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Where do we go from Here?

Adolescent sexuality is a complex issue with trends and counter-trends that make it difficult for policymakers, parents and others to know how to respond. Even the facts often appear in doubt or contradictory. Periodically, the media trumpet reports that adolescent pregnancy rates are "soaring," and indeed, rates among all adolescent women have gone up as sexual activity has become more common in the teenage years. At the same time, pregnancy rates among sexually experienced teenagers--who, after all, are the young women at risk of getting pregnant--have declined significantly since the early 1970s. Birthrates among sexually experienced adolescents have also declined (despite a slight rise recently) during this time.

An accurate appraisal of the situation is complicated by the fact that the outcomes of sex among teenagers that are clearly negative--STDs, unintended pregnancy, abortion and too-early childbearing--are intertwined with such profoundly difficult issues as poverty, race, family structure and substance abuse. Thus, it becomes easy and tempting, for some, to dismiss early sexual activity as a phenomenon confined to teenagers in poor, inner-city areas and dysfunctional families, or as part of a hopeless tangle of social pathology.

This report shows the reality to be quite different. The transition to adulthood has been radically, and probably irrevocably, altered by major social changes. Marriage and childbearing now generally occur much later, and initiation of sexual intercourse much earlier, than they did several decades ago. Most adolescents, regardless of their race, income status, gender or religious affiliation, begin to have sex in their middle to late teens. We must deal with these facts, even if we do not like them.

And we are not alone in our quandary. Current trends in sexual behavior are hardly unique to U.S. teenagers. They mirror trends among U.S. adults, as well as teenage and adult women and men around the world. In the last 20 years, for example, the proportion of births to U.S. women in their early 20s that were out of wedlock quadrupled. (284) Indeed, it is adult women, not teenagers, who account for most unintended pregnancies, abortions and nonmarital births every year. Out-of-wedlock childbearing has also become more common worldwide, and the increase has been less dramatic in the United States than in some other developed countries, including Australia, Austria, New Zealand and Norway. (285)

So, where do we go from here? What can we--as individuals, as parents, and as a society--do to help young people avoid the negative, at times life-altering, effects of sexual activity?

When, If Ever, Are Teenagers Ready for Sex?

This is one of the most troubling questions for adults--and frequently for young people as well. The issue is difficult because there is no defining moment or event--as marriage was for earlier generations--that marks the point at which a person is considered ready for sex, or at least the point at which it is considered appropriate to have sex. Often, teenagers are simply told to wait until they are "older." Age alone, however, is no guarantee of readiness for sex, or for the assumption of many other adult responsibilities, for that matter.

For people who believe that sex outside marriage is morally wrong, the answer to the question of timing, presumably, is that unmarried people--adults as well as teenagers--should not have sexual intercourse. While this view may run counter to current trends, it is entitled to respect and support. Most adults, however, are more concerned that their children avoid the negative consequences of sex if they do begin to have intercourse. Their views on the appropriateness of teenage sex are undoubtedly affected by the maturity of the individuals involved.

Most adults are troubled by the thought of very young teenagers' having sex, which, in fact, is relatively rare. Still, there are a number of reasons why young teenagers should be encouraged to delay the initiation of sexual intercourse: Sex among young adolescents is often involuntary; it frequently involves a man who is substantially older than the woman, which may make it hard for the young woman to resist his approaches and even more difficult for her to insist that contraceptives be used to prevent STDs and pregnancy; teenagers who have intercourse at a young age tend to have relatively unstable relationships and to quickly acquire other sexual partners, which increases their risk of exposure to an STD; and biologically, young teenagers are the most susceptible to a sexually transmitted infection. Additionally, young teenagers who get pregnant are rarely, if ever, in a position to support and raise a family.

For older adolescents, it may be more appropriate--and more effective--to stress the importance of postponing sex until they are sufficiently mature to treat their partner with respect and to assume responsibility for protecting themselves and their partner from the negative consequences of sex. At a minimum, this would mean that they would not consider having intercourse until they are responsible enough to use contraceptives correctly and consistently to prevent an unintended pregnancy and the transmission of an STD.

What If Teenagers Become Sexually Active?

While we should do all we can to delay the initiation of intercourse among adolescents until they achieve a certain level of maturity, there is no clear dividing line that can be established for all young people. Furthermore, some teenagers will ignore admonitions. Many will consider themselves "ready" to have sex whether we agree or not. Thus, it is imperative that we give all adolescents, whatever their age or level of maturity, the knowledge, the means and, perhaps most important of all, strong encouragement to take the necessary steps to protect themselves from the life-altering risks of pregnancy and disease.

