The good news: Recent statistics on teen pregnancy rates in the United States show that the nation’s eclectic mix of pregnancy prevention programs might be working. After hitting a high in 1991 of 117 pregnancies per 1,000 teens (ages 15 to 19), the rate dropped to 90 per 1,000 in 1997, the last year for which national data are available, according to the U.S. Centers for Disease Control.
Nevertheless, teen pregnancy and birth rates in the United States continue to tower over the rest of the developed world. The U.S. rates are nearly double those of the United Kingdom, the runner-up. Only a little more than half of U.S. teen pregnancies end with births; 35 percent end with abortions.
Seventy-eight percent of teen mothers in the U.S. are not married, and 79 percent of their pregnancies are unintended, according to the National Campaign to Prevent Teen Pregnancy (NCPTP).
Proven successes or not, youth programs have embraced new approaches to convincing teens to be sexually prudent. Many of them target youth with specific characteristics:
• Males: Teenage boys are more likely to have sex at younger ages and are less likely to be involved in their children’s lives than are the girls they impregnate. Two-thirds of males have had sexual intercourse before age 18, compared with half of females, according to a 2001 report by the U.S. Department of Health and Human Services.
• Latina girls: Their pregnancy rate of 165 per 1,000 is nearly 70 percent higher than the national average, and the rate is dropping far less than the national average. Some Latino communities have even seen pregnancy rates rise over the past decade. YWCA Teen Pregnancy Prevention youth worker Juanita Smith says she fears that a language barrier among Hispanic immigrants may cause some youth to perceive sex education as sex promotion.
• Low-income teens: Research in this area is limited, but a study of California teens published by the Alan Guttmacher Institute (AGI) found that the best predictor of teen births was the proportion of families below the poverty level within a neighborhood.
When it comes to pregnancy prevention, comprehensive sex education programs – focused on delaying sex while providing information about protection – continue to dominate the field. Most parents (76 percent) and teens (64 percent) want more information about both abstinence and contraceptives provided to teens, according to NCPTP.
But thanks to a financial boost from the Bush administration and Congress, programs promoting abstinence-only education are gaining public support. (“Abstinence Ed Money Makes Odd Bedfellows,” February 2003). The increased funding coincides with what might be a slight conservative shift among teens: Eighty percent of girls and 60 percent of boys say they wished they had waited longer to have first intercourse, reports the NCPTP. Not even the Bush administration is prepared to deem abstinence programs successful yet, but AGI – a research division of Planned Parenthood – estimates that one-quarter of the drop in teen pregnancies between 1995 and 1998 can be attributed to more girls choosing to abstain.
Both comprehensive and abstinence approaches are far different today from a few years ago. The programs have grown well beyond the awkward biology lessons and dire preachings of the past. Many new programs focus on developing future goals for youth, weaving pregnancy prevention in as part of a larger concept of youth development.
Following are profiles of teen pregnancy prevention organizations that target youth with a variety of approaches.
Not Me, Not Now –
Monroe County, N.Y.
40 Wildbriar Road
Rochester, NY 14623
“You, do what you want; I’m going to wait. Not me. Not now.”
That is the simple phrase that concludes most of the abstinence-promoting ads seen by youth in Monroe County, N.Y., the first group of teens to see the ads now sold nationwide by Metrix Marketing. The county – consisting of relatively affluent suburbs surrounding the city of Rochester – began using the media campaign in 1994, when it recorded 1,966 new teen pregnancies.
By 2000, the number of Monroe County teen pregnancies had dropped by 15 percent, even as the teen female population grew by 5 percent. The rate for 15- to 17-year-olds had dropped 25 percent.
“I can’t tell you that we caused the decline in the rate,” says John Riley, who served as the county’s communications director when he helped to develop the campaign. “What I can tell you is that nothing much else changed. [Other pregnancy prevention programs] have continued at roughly the same levels of funding. All that was added was a major high-profile media campaign where kids discussed why it is good to wait. So there appears to be a connection.”
Now Riley’s Metrix Marketing contracts to run Rochester’s campaign, which gives Riley creative control of the program and its evaluation and research. To defray costs, Metrix also licenses the campaign to five states, 20 communities and about 750 private clients nationwide.
The campaign was built around a series of radio and television advertisements, all featuring high school-age teens in social settings. One ad begins with skaters talking about how younger kids think they’re players.
“It’s not that I don’t like girls,” says one teen. “It’s just way too soon for me to get serious about someone.” Another features a girl confronting the sexual pressure put on her by her boyfriend. The boyfriend sounds like a complete loser, and she dumps him.
Riley believes the success of the campaign hinges on the use of older teens as role models and its avoidance of marriage as a benchmark of sexual consent. “Our research and contact with adolescents tells us two things,” says Riley. “One, marriage is kind of irrelevant to younger adolescents. It is not on their radar screen.”
Second, says Riley, many at-risk kids have unmarried or divorced parents. “You don’t influence kids’ attitudes by being implicitly critical of their parents’ lifestyles,” he says.
