Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing, Volume II Working Papers only (1987) / Chapter Skim
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9. The Effects of Programs and Policies on Adolescent Pregnancy and Childbearing
9. The Effects of Programs and Policies on Adolescent Pregnancy and Childbearing
Pages 207-263
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From page 207... ...
For example, making family planning services available may lead some teens to initiate sexual activity at en earlier age than otherwise. Increasing the availability of welfare may increase the probabili~cy that, once pregnant, a girl will bear and keep her boy rather than have an abortion or relinquish the child for adoption.
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From page 208... ...
. Fewer than half c ited a desire to reduce teen pregnancy and only 25 percent cited a goal of reducing teen sexual activity (Sonenstein and Piteman, 1984~.
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From page 209... ...
There was no overall change in attitudes towards sex education, although a slightly increased proportion thought parents were responsible for their children's sex education. The impact of the program was greater in the Fresno area than in the San Francisco Bay area, probably bee cause the prog ram reached more people in Fresno and because San Francisco area parents were better communicators before the program.
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From page 210... ...
Activities are d irected toward the development of educational, career and general life options, not simply towards contraceptive behavior. Clubs are composed of students who may not yet be sexually active, as well as of students who are sexually active or who may already be parents.
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From page 211... ...
According to a lB82 survey of 200 school districts in large US cities conducted by the Urban Institute and jointly ad~snistered by the National Association of State Boards of Education, three quarters of school districts offered some sex education (not necessar fly a separate course) -- in their schools (Sonenstein and Pittman, 1984~.
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From page 212... ...
found no association between the probability of initiating sexual activity and having had sex education; however, for those who were sexually active, those who had had sex education were more likely to contracept and less likely to become pregnant than those who hadnt t. This study was based on survey responses, with only a limited set of questions to measure whether the respondent ever took a sex education course, and with no measure of whether the course Is taken before or after the behavior examined.
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From page 213... ...
for that office found that after controlling, for other factors there was no residual impact of the sex education program. }t is likely that initial differences between counties, rather than the sex education program, led to the initial conclusion that the program had been successful.
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From page 214... ...
The authors found a significant association for white males and females and for black females, such that those who had received sex education were less likely to rem port that they had had intercourse, and this association held up when controls for family income, mother' s education, the mother' s age at f irst birth, family structure, and community size were included.
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From page 215... ...
The National Survey of Family Growth included questions not only on whether the respondent had ever had sex education, but whether the course included instruction on methods of birth control and the age of the respondent when that instruction took place. In addition, the month and year of first intercourse was obtained.
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From page 216... ...
found some evidence that having had a sex education course was associated with a higher likelihood of currently contracepting among 17 and 18 year old women; however, the measure of contraceptive use available in the data is very limited. F inally the authors explored but found no relationship between having had a sex education course and whether had a premarital pregnancy after taking that course.
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From page 217... ...
. Unfortunately, no information on sexual activity was reported for these subjectse Sugary In summary, research conducted on young men and young women has shown that sex education increases knowledge about sexuality; however, the evidence for an impact on behavior is weak.
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From page 218... ...
Howeve r, three recent stud ies based on nationally representatsve samples of young women (Zelnik and Rim, 1982; Dawson, 1986; Mott and Marsiglio, 1986} found that young women who said they had had a sex education course in school also appeared to be more effective contraceptors. The evidence that sex education is associated with better contraceptive use among sexually active teenagers is strong and consistent.
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From page 219... ...
, 92 percent of obstetrician-gynecologists, but only 66 percent of general practitioners and 32 percent of pediatricians would prescribe a contraceptive medic trod for a sexually active unmarried teenager younger than 18 without parental consent. Of those who will prescribe contraceptives for adolescents, 90 percent will prescribe the pill; smaller proportions will prescribe other methods (IUD, diaphragm}.
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From page 220... ...
The former are at higher than average risk of unintended pregnancy, because of their greater level of sexual activity. Zabin and Clark {1981)
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From page 221... ...
. The Impact of Family Planning Services on Contraceptive Use It is clear that family planning clinics change their patients' contraceptive behavior.
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From page 222... ...
Because of increased abortion, birth rates for all teen women declined. Thus in the 19 70~ large numbers of teens were being served by family planning clinics, although coverage varied from county to county, and rates of teen childbearing were declining.
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From page 223... ...
When area differences in adolescent sexual activity were controlled, both white and non-white adolescent birthrates were found to have been reduced between 1970 and 1975 as a result of enrollment by teens in family planning clinics.
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From page 224... ...
Clinics are more likely to respond to demand than to create it, although they may satisfy the needs of some groups who would ordinarily not have access to certain contraceptive methods. Critics of funnily planning programs have claimed that expenditures on family planning and sex education actually cause higher rates of abortions and births.
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From page 225... ...
One unintended and offsetting consequence of family planning prom grams may be that of increasing teen sexual activity. The easy availability of contraception through organized family planning programs may allow teens who would not otherwise engage in sex because of fear of pregnancy to do so or may legitimize early and non-'narita1 sex.
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From page 226... ...
