U.S. to revise strategy on teen-age pregnancy Education, contraception part of plan

September 05, 1993|By Christopher Scanlan | Christopher Scanlan,Knight-Ridder News Service

WASHINGTON -- The federal government is quietly planning a dramatic -- and controversial -- shift in its attack against teen-age pregnancy and the epidemic of sexually transmitted diseases among adolescents.

The Clinton administration plans to revise the 12-year-old Republican message of "Just Say No" to premarital sex by

placing greater emphasis on birth control and disease prevention.

For the past several months, the Department of Health and Human Services has been developing an ambitious proposal that could end up funneling millions, perhaps billions, of dollars into comprehensive health services for the nation's 35 million 10- to 19-year-olds.

The plan would provide more money for sex education, birth control counseling, health care and contraceptives at clinics in or near schools, said HHS officials who described the plan on condition they not be identified.

"It's a huge change," said Lisa Kaeser, a policy expert for the Alan Guttmacher Institute, a leading reproductive health research group in New York City.

"The government is finally recognizing what the reality of [adolescents'] lives is all about. They are under incredible pressure, bombarded with messages from peers, TV, the media, to have sex," Ms. Kaeser said.

A major force behind the change and the official who will champion the new approach is Dr. Joycelyn Elders. The outspoken former Arkansas health director is expected to win Senate confirmation Tuesday as the new U.S. surgeon general.

As the nation's most visible health official, Dr. Elders plans to use her job's "bully pulpit" to lobby for the new plan, according to federal officials and health activists familiar with her efforts to reshape the government's approach to teen sexuality. Dr. Elders refused to give interviews pending Tuesday's vote, but she outlined her pitch at July's confirmation hearing:

"We need to teach our children more than just 'no.' We need to teach them how to say no. And we need to teach them, you know, if they get into problems, to be responsible," Dr. Elders said.

But conservative critics warned that the new federal approach would encourage more sexual activity and abortions among teens and do little to prevent pregnancy or sexually transmitted diseases.

"Teen-agers are just not reliable contraceptive users," said Susan Hirschmann, a spokeswoman for the Eagle Forum, a group headed by conservative activist Phyllis Schlafly.

"The answer is to teach the children to respect their bodies and to respect themselves and the only healthy solution for these kids is abstinence."

Ms. Hirschmann called Dr. Elders "the wrong person to be giving advice to teen-agers. Her statement that every girl should take a condom in her purse when she goes out on a date contradicts the values of most parents in this country."

The teen health initiative is coming at a time when government and public surveys are painting a stark portrait of the risks America's young people face from sex.

Nearly three-fourths of all high school students say they have sex by the time they graduate, according to a 1990 survey by the federal Centers for Disease Control and Prevention.

Three million teen-agers -- about one in eight 13- to 19-year-olds -- acquire a sexually transmitted disease every year, the Guttmacher Institute reports. The United States has the highest rates of teen pregnancy, abortion and childbirth in the industrialized world.

"The high teen pregnancy rate is just a symptom of the fact that [teens] have poor access to health care," said Jackie Noyes, Washington director for the American Academy of Pediatrics.

Few adolescents have access to birth control counseling and services in school-based clinics, according to the Center for Population Options, a Washington-based group that supports school-based clinics.

About 1.3 million adolescents, mostly girls from poor families, can receive contraceptives at more than 4,000 federally financed family planning clinics nationwide.

The impact of the HHS plan would be to reach more teen-agers by substantially increasing the amount of federal dollars used to support clinics associated with public schools.

HHS officials haven't decided on a specific budget request for the teen initiative. Cost estimates for the new program range from several hundred million dollars to as much as $7 billion a year, Ms. Noyes said.

Until now, the government has targeted teens in schools through a $2 million-a-year program started in 1981 that preaches an abstinence-only approach to sex, dubbed the "chastity program."

"There still is going to be an emphasis on abstinence for those kids for whom the abstinence message is going to work," an HHS official said. "But this newer, more comprehensive approach is going to have something for those kids who are going to become sexually active.

"Pitching abstinence with no other message really just abandons those kids you don't hook with the abstinence message. Some of the techniques used by abstinence promoters like 'Pet your dog and not your date,' don't really work very well with kids."

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