Helping Kids Not Have Kids

Abstinence programs and those for boys, prepubescent girls on rise

At the Brotherhood Program in Indianapolis, teen-age boys from many of the city’s roughest neighborhoods meet three times a week to talk, among other things, about sex and sexuality.

And to reinforce their sense of self-discipline, they also receive training in karate.

The program, which is run by Planned Parenthood of Central and Southern Indiana, is uncommon because it is designed to keep teen-age boys from becoming fathers. In the past, non-profit efforts to prevent teen-agers from becoming parents have been aimed at girls, but programs for boys have been growing in popularity as charities and foundations search for new ways to combat adolescent pregnancy.

Other approaches have also been attracting attention as non-profit groups that work with teen-agers try to determine which methods are most effective. Among them:

* Comprehensive youth-development: Sexuality education is usually just one component of efforts that motivate kids to avoid pregnancy. Many programs also get teen-agers to focus on what they want to do as adults. Such efforts help youngsters gain the skills they need to further their education, get a job, or plan a career. For example, the Indianapolis program also offers job training and career counseling.

* Pre-puberty programs: More and more programs to prevent teen-age pregnancy are trying to reach children at an earlier age, before they become sexually active.

* Community involvement: A growing number of efforts seek to involve parents, teachers, health professionals, and other civic leaders in joint efforts to prevent pregnancy. Such programs operate under the belief that teen-age pregnancy is a symptom of larger problems facing society.

* Abstinence-only: These programs teach adolescents that the only certain way to avoid pregnancy or sexually transmitted diseases is by not having sex. Many such programs also teach kids how to be more assertive and are designed to improve their sense of self-worth. Abstinence-only efforts won new momentum from the 1996 overhaul of the federal welfare law, which authorized the payment of $50-million a year to organizations that run programs encouraging young people to avoid sex. But abstinence-only programs have also received much criticism from people who say the approach does not work.

Kristin A. Moore, president of Child Trends, a Washington charity that conducts research on children and families, says the proliferation of approaches shows how prevention programs have matured. “There was a time when people seeking to prevent adolescent pregnancy felt that providing services and information would be sufficient,” she says. “Most people in the field have come to understand that a little bit of knowledge and a basket of condoms is not enough.”

Adolescent pregnancy has long been a problem in the United States. Nearly one million girls get pregnant each year. The number of pregnancies among girls aged 15 to 19 increased 23 per cent from 1972 to 1990. Although those numbers have declined by about 12 per cent since then — a trend that experts attribute in large part to the increase in condom use in the face of AIDS — the United States still has the highest teen-age-pregnancy and birth rates of any industrialized country.

The costs of teen-age pregnancy are borne not only by the young parents, who often must drop out of school at an early age, but also by government.

Half of teen-age mothers and more than three-fourths of unmarried teen-age mothers end up on public assistance within five years of giving birth to their first child, according to the U.S. Congressional Budget Office. Federal, state, and local governments lose $1.3-billion a year in tax revenue due to the unreliable work patterns of young fathers, and an additional $5.6-billion a year in expenses for health-care, criminal-justice, foster-care, and other services.

While non-profit groups have long worked to help teen-agers avoid becoming parents, their efforts got new attention two years ago when President Clinton said inhis State of the Union address that the issue was his top priority. His statement was followed by the creation of the National Campaign to Prevent Teen Pregnancy, a non-profit organization that is spending $2-million a year to reduce teen-age pregnancy rates by one-third by 2005.

The campaign, which is supported primarily by foundation and corporate grants, provides assistance and information to states and localities that seek to tackle the problem. It also works with the entertainment industry to educate teen-agers about how and why to avoid getting pregnant.

In addition, the campaign tries to bring together people and groups who have opposing views about how to solve the problem, although some groups — both conservative and liberal — have declined to participate.

“People are very divided on this issue,” says Sarah Brown, the campaign’s director. “The campaign is trying to change the conversation to focus on what is really best for kids.”

New findings released by the campaign show that comprehensive youth-development programs that work with kids over a period of years have proved to be especially successful in reducing adolescent pregnancy rates.

