Our nation is consistently failing huge numbers of its young girls. The evidence is compelling: According to the National Center for Health Statistics, more than 700,000 of those who are between the ages of 10 and 19 become pregnant every year — that’s a rate of 71.5 pregnancies per 1,000 teenage females in the United States — and the majority of these are unplanned. What’s more, adolescent pregnancy poses a variety of significant health risks to both the mother and her baby, including STIs, birth defects, anemia, and hypertension. Such risks are heightened when the pregnancy is unintended, as the mother may continue to engage in high risk behaviors and delay seeking prenatal care. Additionally, teenage mothers are less likely to complete high school or college, and are consequently more likely to live in poverty.
Despite these disturbing statistics and the harmful outcomes associated with them, reproductive health education models designed to go beyond “abstinence-only” continue to draw vehement opposition from groups morally opposed to such teachings. This opposition continues despite a solid body of statistical evidence supporting a broader, more pragmatic approach to reproductive health education. For the past 15 years, federal funding for reproductive health education programs was solely for the creation of abstinence-only education models. From 1996 through 2007, the Department of Health and Human Services reported more than $87 million in federal and state funds were directed toward “abstinence-only” programs. After an initial decrease in teen pregnancy rates during that same period, the Guttmacher Institute found that during 2006 the number of pregnancies in girls ages 15-19 actually increased by 3 percent—the first increase in the United States in 10 years. Recent data suggest that this was not an isolated uptick, and that the number continued to rise in 2007.
Recognizing the strong evidence in support of a broader, more pragmatic approach to reproductive health education, HHS announced a $155 million grant aimed at the development of evidence based reproductive health education programs. On the heels of this announcement, PolicyLab of the Children’s Hospital of Philadelphia, has disseminated its newest Evidence to Action brief entitled Preventing Adolescent Pregnancy, a report highlighting the critical role played by comprehensive reproductive health education in teen pregnancy prevention. PolicyLab’s findings suggest that the most effective reproductive health education programs for adolescents teach abstinence in addition to providing information on the various forms of birth control available. Moreover, the report emphasizes the need for smarter provision of reproductive health education. Teens who were sexually active were more likely to practice safe sex when birth control information was disseminated discretely and in contexts where teens were likely to seek such information. The report further identifies a knowledge gap among pediatric health care providers regarding adolescent reproductive health. This gap is especially significant among emergency room physicians, as teens at risk of becoming pregnant and/or developing STIs are more likely to seek care in an emergency facility. In addition, when such information is made available by pediatric care providers, teens are more likely to take advantage of birth control methods and practice safer sex.
State Medicaid programs are another important source of contraceptives for adolescents. PolicyLab found that when state programs allocated more of their Medicaid funds toward expanding birth control coverage, and extended family planning coverage to include adolescents, teens reported greater access and willingness to use these services.
What opponents of this newer, more effective approach to sex education refuse to accept is that there is no such thing as a one-size-fits-all prescription for preventing teen pregnancy. The reality is many teens will choose to be sexually active despite pledges of abstinence and having a clear understanding of the perils of premarital sex. Also, there is evidence that knowledge of available pregnancy prevention options leads to increased use of effective birth control practices among this population. Consistent and proper usage, in turn, leads to lower rates of STI contraction and pregnancy. It’s time for our community health efforts to recognize these facts and direct outreach and education efforts toward discouraging adolescent sexual activity and ensuring that any sexual activity will be as safe as possible. It is essential that programs created using these new HHS funds recognize the methods identified by PolicyLab as effective in teen-pregnancy prevention and embrace the more comprehensive approach to reproductive health outreach.