THERE IS good news and bad with respect to the enormously costly and socially destructive problem of adolescent pregnancy in Baltimore.
As reported in The Evening Sun Nov. 26, births to school-age mothers declined during the most recent two-year period (1989-1990) for which data are available. It is really good news that, at long last, there may be a break in the slow but steady increase in births to adolescents. Moreover, the decrease is most marked among the youngest and most vulnerable girls, those from 10 to 15 years old.
The statistics from the Governor's Council on Adolescent Pregnancy indicate that the risk of pregnancy among adolescents has decreased. There is a small decrease in the birth rate and a substantial decrease in the rate of abortions. These decreases are most obvious in those areas of the city and state where intervention programs provide access to the information necessary for responsible sexual decision-making and facilitate the use of contraceptives by those who are sexually active.
These programs include, among others, health clinics in schools and Campaign For Our Children Inc., a private-public partnership that provides information promoting abstinence and responsible sexual behavior among middle school students.
Some years ago, my colleagues and I, in an objective, controlled study (the Johns Hopkins Self Center) sponsored by the Johns Hopkins Medical Institutions, Baltimore schools and the health department, showed that the frequency of adolescent pregnancy could be reduced by intervention that reached students in the schools.
Young boys and girls were exposed to education and counseling, if desired, in two schools. Additional education, counseling and family planning services were available at no cost in a nearby clinic after school. These services were widely used (and appreciated) by both male and female students. Students in the program for 2 1/2 years experienced a 31 percent reduction in pregnancies (both births and abortions), as compared with a 56 percent increase among students in comparison schools with no special program. The students also delayed having intercourse for an average of seven months, compared to the comparison group, indicating that the provision of accurate information did not encourage promiscuity.
The bad news from the governor's council is that over 100 infants were born to the youngest and most vulnerable group of mothers, those below 15 years old who are themselves children, blighting their life chances and those of their children. Dr. Anne Duggan and I, in a study of a large random sample of births to adolescents below age 18, found that adolescent pregnancy was associated with high public costs. Almost 95 percent of the mother/child pairs received medical assistance and 90 percent were on welfare for all or part of the first 18 months after birth. Other costs were associated with high risks of illness, repeat pregnancy, failure to complete high school and difficulty in finding jobs.
The really bad news from the governor's council is the reality that, because of the prevailing economic situation and decreases in public funding, the decrease in the number of births is being used as a reason to shift funds from pregnancy prevention to other services. Reducing preventive services is short-sighted. Rates of adolescent pregnancy, sexually transmitted diseases and AIDS will be on the increase again and long-range costs will continue to increase.
Janet B. Hardy, M.D., is professor emeritus of pediatrics and past director of the Johns Hopkins Adolescent Pregnancy and Pregnancy Prevention Program.