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OCR for page 261
9
Pnonties for Policies and
Programs
Like many others who have addressed the issues of adolescent preg-
nancy and childbearing its recent years, the Pane} on Adolescent Pregnancy
and Childbeanng has recognized that the problems are complex and
controversial. Solutions unD not be easily or rapidly attained. Although
the age of initiation end rates of sexual activity are comparable, the United
States leads most other developed countries In the rate of early pregIlan-
aes, abortions, and births tO adolescent mothers. Fertility vanes by age,
race, and socioeconomic status, but early pregnancy and childbearing are
IlOt limited to any single subgroup. They are DOt confined by urban or
rural boundaries, nor is their Impact limited tO a single gender or genera-
tion. Everyone is affected, directly or Correctly. Adolescent pregnant
and childbeanug are issues of broad national concern, and they are issues
. .
t tat require urgent attention.
Regardless of one's political philosophy or moral perspective, the basic
facts are disturbing: more than ~ million adolescents become pregnant
each year. Just over 400,000 teenagers obtain abortions, and nearly
470,000 give birth. The majonty of these births are to unmarried moth-
ers, nearly half of whom have not yet reached their eighteenth birthday.
For teenage parents and their children, prospects for a healthy and
independent life are significantly reduced. Young mothers, ~ the absence
Of adequate nutntion and appropriate prenatal health rare, are at a height-
ened risk of pregnancy complications and poor both outcomes; they are
also more likely tO experience a subsequent pregnancy while still ~ their
teens. The infants of teenage mothers also face greater health risks, ~nclud
26~
OCR for page 262
262 ADOL~SCEN-T SEXUALITY PREGNANCY AND CHILDBEARING
ing low birthweight, accidents, illness, and infant mortality. Teenage
mamages, when they occur, are characterized by a high degree of instabil-
ity. In addition, teenage parents, both female and male, suffer the negative
impact that untunely parenting has on their educational attainment and
the related limitation of career opportunities. Teenage parents are more
likely than those who delay childbeanng to experience serious unempioy-
ment and inadequate income. Because these young people often fare
poorly in the workplace, they aIld their children are highly likely to
become dependent on public assistance and to remain dependent longer.
Somety's economic burden in sustaining these families is substantial.
Why do young people who are hardly more than children themselves
become parents? Is it due to a lack of individual responsibility, matunty,
knowledge, and values? Or does it result from the pervasive problems
associated with poverty, including limited education and employment
opportunities, and among many high-nsk youth, growing up in a father-
less family? The answer to both of these questions seems to be yes. The
causes of teenage pregnancy are varied and complex, and tO a large extent
the issues of individual responsibility and social environment are mterre-
{ate3. For this reason, the panel has studied and addressed the problems
with both individual and societal perspectives in mind.
On the basis of two years of rewew, analysis, and debate, the panel has
reached six general conclusions, which underlie all of itS specific cor~clu-
sions and recommendations for policies and programs:
I. Prevention of adolescent pregnancy should have the highest pnonty.
In both human and monetary tens, it iS less costly to prevent pregnancy
than tO cope with itS consequences; and it is less expensive to prevent a
repeat pregnancy than to treat the compounded problems.
2. Sexually active teenagers, both boys and girls, need the ability to
avoid pregnancy and the motivation tO 60 SO. Early, regular, and effective
contraceptive use results In fewer unintended pregnancies. Delaying the
Initiation of sexual activity will also reduce the~ncidence of pregnancy, but
we currently know very little about how to effectively discourage unmar-
ried teenagers Tom initiating intercourse. Most young people do become
sexually active during their teenage years. Therefore, making contracep-
nve methods available and accessible to those who are sexually active and
encouraging them tO diligently use these methods is the surest strategy for
pregnancy prevention.
3. Society must adroit treating adolescent pregnancy as a problem
peculiar to teenage girls. Our concept of the high-nsk population must
OCR for page 263
PRIORITIES FOR POLICIES AND PROGRAMS 263
include boys. Their attitudes, motivations, and behavior are as central to
the problems as those of they female partners, and they must also be
central to the solutions.
4. There is no single approach or quick fix to solving all the problems
of early unintended pregnancy and childbearing. We will continue to need
a comprehensive array of policies and programs targeted to the special
characteristics of commun3 ties and to the circumstances of teenagers from
different social, cultural, and economic backgrounds and of different ages.
Because adolescents are not a monolithic group, they do not a] experience
sexual activity, pregnancy, and childbean~g In the same way. Our broad
goal is the same for all young people: that they develop the necessary
capabilities to make and carry out responsible decisions about their sexual
and fertility behavior. The strategies for achieving these goals and the
specific interventions to carry them out, however, should be sensitive to
differences In values, attitudes, and experiences among individuals and
groups.
5. If trade-offs are to be made in addressing the special needs of one
group over another, priority should be given to those for whom the
consequences of an early unintended pregnancy and birth are likely to be
most severe: young adolescents and those from the most socially and
economically disadvantaged backgrounds. In many ways those at highest
risk are hardest to serve, yet they are also the groups that have been shown
to benefit most.
