcton
important
highly developed
the
The
is anomalous
States
socioeconomic
to
most
most
amined,
in
United
teenage
"wnw"
four (Ktors.
fertilityon
position of the
umtaraoa
woman
immedialely
birthrates,
higher
than
as
those
of
analysis. Certain
.
sales of sexually explicit literature
beaches,
and
media
repeals
societ"'
bund
(i.e..
household
under
IS. Of the
information
United
and
States
equitable
these
three
The
minimum
the
(Again,
although
their
in
by
consent
own
rale
increase
to
that the
2-
religiosity
re-
most
of the
countries
to
not
"
59
in
contraceptives
birthrates).
'O
subsidy of
with
for-
teenage
be
in
'"
than
of
the provision
^^"j""**-
con-
g
^^^^^^S^ZZ"L.
\
however,
teenagers,
to
services
^^,'' ^^"'
Sutes
restrictive
more
legal
state,
on
comparable
teenagers
is also
policies
d"n
not
or
at
see,
low
very
to
appears
Teenagers
very
are
low-cost
stodted
IB
cost"
coi
^
the
shall
we
.
studies,
^
country
case
in
aB
in
services
Umiwj
_
^_
m~"
Ivwar
adetescant
of wfcich
birtliralas
have
and
Canada
the
S""d*n
N"n"nanos
auicb
ibartioa
"
briQuna
^".^^fimt'
or
five countries
the other
siaies (loiai)
^!!I^?!rJLt!r*'
of
terms
less likely to gel free
contraceptive
detaii"
as
unportanlm
,
much
than
on
free of charge
factor that,
a
be very
10
obtained
be
the provision of contraceptives
UniledSuies
Slates
could
daU
woman,
VOOOoonan
the
bixth-
study, the United
to
appear
accessibility
government
with
1,000
'0
.
from
aga.
par
1961
traception,
con-
in
high
low
t
AOononapar
"
^"
^^"
"
Aborttoo.
,j
resented
rep-
18.)
United
^^"
"9""
20
traeepttve
fertility.
It is notable
to
access
with
associated
not
low-fertilitycountries
marry
can
include
that govemmeot
er.
high-
the
state
is
^-"
case
detailed
These
(associated with
noteworthy
lower
a
of
about
In the 3T-country
has
not
because
for older
hat respunsne
is
country
more
tdity.
does
was
women
age
Of
States
teenagers
from
stales
most
abortions
States
vanes
Finally, the
somrw
to
United
mamage
the
have
for marriage
this variable
on
at
age
It is
income.
level
figure
woman
teenagers'
on
teaching
schools
the
birthrate.
age
and
this
United
for older
bulhrate
the
the
they
individual
associated
(both
country
Canada,
of
the
countries,
the
for which
Zealand
New
datnbution
far the highest terfuge
where
"
available.
placed
stnctions
rates)
because
available.
was
20
Car girls
birthrate
19 countries
was
least
by
country's total
by the poorest
cumulative
the
a
infemution
income
the
in
of their pol-
that follow, for which
studies
population) is negatively related
of the
to
of
of
significance and
icy
prominently
countries
in
distribution
received
income
given
a
liberal views.
most
proportion
greater
percent
"
the
equitable
a
in
birthrates
low
exemplify
to
More
"
advertising ofcondoms)
because
mention
_____^__i^"
ano
warn
"
^"
"
by
98
ri rtM
ntt*
Pi"gn"neY
3.
Ftgura
1J
pm
The
1961
bywom"n't"9".
1.000
PragnanoMDW
French
to
rales
lb. but
age
increase
In
1961.
abortion
the
(ot births. The
(mi the
highest
age.* while
the
flatter. The
rate
for
between
abortions
speciTicabortion
United
the
The
The
rales
the
Thus,
United
States,
stands
other
knrls
France,
OM"a
SuiM
rmaii
unMO
Sum
lanani
similar
.
than
the
England
and
another.
Sweden
abortion
teeiuge
those
(. niled
States
crrasine
uf rjch
of thf fn
marcin
Lrl\
tor
tlw
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l.(lia)
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uthtT
from
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thr
Dutch
1*^1.
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l"raf
aitrd
lo-lh
low
in
em
IrrruKrrj
and
Franrr
Swrdrn.
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liirthrjtr
acrd
j
iliild
Th"-
a"
orr"
19
wrrr
an
rrlalncly
clrarK
EnglMid
inlrmnJnlt
a"
"ih7"-
alw
and
olds.
trr"
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ihr
only
the
aiasHt
diffrrrnce
Stairs
and
other
whitr
Wain,
11HK.-I1h"hrT
graup
pupotatnm
high far Canadian
in
thr table
than
m
m
fiowesrr.
U.S.
thr
the other
the
neat
the
rep-
isons
compar-
whilr
among
thr
une-rrfih.
for
higher
popubton.
inlemationaJ
ratrs
"
column.
include
people
plosTnent
for young
unmamrd
far the
of
Teams
other
less
have
helped
the
r
pra
of you
i
unen
from
away
tf-
assislaru
particiilarl"
each
investigators
the
France,
week
one
and
conducte
ofiicials.
statu!
gosemmenl
and
olhrr
researcher
and
prosiders. These
to
adolescer
intenie""
discuss altitude
tangibleActors
been
visitr
.Netherlam
that might
possible
to
no
document
investigators to identifyothr
of data.
The
the
mosr
the opportunity
otherwise
ihr d
and
gosrrnmriH
demographers
service
econom
proportions
family planning, abortion
provided
and
mothers
for
with
enhan
to
try
propir and.
two
Sweden
inform
conlraceptii
the
England.
health
and
Ihr
and
programs
and
and
ar
conir
aspects
influrncr
might
patterns,
homr.
for young
and
to
socul
school. emplosTnent
in
"uniK'
US
five countries
Uniied
Stales
that
visited
wrrr
much
have
in
common.
ano
\\
by
pregnancy
adnhmntj
rates
These
sources
brls*rrn
counlnrs
the
children
cians.
of all 15-19-year-
percent
of thr
that
to bear
and
lernagers
reduces
United
rale
U
pregnancy
ternacrrs
black
ISM),
considerations
and
Srseral
expfored
certain
lo
thedelnen
formal
education.
sex
of
creased interviews
in-
rates
ar
addiiio
In
access
services,
thr
and
life wrrr
teenage
preg-
IWlI.
setu
topics: policies
teenage
understanding
U.S.
influrncr
adolrstrnl
total
provision of
Canada.
cxiuntries
propc
of
rates
practice.
abortion
services,
agers.
teen-
pregnancy
to
those
the
in
sufTicirntK
whiirs
in
ihr
no*
deterrr
livuig together
not
of related
ceptive and
older
lUTfiand
thr
an*
among
Restriction
lo
and
lirtwrrn
Stairs,
re-
thai has
drclinr
a
for othrr
trriugrrs
though
In
age
about
thr
for
by
youngrr
those
Unitrd
ihosr
rrsrnted
agr.
ai*
awm
than
r\rn
unr
and
iiKreasr
rate
disparirn hrrvtrrn
liLul
ratrs
at
Ainrrican
binhraln
npecully
vompox-
at
"rri'
Canada.
arr
much
ak
Nrthrrlands
the
oiiiiirn
to
l-l. (hr
offset
stimrwhal
the
In
Thr
\ran
almrtion
in-
number
practices regarding
tice.
the
those
among
assemb
to
proximate
cohabiting,
c
collrctr"
was
specifically,the
"
{"
infefmatwn
made
was
the
on
f"
investigators sought descriptivemalen
except
hern
:
sriectrd
abortions
of contraceptive
a
sire
where
has
the
on
higher
that the
noteworthy
n
only country
both
For
rates
runc-v
among
morr
girU acrd
with
complrtrK
country
pregnancy
ihr
in
birthrate
othrr
With
girU of comparable
DUX)
prr
Trenairrt
and
(unr^tKalofCaiudi.
cvuntr\-
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iht* birth-
in
Slatn
iir"drr IS
ac"
a
th"-
Oct.