The campaign said its study concluded that more narrowly focused approaches, such as school-based health clinics that offer counseling and that refer kids to family-planning clinics for pregnancy testing and contraceptives, do not make a difference in pregnancy rates.

“If you’re really focusing on pregnancy prevention, you have to offer more than just talk,” says Gloria Primm Brown, a program officer at the Carnegie Corporation of New York, which has spent about $18.5-million on efforts to prevent teen-age pregnancy since 1983.

One program that has demonstrated the power of doing more than simply giving kids birth-control information is the Teen Outreach Program, which gets youngsters involved in community-service projects.

The program was started in 1978 in St. Louis by the Junior League and now operates in more than 120 areas across the country. It enrolls some 6,000 9th-through-12th-grade students per year and is usually run out of local school districts.

“It’s based on a very simple concept,” says Sharon Lovek Edwards, the owner of Cornerstone Consulting, a Houston for-profit company that took over management of the program in 1995. “An idle mind is the devil’s workshop. If you give kids positive and productive things to do, you’re keeping them from doing other things that are less desirable. This is not brain surgery.”

Kids in the program perform about 45 hours of community service per year, as hospital volunteers or tutors, for example. They also meet in small groups with an adult once a week throughout the school year to talk about personal issues. The amount of sexuality education the students receive depends on the local program, Ms. Edwards says, and the participants themselves often guide the conversation.

“You can rest assured that once you create an environment where these young people feel comfortable, they will take you to the subject matter that concerns them,” she says.

A recent evaluation of the program, supported by the Charles Stewart Mott Foundation and the Lila Wallace-Reader’s Digest Fund, found that the pregnancy rate among 287 girls who participated in the Teen Outreach Program was just 4.2 per cent — far lower than the 9.8-per-cent rate for a control group that was also studied. The findings of the evaluation prompted Mott and other grant makers to award the program an additional $250,000 to help it expand.

Another highly regarded youth-development program is run by the Children’s Aid Society in New York.

The comprehensive program combines a wide range of activities, from helping kids with their homework to providing employment training and medical services. The youngsters also play sports, study arts and drama, and receive sexuality education.

All of the components are given equal weight, says Michael Carrera, who directs the program. The goal is to build the youngsters’ self-esteem and to make them believe that they can have a successful future. To that end, the youngsters receive a small stipend for participating and are encouraged to open bank accounts with their earnings.

“Self-esteem is not something that you can teach,” Mr. Carrera says. “You catch it, and the way you catch it is by being around people who believe in you, and by mastering life circumstances.”

It’s a time-consuming process, he says. The program, which operates from community centers in Harlem and other neighborhoods in New York, works with the same youngsters for at least five years. Kids who encounter the program in their neighborhood often seek to join it, while others are referred by school counselors — or by the court system.

“Many of these kids have experienced great disadvantage and have been suffering for maybe a decade,” says Mr. Carrera, whose program recently received a $1.4-million grant from the Mott Foundation to expand to six other locations across the country. “It takes a substantial amount of time to deconstruct many of the unhelpful attitudes and practices that the young people bring to the program.”

A comparison between kids who participated in the Children’s Aid Society program and all New York City students found that those enrolled in the program had higher high-school-graduation rates, lower pregnancy rates, used alcohol less, waited longer before becoming sexually active, and were more likely to use condoms if they engaged in sex.

The Brotherhood Program that works with boys in Indianapolis borrowed many of its approaches from its examination of the Children’s Aid Society program.

The program, supported by the Lilly Endowment, was started in 1991, after a review of what the city was doing to combat adolescent pregnancy found that the 65 existing pregnancy-prevention programs focused almost exclusively on girls.

Albert Munn, Jr., who directs the Indianapolis effort, says the program tries “not to preach” about sex, but “we focus around abstinence and education. If they are sexually active, we make sure they know what’s out there.”

The boys who participate in the Brotherhood Program range in age from 12 to 18, Mr. Munn says, though some members bring even younger siblings to visit.

Although the program has not yet been evaluated, Mr. Munn says there are signs that it is working. Among 30 young men who recently completed the program, only two fathered children. Attendance among the current group of 25 is high — 18 to 20 participants show up on a given evening.

