ADVOCATES FOR YOUTH

Teenage Pregnancy, the Case for Prevention

Remarks by James Wagoner, President, Advocates for Youth
National Press Club's Morning Newsmaker
Wednesday, January 19, 2000

Advocates for Youth's study, Teenage Pregnancy the Case for Prevention, compares federal expenditures to support families begun by a birth to a teen to the federal investment to prevent teenage pregnancy in the first place. Advocates for Youth has periodically calculated the cost of too-early child bearing to this nation since 1986. Most years, we issue a press release and disseminate the study on Capitol Hill, because the hard news is in the numbers.

But, this year, I wanted to do more—to release the very important numbers produced by this report, but then to look at the story behind the story, not just the cost of teen pregnancy but what we are spending to reduce teen pregnancy and the current program trend embraced by Congress.

In a nutshell, the news is not great. The costs of teen pregnancy are enormous; we're spending a pittance on prevention; and, increasingly, what we are spending on prevention goes to programs that simply don't work.

According to the latest data available, FY '96, the federal government spends approximately $38 billion a year to help support families that began with a birth to a teenager, but invests only $138 million a year to prevent teenage pregnancy. Let me put this a different way. We spend $300 per individual taxpayer to cover the costs of teen pregnancy, yet we spend only $1 per taxpayer to prevent teen pregnancy. That miniscule level of prevention funding, in our view, will fail to deepen or even sustain the recent declines that have occurred in teen pregnancy.

Moreover, the few federal dollars allocated for prevention are increasingly appropriated for ineffective programs driven by ideology and politics, not research and science. These misguided programs—called abstinence-only-until-marriage programs—censor information about contraception. In the era of AIDS, this is the policy equivalent of playing Russian Roulette with young people's health and lives.

Later in my speech, I will note that countries that have successfully grappled with teen pregnancy have done so with pragmatic approaches that ensure young people access to contraceptive information and services and a stake in society's future.

But, first let's look at the ratio between prevention and treatment and what it really means.

In FY 1996, we spent $38 billion to support families begun by a birth to a teen. These expenditures were allocated to programs like Medicaid, AFDC, WIC, and Food Stamps.

These expenditures represent both this nation's greatness and its failure. Greatness because of our commitment to provide families with the resources to feed, house, and clothe their children. Failure because we clearly have not provided young people with the information, services, and motivation to delay too-early child bearing.

This is not to deny that we have met with some success in this area. Recent declines in rates of teenage pregnancy, births, and abortions have been widely publicized.

Yet, our success needs context. American teens continue to have 750,000 pregnancies, 500,000 births, and 250,000 abortions each year.

The teenage birth rate in the United States remains the highest of all industrialized nations—higher, in fact, than rates found in more than 50 developing nations, higher than the teen birth rate in Morocco and Albania.

Our study measures the cost of this failure in dollars and cents. But you can't hang a cost figure on the human dimension of this story—the dreams lost, futures curtailed, the lives diminished.

Now let's examine current prevention funding.

As mentioned earlier, in FY 1996, the federal government invested only $138 million to prevent too early childbearing among our nation's youth. That is 150 times less than the $22 billion in expenditures that the Pentagon could not account for last year!

In 1996, we invested only $1 per taxpayer to prevent this nation's young people from becoming parents prematurely. One dollar. With a booming stock market and soaring federal revenues, you'd think we'd invest more in our children's future than the price of a cup of coffee at Starbucks.

Clearly, there is more to be done. The 1996 federal prevention investment is insufficient even to sustain recent declines in teenage pregnancy rates. Census Bureau projections indicate that, by the year 2005, 1.2 million more young people will live in the United States than did just 10 years earlier. Higher levels of prevention investment will be necessary simply to sustain current teenage pregnancy rates. For us to achieve rates like those found in Europe, Canada and Australia, indeed to even match those of Morocco or Turkey, U.S. politicians must significantly increase investments in teen pregnancy prevention.

Next let's look at the prevention programs that are being funded.

With too-few prevention dollars being allocated, it is imperative that the investments be made wisely. This is just not happening.

Not only is the federal investment to prevent teenage pregnancy inadequate to sustain the current decline, in recent years policy makers have begun to allocate precious prevention dollars to abstinence-only-until-marriage programs—ineffective programs which have been rejected by leading medical organizations like the American Medical Association.

In FY 1996, the federal government invested $138 million to prevent teenage pregnancy. Then, the majority of these dollars went to fund effective programs. $71 million was invested via Medicaid and almost $58 million via Title X to make contraception available for sexually active young people.

According to the Alan Guttmacher Institute, publicly funded family planning services, like Title X, help avert 386,000 teen pregnancies, 155,000 births and 183,000 teen abortions each year.

In FY 1996, only $2.5 million was allocated via the Adolescent Family Life Program for ineffective programs—programs that promote abstinence as the only method of preventing teenage pregnancy and sexually transmitted diseases.

But in the summer of 1996 prevention funding was drastically altered. Via the Welfare Reform Legislation, conservative forces in Congress yielded to far right factions and allocated an additional $250 million to preach that no sex until marriage is the only acceptable standard of human behavior.

Never mind that 90 percent of American adults do not conform to this standard.

Never mind that these programs prohibit discussion about contraception for the prevention of teenage pregnancy and other sexually transmitted diseases, including HIV.

Never mind that there is not one shred of evidence that censoring critical information about contraception can reduce teenage pregnancy.

In fact, programs that teach young people about abstinence AND contraception demonstrate more success at delaying sexual activity among youth who have not yet had sex AND at improving contraceptive use among teens when they do become sexually active.