In
its
generally
are
It
rrcrnl
in
Hrcti
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r
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unK
birth
rn
jt
fixr hirth"
I' b
the
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iK\-ur\
than
at r\-rty
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m^Kimimi
rjlr
nnintrm
""
iitn^HJrrjIik*
kirikinc
ouicom*
quite
are
is
for any
thr
a
Wales
birthrates, although
uf lernagr
inndrnrr
Canada.
for
rates
Sutes.
very
notable
reported
United
of
At
with
measures.
one
aditirtcent
low
Its
the
is
U
popi
establbhcd
was
countries
efibrt
data
of teenagers
levels
rather
and
of pregnancy
of Canada.
pregnancy.
and
to
births
activity
a
six
Detailed
systematic
a
lion
highest rates
and
and
nants
among
the
examination.
teenage
woui
countries.
of
study
ar
it
white
compare
approach
common
dose
to
that
so
for thr total adolrscrnt
rates
lalion in those
A
(h
Caribbean
(e.g..
England),
appropriate
with
after that age.
Netherlands,
the
all three
on
low
extreme
one
has the
which
be
quantitative
teenage
represerU
At
birth, abortion
teenage
.
six countries
experience.
low
is true
reverie
varied
the
and
younger,
high. The
be
to
Dutch
the
French
The
appear
lAand
ieeiugers
be
flvc countries:
rates
pregnancy
3 reveals.
Figure
as
distinctly higher than
are
other
rates
in
not
counlm
higher-than-averagr trrnai.
women
rates
othrr
populations
minority
Asian
cept
ex-
necessarily
ratesf
clearly lower.
are
higher
or
countries
have
to
of thr
some
have
also
rrproductive
the
pattern,
rates
of the
age-
as.
other
pregnancy
sanw
U.S.
those
high
as
of the
and
has
States.
teenage
follow the
to
rates
rises
births
which
is more,
studied
appear
chief difference
for
patterns
any
Wales
and
Sweden,
with
is somewhat
The
17.
What
French
age.
steeply
curve
age
the
involves
than, those of
each
England
has by
Netherlands,
climb
Cartadian
pattern
States
the
at
rales
relatixelylittle after
"
IS-1
to
respect
to the
United
lowest,
abortion
teenage
with
and
rite,
the
much
very
age
15-17
up
relative
the
2 shows,
countries
surprisinglyclose
are
observed
14 m*
1S-1"
age.
sharply among
verv-
Figure
as
of
positions
a9t
with
women
among
older teenagers.
aronMn
IW
ions
pathally
low
are
*tV
whtmiK
Lm
niin
rrmaiw
4aio*ia
riMw
t jl
irvtuarn
tvuncrf
^
HI
f
mts
nwirr
tiimar
tlvmilyriu
W"MM"i""aRM"r4"dnib"
""d"fc"
te|i"
I
rf4MIMt
100
Contraceptive
French
amonf:
use
prxjbabK-underestimated
is
use
included
not
was
teenagers
in the
rigur*
condom
heciuse
published
P"rc*ntag"
6.
among
results
ctmtracaptlva
of the
It
survey
V nited
the
has
States
traceptiv
likely, therefore,
a
practice
e
lo"
of
level
est
laiuaUy
uaing
"ip"n"nc"d
using
woman
ttia piH. I"y aga
and
marital
eontncaptiw
my
ol
alatua
tmirioo
and
woman
and.
ot
occasion
usa
that the
con-
of all six
teenagen
among
of
parcantaga
uaars,
countries.
particular.pJI
In
widespread
those
among
L'.S.
in the other
suggests
less effecti\e
use
Access
"
contraceptives
to
to
U'aJes
cidental
ac-
using
a
sen
K-es
ustfig
Panataaga
of uaan
maeiod
any
Sueden.
16
and
In
.Netherlands,
the
be
to
England
in
and
Pafcaniaga
vices.
ser-
appear
teenagers
and
abortion
gland
En-
17
those
18
care
general
choose
may
family doctor
either
go
dense
network
clinic system
to
theu*
to
the .Netherbnds)
in
reasonably
to
(limited
practitioner
Dutch
avoid
are
15
and
Netherlands
and
seeking
a
if they
even
Contraceptive
the
ference
dif-
adolescents
contraceptive
to
Wales,
Tho
countries.
method
accessible
most
than
teenagers
that .American
pregnancy,
birth control
less
be
to
appears
use
among
to
or
a
ov^n
19
of
one
20
of clinics. The
is less e\tensn
than
e
the
21
Bntiaih
but
one.
the
meeting
England
in
feu
directed
it is
specialneeds
jnii
largely ttyw-ard
of \x"uth.
Wales,
there
clinics specially designed
In
Sweden,
there
22
23
for young
ple.
peo-
parallel clinic
tux)
are
whereas
relatively
are
24
systems,
oinsistingofthepnmary
one
that
centers
care
and
the
other
network
school-age
and
France
clinic
than
lated
re-
prfi
using
population.
L'nited
these
those
States
found
also
in the
other
the
16
H
be
to
appear
however,
France,
lln
countries-
the
but
systems,
less accessible
and
care
15
the
to
ices
Canada.
have
less complete
a
iding contraceptive
pnn
serv
of
2S
community,
ever"
serve
consisting
health
17
clinic
IB
has
system
lyil.
I
with
The
Canadian
and
The
since
uneven,
is
19
for adolescents
coverage
and
Quebec,
elsewhere.
"icrs
considcribly
clinic system
fairlycomplete
Ontario
in
expanded
scattered
clinic
L' S.
20
ser-
network
is
21
reasonably
accessible
federal
receiving
adolescents.
as
axoided
by
Condoms
however,
ts
onK
welfare
widelv
are
the
to
often
is
clinics
go.'
available
25
'Stuoansoniy
England
in
afid
23
2*
and
Netherlands
L'.S.
oped
devel-
consider
clients
22
sene
it was
poor,
who
clinics
of the
that
for the
teenagers
Wales,
required
are
drawback
service
a
places where
and
funds
planning
basic
.\
clinic system,
strictlygeographic
a
all lamdy
Moreover,
sense.
in
Noias
Tha
Sweden.
iS-yaai-otos
The\
not
unlv
avaiLble
^rr
clinics and
supermarkets
in
vending
and
machines.
parts
of Canada
duiiis
are
issue
In
and
also
other
shops
France
and
the
l'nited
Ml
every
litiitles alxiiit
NrtherLindi
vex
and
found
was
are
luuntry
are
very
Sweden,
mas
63oa"ca""oi
ST-
nanKand
Dacauia
eauaousiy
lor CwaoanKsiainai
hgura
ma
data
i6-i7raa"-oio"srd95Bareaoioi
o"
uwjiiiams
4
n
.mamad
n"vaf
"
axnoaiaowy
m"
among
i6-23-""ar-oioi
""""
uM^g
wiynan
as
auaMy
tm
an
eepaicamoi
nninoo"ii976
aasaiusi^aaivaooniwv
som"
soU
afxl
in
in
many
States,
con-
teams
be
Eve*
open,
tlw
an
inpor-
wfctn
m
"
at-
told
were
keep
their
need
for
best
to
M
snoms
family planning
but
less freely available.
