5. Even though most of the evaluated programs encourage contraceptive use in some way, there is a notable reluctance to actually provide program participants with the contraceptive methods themselves or even to help participants gain access to contraceptive services at some other site. Only nine evaluated programs (programs B, E, H, K, O, P, Q, R, and U) make a clear effort in at least some of their sites to provide contraception or increase access to it. This reluctance is due, in part, to the preponderance of programs targeting adolescents and the ongoing public debate about the appropriateness of providing sexually active, unmarried adolescents with contraceptives.
Even among the evaluated programs working with adolescents who are pregnant or are already parents—a group well known to be at risk of rapid repeat, often unintended pregnancy—the direct provision of contraception is not universal. Only three of seven programs (programs H, K, and U) working with pregnant or parenting adolescents actually provide methods of contraception or direct access to contraception, and two of these three programs (programs H and K) did not provide contraception at all program sites.
The School/Community Program for Sexual Risk Reduction Among Teens reveals the importance of actual access to contraception. This schooland community-based program was designed to reduce high rates of adolescent pregnancy and was a collective effort of parents, teachers, students, clergy, and community leaders. Contraception was made accessible to the students through a school nurse, who provided counseling for the students, condoms for sexually active young men, and transportation to the county health department family planning clinic for sexually active young women. The first evaluation of the program's effectiveness noted that in the 2 years following initiation of the education program developed by the community consortium, pregnancy rates among adolescent girls in the intervention area dropped significantly (Vincent et al., 1987). A reanalysis of this program confirmed that the adolescent pregnancy rate did indeed decrease during the years covered by the earlier evaluation (1984–1986). However, the reanalysis found that in subsequent years (1987–1988), the adolescent pregnancy rate in the intervention area increased to levels that were not significantly different from the pre-program rates. The authors