Teenage Sex: Just Say 'Wait'
The search is on for new and more effective ways to teach teens about the facts of life
Nine in 10 Americans agree: Schools should teach kids about sex. That, however, is the end of the consensus. Most adults fall into opposing camps on exactly which of the facts of life to teach. The "throw in the towel" crowd concedes, with value-free resignation, that having sex is normative teen behavior and the most that adults can do is teach young people how sperm meets egg, toss out loads of condoms and hope for the best. Meanwhile, the "stop it" forces call for scaring teens into premarital chastity with horror stories of shame and disease. Neither solution, however, works very well with today's sophisticated teenagers. That is clear from teen birthrates: After falling for more than a decade, they began climbing rapidly in the late 1980s and are now at their highest levels since the early 1970s--before the widespread availability of birth control and abortion.
Now, a third way of thinking has begun to emerge among sex educators and public-health workers that combines the abstemious and lenient approaches and stresses reaching younger children. The history of teen pregnancy prevention is littered with failure, and even this mixture of pragmatism and values-based teaching promises only modest results. But the results are positive enough to have drawn support from the woman who could be the nation's new sex-ed teacher, the blunt-spoken Joycelyn Elders, a sharecropper's daughter who became a pediatrician and who is now Bill Clinton's nominee to be surgeon general (portrait, Page 60).
"Condom queen"? The debate over Elders makes clear that few subjects polarize the American public as easily as teen sex. As public-health chief of Arkansas, she started school-based health clinics, some of which distribute birth control devices, stirring opposition at home that is following her onto the national scene. "Condom queen" is what Phyllis Schlafly calls Elders, echoing the many conservative groups opposing her nomination, for her support of abortion as well as of giving students birth control. Yet Elders's views on teen sex are mainstream enough to have garnered her endorsements from all the major medical and child health groups--from the American Medical Association to the Child Welfare League of America. Last week, however, questions over her personal finances forced a delay until this week of her confirmation hearings.
There is no denying that if she is confirmed, Surgeon General Elders will want a major change in federal policy. Since 1981, the federal response to teen pregnancy has been to teach students to remain chaste until marriage. Washington has spent some $31.7 million developing "abstinence only" curricula (or, as some of these programs put it, "secondary virginity" for those who have already lost theirs). Some of the programs have run into unexpected troubles. Earlier this year, the Department of Health and Human Services settled a suit that claimed these pro-chastity programs unconstitutionally promoted religion. In one classroom exercise, girls were told to imagine the ideal dating activities as things they would do if they were out with Jesus.
Beyond that, the main criticism is that such programs are unrealistic and ineffective because they never discuss birth control and simply expect teens to avoid sex, sometimes using almost comically out-of-touch techniques. "Pet your dog, not your date" is the slogan of the popular Sex Respect program, conducted in 1,100 school districts nationwide. While it is important to stress abstinence, notes Jerry Bennett, acting director of the HHS office that administers these programs, none of the "abstinence only" programs has a proven record of success.
Elders favors the middle road. She told U.S. News that she supports newer hybrid programs that "stress abstinence," particularly for the youngest teens, but believes it is unrealistic to demand abstinence only. She wants to "give kids the tools" to resist peer and societal pressures to have sex and aims to induce a new sense of social values in the young and teach children as early as kindergarten age that they have the right to decide who touches their bodies. "We need to have our kids understand that sex is good but it has to be appropriate," she says. Teens should be taught to make sound decisions about sex if they choose to have it, says Elders--including informed choices about birth control. But, says Family Research Council Director Gary Bauer, that approach sends a mixed message, akin to saying "it's illegal to shoplift, but if you do it, here are some tips on how to avoid getting caught."
Still, a decade of the abstinence-only approach has failed to end the long claim of the United States to the highest teenage pregnancy, abortion and childbirth rates in the West. Each year, 1 million girls under the age of 20--1 in 10--become pregnant; 43 percent of all adolescent girls will have been pregnant at least once by the time they turn 20. Black teens have the highest birthrates, but whites and Hispanics are closing the gap: In the last half of the 1980s, birthrates climbed by 25 percent for Hispanics, 19 percent for whites and 12 percent for blacks. It is clear that the problem cuts across racial, social and economic barriers. But for those who keep their babies, numerous studies have shown that parenthood is likely to lead to a trip down the economic scale into poverty.
The most troubling trend is that the largest jump in sexual activity is among teens under 16. It's not just that 72 percent of all students by their senior year of high school report having had sexual intercourse, but that 40 percent of 15-year-olds report the same, according to the Centers for Disease Control and Prevention--compared with just 10 percent of 15-year-olds in 1970. These and even younger children have the highest odds of contracting a sexually transmitted disease. Pregnant girls 16 and under are the most likely to drop out of school, then to deliver the sickest and smallest babies. And nearly 1 in 3 gives birth to a second child within two years.
Who is to blame? Social critics identify a welter of culprits, from media excesses and declining family values to--depending on which side is making the case--easy access to abortion (because it lets teens think sex can be risk-free) or the decline in abortion providers (because it leads to unwanted pregnancies). Even physiological reasons conspire: In the past 100 years, largely owing to improved nutrition, the average age of puberty for girls has dropped from 17 to 14.
There is no denying that the surge in teen pregnancies reflects larger developments in American society. Last year, according to a Census Bureau report released last week, 65 percent of teen births were to unmarried girls, up from 48 percent in 1980. That statistic mirrors America, as the same report showed. Nearly a quarter of unmarried women now become mothers, an increase of 57 percent in the past decade, and the rise has been sharpest among adults--particularly college-educated professionals.
