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9 Pnonties for Policies and Programs Like many others who have addressed the issues of adolescent preg- nancy and childbearing its recent years, the Pane} on Adolescent Pregnancy and Childbeanng has recognized that the problems are complex and controversial. Solutions unD not be easily or rapidly attained. Although the age of initiation end rates of sexual activity are comparable, the United States leads most other developed countries In the rate of early pregIlan- aes, abortions, and births tO adolescent mothers. Fertility vanes by age, race, and socioeconomic status, but early pregnancy and childbearing are IlOt limited to any single subgroup. They are DOt confined by urban or rural boundaries, nor is their Impact limited tO a single gender or genera- tion. Everyone is affected, directly or Correctly. Adolescent pregnant and childbeanug are issues of broad national concern, and they are issues . . t tat require urgent attention. Regardless of one's political philosophy or moral perspective, the basic facts are disturbing: more than ~ million adolescents become pregnant each year. Just over 400,000 teenagers obtain abortions, and nearly 470,000 give birth. The majonty of these births are to unmarried moth- ers, nearly half of whom have not yet reached their eighteenth birthday. For teenage parents and their children, prospects for a healthy and independent life are significantly reduced. Young mothers, ~ the absence Of adequate nutntion and appropriate prenatal health rare, are at a height- ened risk of pregnancy complications and poor both outcomes; they are also more likely tO experience a subsequent pregnancy while still ~ their teens. The infants of teenage mothers also face greater health risks, ~nclud 26~

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262 ADOL~SCEN-T SEXUALITY PREGNANCY AND CHILDBEARING ing low birthweight, accidents, illness, and infant mortality. Teenage mamages, when they occur, are characterized by a high degree of instabil- ity. In addition, teenage parents, both female and male, suffer the negative impact that untunely parenting has on their educational attainment and the related limitation of career opportunities. Teenage parents are more likely than those who delay childbeanng to experience serious unempioy- ment and inadequate income. Because these young people often fare poorly in the workplace, they aIld their children are highly likely to become dependent on public assistance and to remain dependent longer. Somety's economic burden in sustaining these families is substantial. Why do young people who are hardly more than children themselves become parents? Is it due to a lack of individual responsibility, matunty, knowledge, and values? Or does it result from the pervasive problems associated with poverty, including limited education and employment opportunities, and among many high-nsk youth, growing up in a father- less family? The answer to both of these questions seems to be yes. The causes of teenage pregnancy are varied and complex, and tO a large extent the issues of individual responsibility and social environment are mterre- {ate3. For this reason, the panel has studied and addressed the problems with both individual and societal perspectives in mind. On the basis of two years of rewew, analysis, and debate, the panel has reached six general conclusions, which underlie all of itS specific cor~clu- sions and recommendations for policies and programs: I. Prevention of adolescent pregnancy should have the highest pnonty. In both human and monetary tens, 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. Sexually active teenagers, both boys and girls, need the ability to avoid pregnancy and the motivation tO 60 SO. Early, regular, and effective contraceptive use results In fewer unintended pregnancies. Delaying the Initiation of sexual activity will also reduce the~ncidence of pregnancy, but we currently know very little about how to effectively discourage unmar- ried teenagers Tom initiating intercourse. Most young people do become sexually active during their teenage years. Therefore, making contracep- nve methods available and accessible to those who are sexually active and encouraging them tO diligently use these methods is the surest strategy for pregnancy prevention. 3. Society must adroit treating adolescent pregnancy as a problem peculiar to teenage girls. Our concept of the high-nsk population must