“They seem to be a lot more responsible and a lot healthier in their attitude toward women,” Mr. Munn says.

While the Brotherhood Program focuses on adolescents and those on the brink of puberty, other efforts to fight teen-age pregnancy are seeking to work with children before they reach adolescence, especially as new research has found that children are becoming sexually active earlier and that girls are starting their periods at an earlier age. Studies also show that the best way to prevent kids from having sex and getting pregnant is to reach them before they start having sex.

Girls Incorporated has three different sexuality-education programs aimed at girls of different ages.

Its Growing Together program, for 9- to 11-year-olds, gives young girls the opportunity to talk about human development and sexuality with their parents or guardians.

Will Power/Won’t Power, for 12- to 14-year-olds, focuses on building girls’ self-esteem and helping them learn how to resist peer pressure. Until this year, the program did not include information on contraception. But program leaders decided to add it to the curriculum after encountering too many girls who were already sexually active.

The program for 15- to 18-year-olds, Taking Care of Business, works at getting girls to think about the future, but it also includes an important sexuality component.

“By this age, close to a majority of these women will have had intercourse,” says Bernice Humphrey, who oversees the program at Girls Incorporated, “so we really need to be up-front about contraception and providing them with skills for managing their lives and the decisions they make.”

Some non-profit leaders say the effort to curb teen-age pregnancy needs to be even broader.

In Pittsburgh, such an approach has had considerable success. Nancy Bare-Knepshield, the director of the Center for Adolescent Pregnancy Prevention, who is overseeing an effort to reduce pregnancy rates in Allegheny County, says civic leaders decided to tackle the issue in a broad way in 1990, after learning that the teen-age pregnancy rates in some parts of the county exceeded 10 per cent.

The effort included an advertising campaign that encouraged parents to talk to their children about sex. College students were trained to talk to kids about birth control, sexually transmitted diseases, and how to resist peer pressure. Teachers and health professionals also got instruction on how to talk to kids.

Since 1990, the adolescent-pregnancy rate in Allegheny County has declined by about 30 per cent. The Robert Wood Johnson Foundation has awarded the Center for Adolescent Pregnancy Prevention a $250,000 grant to help expand the program to four other Pennsylvania counties.

“What made this successful is that we got the community to buy into it,” Ms. Bare-Knepshield says. “We asked them how they wanted to deal with it, and we let them guide us.”

Similar broad efforts are under way across the country:

* The California Wellness Foundation recently embarked on a 10-year, $60-million program that aims to reduce high pregnancy rates in eight localities. Although the plans differ from site to site, they all must provide sexuality education, not only to kids but also to adults. They also must offer kids access to contraception, involve teen-agers in planning and implementing the programs, and provide opportunities for kids to interact with adults through music, art, sports activities, or through other means.

* In Georgia, the Georgia Campaign for Adolescent Pregnancy Prevention, created by the Turner Foundation and the recipient of approximately $3-million in Turner grants, is also working to promote sexuality education on the local level. The campaign is working with non-profit organizations all over the state to teach parents and other adults how to talk to kids about sex. It is also helping organizations start youth-development programs, summer-jobs programs, and community-service programs.

* Plain Talk, a $4.5-million program run by the Annie E. Casey Foundation, also seeks to mobilize neighborhoods to deal with the problem of adolescent pregnancy by examining their attitudes about teen-age sexuality. The program encourages adults — including parents and health professionals — to speak openly to teen-agers about sex. It also works to get neighborhoods to provide sexually active teen-agers with access to medical and contraceptive services.

Such broad efforts face their own set of challenges, primarily because in dealing with large groups of people, they run across a spectrum of opinions on how to deal with teen-age sexuality.

“It seems to be a bottomless debate,” says Kathryn Keeley, executive director of the Georgia campaign. But, she adds, emotion often gives way to reason in the end.

“What we’ve found is that if people can spend a couple of hours talking about what’s really going on in the community, all the rhetoric dies away and they all get pretty practical about what they want to do for their kids.”