And they can do that. Even now, a large majority of teenagers who have sex use contraceptives to prevent pregnancy and STDs, even the first time they have intercourse. Indeed, it cannot be stressed often enough that adolescents generally use contraceptives at least as effectively as adults.

Why Do Teenagers Get Pregnant or Contract an STD?

Sexually experienced teenagers, like adult women and men, do get pregnant accidentally and acquire sexually transmitted infections. Some 3 million teenagers each year acquire an STD, which can have serious, long-term health ramifications, and more than 1 million adolescent women become pregnant, the vast majority of them unintentionally.

Teenagers tend to delay use of the most effective methods of contraception for a substantial period of time after their first act of intercourse, and like older couples, they sometimes use contraceptives incorrectly and sporadically. They also face the same dilemma: whether to choose a method, such as the condom, that protects against STDs and pregnancy, but has a relatively high failure rate in actual use, or to depend on a method, such as the pill, that offers greater protection against pregnancy and does not need the cooperation of one's partner, but provides no protection against sexually transmitted infections.

Teenagers, moreover, face a host of difficulties that do not confront adult women: lack of experience in negotiating with their partner about contraceptive use; fear of disclosure; lack of access to a source of appropriate care; and the barrage of contradictory messages about contraception and responsible behavior emanating from the media, schools, their peers and sometimes their parents.

Teenage Childbearing: Are There Two Tracks?

When adolescent women become pregnant unintentionally, the path they follow in resolving their dilemma is determined largely by their income and socioeconomic status. Young women from advantaged families generally have abortions, so they can finish their education, get a good job and establish their financial independence before they have children. Poor and low-income teenagers also frequently have abortions; more often, however, they continue their pregnancies to term and raise the children themselves. It bears repeating that more than 80% of teenagers who give birth are poor or of marginal income.

Childbearing among unwed teenagers is often cited as the cause of some of the country's most difficult problems--poverty, welfare dependence, crime, drug abuse and homelessness. About a quarter of young women who have a child as a teenager are poor later in their lives, but their poverty is as much a function of their initial economic, social and educational disadvantage as it is of becoming a teenage parent. Policymakers and others who want to reform the nation's welfare system by, among other things, denying eligibility to unwed mothers (284) should understand that while this change might cut the welfare rolls, it would not address a major underlying cause of adolescent childbearing--namely, poverty. Furthermore, such a drastic step might reinforce adverse effects of poverty for subsequent generations of children.

Few would disagree that it would be better for everyone involved, as well as for society in general, if every child were horn into a two-parent family. That, in fact, is the aspiration of most teenagers, whatever their actual life circumstances. Surveys show that adolescents overwhelmingly want to marry and to raise their children with a spouse. (237) All too often, however, the young women who have births in their teenage years are unable to make that aspiration a reality. These young people know that they can have a better life if they get a good education that leads to a decent job, but if they cannot, or think they cannot, achieve these goals, they have little incentive to postpone childbearing. The reality is that many, if not most, of the young women who become adolescent mothers face restricted options for the future, poor prospects for finding decent jobs and little chance of marriage.

What Interventions Are Needed?

No single approach to adolescent sexuality and its consequences is appropriate for all teenagers of all ages in all circumstances and in every community. Nevertheless, it is clear that all teenagers need certain interventions if they are to avoid the negative consequences of sex. All adolescents, for example, need sex education that teaches them the interpersonal skills they will need to withstand pressure to have sex until they are ready, and that includes accurate, up-to-date information about methods to prevent pregnancy and STDs--and they need this before they begin to have sex.

But education and knowledge are not enough. Teenagers also need clear, strong messages, coming first from their parents and reinforced by the schools, the media and other sources, about the importance of making conscious decisions about whether to have intercourse; about the necessity of consistent, correct condom use to protect themselves and their partners from HIV and other STDs; and about the use of condoms or another method of contraception to prevent unintended pregnancies. Additionally, all sexually experienced teenagers, including young men, need easy access to contraceptive services and STD screening and treatment. The network of freestanding, publicly supported family planning clinics that is a major provider of confidential family planning and STD services for teenagers, especially young women, has been weakened in recent years by serious underfunding. Moreover, its future is uncertain in the face of health care reform efforts. Teenagers' access to these confidential services must be maintained and expanded, whether through a discrete clinic system or through broader health care networks.

