Teen Pregnancy: Mixed Messages and the Responsibility Question

Jodi Jacobson

We keep telling teens to be responsible.  But to whom are the politicians, corporate do-gooders and celeb-vocates concerned about teen pregnancy responsible and for what?

Yesterday, my colleague Emily Douglas attended the Candie’s Foundation event on teen pregnancy featuring Bristol Palin, a handful of "celeb-vocates" and some experts, including Sarah Brown, CEO of the Campaign to Prevent Teen and Unplanned Pregnancy.

Her excellent post on that event can be found here.

Today, Gail Collins writing in the New York Times, takes on the mulitple levels of hypocrisy evident during the event, including that of a corporate actor trying to clean up its own image by "doing good" when it appears unprepared for what it is actually doing or the ambiguity of the signals it is sending.  She writes: 

A couple of years ago, under fire from critics who accused him of
dressing high schoolers like tarts, he [Neil Cole] established the Candie’s
Foundation, which fights teen pregnancy. And there he was on Wednesday
introducing the foundation’s new teen ambassador, Bristol Palin.

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Palin, she continues:

is not in any way to be confused with the new Candie’s brand spokesperson, Britney Spears. Bristol is the one endorsing abstinence; Britney is the one promoting “hot bottoms.”

Mixed message, anyone?  It’s a routine.  In seeking to up their sales, corporate giants from the fashion, media, and clothing industries constantly sell sex to adolescents as a means of selling products.  But then they turn around and say, "yikes, we didn’t mean that!" when the consequences of their marketing strategies feed into and amplify in adverse ways the natural curiousity and desires of teenagers to experiment with sex and sexuality.  To put the icing on the hypocrisy cake, they then hold forums in which they talk about abstinence and the burdens of early parenthood and no one talks about safe sex.  This recently happened as well in the movie, 17 Again, as reviewed by Amanda Marcotte.

In her piece, Collins goes on to underscore the hypocritical actions of the Palin family in its ongoing efforts to put their kids on the frontlines of shaping a "wholesome" image that continually seems to backfire.  Collins writes:

Surely, when it comes to combating teen pregnancy, the Palin
family has done enough damage already. What worse message could you
send to teenage girls than the one they delivered at the Republican convention: If your handsome but somewhat thuglike boyfriend gets you
with child, he will clean up nicely, propose marriage, and show up at
an important family event wearing a suit and holding your hand. At
which point you will get a standing ovation.

Now a single mom on the outs with the father of her baby, Bristol wants a new kind of happy ending.

“I just want to go out there and promote abstinence and say this is the safest choice,” she said on “Good Morning America.”

Because Bristol’s own philosophy seems, at minimum, tentative, it’s
hard to tell whether she believes that cheerleading for abstinence
should be coupled with education about birth control methods. She and
Levi used condoms, except when they didn’t. 

 

And…

Her mom has said
in the past that she opposes “explicit” sex education, which kind of
sounds like … sex education. And while encouraging kids to wait is
obviously fine, the evidence is pretty clear that abstinence education
is worse than useless. Texas, where virtually all the schools teach
abstinence and abstinence alone, is a teen pregnancy disaster zone.
“It’s had one of the highest rates for as long as I can remember,” said
David Wiley, a professor of health education at Texas State University.

So this got me wondering about the responsibility question.  A lot of discussion around teen sex and pregnancy–or around sex plain and simple–focuses incessantly on personal responsibility.  The most common line I can think of is: "If you are going to have sex, accept pregnancy as the consequence," which from what I understand was the underlying message of the Candie’s event yesterday because Emily has reported here that no one really talked at all about prevention. And it seems no one really got real about sex either.

But why do we expect adolescents to be any more responsible than we are as adults, as political leaders, as heads of major corporations, or as celeb-vocates when we can’t own up to our own responsiblity to get real, speak plainly, and as I have heard incessantly at recent meetings, hear from and engage with teens where they are instead of talking at them?

How responsible is it for leaders, corporations and politicians to
constantly tell teens not to have sex, not to risk disease, not to get
pregnant, or to be responsible if they do, if we are unwilling to talk
frankly with them and hear from them about healthy relationships, consensual sex, about birth control, safer sex, partner negotiation, maturity and other necessary attributes not only of sexual responsibilty but of health and well being? 

Let’s face it. Even as a candidate, Sarah Palin gave mixed messages.  She’s a gun-totin’ ab-only supportin’ Alaska governor who also was a beauty queen, and who used her sex appeal unfailingly throughout the campaign, even winking at the camera to score points. 

