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Teen Sex: Truth and Consequences
By Douglas J. Besharov and Karen N. Gardiner
This article originally appeared in The Orlando Sentinel, February 21, 1993.
As a result, there will be about 1 million pregnancies, resulting
in 406,000 abortions, 134,000 miscarriages and 490,000 live births.
Of the births, about 313,000, or 64 percent, will be out of
wedlock. And about 3 million teen-agers will suffer from a sexually
transmitted disease, including AIDS. This epidemic of teen pregnancy and
infection has set off firestorms of debate in school systems across the
country. Both sides have rallied around the issue of condom distribution as
if it were a referendum on teen sexuality. Proponents argue that
teen-agers will have sex whether contraceptives are available or not, so
public policy should aim to reduce the risk of pregnancy and the spread of
sexually transmitted diseases by making condoms easily
available. Opponents claim that such policies implicitly endorse teen sex
and will only worsen the problem. The causes of teen pregnancy and
sexually transmitted diseases, however, run much deeper than the public
rhetoric that either side suggests. Achieving real change in the sexual
behavior of teen-agers will require action on a broader front.
More active and younger
Some things are not debatable: Every year, more teen-agers are
having more sex, they are having it with increasing frequency, and they are
starting at younger ages. There are four principal sources of information
about the sexual practices of teen-agers: the National Survey of Family
Growth, a national in-person survey of women ages 15-44 conducted in 1982
and again in 1988; the National Survey of Adolescent Males, a survey of
males ages 15-19 conducted in 1988 and 1991; the National Survey of Young
Men, a 1979 survey of 17-to l9-year-olds; and the Youth Risk Behavior Survey,
a 1990 questionnaire-based survey of 11,631 males and females in grades 9-12
conducted by the Centers for Disease Control. In addition, the Abortion
Provider Survey, performed by the Alan Guttmacher Institute, collects
information about abortions and those who provide them. With minor variations
caused by differences in methodology, each survey documents a sharp increase
in the sexual activity of American teen-agers. All these surveys, however,
are based on the self-reports of young people and must be interpreted with
care. For example, one should always take young males' reports about their
sexual exploits with a grain of salt. In addition, the social acceptability
of being a virgin may have decreased so much that this, more than any change
in behavior, has led to the higher reported rates of sexual experience. The
following statistics should therefore be viewed as indicative of trends
rather than as precise and accurate measures of current behavior. A
cursory glance at National Survey on Family Growth reports shows that there
was indeed a sexual revolution. Teen-agers in the early 1970s were twice as
likely to have had sex as were teen-agers in the early 1960s. The trend of
increased sexual activity continued well into the late 1980s. Rates of
sexual experience increased about 45 percent between 1970 and 1980 and
increased another 20 percent in just three years, from 1985 to 1988, but
rates have now apparently plateaued. Today, over half of all unmarried
teen-age girls report that they have engaged in sexual intercourse at least
once. These aggregate statistics for all teen-agers obscure the second
remarkable aspect of this 30-year trend: Sexual activity is starting at
ever-younger ages. And teens are not only having sex earlier, they are also
having sex with more partners. Almost 7 percent of ninth-grade females told
the Youth Risk Behavior Survey in 1990 that they had had intercourse with
four or more different partners, while 19 percent of males the same age
reported having done so. By the 12th grade, 17 percent of girls and 38
percent of boys reported having four or more sexual partners. A major
component of these increases has been the rise in sexual activity among
middle-income teen-agers. Between 1982 and 1988, the proportion of sexually
active females in families with incomes equal to or greater than 200 percent
of the poverty line increased from 39 percent to 50 percent. At the same
time, the proportion of females from poorer families who had ever had
sexremained stable at 56 percent. Until recently, black teens had
substantially higher rates of sexual activity than whites. Now, the
differences between older teens of both races have narrowed. But once more,
these aggregate figures obscure underlying age differentials. For males and
females, the gap narrowed between the 15-year-old and 18-year-old
groups.