Mean delay is increased if pharmacies in the community make non-prescription contraceptives easier to obtain. The Snore priorate physicians there are who provide family planning services to teens does not appear to affect mean delay in attending clinics: however, the more they charge the shorter the delay in attending a clinic.
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From page 227... ...
studied clients and the professional staff of 78 Maryland county health department family planning clinics. In a study using clinics as the unit of analysis, contraceptive use was measured as the proportion of time subsequent to the baseline interview that women at risk of pregnancy were using a medical method of contraception.
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From page 228... ...
during all periods of sexual activity, with tire exception of the month In which the clinic visit occurred. Inconsistent contraceptors included those adolescents who used a reliable method most of the time, but not continously, as well as those adolesc<`r~ts who primarily relied on the least effective methods or no method at all.
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From page 229... ...
for Hales Fewer than half of one percent of all family planning clinic patients in the United States are male (Dr~foos, 19851. Reasons for the low rate of male utilizaton include lack of funding, negative staff attitudes toward males, lack of male staff or difficulty integrating male staff into the program, and the general perception of clinics as .woman oriented,.
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From page 230... ...
Conf identiality is increased by providing a number of non-family planning services such as athletic, job and college physicals, immunizations and a we ight control prog ran. Males can be attracted and served as well as
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From page 231... ...
About one-third of the students served use the clinic for family planning. Services provided include educational counseling and family planning services, prenatal and post-partum care, nutrition education, day care, and parenting, family life and sexuality education.
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From page 232... ...
Some delay in the initiation of first intercourse occurred in program compared with non-program schools, delay substantial enough to lay to rest fears that access to contraceptive services in schools would increase levels of sexual activity, and to suggest that such prom grams may, in fact, delay first intercourse. One of the Cost important findings was that students in program schools attended clinics sooner after initiating sexual activity than prior to the program and in cow parison with non-program schools.
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From page 233... ...
In addition, the birth rates in 1977 were lower among WDYC part ic ipants than among non-pa rt tic ipants. The authors concluded that the clinic program did reduce teen births in West Dallas.
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From page 234... ...
Third, what effect does communication with parents about contraception or sexual activity have on children' s behavior, and under what circumstances? Fourth, what effect does fear of parental knowledge about their sexual behavior have on children's use of contraception and attendance at clinics?
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From page 235... ...
Presumably it is not communication per se that matters, but the closeness of the relat ionsh ip and the content of the cononun icat ion ~ see, for example, Fox, 1980; Newcomer, 1983~. A recent study (Kahn et al., 1984} found no association between several measures of parent-child communication and sexual activity of daughters, but an association for sons.
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From page 236... ...
Rem search in sex education, in parent-child communication programs and other areas suggests that improving communication prior to adolescence may be a more successful strategy ~ see earlier discussion} . Sundry Family planning prog reins have been evaluated and shown to be very successful in improving contraceptive use, and therefore preventing pregnancies and births to teen women.
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From page 237... ...
PREGNANCY AND PREGNANCY RESOLUTION Several types of programs are designed specif ically for pregnant teenage women. These include nutritional programs such as WIC, Maternal/Child Health programs with emphasis on prenatal care, and public school programs for pregnant adolescents.
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From page 238... ...
Nor did they f ind any evidence of abortion availability on the transition to sexual activity. They did, however,
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From page 239... ...
Thus this analysis suggests that the availability of abortion affects the probability that an unmarried woman will chose to have an abortion rather than having an out-of-wedlock birth or mar Eying once a woman is pregnant. I t does not appear to affect sexual activity or the probability of becoming pregnant.
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From page 240... ...
In line with its new mandate, the Office of Adolescent Pregnancy Programs has funded several programs whose purpose is to increase the proportion of pregnant teens who opt for adoption over abortion or childbearing. OAPP is also funding two ongoing studies (fallen, 1984; Resnick, 1984)
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From page 241... ...
Pregnant teens are separated f rom regular classes and offered an educational curriculum supplemented by classes in parenting and child development. Other services such as health monitoring and child care may be of f ered .
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From page 242... ...
Experimental and control groups were matched on age, race, parity, years of education, and merited status. Resu Its show improved pregnancy outcomes, including decrease in low birthweight incidence, an increase in gestational age, and a reduction in inadecpaste prenatal care.
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From page 243... ...
Comprehens ive Services to Pregnant and Parenting Teens Family planning programs are directed at the prevention of concept tion, at facilitating the planning of births. Although data on pregnancy, the most appropriate outcome variable to measure are not available because of problems with abortion statistics, still it appears as though they are relatively ef fective in achieving their goals.
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From page 244... ...
Although subsequent pregnancy was not qu ite as rapid among exper imental as controls in the f irst 15 months, by 36 months there were no significant differences in repeat pregnancy. Contraceptive use was a poor prep dictor of subsequent pregnancy -- being in school at 3 months postpartum was a better predictor of delaying subsequent pregnancies than was acceptance of contraceptives.
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From page 245... ...