This view has alienated Metrix from groups such as the National Abstinence Clearinghouse, based in Sioux Falls, S.D., which has twice prohibited Riley from marketing the campaign at its conferences.
This doesn’t bother Riley much. Despite the campaign’s content, he says he is not a proponent of the abstinence-only approach. “I think there are valid roles for abstinence education,” he says. “It should come in the context of what is usually a matrix of family planning and other comprehensive services. Ours focuses on media rather than on direct services, which allows us to step in and reinforce the message most parents are already giving to their kids.
“I think [abstinence] is a message too many people have dismissed as unrealistic, too corny for youth to buy into.”
Not Me Not Now targets 9- to 14-year-olds. “Kids are most receptive to our message before they reach puberty, and before their peer group begins to have a greater influence on them,” Riley says. “If you grow up with abstinence as a value, and it’s supported in a community and by your family, you are more likely to continue to believe that waiting is the right behavior.
“When we measure success, we measure it by attitudes of younger kids and the pregnancy rates of older kids” who saw the ads when they were younger.
Pregnancy Prevention Healthy Teens
and Young Adults Center
1374 W. North Ave.
Baltimore, MD 21217
Baltimore is an incubator for health problems. Faced with 36 percent of its population living under the poverty line, one of the highest HIV infection rates in the United States and a teen pregnancy rate that was once tops in the nation, Maryland and its largest city launched a multifaceted awareness campaign several years ago. To reach teens in the lowest income brackets, the Baltimore Health Department turned to one of the most lauded and most expensive pregnancy prevention models available.
The CAS-Carrera model, developed by Dr. Michael Carrera of the New York City-based Children’s Aid Society (CAS), is the Lexus of pregnancy prevention programs: Spend a lot, and you can expect performance. Pricing the program at about $4,000 per youth, the model hinges on providing kids in low-income areas with enough services to keep them in the program from age 11 until they graduate from high school. Services include health and dental care, mental health counseling, bilingual tutoring, employment readiness training and sex education.
Some in the youth work field wonder whether the program is worth its high price tag. With a relatively low number of youth served at a high cost per youth, one former CAS employee wondered whether those kids would have enough peer influence on others to justify the expense.
But nobody disputes the program’s success with the youth who participate. In an evaluation begun in 1997 by Philliber Associates, the three-year retention rate in the program was 70 percent. When asked if they chose to have sex when pressured to, 50 percent of girls in the program said no, compared with only 39 percent of girls in a control group. Girls in the control group were twice as likely to get pregnant or report a birth during the three-year span of the study.
Carrera says he disagrees with programs “centered on the belief that you help young people overcome tragedies – including sexual tragedies – by simply providing information. If you give them facts and data, developing their capacity to understand, but don’t link it with helping their desire to have a better life, then you fail.”
Baltimore was one of the first cities to replicate the model that began in New York City. Baltimore’s program hosts two groups of 45 youth (11- and 12-year-olds) at two sites: one geared toward African-Americans (“Carrera West”) and another toward Hispanics (“Carrera East”). There are no racial barriers to the program, says Tyrinda Griffin, the Baltimore-raised coordinator for Carrera West. The distinctions are made mostly so that Hispanic youth are teamed with bilingual staff.
Youth arrive in the afternoon six days a week for the program, held at health department centers. Youth mingle for an hour before starting a set of three 45-minute sessions. Every day, one of those three is an education segment, where two staff tutors are on hand to help students get through their regular homework.
For the other two sessions, youth rotate through a number of components. Participants get equal doses of sports, employment training and creative arts each week. The program ends at 6 p.m.
The program also includes cultural field trips, entrepreneurial projects and a bank account for each youth, which staff help them to maintain. Parents are regularly apprised of their children’s progress through group sessions and personal conferences.
The distinction between Carrera and less expensive programs, though, lies in its health services and staffing standards.
All of the youth in the program receive free medical and dental services from a Baltimore Health Department clinic.
Carrera refuses to allow volunteer staff at his 21 directly replicated programs. (He does allow programs with volunteers who loosely adapt the model to access the national training center housed at CAS.) Requiring that the program’s entire staff be full-time increases the bill, but Carrera believes it is the key to consistency.
“Volunteers tend to come and go,” Carrera says. “Their lives are dictated by family life.”
Moreover, he insists on youth workers sticking to the script in their approach to their jobs. “We are somewhat unorthodox in what we do, but I believe … we have proven it to work,” says Carrera. “If you’re here, you do it our way or you’re out.”
The cost of the program is estimated at about $17 per day per youth, about $450 per month. The Baltimore program draws funding from a C.S. Mott Foundation grant to CAS, and from the Newport, Calif.-based Donald Strauss Foundation.
“It is always a balance between doing something intensively that makes the difference versus spending less on larger numbers,” says Dr. Cynthia Mobley, who heads the health department’s Healthy Teens and Young Adults division. “But Carrera is one of the few programs that have been validated. Until other things have been proven to work, we believe [this program] can have the greatest impact.”
