Risking the Future Adolescent Sexuality, Pregnancy, and Childbearing, Volume II: Working Papers and Statistical Appendices (1987) / Chapter Skim
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9 The Effects of Programs and Policies on Adolescent Pregnancy and Childbearing
9 The Effects of Programs and Policies on Adolescent Pregnancy and Childbearing
Pages 207-263
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From page 207... ...
For example, making family planning services available may lead some teens to initiate sexual activity at an earlier age than otherwise. Increasing the availability of welfare may increase the probability that, once pregnant, a girl will bear and keep her baby rather than have an abortion or relinquish the child for adoption.
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From page 208... ...
Three programs that fall into this area include Project Choice, the Association of Junior Leagues programs, and the G iris Clubs programs. A third type, the most common, falls under the heading of sex education or family life education.
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From page 209... ...
There was no overall change in attitudes towards sex education, although a slightly increased proportion thought parents were responsible for their children's sex education. The impact of the program was greater in the Fresno area than in the San Francisco Bay area, probably because the program reached more people in Fresno and because San Francisco area parents were better communicators before the program.
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From page 210... ...
Activities are directed toward the development of educational, career and general life options, not simply towards contraceptive behavior. Clubs are composed of students who may not yet be sexually active, as well as of students who are sexually active or who may already be parents.
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From page 211... ...
Traditional Sex Education Information on sex education in schools comes f ram two major national studies. According to a 1982 survey of 200 school districts in large US cities conducted by the Urban Institute and jointly administered by the National Association of State Boards of Education, three quarters of school districts offered some sex education (not necessarily a separate course)
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From page 212... ...
In an analysis of the effects of having had sex education in high school among a national sample of 15 to 19 year old females in 1979, Zelnik and Kim {1982) found no association between the probability of initiating sexual activity and having had sex education; however, for those who were sexually active, those who had had sex education were more likely to contracept and less likely to become pregnant than those who hadn't.
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From page 213... ...
for that office found that after controlling for other factors there was no residual impact of the sex education program. It is likely that initial differences between counties, rather than the sex education program, led to the initial conclusion that the program had been successful.
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From page 214... ...
A subset of teens 15 to 16 were analyzed (Moore et al., 19857. The authors found a significant association for white males and females and for black females, such that those who had received sex education were less likely to report that they had had intercourse, and this association held up when controls for family income, mother's education, the mother's age at first birth, family structure, and community size were included.
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From page 215... ...
The second model made the equally extreme assumption that all women receiving formal contraceptive education at age x received that education at the end of that year of age. Under this assumption none of the women would have received sex education before first intercourse.
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From page 216... ...
found some evidence that having had a sex education course was associated with a higher likelihood of currently contracepting among 17 and 18 year old women; however, the measure of contraceptive use available in the data is very limited. Finally the authors explored but found no relationship between having had a sex education course and whether had a premarital pregnancy after taking that course.
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From page 217... ...
Male-female differences in responses to these programs have not been explored. CONT RACEP T T ON/ PREGNANCY P REVENT I ON The types of programs that are directed at contraceptive use and pregnancy prevention include the assertiveness/decision-making approach, sex education, family planning services, school-based programs, and non-school based multi-purpose youth centers.
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From page 218... ...
The evidence that sex education is associated with better contraceptive use among sexually active teenagers is strong and consistent. Family Planning Services Family planning means the provision of information and services relating to birth control primarily to women.
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From page 219... ...
According to the recent Orr study (1984) , 92 percent of obstetrician-gynecologists, but only 66 percent of general practitioners and 32 percent of pediatricians would prescribe a contraceptive method for a sexually active unmarried teenager younger than 18 without parental consent.
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From page 220... ...
. The former are at higher than average risk of unintended pregnancy, because of their greater level of sexual activity.
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From page 221... ...
The Impact of Family Planning Services on Contraceptive Use It is clear that family planning clinics change their patients' contraceptive behavior. Whereas 32 percent of teenage patients were using the pill before enrollment, 80 percent are using the pill after enrollment (according to 1976 data)
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From page 222... ...
Pregnancy rates among those sexually active actually declined over the period. Because of increased abortion, birth rates for all teen women declined.
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From page 223... ...
found family planning clinic enrollment to be associated with substantially lower white teen birthrates in 1976, net of other factors; and an increase in family planning clinic enrollment between 1970 and 1975 also was strongly associated with a drop in white birth rates between 1970 and 1976. When area differences in adolescent sexual activity were controlled, both white and non-white adolescent birthrates were found to have been reduced between 1970 and 1975 as a result of enrollment by teens in family planning clinics.
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From page 224... ...
Clinics are more likely to respond to demand than to create it, although they may satisfy the needs of some groups who would ordinarily not have access to certain contraceptive methods. Critics of family planning programs have claimed that expenditures on family planning and sex education actually cause higher rates of abortions and births.
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From page 225... ...