6. Responsibility for addressing the problems of adolescent pregnancy
and childbearing should be shared among m~induals, families, voluntary
org~7~ations, communities, and governments. In the Unite] States, we
place a high priority on ensuring the rights of ~ndinduals to hold different
values and the rights of families to raise their children according to their
own beliefs. Therefore, public policies should affirm the role and respons~-
bility of families to teach human values. Federal and state governments
and community institutions should supplement rather than detract from
that role.
The prevalence of adolescent pregnancy and childbearing is weL docu-
mented. Knowledge about the causes and consequences of these behaviors
has greatly expanded over the past decade and a half. Knowledge from the
growing body of evaluation literature and accumulated intervention expe-
nence, though incomplete in many respects, suggests opportunities and
directions for policies and programs aimed at sobering these problems. In
the remainder of this chapter we present specific conclusions and recom
OCR for page 264
264 ADOLESCENT SEXUALITY; PREGNANCY AND CHILDBEARING
mendations within a basic framework for establishing policy goals, identi-
fying alternative strategies to achieve these goals, and selecting specific
programmatic approaches to carry out these strategies.
PRIORITIES FOR POLICIES AND PROGRAMS
The panel's conclusions and recommendations cover a range of actim-
ties that includes research, planning, policy development, service delivery,
and monitoring. Some of the specific actions we propose would involve
steps by federal, state, and local policy makers to enact new legislation or
direct the agencies under their jurisdiction to undertake new initiatives.
Others would require the continuation or intensification of public and
private efforts already under way. When existing knowledge supports
new or revised policies and programs or highlights the effectiveness of
. . . . . ,. .
Ongoing 1mtlatlves, we propose specific new or continues programs or
specific agenda for research and development. When existing knowledge
provides insights but is incomplete, we advise further demonstration and
evaluation to enhance understanding of the relative COStS, effects, and
effectiveness of promising approaches. When innovative policies have
been indicated but there are as yet no scientifically measurable outcomes,
we urge carefid observation and mon~tonng. Many of our recommenda-
tions build on policies, programs, and research that are already under way.
Many reinforce the priorities of other individuals and groups that are
addressing these complex and controversial issues of adolescent pregnancy.
The panel has identified three overarching policy goals, presented in
order of prionty, that provide a framework for our specific conclusions and
recommendations:
1. Reduce the rate and incidence of umntended pregnancy among
adolescents, especially among school-age teenagers.
2. Provide alternatives to adolescent childbearing and parenting.
3. Promote positive social, economic, health, and developmental out-
comes for adolescent parents and their children.
For most young people in the United States, realizing fuming adult
work and family roles depends on completing an education and entering
the labor force before becoming a parent. Many do delay the in~tiai~on of
sexual acidity until after they have graduated from high school, pursued
postsecondary education or gained work experience or both, and perhaps
married. Many others become sexually active before they have passed these
OCR for page 265
PRIORITIES FOR POLICIES AND PROGRAMS 265
milestones in the transition from adolescence to adulthood. Regardless of
the timing they choose for initiation of sexual activity, however, all
adolescents need the ability and the motivation to avoid becoming parents
before they are socially, emotionally, and economically prepared. As a
society, our approach to pregnancy prevention must be targeted to the
complex social, emotional, and physical needs of all adolescents. Preg-
nancy prevention strategies must provide teenagers the necessary support
and encouragement to strive for fulfilling, productive adult roles in addi-
iIon to parenthood.
Despite the amount of energy and resources that are devoted to prever~-
tion strategies, however, some teenagers will experience unintended and
untimely pregnancies Given the potentially adverse consequences of early
parenting for the life chances of these young people, there should be
alternatives to childbeanng and childrearing. Abortion is a legal option for
all women, including adolescents. We acknowledge that voluntary termi-
nation of pregnancy is controversial, and for many in our society it iS
morally reprehensible. Although we strongly prefer prevention of preg-
nancy to avoid parenthood, abortion is an alternative for teenagers for
whom prevention fails. Adoption is also available to those teenagers who
choose not to voluntarily terminate their pregnancies yet are unable or
unwilling to assume the ~11 responsibilities of parenting.
Finally, for teenagers who choose to bear and to raise their children
themselves, supports and services to promote healthy development, re-
sponsible parenting, educational attainment, and economic self-
sufEc~ency should be available. Indeed, investing In the quality of life of
teenage parents, their families, and their children may be the first step
toward preventing early unintended pregnancies in the next generation.
Inherent ~ this policy Framework for addressing the problems of ado-
lescent pregnancy and childbeanug is a sigIliEcant dilemma. In placing the
highest pnonty on prevention, we do not mean tO diminish the significant
need for supports and services for pregnant and parenting teenagers. Yet,
remedial responses, however effective, do not address the basic needs of
young people who have not become sexually active and who have not
expenenced pregnancy. And some have raised concerns that policies and
programs that offer support and assistance only after a pregnancy has
occurred may even have created the wrong incentives, especially for those
from severely disadvantaged backgrounds. Ad young people, regardless of
whether they are teenage parents, need tO be encouraged tO develop
positive perceptions of what their lives can be. They need opportunities tO
OCR for page 266
266 ADOLESCEN T SEXUALITY PREGNANCY AND CHILDBEARING
achieve their goals, and they need support an] assistance from their
families and their communities to become healthy, productive adult mem-
bers of society.
