Click for next page ( 2


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 1
Summary Adolescent pregnancy is widely recognized in our society as a complex and serious problem. Regardless of one's political philosophy or moral perspective, the basic facts are disturbing: more than ~ million teenage girls in the United States become pregnant each year, just over 400,000 teenagers obtain abortions, and nearly 470,000 give birth. The majonty of these births are to umnarried mothers, nearly half of whom have not yet reached their eighteenth birthday. For teenage parents and their children, prospects for a healthy arid independent life are significantly reduced. Young mothers, in the absence of adequate nutntion and appropriate prenatal care, are at a heightened risk of pregnancy complications and poor birth outcomes; they are also more lil~ely to experience a subsequent pregnancy while still in their teens. The infants of teenage mothers also face greater health and developmental nsks. Despite declining birth rates since 1970, adolescent pregnancy, abor- tion, and childbearing have remained considerably higher in the United States then ~ the majority of other developed countries of ache world, even though the age of miilation and rates of early sexual activity are compara- ble. The most striking contrast is among the youngest teenagers: U.S. girls uncles age IS are at least five times more likely to give birth than young adolescents in any other developed country for which data are available. Teenage families with children are disproportionately fatherless, and most are poor. Teenage marnages, when they occur, are charactenzed by a high degree of instability. In addition, teenage parents, both male aIld

OCR for page 1
2 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING female, suffer the negative impact that untimely parenting has on their education and the related limitation of career oppornmines. Teenage parents are more likely that} those who delay childbearing to experience clonic unemployment and Inadequate income. Because these young people often fare poorly in the workplace, they and they children are highly likely to become dependent on public assistance md to remain dependent longer than those who delay childbearing until their twenties. Society's economic burden in sustaining these families is substantial. Why do young people who are hardly more than children themselves become parents? Is it primarily due to a lack of individual responsibility, maturity, knowledge, and values? Or does it result Tom the penasive problems associated with poverty, ~CiU3iDg limited education and em- pioyment opport~iies and the likelihood of growing up in a fatherless family, so common among high-nsk youth? The answer to both of these questions seems to be yes. Yet there is widespread disagreement a~nollg politick, educational, and religious leaders, as we] as parents, about the problems of adolescent pregnancy and what to do about them. Indeed, many people fee} that the primary emphasis of U.S. social policy should be on eliminating poverty, streIlgthemng family ties, and enhancing young people's perceptions of they Fiches. The pane] joms those who believe that the primary goal should be to ameliorate these conditions, and perhaps ~ doing so also solve the problems of adolescent pregnancy and childbearing In Amenca. Unfommately, however, smeni~sts, policy makers, =d concemed citizens have so far been Cable to And easy and effective solutions to these greater social and economic problems. As a result, during *le past two decades, there has been Ilo coherent U.S. policy toward adolescent progeny and childbearing, despite explicit recognii~on on the part of many that government involvement Is needed and appropriate. In pan we lack a coherent approach toward policy because adolescents are not a monolithic group, and adolescent pregnancy is not a unitary problem. For yoga people of different aces, living in different social, ~ ~ _ ~ ~ ~ _ . . . t ~ t ~ ~ t ~ - economic' and cultural circumstances' the mug of early sexual aci~v- ity, pregnancy, and childbearing is IlOt the same. In Addison seaman relationships and family formation have m~ino~y been regarded as personal matters in our society. As increasing utlmbers of young people have become involved ~ these behaviors outside marriage, however, rr any people have expressed concern about the appropnatejurisdiciion of parents, the state, and teenagers the...celves ~ these matters. At what age should adolescents, rather tin their parents, have the authority to make