Ciinlideiitulitv
laiil
from
pharmacies,
rSmoanaxonacay
conaomusaa"ciudsd
oaia
otno^nraad
axanvia
met
confidential
Sweden,
m
ciRcally forbidden
adolncvM
the
s
Dutch
keep
the
that
personal
vmt
lives
rc"|urft
dutWiti
doctors
inform
for
wish
parents
are
aho
m
spe-
about
are
vers.
ser-
trrna^r
to
the
stipulatesthat
under
18
age
the
gu-ls younger
that
services
entirely conTidential.
an
requmd
tf the
it: and
requests
probably
coMnceptne
oo"fidr*tal
to
private. The
is
services
where
to
people
young
sex
the
be
clinic
than
pwents
IrgaDv coatestcd
16
be
m
Dutch
clinics
official
for
services
absolutely
prescription
in
French
icy
pol-
women
though
confidential. .Al-
of contraceptives
without
a
informed
Bntam.
the
to
requirement
is
now
being
practice
was
101
Teenaft
Prtptttef
followed
through
study, and
to
the
and
individual
doctors
before
to
However,
Caiuda
in
pixivide services
such
any
Like
insist
to
United
charge
Wales
to
people
young
under
women
IH. and
age
most
of these
under
social
covered
fee. Until
to have
but
Caiuda.
doctors'
services
obtained
from
to
pharmacies.
the
United
States
tree
to get
do
to
The
potential
Medicaid,
clinic policv
and
in
portion
of the
otherwise,
able
under
of individual
clinic fees
are
for
doctor
private
a
expense,
additional
cvntral
the
n"le
United
sean'h
the
ol
adolescents
The
emphasis
nn
incomplete
medical
piiteiitui yming
protooil
be
aniiiutiun
he
a
re"|iiiremenl
method
veleitiun
Pnvttviital
available
at
the
In
sume
Whetkrr
a
in
Sweden
ing
voung
ftaifiti
ex-
tainilv
of
iM.
tva
Iwve
hiiw
"4.
all grade
"Mch
teeMgr
Ainnf
in
In
dcchaed
the
rates
in
a
ik" pmod.)
dramaticallv
rair*
TW
in
adaki
have
Swnhak
aot
visited
struck
pru-
tlie (iptionof
courses.
basic
be
to
abor-
commitment
since
an
the
as
to
the
the
to actun
and
with
roaiiiliiigtlir
itBea
varwed.
m
of
provision
"
the
"rneral.
exists
be
Thu
of
be
to
sur-
childbearing
Teenage
to
its
nancy
preg-
enuncution
public clunale
poutive
the
contraceptive
teenagers.
social policy appear
msr.
were
perceives
of adolescent
active
of
who
ider of preventive
services,
area
pear
ap-
countries,
pros
sexually
stud-
countries
those
in
main
health
in
unambiguous
maialiJ
iiivestiitaturv
Eunipean
fuur
that
phenomenon
The
pregiuncv
the
iiiimlieruf other
a
the
to
by the fact tfut
and
to
politicalfactors
rebted
responsibility
services
net
and
government,
age
teen-
aadMnlin
distrK-ts that
Iniiii such
given
was
be
acfolescent
other
kwc
couBtrm
I nited
Context
ex.oiiumic
to
access
nse
fact, adolescent
br
social.
folfow-
abortion
Wider
clinic
law. because
sharp
(In tiir otfcrf
abortm
1975.
Th*
a
model.
the Swedish
this link
result
rates
wWma
to
s
Sweden
of the
a
ish
Briteduca-
sex
(he
In
parents
give
their children
Oinsideratiun
ships
relation-
in
fur
reprevenls
offering
parents
education
(larents.
cdiic-ation
trajitioiiv
n
of the school
many
sex
v"-v
Olijiiiioii^ jre
ow
vchmilv
the
nolih
had
cviniiiiiiiiiiy.
their
to
reijlures
to
excusing
and
contraceptive
None
bw
nl
cdiicatKiii
sex
completely
is
is
levels,
there
link
liberalized
se
have
sexual
of the abortion
that
latrs
HTS.
pdb
and
challenge
prti:iuncy
majiintv
immigrant
whom
direct
in
vhow
vurvi-vv
vchtml
in
the
of
vide
lum
curricu-
were
lo
States,
have
which
important,
ckne
established
abortion
eiuMvd
vn
most
to
contraception
and
thev
Inn
vast
ihriiivelves
some
lar,
particu-
the worU
to
lo
of human
olherw
in
cumculum.
extends
comes
concern
ple
peoor
and
liberalization
might
confined
must
education
sex
The
the schools
countries
while
has the distinction
in
for adolescents.
among
pill can
oSWial
its schools.
services
was
on
topics
rt-vponsihle
jvohI
to
years
inatcruls
iil a
iv
educatun
vex
the
ol whom
vice
ser-
themselves.
abortion,
carefullyestablished
between
the
wtmten
procedure
Sweden
Perhaps
the
same
ri-cent
in
of
irtiiallviinivcr\al.
v
hv
accepted
under
pbnning
\iHith
how
of
bile
mo-
npiratr
vev-rebted
nature
be
to
teaching
laiiiilv
tune,
other
on
ral
natu-
in
viiiniduing
that
iiiiicli of whicli
Sweden,
most
hv
cvpfosKiii
ol
limited
tfoveminent.
the
same
and
knowledge
In
borne
is
on
Oiverage
c"
Dutch
private
^n
inJomialive
appears
pay
the
been
media,
that
be substantial.
an
discussion
States,
pelvic
the
US.
specialattention
use
the
on
Most
the first countrv
compulsory
In
all
devolves
repniduction
teams
the
M
has
contraception
and
service.
now
tor
tion
interpreta-
apart.
case
The
iif the
auspices
there
Bntain
sector
free.
the
the
when
classes.
association.
to
high. The
a
bcisuf
ediic-alioiial
and
small
prac-tK-e.
currK-uliim
indirectlv
choose
I9H2.
is
school
lothe
science
obtained
abortion
an
iH vevualitv
in
sex
Canacb
m
policv
vimilarlv
Netherbnds
in the
sex
the whole
ion;
policv
cxjverjue
cxjntraceptiun
in
until
may
established
close,
undonterdK
among
cvintrjirptive
iiijiiv
and
United
before
being
the
good deal
both
that
Sex
The
volve
in-
to
whereas
focal decision-makers.
of
of bureaucratic
is not
education.
"
of
the
more
of
second-trimester
a
gives
from
a
prutessiun
procedure
find daiintim:
be
pill use.
reijuires
^
pillcan
private
broad
policy
rebted
French
States.
is
and
national
a
naliunal
United
likely to
a
health
women
abortion
the cost
in
countries
contrast,
to
performed
prescribed,
this
Bv
h
users
For
contraceptive
seems
For
examination
than
uii
ahinit
pro-
ate,
appropri-
emerged
use
for the
pay
service
such
no
much
curriculum,
eiKoiirages
only
pay
the
in
nevertheless.
tvpicalK'
up
France
is
the
cilities.
fa-
England
national
cost
patient but
in
true
re-
method
these
iiitcrMrws
there
anibnalewe
iiiedicul
pill
Ktgiirr
in
t"f the
the
lieture the
of
vtjtistic-s
States,
highly
peKic
a
vnmr
tin-
siimniarued
a
m|utrrd
in
Inini
outside
country,
appruprute.
Murruvrr.
nei-essorilv
I nited
each
pill as
nuul
prescrilied
clearlv
the
concerns
tuld that the medical
the
be
part
.N'etheriands. the
by the
preciable
ap-
of supplies
pill rveryw-here
lo
were
iisuailv ihr
of
entails
purchase
ubservatwn
accepts
nut
sulting
con-
became
States
teams
fessmn
IS
usualK
does
as
hand,
are
because
the
in
there
is
the
tu
indiv k1-
England
uf topics
Canada
in
abortions
However,
the
family life
and
and
hospitalstay.
health
national
abortion
an
as
there
the
jcxim-
up
how
In
age.
of this
pniviswn
in
aburtun
charge fur abort
no
and
cost,
half of Bnlish
pharmacies.
at
\n
the other
Un
is
however,
jnd
is
priiK-ipaK ur
Jetemiinr
what
at
Wjjr^.
essentully
is
adolescents, although
attributable
Canada.
overnight
in
be
to
usually
free.
delays
almost
.
likelytubemudnt
the
also
are
den.