Goal 1: Reduce the Rate and Incidence of Unintended Pregnancy Among
Adlolescents, Especially Among School-Age Teenagers
The panel is unequivocal in its conviction that the primary goal of
policy makers, professionals, parents, and teenagers should be a reduction
in the rate and incidence of unintencled pregnancy among adolescents,
espectaDy among school-age teenagers. Pregnancy prevention would
result not only in fewer births but also in fewer abortions to teenagers.
Although an ur~planned pregnancy can have seriously negative conse-
quences at age 18 or 19 among those who have completed high school, it is
likely to present even greater hurdles for younger teenagers. When preg-
nancy results in childbeanng, it increases the probability that adolescent
parents will drop out of school and reduces the probability that they will
complete high school or pursue postsecondary education. Early childbear-
ing is also associated with larger family size. For these reasons, younger
teenage parents are often vulnerable to an array of adverse social and
economic consequences, which we have discussed In detail in this report.
In addition, the younger the teenage mother at the rime of birth, the
higher the average estimated public costs of her childbeanng and the
higher the estimated potential savings of her postponing that birth.
The panel has identified three general strategies that con lead to a
reduction in the rate of early pregnancy: enhance the life options of
disadvantaged teenagers, `delay the initiation of sexual activity, and en-
courage contraceptive use by sexually active teenagers. Central to all of
them is the need for teenagers themselves to embrace values that lead to
responsible, healthy, and productive lives, including the avoidance of
unplanned and untimely parenting, and to be steadfast In their belief that
they can achieve their goals. Parents and family members can and should
play a key role in helping young people, both male and female, acquire and
retain these values. But indiv3 duel and family values are influenced by
community and societal norms: therefore, the community as a whole
must reinforce and support in~im~ual and family efforts to discourage
early pregnancy and encourage adult self-su~ciency.
Enhance Lithe Oprior~s Poverty and hopelessness, which exacerbate
many social problems, play an especially important role in the problems
OCR for page 267
PRIORITIES FOR POLICIES AND PROGRAMS 267
associated with adolescent pregnancy. Sexual activity and pregnancy
among teenagers are not confined by race and income, yet the correlation
between poverty and adolescent fertility is well documented. Nationally,
more than half of Aid to Families With Dependent Children (AFDC)
benefits support families in which the mother gave birth as a teenager. The
median income of families headed by women under the age of 25 is below
the poverty level, and approximately three-quarters of all such families live
in poverty.
Research has shown the deleterious effects of poverty on those caught
in its cycle: attitudes offatalism, powerlessness, alienation, and helpless-
ness that are perpetuated from one generation to the next. For tOO many
high-risk teenagers, there are too few disincentives to early childbearing.
Inadequate basic skills, poor employment prospects, and few successful
role models for overcoming the overwhelmingly negative odds of in-
tergenerational poverty have stifled the motivation of many to delay
immediate gratification and avoid pregnancy.
Teenagers need a reason to believe that parenthood is inappropriate at
this point in their lives. Accordingly, one important strategy for reduc-
ing early unplanned pregnancy is to enhance their life options, by en-
couraging them to establish career goals in addition tO parenthood and
by helping them understand the value of educational attainment and
employability skills. This strategy is aimed at reducing adolescent fertil-
ity by nurturing the motivation to prevent untimely and unplanned
parenthood.
We lack program research that clearly demonstrates the effectiveness
of this strategy for reducing early pregnancy. Nevertheless, we outIme
below several interventions that seem promising and merit farther de-
velopment and evaluation.
Life-planning courses Helping teenagers to understand the seriously
negative consequences of an unplanned birth for their present and future
lives may be an important component of developing motivation. Life-
plann3ng courses are aimed at helping high-risk teenagers identify educa-
tion, career, and family options, develop life plans and goals, and under-
stand how early childbearing might affect the* ability to achieve those
goals. Programs of this type have been smaD-scale, and there is little
deEninve evidence oftheir success. Early returns, however, suggest that
this may be a promising approach. Intervention models of this type need
further development and evaluation. In particular, attention Is sleeked on
OCR for page 268
268 ADOLESCENT SEXUALITY PREGNA.NCY AND CHILDBEARING
the related supports and services that are necessary to help teenagers
effectively use the information, planning, and decision-making skills
they can gain in life-planning courses.
Programs to improve school performance Boosting school achieve-
ment and preventing school dropout may also be a promising approach
to reduce early umOten~e] childbearing among school-age teenagers.
Teenage pregnancy rates have been shown to be higher among poor
achievers. Poor school performance negatively affects self-concept and
motivation. It also has adverse eRects on later employment opportuni-
t~es.
As many researchers, sernce providers, and advocates have observed,
educational opportunity and achievement are key to helping high-nsk
teenagers develop execrated expectations, a sense of can-do, and the basic
skips necessary to achieve their goals. Although developing afuD agenda
of educational refonn was not within the mandate or expertise of the
panel, we highlight the need for educational interventions whether
alternative schools or special programs in regular schools-to overcome
the educational problems and ~e~clenaes of many young people. in
particular, such programs need to identify high-risk students early in
the* educational careers and provide the remediation required to ensure
that they develop essential basic skids and achieve smooth education-to-
work transitions. Although research has not specifically linked pro-
grams to improve school performance with reductions in adolescent
pregnancy, such programs merit further development and evaluation to
assess their potential effects on fertility.
