Tuesday, January 29, 2008

Teen-age Pregnancy and Policy

Last week in class we briefly discussed social policies that aim at preventing teen-age pregnancy. We went through a process that I want to highlight here.

First, we asked what made teen-age pregnancy a problem. Defining the problem is an important first step in the analysis of poverty. What is the problem, and why is it a problem? What is the desired situation, and how does the problem differ from some goal?

The problems with teen-age sexual activity and teen-age pregnancy include:

1) Sexually transmitted diseases, some of these can be lethal (HIV leading to AIDS, HPV leading to cervical cancer, Hepatitis B leading to liver failure, and the various other STDS that can be treated with antibiotics). The suffering, illness, and premature death are undesirable, and the extra costs associated with treating these diseases are also a form of pure consumption, and a drain on the economy.

2) Frustrated futures. Young people who have children before completing high school are less likely to complete high school or attend university. They are at higher risk for living lives as the marginal or residual poor, hardly ever earning enough money to pull themselves out of poverty, and their children growing up in poverty are likewise at higher risk for various problems. This loss of future earnings and frustration of life plans is a high cost paid by the young parents, but it also is a cost to society in terms of economic losses and problems associated with children who are in poverty (higher risk of school failure, criminal behavior, etc.)

3) Health risks to the mother and baby. In some parts of the world (poorer areas of sub-Saharan Africa, for example) women face a 1-in-20 chance of dying during childbirth, and although the risks are orders of magnitude smaller in the developed world, there are still risks to a young mother’s health and life when she becomes pregnant. Younger mothers have higher odds of giving birth to smaller babies, or babies with problems. The human suffering and medical costs associated with these problems deserve our attempts to avoid them.

4) Psychological problems. When young women become pregnant this may trigger extreme stresses. Younger mothers may become socially isolated. They face higher risks of having poor parenting skills, and child maltreatment. Younger mothers may feel some gain in self-esteem related to their new role and status as mothers, but society stigmatizes young unmarried mothers, and women know this. Long-term feelings of low self-worth, and an excessive feeling of dependence upon men, or the welfare state, may result. Home visiting nurses or social workers or parent educators need to be paid to help prevent or detect child maltreatment.

Okay, this establishes that teen-age pregnancy is a problem. Actually, the way the issue has been framed, it seems sexual behavior that could lead to pregnancy is the problem, and the problem is related to the age of the person having sex and their marital status, and perhaps their wealth. If a rich person is 18-years-old and married, that’s a different setting for sexual behavior than a poor person who is 16-years-old and unmarried.

Anyway, what are the indicators for us to measure so we can know how much of a problem sexual behavior and pregnancy rates are for teen-agers in our society?

Possible indicators:
Age of first sexual intercourse.
Number of sexual partners so far in life. Plus person’s age.
Number of sexual partners in the past month, or six months, or year. Plus person’s age.
Rates of pregnancies among women of a certain age. For a thousand women aged 10-14, how many will become pregnant in a given year, how many of women aged 15-16, of women aged 17-18, and of women aged 19-20?
Percentage of all pregnancies for which teenagers are the parents.
Fertility rates of teenagers. How many children do they bear? Again, this could be done as a rate of births per 1,000 girls or women of particular ages.
Raw numbers of pregnancies or live births to girls and women of particular ages.
Rates of sexually transmitted diseases among boys or girls of a certain age.
Use rates of contraceptives that prevent STDs among teenagers who do have sex. (How often do sexually active teenagers use condoms?)

Well, what are the numbers for these various indicators? What are the trends?
The Centers for Disease Control have some figures and reports that I trust.  Each  year in America, among 1,000 girls aged 15-19 about 41.9 will have a baby.  That's 4.2% of all 15-19 year-old girls having babies each year in our country.  The figure seems high to me.  Ideally, I can imagine a society in which the birth rate among 15-19 year-olds is under 2%, or even close to 1%.  Elsewhere in the CDC site you can see that about half of teenagers have initiated sexual intercourse activity by their junior year in high school (slightly over 40% have done so by their sophomore year in high school).  Guessing that early in their junior year most students are late in their 17th year (near their 17th birthday, but still 16 years-old), I'd hazard a guess that the median age of sexual intercourse onset is close to 16.9 years-old in the USA.

In fact, the Guttmacher Institute (a very reliable source for information about sexual activity and abortion) reports that the median age at first sex for European-American kids is 16.6, but the overall median age across all ethnicities was 16.9, so I wasn't far off (in fact, I nailed it!).

The CDC has a fact sheet (pdf) about pregnancy prevention.  You can see that the main policy approach is to provide various forms of sex education during public education health classes. 

Now, what is the evidence that particular policies will influence teen-age sexual behavior or pregnancies?  Well, the variables that seem to explain most of the variation in whether kids have sex or get pregnant are related to ethnicity and family composition (single parents and especially step-families tend to make sexual activity more likely than in-tact two-parent families).  You can't change people's ethnicities, although you can try to influence popular culture and that might have an influence.  It isn't much easier to change divorce and marriage rates than it is to change adolescent sexual behavior, but if you had some policies that made marriages more stable, that would probably help decrease the teen pregnancy problem.

 What about sex education technologies?  Are there particular systems of training that we can give to teachers, and specific pregnancy-prevention programs we can have them use in their schools, that will dramatically reduce sexual behavior?  If such technologies exist, can we get state legislatures to pass laws and funding plans to provide the training and the prevention programs?  

  Well, it's been a while since the 1997 review of the research literature published in the Journal of Adolescent Research (Vol. 12, no. 4, pages 421-453). You could probably look through issues of Health Education Research or a similar journal to see if any new studies have been done. In January of 2007 the British Medical Journal had an article about a program that didn't have an effect beyond what is usually done.  There is an entire journal devoted to sex education. I'm unaware of any technology that is so effective that it's use could be mandated in a policy of general sex education in the schools.  Generally, the policy we have in the USA seems to be allowing state education boards and local school districts make up their minds about how they want to approach pregnancy prevention in their states or their communities, and most are choosing some sort of sex education content in middle schools and high schools. 

  The Federal Government supports sex education (pdf) through the Adolescent Family Life Act (AFLA) and the "Special Projects of Regional and National Significance Community-Based Abstinence Education grant program" (SPRANS-CBAE).  The Welfare Reform legislation of 1996 established some automatic appropriations for abstinence education (in Section 510, Title V, of the Social Security Act).  With these three sources of funding, the Federal Government gives over $100 million in grants to support sex education and pregnancy prevention. That's not really very much.   

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Jessie said...
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