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PRIORITIES FOR POLICIES AND PROGRAMS 263 include boys. Their attitudes, motivations, and behavior are as central to the problems as those of they female partners, 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 will continue to need a comprehensive array of policies and programs targeted to the special characteristics of commun3 ties and to the circumstances of teenagers from different social, cultural, and economic backgrounds and of different ages. Because adolescents are not a monolithic group, they do not a] experience sexual activity, pregnancy, and childbean~g 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 goals and the specific interventions to carry them out, however, should be sensitive to differences In values, attitudes, and experiences 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 unintended pregnancy and birth are likely to be most severe: young adolescents and those from the most socially and economically disadvantaged backgrounds. In many ways those at highest risk are hardest 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 childbearing should be shared among m~induals, families, voluntary org~7~ations, communities, and governments. In the Unite] States, we place a high priority on ensuring the rights of ~ndinduals to hold different values and the rights of families to raise their children according to their own beliefs. Therefore, public policies should affirm the role and respons~- bility of families to teach human values. Federal and state governments and community institutions should supplement rather than detract from that role. The prevalence of adolescent pregnancy and childbearing is weL docu- mented. Knowledge about the causes and consequences of these behaviors has greatly expanded over the past decade and a half. Knowledge from the growing body of evaluation literature and accumulated intervention expe- nence, though incomplete in many respects, suggests opportunities and directions for policies and programs aimed at sobering these problems. In the remainder of this chapter we present specific conclusions and recom

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264 ADOLESCENT SEXUALITY; PREGNANCY AND CHILDBEARING mendations within a basic framework for establishing policy goals, identi- fying alternative strategies to achieve these goals, and selecting specific programmatic approaches to carry out these strategies. PRIORITIES FOR POLICIES AND PROGRAMS The panel's conclusions and recommendations cover a range of actim- ties that includes research, planning, policy development, service delivery, and monitoring. Some of the specific actions we propose would involve steps by federal, state, and local policy makers to enact new legislation or direct the agencies under their jurisdiction to undertake new initiatives. Others would require the continuation or intensification of public and private efforts already under way. When existing knowledge supports new or revised policies and programs or highlights the effectiveness of . . . . . ,. . Ongoing 1mtlatlves, we propose specific new or continues programs or specific agenda for 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 effectiveness of promising approaches. When innovative policies have been indicated but there are as yet no scientifically measurable outcomes, we urge carefid observation and mon~tonng. Many of our recommenda- tions build on policies, programs, and research that are already under way. Many reinforce the priorities of other individuals and groups that are addressing these complex and controversial issues of adolescent pregnancy. The panel has identified three overarching policy goals, presented in order of prionty, that provide a framework for our specific conclusions and recommendations: 1. Reduce the rate and incidence of umntended pregnancy among adolescents, especially among school-age teenagers. 2. Provide alternatives to adolescent childbearing and parenting. 3. Promote positive social, economic, health, and developmental out- comes for adolescent parents and their children. For most young people in the United States, realizing fuming adult work and family roles depends on completing an education and entering the labor force before becoming a parent. Many do delay the in~tiai~on of sexual acidity until after they have graduated from high school, pursued postsecondary education or gained work experience or both, and perhaps married. Many others become sexually active before they have passed these

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PRIORITIES FOR POLICIES AND PROGRAMS 265 milestones in the transition from adolescence to adulthood. Regardless of the timing they choose for initiation of sexual activity, however, all adolescents need the ability and the motivation to avoid becoming parents before they are socially, emotionally, and economically prepared. As a society, our approach to pregnancy prevention must be targeted to the complex social, emotional, and physical needs of all adolescents. Preg- nancy prevention strategies must provide teenagers the necessary support and encouragement to strive for fulfilling, productive adult roles in addi- iIon to parenthood. Despite the amount of energy and resources that are devoted to prever~- tion strategies, however, some teenagers will experience unintended and untimely pregnancies Given the potentially adverse consequences of early parenting for the life chances of these young people, there should be alternatives to childbeanng and childrearing. Abortion is a legal option for all women, including adolescents. We acknowledge that voluntary termi- nation of pregnancy is controversial, and for many in our society it iS morally reprehensible. Although we strongly prefer prevention of preg- nancy to avoid parenthood, abortion is an alternative for teenagers for whom prevention fails. Adoption is also available to those teenagers who choose not to voluntarily terminate their pregnancies yet are unable or unwilling to assume the ~11 responsibilities of parenting. Finally, for teenagers who choose to bear and to raise their children themselves, supports and services to promote healthy development, re- sponsible parenting, educational attainment, and economic self- sufEc~ency should be available. Indeed, investing In the quality of life of teenage parents, their families, and their children may be the first step toward preventing early unintended pregnancies in the next generation. Inherent ~ this policy Framework for addressing the problems of ado- lescent pregnancy and childbeanug is a sigIliEcant dilemma. In placing the highest pnonty on prevention, we do not mean tO diminish the significant need for supports and services for pregnant and parenting teenagers. Yet, remedial responses, however effective, do not address the basic needs of young people who have not become sexually active and who have not expenenced pregnancy. And some have raised concerns that policies and programs that offer support and assistance only after a pregnancy has occurred may even have created the wrong incentives, especially for those from severely disadvantaged backgrounds. Ad young people, regardless of whether they are teenage parents, need tO be encouraged tO develop positive perceptions of what their lives can be. They need opportunities tO