Employment programs Chronic unemployment and poorjob pros-
pects among some subgroups of the population have had serious adverse
eRects on many young people's perceptions of opportunity. The lack of
meaningful employment options may diminish the motivation to delay
parenthood. As with educational refonn, the development of a compre-
hensive plan for youth employment is beyond the mandate and expertise
of the panel, yet we emphasize the need to enhance the employability of
high-nsk youth by providing them with i~ors~ation concerning career
alternatives, by teaching job skills and job search skills, and by helping
them gain work experience while completing their educations. Again,
although research has not specifically linked youth employment pro-
grams to reductions in adolescent pregnancy, such programs merit fur
OCR for page 269
PRIORITIES FOR POLICIES AND PROGRAMS 269
ther development and evaluation to assess their potential effects on
fertility.
Role models All young people adopt role models-whether in their
.
families, among their peers, or in their communities that significantly
influence their developing values, attitudes, and behavior. Prov3 ding
high-nsk teenagers with positive examples on which to model their
behavior may help them form aspirations, expectations, and activity
patterns that match desired norms. Role mode] and mentonug pro-
grams are intended to help teenagers see in others what they can become
themselves. Most emphasize the importance of educations attainment,
employability, and responsible sexual and fertility behavior. These inter-
ventions are relatively new and to date most have been small in scale. As a
result, there is no definitive evidence of their success in reducing early
nmutended pregnancy, yet they ment further examination and trial.
Delay Sexual Initiation A second strategy for reducing the rate of
teenage pregnancy is to help teenagers, both male and female, develop
ways to postpone sexual initiation until they are capable of making wise
and responsible decisions concerning their personal lives anti family
formation. For young teenagers especially, pregnancy and parenthood
are often distant, intangible abstractions. Relating sexual decisions to
lifelong consequences is difficult. Adolescents who cannot conceptually
link current behavior to future contingencies are often unreliable users of
contraceptive methods. For them, efforts directed at discouraging the
iIiitiation of sexual activity may be an appropriate means of reducing
umOten~e] pregnancy. Essential to the success of this strategy are the
acquisition of probiem-solv~ng and communication skills, understand-
ing of the personal and societal consequences of unprotected sexual
acidity, and knowledge of how to act responsibly. Enhancing life op-
tions, which has been discussed above, may also encourage teenagers to
delay the initiation of sexual acunty.
Several interventions have the potential for helping young people
delay the initiation of sexual activity, although there is little available
endence at this time to document their effectiveness.
Sex education and family life education Courses that provide wfor-
mation about sexuality and family roles and interactions have been
shown to increase students' knowledge of reproduction and the proba
-
OCR for page 270
270 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING
ble consequences of sexual activity without contraception. Although
these courses are widely available in school systems nationwide, they
crazy substantially in their content, their comprehensiveness, and the
quality of instruction. They also vary in the extent of parent and com-
mum~y involvement in their planning and implementation. In addition,
few school districts have programs that are directed at children of ele-
mentary school age. While knowledge alone cannot be expected to alter
adolescent behavior, education programs that are combined with other
approaches, such as assertiveness and decision-making training and role
modeling, may help reinforce family values, responsible behavior, and
self-control with regard to sexual activity. Similarly, age-appropnate
education programs that provide young children with information con-
cerning sexuality and sex abuse, as well as training to deal with poten-
tiaDy abusive encounters, may help reduce their anxieties and fears about
personal sexual development and improve their ability to avoid sexual
exploitation. Unfortunately, program research to date has not pronded
conclusive evidence of the impact of sex and family life education on the
. . . . .. .
tang o: : sexua . Stratton.
Assertiveness and decision-making training Programs that teach ad-
olescents problem-soinng, decision-making, and interpersonal commu-
nication skills are sometimes aimed at promoting sexual abstinence by
counseling younger adolescent boys and girls on how to resist pressures
to become sexually active before they are ready. An evaluation of one
program using this approach is now under way. If the results of that
study are positive, replications and adaptations of this program mode!
may be warranted.
Role models Many adolescents learn by example; they are attracted
to real and fictional characters who seem powerful and successful. Soa-
ety's response to the behavior of those models helps young people to
develop expectations for their own behavior and the behavior of others
and to cianf y their personal values. When role models exemplify societal
ideals, the process can potentially have positive effects on adolescents'
attitudes, motivations, end behaviors, including sexualbehanor. Several
interventions using peer counselors, mentors, and adult community
volunteers to work on a one-to-one basis with high-risk teenagers are
now berg tested. Among the tasks of the role models is to help teenag-
ers find activities other than sexual ones that can Fife they needs for
OCR for page 271
PRIORITIES FOR POLICIES AND PROGRA.~S 271
emotional gratification, for example, SportS and community service. If
the results of these efforts show positive effects on delay of sexual
initiation, replications and adaptations of this approach may be war-
ranted.