Finding birth control
Many people believe that there would be less teen pregnancy and
sexually transmitted diseases if contraceptives were simply more available
to teen-agers, hence the call for sex education at younger ages, condoms in
the schools, and expanded family planning programs in general. (In Florida,
a task force appointed by the governor has recommended that condoms be made
available to high school students. Some school districts in Central Florida
have passed resolutions against the idea.) But an objective look at the
data reveals that availability is not the prime factor determining
contraceptive use. Almost all young people have access to at least one form
of contraception. In a national survey conducted in 1979 by Melvin Zelnik
and Young Kim of the Johns Hopkins School of Hygiene and Public Health in
Baltimore, more than three-quarters of 15-to 19-year-olds reported having
had a sex education course, and 75 percent of those who did remembered being
told how to obtain contraception. Condoms are freely distributed by family
planning clinics and other public health services. They are often sitting in
a basket in the waiting room. Edwin Delattre, acting dean of Boston
University's School of Education and an opponent of condom distribution in
public schools, found that free condoms were available at eight different
locations within a 14-block radius of one urban high school. And, of
course, any boy or girl can walk into a drugstore and purchase a condom,
sponge or spermicide. Price is not an inhibiting factor: Condoms cost as
little as 50 cents. Although it might be a little embarrassing to purchase a
condom - mumbling one's request to a pharmacist who invariably asks you to
speak up used to be a rite of passage to adulthood - young people do not
suffer the same stigma, scrutiny or self-consciousness teen-agers did 30
yearsago. Teen-agers can also obtain contraceptives such as pills and
diaphragms fromfamily planning clinics free of charge or on a sliding fee
scale. In 1992, more than 4,000 federally funded clinics served 4.2 million
women, some as young as 13. In all states except Utah, teen-agers can use
clinic services without parental consent. To receive free services under the
Medicaid program, however, a teen-ager must present the family's Medicaid
card to prove eligibility. The evidence suggests that as with condoms,
teens know how to find a clinic when they want to. When they are younger,
they do not feel the need to go to aclinic since condoms tend to be their
initial form of contraception. Susan Davis of Planned Parenthood explains,
"The most common reason teen-agers come is because they think they are
pregnant. They get worried. Or they get vaginal infections." The median
time between a female teen-ager's first sexual experience and her first
visit to a clinic is one year, according to a 1981 survey of 1,200
teen-agers using 31 clinics in eight cities conducted by Laurie Zabin of
JohnsHopkins. Two pieces of evidence further dispel the notion that lack
of availability of contraception is the prime problem. First, reported
contraceptive use has increased even more than rates of sexual activity. By
1988, the majority of sexually experienced female teens who were at risk to
have an unintended pregnancy were using contraception: 79 percent. In
addition, the proportion ofteen females who reported using a method of
contraception at first intercourse increased from 48 percent in 1982 to 65
percent in 1988. The second piece of evidence is that as they grow older,
teen-agers shift the forms of contraception they use. Younger teens tend to
rely on condoms, whereas older teens use female-oriented methods, such as a
sponge, spermicide, diaphragm or the pill, reflecting the greater likelihood
that an older female will be sexually active. A major reason for this
increase in contraceptive use is the growing numberof middle-class youths
who are sexually active. But it's more than this. Levels of unprotected
first sex have decreased among all socioeconomic groups. Unprotected first
sex also decreased among racial groups.It's not just that teens are telling
interviewers what they want to hear about contraception. Despite large
increases in sexual activity, there has notbeen a corresponding increase in
the number of conceptions. Between 1975 and 1988, when about 1.3 million
more teen females reported engaging in sex (a 39 percent increase), the
absolute number of pregnancies increased by less than 21
percent.
Too often unprotected
Although the conception rate among teens is declining, the
enormous increase in sexual activity has created a much larger base against
which the rate is multiplied. Thus there have been sharp increases in the
rates of abortion, out-of-wedlock births, welfare dependency and sexually
transmitted diseases as measured within the whole teen
population. Teen-age sexuality does not have to translate into pregnancy,
abortion, out-of-wedlock births or sexually transmitted diseases. Western
Europe, with roughly equivalent rates of teen sexuality, has dramatically
lower rates of unwanted pregnancy.The magnitude of the problem is
illustrated by data about reported condom use. Between 1979 and 1988, the
reported use of a condom at last intercourse for males ages 17-19 almost
tripled, from 21 percent to 58 percent. A decade of heightened concern about
AIDS and other sexually transmitted diseases probably explains this
tripling. According to Freya Sonenstein and her colleagues at the Urban
Institute, more than 90 percent of males in their sample knew how AIDS could
be transmitted. Eighty two percent disagreed "a lot" with the statement,
"Even though AIDS is a fatal disease, it is so uncommon that it's not a big
worry." As impressive as this progress was, 40 percent did not use a condom
at lastintercourse. In fact, the 1991 National Survery of Adolescent Men
found that there has been no increase in condom use since 1988 - even as the
threat of AIDS has escalated. The roots of too-early and too-often
unprotected teen sex reach deeply into our society. Actor Robin Williams
reportedly asked a girlfriend, "You don't have anything I can take home to
my wife, do you?" She said no, so he didn't use a condom. Now both Williams
and the girlfriend have herpes, and she's suing him for infecting her. (She
claims that he contracted herpes in high school.) When fabulously successful
personalities behave this way, should we be surprised to hear about an
inner-city youth who refuses his social worker's entreaties to wear a condom
when having sex with his AIDS-infected girlfriend? This is the challenge
before us: How to change the behavior of these young men as well as the one
in five sexually active female teens who report using no method of
contraception. First, all the programs in the world cannot deal with one
vital aspect of the problem: Many teen-agers are simply not ready for sexual
relationships. They do not have the requisite emotional and cognitive
maturity. Adolescents who cannot remember to hang up their bath towels may
be just as unlikely to remember to use contraceptives. Current policies and
programs do not sufficiently recognize this fundamental truth. At the
same time, the clock cannot be turned all the way back to the innocent
1950s. Sexual mores have probably been permanently changed, especially for
older teens - those who are out of high school, living on their own or off at
college. For them, and ultimately all of us, the question is: How to limit
the harm being done? The challenge for public policy is to pursue two
simultaneous goals: to lower the rate of sexual activity, especially among
young teens, and to raise the level of contraceptive use. Other than
abstinence, the best way to prevent pregnancy is to use a contraceptive, and
the best way to prevent sexually transmitted diseases is to use a barrier
form of contraception. Meeting this challenge will take moral clarity,
social honesty and political courage - three commodities in short supply
these days.
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