OCR for page 1
SUMMARY 3 decisions? Under what circumstances should the state mtenrene? These issues have not been resolved. The past decade and a half have u~tnessed a dramatic burgeoning of policies and programs to help delay teenage pregnancies and to reduce the adverse consequences of early childbearing. Some of these have been promoted and supported by the federal government; others have been Ligated by states and local communities; and still others have developed from significant investments by pirate foundations and philanthropic groups. Many have been the result of productive public-pn~rate partner- ships. Some have focused on 3DdinduA teenagers as the unit of treatment; others have focused on families. Some have provided speared sernces; others have been comprehensive In their approach. Programs have been organized in schools, churches, community centers, social service agen- cies, clinics, aIld hospitals. Some have been single-site programs, while others have been replicated at several sites within a City or across Me nation. Despite the magnitude of human and monetary resources that have been directed at tackling the problems of adolescent pregnancy, however, there has been no systematic attempt to assess the effects and effectiveness of alternative approaches In light of growing scientific under- stand~g of early pregnancy and parenting. With support fiom a consoriimn of pn~rate fotmdations, the Panel on Adolescent Pregnancy and ChildbeaIing undertook a comprehensive ex- ~mma~aon of issues associated With teenage sexual and ferocity behavior and reviewed what is known about the costs and benefits of alternative policies and programs to address these issues. On the basis of two years of review, analysis, and debate, the panel has reached six general conclusions: I. Prevention of adolescent pregnancy should have the highest pnonty. both human and monetary terms, it is less costly to prevent pregnancy than to cope with its consequences; and it IS less expensive to prevent a repeat pregnancy than to treat the compounded problems. 2. S=ually active teenagers, both boys and girls, need the ability to avoid pregnancy and the motivation to 60 So. Early, reg - , "d eEe~ve contraceptive use resets in fewer pregnancies. Debug the ~tianoD of sow activity wiD also reduce the madence of pregnancy, but we cur- rendy know very linIe about how to e~ece~vely discourage unmarried teenagers Mom initiating intercourse. Most young people do become squally active during their teenage years. Therefore, making contrace~ rive methods available and accessible to those who are sexually active add

OCR for page 1
4 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING encouraging them to diligently use these methods is the surest strategy for pregnancy prevention. 3. Society must avoid Cueing adolescent sexuality as a problem pecul- iar to teenage gels. Our concept of the high-nsk population must include boys. Their attitudes, motivations, and behavior are as central to the problems as those of they female parmers, and they must also be central to the solutions. 4. There is no single approach or quick fix to solving all the problems of early unintended pregnancy and childbearing. We wig continue to need a comprehensive array of policies and programs targeted to the special charactensucs of communities an] to the circumstances of teenagers Tom different somal, cultural, and economic backgrounds and of different ages. Because adolescents are not a monolithic group, they do not ad experience sexual acnvity, pregnancy, md childbearing in the same way. Our broad goal is the same for all young people: that they develop the necessary capabilities to make and carry out responsible decisions about their sexual and fertility behavior. The strategies for achieving these gods and the specific Interventions to can; them out, however, should be sensitive to differences in values, attitudes, aIld expenences among individuals and groups. 5. If trade-offs are to be made in addressing the special needs of one group over another, priority should be given to those for whom the consequences of an early ',nintended pregnancy and birth are likely to be most severe: young adolescents and those Dom the most society and economically disadvantaged backgrounds. In many ways those at highest risk are hastiest to serve, yet they are also the groups that have been shown to benefit most. 6. Responsibility for addressing the problems of adolescent pregnancy and ~il~beanng should be shared among m~induals, families, voluntary organizations, communines, and governments. In the United States, we place a high priority on ensuring the rights of indi~riduals to hold different values and the rights of families to raise their children according to (hm own beliefs. Therefore, public policies should alarm the role and responsi- !oili~r of families to teach Herman values. Federal and state governments and commLmity institutions should supplement rather than detract Tom that role. These general conclusions underlie all of our specific conclusions and recommendanons for policies, programs, and research.

OCR for page 1
SUMMARY 3 The pane] presents its conclusions and recomunendations Froth an mtense awareness of the fits of scientific knowledge in dealing with the problems of adolescent pregnancy and childbeanng. The issues in- volved are not only sclentirSc; they also reflect widely diffenng values. We also recognize the importance of families ~ establishing attitudes, behavior patterns, and traditional values ~ developing children, and we encourage efforts to involve families as an essential component ~ the solution of the problems associated with adolescent sexuality. As scien- tists, however, our role is to contribute to the base of knowledge about the problems ir~volved, and our goal is to inform the policy debate by cianf ring the sc~entiEc issues. PRIORITIES FOR POLICIES AND PROGRAMS The panel's specific conclusions and recommendations cover a range of activities that include research, planning, policy development, service delivery, and monitonng. When existing knowledge supports new or revised policies and programs or highlights the effectiveness of ongoing . . . -. , , ~ tlatl~res, we propose specs: 1C new or continuer programs or specl tic research and development. When existing knowledge provides insights but is incomplete, we advise further demonstration and evaluation to enhance understanding of the relative CoStS, effects, and electiveness of proms approaches. When innovative policies have been initiated but there are as yet no scientifically measurable outcomes, we urge carefid observation and mon~tonng. Many of our recommendations build on policies, programs, and research that are already under way, and many reinforce the phonics of other m~induals and groups that are address- ~ng the complex and controversial issue of adolescent pregnancy. The panel has identified three overarching policy goals, presented in order of pnonty, that provide a Framework for our specific conclusions and recommendations: / I. Reduce the rate and incidence of unintended pregnancy among adolescents, especially among school-age teenagers. 2. Pronde alternatives to adolescent childbearing and parenting. 3. Promote positive social, economic, health, and developmental out- comes for adolescent parents add their children. I:or most young people in the United States, realizing fulfilling adult work and family roles depends on completing ~ education and entenng