Teenagers of all income levels also need access to abortion services. Young women who are poor or low-income are substantially less likely than their more advantaged peers to terminate their pregnancies. Surely, one reason for the difference is that most state Medicaid programs will not pay for abortions for indigent women except in very limited circumstances (but will pay for services related to childbirth). Congress took a first, but largely symbolic, step toward the restoration of Medicaid coverage when it voted, in the fall of 1993, to allow payment for abortions needed by women whose pregnancies resulted from rape or incest. (238) It must go further, however, and extend coverage to all abortions, so that women of all income levels have the same opportunity to terminate a pregnancy if they conclude that they are not in a position to bear and raise a child. Additionally, abortion must be included on the list of basic services in whatever health care reform package is ultimately adopted.Better sex education and improved access to contraceptive, STD and abortion services will not be sufficient, however, to address the root cause of early childbearing among disadvantaged teenage women who become parents. For these young women, entrenched poverty, not adolescent pregnancy, is the fundamental problem that must be addressed. Some will have the grit, the inborn talent and, somehow, the support to escape their circumstances. But for most, real change in sexual behavior and its outcomes will become likely only when their poverty is alleviated, when they--and their partners--have access to good schools and jobs, and when they develop a sense that their life can get "better."

Change Is Possible

The United States is not alone in grappling with the implications of adolescent sexual activity or unwed motherhood. However, teenage pregnancy, abortion and childbearing are larger problems in this country than in many other developed nations (Figure 55, page 76)--even though levels of adolescent sexual activity are about the same. Inmost other industrialized societies, there is greater openness about sexual relationships; the media provide positive reinforcement for using contraceptives to avoid pregnancy and STDs; and reproductive health care is better integrated into general health services, which make contraceptives more accessible to teenagers.

In the United States, by contrast, sex education is still controversial in some communities; the full panoply of contraceptives is often not readily accessible to teenagers (or to many adults, for that matter); and the media are reluctant to discuss or portray responsible sexual behavior, preferring to offer a mindless and constant display of titillating sexuality. Indeed, nothing better illustrates this country's unwillingness to confront sexual issues directly than its failure to use the national media, particularly the national television networks, to educate young people and adults alike about the importance of using protection against pregnancy and STDs, including AIDS, an invariably fatal disease. Incredibly, although the networks have agreed to run public service announcements about the importance of using condoms to prevent HIV and other STD transmission, they still refuse to accept advertising for the very same products for the purpose of preventing pregnancy, on the ground that it would offend some viewers. Americans seem to prefer bemoaning the high rates of adolescent pregnancy, abortion and childbearing to taking positive steps to address those issues. In many respects, it seems, it is adults, not teenagers, who act irresponsibly.

In an effort to develop more effective policies for helping American youth, there is much to be learned from the approaches of countries where teenagers are much less likely to experience negative outcomes of sexual behavior. We can also learn from the handful of programs, described in the previous section of this report, that have had a positive impact on teenagers' initiation of sexual intercourse and contraceptive use. These programs need to be adapted to local circumstances and widely replicated. In addition, other approaches must be tested and implemented in a variety of school systems and communities.

Many young people are managing the transition to adulthood well: They are succeeding in school, building healthy relationships with friends of both sexes, avoiding STDs and unintended pregnancy when they become sexually active, and preparing for careers. Often, however, they accomplish some of these tasks without appreciable guidance and support from their parents and other adults (who tend to be uncomfortable talking about sex with children), schools and other institutions. Inmost other aspects of life, society tries to ensure that young people have the information and skills they will need to function as competent adults. We try to give them a good education, provide job skills, instill values and establish standards of behavior. When it comes to sex, however, we say little or nothing and expect that upon reaching a magical age, young people will know how to manage such an important part of their lives. We know that avoidance is not working, not only for young women and men, but also for adults, who even m ore than teenagers experience the negative consequences of sex. So, we are paying a high price for our silence in two ways: First, many of our children are-needlessly--affected adversely by the consequences of their sexual behavior. Second, today's teenagers become tomorrow's adults, and the problems they had as teenagers do not go away, but are perpetuated into adulthood and passed on to the next generation.

We can and must do better.

(284.) Moore, 1993, Table, p. 2.

(285.) Ferguson, 1993, Table 2, p. 639.

(286.) Murray, 1993.

(287.) Bezilla, 1988, p. 35; Crimmins, Easterlin and Saito, 1991, Table 1, p. 119.

(288.) P.L. 103-112 (Oct. 21, 1993).

(289.) Jones et al., 1986.


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The United States, compared with many other industrialized countries,
has high adolescent pregnancy rates.

