Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing (1987) / Chapter Skim
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6 Preventive Interventions
6 Preventive Interventions
Pages 141-188
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From page 141... ...
They are aimed at enhancing young people's ability to avoid early childbeanng, and they are intended to directly influence the process of decision making by adolescent girls (and boys) at the time of choice (e.g., initiation of sexual intercourse, contracepove use, pregnancy resolutions Preventive interventions In the third category are Intended tO influence sexual decision making indirectly by developing and strengthening adolescents' "motivation to avoid early childbearing" (Dryfoos, 1984c)
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From page 142... ...
Programs designed to increase knowledge and influence attitudes, as well as those intended to enhance life options, are frequently unable to show long-term changes in pregnancy rates. They may, however, significantly affect other factors, such as school achievement and peer influences, which have been shown to be related to adolescent sexual behavior.
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From page 143... ...
PROGRAMS THAT IMPART KNOWLEDGE AND/OR INFI~VENCE ATTITUDES A vanety of programs has been developed tO impart knowledge about sexual behavior, human relationships, reproduction, and contraception and tO influence teenagers' attitudes about seniority and fertility. These have included sex education and family life education courses, assertiveness and decision-making training, programs to encourage family commun~cation, teenage theatre projects, and popular media approaches.
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From page 144... ...
While schools across the country demonstrate strong agreement on.the goals of sex education, they differ somewhat in the content and comprehensiveness ofthe~r programs. One study reports that 94 percent of school districts agree that a major goal is to promote rational and wfonned decision making about sexuality; 77 percent agree that a goal is to increase a student's kIIowledge of reproduction; 25 percent report that a goal is to reduce the sexual activity of teenagers; and 21 percent say that a goal is to reduce teenage childbearing (Alan Guttmacher Institute, 1981, as referenced ~ Hofferth, Vol.
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From page 145... ...
Instruction in values as a part of sex education has been controversial. Some educators have advocated a value-free approach in order to avoid offending individuals and families with different onentations and to encourage teenagers to make decisions about sexual matters in light of their own values and beliefs.
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From page 146... ...
In addition, family life education courses tend to emphasize values and attitudes (Muraskin and Jargowsky, 19851. Several recent studies of sex education and family life education programs have shown them to be effective at increasing students' knowledge and understanding of these subjects (Kirby, 1984; Eisen et al., 1985; Finkel and Finked, 19841.
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From page 147... ...
Many critics have expressed concern that teaching sex education promotes early or more frequent sexual activity among teenagers. Others have womed that it may not be effective enough in promoting responsible contraceptive practice among sexually active young people (Zelnik and Kim, 1982; Kirby, 1984; Cooper, 1983)
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From page 148... ...
In some cases the approaches embodied in these programs have been included as components of comprehensive sex education programs (Kirby, 1984~. Typically, their goal is to teach problem-solving skins, decision-making skills, and interpersonal communication skills in order tO help young people employ knowledge about reproduction and contraception in developing and implementing personal approaches tO sexual activity.
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From page 149... ...
to prevent or delay early sexual activity among young teens by improving parent-child communication. They are intended to develop and test approaches to " enable parents to better communicate their values and attitudes regarding sexual behavior to their children and to help their adolescents develop positive self-concepts and improved decision-making skills to enable them to exercise greater responsibility over their sexual behavior" (Montana State University as quoted in Hofferth, Vol.
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From page 150... ...
Some have involved live stage productions schools and community organizations; others have involved radio and television spots accompanied by information concerning local family planning, maternal and child health, or other relevant health and social services. Based on the assumption that peers can significantly influence teenagers' attitudes and behavior, teenage theatre projects have sought tO raise consciousness about sexual activity, pregnancy, add childbeanng among adolescents and to pronde outreach for local service agenaes and .
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From page 151... ...
has initiated a Los Angeles-based media project intended to serve as a factual resource for television programmers and to encourage more responsible presentation of sexual content. In particular, the project has been concerned with the portrayed of male-female relationships and nonmantal sexual activity, as well as the lack of attention to pregnancy prevention and responsible contraceptive use.
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From page 152... ...
Public sernce announcements represent another avenue for using radio and television to raise consciousness about adolescent pregnancy and childbeanug and for reaching out to teenagers in need of health and social services, especially family planning services. Although the pane]
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From page 153... ...
Family planning services are available to teenagers from organized health service providers, such as public health departments, local hospital outpatient clinics, school-based clinics, and private, freestanding clime facilities, as wed as from priorate physicians. Some family planning service providers offer a All range of reproductive health services, inciuding testing and treatment for sexually transmitted diseases, obstetncs, abortion, and sterilization.