Candie’s, now invested in teen pregnancy prevention, sells sex online in what can only frankly be called soft-core porn.  Go to the website and you will see a barely clad Britney Spears writhing across the stage and in the air on her Circus Tour, juxtaposed by images of lingerie, shoes, shorts and tops all intended to maximize "looking sexy."

This is only a small microcosm, of course, of what kids are subjected to every day.  I think most teens could make better distinctions about sex and personal responsibility even when subject to this stuff if we were frank about sex rather than lighting a fire in one section of a forest full of dry tinder, and then using dixie cups with wholes in the bottom to try and put it out.

It is pretty clear that from birth, we are sexual beings.  Learning how to respect our bodies, use them wisely, engage only in consensual activities and only when we are emotionally mature enough is not something that can be learned starting at age 15.  It is a lifelong enterprise.  But we are so awash in sexual imagery and the use of sex for marketing products and politicians but so bogged down in our own moral straitjackets about talking straight about sex, even to older teens, that we abdicate our own responsiblity to prepare children and teens–as individuals and collectively–to live safe, consensual and healthy sexual lives. 

Who is responsible to whom and for what?  Politicians want to garner votes, corporations want to sell products, and celeb-vocates want to raise their profiles and to be noted for their charity work….none of them wants to risk talking straight to teens about sex, birth control, disease prevention, gender stereotypes or mutual respect for fear of some "backlash."

Yet for the most part, while they are talking about teen responsibility 5 percent of the time (if that), many of the same corporations and celeb-vocates are selling sex the other 95 percent of the time, directly or indirectly. 

Before we get all over teens, let’s start with some adult responsibilty first.

 

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.

Commentary Sexual Health

Fewer Young People Are Getting Formal Sex Education, But Can a New Federal Bill Change That?

Martha Kempner

Though the Real Education for Healthy Youth Act has little chance of passing Congress, its inclusive and evidence-based approach is a much-needed antidote to years of publicly funded abstinence-only-until-marriage programs, which may have contributed to troubling declines in youth knowledge about sexual and reproductive health.

Recent research from the Guttmacher Institute finds there have been significant changes in sexuality education during the last decade—and not for the better.

Fewer young people are receiving “formal sex education,” meaning classes that take place in schools, youth centers, churches, or community settings. And parents are not necessarily picking up the slack. This does not surprise sexuality education advocates, who say shrinking resources and restrictive public policies have pushed comprehensive programs—ones that address sexual health and contraception, among other topics—out of the classroom, while continued funding for abstinence-only-until-marriage programs has allowed uninformative ones to remain.

But just a week before this research was released in April, Sen. Cory Booker (D-NJ) introduced the Real Education for Healthy Youth Act (REHYA). If passed, REHYA would allocate federal funding for accurate, unbiased sexuality education programs that meet strict content requirements. More importantly, it would lay out a vision of what sexuality education could and should be.

Can this act ensure that more young people get high-quality sexuality education?

In the short term: No. Based on the track record of our current Congress, it has little chance of passing. But in the long run, absolutely.

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Less Sexuality Education Today

The Guttmacher Institute’s new study compared data from two rounds of a national survey in the years 2006-2010 and 2011-2013. It found that even the least controversial topics in sex education—sexually transmitted diseases (STDs) and HIV and AIDS—are taught less today than a few years ago. The proportion of young women taught about STDs declined from 94 percent to 90 percent between the two time periods, and young women taught about HIV and AIDS declined from 89 percent to 86 percent during the same period.

While it may seem like a lot of young people are still learning about these potential consequences of unprotected sex, few are learning how to prevent them. In the 2011-2013 survey, only 50 percent of teen girls and 58 percent of teen boys had received formal instruction about how to use a condom before they turned 18. And the percentage of teens who reported receiving formal education about birth control in general decreased from 70 percent to 60 percent among girls and from 61 percent to 55 percent among boys.

One of the only things that did increase was the percentage of teen girls (from 22 percent to 28 percent) and boys (from 29 to 35 percent) who said they got instruction on “how to say no to sex”—but no corresponding instruction on birth control.

Unfortunately, many parents do not appear to be stepping in to fill the gap left by formal education. The study found that while there’s been a decline in formal education, there has been little change in the number of kids who say they’ve spoken to their parents about birth control.

