You have probably heard that the teen pregnancy and birth rate is up in the United States, for the first time since 1991. As is reasonable, the primary issue most talking about this are addressing is abstinence-only sex education and, due to the way the U.S. has only given federal funding to those programs since 1996, the lack of comprehensive sex education. Of course, too, the ab-only corner is immediately coming to the table with the strange idea that pregnancy and birth rates are up because of comprehensive sex education. Logic and sound data obviously is not the order of the day for that faction, including in their curricula chock-full of intentional medical and practical misinformation, so it's hardly a shocker that they either haven't looked at the facts here or have, but don't care about misrepresenting them.
It's not tough to find the flaw in that supposition: we've only had the abstinence-only mandates, and the popularity of those programs, in this country since 1996, and those mandates have grossly limited comprehensive sex education for teens everywhere. It was during the heyday of comprehensive sex education in the States -- combined with the heyday of the greatest access to and awareness of reliable methods of contraception -- that we saw teen pregnancies and births begin one of the strongest declines ever. As well, if they're going to posit that comprehensive sex education is to blame, then as Desi Arnaz liked to say, they've got a lot of 'splaining to do, Lucy. Why, then, aren't we seeing these increases in other nations, in which comprehensive sex ed, and contraception, is often even more widely available than it is here of late? Why, before the advent of abstinence-only, and in the swell of comprehensive sex education, did we see a decline in these rates begin around 1990, and a rise again now? If social and sexual conservatism is the answer to teenage pregnancy, why does the U.S. and other socially conservative nations have the highest rates of teen pregnancy?
As someone who talks to scores of sexually active teens every day, and has watched these trends closely for many years, I worry that critical issues will get lost in the battles between groups of adults fighting about who is in the right when it comes to sex education that isn't even for them in the first place. Increases in pregnancy and birth rates to any group, including teens, are about more than just what sort of sex education people are getting, and tunnel-vision or polarized thinking is never helpful.
By all means, a lack of accessible, approachable and accurate comprehensive sex education is always going to create problems with unwanted pregnancy. It always has. Heck, in any given day, we see at least one teen -- and sometimes full-fledged adults -- who really, truly, doesn't even know exactly how pregnancy can occur (and most abstinence-only curricula are incorrect or incomplete in that regard). If you don't know how something even happens, and know ALL that you can do to prevent it, it's not rocket science to figure that preventing it is going to prove a challenge. So, we know that sound, accurate sexuality education is a vital starting point, but what else should we be addressing?
1. The refusal of men of all ages -- but particularly teen men and older men sleeping with teen women -- to always and gladly use condoms. It's a given that this remains one of the biggest problems with sexually transmitted infections, but this is also a huge issue when it comes to teen pregnancy. Many teen women do not have -- and many cannot get -- another method of birth control. Even when the female partner is using a method of hormonal birth control, effectiveness rates for those methods are lower among teens than they are for adults (largely due to so many teens having to hide use of that method from parents). If I had a dollar for every teen who I have had tell me that they (usually if they are male, or if they are female, if their male partner has given them this message) or their male partners "just don't like" condoms and "can't feel anything," I would be an incredibly wealthy woman. Ironically, I get as many teens saying that as I hear about condoms having slipped off without anyone even knowing. We hear a lot about how condoms aren't "natural" (as if hormonal birth control, the preference of most men, was), how they "get in the way" of sex (as if headaches, extra depression and decreased libido and vaginal lubrication on the pill don't), and about how teen women will often go without them, even when they don't want to, because it isn't worth the strife and conflict they get from their male partners.
That negativity is often learned. A lot of the time we dig deeper into condom bellyaching, we discover that at least half the time, the guys complaining have never even used a condom, and/or have gotten messages that risk prevention is only women's responsibility. They're often parroting what they hear from other men: fathers, brothers, friends, men in media.