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266 ADOLESCEN T SEXUALITY PREGNANCY AND CHILDBEARING achieve their goals, and they need support an] assistance from their families and their communities to become healthy, productive adult mem- bers of society. Goal 1: Reduce the Rate and Incidence of Unintended Pregnancy Among Adlolescents, Especially Among School-Age Teenagers The panel is unequivocal in its conviction that the primary goal of policy makers, professionals, parents, and teenagers should be a reduction in the rate and incidence of unintencled pregnancy among adolescents, espectaDy among school-age teenagers. Pregnancy prevention would result not only in fewer births but also in fewer abortions to teenagers. Although an ur~planned pregnancy can have seriously negative conse- quences at age 18 or 19 among those who have completed high school, it is likely to present even greater hurdles for younger teenagers. When preg- nancy results in childbeanng, it increases the probability that adolescent parents will drop out of school and reduces the probability that they will complete high school or pursue postsecondary education. Early childbear- ing is also associated with larger family size. For these reasons, younger teenage parents are often vulnerable to an array of adverse social and economic consequences, which we have discussed In detail in this report. In addition, the younger the teenage mother at the rime of birth, the higher the average estimated public costs of her childbeanng and the higher the estimated potential savings of her postponing that birth. The panel has identified three general strategies that con lead to a reduction in the rate of early pregnancy: enhance the life options of disadvantaged teenagers, `delay the initiation of sexual activity, and en- courage contraceptive use by sexually active teenagers. Central to all of them is the need for teenagers themselves to embrace values that lead to responsible, healthy, and productive lives, including the avoidance of unplanned and untimely parenting, and to be steadfast In their belief that they can achieve their goals. Parents and family members can and should play a key role in helping young people, both male and female, acquire and retain these values. But indiv3 duel and family values are influenced by community and societal norms: therefore, the community as a whole must reinforce and support in~im~ual and family efforts to discourage early pregnancy and encourage adult self-su~ciency. Enhance Lithe Oprior~s Poverty and hopelessness, which exacerbate many social problems, play an especially important role in the problems

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PRIORITIES FOR POLICIES AND PROGRAMS 267 associated with adolescent pregnancy. Sexual activity and pregnancy among teenagers are not confined by race and income, yet the correlation between poverty and adolescent fertility is well documented. Nationally, more than half of Aid to Families With Dependent Children (AFDC) benefits support families in which the mother gave birth as a teenager. The median income of families headed by women under the age of 25 is below the poverty level, and approximately three-quarters of all such families live in poverty. Research has shown the deleterious effects of poverty on those caught in its cycle: attitudes offatalism, powerlessness, alienation, and helpless- ness that are perpetuated from one generation to the next. For tOO many high-risk teenagers, there are too few disincentives to early childbearing. Inadequate basic skills, poor employment prospects, and few successful role models for overcoming the overwhelmingly negative odds of in- tergenerational poverty have stifled the motivation of many to delay immediate gratification and avoid pregnancy. Teenagers need a reason to believe that parenthood is inappropriate at this point in their lives. Accordingly, one important strategy for reduc- ing early unplanned pregnancy is to enhance their life options, by en- couraging them to establish career goals in addition tO parenthood and by helping them understand the value of educational attainment and employability skills. This strategy is aimed at reducing adolescent fertil- ity by nurturing the motivation to prevent untimely and unplanned parenthood. We lack program research that clearly demonstrates the effectiveness of this strategy for reducing early pregnancy. Nevertheless, we outIme below several interventions that seem promising and merit farther de- velopment and evaluation. Life-planning courses Helping teenagers to understand the seriously negative consequences of an unplanned birth for their present and future lives may be an important component of developing motivation. Life- plann3ng courses are aimed at helping high-risk teenagers identify educa- tion, career, and family options, develop life plans and goals, and under- stand how early childbearing might affect the* ability to achieve those goals. Programs of this type have been smaD-scale, and there is little deEninve evidence oftheir success. Early returns, however, suggest that this may be a promising approach. Intervention models of this type need further development and evaluation. In particular, attention Is sleeked on