The major conclusion from Project Redirection was that the program had a small impact on participants within the first year, but that most of the effects had disappeared by the second year follow-up. The project had its strongest impact on the most disadvantaged of the participants: those who were not in school at baseline, those with no work experience at baseline, younger teenagers and Puerto Rican teenagers, and teenagers with a subsequent pregnancy.
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From page 246... ...
In contrast, the bi th control knowledge scores of participants cons intently exceeded those of non-pa rt ic ipants. The rate of repeat pregnancy was slightly lower for Project Redirection Participants than non-participants at 12 months; by 24 months the difference between the groups had disappeared.
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From page 247... ...
Short term objectives are to reduce the incidence of low birth weight, baby's complications, and mother's complications, and to increase school enrollment. Long term objectives are to reduce the incidence of repeat pregnancy, increase educational attainment, increase the number who obtain training and employment and reduce welfare dependency.
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From page 248... ...
Receipt of family planning services was associated with a lower probability of repeat pregnancy 12 months postpartum for women who were mothers at entry into the prom gram. For many of the counseling variables cause and effect links are tenuous; many appear to be outcomes rather than causes, because women at risk of poor outcomes were often identified and receive greater attest awn as a result.
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From page 249... ...
These figures are favorable relative to national statistics which show about S8 percent of young women in school or completed school one year after the birth and a repeat pregnancy rate of 20 percent (Most and Maxwell, 1981; Koenig and Zelnik, 19821. Of course, the repeat pregnancy rate provided by the MIC program applied only to those who remained in school.
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From page 250... ...
The results so far f ram the pro jects are somewhat encourag ding . Four programs showed the incidence of low birth weight babies below their local comparison data and three showed the incidence to be below national comparison figures.
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From page 251... ...
. The incidence of repeat pregnancy appears to be rather high: 16 percent were pregnant again within one year (approximately)
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From page 252... ...
The repeat pregnancy experience of the experimental group was substantially better than that of the control ~ Coup; the repeat pregnancy rates for the latter were s Similar to those of national samples of teens. The second study compared young women enrolled in the Hop k ins Come prehensive Care Clinic with those in the Teenage Clinic (TAC clinic referred to above)
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From page 253... ...
In any case, using other programs as camper isons would seem to reduce the likelihood of finding significant program effects. Prenatal/Early Inf ancy Pro ject This study evaluated a comprehensive nurse-home visitation and transportation service designed to improve pregnancy outcomes and child health and development in a group of families at risk for preqnancy and childrearing dysfunctions.
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From page 254... ...
Women having repeat pregnancies were especially at risk of undesirable outcomes The Project Redirection staff also discovered the importance of focusing on delaying repeat pregnancy. They did not focus much iJnportance on it at first, but, soon alarmed at the number of repeat pregnancies, began putting more pressure on participants to contracept effectively.
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From page 255... ...
In fact, most prom grams appeared to ignore the family responsibilities of enrollees, in spite of the fact that a large proportion of male and female participants have children of their own. AS a result, there is not much evidence as to the impact of such programs on teen childbearing.
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From page 256... ...
to improve knowledge of birth control and outcomes of teen pregnancy. Inter" (medium length} goals are 1)
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From page 257... ...
In an early study of out-ofwedlock birth rates in 58 SMSA's, Janowitz (1976) found that a higher
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From page 258... ...
None found any impact of either level of AFOC benefits or acceptance rates on out-ofwedlock birth rates among teens in 1971, 1974 or 197S (Field, 1981; Moore and Caldwell, 1977; Moore, 19801. Moore and Caldwel1 (1977, also explored the impact of AFDC benefit lent and acceptance rates on initiation of sexual activity, pregnancy and pregnancy resolution among teens.
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From page 259... ...
The conclusion is that level of welfare benef its and acceptance rates and other indicators of availability do not appear to be ashy ciated with sexual activity or pregnancy; however, they may be ascot elated with whether or not a girl who in pregnant decides to abort, mar ry or bear an out-of-wedlock child, and with whom she chooses to live. The evidence is not very strong; more research is needed e The availability of Medicaid and other health care benefits might also affect teen childbearing.
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From page 260... ...
Programs to Prevent Sexual Activity Sex educa~cion programs appear to be consistently associated with increased knowledge about sex and sexual behavior among participants; however, there is little evidence for a relationship with sexual activ~ty. In spite of common beliefs, those taking a sex education course do not appear to change their own beliefs and values, although they do become more tolerant of the beliefs and values of others.
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From page 261... ...
wIC, a nutritional pros ram for pregnant and parenting women, has been shown to successfully reduce the incidence of low birth weight babies, an impact which is espec tally strong for teenagers. Parenthood Teenage pregnancy programs are directed primarily at pregnant teens and/or teen mothers.
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From page 262... ...
An area of great interest is that of the impact of welfare availability and benef it levels on sexual activity and out-of-wedlock childbear ing . There is little theoretical rationale for expecting an assort elation between welfare benef its and initiating sexual ace ivity, and no evidence exists for an empirical relationship either.
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From page 263... ...
Note 1. Authoritative guidance refers to the nurse, an authority figure either telling The client what birth control method to use or persuading her to use a particular method.
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