Too, girls are still getting the message that if they want to be sure to be prepared even when their male partners are not by having condoms in their own pockets and purses, then they must be sluts. "Good" girls don't carry condoms: they may still have sex -- and that can be socially acceptable, especially if they are in love, and especially when it's what their male partners want -- but being prepared on their part FOR that sex is not very acceptable these days. Condoms, in particular, are a no-no for girls to carry because it's often assumed that they're then concerned about STIs, and would only have that concern if a) they didn't trust their male partners, and/or b) they have had many sexual partners and an STI themselves.
Condoms are, in my book, great birth control, especially for teens who can't access or use other methods. They protect against STIs as well as pregnancy, they have no side effects for either partner, they are one of the least intrusive methods when it comes to impacting the sexual experience of either partner; they're cheap, easy to find, and easy to use. And when a person knows how to use them and uses them properly, they are nearly as effective as any hormonal method. To boot, they engage men in taking equal responsibility in managing the risks of sex, and allow female partners of men to earnestly feel that investment when men not only use condoms, but do so gladly and of their own accord.
2. Steep increases in costs of birth control methods and the decreased access to birth control methods and sexual health services. Birth control costs have been skyrocketing, especially for student health centers, due to a loophole in federal law which penalizes companies (by receiving lower payments from Medicaid) for offering prescription medications at a discount. Some student groups and organizations have been working to try and subsidize birth control costs for students to offset this, but many young women are having to just leave methods behind which were working for them.
While it should be obvious, it's always worth reminding everyone that birth control methods fail. Sure, we can say that abstinence does NOT fail, but the problem is that it does, because few people WILL remain abstinent for the whole of their lives (and unwanted pregnancy is still unwanted pregnancy, even in marriages). Abstinence-pledges have NOT proved more effective than most birth control methods: based on the data we have for the long-term effects of abstinence programs, we can basically say that abstinence is about as effective as the withdrawal method.
3. Rising rates of poverty. In every country, during every time, poverty has always created increased earlier pregnancy and birth rates, as well as presenting additional health and quality-of-life risks to young, pregnant mothers and their children. Worse still in the states, family planning services through Title X -- and the placement of individuals in that department who outright oppose the services it is in place to provide -- have been diminished or cut off for the poorest young women. The Senate tried to give it an increase in funding last month: the . It's particularly nefarious in an antichoice administration which never shuts up about how concerned it is about giving children life, knowing that poor mothers equal children living in poverty, too. No child left behind my fat fanny: the United States ranks next-to-last in child welfare in a recent United Nations survey of the wealthiest countries.
Unintended teen pregnancy in poverty increases health and other quality-of-life risks to mother and child, makes it even more likely for poor young women to complete their education and reach life goals, and it is usually far more challenging to be a teen parent than it is to parent at older ages. Don't care enough about teen parents and their children, or about those living in poverty, to feel this is your problem? Then you probably at least care about our collective wallet: teen pregnancy costs the U.S. over nine billion dollars a year.
4. Self-esteem issues and lack of assertiveness among young women. Young women often struggle with low self-esteem, especially in a culture where everywhere they look -- the media, peers, and from the right and the left -- they're sent endless messages every day about how their appearance and sexual appeal to others is everything. We've also been seeing with some feminist backlash in terms of gender roles, resulting in young women getting the message that they are supposed to be passive about sex and with sexual partners. Several times daily we counsel young women at Scarleteen through sexual conflicts and negative consequences due solely or largely to lack of esteem. And abstinence-until marriage attitudes don't help that at all. Telling young women that sex is only acceptable within the context of marriage, and that they aren't as good unless they do does not increase their self-esteem. Telling young women and men that sex is only okay (for them: you can say it's not okay for men either, but male sexual behavior and cultural double standards about male and female sexuality show that up) within a certain type of exchange -- in other words, men "earn" sex from women by marrying women -- only enables and validates the message that women's primary value is a sexual one. Positing every aspect of sex as something that needs to be bartered with or controlled is not empowering. On the other hand, young women generally report that learning how to set limits and boundaries, that they have their own sexuality which they can choose to share or not, on their own terms, that sex is about personal expression, not performance or duty, about how their bodies and sexualities work and learning how to use safer sex methods and birth control -- even if they don't plan to do so for a while -- IS empowering for them. Not sure what young women need to raise their esteem and learn to be assertive? Then ask them.