Fifth Ward Enrichment Project
4014 Market St., Suite 105
Houston, TX 77020
When Ernest McMillan returned in 1984 to his home state of Texas from working as a civil rights activist, Houston’s Fifth Ward neighborhoods were ravaged by crimes and gangs. The unaffectionately dubbed “Bloody Fifth” is still no paradise, but McMillan’s Fifth Ward Enrichment Project (FWEP) gives young men in the Houston neighborhood a chance to envision a better future.
Teen pregnancy “was a burning issue here in the early 1980s,” McMillan says. “We had to take a more comprehensive approach and not just meet [male participants] when they came in. We need to be involved, to be a bridge between parents and school.”
The program draws youth between the ages of 12 and 19 – currently about 130 of them – seeking to develop a sense among males that fathering a child is serious business. An additional 150 youth are reached less intensively by FWEP’s three-day intervention programs in several schools in northeast Houston.
The cornerstone belief is similar to the Carrera approach. “We know that we have to look at psychological needs of these young people first, in terms of education, the economy, jobs and careers,” McMillan says.
But FWEP targets the one group that the Carrera program has yet to prove it significantly affects: males.
FWEP is run by a team of youth workers, peer mentors and health educators. All the staff and participants are minority males. McMillan says he welcomes any low-income youth, but the area served by the program is about 65 percent black and 32 percent Hispanic.
The reproductive health curriculum, consisting of an adolescent life program and a sexuality component in the life skills program, teaches youth about science, relationship development, abstinence and safe choices. Because part of the project’s funding comes from the abstinence-based Adolescent Family Life project, overseen by the Office of Population Affairs within the U.S.
Department of Health and Human Services (HHS), McMillan says his staff provides information about safe sex alternatives only in response to a participant’s questions. He says this has never been a problem: Someone always asks the questions.
The sessions are generally led by a team of youth workers trained in health education, who also do outreach to recruit new participants. McMillan also relies on males from a separate young fathers program to provide cautionary tales.
One indicator of the program’s impact is how its participants, living in a high-risk environment, measure up against the rest of the country. An outside evaluation by Communication Health Education Concepts found that youth in the program had sex (safely or unsafely) about as much as youth responding to the National Youth Risk Behavior Survey. But 80 percent of the enrichment project youth said they were not using drugs or alcohol before they had sex, compared with a national figure of 60 percent.
The project operates on a $1.1 million annual budget. Aside from the $250,000 HHS grant, other funders include the Texas Department of Health and companies such as Prudential and Halliburton.
McMillan is working on plans to publish an implementation guide, as well as host conferences, to help others replicate the program.
Teen Outreach Program
600 Kiwanis Drive
Eureka, MO 63025
When staff at the Wyman Center decided to use the Teen Outreach Program (TOP) in 1998, teen pregnancy prevention was not the issue of concern to the 106-year-old nonprofit, which develops long-term youth development programs. “We looked at the program in terms of what assets it would develop in young kids,” says Claire Wyneken, senior vice president for the youth center in St. Louis’ Near South Side neighborhood. “Will it fill a need?”
That isn’t to say pregnancy prevention wasn’t part of what was needed. Teenage mothers account for 20.8 percent of births in St. Louis, putting it 8 percentage points over the national average. In some of the poorest areas of the city, they account for 43 percent of the births.
TOP uses leadership development and service-learning to build character and decrease health risk factors for youth, including teen pregnancy. By urging youths to “own” their projects, Wyneken says, the program builds resistance to peer pressures to have sex.
It seems to be working. As of 2001, according to internal evaluations of current participants, only one TOP member had gotten pregnant, none of the members had dropped out of school, and 75 percent were passing all classes. Wyneken estimates that about half of the current 50 participants have been TOP members since 2000.
TOP club youth break into two age groups (11 to 13 and 14 to 17) and meet once a week for experiential activities, with a new topic every week. For younger groups, topics include how to maintain relationships with the opposite sex and what it means to have a boyfriend or girlfriend. The older group is raising funds for a trip to visit African-American universities in Atlanta.
Some of the weekly programs directly approach health issues in what Wyneken describes as an “abstinence-plus” approach. The decision to abstain is stressed as the safest choice, but fact-based presentations about contraception are provided.
Wyneken emphasizes that the complete participation of youth at all stages is crucial to keeping them involved. With the service-learning projects, youth identify the needs of the community, develop a plan for projects and implement them. They also help run an annual senior breakfast, a community talent show and a drug-free weekend celebration in the summer.
Balancing a funding portfolio that includes federal, foundation and corporate money, the Wyman Center operates on a $4 million annual budget. Of that, $258,000 goes to the department within the center under which TOP falls. The spending is just above the average spending estimated by Cornerstone Consulting Group, the Houston firm that sells the TOP curriculum for around $400.