Media treatment of sexuality Among the most pervasive influences
on adolescents are the personalities and heroes of television, movies, and
rock music. The exploitation of sex, aggression, and violence in media
programming and advertising has become a central issue for many indi-
viduals and groups concerned about adolescent pregnancy and childbear-
ing (e.g., the Children's Defense Fund, the National Urban League, the
Center for Population Options, and several state and local coalitions and
task forces). Some of these groups are exploring ways to encourage the
media to present more realistic and responsible portrayals of personal and
sexual relationships among adult heroes and to discourage sexual activity
and parenting among young adolescents. Because most of these efforts
are in preliminary stages, it is too early to assess their effects on program-
ming content and advertising approaches. Indeed, the incentives for
network executives to alter they current messages and models are weak.
Nevertheless, multiple coordinated efforts at the community level and at
the national level to exert pressure may have greater potential for e~ect-
ing change than isolated appeals.
Encourage Contraception The panel's research has established that the
most effective intervention for reducing early unintended pregnancy in
sexually active teenagers is diligent contraceptive use. Male contracep-
tion, as we] as mate support for female contraception, is essential.
Adolescents who practice contraception are less likely to experience an
unplanned pregnancy than those who do not; those who rely on the
contraceptive piD are less likely to conceive than those who use noupre-
scnption methods. Although modem contraceptive technology, espe-
c~ally the pill, may have contnbuted to the liberalization of societal
sexual attitudes and practices, which In turn have influenced adolescent
behavior, there is no evidence that the availability of contraceptive
services per se has caused increased sexual activity among teenagers, mate
or female. In fact, studies show that many adolescent girls are sexually
active a year or more before they obtain contraceptives. This pattern
must be changed in order to reduce the incidence of early unintended
pregnancy and ultimately the more painful, hazardous, and disruptive
OCR for page 284
284 ADOLESCE.~JT SEXUALITY PREGNANCY AND CHILDBEARING
with malnourishment. It has also been shown to serve as a means of
recruiting hi~h-risk pregnant women into prenatal care.
O cot ~ ~
Pediatric care Well-baby care, as well as emergency care, has been
shown to improve the physical health of all children, especially those at
serious risk of pennatal dysfunction. As with prenatal care, info' Elation
and health education can help young mothers and fathers understand the
importance of well-baby care and positive health behaviors for their
children's long-term development and well-being.
Pediatric care programs and well-baby clinics are available to teenage
parents through public health departments, hospitals, freestanding com-
munity clinics, and school-based clinics. These programs involve a van-
ety of sennce delivery models, including clinic services, home nsits, and
the integration of other necessary services, such as nutrition services,
contraceptive seances, and education and career counseling. Most teen-
age parents who seek publicly subsidized services rely on federal pro-
grams to pay for those services, among them Medicaid, the Early and
Penodic Screening, Diagnosis and Treatment Program, and to some
extent other maternal and child health programs. There is some evidence
that eligibility standards and application procedures in some states may
discourage needy parents from seeking well-baby and emergency care for
their children. These bureaucratic barriers should be minimized.
Prevent Subsequer:t Untimely and Unintended Births An untimely and
unintended birth tends to have seriously negative social and economic
consequences for young mothers, young fathers, and their children. A
second untimely an] uninten~eci birth is likely to compound the already
complex and overwhelming problems. Many adolescents who give birth
experience repeat pregnancies within two years. Although most adoles-
cent parents report that they did not intend to become pregnant again SO
quickly, most did not take effective steps to prevent conception. Contra-
ceptive diligence requires a significant degree of commitment. Many
teenage girls are easily dissuaded from regular contraceptive use by
boyfriends, by problems in using their chosen method, or by informa-
tion (often inaccurate) about possible negative side effects. Adolescents
who have expenenced childbeanng are no different. Helping them to
prevent subsequent untimely and unintended births requires that their
family planning needs receive special attention and emphasis.
OCR for page 285
PRIORITIES FOR POLICIES AND PROGRAMS 285
Several interventions have the potential for preventing subsequent
untimely and unintended births to adolescent parents.
Contraceptive services The use of contraception reduces the proba-
bility of pregnancy. Getting adolescent mothers and fathers to practice
contraception regularly can substantially lower the likelihood of a repeat
pregnancy an] birth. Several aspects of service delivery to this target
population are important: aggressive outreach and follow-up to reach
parenting teenagers as soon as possible after delivery, assistance in getting
them to clinics, and close monitoring of their success or difficlity in
using their chosen method; directive advice on contraceptive practice;
easy access to convenient, low-cost (or no cost) contraceptive seances;
and intensive irldindualized care. Low-key approaches to contraceptive
use in several comprehensive pregnancy care programs have been shown
to be insufficient. Leaming to contracept successfully is difficult for
many adult women. For teenagers who lack experience, confidence in
their social relationships, and the ability to plan ahead, it is even more
difficult. For many parenting teenagers who cannot foresee other viable
life options than motherhood, a forceful and consistent message about
the risks of subsequent pregnancy and the importance of contraception
are essential. While contraceptive services alone cannot control subse-
quent fertility among teenage parents, they are a necessary first step.
The panel concludes that contraceptive services should be available and accessi-
ble to adolescent parents at 20w or no cost. Because of the special needs of this high-
nsk population, sentence providers should strengthen: theirprograms by0J enhanc-
ing their outreach efforts to encourage early use of contraceptive methods; (2)
developing 2r'rensive individualized counseling and care techniques to encourage
compliance; and (3) enhancing their follow-up procedures to track contraceptive
use.
