Advance Practice nurses play a central role in meeting the health care needs of pregnant teenagers. As a Certified Registered Nurse Anesthetist in the Department of Obstetrics in our hospital, this writer is confronted regularly by the unique challenges of the pregnant adolescent in day to day practice. These point at the question of the growing epidemic of teen pregnancy in the United States (Kegler, MC., Bird, ST., Kyle-Moon, K., and Rodine, S., 2001). The situation of Bristol Palin, daughter of Republican Vice-Presidential candidate Sarah Palin, a seventeen year old unmarried and pregnant teen, has cast a spotlight on teen pregnancy and opened discussions again about current public health policies in the United States (Hawkins, K., 2008).
There has been a growing agony regarding the problem of teenage pregnancy and early parenthood, since it is acknowledged that these lead to poor educational achievement, poor physical and mental health, poverty, and social isolation for both the parents, especially the mother and the children. Teenage pregnancy carries high costs in terms of both social and economic health of both mothers and their children. This paper will introduce the historical background of this epidemic, focusing on the controversy that encompasses the topic of public school sex education. Then, policy goals and options will be critically discussed. , in an attempt to analyze this issue, this paper will conclude with an evaluation of this policy and recommended solutions regarding the problem of teen pregnancy overall (Hoyt, HH and Broom, BL., 2002).
Among the industrialized nations, the United States has the highest rates of teen pregnancy, abortion, and sexually transmitted disease. Publicly, the religious right had had a tremendous influence over the formation of federal policy in regards to teen sex education since the Reagan Administration in the 1980’s. Since this time, the federal government has taken a rigid stance that the only allowable form of sex education is solely abstinence (Hampton, T., 2008). Morally speaking, the focus of federal policy is on preventing sexual conduct prior to marriage, which ignores the morality of trying to prevent teens from gaining the knowledge that could protect them from both disease and unwanted pregnancies (Dinan, J., 2008). Numerous people often question the ethics regarding this public policy. Teenage pregnancy carries high costs in terms of both the social and economic health of mothers and their children. Economically, teen pregnancy is an enormous drain on American society, as the responsibility of parenting a child often prevents young mothers from completing their basic high school education. Only one-third of pregnant teen mothers manage to complete high school and only 1.5 percent obtains a college degree by the age of thirty, while close to 80 percent of all single teenage mothers rely on welfare for support (Kelly, K and Grant, L., 2007). Thirty-four percent of teenage girls in America get pregnant at least one time prior to reaching the age of twenty (Horgan, RP and Kenny, LC., 2007). Thus far by law, abstinence-only sex education programs are mandated to eliminate educating complete, medically accurate information (Kohler, PK, Manhart, LE., and Lafferty, WE., 2008). Educators are prohibited by law from following research and public opinion supporting comprehensive sex education, regarding tactics that actually work in a positive manner to prevent teen pregnancy and lower STD rates (Rose, 2005, p. 1207).
The most influential stakeholder group on this issue is the religious right. Rose (2005) makes it very clear that this group represents only 10 percent of the adult American population. A 2004 report, “Public Support for Comprehensive Sexuality education, “reveals that 93 percent of parents of junior high school students and 91 percent of parents of high school students indicate support for comprehensive sex education (Rose, S., 2005) . Furthermore, many conservative Christians indicate that they support comprehensive sex education as long as it includes abstinence as an open option (Rose, S., 2005).
Policy Goals and Options
The US federal government has chosen to promote abstinence-only programs, the ultimate goal of which is to reduce STD and teen pregnancy rates by convincing teens to have sex only within the context of marriage (Santelli, JS., 2008). Legislation prohibits schools from advocating the use of contraceptives or teaching students about contraceptives, except in regards to their failure rates (Trenholm, C. et al., 2008). The intent of Congress, with the legislation passed in 2000, was to forces the states to have “pure” abstinence-only programs, as programs funded under this program are also prohibited, except under limited circumstances, from providing information about contraception or safe-sex practices even when these programs use non-federal funds (Santelli, JS., Lindberg, LD., Finer, LB., and Singh, S., 2007).
An alternative option to the current policy of the US government would be to offer American teenagers comprehensive sex education. In the US, as in other countries, sexual behavior typically begins by late adolescence, as the average age for first intercourse for males is 16.9 years and for females, 17.4 years. The American Medical Association, the American Academy of Pediatrics, and the National Academy of Science recommend that public schools should implement comprehensive sex education programs that offer adolescents all the information required to prevent unwanted pregnancies as well as STD’s (Landry, DJ., Darroch, JE., Singh, S., and Higgins, J., 2003).