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268 ADOLESCENT SEXUALITY PREGNA.NCY AND CHILDBEARING the related supports and services that are necessary to help teenagers effectively use the information, planning, and decision-making skills they can gain in life-planning courses. Programs to improve school performance Boosting school achieve- ment and preventing school dropout may also be a promising approach to reduce early umOten~e] childbearing among school-age teenagers. Teenage pregnancy rates have been shown to be higher among poor achievers. Poor school performance negatively affects self-concept and motivation. It also has adverse eRects on later employment opportuni- t~es. As many researchers, sernce providers, and advocates have observed, educational opportunity and achievement are key to helping high-nsk teenagers develop execrated expectations, a sense of can-do, and the basic skips necessary to achieve their goals. Although developing afuD agenda of educational refonn was not within the mandate or expertise of the panel, we highlight the need for educational interventions whether alternative schools or special programs in regular schools-to overcome the educational problems and ~e~clenaes of many young people. in particular, such programs need to identify high-risk students early in the* educational careers and provide the remediation required to ensure that they develop essential basic skids and achieve smooth education-to- work transitions. Although research has not specifically linked pro- grams to improve school performance with reductions in adolescent pregnancy, such programs merit further development and evaluation to assess their potential effects on fertility. Employment programs Chronic unemployment and poorjob pros- pects among some subgroups of the population have had serious adverse eRects on many young people's perceptions of opportunity. The lack of meaningful employment options may diminish the motivation to delay parenthood. As with educational refonn, the development of a compre- hensive plan for youth employment is beyond the mandate and expertise of the panel, yet we emphasize the need to enhance the employability of high-nsk youth by providing them with i~ors~ation concerning career alternatives, by teaching job skills and job search skills, and by helping them gain work experience while completing their educations. Again, although research has not specifically linked youth employment pro- grams to reductions in adolescent pregnancy, such programs merit fur

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PRIORITIES FOR POLICIES AND PROGRAMS 269 ther development and evaluation to assess their potential effects on fertility. Role models All young people adopt role models-whether in their . families, among their peers, or in their communities that significantly influence their developing values, attitudes, and behavior. Prov3 ding high-nsk teenagers with positive examples on which to model their behavior may help them form aspirations, expectations, and activity patterns that match desired norms. Role mode] and mentonug pro- grams are intended to help teenagers see in others what they can become themselves. Most emphasize the importance of educations attainment, employability, and responsible sexual and fertility behavior. These inter- ventions are relatively new and to date most have been small in scale. As a result, there is no definitive evidence of their success in reducing early nmutended pregnancy, yet they ment further examination and trial. 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 anti family formation. For young teenagers especially, pregnancy and parenthood are often distant, intangible abstractions. Relating sexual decisions to lifelong consequences is difficult. Adolescents who cannot conceptually link current behavior to future contingencies are often unreliable users of contraceptive methods. For them, efforts directed at discouraging the iIiitiation of sexual activity may be an appropriate means of reducing umOten~e] pregnancy. Essential to the success of this strategy are the acquisition of probiem-solv~ng and communication skills, understand- ing of the personal and societal consequences of unprotected sexual acidity, and knowledge of how to act responsibly. Enhancing life op- tions, which has been discussed above, may also encourage teenagers to delay the initiation of sexual acunty. Several interventions have the potential for helping young people delay the initiation of sexual activity, although there is little available endence at this time to document their effectiveness. Sex education and family life education Courses that provide wfor- mation about sexuality and family roles and interactions have been shown to increase students' knowledge of reproduction and the proba -