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From page 154... ...
Of those teens who had used any farruly plating sernces, 45 percent had last used a private physician, 49 percent a clinic, and 6 percent a counselor. Teenagers' first source of contraceptive services was slightly more likely to have been a clinic (~3 percent)
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From page 155... ...
Family planning clinics tend to be female-onented in their approach and In the primary health and social services they offer, and therefore are rarely Visited by young men unless they are accompanying a female partner. Family planning clinics are generally more willing to provide contraceptive services to unmamed adolescents under age 18 without parental consent or notification than are private physicians.
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From page 156... ...
°Data provided are for fiscal years through 1974, and for calendar years thereafter. SOURCE: Alan Gut~macher Institute, 1984, Organized Family Planning Services in the ZJnited States, 1981-1983, New YorI;, AGI.
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From page 157... ...
Researchers at the Alan Guttmacher Institute estimated that in 1981 more than 5 minion young women ages 15-19 were at risk of an unintended pregnancy; 57 percent of them received family planning services during that year-approximately 30 percent from organized programs and 21 percent from pnvate physicians (Torres and Forrest, 1985~. Family planning agenaes offer a variety of seances in addition to contraceptive counseling and service (Table 6-4~.
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From page 158... ...
Data concerning changes in the number of adolescents obta~n~g contraceptive services from private physicians are not available. Data from the National Surveys of Young Women show increased use of clinics between 1976 and 1979.
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From page 159... ...
This fee does not include the cost of the prescnbed contraceptive. Birth control piss, the most commonly prescnbed method for adolescents by both climes and private physicians, COSt between $8.75 and $15.00 per cycle (Hofferth, Vol.
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From page 160... ...
Only 28 percent of agencies receive these fiends, however, and they account for only 7 percent of average agency income. Funds from TABLE 6-5 Sources of Funding for Rainily Planning Agencies, 1983 Mean Percentage Source Percentage Receiving of Funds Received Federal 98 63 Title X 77 33 Title XIX 90 10 MCH block grant 28 7 Social Services block grant 4o 13 State and local government 52 17 Panent fees 92 13 Other private 41 7 Total 100 100 NOTE: Percentages may add to more than 100 because most agendas received funds Dom more than one source.
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From page 161... ...
. In fiscal 1983, $108 million of Medicaid fiends were tlsed to reimburse organizations and private physicians for contraceptive services.
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From page 162... ...
. Among new family planning clinic patients under age 20, 70 percent were using no method of contraception before their fist visit, compared with 12 percent after the nsit.
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From page 163... ...
= oncontracepdvebob ~ on anegativeeB>= onb~tb rates, and presumiEtF ~ negati~eeB>ct on tbeinddence ofunintended pregnancy (PoIIe~ et ~ - 19817 Citric pahents aro more Uketr tin tb6i co ~ terp~s~'bo are notinf~ndly pbuning progla~asto use more rebukable methods ana less ~ etyto use no method at ED (Porrestet d., 1981)
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From page 164... ...
Thus, clinics that offer a community education program for teenagers in combination with the provision of contraceptive services (physical examination and prescnption) have a Tower mean delay between first intercourse and first nsit.
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From page 165... ...
Cntics of family planning programs suggest that the availability of contraceptive services has caused higher rates of sexual activity, unintended pregnancy, abortion, and births to unmarried teenagers. Indeed, the penod of significant increase ~ teenage sexual activity 3unng the 1970s was paralleled by a significant growth in the availability of contraceptive services for both adult women and adolescents.
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From page 166... ...
Condom Distribution Programs Programs aimed at condom distribution are more narrowly targeted toward young men than traditional contraceptive services prowded by family planning agencies. Although many clinics have initiated efforts to involve young men In their programs, there is little ewdence of success.
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From page 167... ...
Condom distribution programs have been implemented by a Variety of organizations, including public health departments, Planned Parenthood affiliates, and university hospitals. Distribution has been managed by orgaIiizatiorls raIlging from family planning providers and public health organizations to youth organizations, public employment programs, and labor unions.
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From page 168... ...
A wide range of organizations has taken responsibility for establishing and operating clinics, including hospitals and medical schools, commum~y clinics, public health departments, and Planned Parenthood affiliates. In general, the goal of school-based clinics is to improve the overall physical and mental health of teenagers, including the reduction of teenage pregnancy.
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From page 169... ...
Clinics also vary in the scope of their family planning services. At a minimum they all provide counseling, make referrals to family planning clinics or private physicians, and do follow-up after referrals.
