Gloucester, a Massachusetts fishing town, made national headlines in the summer of 2008 when it was discovered that 17 teenage girls from the same high school were pregnant. This pregnancy pact hasn’t been confirmed by any of the teens, but that hasn’t stopped Lifetime from making a movie based upon these events. The movie, “The Pregnancy Pact,” is scheduled to premier Saturday, January 23.
When I started my career as a pediatrician in the mid 1980s, teen pregnancy was rising dramatically. The consensus at the time was that our society sent mixed messages to teens about sex. The media projected highly sexualized images while communities often avoided discussions about sex.
From my present vantage point, having provided primary care to children and teens for the past 20 years, it’s clear that there have been dramatic advances in teen pregnancy prevention. At the same time, the teen pregnancy event among Gloucester High School students are cause for concern, especially since Gloucester is not alone and we are seeing quite dramatic increases in teen births in other communities.
These increases need to be understood against the background that as a state and country we have made significant progress in reducing teen pregnancy and birth rates. From 1990-2005, the birth rate for 15-19 year olds in the U.S. declined 34% and Massachusetts has done even better, realizing a 42% reduction in teen pregnancy among females 15-19 years old.
But securing these gains and making continued progress is not assured. You cannot “solve” the teen pregnancy problem once and for all. It requires ongoing effort and investment to make sure every new generation is educated and has access to services. As we have witnessed in Gloucester, many of the same underlying conflicts we saw 20 years ago remain between those emphasizing safe sex and those urging abstinence. If we are going to prevent any backsliding of the gains we have made in reducing teen pregnancies, we need to transcend this dialectic.
Effective strategies for preventing teen pregnancy require both education and access to important health services. Teens need to have information about sex and the consequences of pregnancy. Abstinence promotion is an important element of comprehensive sexual education programs. Teenage girls especially should be encouraged to plan for the future and understand the opportunity costs of becoming mothers at an early age.
Teens also need clear and unbiased information about contraception and the practice of safe sex. It is important to empower young women and men who may be sexually active to use contraception. There is no evidence that contraceptive education results in increased sexual activity.
Comprehensive school and community-based sex education is critical. But education alone will not suffice. Community health centers are vital resources for teens, especially for those in underserved areas.
In areas where community health centers do not exist, family practitioners, pediatricians, and nurse practitioners must step into the gap. All teens need access to confidential risk assessment and counseling from their health care provider. It is considered a normal part of growing up for a teen to start taking responsibility for some of their own health care. The parents of my teen patients are most often appreciative when I ask them to step out for part of the visit, allowing me to provide information to my patients on pregnancy, sexually transmitted diseases and contraceptives.
The provision of contraceptives in school-based clinics is highly controversial, with the issue generating most of the debate in Gloucester, but studies strongly suggest that availability of contraceptives is crucial to preventing pregnancy in areas with otherwise poor health access for teens.
The bottom line is we have a common interest in preventing teen pregnancy. We need to embrace strategies aimed at delaying sexual activity as well as providing comprehensive and confidential health services for preventing and limiting teen pregnancy before it becomes epidemic again.
What do you think is the most effective way to avoid teen pregnancy?