Abortion services For those who experience repeat pregnancies and
fee] unable to cope with the compounded difficulties of raising more
than one child, abortion is an option for pregnancy resolution.
Ensure the Economic Weli-being of the Teenage Family For teenage
parents, especially those under age 18 and those without a high school
diploma, who have not yet developed the ability to support themselves,
economic well-being is a major concern. Adequate income support is a
OCR for page 286
286 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING
necessary precondition to school completion and to promoting the
health and well-being of young mothers and their children. Severe
poverty increases the likelihood of poor health, inadequate nutrition,
personal frustration, and early economic dependence.
Ensuring the economic security of teenage families until they are able
to become self-sufEc~ent is an essential strategy to achieving the larger
goal of promoting positive outcomes for these young parents and their
children and should involve partners, families, and the community. Two
interventions are especially relevant.
Child support enforcement Fathers should be involved in the Enan-
cial support of their children. Teenage fathers, who may not have com-
pleted school and who are employed only part-time or who are unem-
ployed, are unlikely to be able to make a significant contnbution to the
support of their children while they are still in their teens. For this
reason, young fathers have not typically been actively pursued by the
state for child support. However, there has been renewed interest In
enforcing child support by fathers of children born to teenage mothers,
both to provide additional financial assistance to young mothers and as a
means to increase young men's sense of parental responsibility. Indeed,
parents are obligated to provide support until their children reach age 18,
and even if the father's current level of financial assistance is low, his
contnbution may increase over time and have long-term positive effects
on his children.
There is little existing research or program experience to guide new
polices in teds area. However, farther efforts shoed be made to encore
the effects and effectiveness (short-term and long-term) of child support
enforcement among teenage fathers. As a first step, young men should
be educated about their child support obligations. In addition, efforts
should be made to link child support to education and work require-
ments in the fonn of (~) registration tenth the state employment service
and (2) participation ~ job training and job search activities as well as
work opportunities. At a tUne when an increasing number of states are
adopting "workfare" programs for welfare mothers (including the
mothers of very young children), it is appropriate to consider similar
public jobs programs for the fathers of young children who camlot
otherwise fed work and pronde support for their families.
The families of adolescent parents should also be encouraged to as-
sume responsibility for the support and obligations of their minor chil
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PRIORITIES FOR POLICIES AND PROGRAMS 287
dren, including the children of teenagers under 18. Research suggests
that adolescent mothers, especially school-age gratis, who remain in their
parents' home and receive support and assistance from their families, fare
better In the short term than those who establish independent house-
holds. In turn, the children of young mothers benefit from this support
and assistance. Program experience in this area is extremely limited,
although several states, most notably Wisconsin, have recently enacted
statutes requiring grandparent support for the children of adolescent
mothers. While it can be assumed that enforcing grandparents' liability
win increase the financial resources to teenage parents and their children,
there are no data to show whether such provisions will serve the larger
purpose of strengthening family bonds and stimulating emotionally
supportive parental involvement, or wig have less desirable effects.
Aid to Families With Dependent Children Public assistance for
adolescent mothers and their children represents an important source of
economic secunty when husbands or partners and families are unable to
meet the necessary level of financial support. The availability of AFDC
and related food stamp and Medicaid benefits has raised controversy over
the extent to which it encourages young women to become parents
before they are able to become economically self-sufficient. Although
there is no evidence that AFDC benefits encourage young women to
become sexually active or to become pregnant, there is some evidence
that they may influence decisions concerning living arrangements of
pregnant and parenting teenagers. The 1984 Deficit Reduction Act
amendments to the Somal Security Act established that teenage parents
eligible for AFDC and living with their parents must be included In a
household grant. Minor mothers living apart from their families, how-
ever, are eligible to receive benefits on their OWD . This regulation may
constitute an incentive for a teenage mother to establish independent
Wing arrangements, thereby ~r~dermining her fan3ily's obligation and
ability to provide financial and emotional support. To the extent that
1984 legislative changes governing AFDC eligibility deny income and
Medicaid benefits to young mothers and their children if they remain in
the parental home, these provisions should be carefully reviewed. Trre-
spective of federal action governing AFDC eligibility, the states should
explore policy options to allow adolescent parents under age 18 to
remain in their families of origin whenever possible until they have
completed high school (or the equivalents, until they are able to become
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288 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING
economically self-sufficier~t, or both. There is little research evidence to
support policies in this area. One possibility, however, is to link the
receipt of AFDC benefits by teenage mothers to remaining in their
parents' home, except under conditions that pose a physical or emotional
hazard to the adolescent or her baby.
Enhance Life OptionsforAdolescent Parents Efforts to improve mater-
nal and child health outcomes, to improve developmental outcomes
among the children of adolescent parents, and to prevent subsequent
pregnancy may have little positive eEect until teenagers can be persuaded
to "invest in their own Futures." Both the motivation and the means are
essential to overcoming the likely negative consequences of early child-
beanug. Although many teenage mothers (and fathers) report aspira-
tions that are very similar to those of their peers who delay
childbearing a nice home, a good job, and a Toning spouse they
frequently have ~if~cuity ennsion~g in concrete terms how to make
their dreams attainable. Therefore, a fourth important strategy for im-
pronng social, economic, and health outcomes for adolescent parents
and their children is to enhance their life opportunities.