Swe-
Wales
abortions
there
women
others
because
an
Canadian
gent
Indi-
are
least
and
the
services
In
France,
pense
ex-
services
Slates,
Sweden,
In
and
countries,
cities.
in
most
ailaliilitv of abortion
av
and
are
ices
in
believed
are
all three
found
Wales,
England
in the
United
at
for supplies
anything
pay
the
euept
pay
eligible tunJies
ihnnigh
cure
have
not
ic
clin-
considerably
varies
from
teenagers
and
they
clinics
theorelicully
are
differences
area
variation
be
ered
cov-
and
uf olitaininc cuntraceptne
to
In
In
likewise
all patients
have
by
rates
serv
the .Netherbnds
in
Wales,
it
with
for the decline
ediic-atKin
sex
schuol
to
and
mandates
abortion
senices
wide
made
was
insurarKe,
free, but
are
wellare
on
small
pharmacy.
a
irr
medicJ
easily accessible
.Although
insura
but
teachers
taught
and
States,
them,
and
option,
educ-ation
sr\
and
schuul
favoring the inclusion
centers
France,
health
United
market
Fixxl
approved
not
of
program
England
States,
focal authorities,
ual
vet
federal
has
the
not
college health
treatment
rape
appreciably
pill is
The
use
some
Geographically,
agers,
teen-
birthrate
to
in
place throughout
charge
at
exists
Contraceptne
national
filled
and
a
morning-after
family doctors
clinics charge
no
plan
no
able
reimburs-
the
services
by rutional
plies
sup-
munity
lized
uti-
of pills in
available
French
the
prescription
j
those
Dutch
recently,
ver\
and
to
are
security.
under
scheme,
aitce
are
for older
eipenses
provided by
services
and
and
clinics
that
.Administration
free
Canada.
In
unlikely
it
and
England
both
sufTiciently widely
for general
use
bv
nin
the covnbmatDa
the adolescentclinic
United
permitted
Drug
credit
v-ears
family pbnning
the
the
provided
ser\-ices
from
French
are
influence
to
Sweden,
postcoital
in
Free
available
methods
of
oral contraceptives
the clinics
m
the
However,
associations.
vices,
ser-
contraceptive
care,
aiKJ Sw'eden.
are
are
without
and
number
a
and
insertion
available
Dutch
In
for
Kingdom
lUD
are
the
these
States
women
iitcludingsupplies,are
of
parental
tives
contracep-
restriction.
all medical
United
Postcoital
"unily plan-
the
young
Stales,
on
most
and
the
agers.
teen-
young
United
they will provide
minors.
clinics
/iing
the
by this
seeking
is
govenunenl
Canada
In
many
covered
penod
th"
Bntnh
Commtrtu
conTidentiality for
preserve
(X"nsent
Dnataifd
im
undesirable,
that
teenagers
is
and
re-
102
help
quire
td
Another
and
in
iTient
of
aspect
commitment
ibr such
such
develop
desire
the
for
example,
had
groups
shown
the
of
services
made
the
also
laid the
of
prevention
best
be
the
by
that the
acts
L'nited
and
activity
claun.
actually
States,
as
an
of
all kinds
ihiTHigh national
public
probably
ps\chok"giral
socul.
people
There
In
seem*
sexual
visited
dtin
than
and
Stain
he
more
in
the
ity
then-
a
support
sex.
in
the
One
be
that
lahiios
against
teenage
with
hut.
lur
tdity
the
and
the
a
standards
drr
differs, and
and
in
countrv
which
public
lu
and
was
diwttiJ
preveni
childbeanag.
ofpalitK^llfcialhrallMic"
tn-
at
a
tia*.
IW
ttw
I'aMj
xndesftaad
S*Mn
aw
The
tn*
tam
a
of privalc
date
on
life is the
compared
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ferthe
the
or
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a
part
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iatmmmkti
la
^
aMMal
terms
a
he
population
This
uf
up
is
some
of Canada
to
has
structure
the prov
tu
tvvo
the country
in
ernment
govinces
quences:
conse-
main
differences
op
devel-
can
policy-making.
shape
tu
ond,
Sec-
social change,
public policies and
Ibc tooetimes
with
central
the
First, major
bureaucracies
have
txnintries
stnictiires.
reserved
enormously
gland
En-
arrangement
systems
Buth
States.
as
even
wtthm
sunple
a
na-
cited
and
stale,
ministrative
ad-
the
in
"lutions"
tw-o
nalunal
is often
centralized
delegated
of
fessionals
proiiiav
politicaland
government
dartnarHMri
L'nited
delute
facet
the federal
with
L'nited
many
mriliiand
of sacMe,
tatirat
in
becomes
in
wxiuki
in the
a
which
the task of giving
in
dnisiveness
aum.
states.
of
France
uf
powers
the
resulted
process
is cxjncentrated
Wales
and
the
m
uf
twxi-liered
some
early
medical
quickly
related
to
government.
and
the
Dutch
the general
power
existence
to
parties
in
issue
extent
the
the
the
in
debate
adv isabililyuf prescribing
terms
cknely
epitome
L' S. political
iiMiii
any
.\nother
national
a
implement
the
keeping
as
the
developed
are
Irvek
awn
.
to
institutions
foster
to
appean
about
hard
than
easier
.\ simiLir
to
mure
reviilt. iiifurmingwincenied
a
to
variation
issues
.\s
is
teenagers
harder
much
tional
wa
demucracies.
considerable
at
morality "f aH"'
rather,
is
be
the
consensus.
small
was
pditicJ
s
pilltu
vmaller.
appnipnate
within
er
of
any
geographic
its
example,
For
ov
broad
it
in
all the
debate
1960s,
community
of
other
felignsitv
public policiesformulated.
was
the
uii
the
in
includes
L nited
than
liiH-s of communication
engage
discussion.
the
that
behavor
included
countries
su
there
tysleoi
more
serve
to
ihe
In
size.
direct,
more
the fact that
country
where
out
with-
society
is
uf both
terms
States
rope
Eu-
public debate
observaturu
parliamentary
of each
nature
the way
Canada,
all
sort
study, although
3T-countrv
.\llhough
survey
a
in
ixHintnes.
L'nited
that
larger
birth
teenagers
in the
the
in
make
to
of Canada,
population
its
compact
servative
con-
highly with adolescent
of country
number
ry
k"ng histo-
in
correlate
in
thai
and
tions
administra-
this issue
to
much
a
others,
as
intensiTy
Slates
sexual
the
IS
tu
into
have,
able
divisions
resolve
accx"mmoda-
Uulch
avaiUble
informal
emerge
through
been
exception
cent
re-
estem
the
quality into
notable
is
the
strong
and
these
the
so.
services
States.
highly
of
of \\
generally lacking
be
It
to
and
behavnr.
L'nited
adokrscent
European
attentwn
sulultuns
prrgiuiKA
and.
for the
found
tance
accep-
represents
traditional
France
reason
fiicuM'd
jctiMtv
vearxh
break
with
to
seems
premarital
siK'h acceptance
public
dirrxiK
ual
uf
uf the
experience
its
freedom,
Netherlands.
Queliec.
with
emotional
inject an
countries.
unremarkable
sexual
However
considerable
ts
age
teen-
L'niied
Such
Canada.
sexuality
of
countries
for
there
alisence
by
the
in
of
aspect
exliemely
and
nature
and
France
or
years
Directly related
with
and
politicaltendencies
exacerbating
a
Fundamentalist
most
in
religious feeling
15
the
States.
secularization
hold
sexual
on
the
Both
dealing
of the
m""t
like Sweden,
ciiunlrx
of
of
ers
barri-
often
tablished
es-
result,
a
has
It
political groups,
defuse
to
negotiation,
control
more
are
premineni
are
groups
an
L'nited
important
encountered
rvely
care
expeneneed
tolerance
in
ul
parts
in
uf adule%4ent
in
is
Such
views
many
European
vtxal.
the
in
.\lthough
have
countries
changes.
in America
groups
'"
Sweden
increasing
social
and
.\s
are
than
Stales
Netherlands.
an
tion
tion
propor-
religious
important
a
L'nited
than
be
to
The
countries.
both
the
in
bility
accessi-
(.'nited States.
the
in
of
Cod
the
and
Province,
broad
to
financial
and
Wakn
oulkiok
in
is believed
agers,
teen-
health
remove
services
tuconlracrptive
yoting
the
to
serves
of
ease
in
case-study
Moreover,
matter
a
thai
and
Quebec
visiting
to
or
feel
higher
in
relationship
attend
who
servatism
con-
automatic,
the
ck"e.
relatnely
church,
medical
and
ai
of
(iunilianty with
and
system
facilities
practitioner
it
the other
England
secular
accustomed
up
in
accessible
programs,
tombinution
This
course.
the
health
kical general
their
vices
ser-
tries,
coun-
that
easdy
particular,grow
in
lives
their
sexual
not
States
population
and
services
ously
is obvi-
services
are
health
such
European
by the bet
Canada,
in
services
of the
sexual
between
L'nited
open.