In order to teach young women to be assertive, we have to protest traditional gender roles and heterosexism, because they are based in male assertiveness and female passivity as well as the notion that the only basis for relationships between men and women is sex and/or romance. We need to be talking to teens about sexuality honestly. We need to counter the messages they're sent from the media about appearance and its value; about women as sexual objects or conquests. We need to let young women know that a young man not being down with them taking a turn in the driver's seat is not the worst thing that can happen to them. We need to challenge young women to create a better world with better dynamics than the one they've got now, not just figure this is as good as it's going to get.
We also need to pay teens real respect. The fact that most of the argument we hear about teen sexuality and sex education happens among a group of people it isn't even about, and who are not directly impacted -- adults, and adults who often aren't even parents to teens -- speaks volumes about the respect we have for young people. The fact that it's up to adults what kind of sex education teens receive -- rather than say, voted for amongst student bodies in the schools teens attend -- is appalling and patronizing, and no wonder many kind of sex education aren't effective. Speaking for teens without speaking with teens doesn't increase esteem: we need to be their allies, not their zookeepers.
5. Rape and gender-based violence. Studies have found that between 11% and 20% of pregnancies in teenagers are a direct result of rape. 62% of pregnant and parenting adolescents had experienced contact molestation, attempted rape, or rape prior to their first pregnancy (Boyer & Fine, 1993). Around 60% of teenage mothers state their pregnancies were preceded by unwanted sexual experiences (Gershenson et. al., 1989). Before age 15, a majority of first intercourse experiences among females are reported to be non-voluntary. The Guttmacher Institute found that 60% of girls who had sex before age 15 were coerced by males an average of six years their senior. The California Center for Health Statistics found that 70% of babies born to teenage mothers are fathered by adult men. Sexual exploitation of minors, rape and other sexual abuses are NOT a small factor when we're talking about teen pregnancy OR a lot of teenage sex. Do the math: you can see that that doesn't leave us a lot of teen pregnancies that have NOT had something to do with rape, abuse and exploitation.
Most messages about sex and when to have it are directed at girls and young women, and when they become pregnant, they are often told, overtly and covertly, that they have been irresponsible. And yet, rates of partner abuse and date rape among teens are incredibly high, and for the youngest women, not only was pregnancy often unwanted, so was the sexual activity which created that pregnancy. "Just say no," doesn't help when you ARE saying no -- or don't feel your no would even have influence -- and someone else is going to have sex on you anyway.
What's our federal government been doing about that? Well, slashing away at domestic violence prevention and gender-based violence programs like VAWA and rape prevention programs and rape crisis services included under that vetoed Labor HHS bill, of course.
6. A greater window of teen fertility due to earlier menarche. This is a simple statistical matter. With menarche happening earlier and earlier, teen women have a larger window in which to become pregnant than they have before. What does that mean to us? Yet one more reason (as if we needed more) to do all we can to prevent sexual abuse and exploitation of the youngest women, to be sure young women know that common myths like them being unable to become pregnant the first time or at a certain age aren't true, to do all we can to empower girls from day one so that they can be assertive about limits and birth control when they need to be.