Evaluation of Policy Options
In regards to the issue of quality, the Waxman Report, which was published in 2004, investigated school-based, federally funded sex education and found that many programs teach medically inaccurate or misleading information (Rose, S., 2005) (Santelli, JS., 2008). The Republicans who argued in favor of spending $50 million over the next five years on abstinence-only sex education, argued that it would be impossible to agree on what information is medically accurate (Cibulka, JG and Myers, N., 2008). One evangelical sex educator compares having sex to playing Russian Roulette, while another uses rubber snakes to educate young people about STDs.
Leslie Kantor, former director of the SIECUS Community Advocacy Project, investigated the content of many of the abstinence-only sex educational programs that being used in public school and concluded that these programs frequently omit basic information regarding disease prevention, while perpetuating medical misinformation (Lindau, ST., Tetteh, AS., Kasza, K., and Gilliam, M., 2008), as they rely on fear tactics to discourage sexual behavior (Rose, 2005). As this indicates, abstinence-only programs are predicated on denying teenagers access to accurate sex education. Furthermore, they often try to achieve this policy goal by using practices that could possibly cause tremendous psychological harm, as they demonize sex to the point that it is conceivable that some teenage tactics may find it difficult to have a positive sexual experience even within marriage (Allen, L., 2008).
Another evaluation issue is fairness. Many voices dispute that it is unjust to restrict access to accurate and comprehensive sex education. Furthermore, a great deal of the current policy is focused on teenage girls, which ignores the responsibility of the males involved. In the United States, 60 percent of the babies born to unwed teenage mothers are fathered by adult males – not teenage boys. In order for teen pregnancy prevention to be successful, efforts must be made to reach the adult male population (Lindberg, LD., Sonfield, A., and Gemmill, A., 2008).
The US government has spent considerable amount resources and actually plans on spending millions more on abstinence-only programs. Politicians supporting this policy point to the declining teenage pregnancy rate as a rationalization for the continuation of this policy. However, a study conducted by Santelli, et al (2007), based on data from 1995-2002 on teenage women, aged 15-19, attribute this decline primarily due to improved contraceptive use. While the government attempts to restrict teens’ access to this vital information, as well as the availability of contraceptives, public school sex education is not the only avenue for teens receiving this information. They also found that although teens are delaying the initiation of sexual activity, this change is “small and confined to younger teenagers,” i.e., 15 to 17 year olds (Santelli, et al, 2007).
Changes to the current policy of abstinence-only policy would entail changing legislation. Past experiences shows that politicians will prioritize the political feasibility of such an action, that is, the reaction of the religious right, over and above what social research indicates about the efficacy of current policies or issues of social justice (Abell, S. and Ey, JL., 2008).
The religious right, as they represent only 10 percent of the populace, presently has an undue influence over current policy regulating the content of public school sex education. It also made evident from studies performed which were not bearing affiliation to the religious right, abstinence-only programs are ineffective in contributing to the goal of preventing teen pregnancies and reducing the STD rate (Kirby, D., 2001). Efforts to decrease unintended pregnancy all try to increase factors protecting teens against risky behaviors (Nitz, K., 1999). These general strategies include finding better forms of contraception and encouraging contraceptive use and adherence, providing a comprehensive health education including information on contraception (which may delay sexual intuition and increase contraception use) (Kirby, D., 2001), and developing youth programs which include sex education coupled with activities consisting of mentoring, job training, and volunteering. Health Clinics can be a valuable partner in educating teens. Clinics that use one-on-one counseling, provide accurate information about abstinence and contraception, and provide contraception, have been shown to increase the contraceptive use without increasing sexual behavior. For adolescents in high school, teens play the most influential factor of weather to have sex; if they perceive their peers are engaging in sexual activity, they are more likely to take on this risky behavior as well. Although peer education programs are a popular way to address adolescent health issues, peer sexual education programs have not yet been extensively evaluated. Programs should address peer influence through teaching behavioral skills and changing teen perceptions on sexual activity (Bennett, S. E., 2005).
Overall, there is not one simple approach that could be utilized to reduce teenage pregnancy. Whatever the approach may be, the need for increasing the teenagers’ assets such as knowledge about sex and sexuality coupled with communication skills, allowing them to approach sexual encounters responsibly are paramount. It is time for American policy makers to reconsider this country’s stance on sex education and offer abstinence as an option in sex education rather than as the only option available to young people. America’s youth deserve to be told the truth about possible pregnancy, STD’s, and contraception.
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