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270 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING ble consequences of sexual activity without contraception. Although these courses are widely available in school systems nationwide, they crazy substantially in their content, their comprehensiveness, and the quality of instruction. They also vary in the extent of parent and com- mum~y involvement in their planning and implementation. In addition, few school districts have programs that are directed at children of ele- mentary school age. While knowledge alone cannot be expected to alter adolescent behavior, education programs that are combined with other approaches, such as assertiveness and decision-making training and role modeling, may help reinforce family values, responsible behavior, and self-control with regard to sexual activity. Similarly, age-appropnate education programs that provide young children with information con- cerning sexuality and sex abuse, as well as training to deal with poten- tiaDy abusive encounters, may help reduce their anxieties and fears about personal sexual development and improve their ability to avoid sexual exploitation. Unfortunately, program research to date has not pronded conclusive evidence of the impact of sex and family life education on the . . . . .. . tang o: : sexua . Stratton. Assertiveness and decision-making training Programs that teach ad- olescents problem-soinng, decision-making, and interpersonal commu- nication skills are sometimes aimed at promoting sexual abstinence by counseling younger adolescent boys and girls on how to resist pressures to become sexually active before they are ready. An evaluation of one program using this approach is now under way. If the results of that study are positive, replications and adaptations of this program mode! may be warranted. Role models Many adolescents learn by example; they are attracted to real and fictional characters who seem powerful and successful. Soa- ety's response to the behavior of those models helps young people to develop expectations for their own behavior and the behavior of others and to cianf y their personal values. When role models exemplify societal ideals, the process can potentially have positive effects on adolescents' attitudes, motivations, end behaviors, including sexualbehanor. Several interventions using peer counselors, mentors, and adult community volunteers to work on a one-to-one basis with high-risk teenagers are now berg tested. Among the tasks of the role models is to help teenag- ers find activities other than sexual ones that can Fife they needs for

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PRIORITIES FOR POLICIES AND PROGRA.~S 271 emotional gratification, for example, SportS and community service. If the results of these efforts show positive effects on delay of sexual initiation, replications and adaptations of this approach may be war- ranted. Media treatment of sexuality Among the most pervasive influences on adolescents are the personalities and heroes of television, movies, and rock music. The exploitation of sex, aggression, and violence in media programming and advertising has become a central issue for many indi- viduals and groups concerned about adolescent pregnancy and childbear- ing (e.g., the Children's Defense Fund, the National Urban League, the Center for Population Options, and several state and local coalitions and task forces). Some of these groups are exploring ways to encourage the media to present more realistic and responsible portrayals of personal and sexual relationships among adult heroes and to discourage sexual activity and parenting among young adolescents. Because most of these efforts are in preliminary stages, it is too early to assess their effects on program- ming content and advertising approaches. Indeed, the incentives for network executives to alter they current messages and models are weak. Nevertheless, multiple coordinated efforts at the community level and at the national level to exert pressure may have greater potential for e~ect- ing change than isolated appeals. Encourage Contraception The panel's research has established that the most effective intervention for reducing early unintended pregnancy in sexually active teenagers is diligent contraceptive use. Male contracep- tion, as we] as mate support for female contraception, is essential. Adolescents who practice contraception are less likely to experience an unplanned pregnancy than those who do not; those who rely on the contraceptive piD are less likely to conceive than those who use noupre- scnption methods. Although modem contraceptive technology, espe- c~ally the pill, may have contnbuted to the liberalization of societal sexual attitudes and practices, which In turn have influenced adolescent behavior, there is no evidence that the availability of contraceptive services per se has caused increased sexual activity among teenagers, mate or female. In fact, studies show that many adolescent girls are sexually active a year or more before they obtain contraceptives. This pattern must be changed in order to reduce the incidence of early unintended pregnancy and ultimately the more painful, hazardous, and disruptive