The easy availability of contraception through organized family planning programs may allow teens who would not otherwise engage in sex because of fear of pregnancy to do so or may legitimize early and non-marital sex. And, in fact, the period of greatest increase in teen sexual activity was paralleled by a tremendous growth in organized family planning activities.
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From page 226... ...
Mean delay is increased if pharmacies in the community make non-prescription contraceptives easier to obtain. The more private physicians there are who provide family planning services to teens does not appear to affect mean delay in attending clinics; however, the more they charge the shorter the delay in attending a clinic.
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From page 227... ...
studied clients and the professional staff of 78 Maryland county health department family planning clinics. In a study using clinics as the unit of analysis, contraceptive use was measured as the proportion of time subsequent to the baseline interview that women at risk of pregnancy were using a medical method of contraception.
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From page 228... ...
during all periods of sexual activity, with the exception of the month in which the clinic visit occurred. Inconsistent contraceptors included those adolescents who used a reliable method most of the time, but not continously, as well as those adolescents who primarily relied on the least effective methods or no method at all.
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From page 229... ...
No evaluation of the success of such efforts has been made (Dryfoos, 1985~. Condom Distribution Program for Males While the distribution of condoms may be part of family planning services offered in clinics, several innovative programs have aimed specifically at distributing condoms and encouraging their use among teenage males (Dryfoos, 1985~.
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From page 230... ...
Follow.up is facilitated by provider accessibility to school schedules. Confidentiality is increased by providing a number of non-family planning services such as athletic, job and college physicals, immunizations and a weight control program.
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From page 231... ...
About one-third of the students served use the clinic for family planning. Services provided include educational counseling and family planning services, prenatal and post-partum care, nutrition education, day care, and parenting, family life and sexuality education.
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From page 232... ...
Some delay in the initiation of first intercourse occurred in program compared with non-program schools, delay substantial enough to lay to rest fears that access to contraceptive services in schools would increase levels of sexual activity, and to suggest that such programs may, in fact, delay first intercourse. One of the most important findings was that students in program schools attended clinics sooner after initiating sexual activity than prior to the program and in come parison with non-program schools.
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From page 233... ...
In addition, the birth rates in 1977 were lower among WDYC participants than among non-participants. The authors concluded that the clinic program did reduce teen births in West Dallas.
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From page 234... ...
Third, what effect does communication with parents about contraception or sexual activity have on children's behavior, and under what circumstances? Fourth, what effect does fear of parental knowledge about their sexual behavior have on children's use of contraception and attendance at clinics?
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From page 235... ...
A recent study {Kahn et al., 1984) found no association between several measures of parent-child communication and sexual activity of daughters, but an association for sons.
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From page 236... ...
In conclusion, parental involvement in and knowledge about children's contraceptive behavior may be a worthy goal; however, at the present time the evidence that it will reduce the sexual activity of their adolescent children or improve their contraceptive behavior is weak or non-existent. Certainly there is no evidence that communication would be furthered through requiring parental notification for family planning services.
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From page 237... ...
PREGNANCY AND PREGNANCY RESOLUTION Several types of programs are designed specifically for pregnant teenage women. These include nutritional programs such as WIC, Maternal/Child Health programs with emphasis on prenatal care, and public school programs for pregnant adolescents.
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From page 238... ...
using the Kantner-Zeloik data from 1971 with added state level variables, found no evidence for an impact of abortion availability on the probability of pregnancy. Nor did they find any evidence of abortion availability on the transition to sexual activity.
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From page 239... ...
It does not appear to affect sexual activity or the probability of becoming pregnant. In fact, a recent study suggests that in 1979 the probability that a young women who aborted a previous first pregnancy will become premaritally pregnant again within 24 months was substantially lower than that of a comparable woman who carried th.e first pregnancy to term (Koenig and Zelnik, 1982~.
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From page 240... ...
In line with its new mandate, the Office of Adolescent Pregnancy Programs has funded several programs whose purpose is to increase the proportion of pregnant teens who opt for adoption over abortion or childbearing. OAPP is also funding two ongoing studies (Kallen, 1984; Resnick, 1984)
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From page 241... ...
Pregnant teens are separated from regular classes and offered an educational curriculum supplemented by classes in parenting and child development. Other services such as health monitoring and child care may be offered.
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From page 242... ...
Results show improved pregnancy outcomes, including decrease in low birthweight incidence, an increase in gestational age, and a reduction in inadequate prenatal care. The impacts of WIC on teens and on unmarried women were stronger than those on other subgroups.
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From page 243... ...
Comprehensive Services to Pregnant and Parenting Teens Family planning programs are directed at the prevention of conception, at facilitating the planning of births. Although data on pregnancy, the most appropriate outcome var table to measure are not available because of problems with abort ion statistics, still it appears as though they are relatively effective in achieving their goals.
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From page 244... ...
