May 30, 2001 -- Programs designed to address teen sexuality, and several that do not address sex at all, have played a major role in reducing teen pregnancy rates over the past decade, a newly released study suggests. But it is not yet clear whether the abstinence-only programs favored by the Bush administration are effective.
Research from The National Campaign to Prevent Teen Pregnancy, or NCPTP, found that sex education programs discussing and/or providing contraception did not hasten the onset of sex, increase the frequency of sex, or increase the number of sexual partners teens had.
"We now know that several different types of programs actually do reduce sexual risk-taking behavior, either by delaying sex or increasing condom and contraceptive use," study author Douglas Kirby, PhD, tells WebMD. "This research shows that a variety of different programs are effective. This is important because it means organizations and communities can pursue different approaches and still have an impact upon teen pregnancies."
Kirby reviewed research on a wide range of programs aimed at children and teens, including school-based sexuality and abstinence programs, those associated with contraceptive and family planning clinics, those focusing on voluntary community service, and those combining education, healthcare, community involvement, and recreation.
As a presidential candidate, George W. Bush repeatedly expressed his support for abstinence-only school-based programs, saying a top administration priority would be to "elevate abstinence education from an afterthought to an urgent goal." In a speech delivered in July 1999, candidate Bush said, "It seems like to me the contraceptive message sends a contradictory message. It tends to undermine the message of abstinence."
According to Kirby, there have not been enough good studies to determine whether abstinence-only education is effective in reducing teen pregnancies. A large, federally funded study addressing the question is now under way, but findings aren't expected for several years.
"We don't know whether abstinence-only programs work. They might or they might not," Kirby says. "But the evidence is overwhelming that talking about condoms and contraception, while emphasizing abstinence, does not increase sexual activity among young people."
Approximately 1 million teenage girls get pregnant in the United States each year, by far the highest rate of teen pregnancies of any industrialized nation, and eight out of 10 are unplanned, according to NCPTP figures. After rising 23% between 1972 and 1990, pregnancies among girls between the ages of 15 and 19 declined 17% between 1990 and 1996. The teen birth rate dropped by 20% between 1991 and 1999, to approximately 50 births per 1,000 young women.
The report, released today, highlighted several types of programs that are effective in delaying the onset of sex among teens, improving contraceptive use, and preventing pregnancy. Several programs focusing on sex and HIV education, with strong condom and contraception components, were found to successfully do all three.
Some programs that do not address sex at all, but instead get teens involved in volunteer work within the community, were found to have a significant impact on teen pregnancy.
"To be honest, we don't know why these programs are effective in reducing teen pregnancy," Kirby says. "It may be that they keep kids busy, or they may increase self esteem and cause kids to think about the future. For some very high-risk youth, participation in these programs may represent one of the first times that they are recognized by adults and the community for doing good, and that, in turn, makes them feel good about themselves."
The NCPTP report suggests that comprehensive programs incorporating a host of services for teens and preteens may be the most successful in reducing pregnancies over the long-term among high-risk adolescents. Among the best of these programs, the report found, is the Children's Aid Society Carrera program in New York.
Founded in 1985 in central Harlem by Michael A. Carrera, PhD, the program is now the model for 50 similar programs operating in 20 states. In addition to counseling and medical services, kids receive general education, sex education, and help finding after-school jobs. They are also given the opportunity to participate in sports and the performing arts.
Although other programs take a comprehensive approach to dealing with at-risk children and adolescents, Carrera says his program is unique because kids are followed closely and treated more like family than program participants.
"When a kid enters our program at 11, 12, or 13, we generally work with them until they graduate from high school," Carrera tells WebMD. "We see these kids almost every day, 12 months a year. And if they don't show up, we go and find them. There is a person on staff whose sole job is to track kids once they are in the program."
Program officials also released their own report Wednesday, outlining the findings from a three-year evaluation of six New York City sites and six sites in other urban areas. There were one-third fewer pregnancies and births among the 941 program participants than among a control group. Young girls in the program were also found to be able to avoid coercive sexual situations better than those who did not participate in the program.
"That is a stunning outcome, because it can easily impact a young woman's sexuality for the rest of her life," Carrera says. "If you can help a young woman withstand coercive sexual pressure, you may be influencing how she deals with sexual pressure from then on."
The Carrera program, while effective, is also expensive -- about $4,000 per year per child. It is funded entirely through private contributions, with the largest grants coming from the Robin Hood Foundation in New York City and Michigan's Charles Stewart Mott Foundation.
"The federal government has basically stayed away from programs that provide reproductive healthcare services that include contraception," Carrera says. "I would urge them to take a very careful look at this study and what we do. Without equivocation it indicates that we do know how to prevent teen pregnancy, and the government needs to have the will to enact it."