Several approaches appear to be especially promising:
Life management training Life planning assistance is important to
help teenage parents, both mate and female, establish education, career,
and family formation goals for themselves and to identifier pathways to
achieving these goals that take account of their parenting responsibili-
ties. Similarly, life skills training to help them learn how to manage their
everyday lives independently are important to success in pursuing their
chosen work and family goals. Teenage parents need to have realistic
dress Is of what they can be, in addition to being a parent, and an
understanding of how to ~ those dreams, one step at a time. Re-
search conclusively demonstrating the impact of life management train-
ing on the economic self-sufflaency, marital stability, and parenting
skills of teenage parents is not available, and efforts to develop and test
mode} programs of this type are needed.
Educations support and remediation The detrimental effect of early
childbeanng on educational attainment has been clearly demonstrated.
Most teenagers who become mothers before they graduate do not finish
high school. Similarly, many adolescent fathers who assume parenting
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PRIORITIES FOR POLICIES AND PROGRAMS 289
responsibiiines often find it difficult to complete their education. The
relationship between school performance, school attendance, and ado-
lescent childbearing is complex. Many teenagers who become parents
are at risk of dropping out of high school or have left school before they
became pregnant. Parenthood for these young people may represerlt a
more positive immediate experience than education. For those who have
consistently failed ~ the classroom, there is understandably little incen-
tive to return. Yet adolescent parents must be made to recognize that
Hmshing school is essential to fulfilling their other aspirations for home,
family, and work. In some cases, regular classrooms and mainstream
educational programs may not be appropriate. Many of these young
people need intensive remedial education and self-paced instruction to be
successful. Alternative school programs, including high school equiva-
lencyr courses, represent one option; others may include home instruc-
tion or TV instruction to meet the special needs of these high-nsk
students.
Accordingly, the panel urges that a broad array of special education programs
and servicesforpregrzantandparenting teenagers be developed and implemented
to assist these young people in completing their education.
Employment programs Regardless of the availability of child sup-
port, older pregnant and parenting teenagers (18- and 19-year-olds) need
employment services that provide job training and assist In job place-
ment. Those under age 18 need services that emphasize the importance
of completing high school, while eIlhaIlcing their later employability
and transition from school to work. Younger teenagers may benefit
from information concerning career alternatives and job requirements,
job readiness and job search skids, and temporary or part-time work
experience. As with employment programs that are aimed at preven-
tion, those sensing pregnant and parenting teenagers need to take into
account the related service needs of these young people, including child
care, transportation, counseling, etc., which can significantly affect
their participation and outcomes. Many existing youth employment
programs have excluded teenage parents because of their special needs.
In this regard, the problems of adolescent fathers require special
attention. Employment opportunities are so inadequate and earnings are
so low for many young men, especially m~nonties, who have been reared
in poverty and who lack education, job training, and work expenence,
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290 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING
that they are not able to participate in their childrer~'s support. To
encourage teenage fathers to become economically responsible for their
offspring and to form self-sufficient two-parent fa:Tulies requires that
opportunities be available to them to enhance their employability and
earnings.
The panel concludes that efforts should be continued to strengthen and expar2d
age-appropnate employment programs for pregnant girls and teenage parents,
both male andiemale.
Child care services Research confirms that young parents who have
access to and use child care in their families or In their community are
more likely to finish high school and to enter thejob market. Studies also
suggest that some child care services can positively affect the parent-child
relationship-for both mothers and fathers. In general, there is a short-
age of organized child care services, especially infant care, and sernces
that are geared to the special needs of adolescent parents are few. For
many teenage parents who have working parents themselves, family care
is unavailable. For teenagers to appropnate~y use child care, these serv-
ices must be conveniently located; they must have hours of operation
that are compatible with school schedules; they must be affordable; and
they must provide emotional support and guidance to young parents
who may not Filly understand their roles and responsibilities. Some
schools and employment training programs are experimenting with on-
site child care. Such facilities have the potential for responding to the
special needs of adolescents. Neighborhood-based family care and center
care can similarly provide the necessary services to help teenagers remair
in school or enter the job market and enhance their parenting behavior.
The pane] recommends that support be rovidedfor the development, impZe-
mentation, and evaluation of mode] child care programs that are targeted to the
needs of teenage parents. Schools and other community organizations should
place high priority on establishing and maintaining these servicesfor the children
of adolescents.
Comprehensive care programs The expenence of comprehensive
care programs for pregnant and parenting teenagers has been mixed.
While these programs have frequently produced positive short-term
outcomes In a number of areas-education, work, parenting, health
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PRIORITIES FOR POLICIES AND PROGRAMS 291
behavior, and so on there is no evidence of their having significant
long-term positive effects. Indeed, the special needs of teenage parents
are many, and coordination of supports and services to respond to those
needs is difficult without a centralized case management capability. In
addition, because most teenage parents have expenenced frustration and
failure, they often require intensive, individualized attention, encour-
agement, and assistance to overcome the complex problems they face.
