Teen pregnancy and resulting births pose many societal challenges, and as a result require the collective efforts of many to provide solutions. Teen pregnancy has been considered a "social ill" for centuries in the United States and has always challenged moral and ethical sensibilities. The economic costs of teens giving birth are significant, and there are many compelling reasons to reduce the teen pregnancy. Research shows that reducing the number of births to teens and increasing the age at which a women gives birth yields significant cost savings for the public sector. Efforts to reduce teen pregnancy are mainly focused on prevention and sex education is a large part of the effort. Twenty-first century sex education programs focus on two main strategies, they are: abstinence only education and abstinence plus education. Abstinence only teaches that abstaining from sexual activity is the only truly effective way to prevent unintended pregnancy. Abstinence plus education focuses on delaying the initiation of sexual activity and recommends the use of contraception if a teen is sexually active. The success of abstinence only education has been exaggerated according to many sociologists and researchers. Scientific research indicates that abstinence plus education is actually much more effective in preventing teen pregnancy. Solving the problem of teen pregnancy has largely been relegating to treating the symptoms of the problem and employing prevention strategies aimed at young women. Sociologists believe that reducing the rate of teen pregnancy will require developing more comprehensive and holistic solutions in the future. Researchers, teachers, parents and community leaders are recommending and developing programs that focus on the role of boys and young men in the teen pregnancy puzzle. Research indicates that involving boys and young men in "male only" sex education may help to significantly reduce the rate of teen pregnancy over the coming years. The effectiveness of approaching the teen pregnancy problem from holistic or system-wide view will be documented in future research.
Keywords Abstinence Only; Abstinence Plus; Comprehensive Sexuality Education; Non-Marital Births; Public Sector Costs; Punitive; Teen Childbearing
Teen pregnancy is largely regarded as a societal problem that is most effectively dealt with through prevention strategies. However, some researchers argue that the discrepancies between the realities of teen pregnancy and the strategies for its prevention hinder the issue from being adequately addressed on a holistic level (Kohili & Nyberg, 1995). Cultural and political attitudes toward sexuality may also hinder the formulation of a concerted effort toward confronting the problem of teen pregnancy. Instead, policy makers, educators, researchers, and parents have generally focused on preventing teen pregnancy itself rather than on addressing the societal influences that may encourage teen pregnancy. Variables such as the age at which a teen first engages in sexual intercourse and the use or non-use of contraception can all predict the likelihood of a teen becoming pregnant. However, both of these variables are in turn influenced by a number of societal indicators such as peer pressure, pro-social values, parent-child communication, and self esteem (Kohili & Nyberg, 1995).
Young, unwed women have been giving birth for centuries. The "objective conditions" around teen births have not changed significantly over time. However, changes in the language associated with the issue illustrate significant shifts in the subjective perception of "teen pregnancy" throughout history (Luker, 1997).
In the Colonial era, women who gave birth outside of wedlock were called "fallen women" and considered to be sinners. The children born out of wedlock were "bastards" or "illegitimate." The economic impact of these children and their mothers were a pressing social concern: without a husband's support, unwed mothers and their children might need to become wards of the state. During the Progressive era of the early 1900s a more compassionate attitude toward unwed women and their children evolved. Unplanned pregnancies were no longer considered a moral or economic problem, but rather "a societal problem, an index of what was wrong with society" (Luker, 1997, p. 20). A stigma has long been associated with giving birth out of wedlock, and the fear and shame that went along with bearing illegitimate children kept the number of unmarried births low until relatively recent decades. Today, many sociologists admit that the stigma is largely gone, and that its disappearance has had at least some relation to the increase in teen sexual activity and pregnancy. (Kohili & Nyberg, 1995)
The Economic Cost of Teen Pregnancy
Though teen pregnancy rates declined by 36 percent from 1990–2002 and by 33 percent among girls aged fifteen to nineteen from 1991–2004; as of 2012 the teen pregnancy rate in the United States is still the highest of all the industrialized nations. Children born to teens are very likely to grow up in single parent households, and poverty in households that are headed by single women is between four and five times more severe than in households headed by married couples (Haskins & Sawhill, 2007). According the Haskins & Sawhill, "reversing the trend toward single-parent families would have an immediate effect in reducing poverty rates. But perhaps more important, it would also have a long-term effect on children's growth and development" (p. 4).
The age of a woman when she has her first child has a significant impact on the public sector costs associated with the birth. The younger the mother is, the higher the net cost of the birth (Hoffman, 2006). A 1996 report Kids Having Kids and a later 2006 report By the Numbers: The Public Costs of Teen Childbearing both attempted to calculated the relative costs associated with births to teens. The author of the later report described his methodology, which was similar to that of the former report:
The cost estimates provided in this report are based on a very conservative research approach that only includes costs that can be confidently attributed to teen childbearing itself rather than to other traits or disadvantages that often accompany teen childbearing (such as poverty) (Hoffman, 2006, p. 3).