States
religiosity a
be
to
appears
abortions.
in
the
in
fertility.
of the
the
be
may
kjwering
in
uf politicalstyle,
of formal
range
with
contrast
Netherbnds.
exists
ties
possibilinarrowed
are
terms
in
Positions
the
(o
country
religious and
complex
past
to
and
ideological conflicts before
study,
sex
Eictor
important
the association
case
view
senices
that
the
about
that openness
and
in contrast,
incrrate
simpler
found
While
of all
tend
observations
the
diverse
of all
"not
was
achieve
compromise
Stales,
It
uses.
emotionallv
certain
to
interesting
L'nited
percent
premarital sex
These
especially
adolescent
could
reflect the
therritKr.
cause
all
39
the findings of the 37-countTy
which
an
that
premarital
of contiaceplixe
use
made
opment
devel-
thought
the
outside
even
only
1978.
in
with
agreed
creative
a
of
polarued.
conventions
T6
I9H1.
in
is natural"
whereas
at
conTirm
from
for
political
its
hard
issues
become
tional
confronta-
Aaterican
resolution
to
most
but
the questions
instance,
adults
that "sex
wrong
tion
abor-
reach
Dutch
of .\menc-afu
for young
the
to
of
is
and
tW
have
may
probably
of
to
most
in
The
the
results tend
although
For
country.
marruge."
ment,
govern-
the
to
is
contrast
evident
Survey
tend
Sweden
the
the
charged
attitudes
but
was
be
to
European
directly comparable
not
are
statement
nection
con-
States
visited
this impression,
out
sale, effectne.
putting
incitement
an
using
the
availability uf contraceptive
js
The
the
several
example,
L'niied
asked
among
ibr abortion
within
the
In
bear
the
countries
dorse
en-
that such
br
powerful public figures
some
medical
rates
them
services
need
senices
leenagen.
the
specificunderstanding
achiexed
conTidenlial
with
percent
groundwork
the
with
people,
among
that liberalired
of conlracepti\e
outstanding
.Apparently, the
explicit by
bw
1975
the
lands,
Nether-
to
justified.In Sweden,
w:as
to
makes
also sinful and
prevalent, .\gain.
more
style
am-
also something
in
Ulule
"*ai-
oHich
"
matter-of-fact
where
to be
but
but
be
to
theie
is less true
countries,
.ountry
persuade
to
This
seem
and
romantic
"
flaunted
ts
hidden.
to
abortion
ruing
were
and
the
Sex
dirty; it
to
contraceptives
women.
helped
teenagers
the
linked
reluctance
of
tionale
ra-
decision
conservative
proMsion
alternative
France,
and
some
unmarried
young,
the
aboftiORt
France
In
In
stron^y
was
minimize
to
people.
young
with
the
Sweden,
services
do
to
mwnA
StMrt,
ipeeiii topic,
*
at
btvihwrr
contraceptive
to
has
proRranx.
and
Netherlands
invoke-
go""nimeM
for teenagers
services
Caitad
la tiM
avoiding
in
births.
programs,
complicated
because
that
be
must
indeterminate
of
dealt
boun-
103
TttKogi
Pregnancy
aboul
hopelessness
large numbers
the
the
course
in order
States
greater
than,
leave
still in school
are
aitd Wales,
or
participation and
from
country
to
the
and
ever"'where.
The
chances
of getting
the
in
worse
United
form
It
ofien
IS
unmarried
mothers
(or poor
than
problem,
a
especially the
studied
food
support
that
Inmost
under
Benefits
available
Wales
in
single mothers
the
nut
birthrates
their
The
rates
Families
estst.
In
appear
or
the
US
final dii^rence
the
States
rates
than
gmttr
with
and
of
much
poor
cial
finan-
(MdbMnag
other
oped
devel-
in
these
other
too
immature
not
are
correlated
with
"
the
those
teenage
and
the
in
not
with
ia
Ik*
tMltd
explam
not
other
afipran
SlatM.
be
to
more
of American
rates
in
countries,
be
to
at
the
the
United
teenage
least
as
tween
be-
gap
a
to
un-
serious
high
be
the
in
a
in
cation
edu-
sex
important
more
the
in
other
to
tries,
coun-
cxintrjcep-
sex-related
in
topics
the
Neth-
widely available
more
Netherbnds
and
teerugen
hand,
is
Sweden.
probably
States
although
than
in
the other
from
designed
having
Mtervention
iMbMdized
IWotlMr
have
countries
that
have
US
dis-
to
sexual
b" the
in
countries
of the others
none
officialprograms
m
of
initiation
begin slightly earlier
may
(except for Sweden),
devebped
cy
pregrun-
.Netherlands.
other
activity
United
are
pillby
the
in the
it
is prominent
the
Engbnd.
the
much
a
and
condoms
bw
school
level of exposure
erbnds.
to
with
example,
than
the media
sexual
nut
are
are
levels of emphasis
varying
For
through
On
tion,
contracep-
thev
as
is
States,
least theoretically, transferable
information
tive
the
fiinded
at
are.
appears
easiest
United
oppove
factors associated
receive
in
cial
so-
distrihutlun
the
legal aburtun
and
well
or
ami
mmmidfkt
in
United
by parties labeled
income
that
"|ii"ii"i"di"fc"nimiiii
imJliiaiiia
nabaMat*
the
in
is
firmly established,
is
it is in
education
country.
though Access
al-
rates,
rate
than
that
rates
is
^xr
ctMintnes
pregruncy
ntm
it
is led
liberal,
factor in Sweden
there
States
pregruncy
pregnancy
HUplanaMM
tility);
fer-
cxjnser-
States.
Some
er
high-
higher than that of whites,
this difference does
the
United
United
each
pregnancy
where
counlnes
benefits
or
powerful
tively;
effec-
availabJity of welfiue
seem
is much
of
less pervasive
is
lend
the country
sex
to
consistently and
fit"m
so
must
"
erase
inllueiicr
than
constituerKies
so
and
the teenage
blacks
Slates
bund
availabilityof contraceptive
services
educatnn.
levels of adolescent
lavitr
countries,
rates
States
in
welfire
unequal
and
teenage
sex
differem
England
less
evidence
ences
large differ-
the
fertility,
teenage
actn'ity
the
are
pupula-
higher-than-av
govemments
conservative
Teenagers
in
the
nut
nunwhitr
minority
countries
their
ithuueh
assiimrd
religiousbodies,
other
and
than
pupuUtkins
ethniculK
religion,and
case-
rapid dissemiiutnn
is commonh
as
the
to
five
smaller,
their
easier:
cussed
disferable,
trans-
all.
at
other
compact
more
making
"
hern
ratilv
is considerjblv
usually with
States;
individual
beliefa about
pregruncy
and
louier
are
the
explain
not
adolescent
verv'
for
held
level
tloes
and
provide convincing
United
of the
are
substantial
valKe
situation
have
nut
exportable
not
Each
less heterogeneous
whether
apparently
services
to
to
explain the AS
and
United
the
least among
at
Canada
tbns.
the
centralized; the provision of wide-rangms
study
adolescent
the
or
of considerable
existence
"
irr
countries
3T-
is aidocuted
fertility
contraceptives
use
least, special
those
the
that
course,
are
all but
have
equitable dis-
more
income
cannot
countries
tend
progranu
earlier,
study
to
experience
unprove
of bctors
States:
homogenous
would
teenagers.
countries:
marital
in
that
teenage
widely
between
sexual
countries
of
adolescent
examine
noted
as
studies
country
United
in the
at
for out-of-""4bdi
support
does
also
medical
generous
although
France,
benefit
supplementary
however,
the other
status,
and
to
level of
procram
that
or
and
amthing
countries'
to
nancy
preg-
Stairs
there
of
of innovatbns
tion
propor-
culture
a
of teenagers' family income.
terms
3T-country
benefits
regardless of women's
reproductive
and
in
for
the o^erall
to
larger
in
hnpllcatlona
PoUcy
tive
incen-
family
more
States, but
available
possibleto
ment
fulfill-
tions
explana-
United
up
here,
United
who
be responsible
to
United
is
a
.Although
SUtes?