Debra Hauser, president of Advocates for Youth, told Rewire that this can lead to a dangerous situation: “In the face of declining formal education and little discussion from their parents, young people are left to fend for themselves, often turning to their friends or the internet-either of which can be fraught with trouble.”

The study makes it very clear that we are leaving young people unprepared to make responsible decisions about sex. When they do receive education, it isn’t always timely: It found that in 2011-2013, 43 percent of teen females and 57 percent of teen males did not receive information about birth control before they had sex for the first time.

It could be tempting to argue that the situation is not actually dire because teen pregnancy rates are at a historic low, potentially suggesting that young people can make do without formal sex education or even parental advice. Such an argument would be a mistake. Teen pregnancy rates are dropping for a variety of reasons, but mostly because because teens are using contraception more frequently and more effectively. And while that is great news, it is insufficient.

Our goals in providing sex education have to go farther than getting young people to their 18th or 21st birthday without a pregnancy. We should be working to ensure that young people grow up to be sexually healthy adults who have safe and satisfying relationships for their whole lives.

But for anyone who needs an alarming statistic to prove that comprehensive sex education is still necessary, here’s one: Adolescents make up just one quarter of the population, but the Centers for Disease Control and Prevention estimate they account for more than half of the 20 million new sexually transmitted infections (STIs) that occur each year in this country.

The Real Education for Healthy Youth Act

The best news about the REHYA is that it takes a very broad approach to sexuality education, provides a noble vision of what young people should learn, and seems to understand that changes should take place not just in K-12 education but through professional development opportunities as well.

As Advocates for Youth explains, if passed, REHYA would be the first federal legislation to ever recognize young people’s right to sexual health information. It would allocate funding for education that includes a wide range of topics, including communication and decision-making skills; safe and healthy relationships; and preventing unintended pregnancy, HIV, other STIs, dating violence, sexual assault, bullying, and harassment.

In addition, it would require all funded programs to be inclusive of lesbian, gay, bisexual, and transgender students and to meet the needs of young people who are sexually active as well as those who are not. The grants could also be used for adolescents and young adults in institutes of higher education. Finally, the bill recognizes the importance of teacher training and provides resources to prepare sex education instructors.

If we look at the federal government’s role as leading by example, then REHYA is a great start. It sets forth a plan, starts a conversation, and moves us away from decades of focusing on disproven abstinence-only-until-marriage programs. In fact, one of the fun parts of this new bill is that it diverts funding from the Title V program, which received $75 million dollars in Fiscal Year 2016. That funding has supported programs that stick to a strict eight-point definition of “abstinence education” (often called the “A-H definition”) that, among other things, tells young people that sex outside of marriage is against societal norms and likely to have harmful physical and psychological effects.

The federal government does not make rules on what can and cannot be taught in classrooms outside of those programs it funds. Broad decisions about topics are made by each state, while more granular decisions—such as what curriculum to use or videos to show—are made by local school districts. But the growth of the abstinence-only-until-marriage approach and the industry that spread it, researchers say, was partially due to federal funding and the government’s “stamp of approval.”

Heather Boonstra, director of public policy at the Guttmacher Institute and a co-author of its study, told Rewire: “My sense is that [government endorsement] really spurred the proliferation of a whole industry and gave legitimacy—and still does—to this very narrow approach.”

The money—$1.5 billion total between 1996 and 2010—was, of course, at the heart of a lot of that growth. School districts, community-based organizations, and faith-based institutions created programs using federal and state money. And a network of abstinence-only-until-marriage organizations grew up to provide the curricula and materials these programs needed. But the reach was broader than that: A number of states changed the rules governing sex education to insist that schools stress abstinence. Some even quoted all or part of the A-H definition in their state laws.

REHYA would provide less money to comprehensive education than the abstinence-only-until-marriage funding streams did to their respective programs, but most advocates agree that it is important nonetheless. As Jesseca Boyer, vice president at the Sexuality Information and Education Council of the United States (SIECUS), told Rewire, “It establishes a vision of what the government could do in terms of supporting sex education.”

Boonstra noted that by providing the model for good programs and some money that would help organizations develop materials for those programs, REHYA could have a broader reach than just the programs it would directly fund.

The advocates Rewire spoke with agree on something else, as well: REHYA has very little chance of passing in this Congress. But they’re not deterred. Even if it doesn’t become law this year, or next, it is moving the pendulum back toward the comprehensive approach to sex education that our young people need.

CORRECTION: This article has been updated to clarify Jesseca Boyer’s position at the Sexuality Information and Education Council of the United States.