Pregnancies per 1,000 women aged 15-19 and younger, 1988

 Births Abortions

United States 44 97
Czechoslovakia 22 71
Hungary 26 70
New Zealand 15 47
England & Wales 19 46
Iceland 13 45
Canada 16 40
Norway 22 40
Sweden 24 35
Finland 15 27
Denmark 16 25
Netherlands 4 10
Japan 6 10

Sources: United States: Birthrate--National Center for Health
Statistics, "Advance Report of Final Natality Statistics, 1988,"
Monthly Vital Statistics Report, Vol. 39, No. 4, Supplement, 1990,
Table 3. Abortion rate--S. K. Henshaw, "Abortion Trends in 1987 and
1988: Age and Race," Family Planning Perspectives, 24:85-86, 1992,
Table 1, p. 69.

Czechoslovakia: Number of births--United Nations, Demographic Yearbook,
1990, New York, 1992, Table 11, p. 335. Number of abortions-Vydava
Ustav zdravotnickych inofmacia statistiky, Zdravotnicka Statistika
CSSR, Potraty, 1988, Prague, 1989, Table 64, p. 35. Total women 15-19-
Population data for women aged 15-19 were interpolated from United
Nations, Demographic Yearbook, 1987, New York, 1989, Table 7, p. 246;
United Nations, Demographic Yearbook, 1989, New York, 1991, Table 7, p.

Hungary: Birthrate--Council of Europe, Recent Demographic Developments
in Europe, 1991, Strasbourg, 1991, Table H-3 p. 119. Abortion rate-
Ferenc Kauraras, "In Your Part of the World: Survey of Central and
Eastern Europe (Part I)," Entre Nous, No. 14--15, 1990, pp. 13-14.
Table 1, p. 14.

New Zealand: Birthrate--United Nations, Demographic Yearbook, 1990, New
York, 1992, Table 11, p.336. Number of abortions--Abortion Supervisory
Committee to Parliament, "Report of the Abortion Supervisory Committee,
for the Year Ended 31 March 1990," Wellington, New Zealand, Table 2, p.
4. Total women 15-19--Interpolated from United Nations, Demographic
Yearbook, 1989, New York, 1991, Table 7, p. 198; United Nations,
Demographic Yearbook, 1987, New York, 1989, Table 7, p. 246.

England and Wales: Number of births-Office of Population Censuses and
Surveys, "Birth Statistics, 1988," London, 1990, Table 3.1, p. 28.
Number of abortions--Office of Population Censuses and Surveys, Abortion
Statistics, 1988, Series AB, No. 15, London, 1989, Table 3, p. 6. Tolal
women 15-19--Office of Population Censuses and Surveys, Key Population
of Vital Statistics, London, 1990, Table Al, p. 83.

Iceland, Norway, Sweden, Finland and Denmark: Birthrates and abortion
rates--Nordic Medico-Statistical Committee, Health Statistics in the
Nordic Countries, 1966-1991, Copenhagen, 1991, Table 5.a, p. 121.

Canada: Birthrate--Statistics Canada, Selected Birth and Fertility
Statistics, Canada, 1921-1990, Ottawa, 1993, Table 10, p.46. Abortion
rate-Statistics Canada, "Therapeutic

Abortions, 1988," Health Reports, 2(1), Supplement, Ottawa, 1990, Table
6, P. 25.

Netherlands: Birthrate--Council of Europe, Recent Demographic
Developments in Europe, 1991, Strasbourg, 1991, Table NL, p.158. Number
of Abortions--J. Rademakers, Abortus in Nederland 1987-1988,
Stimezo-Onderzoek, Utrecht, 1990, Tables 2.1 and 2.2, pp. Band 10. Total
women 15-19-- United Nations, Demographic Yearbook, 1989, New York,
1991, Table 7, p.192.

Japan: Birthrate--United Nations, Demographic Yearbook, 1989, New York,
1991, p.321, Table 11. Abortion rate--Kuno Kitamura, "Every Child Should
Be a Wanted Child," Integration, Dec. 1991, Table 2, p. 42. Total women
15--10--United Nations, Demographic Yearbook, 1989, New York, 1991,
Table 7, p.184.

Note: Pregnancies are the sum of births and abortions and do not include
miscarriages. For New Zealand and Japan, the numerator is births and
abortions among all women aged 19 and younger. In all other cases, the
numerator is births and abortions among women aged 15--19. The
denominator is women aged 15--19.

Note: Table made from bar graph
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Title Annotation:adolescent sexuality and politics
Publication:Sex and America's Teenagers
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Jan 1, 1994
Previous Article:Organized responses to adolescent sexual and reproductive behavior.

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