Although subsequent pregnancy was not quite as rapid among experimental as controls in the first 15 months, by 36 months there were no significant differences in repeat pregnancy. Contraceptive use was a poor predictor of subsequent pregnancy -- being in school at 3 months postpartum was a better predictor of delaying subsequent pregnancies than was acceptance of contraceptives.
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From page 245... ...
The specific goals of Project Redirection were the following: continued schooling, the development of marketable skills, acceptance and use of needed health care and social services, and planning for eventual employment and self-sufficiency. Specific objectives included completion of a school or GED program, delay of subsequent pregnancy, attainment of job skills, and improved maternal and infant health.
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From page 246... ...
The rate of repeat pregnancy was slightly lower for Project Redirection Participants than non-participants at 12 months; by 24 months the difference between the groups had disappeared. There were no differences between Project participants and comparison teens in prenatal care, length of hospital stay or birth weight.
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From page 247... ...
Short term objectives are to reduce the incidence of low birth weight, baby's complications, and mother's complications, and to increase school enrollment. Long term objectives are to reduce the incidence of repeat pregnancy, increase educational attainment, increase the number who obtain training and employment and reduce welfare dependency.
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From page 248... ...
Receipt of family planning services was associated with a lower probability of repeat pregnancy 12 months postpartum for women who were mothers at entry into the program. For many of the counseling variables cause and effect links are tenuous; many appear to be outcomes rather than causes, because women at risk of poor outcomes were often identified and receive greater attention as a result.
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From page 249... ...
These figures are favorable relative to national statistics which show about 58 percent of young women in school or completed school one year after the birth and a repeat pregnancy rate of 20 percent (Most and Maxwell, 1981; Koenig and Zelnik, 1982~. Of course, the repeat pregnancy rate provided by the MIC program applied only to those who remained in school.
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From page 250... ...
However, in the case of repeat pregnancy the appropriate national statistics were not available, and those used produced a much more favorable outcome picture than warranted from the data. JRB Associates Projects In their report on a national study of teen pregnancy, JRB Associates (1981)
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From page 251... ...
. The incidence of repeat pregnancy appears to be rather high: 16 percent were pregnant again within one year (approximately)
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From page 252... ...
The repeat pregnancy experience of the experimental group was substantially better than that of the control group; the repeat pregnancy rates for the latter were similar to those of national samples of teens. The second study compared young women enrolled in the Hopkins Comprehensive Care Clinic with those in the Teenage Clinic (TAC clinic referred to above)
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From page 253... ...
who were visited by a nurse had either completed or returned to school, compared to 52 percent of those comparable mothers who had no nurse. There was essentially no reduction in the incidence of repeat pregnancy among adolescents.
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From page 254... ...
Finally, it pointed out the importance of looking at repeat pregnancies as an important outcome. Women having repeat pregnancies were especially at risk of undesirable outcomes The Project Redirection staff also discovered the importance of focusing on delaying repeat pregnancy.
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From page 255... ...
Delaying family formation or preventing repeat childbearing has not been a primary goal of job training programs. In fact, most programs appeared to ignore the family responsibilities of enrollees, in spite of the fact that a large proportion of male and female participants have children of their own.
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From page 256... ...
to produce learning gains instead of decline in the summer months, and 2) to improve knowledge of birth control and outcomes of teen pregnancy.
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From page 257... ...
In an early study of out-ofwedlock birth rates in 58 SMSA's, Janowitz (1976) found that a higher
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From page 258... ...
also explored the impact of AFDC benefit level and acceptance rates on initiation of sexual activity, pregnancy and pregnancy resolution among teens. They found weak and inconsistent effects which led them to conclude that there was no association between welfare generosity or acceptance rates and the probability of initiating sexual activity or becoming pregnant.
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From page 259... ...
The conclusion is that level of welfare benefits and acceptance rates and other indicators of availability do not appear to be associated with sexual activity or pregnancy; however, they may be associated with whether or not a girl who is pregnant decides to abort, marry or bear an out-of-wedlock child, and with whom she chooses to live. The evidence is not very strong; more research is needed.
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From page 260... ...
Programs to Prevent Sexual Activity Sex education programs appear to be consistently associated with increased knowledge about sex and sexual behavior among participants; however, there is little evidence for a relationship with sexual activity. In spite of common beliefs, those taking a sex education course do not appear to change their own beliefs and values, although they do become more tolerant of the beliefs and values of others.
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From page 261... ...
WIC, a nutritional program for pregnant and parenting women, has been shown to successfully reduce the inside we of low birth weight babies, an impact which is especially strong for teenagers. Parenthood Teenage pregnancy programs are directed primarily at pregnant teens and/or teen mothers.
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From page 262... ...
There is little theoretical rationale for expecting an association between welfare benefits and initiating sexual activity, and no evidence exists for an empirical relationship either. However, there is a stronger argument that for some pregnant teens, welfare may be an attractive option.
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From page 263... ...
Note 1. Authoritative guidance refers to the nurse, an authority figure either telling the client what birth control method to use or persuading her to use a particular method.
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