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From page 170... ...
, ~ a recent report on adolescent pregnancy stror.g~y recommended the establishment of school-based clinics. However, the
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From page 171... ...
This program, established and directed by the Johns Hopkins School of Medicine, imrially focused its sermces on the students at a predorr~inantly black, inner-city senior high school and junior high school. The program combined sex education with family planning and counseling services.
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From page 172... ...
The proportions of sexually active students hanng attended a clinic rose for students of both genders and at all grade levels. In addition, the proportion of girls with no sexual experience who attended in preparation for first coitus and those who attended in the early months after initiation of sexual activity increased markedly.
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From page 173... ...
Pregnancy Testing and Counseling Pregnancy testing is available to teenagers in public health centers, hospitals, family planning clinics, and abortion clinics, from private physicians, and even at many drugstores. This service is generally pronded at little or no cost to the client.
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From page 174... ...
Available studies of decision making, however, suggest that Marty teenagers have already made up their minds about whether to abort or carry to term before they seek pregnancy testing and counseling services and therefore choose service providers on this basis (Rosen, 1980~. Hot Litter Telephone hot lines that teenagers can use anonymously tO obtain accurate information about contraception, pregnancy, abortion, sexuaDy transmitted diseases or other reproductive health problems, and adoption alternatives have developed in several cities.
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From page 175... ...
In New York City, a similar hot line to pros e information and referral linked callers directly to clinics by scheduTir~g appointments for those who expressed interest in obtaining . ~ contraceptive services.
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From page 176... ...
Information concerning contraception and access tO contraceptive services is prodded, but altering contraceptive behavior is neither the only nor the primary goal of the program (Alexander, 1984~. An evaluation of Project Choice did not pronde cor~nucing evidence of its effectiveness, although as Hofferth (Vol.
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From page 177... ...
In a related effort, the Giris' Clubs of Santa Barbara, Calif., developed a workbook for adolescent girls entitled Choices. The workbook prondes teenagers with problem-solving exercises that require sexual decision-making and life-planning skills.
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From page 178... ...
Special attention is given to encouraging responsible sexual behavior. A similar program through Delta Sigma Theta, a national black soronty, has recently been organized.
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From page 179... ...
There are no data, however, on whether such programs lower fertility rates. Studies that focus on how and to what extent such programs influence adolescent sexual and fertility behavior are needed.
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From page 180... ...
A study, which is now under way using data from the federally supported Youth incentive Entitlement Pilot Projects (YlEPP) , promises to yield additional information on the impact of youth employment programs on family formation.
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From page 181... ...
Comprehensive Community-Based Prevention Programs Several community-based programs have been established in recent years to provide educational, vocational, recreational, legal, health, and social services to disadvantaged young people in an integrated services setting. Pregnancy prevention is usually only one (although an important one)
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From page 182... ...
Among the most visible national interest groups to have formed adolescent pregnancy coalitions are the Children's Defense Fund and the National Urban League. The Chil~en's Defense Fund has directed its efforts toward (~)
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From page 183... ...
However, they high visibility suggests that they have been successful at raising public and professional consciousness about the issues of adolescent pregnancy and childbeanug and the need to address them at the state and local level. MEASURING THE COSIS AND BENEFITS OF PREVENTION PR~ Polipy makers, program administrators, and advocates frequently caD for ~fo:~ation ore the costs and benefits of alternative programs, espeaally those aimed at pregnancy prevention.
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From page 184... ...
For this reason, traditional cost-benefit analyses of adolescent pregnancy programs are often problematic. Burt and Leery (Vol.
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From page 185... ...
Although the COStS of operating programs to reduce the incidence of pregnancy cover a wide range-from an estimated $~0 per participant per year for sex education courses to an estimate] $125 per participant per year for comprehensive school-based adolescent health clinics in general these costs are significantly less than the costs to taxpayers that result from nonmantal adolescent childbearing.
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From page 186... ...
Sex education programs and contraceptive sernces are especially vulnerable to charges that they may induce more sexual activity among adolescents than would otherwise occur. Similarly, some critics have expressed concern that more intercourse with contraception may also lead to more intercourse without contraception, which in turn might lead to more unintended and untimely pregnancies than would otherwise occur.
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From page 187... ...
. preventive Interventions we examined save pregnancy prevention as a primary goal Most programs tO provide knowledge and influence attitudes and tO enhance life options have other primary (direct)
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From page 188... ...
and some scattered data for other programs (e.g., sex education) , we know very little about the costs of other types of preventive interventions.
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