7. When two people love each other very, very much... I've always found it pretty darn strange to hear people trying to keep teens from sex talking a blue streak about how partnered sex -- or more pointedly, heterosexual vaginal intercourse -- is the most super-special thing any two people can ever do together. Not only do I tend to disagree with that -- simply because it can be mighty special, but isn't always, and there are lots of other equally special things people can do together -- I can't for the life of me figure out why that is supposed to make anyone want to avoid sex. If you're in a relationship that feels very special, you've got some sexual chemistry going as well as some sexual desire, AND you -- understandably -- want to do something with someone to enjoy and celebrate that specialness and those desires, then sex is going to be one of the first things you think to do. especially with everyone and their uncle telling you how precious it is.
The same goes for putting motherhood on a pedestal. We can all be supportive of mothers (and fathers) without being a perpetual Hallmark card about it. If you're wondering why so many young people can't get how much of a challenge parenting is, look around and listen: most of the messages we're all sent about parenting are not realistic or practical, and many make pregnancy and parenting sound like a state of constant bliss and a guarantee of unconditional love. On top of sending teens really mixed messages, this kind of treatment of parenting also makes a lot of good parents feel like awful parents, and keeps their realities invisible, because they figure all the doubts they have, all the times they're not so stoked about being a Mom or a Dad may mean they're substandard or bad parents.
8. Which country won't make emergency contraception over-the-counter for teen women? Oh right, ours! EC is incredibly effective, safe and easy to use, and yet, for all the bellyaching about teen pregnancy, and despite finding no scientific data that shows EC would be a danger to young women (especially when you consider that we have plenty of OTC drugs anyone can get which can be dangerous and even deadly); even despite losing valuable FDA staff over this, the U.S. refuses to have the same policies about teens and EC that other countries have.
Many teens who want EC are still going to find a way to get it, as they should. But because EC needs to be used in such a short window of time -- before a pregnancy occurs -- to be effective, the harder we make it for teens to get it, the less likely they are to use it when they need to (not to mention that we then increase the stress of an already panicked teen further).
9. Stop chipping away at reproductive rights. When we're also talking about birth rates, not merely pregnancy rates, it's also a whole different ballgame. Whether or not a teen woman continues or terminates a pregnancy isn't really about why or how she became pregnant in the first place. And when we consider that most of the abstinence-only faction is also usually antichoice, you have to admit that it's awfully strange to see them framing increased teen births as someone else's fault, or as a problem they don't like. (Leslie Unruh -- who has previously offered teen women money to bribe them into continuing pregnancies and who was key in the South Dakota abortion ban -- in particular did a particularly creepy spot on a news show a while back cooing about how women, period, shouldn't be using birth control because we all needed babies, babies and more babies! Thinking about it still gives me the willies and helps keep me from wanting to reproduce: I get the feeling she would eat my babies. Her statement in that link about ab-only getting 1/12th of the funding comprehensive sex ed gets is also a blatant untruth, and one easily checked.) They may or may not desire teen pregnancy -- though I think it's more accurate to say they are more concerned about teen sex than teen pregnancy -- but most abstinence-only proponents DO desire births, especially if those births occur within a marriage or result in adoption. Additionally, for those who push adoption on pregnant women, it should be noted that teens who have been reared in foster care often have doubled rates of teen pregnancy as compared to other teens. Setting aside the grotesque of guilt-tripping women into what for many is such a difficult thing to do and treating woman as baby factories, consider how many children never are placed in a permanent home here. According to the U.S. Department of Health and Human Services, between 1999 and 2005, each year around 125,000 children are not placed, and of course, race plays a part: the poorest women so often being women of color, their children are less likely to be adopted.
If it's teen births, not teen pregnancy that troubles you -- and when those births are unwanted, it really should -- then you've got to make sure that abortion becomes and remains widely available, accessible and affordable, including to minors. At the present time, 87% of counties in the United States have no abortion provider. Abortion continues to become more and more costly thanks to our policies about it. Most states have laws and policies which require parental consent or notification for minors seeking abortion (and the same is not required for minors continuing pregnancies), and in several states it is illegal for a teen to cross state lines to terminate an unwanted pregnancy. I know I'm yelling into the void when I tell many conservatives that every birth and every child should be a wanted birth and child, and that we may never reach an agreement there. But if you're going to talk about not just teen pregnancy, but unwanted pregnancy being a problem, you have to recognize that limiting reproductive choice is a huge part of that problem.
