Back to ab­sti­nence-only for teens?

Modern Healthcare - - NEWS - By Steven Ross John­son

In 2008, the United Way of Greater Mil­wau­kee & Wauke­sha County launched an ini­tia­tive to lower Mil­wau­kee’s high rate of teen child­births. That year, more than 5% of Mil­wau­kee teens be­tween 15 and 17 gave birth—dou­ble the na­tional av­er­age. The cam­paign in­volved build­ing com­mu­ni­ty­wide aware­ness through the Mil­wau­kee Health Depart­ment, lo­cal busi­nesses, healthcare providers, schools and com­mu­nity groups. The goal was to cut the rate of teen preg­nan­cies in half by 2015.

The cen­ter­piece of the cam­paign was an eight-hour, ev­i­dence-based, sex ed­u­ca­tion cur­ricu­lum aimed at mid­dleschool youth called “Mak­ing Proud Choices! A Safer Sex Ap­proach to STDs, Teen Preg­nancy, and HIV.” By in­creas­ing teen knowl­edge, Mil­wau­kee low­ered its teen preg­nancy rate for six straight years. By 2012, it stood at 2.6%, nearly achiev­ing its goal three years early.

“We know that we have to give young peo­ple in­for­ma­tion to help em­power them to make health­ier de­ci­sions,” said Ni­cole An­gre­sano, who has led the United Way’s teen preg­nancy preven­tion ef­fort for the past nine years. “We think it was a sig­nif­i­cant con­trib­u­tor to the re­duc­tion in rates.”

Proud Choices is one of more than 40 teen preg­nancy preven­tion pro­grams en­dorsed by HHS’ Of­fice of Ado­les­cent Health as part of its Teen Preg­nancy Preven­tion Ini­tia­tive (TPPI). The Obama ad­min­is­tra­tion pro­gram pro­vided grants to agen­cies and or­ga­ni­za­tions to im­ple­ment pro­grams with demon­strated ef­fec­tive­ness as well as de­velop new strate­gies that ed­u­cate youth on sex-re­lated is­sues.

Whether those de­serve all the credit— some ar­gue the cul­ture is shift­ing away from early sex­ual ac­tiv­ity among teens— the fact is be­tween 2007 and 2015 the rate of teen births fell 50% in ur­ban coun­ties and 37% in ru­ral coun­ties, ac­cord­ing to a re­cent study from the Cen­ters for Dis­ease Con­trol and Preven­tion. In­deed, rates of both teen preg­nancy and child­birth have fallen every year since 1991, with only a brief two-year rise be­tween 2005 and 2007.

Crit­ics who sup­ported the ab­sti­nence-only sex ed­u­ca­tion ap­proach taken by fed­eral pol­i­cy­mak­ers dur­ing the 1990s and 2000s ar­gue the Obama ad­min­is­tra­tion pro­grams have been in­ef­fec­tive at best and may have even pro­moted an in­crease in sex­ual ac­tiv­ity among teens. But pub­lic health ad­vo­cates are con­vinced ev­i­dence-based, med­i­cally ac­cu­rate sex ed­u­ca­tion pro­grams pro­vided teens with the re­sources needed to make in­formed de­ci­sions when it comes to sex and con­trib­uted to low­er­ing the teen preg­nancy rate.

A 2015 Na­tional Fam­ily Growth Sur­vey con­ducted by the Cen­ters for Dis­ease Con­trol and Preven­tion showed a 14% de­cline over the past quar­ter-cen­tury in fe­male teenagers and a 22% drop among male teenagers age 1519 who re­ported hav­ing sex. The study also found an in­crease in the num­ber of teen girls who re­ported us­ing con­doms dur­ing sex from 94% in 2002 to 97% in 2013.

A change in sex ed pol­icy

The Obama ad­min­is­tra­tion’s sex ed­u­ca­tion poli­cies rep­re­sented a ma­jor break from the ab­sti­nence-only ap­proach, which had been fed­eral pol­icy for decades. Ab­sti­nence-only pro­grams re­ceived $1.5 bil­lion in fed­eral fund­ing over the past quar­ter­century, ac­cord­ing to the Sex­u­al­ity In­for-

ma­tion and Ed­u­ca­tion Coun­cil of the United States.

The Obama ad­min­is­tra­tion ini­tially in­vested $110 mil­lion in a more com­pre­hen­sive ap­proach, which grew to $180 mil­lion this year. “We have moved to­ward fo­cus­ing on the re­sults and not the con­tent,” said An­drea Kane, vice pres­i­dent for pol­icy and strate­gic part­ner­ships with the Na­tional Cam­paign to Pre­vent Teen and Un­wanted Preg­nancy.

With the ar­rival of a Trump ad­min­is­tra­tion in Jan­uary, how­ever, ad­vo­cates of ev­i­dence-based pro­grams fear pol­icy will shift back to the old ap­proach and set back progress in re­duc­ing teen preg­nancy rates. “The fed­eral in­vest­ments since 2010 have re­ally moved from be­ing fo­cused on a par­tic­u­lar type of sex ed­u­ca­tion that’s based on a cer­tain ide­ol­ogy to ev­i­dence-based pro­grams,” Kane said.

Even some pub­lic health of­fi­cials in con­ser­va­tive parts of the coun­try are wor­ried about cuts to the pro­grams. “Every lit­tle bit we do cer­tainly is cost-ef­fec­tive be­cause lives are for­ever changed when a wo­man has a child sooner than they are ready,” said Dr. Bob Eng­land, di­rec­tor of the Mari­copa County Pub­lic Health Depart­ment in Ari­zona, where the state’s teen birth rate fell 57% be­tween 2007 and 2015.