OCR for page 1
6 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING the labor force before becoming a parent. Accordingly, our highest priority should be to help teenagers, regardless of the timing of sexual initiation, to develop the ability and the motivation to avoid becoming parents before they are socially, emotionally, and economically prepared. Despite the amount of energy and resources devoted to prevention strategies, however, some teenagers will experience unintended and untimely pregnancies. For those who choose to keep an] raise then children, supports and services to promote healthy development, e~uca- tional attainment, and economic self-sufEc~ency should be available. Given the potentially adverse consequences of early parenthood for the life chances of young people, however, there should be alternatives to childbearing and childrearing. Abortion is a legal option for all women, including adolescents. We acknowledge that voluntary termination of pregnancy is controversial, and for many in our society it is morally reprehensible. Although the panel strongly prefers prevention of preg- nan~y to avoid parenthood, abortion is an alternative for teenagers for whom prevention fails. Adoption should also be available to those teenagers who choose to continue they pregnancies yet are unable or unwilling to assume the responsibilities of parenting. Goal 1: Reduce the Rate and Incidence of Unintended Pregnancy Among Adolescents, Especially Among Sckool-Age Teenagers The pane! is unequivocal ~ its con~ci~on that the primary goal of policy makers, professionals, parents, and teenagers themselves should be a reduction ~ the rate and incidence of Contended pregnancies among adolescents, espec~aDy school-age teenagers. Several strategies can assist in achieving this goal: enhance the life options of disadvantaged teenagers, delay the initiation of sexual activity, and encourage contra- ceptive use for teenagers who are sexually active. Unfortunately, very little scientific evidence is available on the electiveness of pro grams associated with the first two strategies, and so we can only endorse the development, implementation, and evaluation of such programs. For the third strategy, the scientific base is much ~eater, and promos can be based on the demonstrated effeci;veness of contraceptive use. Enhance Life Options Poverty and hopelessness, which exacerbate many social problems, play an especially important role in the problems associated with adolescent pregnancy. Sexual aciinty and pregnancy

OCR for page 1
SUMMARY 7 among teenagers are not confined by race and income, yet the correlation between poverty and adolescent fertility is well documented. For too many high-nsk teenagers, there are too few disincentives to early child- beanug. Inadequate basic skids, poor employment prospects, and the lack of successful role models for overcoming the overwhelmingly nega- i~ve odds of intergenerational poverty have stifled the motivation of many to delay ~mme~ate gratification and avoid pregnancy. Young people need a reason to believe that parenthood is ~nappropnate at this powt in their lives and that their opportunities for personal and occupa- tional success will be enhanced by postponement. Several possible inter- ventions are aimed at Indirectly reducing adolescent fertility by nurtur- ing the motivation to prevent untimely and unplanned parenthood, inClUdiIlg life planning courses, programs to improve school perfor- mance, employment programs, and programs to provide role models for high-risk youth. Program research clearly demonstrating the e~ective- ness of these interventions is not cuITent~y available. Nevertheless, the pane] endorses the development, implementation, and evaluation of such programs as a basis for future policy and program development. Delay Sexual Initiation A second strategy for reducing the rate of teenage pregnancy is to help teenagers, both male and female, develop ways to postpone sexual initiation until they are capable of making wise and responsible decisions concerning their personal lives and family formats on. Several interventions are anned at helping young people delay sexual initiation, ~nclud~g sex and family life education, asseri~ve- ness and decision-making training, programs to provide role models to yo',ng adolescents, and efforts to influence the media treannent of sexuality. Although there is little available evidence to document their effectiveness, the pane! endorses the development and evaluation of such programs as a basis for future policy and program decisions. In addition, Interventions to enhance the life options of teenagers may also encourage young people to delay the initiation of sexual acidity. Encourage Contraception Because there is so little evidence of the effectiveness of the other strategies for prevention, the pane} believes that the major strategy for reducing early unintended pregnancy must be the encouragement of diligent contraceptive use by aD sexually active teenagers. Male contraception, as wed as male support for female contra- cept~on, is essential. In light of the demonstrated effecnveness of contra

