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.   

Inequality Discussion

In our class this week and last week we've been looking a bit at poverty and inequality as issues related to social work and issues of social justice. One point I tried to make is that in a global perspective the top 80% of the American population would be wealthier than 95% of the population in most of the nations of Asia, Africa, and Latin America. The very poorest Americans live with a level of wealth and material consumption approximately higher than 97% to 98% of the population in most of the poorest countries. So, from a global income perspective, or a global standard of living comparison, almost all Americans are in the top 5%, in the wealthy category.

It's a point to consider. I'll let the students decide whether there are implications to this observation.

Then, after looking at some conservative arguments that inequality isn't so bad, and isn't really very extreme in our society anyway, I tried to show you a short propaganda film trying to make quite the opposite point. Here are two links that might help you, if you have access to a computer with the capacity to play video and sound (unlike the computer in our "smart" classroom at UIS): Try the War on Greed website or else the version of the film posted on You-Tube.

Check out the viewer responses to these films. What are your reactions to the films, or the reactions to the films?

Political Compass

 Last week I suggested that the students in my class might like to go to the political compass website and see how it rates their political orientation. While looking for similar sites I also found a Moral Politics Test website, and took that test.

I suggested this because the students read the first chapter in Popple & Leighninger's Social Work, Social Welfare, and American Society. The first chapter describes political perspectives on social welfare issues, and includes explorations of radical, liberal, moderate, conservative, and reactionary political viewpoints. As I recall, I learned this idea of liberal and conservative in sixth grade in Jack Monninger's social studies class. And then of course one learns about it again in high school world history when you cover the French Revolution. And by the time I was in seventh or eighth grade I was reading the newspaper and The New Republic, so to me, this stuff about ideology seems sort of basic.  On the other hand, many people, even perhaps some undergraduate social work students, don't know much about political ideologies, so this chapter will be a good introduction to some of the values and assumptions people make when they consider what sort of welfare policies they support.

   As I was taking some of these political surveys I noticed a problem with one type of question.  Some of these surveys ask people if they think private charity is better than public welfare at helping people in need, or they ask if private charity is more important or should be more important than public welfare.  Well, in an ideal world, people would be extremely generous and helpful with private charity, and public (collective) social welfare would be residual.  But of course we don't live in such a perfect world, and private charities are not able to take care of social welfare.  Even so, if one accepts that collective (taxes and public spending) approaches to social welfare must take the lead and be the foundation for helping people with health care, old-age pensions, and relief during periods of poverty or unemployment, one might still consider private charity to be more important in some personal moral sense. That is, I'm glad to pay my taxes and know that the money will go to help my society, and that is important, but my personal time and private donations are more important to me, and more meaningful. So, when asked, "which should be more important" I respond with public welfare programs because they must be the primary source of charity, but really I think private charity is more important on a personal or moral level.

    I've posted the results from my political compass test and the moral politics test. You can compare your results to mine.

  I think it's interesting that the moral politics site tells me only 6% of the people who take that test are more authoritarian than I am (implying that I'm pretty darn authoritarian, and not very much a libertarian), but in the political compass I'm pretty far into the libertarian territory, and away from the authoritarian area of the field.  I guess this may mean that when it comes to political positions and state control I'm in favor of a light hand and little collective interference in personal life, but when it comes to actual personal and private thinking about behavior, I am something of a moralist who feels concerned about the decadence I see in the world around me. 

Medieval Cities

As I was reading over the section on this history of social welfare and the religious roots of social work I was reminded of an old book by Henri Pirenne (1862-1935) called Medieval Cities (in a 1925 English translation made by Frank D. Halsey).

I think I'll share some passages from pages 143-150 of my edition of the book. Henri Pirenne thought very highly of the organization of the cities of the eleventh and twelfth centuries. According to him, by the fourteenth century the situation he describes here was lost, and people were exploiting each other and fighting each other in cities.


. . . The peace (of the city), on the other hand, contributed largely in making the city a commune. It has, in effect, the oath as its sanction. It supposed a conjuratio of all the city population. And the oath taken by the burgher was not confined to a simple promise of obedience to municipal authority,. It involved strict obligations and imposed a strict duty to maintain and respect the peace. Every juratus—that is to say, every burgher sworn—was obliged to lend a helping hand to any burgher calling for help. Thus the peace created, among its members, a permanent solidarity. Hence the term “brothers” by which they were sometimes designated, or the word amicitia used at Lille, for example, as synonym for pax. And since the peace covered the whole city population, the later, therefore, was a commune. The very names which the municipal magistrates bore in a number of places—”warders of the peace” at Verdun, “reward of friendship” at Lille, “jurors of the peace” at Valenciennes, Cambrai, and many other cities—make it easy to see the close relationship between the peace and the commune. . . .