Comprehensive care programs have sought to do this by providing or
brokering a mix of services appropriate to the special needs and circum-
stances of indiv3 duel teenagers. These programs are expensive, and eval-
uations have not yielded much insight concerning the value or benefit of
the van ous program components, either singly or ~ combination. In the
absence of more complete understanding of how particular aspects and
components of comprehensive care programs work and the extent of
their potential benefit to clients beyond the period of participation, large
new expenditures for interventions of this type are not warranted.
Nevertheless, we recognize that many teenage parents need a variety
of supports and services that are riot available unthm their families.
Simply putting these services in place in the community will not ensure
that teenagers wiD benefit Tom them. Many high-nsk adolescent par-
ents require intensive individualized attention and care in order to have
their basic needs met, to help them locate and take advantage of available
public aide private services, and to help them fillEll their aspirations.
The pane] urges that public and voluntary community agencies explore ways
of developing and evaluating case management capabilities to help adolescent
parents obtain necessary supports and services.
Promote the Social, Emotional, and Intellectual Development of the Children
of Adolescent Parents The children of adolescent parents are espec~aDy
vulnerable to behavior disorders, problems In school adjustment, lower
mtedigence and achievement scores, and retention ~ grade. These diffi-
culi~es are only partly the Sect reset of their mothers' young age =d
lack of schooling. They are also affected by poverty, poor nutrition, low
birthweight, andlivingm a s3mgI-parent household, many of which are
closely associated with adolescent childbearing. Special supports and
services are needed by many adolescent parents to prevent or overcome
these difficulties and to promote their children's healthy somal, emo-
tional, and cognitive development.
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292 ADOLESCEAi-T SEXUALITY PREGNANCy AND CHILDBEARING
One intervention in particular has the potential for ~rthenng this
strategy.
Parenting education Parenting education has been shown to im-
prove young parents' knowledge of children's patterns of growth and
development and appropriate child care, as wed as to help them learn
techniques for stimulating infant response and development. Such pro-
grams should be available to teenage parents, both male and female, and
should be sensitive, not only to the developmental requirements of
infants and toddlers, but to the developmental matunty and capabilities
of the young parents. Teenagers who have not grown up ir1 supportive,
ennch~g families may have little positive basis for modeling their own
parenting behavior.
The pane] urges that parenting education for teenage parents, especially those
from severely disadvantaged backgrounds, receive special attention and emphasis.
Schools and other community organizations should place high pnority on the
development, implementation, and evaluation of these programs.
CONCLUSION
As we stated at the beg~namg of this chapter, the panel's framework
for policy and program development is organized around three funda-
mentai goals: the East is reduction of adolescent pregnancy; the second is
provision of alternatives tO adolescent childbeanng and parenting; the
third is promotion of positive outcomes for adolescent parents and their
children. For each of these goals, several strategies and specific interven-
tion approaches have been presented. It is important tO recognize that
none of these interventions alone can solve the complex problems of
adolescent pregnancy and childbeanug; nor can any single strategy ad-
dress the special needs and characteristics of aD youth at risk of untimely
and unintended pregnancy and birth. In presenting several strategies for
achieving each of these goals, we have med tO take account of the
diversity of the adolescent population of their different values, differ-
ent social, economic, and CU]tUI~ backgrounds, different ages and stages
of development, different communities and support systems, and differ-
ent dreams for the fixture. The strategies toward each goal are interde-
pendent. They are not mutually exclusive. Providing young people Ninth
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PRIORITIES FOR POLICIES AND PROGRAMS 293
the ability to avoid pregnancy and childbearing or to cope with early
unplanned parenthood and helping them develop the will and the will-
ingness to do so are both important. Neither alone is sufficient.
As we have stressed throughout this report, there are no easy answers
or quick fixes. Those seeking simple new solutions will 6~d there is
really very little that is new or simple. Any efforts to alleviate the
problems of adolescent pregnancy and childbeanug will ultimately re-
quire a sustained, coordinated commitment by policy makers, service
providers, parents, and teenagers themselves. Everyone can be touched
by the problems; everyone can indeed, must contribute tO the solu
tiOIl.
The problems of adolescent pregnancy and childbearing are solidly
rooted in many of the forces and pnnc~ples that shape our sonety-
~ndiv~dualism, family autonomy, and free enterpnse. As a nation, we
have no coherent policy in this area because we have no unitary view of
these issues or approach to addressing them, and because we have been
unable to deSIle an appropriate public role ~ decisions regarding the
initiation of sexual activity, contraception, pregnancy resolution, and
parenting. This ambiguity and disagreement will not be easily resolved.
Nor should it. We are a diverse society of individuals, families, and
communities with diffenug values, traditions, and cultures. In shoe,
the panel believes that a number of actions should continue to be taken
sunultaneously. They must involve government at all levels as well as the
private sector, including business and labor, religious groups, special
interests, and the media. Some represent immediate steps that can yield
shon-term results; others wiD require a longer-ter~ investment of time
and resources.
This report represents one step in a continuing, incremental process.
As a scientific group, we have staved to clarify the issues, sharpen
awareness of crucial decision points, and bring knowledge to bear on the
trade-offs and complementani~es among different political and ideolog~-
cal positions. Perhaps our most important contnbution is to ~nfo~u the
continuing debate concerning this salient and often divisive issue of the
limits of scenic understanding.
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Representative terms from entire chapter:
sexually active