OCR for page 1
8 ADOLESCENT SEXUALITY; PREGNANCY; AND CHILDBEARING ceptive use, especially use of the contraceptive pill and the condom, in achieving this goal The panel concludes that use of the contraceptive pill is the safest and most effective means of birth controlforsexually active adolescents. Aggressive public education is needle] to lisper myths about the health risks of pill use by girls in this ad egroup, and co n traceptive service programs should explore nonmedicaI mod ells for distnbution of the pill. The panel concludes that, to make this strategy effective, there must be continue~publicsupportfor contraceptive cervices to adolescents, such as has been suppliedipnmanly through Title X of theFamilyPlanning Services and[Popuia ~ tion Research Act, Medicaid, and other federal and state maternal and chill health programs. Such programs should minimize the potential barriers of cost, convenience, and confidentiality. The panel urges that sex education programs include information or methods of contraception, how to use them, and how to obtain them. The panel urges continued support for a variety of contraceptive service models including private physicians to reach adolescents. Contraceptive serv- ices should be available to all teenagers at low or no cost. Clinic service providers, whether based in hospitals' public health departments, private clinics, orcommu- nity service organizations, should make efforts to improve the effectiveness of their programs by (1J enhancing their outreach efforts to encourage earlier use of contraceptive methods; 627 exploring more effective couttseling approaches to encourage compliance; andit3) enhancing theirfolZow-up of clinic patients to track their contraceptive use. The panel concludes that school systems, in cooperation with various health care and youth-sen~ing agencies, shouldfurther develop arty refine comprehensive school-haled clinic models for implementation in schools with large, high-nsk populations. The panel recommends the development, implementation, and: evaluation of condom ~istri~udon programs. The panel concludes that efforts should be undertaken to develop and test the effects on contraceptive use and unintended pregnancy of paid promotional messages for contraceptives that are directed at sexually active adolescents.

OCR for page 1
SUMMARY 9 Goal 2: Provide Alternatives to Adolescent Childbearing and Parenting The panel believes that prevention of pregnancy through abstinence or contraception is far preferable to unintended pregnancy among teen- agers. Regardless of one's personal convictions, decisions concerning pregnancy resolution whether to become a parent, to testate a pregnancy, or to relinquish a child for adoption are difficult, often painful choices. Nevertheless, when prevention fails, early parenthood is not the only available course. For young people who are unwilling to give birth or unable or unwilling to assume the responsibilities of parent- hood, two alternatives exist-abortion and adoption. Abortion In 1973 the Supreme Court made abortion a legal option for pregnancy resolution for all women, yet its use by teenagers, espe- chilly young teenagers, remains a special issue. There is no evidence coIlcerniIlg either the cognitive capacity of adolescents to make decisions about pregnancy termination or the psychological consequences of abor- tion that would support or refute the imposition of age restnctions governing access to abortion services. There is, however, growing en- dence that parental consent statutes cause teenagers to delay their abor- tions, if for no other reason than that those teenagers unwilling or unable to consult they parents must undergo the de facto waiting period associated with Owing a lawyer and gaining access to the courts ~ order to obtain a judicial bypass. Such delays may increase the health risks associated with abortion if they result ~ postponing it U=ti] the second tumester of pregnancy. In general, the health risks associated with an early, legal abortion are no greater for adolescents than for adult women, and in most cases they are lower. They are also lower than the risks associated with pregnancy and childbirth. The panel urges that at each step along the path from sexual initiation to parenting-regardless of whether one might wish that that step had not been reached the girl or woman should be treated with the same dignity, confidential- ity, kindness, and excellence of health care that are due any patient. The panel concludes that there is no scientific basisfor restricting the availabiZ- ity of abortion to adolescents. Evidence shows that to require minor teenagers to seek parental consent often causes them to delay abortions, with attendant health risks. On this basis, the panel concludes that minor adolescents should be encour