That is why the American Medical Association, the American Academy of Pediatrics, the American Nurses Association, the World Health Organization, and more than 100 additional medical organizations all support comprehensive sexuality education—sex education that includes abstinence and contraception. The research is clear. Abstinence education alone is not the answer.

Yet, in November, Congress allocated almost $40 million additional dollars to abstinence-only programs—which means these programs have been increased by 3,000 percent over the last four years.

This policy of censoring critical information about contraception is not only naïve and misguided, it is dangerous and irresponsible. It represents the triumph of politics over public health and the refusal to adopt pragmatic approaches to the prevention of teen pregnancy.

And these aren't just numbers, these are our sons and our daughters whose health and well-being are being sacrificed while politicians push simplistic solutions to complex problems.

So why would policy makers who say they are concerned about the escalating costs of teen births and new HIV infections and other sexually transmitted diseases among teens ignore the professional advice of scientific and health care experts?

And, more importantly, why do they ignore the desires of the American people?

Seventy percent of the American people oppose censoring information about the use of condoms and contraception for the prevention of teen pregnancy. Why does this Congress continue to place conservative political ideology above sound public policy and the health and well being of our nation's young people?

Despite the experts—who know Congress is wrong.

Despite the research—that shows Congress is wrong.

Despite the American public—who want and deserve better.

The answer is clear—it's politics, and the perpetual pursuit of simplistic solutions to complex problems.

Again, this isn't just a harmless congressional policy gone awry. It represents a rejection of science, a rejection of research, and a refusal to acknowledge that ignorance is nobody's ally in the era of AIDS.

Let's get real. The average age of puberty is 13 and the average age of marriage is 26. By the age of 18, 70 percent of young people have had sexual intercourse. In addition, research shows that providing young people with information about sex does not cause them to have sex. Likewise, condom availability does not increase sexual activity.

From a public health perspective, there is simply no excuse for this policy.

We need to focus instead on what works. Recent research by the Alan Guttmacher Institute shows that 80 percent of the recent decline in teen pregnancy rates can be attributed to increased contraceptive use by teens and 20 percent of the decline can be attributed to a decrease in sexual activity among young people.

We've got to get out of this either/or mindset. It's not abstinence or contraception. We need information about both. That's the comprehensive approach.

As a parent, I hold tight to the ideal that neither of my sons will become sexually active until they are mature enough. As a public health advocate, I realize my definition of maturity may mean a lot older than my sons' definition of maturity.

That's why I want them to have all the information they need to protect themselves and their partners from pregnancy, HIV, and other STDs, when they do become sexually active.

It is time for Congress to pull its collective head out of the sand and adopt effective programs that deal in realistic ways with the sexuality of young people.

We know that this is an achievable goal. In fact, in some parts of the world, teen pregnancy is significantly less of a problem than here in the U.S.

For the last two years, Advocates has led a fact-finding trip of health care experts to the Netherlands, France, and Germany to examine their approaches to adolescent sexual health.

We found a more open, honest, and realistic approach to teen sexuality. It is by no means a perfect model, but one that has clearly produced results.

The Netherlands has a teen birth rate thirteen times lower than that in the U.S. In Germany, sexually transmitted disease rates are up to 25 times lower than ours; and, in France, the teen abortion rate is one-third that in the U.S. In all these countries, teens begin having sex later than their U.S. peers.

Advocates for Youth looked for answers in their media, in their school sexuality education programs, in their clinics and youth centers.

We found a health care system that covers all young people—while in the U.S., four million adolescents are uninsured.

We found that virtually no subject was off limits in their sexuality education campaigns—while, in Washington, Congress puts a quarter billion dollars into sexuality education programs that prohibit the mention of contraception.

We found that policymakers in these countries treated sex as a public health issue driven by research, while U.S. politicians treat sex as a political issue driven by controversy.

The U.S. could learn a few things from Europe. Most importantly about the value of an open and pragmatic approach to adolescent sexualityone that promotes rather than censors information and provides rather than restricts services.

The U.S. isn't Europe—we all know that. But the values that underpin their systems—rights, respect, responsibility—are core American values, and they can provide the basis of a new paradigm of adolescent sexual health.

Young people don't only need, but they have rights to, information that could protect their health and save their lives.

Young people do have the responsibility to postpone early sexual involvement and to protect themselves and their partners when they do become sexually active.

But responsibility is a two-way street. Society needs to provide young people with the tools—the information, health care, family support. Parent-child communication about sex and discussion of values is critically important.

And then there's respect. Young people deserve respect. Their value exceeds the sum of their risk factors. They aren't stereotypes - schoolyard assassins, babies having babies, gangs invading the suburbs. They're real people with real needs and something important to say.

Many adults don't give the state of adolescence much credibility. Adults seem to subscribe to a "Bermuda Triangle" theory of human development - where they trust and value the child entering adolescence and joyfully await the mature adult who will emerge from adolescence, but treat with fear and suspicion that "transitional state" of adolescence, itself, where young people are defined more by their risk factors than by the assets they bring to society. As a result we tend to devalue their thoughts, experiences, and needs.

The point is this. It's difficult to take people seriously when you believe that their real value lies in what they will become rather than who they really are.

This needs to change. Young people need to be given respect. They need to be seen as not just part of the problem, but part of the solution. Congress needs to condemn and control less, listen and support more.

In conclusion, Advocates for Youth's report underscores the clear and dire need for increased public commitment to preventing teen pregnancy. And research underscores the critical need to place increased funding into programs that work.

If teen pregnancy rates are to be reduced and the further spread of AIDS among young people is to be prevented, Congress must put political ideology aside, stop censoring critical health information and provide young people with the tools of responsible decision-making about sex. It wouldn't hurt to show a little respect along the way.