Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing (1987) / Chapter Skim
Currently Skimming:
9 Priorities for Policies and Programs
9 Priorities for Policies and Programs
Pages 261-294
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From page 261... ...
Young mothers, ~ the absence Of adequate nutntion and appropriate prenatal health rare, are at a heightened 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~
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From page 262... ...
2. Sexually active teenagers, both boys and girls, need the ability to avoid pregnancy and the motivation tO 60 SO.
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From page 263... ...
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.
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From page 264... ...
3. Promote positive social, economic, health, and developmental outcomes for adolescent parents and their children.
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From page 265... ...
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.
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From page 266... ...
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 encourage contraceptive use by sexually active teenagers.
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From page 267... ...
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 intergenerational poverty have stifled the motivation of many to delay immediate gratification and avoid pregnancy.
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From page 268... ...
Although research has not specifically linked programs 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 prospects among some subgroups of the population have had serious adverse eRects on many young people's perceptions of opportunity.
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From page 269... ...
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.
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From page 270... ...
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 concerning sexuality and sex abuse, as well as training to deal with potentiaDy abusive encounters, may help reduce their anxieties and fears about personal sexual development and improve their ability to avoid sexual exploitation.
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From page 271... ...
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 nouprescnption methods. Although modem contraceptive technology, espec~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.
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From page 272... ...
concludes that use of the contraceptive pill is the safest and most effective means of birth controlfor sexually active adolescents. Aggressive public education IS neelelto dispel myths about the health risks of pilluse by girls in this age group, and contraceptive serviceprogra~c should explore nonmedical models for 12stnbutio?
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From page 273... ...
Several interventions have been shown to encourage diligent contraceptive use among sexually active teenagers. Sex education Sex education courses vary In their attention to and treatment of contraception.
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From page 274... ...
sensitivity to the special concerns and apprehensions of teenagers ire coming to family planing cynics. In order to encourage contraceptive use among sexually active teenagers with diffenng needs and predispositions to use contraceptive services, numerous models and approaches should continue to be available and accessible to teenagers from a variety of service providers.
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From page 275... ...
. In addition, data show that many sexually active adolescent girls, who delay obtaining prescription contraceptive methods after initiating intercourse, frequently rely on male methods in the intenm.
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From page 276... ...
The panel concludes that efforts should be undertaken to develop and test the effects on contraceptive use and uninterested pregnancy of paid promotional messages for contraceptives that are directed at sexually active adolescents. Goal 2: Provide Alternatives to Adolescent Childbeanug and Parenting The pane!
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From page 277... ...
The question has been raised of whether the availability of abortion has undermined delay or contraception. While it is true that adolescent girls in the early phase of sexual activity often do not use contraception regularly, we have found no evidence that abortion is used preferentially
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From page 278... ...
Repeat abortions do occur among teenagers as well as among adult women. However, concern that the availability of abortion services will lead to higher rates of teenage sexual activity an]
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From page 279... ...
Because many adolescent girls' first nsit to a family planning clinic is for pregnancy testing' outreach to encourage them to seek help early may affect the tuning of their visit. Pregnancy counseling to outline the available options for pregnancy resolution should also be pronded as early as possible.
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From page 280... ...
Pregnancy counseling and referral Teenagers who experience an unintended pregnancy should receive objective, nonjudgmental counseling to inform them of aD their options for pregnancy resolution and the associated risks and beneSts of each abortion, parenthood, and adoption. Such counseling should also include decision counseling to help pregnant girls explore their reasons for choosing one course of action over another.
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From page 281... ...
Although parenting teenagers represent a small proportion of the overall adolescent population, their problems and needs entail high public costs. Accordingly, a third important goal is to promote positive outcomes for adolescent parents and their children.
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From page 282... ...
Information, outreach, and follow-up are essential aspects of maternal and child health services for adolescents. The panel recommends continuer support for the provision of appropriate health and nutrition services, including prenatal, labor, and delivery care for pregnant adolescents and regularanl emergency pediatric carefor the children of teenage mothers, through Medicaid; the Early and Periodic Screening, Diagnosis and Treatment Program; and other federal and state maternal and chill health programs.
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From page 283... ...
Such barriers should be minimized. Program research suggests that two components of service delivery are essential to help pregnant teenagers receive adequate prenatal care beginning in the first trimester of pregnancy.
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From page 284... ...
Pediatric care programs and well-baby clinics are available to teenage parents through public health departments, hospitals, freestanding community clinics, and school-based clinics. These programs involve a vanety 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.
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From page 285... ...
While contraceptive services alone cannot control subsequent fertility among teenage parents, they are a necessary first step. The panel concludes that contraceptive services should be available and accessible to adolescent parents at 20w or no cost.
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From page 286... ...
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.
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From page 287... ...
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.
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From page 288... ...
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 maternal 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 childbeanug.
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From page 289... ...
Employment programs Regardless of the availability of child support, older pregnant and parenting teenagers (18- and 19-year-olds) need employment services that provide job training and assist In job placement.
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From page 290... ...
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.
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From page 291... ...
Many high-nsk adolescent parents 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]
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From page 292... ...
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 fundamentai 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.
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From page 293... ...
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.
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