number
.A
and
in
and
the .^id
Children
Dependent
be
be
to
appears
provided
States.
cases,
fower
the younger
and
applied
and
it".
so.
adolescent
in
the
these
activ
found
er
low-
the presence
in
done
has been
from
United
the
have
between
be
can
the
as
achieve
to
even
of sexual
rates
five countries,
deprived,
Such
much
of househoM
that many
Yet. all the
eitensive
supplements, housing
jllo%k'ances.
in
young,
that usually include
mothers
to poor
care,
prmide
a
study found
United
(inaiKial
bearchildrenoutstdeofmamage.
countries
it
in
prvgnancy
the
in
to
are
However,
The
tries
coun-
public assistance
creates
women,
the
in
unemployment
that
suggested
made
with
the
learned
other
in
of support.
the availabilityof
States,
than
be
to
data
No
pregnancy
ing
satisfy-
a
in
be
most
was
been
own.
people growing
poverty.
tributun
apph-
to
ha%e
other
in
rates
differences
for the
extensive
so
underclass
an
possible
it is
of countries
the
ha\e
nut
more
benefit
States.
single factor
no
that
the
be
and
gratification
also gnen
of
wouM
answer
economKally.
as
of their
child
a
tend
they
country
the
training,
kinds
other
in
score.
appear
who
well
as
unrealtstically seek
selves
them-
all the other
ease
adolescents
people
this
who
thild. the
a
in
is
describe
to
high
have
wrltire
deprived
pregnancy
rates
when
country,
every
of
number
sonably
rea-
it
they do
United
teenage
those
as
and
Clearly, then,
contrast
great
countries
and
the
gland
in En-
off and
so
pressed
woirun
emotionally
have
can
among
In
not
does
have
even
the
better
off is
were
bear
but
caae-study
public health
economically
of the welfare
Swedes
France,
are
States.
of young
lem
prob-
eitent
to
kind
serious
not
howe\er.
of youth
and
that
on
States
assistance
benefits
differ
keeping
do
greater
a
Slates.
offer
the
and
United
To
countries.
very
uneasy
well-paying job
or
United
respondents
of labor-
most
"'oung
unnersalK
are
difficult to
unemployment
a
the
who
less well
are
are
is
The
countrv-.
who
those
and
and
are
achieving
in
societies,
Wales
between
16.
age
definitions
is considered
"oung
England
unemployment
is that
egalitanan
sx'Stems.
States
governments
the
especiallysuccessful
same:
half of girls
in
situation
force
be concluded
college. However,
at
been
and
Dutch
Poverty
less
Regard-
philosophy
the
to
The
state.
European
other
extensive
the United
Europe
Th*
the
politicalwinds
the
way
committed
are
of poverty
m
be
may
concerns
m
Western
likelyto
people end
since
assess,
in the
of young
schooling
employment
compare
they do
as
In
people
18. while
the majority
their full-time
The
age
pur-
Schooling.
only about
at
8S
nature
exists
which
and
higher proportion
a
to
on
go
are
young
18.
Netherlands,
of
""
about
1"-19
most
although
students
the
aged
at around
States,
of U.S.
In Sweden,
and
that
essentially unknown
or
as.
countries.
vocational
or
the
in
extent
degree
that
countries
pregnancy
is
finding
great
as
other
in
France,
school
United
be
people
and
Canada
attitudes
The
other
teenage
the
bfowing.
life opportunities
aitd their
to
those
suii\g academic
in
and
opportunities
appear
of young
percent
terns,
pat-
the
to
to
fiirther the (lossible
possibly.Sweden.
cepi,
on
empbyment
career
educational
United
visits,
mfbmutnn
reproductive planning.
that
was
overall
people
for young
toward
of the country
ezpbre
to
between
association
and
States
relevant
and
education
the part of
on
people growing u|S in
collected
investigators
teenage
(iihire
the
of young
In
poverty.
Dtvl"p*d
in
relanow
is
gov-
tended
to
104
such
leave
large, of all the
By and
(he
has been
Sweden
schools
contraceptive
receive
and
contraceptive
media,
frank
from
than
rales
examined,
have
Sweden.
in
Svveden
sened
only
h.ave shown
to
abortion
in recent
rates
law
its abortion
study findings
The
observed
rates
presiiiancy
include
ti\e
the
publicizing
limited
not
are
with
schools,
health
where
pnigrams.
with
relaxation
of
advertising
restrictions
of
realulic
mure
benefits,
the
a,
the
of
apprxnal
tn
and
health
risks, of the
I
declinim*
been
(heir
postcoital
legitimacy
of cvntraieption
linudest
Its
in
(he
teenage
the
and
sense'
a
of
educa-
sex
That
rates
pregruncx'
expeneiKtr
and
likely (o result
and
(heir
has
hi/ihr.iln
^n]
Mbni
IV
hw
IVW
IW
k"
IN-
jnj
hif
iinJrT
wn"iH*n
wuanrn
IV
ihr
i-uinuLlnr
hikItt
lAiimm
Jll
int
likeK
i\
kM
lu"
r^ln
p"wium-\
Irtk
""mrti
than
kjrwtmwn
rolr
Is-
lAtNiirii
"
iraiMr
wa\
j^Or-MT-nl
/rihin.hi"."ku
lliiiMun
VimLinI
visible
(hey
sexual
(une.
young
of
few
in
people
Yet.
the
ge(
are
voked
in-
(he
at
due
only rough
(hey
a
(he
forms
and
even
the
not
were
country,
lo
noncomparability
of
tionship
rela-
a
available
data
the
country
addition,
In
remain.
k"w
potential variables
because
from
comparable
der
or-
a
of (he concep(
represent,
lo
in
in (he da(a.
measures
of uther
excluded
were
of
absence
opproximadons
number
duce
re-
the data
also
are
tell whether
(he
in(ended
were
though
qualityof
(he
shortcomings
(o
not
to
42.
possible to
IS
3T-
svere
necessary
analysis
ins(ances.
many
subtle
message
nothing that
Almost
no.
In
life
countries
it
(o
abou(
were
the
in
htgh-"{uality data
of
indicates
or
the
across
varubles
inclusion
making
bivarute
not
IS
ables.
vari-
summing
birthrates
However.
cavea(s
correlation
AXt
for
numbers
the
It
sex
bu(
separa(ed
or
say
A
used
women
spans.
final number
is
about,
hear
relationships
girlsshould
sex
was-s
and
see
divorced
in
ies,
.Mov-
(ha(
their parents' friends
or
the
for
more
doubt
no
derived
variables
wiwnrn
llten
Ihey
or
see
about
hear
about
contraception
asoiding
Is ^nd
or
For
precruncy.
likely
to
they
abortions
from
the
of
imporunce
example,
abou(
hear
them
informs
sex
the
are
as
AGI
rather
(han
to
a
than
be
must
survey
considerable
quantitative
garded
re-
margin
informed
they represent
since
error,
eounlry
subject
"3i
vation
obser-
"ct.
14
*Thrtjl"iiL4iB"nw"mAldinK
iLiirf (in
be
(0
more
liir
adul(s
paren(s
sex:
(filiating, premarital
are
age
always available,
regarding
(ell (hem
T\'
ed
inherit-
by
independent
s(udy.
coun(ry
and
ivmuLk-u
"Mwnm
pfr^iuim
(he
own
have
two
IIIO
for suffk'ieni
ac-
motion
pro-
about
messages
and
exciting,
of
same
IS
radio
the
through
to
of the
.\lmost
than
cumulative
dependent
formed
initially considered
over
be:
W
as
and
nancy
preg-
fewer
"
finallychosen
were
that
and
"
for
(ountries
for girls under
were
suggested
asailable
of
coefficients!
ckise
single-year oge-specific
each
the
possible worlds
cohabitation
among
good
1-Vl*f
to
exposure
music,
in
countries
many
*Thf-,r"irn*thrhtfThr.ilrtiirwiHiM"njcnl
Inr
of all
trast,
con-
of sexual
seem
19
These
use.
teenagers
worst
IH-
alfow-
precision
bir(hra(es
quite
the
in-
pregiuncy
and
between
were
so
ikampling
varubles*
correlation
was
of
birthrates
people, or
pregnancy
of contraceptive
romantic,
(he
increasing
sum.
avaiUhility
(Km
of teenage
reduction
ra(es
sample,
a
on
and
eight variables
reladonship
be
countries
for consideration,
(he
sepa-
a
the findings.
coserage
ing
Since
these
(he
from
birthrates
vary
da(a.
among
religious
should
unmarried
young
in
dnided
mission
(he
(han
dependen(
selected
""ere
as
of 37
based
made
(eeiuge
rates
sion
expres-
and
discouragement
or
it"'among
the health
of
use
Political
solving
and
States,
be
cannot
possible.
should
l(
ra(her
capita
per
(rea(ed
final group
universe
two-fifths
young
well-deTined
no
primary
American
methtids.