By the Numbers calculated the costs in two areas: costs associated with the mother and her partner and costs associated with the children of teen mothers. Public sector costs associated with teen mothers and partners are calculated primarily as loss of tax revenue due to lower lifetime earnings. Public sector costs associated with children of teens include publicly provided healthcare, foster care, and child welfare services. The more indirect costs incurred by children who are born to teens often show up as incarceration costs and lost tax revenue due to the children's lower earnings (Hoffman, 2006).
Sociologist's goals in reviewing these net costs associated with teen births is to "make apparent the economic value of preventing early pregnancy" (Hoffman, 2006, p. 3) Delaying the age of first birth saves significant money in the public sector because teens who have children frequently rely on social services for support and, over their lifetimes, pay lower taxes (Hoffman, 2006) The primary goal is to measure the costs that could be averted if today's mothers delay their first birth until their early 20s (Hoffman, 2006).
Teen pregnancy declined by about one-third between 1991 and 2009, consequently reducing the number of children in poverty; by 2013 the rate of teen pregnancy was still declining. Trends in teen sexual activity and contraceptive use suggest that a combination of existing policies and changes in the larger culture have produced reductions since the early 1990s (Haskins & Sawhill, 2007).
Between 2010 and 2011 there was an additional drop of 8 percent for babies born to mothers between the ages of fifteen and nineteen. Birth rates fell by 11 percent for mothers between the ages of fifteen and seventeen.
Sociologists are eager to identify programs and policies that successfully reduce the number of teen pregnancies. A great many programs focus on preventing teen pregnancy; however, this essay will not attempt to provide a comprehensive review of all of them. Instead, it will discuss research surrounding sex education, namely abstinence only education and abstinence plus education. The discussion surrounding sex education will focus not only on current research findings, but also on the veracity of the research that has produced different and often conflicting results. Finally, this essay will discuss programs that focus on the role of boys...
This article focuses on the controversial practice of dispensing birth control in public schools. Minors' constitutional right to contraception is described. This article explores the way in which the federal government frames teen pregnancy as a public problem with a public policy solution. The differences in state laws governing the practice of dispensing birth control in public schools are described. The history, funding, and scope of school-based health centers is explored. The debate over promoting the Title V abstinence education program versus dispensing birth control in public schools is included.
Keywords Abstinence; American Civil Liberties Union; Birth Control; Comprehensive Sex Education; Public Policy; Public Problems; Public Problem Solving; Public Schools; School-Based Health Centers; Supreme Court; Values
Adolescents are a population at high risk for pregnancy and sexually transmitted disease. The Guttmacher Institute, a reproductive health advocacy group, reported that in 2008, there were nearly 750,000 pregnancies among women younger than 20 in the United States. The pregnancy rate among women aged 15 to 19 was nearly 68 pregnancies per 1,000 women — a decline of 42 percent from its high of nearly 117 in 1990 (Kost & Henshaw, 2012, p. 2). Researchers associate the decline with teenagers' decision to delay sex and an increase in contraceptive use. Despite declining teen pregnancy rates, the United States still has one of the highest teen pregnancy rates among major industrialized nations. In addition to the high risk and likelihood of pregnancy resulting from sex between teenagers, sexually transmitted diseases are common. In 2003, the American Civil Liberties Union reported that approximately half of all new HIV/AIDS infections in the United States occur in teenagers. In the United States, three million teenagers contract a sexually transmitted disease annually. Possible consequences of sexually transmitted diseases include infertility, infection, and death. Legal and medical advocates argue that limiting students' access to contraceptives puts students at risk for disease and pregnancy.
Society debates the role that public schools should play in dispensing birth control to students. Health and sex education became common in public schools in the 1960s. School-based health clinics began to appear in public schools in the 1970s. Pregnancy and sexually transmitted diseases among teens became recognized as a public problem in the 1970s. The first school-based comprehensive health clinics, which included family planning services, were established in St. Paul, Minnesota, in 1972. Schools began teaching and advocating abstinence decades before discussing and promoting contraception. While state, federal, and church-funded abstinence education programs continue, numerous public schools now dispense contraceptives to sexually active teens. Supporters of the practice of dispensing birth control in the public schools cite studies that illustrate how schools that dispense or prescribe birth control lower their student pregnancy rates significantly. Opponents of the practice of dispensing birth control in the public schools argue that providing birth control to students promotes promiscuity (Ruby, 1986).