Stud­ies have found ba­bies born to teen moth­ers are more likely to be pre­ma­ture and have low birth weights, which car­ries a higher risk of in­fant mor­tal­ity as well as phys­i­cal and men­tal dis­or­ders. Only 40% of teen moth­ers earn a high school di­ploma, ac­cord­ing to the Na­tional Con­fer­ence of State Leg­is­la­tures, with two-thirds of teen moth­ers liv­ing in poverty and a quar­ter de­pen­dent on pub­lic as­sis­tance within three years after giv­ing birth. TPPI pro­gram sup­port­ers hope the data will con­vince the new ad­min­is­tra­tion to main­tain the pro­grams. “We’re hop­ing … we can make the con­nec­tion that, yes, these ev­i­dence-based pro­gram ini­tia­tives re­ally make a dif­fer­ence,” said Lau­ren Kil­le­lea, di­rec­tor of de­vel­op­ment and com­mu­ni­ca­tions with the Mas­sachusetts Al­liance on Teen Preg­nancy.

Providers brac­ing for cuts

Yet many providers are brac­ing for cuts. They say GOP-led leg­is­la­tures are likely to shift the fo­cus of teen preg­nancy-preven­tion to ab­sti­nence-only sex ed­u­ca­tion. “Cer­tainly when we’ve had Repub­li­cans in the White House and Repub­li­can-con­trolled houses of Congress there’s been more sup­port for ab­sti­nence-only pro­grams,” said Ni­cole Cush­man, ex­ec­u­tive di­rec­tor for An­swer, a na­tional or­ga­ni­za­tion that trains teach­ers and other pro­fes­sion­als to pro­vide sex ed­u­ca­tion for youth.

GOP ma­jori­ties in the House and Se­nate rou­tinely pro­posed fund­ing cuts to pro­grams that pro­vide con­tra­cep­tion and screen­ing for HIV and sex­u­ally trans­mit­ted dis­eases. Only a threat­ened veto from Pres­i­dent Obama saved the pro­grams. More than 4 mil­lion low-in­come and unin­sured

in­di­vid­u­als re­ceived ser­vices un­der the pro­grams dur­ing the Obama years.

It is still un­clear where the Trump ad­min­is­tra­tion will take the is­sue. Ac­cord­ing to the New York Times, the pres­i­dent-elect plans to del­e­gate re­spon­si­bil­ity for re­pro­duc­tive health is­sues to Vice Pres­i­dent-elect Mike Pence, the con­ser­va­tive gov­er­nor of In­di­ana.

Last March Pence signed an anti-abor­tion law in In­di­ana that makes it a crim­i­nal act to seek an abor­tion based on the fe­tus be­ing di­ag­nosed with a ge­netic dis­or­der. Pence has also sought to de­fund Planned Par­ent­hood, which re­sulted in the clos­ing of a num­ber of clin­ics in the state and the loss of pre­ven­tive health ser­vices such as ac­cess to con­tra­cep­tion for low-in­come in­di­vid­u­als.

“The same law­mak­ers that tend to sup­port re­stric­tions on re­pro­duc­tive rights and ac­cess to abor­tion also have tended to fa­vor ab­sti­nence-only pro­grams and to op­pose more com­pre­hen­sive ap­proaches to sex ed­u­ca­tion,” Cush­man said.

In­deed, that’s ex­actly what ad­vo­cates for ab­sti­nence-only ed­u­ca­tion ex­pect from the new ad­min­is­tra­tion. “We are hop­ing that the Trump ad­min­is­tra­tion gives the sex­ual risk-avoid­ance ap­proach, also known as ab­sti­nence ed­u­ca­tion, a stronger ac­cep­tance in both the pol­icy and the fund­ing lev­els than the past ad­min­is­tra­tion has of­fered,” said Mary Anne Mo­sack, na­tional di­rec­tor of state ini­tia­tives for As­cend, for­merly known as the Na­tional Ab­sti­nence Ed­u­ca­tion As­so­ci­a­tion.

Mo­sack said the launch of Obama’s TPPI ef­fec­tively ended more than two decades of bi­par­ti­san sup­port for sex­ual risk-avoid­ance ed­u­ca­tion. There were 169 such pro­grams prior to 2010, she said.

Of course, no one knows what im­pact re­turn­ing to that ap­proach will have on teen preg­nancy rates. Eng­land in Ari­zona be­lieves greater aware­ness of the un­fa­vor­able eco­nom­ics of teen preg­nancy and a cul­ture shift away from early child­bear­ing had a greater im­pact on re­duc­ing the rate of teen child­births than re­pro­duc­tive health ed­u­ca­tion.

“What will hap­pen if these pro­grams get de­funded is we will have a large na­tional ex­per­i­ment, and we’ll see what the im­pact was,” Eng­land said.

Mil­wau­kee’s suc­cess­ful cam­paign to re­duce teen preg­nan­cies fo­cused on col­lab­o­ra­tion among the city’s health depart­ment, healthcare providers, schools and com­mu­nity groups.

Videos in the AMAZE pro­gram aim to “take the awk­ward out of sex ed.” The pro­gram was launched by the groups An­swer, Ad­vo­cates for Youth and Youth Tech Health.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.