In
their
eradicadon
dissemination
about
the
tegrated
in-
services,
been
a
the
no
Scodand
statistical inferences
varying
pregnancy
L'nited
the
In
constitute
pregnancy
concerted,
a
unintended
has
problem.
active
particularly,appear
leaders,
what
made
sexually
politicalwill.
tives.
contracep-
condom,
iiifurmalion
well
as
pill, and
clinic
nonprescription
there
cation
edu-
sex
distribution
on
childbearing.
of
school
possible,closely
family planning
rspecialK
of
local
comprehensive
pnnide
to
clinics
nancy.
Pregactivity
of eftirt. the gosemments
have
that
were
"
they had
\N here
were
from
stressed
rates
to
(act that
U'ales
coun(ry
coun-
.\rgentina.
"
Uruguay
available.
were
and
England
ing fur (he
will
with
da(a
(he
lion
mil-
Cubasvas
fertility
teenage
on
despite
.\
year.
of (he 40
and
of
per
a
one
analysis because
Initially, eight
the
is
the
a
least
at
inclusion
Tobago,
data
recen(
income
tries
coun-
of those
major
and
from
dropped
theory
tions
observa-
sexual
of routes,
Trinidad
$2,000
of
Three
qualifiedfor
and
woman,
over
also imposed.
(hat
"de-
anals^is
total fertilits rale
a
boundary
size
defining
m
siatutical
per
level of
income
was
that
pregnancy.
the
help
avoid
to
church
study:
children
3.5
population
ra(e
cast
broad-
the clear-cut
as
types
to
lies
fami-
to
study
adolescent
countries
people
of general
part
as
encouraging
care:
districts
ices
of
tial
confiden-
provide
to
ser\
on
charitable
politicalpersuasion,
of teenage
than
public eK"rt
services
including
a
emphasis
as
governments
number
Through
of those
them,
want
these
establishment
poor:
clinm.
conlraceplrve
clinic
well
European
their
itself, is identified
contracep-
who
fact that
the
to
special adolescent
associated
low-cost
levels
reduce
intendents
super-
agencies.
demonstrated
ra(her
These
States.
the
capita
no
for (he
37-country
less than
(ries
applied
were
countries
included
islatures,
leg-
and
six-coun(ry
whatever
teenage
family planning
or
all teenagers
to
senices
and
the
than
the
in
which
to
have
proaches
ap-
other
t'nited
free
provide
several
help reduce
the
in
degree
countries,
countries
m
upgrading
to
system
alter
even
to
point
that also might
Sweden
years,
school
executnes,
four
(he
(o
just
state
striking of the
most
included
in teenage
liberalized.
w-as
the
common
munities.
com-
not
companies,
youth-serving
Among
ob-
countries
insurance
[Publishing
and
groups
that
noteworthy
rapid decline
a
and
though
al-
earlier
at
as
"
as
and
be
of government,
and
private-sector
criteria
fused.
dif-
more
in fKt.
courts,
principals
such
enterprises
Netherlands,
of the
one
and
and
nancy
preg-
countries
intercourse
is also
It
the
is
the
begin
local authorities
It is
sources.
teenage
is fai
directed
the
is
na(ionally.
branch
executive
to
countries
states
to be
Two
in (he
gram
pro-
appear
Sta(es
some
need
Congress,
to
ity
availabil-
all of the
for
except
teenagers
ages
of
has lower
but
other
in
in
easier
federal
the
to
of the
any
application may,
Efforts
all
in
and
sex.
variety
a
or
easy
aiao b"
vekiped~
that
authority
their
to
reana
not
States.
L'nited
government
But
as
spread
wide-
ii no
would
measures
effective
been
confidential
services:
of
that Sweden
ing,
counsel-
policy
difficult inihe
where
ated
associ-
contraceptives
treatment
of condoms
notable
and
and
abortion
advertising of
have
velopment
demore
people
young
services
available
widely
free,
closely
"
where
"
and
universal
L'nited
the
in
than
approach
an
Admittedly, application of
teenage
contraception;
specialclinics
of
the
successful
devekjp-
in
reduce
include
seiuality and
in
with
active
most
eSbrtj
These
pregnancy.
education
studied,
countries
policiesto
and
ing programs
that such
(hink
judgmenU.
informed
and
Eufope.
Wciun
to
matters
leenagen'
to
or
IVnmori
iImS^nlrn
f
jl*,^
ttcn-
jv
t. iKlaiKi ."mJ
NrlhrrUiKi*
ojmI
the
ji
V^
Nrsk
V "ii(rO
^tUtr%
coawactptioa
open.
Sacfcteiwwbadtoaa"
ifca whafc
jiwihrnwiiilia
JawlBHi
abaot
.Jps
abwtt
*n
paan
""!""
that tlrfWs
ea
Ifc* dady
TV
It
mp
biiraltaci
aad
caaraMaKaliaa
e"-
ititiKA
wai
varialr
to
tic
aaaiysis vinaUn
cooMry
otacfvatioaa
Mi
from
for which
were
the
multior
er
few-
available
and
18
Fl
aaaey
paeph
ovl-af^avdadi
.
lo
hik
ianiii"
bath*
and
of prcf-
abeffna.
thoir
dian
hatiag
0.3
widi
a
twrelaliBW
bath
coefficient
dapandtat
of less
variables.
105
Teenage
Frtgnaacy
m
Devehped
Countna
Appeodw
App"n"li
ttv*
T"t"f
eofflttom
Zfo-wOf
1
th"
Indapaodant
vanaw**
.
tor wo"n"n
WrthnlM
urtOut
eg*
ia ind
agadlS-19
and
ttw
eumula-
1 shim^
TjMe
thr twodrpf
l)*'t\\trtrn
dent
arubles
\
headines
w
The
with
de"rer
to
capita,
unm.UTied
fur
fuo
altoul
at
older
onK
with
maternal
ojmptJsed
force
older
fruin
ol
hnlh
a
servattoiis
the
with
("f females
proportion
the al""rtKm
and
Itw
rate
whose
and
Thvse
al
aeed
had
this
the iniilti\arule
to
ver\'
small
ol
procedures
impact
added
varution
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bnrf
varute
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jaoan
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A""
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on
sample
used
each
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and
size
data
having
at
tune
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to
far
thiit accoufilvd
dacuuvnof
afwK-stt
the
can
be
tial
substan-
the
the
three
leretitesl
then
and
varubles
explain
by the
m
much
the
and
oser
initul
muhsofthe
Ibutid
were
how
assess
could
ofthem
the
step-wise
varuble.
dependent
independent
each
(he
First,
identtK
to
varialiles
remaininK
b\
a^vKuted
problems
missine
marily
pri-
recression
determined
wai
the
were
independent
iKLsed
was
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minimize
formation
in-
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lor inclu-
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ordinary
amount
the
countries
the retjuirement
appn"ac*h taken
with
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"
t^Mintrv
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used
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aees
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Ii""e-
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ipositKe). but
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partner
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taified for the\anable"pniportiono(
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oi"-
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\
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ly correlated
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14
to
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cients
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106
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108
that theyare afraidof contracting
the HIV virus,
dom."
we
say "Use a conthat
afraid
tell
of becoming pregnant, we say,
us
theyare
young women
"Use a contraceptive."