In the United States, federal and state governments approach teen pregnancy as a public problem with a public policy solution. When teen pregnancy is recognized as a public problem, birth control becomes official public policy. Government-funded contraceptive programs, in schools, community clinics, and throughout society, provide and promote contraception to avoid unwanted pregnancy and to lower the risk of contracting sexually transmitted diseases. A limited number of school-based health centers dispense birth control, such as condoms, oral contraceptives, patches, and emergency contraceptives, to students. Despite the relationship between dispensing birth control in the public schools and lowered teen pregnancy rates, significant religious, legal, and moral opposition remains against this practice.
The following section provides an overview of minors' constitutional right to contraception. This section serves as a foundation for later discussion of the way in which the federal government frames teen pregnancy as a public problem with a public policy solution. The differences in state laws governing the practice of dispensing birth control in public schools are described. The history, funding, and scope of school-based health centers is explored. The debate over promoting abstinence versus dispensing birth control in public schools is included.
Minors' Constitutional Right to Contraception
The U.S. Supreme Court has ruled that minors do not need to get permission from parents to attain contraceptives. In 1977, the court heard Carey v. Population Services International. In this case, the Supreme Court overturned a New York law that forbade the sale of nonprescription contraceptives to adolescents under 16. The Supreme Court found that both minors and adults have a right to privacy in situations that affect procreation.
In 1983, a U.S. District Court heard Planned Parenthood Association of Utah v. Matheson. In this decision, the U.S. District Court overturned a Utah statute that required parents or guardians to be notified before contraceptives could be dispensed to a minor. The District Court found that the Utah law was unconstitutional in that it infringed on the right of a minor to decide whether to bear children. Minors and adults alike have a constitutionally protected right to determine whether they want to have a child or use contraceptives. Ultimately, the federal government protects the constitutional rights of minors and does not require minors to attain parental consent and notification for contraceptive services. Title X and Medicaid, the two major sources of federal family planning funds in the country, provide contraceptive services to all teens in these programs without parental permission or notification.
Teen Pregnancy as a Public Problem
Teen pregnancy is a religious, ethical, social, and economic problem for stakeholders in society. The financial and social costs of teen pregnancy affect everyone in society. As a result, the federal government treats teen pregnancy as a public problem with a public policy solution. Public problems, such as teen pregnancy, are characterized as undesirable conditions that impinge on a society. All undesirable conditions within society do not become classified as public problems. Citizens and their elected officials establish their public problem agendas based on their levels of tolerance for specific adverse conditions. Theoreticians use decision or choice theory, which studies how real or ideal decision-makers make decisions and how optimal decisions can be reached, to explain how public problems are solved in ideal circumstances. In reality, historical, social, and economic variables make many public problems difficult to solve if not intractable. Declining teen pregnancy rates suggest that teen pregnancy is not an intractable public problem.
The U.S. government addresses public problems, such as teen pregnancy and teen parents, through multiple means and strategies. In government, public administrators and politicians are responsible for solving many types of public problems. A common, generally applied problem-solving or decision-making model includes the following steps:
• Determine whether a problem exists;
• State decisional objectives, alleviations, or solutions;
• Identify the decision apparatus and possible action options;
• Specify alternatives;
• State recommendations;
• Ascertain ways to implement recommendations.
Public problems may be routine, out-of-the-ordinary, small-scale, or large-scale. Teen pregnancy is a large-scale public problem that occurs in each geographic sector of the nation. Systematic decision-making processes may or may not be used in their entirety to solve or alleviate the public problem. Factors influencing the formal adoption and use or a problem-solving process or model include agency or department regulations, personal preference of public administrator, and the variables of the public problem at hand (Hy & Mathews, 1978).
While teen pregnancy rates are declining, the public problem of teen pregnancy still requires multiple types and categories of problem-solving techniques. Problem solving strategies are often situation or condition-specific requiring carefully selected problem-solving strategies and techniques such as the multiple criteria decision making model (MCDM), consensus or group decision making, ethical decision-making, and finance-based or budget-maximizing decision making. The federal government's problem-solving process involves activities such as intergovernmental collaboration, public budgeting, public policy, public education, and regulation (Andranovich, 1995). Important trends in public problem solving include increased community participation in government decision-making and collaborative public decision-making (Irvin, 2004). The political economy of public problems, and closely related public policy, is a long-established area of study and interest. The federal government uses economic tools of analyses to determine the economic effects of public problems and their solutions. The economic problem of teen pregnancy, possibly more than any other factor, drives the federal government to promote contraceptive and abstinence programs and policies in public institutions such as schools.
State and federal governments work cooperatively on education and health policy for minors. States differ significantly in their laws and guidelines for sex education, health services,...