OCR for page 1
10 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING aged, but nor required, to involve the~rparer~tsarz~partners in the decision- making process. The panel believes there should be no compromise ire the medical andpersona supportive carefor the 400~000 adolescents who have an abortion each year. For those adolescents who choose to terminate their pregnancy, abortion services should include both decision counseling and contraceptive counseling. Adoption For pregnant adolescents who choose to continue their pregnancies but are unable or unwilling to assume the role and responsi- bilities of parenthood, adoption should be a viable option. The panel recommends that relevant public agencies, in cooperation with the private sector, explore ways of strengthening adoption services, including ifs improved decision counseling for pregnant teenagers and (2) development of effective models for providing comprehensive care to pregnant girls who choose adoption as an alternative to parenthood. Goal 3: Promote Positive Social, Economic, Health, and Developmental Outcomes for Adolescent Parents and Their Children Regardless of pregnancy prevention strategies or available alternatives to parenthood, some teenagers experience unpla$lued pregnancies and become parents. Many of those who do are at serious risk of health and nutntional deficiencies, dropping out of school, unemployment, single parenthood, poverty, and long-tenn welfare dependence. Their children have a higher probability of physical, social, and cognitive problems and defiaenaes. Although unmarred teenage parents represent a small pro- portion of the overall adolescent population, their problems and needs entail high public costs. Accordingly, a thud important goal is to pro- mote positive outcomes for adolescent parents and their children. Several . . . . . strategies can assist In ac llenOg t 11S goa .. Promote Healthy Birth Outcomes and Support the Physical Health of Young Mothers and Their Babies Young expectant mothers who receive early and regular prenatal care and nutrition are significantly more likely to have healthy birth outcomes than those who do not. Similarly, young children who receive regular health care as wed as appropriate emer- gency care are likely to be in better physical health than those who do not.

OCR for page 1
SUMMARY 11 The panel recommends continued support for the provision of appropriate health and nutrition services, ir~cZuling prenatal, labor, and delivery care for pregnant adolescents and reguZaranl emergency pediatric carefor the children of teenage mothers, through Medicaid; the Early and Pen olic Screening, Diagnosis and Treatment Program; and otherfederal and state maternal arz1 child health programs. Bureaucratic barriers that prevent teenagers from receiving early, regular, and appropriate care for themselves and their children shout: be mini- mizel. Prevent Subsequent Untimely and Unintended Births A second untimely and unintended birth is likely to compound the already complex and overwhelming problems faced by many adolescent parents. Prevention of subsequent pregnancies and births is thus an important strategy for promoting positive outcomes for teenage parents and their children. The pane, concludes that contraceptive services should be available and accessi- bZe to adolescent parents at low or no cost. Because of the special needs of this high- risk population, service providers should strengthen their programs by (1J enhanc- ing their outreach efforts to encourage early use of contraceptive methods; (29 leveZoping intensive ir'dividuaZizel counseling and care techniques to encourage compliance; and (3) en Lancing theirfoZZow-up procedures to track contraceptive use. Ensure the Economic Well-being of the Teenage Family Parents, includ- ing fathers, are obligated to pronde support until their children reach age 18. But many fathers, especially teenage fathers, who may not have completed school and who are unemployed or employed only part-time, are unlikely to be able to make a significant contribution to the support of their children. For this reason, young fathers have often not been pursued by child support enforcement authorities. There has been re- newed interest, however, In enforcing child support by fathers of chil- dren born to teenage mothers, both to provide additional financial assistance to young mothers and their children and to increase young men's sense of parental responsibility. There is little emsung research or program expenence to guide new policies in this area. Nevertheless, the pane! urges efforts to educate young men about their cold support obligations and to enforce those obligations over time. Expenmental efforts to link chilc! support enforcement to work requirements, mclud- ~ng part-i~me and summer jobs for fathers who are enrobed in school, should be Ligated and tested.