For the progressives reading sure they're already doing all they can? One extra tip: stop apologizing for and about abortion. It's nothing to apologize for, a procedure which most women who have it report as a positive, and there is no utopia we can imagine up -- including a world where there are no-risk BC methods all women can use and afford which are 100% effective and reversible, a world where every woman always gets a say about sex, a world where infant health risks or defects are a nonissue, a world where every woman who wanted a child could afford to raise one -- where abortion would not be an essential and needed service for women to prevent unwanted births. Women have had or sought abortions for as far back as we go, and the option of safe, legal and effective abortion is nothing to be sorry for.
10. An overall acceptance that teenagers always have and always will often be sexually active in some respect. There is no teen sex epidemic right now. Historically, teens have, as a group, always been sexually active, and that activity tends to happen with the physical, emotional and social sexual development that no one can halt and which is developmentally normal. By all means, it's beyond sound to talk to teens about sex and sexuality and let them know about risks and consequences, and about what sorts of things they need to be ready to manage if they're going to be sexually active. By all means, we should be talking to teens to let them know that if sex isn't fully wanted on their part, then they should not be having sex (and sex-until-marriage rarely sends that message: instead, it tends to enable the message that once a person -- especially a woman -- is married, she MUST have sex, and often not based on her own desires). By all means, we should be supporting teens in waiting for any kind of sex until it is wanted and until they're ready to handle it.
But trying to stop teens from doing something which is developmentally normal for them is not only ineffective, it's ridiculous. Sure, once a two-year-old learns how to walk they're going to face more risks and potential dangers than they did when they were less mobile. But we don't hear anyone trying to make a strong case that because of those increased risks, we should be doing everything we can to keep toddlers from walking, an essential part of their growth and development. Sex isn't inessential. It's not required, but it isn't inessential for most people and teenagers know that, even if older adults have forgotten (or their own sex lives have grown so stale and rote that sex seems inessential to them).
As a final aside, it's important to realize that some teens, though they are in the minority, choose to become pregnant. It's patronizing and ignorant to class all teen pregnancies as accidental. Most are, but many are not. Plenty of teen women want to become pregnant, some even more than they want to sex they're having to get there. Certainly, with many of those young women, we can identify some common causes for that desire to have a child. Poverty, low self-esteem (primarily, thinking that the only thing they have the capacity to become is a mother), loneliness, a need to prove maturity, as well as looking to try and cement young relationships have often been found to be common issues of the youngest parents who want to be parents. But too, not only are some of these some of the same reasons that older women want to be parents, some teens also share another common reason older women have to want to become pregnant: the desire to be a parent. Whether or not you feel teen pregnancy is or is not acceptable (and from a standpoint of real reproductive choice, if you feel it's outright not-okay when you're not the one pregnant and parenting, I'd urge you to rethink that), it is not always accidental, and teen women do have the right to choose to become pregnant and remain pregnant if that is what they want to do.
So, you want to help halt unwanted teen pregnancy? What can we do besides supporting comprehensive sex ed?
Comprehensive sexuality education does address usually all or nearly all of these issues, and incorporates an awareness about all of them into our approaches to sexuality education. Obviously, as a comprehensive sex educator, I'm all about doing all we can to get comprehensive sex back back in the game, for real. Even from a personal standpoint, every year when I file my taxes and know that I have no choice but to fund the institutionalized misinformation that I have to bust my butt every day, without funding, to correct, my blood boils. And I absolutely think that abstinence-only funding and curricula -- and the lack of comprehensive sex education that has been a result -- are a big part of the unwanted teen pregnancy and birth problem.
But I also think -- scratch that, I know -- that that's only one part of the problem.