But when young peoplesay that iheyare afraidof engaging in
sexual activity
with peopletheylove todayand who are gone tomorrow,
there is no
device we can givethem. I know from personal
technological
experienceand from
of the most detrimental effectsor falloutof early
teen
counseling
teenagers that some
sexual involvement are the emotional scars that resultwhen theyare torn apart and
have not addressed thisissue,
theirpartners move
to greener grass. Yet we
on
nor
can
the
debate is framed around reducing
what we would consider the most
we
as longas
detrimental effectsof thiscrisis.
peoplesay
young
When
FAULTY
There
are
three
reasons
that we
RATIONALE:
have
engagedin
a
instead of
high-tech
a
high-
touch
philosophy:
1 ) We
optedfor control economics
havior
education and beas opposedto responsible
That is,our overallconcern
and moral expectations.
for the quality
of lifehas
the
when dealing
with young peopleof color. We recognize
diminished,particularly
is an extension of the failurethat beganwith the generacrisisin these communities
tion
before them. We find ourselves coming back to stopgap measures
as opposedto
solutions.
long-term
2) The second
logical
that we find ourselves defining
the problemfrom a technoreason
lieve
approachis that we do not believe in young peopleanymore. We do not bethat theycan control their sexual desires and urges for the most
appropriate
to
opportunity
in these young
wonderful of allhuman emotions. Our lack of faith
express that most
few programs which
peopleis demonstrated by the fact that relatively
the "A" word as the cornerstone
for itseducational program have been supported
which has
the federal,
state, and locallevel.The "A" word,of course, is abstinence,
become
and outdated. One New York Cityofficial
in the minds of many, profane
Neanderthal for talking
called me
to young
peopleabout abstinence. Our lack of
much like a runthe past severalyears has resulted in a growingepidemic
faithover
away
use
on
train.
or
3) This epidemicis fueled not justby the fireof technological
approaches,
by
the fireof our lack of faithin young people's
to control themselves. This problem
ability
adults refuse to giveup our sexual vices. Consequently,
is fueled also when we
lack the resolve and moral commitment
trolling
to tellyoung
we
peoplewhat is best in conis not
this problem.A society
for sexual relationships
without moral guidelines
for anarchy
and destruction. For without
but a group of peoplepoised
at all,
a society
moral guidelines,
there is no community.
there are no families. Without families,
ing
buildwhich
Without community,there is no structure
to
or
hinge
upon
any training
for the future.
SOLUTIONS:
address them,we must have a vision
In order to solve these problems
or properly
for the future. We need to be willing
standards
for young peopleand for the
to set
standards
of
These
do not have to be set by
behavior
that
have
them.
we
expected
but
what
know
code or dogma,
as educators and health
we
by
religious
any particular
guished
the most
behavior for them. I am sure that my distinas
professionals
appropriate
is
sexual
with
from
in sayingthat abstaining
activity
me
panelwould allagree
then
that
that
the wisest choice
is the wisest choice,
a young
why
person can make. If
aren't we using abstinence as the cornerstone
for allof our educational programs and
levelof expectations.
have raisedthe condom to a new
we
emphasestoday?Instead,
Condoms?:
found about the condom thirty
true
dom,
today. The conyears ago is still
with noxynol-9,
is not a very effectivemode of birthcontrol because,for a
even
number of reasons, it cannot totally
duringsexual
prevent the transmission of semen
New York Cityofficials
intercourse. Nevertheless,
I have heard said by high-ranking
What
we
109
with young peopleand, thereand others that abstinence is not realisticwhen dealing
fore,
Their antidote is to make condoms and condom usage
is not worth discussing.
effective.With these prescribed
more
however, we can never
remedies,
hope to win
or
solve the
problem.
Contraceptives?:
I
opposedto
not
am
the discussion of
with
contraceptives
young
ever,
people.How-
that messages
imperative
of such a sensitive nature
be done in a mixed
not
Call
that
I
but
believe
old-fashioned,
and
ladiesought
me
men
group.
young
young
when talking
about intimate sexual matters.
I am
to be separated
not opposedto this
information beingtargeted
at senior highschool students because theyare
at a stage
in their lives when
theycan handle it,and when theyneed to hear this information.
them in building
We would go a longway to helping
their self-esteemif we separated
tJiem and did not have die uncomfortable situation of young men
and young ladies
while
information
devices
and
are
together
beingpassedaround
sitting
contraceptive
the room.
The giggling
and the comments
make education in that settinga virtual
it is
impossibility.
(I will share
an
antidote here from my
own
experience.)
personal
Illustrations:
let me cite a great exampleof a program that is on the right
track,and
Finally,
which we need to support. You may be aware
of the Emory Universitystudyof one
thousand sixteen-year-old
These
from low-income familiesin the Atlanta area.
girls
a
ll
whom
of
been
the
had
and
health
active
clinic,
were
sexually
people,
using
young
ceive.
givena listof twenty optionsof sex education materials theywould most like to refending
Eighty-four
percent said theywanted to learn how to say no to sex without oftheir friends or partners. This is a message
from the group that is most
at
the most
risk,
abused,and the most talked-about group in our discussion. When we
know in our minds that this crisisextalk about the teen sexuality
tends
crisis,
we
although
for
those
racial
and
is
socioeconomic
our
barriers,
really
concern
beyond
primary
who willnot be able to support the children or pay for pregnancy terminations: abortions.
the poor who were
born poor and who will bringinto this
babies.
before theybecome
We
need
these
to
poor
young people
suppon
and
of
We can
them
self-esteem,
a
accomplishment.
by
giving
feeling
hope,
parents
do this by settingthe standards and givingthem the resources
and support to meet
those standards,
that we think is necessary to helpthem
not
simplythe technology
avoid the pitfalls
lock
sexual involvement. If a young ladygivesbirth out of wedof early
before graduating
her
chances
for
degree?
w
hat
school,
are
a
college
high
completing
We
And
allknow that statisticstellus she has virtually
chance.
no
yet, we
continue to pump
dollars into technology
rather than into die programs that
more
have a proven track record for the outcomes
desired.
We
are
about
talking
earth more
of diistype of self-help
with programs right
success
program can be paralleled
model.
WashingtonD.C. such as the Kenilworth community management
selfor
Many peoplesaid that poor peoplein inner cities do not want self-help
that theydo not want
the governto be empowered,and that theywant
ownership,
ment
The
here in
of them. That message, of course, was ludicrous and racist,to say
that the residentsof die Kenilworth housingcommunity have not
taken
of theircommunity, but are a shining
only
ownership
exampleof what people,
to
the
take
care
for we
least,
see
will do if giventhe opportunity.
Our young
people,
for
to prove
to
dying an opportunity
theycan exercise self-control.
any
and of color,are
the poor
particularly
people,
themselves and
to
others that
CONCLUSIONS:
the tideof the economic, health,
and socialdevastation caused by
members
of
thisesteemed
committee, I urge you to support propregnancies,
grams
such as the Tide XX programs diat promote abstinence-basedsex education
In order
teen
to
stem
110
materials.
the
I
truth
that
if
tney
positive
is
not.
Thank
of
does
going
are
going
Sex
to
to
think
is
you
in
choice
a
would
not
have
that
wonderful,
very
much
with
argue
but
sex
for
their
their
control
someone,
give
people
young
a
demonstrating
and
bly,
inevita-
sexually
a
invest
in
choice.
how
future.
will
contract
to
sharing
to
the
in
device
or
need
We
lives
invest
to
you
birth
an
this.
us
to
faces
and
me
they
mean
sex,
dedicated
urge
the
most
Pushing
to
use
does
a
not
all.
at
having
it is
tell
need
We
I
impregnate
clearly
future.
our
that
pregnant,
statistics
have
abstain.
thinking
contraceptives
people
concfom
a
they
The
for
much
Many
condom
who
will
and
can
fertile, become
other
or
them
use
a
disease.
outcome
condom
give
use
educators
support
people
young
are
transmitted
to
you
who
people
Young
are
urge
it does
sex
is
with
me
have
that
mean
a
beautiful,
allowing
to
condom
and
to
sex
share
O"
because
"Just
say,
going
are
sex."
when
is
as
is
meant
these
we
that
good
show
question
not
as
to
comments.
be
them
it does
No,
not
comes
having
enjoyed
how
up,
sex
for
to
that
mean
at
they
all.
marriage.
It