. . . Taxes, naturally, provided the means of securing the needed resources. To subject the taxpayers thereto, recourse had to be had to compulsion. Everyone was obliged to participate, according to his means, in the expenses incurred in the interests of all. Whoever refused to support the charges which they involved was barred from the city. The latter was therefore a commune, an obligatory association, a moral personality. . . .

. . . The [town] council carried on the routine administration. It had charge of finances, commerce, and industry. It ordered and supervised public works, organized the provisioning of the city, regulated the equipment and the deportment of the communal army, founded schools for children, provided for the upkeep of almshouses for the old and the poor. The statutes it degreed formed a genuine body of municipal legislation of which there existed, north of the Alps, scarcely any prior to the thirteenth century. . . .

. . . In the first, taxes were merely a fiscal pre-station, an established and perpetual obligation taking no count of the means of the taxpayer, bearing down only on the people, and the proceeds of which were added to the demesnial resources of the prince or seigneur who collected them, without any part of them being directly appropriate for the public interest. The second, on the contrary, recognized neither exceptions nor privileges. All burghers, enjoying equally the advantages of the commune, were equally obligated to contribute towards the expenses. The quota of each was in proportion to his means. At the start it was generally calculated on the basis of income. Many cities kept consistently to this practice up the end of the Middle Ages. . .
. . . But this city-excise was in no way connected with the old market-tolls. It was as flexible as the latter were strict, as variable in accordance with the circumstances of the needs of the public as the latter were immutable. But whatever might be the form they took, the proceeds of these taxes were entirely devoted to the needs of the commune. By the end of the twelfth century, a fiscal system had been developed and at this era can be discovered the first traces of municipal accounts.. . .

. . . The city economy was worthy of the Gothic architecture with which it was contemporary. It created with complete thoroughness—and, it may well be said, it created it ex nihilo—a social legislation more complete than that of any other period in history, including our own. In doing away with the middlemen between buyer and seller, it assured to the burgher the benefit of a low cost of living; it ruthlessly pursued fraud, protected the worker from competition and exploitation, regulated his labor and his wage, watched over his health, provided for apprenticeship, forbade women-and child-labor, and at the same time succeeded in keeping in its own hands the monopoly of furnishing the neighboring country with its products and in opening up distant markets for its trade.
All this would have been impossible if the civic spirit of the burghers had not been equal to the tasks that were laid upon them. It is necessary, in fact, to go back to antiquity to find as much devotion to the public good as that of which they had given proof. Unus subseviet alteri tamquam fratri suo—”let each help the other like a brother”— says a Flemish charter of the twelfth century, and these words were actually a reality. As early as the twelfth century the merchants were expending a good part of their profits for the benefit of their fellow citizens—building churches, founding hospitals, buying off the market-tolls. The love of gain was allied, in them, with local patriotism. Every man was proud of his city and spontaneously devoted himself to its prosperity. This was because, in reality, each individual life depended directly upon the collective life of the municipal association. The commune of the MIddle Ages has, in fact, all the essential attributes which the state exercises today. It guaranteed to all its members the security of his person and of his chattels. . . .

International Adoption and Child Welfare

The Dateline story featuring my sister and brother-in-law evidently was on last night at 6:00 Central time, so I missed it, but some scenes from the program are available at the Dateline website. Take a look at a few minutes of the videos at that website to get a picture of life in Guatemala. There is also a transcript of some of the story filmed with Jennell and Jason.

I can actually tie some of this to a political ideology perspective, to match our reading for this week. Here is a conservative blogger describing a lecture given at Universidad Francisco Marroquin in Guatemala City. The blog has some interesting discussion of adoption issues.

The blog also makes some unkind remarks about Venezuela. I often wonder what's really going on in Venezuela. There are many sources on the Internet, evidently funded or run by conservatives and libertarians, who portray Venezuela as a place in a state of collapse, thanks to the misrule of Hugo Chavez. I'm not really a fan of Hugo Chavez, he seems to be a wanna-be tyrant and somewhat anti-democratic. But, to me, I see Chavez as a complex figure who seemingly has some good points, and I don't trust everything I hear about him from conservative sources.