Amid such statistics, America has been bombarded recently with harrowing scenes that confirm something is out of control when it comes to the way many teens think about sex. Most disturbing is the involvement of the youngest teens and even preteens. The molestation of a 10-year-old girl led to arrests in March of members of the Spur Posse, a group of middle-class boys in Lakewood, Calif., who proudly bragged of sex-for-points score keeping. In Yonkers, N.Y., last month, police charged nine elementary-school pupils, ages 9 to 13, with sexually abusing a 12-year-old girl. School officials had casually dismissed the incident as a "let's play rape" game. In most schools, sex education begins too late to instruct such young students--or even many older ones. One survey shows that among sexually active 15-year-olds, only 26 percent of boys and 48 percent of girls had had sex education by the time they first had intercourse.
Finding an answer. That it is the youngest who most need the abstinence message was clear to two Cincinnati doctors. For Dr. Reginald Tsang, the moment of recognition came as he watched a 13-year-old mother and father--who could have walked out of any junior-high school in America--peer over the rim of an incubator at their baby, no bigger than Tsang's hand, and confide they had no idea what to do next. Tsang began to think about how "our societal chaos has overwhelmed our technological advances." After all, a computer-controlled neonatal unit like Tsang's at Cincinnati's Children's Hospital Medical Center now almost routinely saves 9 of every 10 babies born weighing as little as 2 pounds. At the same hospital, Dr. Joseph Rauh, an adolescent-medicine specialist, was similarly frustrated. He provided birth control to teens, but, he noted, 13- and 14-year-old girls were coming back pregnant, "bewildered and confused."
So, in 1991, Tsang (conservative and opposed to abortion) and Rauh (liberal and in favor of abortion rights) joined forces to find local funding for a new kind of sex-education program. The one they brought to Cincinnati grew out of a surprise discovery by Dr. Marion Howard in the late 1980s while she was surveying teens who received birth control information at her Atlanta clinic. Her clients wanted birth control, she says, but "84 percent wanted to know how to say no to someone pressuring them for sex--and to say no without hurting their feelings."
As a result, Howard developed a curriculum called Postponing Sexual Involvement. Discarding the old-fashioned approach--a gym teacher with a pointer and a reproductive-system poster giving rote lectures on sexual plumbing--Howard opted for a peer system that relies on teens as teachers. In PSI, older teens--especially school leaders and athletes--are chosen as believable messengers for the spiel: "I can postpone sex and still be cool." And teen leaders must also embrace abstinence themselves. "I'm happy because of my beliefs," says Monique Chattah, a Cincinnati peer leader. "I have a better self-image."
The heart of PSI is role-playing. In a recent PSI class in Cincinnati, seventh graders played out a classic confrontation: Boy takes girl on an expensive date and then insists on sex. The girls practiced handling the pressure, then the exercise was reversed, with the girl as the aggressor. This led to an open discussion of respect, values and even the way sex is glamorized in the media to sell products.
How to say no. The early signs are that PSI is filling an important need. National studies show that only 17 percent of girls say they planned their first sexual intercourse--meaning most apparently have sex because they don't know how to thwart advances, says Christopher Kraus, the coordinator of Cincinnati's PSI program. A 1991 survey of Atlanta students found that those who had gone through PSI training were five times less likely than other teens to have started having sex by the end of eighth grade.
Still, the political divisiveness surrounding teen-sex programs--even those as neutral as PSI--threatens their effectiveness. Howard's curriculum omits specifics about how to use contraception, a concession to local authorities who typically want to decide on such teaching themselves. The result is a confusing muddle of programs. In Cincinnati itself, for instance, school officials opted for no birth control instruction. Meanwhile, across the Ohio River in suburban Newport, Ky., schools teach PSI to seventh graders--then give ninth graders a similar abstinence curriculum that, unlike PSI, provides birth control instruction. "It's being realistic," explains Maxine Jones of the Northern Kentucky District Health Department. And still another neighboring Kentucky county last week restricted the use of county taxes for any program that counsels any unmarried people about contraceptives.
In the end, the causes of teen pregnancy are so complex that even the most well-considered programs are limited in what they can accomplish. That is clear among some young Cincinnati women who meet at the Lower Price Community School in a neighborhood of brick tenements along the Ohio River. They are part of yet another teen-pregnancy program called the Birth Partner Project, which since last year has been helping young mothers try to avoid having a second child too soon, a development that often dooms their last chance to finish school or find jobs.
The women are at once realistic and naive. For example, Tina Daniels, 20, has enrolled in a local college this summer in hopes of becoming a social worker. Like most of her friends, Daniels planned her pregnancy--she knew that caring for a baby would give her the impetus she needed to leave a boyfriend she says was physically abusive--and her daughter is now 1 1/2 years old. Although Daniels never took a PSI class, she still heard the abstinence message at the special school. She emerged as a leader among the mothers in the project and was the first to try Norplant, the surgically implanted birth control device that works up to five years.
Yet last month, Daniels had a doctor remove the Norplant. Her new boyfriend wanted a baby and then marriage next April. Now, the wedding is off but a second child is due in March. Daniels says the baby will not interfere with her dreams. Yet her pregnancy is a reminder that the causes of teen pregnancy are often ambiguous and trying to reduce teen birthrates is always formidable.
This story appears in the July 26, 1993 print edition of U.S. News & World Report.