OCR for page 1
12 ADOLESCENT SEXUALITY, PREGNANCY AND CHILDBEARING The parents of adolescent parents should also be encouraged to assume responsibility for the support and obligations of their minor (under age i8) chi~ciren an] the children of these minors. Again, research and program experience in this area is liniite]. Recent state legislation estab- lish3=g grandparent liability should be carefully monitored to dete~ine its elects. Enhance Life Options for Adolescent Parents Teenage parents must be encourage] to invest in their own futures. Both the motivation and the means to overcome the likely adverse consequences of early childbeanng are essential. Therefore, another important strategy for improving so- c~al, economic, and health outcomes is to enhance the life opportunities of adolescent parents. Thepanel urges that a broad array of special education programs and cervices for pregnant and parenting teenagers be developed and implemented to assist these young people in completing their education. Thepane2 concludes that efforts should be continued to strengthen and expand age-appropruz~e employment programs for pregnant girls and teenage parents, both male andiemale. The panel recommends that support be providelfor the development, imple- mentation, and evaluation of model child care programs that are targeted! to the needs of teenage parents. Schools and other community organizations should place high priority or' establishing and maintaining these senJicesfor the children of adolescents. The panel urges that public and voluntary community agencies explore ways of developing and evaluating case management capabilities to help adolescent parents obtain the necessary supports and services. Promote the Social, Emotional, andlntellectualDevelopment ofthe Children of Adolescent Parents The children of adolescent parents are especially vulnerable to health, social, and cognitive problems. Special supports and services are needed by many adolescent parents to prevent or over- come these difficuli~es and to promote their chil~en's healthy develop meet. The panel urges thatparenting education for teenage parents, especially those from severely disadvantaged backgrounds, receive specialattention and emphasis.

OCR for page 1
SUMMARY 13 Schools arid other community organtzatiorts should place high pnonty on the development, implementation, arid evaluation of these programs. RECOMMENDATIONS FOR DATA COLLECTION AND RESEARCH Over the past several years, researchers have made significant advances in knowledge of teenage sexuality, pregnancy, and parenting. Yet many questions remain unanswered, and they suggest priorities for future data collection and research. Program Evaluation Research Despite the enormous commitment of public and private monetary resources and human effort toward designing and implementing preven- tive and ameliorative interventions, evidence of program COStS, effects, and effectiveness is frequently unavailable or of poor quality. Although there are significant methodological, ethical, and practical problems associated with evaluations of these programs, they can be evaluated. Evaluation research methods have become quite sophisticated, yet they are fi:equeIltly not used ir studying the effects of adolescent pregnancy programs. Reliable data are needed as a basis for policy and program development. The pane] recommends that evaluation lo measure the costs, effects, and effectiveness of service programs be an essential component of intervention: strategies. Federal and state-leve!funding agencies should be urged to set aside adequate supportfor evaluation research, and the research community should be urged to take a more active role in designing and implementing these studies. Data Collection Data on teenage sexual acidity, contraceptive use, pregnancy, abor- tion, childbearing, and other fer~ity-related behaviors have been vital to Me panel's deliberations and are equally essential for figure research and analysis. Relevant information is available from several different sources, including large-scale surveys, federal and state administrative reporting systems, and service providers. Individual data systems vary in their underlying purposes and special emphases as wed as they specific charac

OCR for page 1
14 ADOLESCENT SEXUALITY; PREGNANCY; AND CHILDBEARING ter~stics (e.g., reeditions, sample size, data collection integrals). For these reasons, and because information on sensitive issues requires ~ralida- tion Mom more than one source, a muiti~imensionai strategy for data collection is needed. The panel recommends that data systems that monitorfertility anlfertility- retatedbehaviorsshould be maintained and strengthened. Such data are essential for understanding bends anlcorrelates of adolescent sexualactivity, contraceptive use, pregnancy, abortion, and childbearing and as a basisforpolicy Deprogram development. Fiscal cutbacks that affect ongoing Eta collection programs could seriously damage the quality and availability ofthese Eta systems. Research on Adolescent Sexual and Fertility Behavior Research on adolescent sexuality and fertility has increased substan- tia~y over the past decade, and this knowledge has pronded an essential basis for the panel's deliberations. Nevertheless, there are several signifi- cant gaps. In some cases, the gaps reflect issues that have not been adequately studied because of methodological problems; in others, new issues have emerged from the accumulation of past findings. Future research should reflect the domains of causes and consequences of teen- age pregnancy end childbearing: indim~uals, families, communities, and society. The parle! recommends the continue] support of a broad-based researchpro- gram on adolescent se~cuality antifertility to enhance understanding ofthe causes and consequences of these behaviors and to inform poll anlprogram levelop- ment E:cpenmentation Although promising program models require further monitoring and evaluation, emsiingprogr~m development efforts should be expended to Include arpenmentaiIon with innovative models for and novel ap- proaches to pregnancy prevention and for the support an] care of preg- ~t an] parenting teenagers and their chidden. Iltepanelrecommends thatiederalfunding agencies, privatefoundations, and researchers cooperate in designing, implementing, and evaluating experimental approaches for pregnancy prevention among hith-nsk a doZescents anclfor im- proving the well-being of teenage parents and their children.