Dealing Sanely with Teen Sex

SARA ENGRAM

December 13, 1992|By SARA ENGRAM

In many cities, news that a five-year contraceptive implant would be available in school-based health clinics would cause a firestorm of criticism. In Baltimore, The Sun's report that the city health commissioner has formed a consortium of doctors, hospitals and private foundations to make Norplant available to sexually active teen-agers was met with relatively minor mutterings.

Meanwhile, the story drew national attention, including a front-page story in the New York Times and a full-page report in Newsweek. Teen-agers and contraception is a volatile enough combination. But Norplant in the schools? How can they get away with it?

In fact, the Norplant consortium is a logical extension of a program that has been in effect for a couple of years, in which school-based clinics offer a variety of health services, including contraceptives. Until now, the clinics have only been able to give referrals for Norplant, but didn't have the money themselves to provide the implant. Now they will be able to offer the choice to people who could not otherwise afford it.

The school-based clinics were established in the mid-1980s, their numbers limited only by funds to support them. A big reason for the lack of controversy about Norplant and about contraceptives in general was the approach of the school board, which regarded the clinics as a health program, not an educational function. As such, their policies and procedures were considered health department decisions rather than matters for board deliberation and public debate.

That way, potentially controversial matters were kept out of a forum in which people driven by ideology could grandstand on issues or proposals in which they had no personal involvement. Instead, health department officials could consult with parents and officials of the schools where the programs would be located.

In those settings, discussions of adolescent pregnancy can be informed as much by reality as by ideology or morals or whatever else adults want to call their hopes that adolescents will simply abstain from sex.

Few people would quarrel with the desirability of adolescent chastity -- and not just to prevent premature parenthood. In the age of AIDS, chastity can easily be a matter of life and death.

But if one thing is clear about human nature -- and human physiology as well -- teaching abstinence to teen-agers will always be an uphill struggle with varying degrees of success.

nTC In Baltimore, as in many other parts of the country, the reality is that many teen-agers are sexually active -- and that many girls become mothers before they are able to take responsibility for a child.

Teen-age parenthood is not new. But earlier, teen-agers could usually find employment that allowed them to support their families. A society in which teen-aged mothers face parenthood without a partner and with few prospects of becoming self-sufficient citizens produces a new twist.

In that context, the figures on adolescent pregnancy are sobering. About a million teen-age girls in this country become pregnant every year and about 600,000 give birth.

The 1990 figures for Maryland indicate that about 35 of every 1,000 girls aged 15 to 17 gave birth. In Baltimore, the rate was almost three times higher -- about 97 of every 1,000 girls aged 15 to 17. Many of those girl-mothers dropped out of school and will probably live welfare-dependent lives.

The good news is that Maryland's rate of adolescent pregnancy has shown some improvement. Statewide, between 1989 and 1990 there was a decrease of 11.6 percent in births to women under 18, as well as a decline of 8.1 percent in the number of abortions in that group.

In Baltimore city during the same period, there was a 5 percent drop in the number of births, and a 17 percent decrease in abortions.

It's unlikely that school-based clinics account for much of this decrease, since there are too few of them to make a sizable dent. But it is possible that concerted efforts from a number of directions -- ranging from programs of the Governor's Council on Adolescent Pregnancy, including imaginative public awareness campaigns, to church-based efforts to persuade teen-agers not to become sexually active -- are having an effect. And, of course, access to family planning services, whether in school or through other sources, has played a major part.

Contraceptives, Norplant included, are part of the solution to adolescent pregnancy. So are programs aimed at promoting chastity.

What doesn't help is over-heated rhetoric based more on ideology than on real lives, real problems and real answers.

Sara Engram is editorial-page director of The Evening Sun.

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