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284 ADOLESCE.~JT SEXUALITY PREGNANCY AND CHILDBEARING with malnourishment. It has also been shown to serve as a means of recruiting hi~h-risk pregnant women into prenatal care. O cot ~ ~ Pediatric care Well-baby care, as well as emergency care, has been shown to improve the physical health of all children, especially those at serious risk of pennatal dysfunction. As with prenatal care, info' Elation and health education can help young mothers and fathers understand the importance of well-baby care and positive health behaviors for their children's long-term development and well-being. Pediatric care programs and well-baby clinics are available to teenage parents through public health departments, hospitals, freestanding com- munity clinics, and school-based clinics. These programs involve a van- ety of sennce delivery models, including clinic services, home nsits, and the integration of other necessary services, such as nutrition services, contraceptive seances, and education and career counseling. Most teen- age parents who seek publicly subsidized services rely on federal pro- grams to pay for those services, among them Medicaid, the Early and Penodic Screening, Diagnosis and Treatment Program, and to some extent other maternal and child health programs. There is some evidence that eligibility standards and application procedures in some states may discourage needy parents from seeking well-baby and emergency care for their children. These bureaucratic barriers should be minimized. Prevent Subsequer:t Untimely and Unintended Births An untimely and unintended birth tends to have seriously negative social and economic consequences for young mothers, young fathers, and their children. A second untimely an] uninten~eci birth is likely to compound the already complex and overwhelming problems. Many adolescents who give birth experience repeat pregnancies within two years. Although most adoles- cent parents report that they did not intend to become pregnant again SO quickly, most did not take effective steps to prevent conception. Contra- ceptive diligence requires a significant degree of commitment. Many teenage girls are easily dissuaded from regular contraceptive use by boyfriends, by problems in using their chosen method, or by informa- tion (often inaccurate) about possible negative side effects. Adolescents who have expenenced childbeanng are no different. Helping them to prevent subsequent untimely and unintended births requires that their family planning needs receive special attention and emphasis.

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PRIORITIES FOR POLICIES AND PROGRAMS 285 Several interventions have the potential for preventing subsequent untimely and unintended births to adolescent parents. Contraceptive services The use of contraception reduces the proba- bility of pregnancy. Getting adolescent mothers and fathers to practice contraception regularly can substantially lower the likelihood of a repeat pregnancy an] birth. Several aspects of service delivery to this target population are important: aggressive outreach and follow-up to reach parenting teenagers as soon as possible after delivery, assistance in getting them to clinics, and close monitoring of their success or difficlity in using their chosen method; directive advice on contraceptive practice; easy access to convenient, low-cost (or no cost) contraceptive seances; and intensive irldindualized care. Low-key approaches to contraceptive use in several comprehensive pregnancy care programs have been shown to be insufficient. Leaming to contracept successfully is difficult for many adult women. For teenagers who lack experience, confidence in their social relationships, and the ability to plan ahead, it is even more difficult. For many parenting teenagers who cannot foresee other viable life options than motherhood, a forceful and consistent message about the risks of subsequent pregnancy and the importance of contraception are essential. While contraceptive services alone cannot control subse- quent fertility among teenage parents, they are a necessary first step. The panel concludes that contraceptive services should be available and accessi- ble to adolescent parents at 20w or no cost. Because of the special needs of this high- nsk population, sentence providers should strengthen: theirprograms by0J enhanc- ing their outreach efforts to encourage early use of contraceptive methods; (2) developing 2r'rensive individualized counseling and care techniques to encourage compliance; and (3) enhancing their follow-up procedures to track contraceptive use. Abortion services For those who experience repeat pregnancies and fee] unable to cope with the compounded difficulties of raising more than one child, abortion is an option for pregnancy resolution. Ensure the Economic Weli-being of the Teenage Family For teenage parents, especially those under age 18 and those without a high school diploma, who have not yet developed the ability to support themselves, economic well-being is a major concern. Adequate income support is a

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286 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING necessary precondition to school completion and to promoting the health and well-being of young mothers and their children. Severe poverty increases the likelihood of poor health, inadequate nutrition, personal frustration, and early economic dependence. Ensuring the economic security of teenage families until they are able to become self-sufEc~ent is an essential strategy to achieving the larger goal of promoting positive outcomes for these young parents and their children and should involve partners, families, and the community. Two interventions are especially relevant. Child support enforcement Fathers should be involved in the Enan- cial support of their children. Teenage fathers, who may not have com- pleted school and who are employed only part-time or who are unem- ployed, are unlikely to be able to make a significant contnbution to the support of their children while they are still in their teens. For this reason, young fathers have not typically been actively pursued by the state for child support. However, there has been renewed interest In enforcing child support by fathers of children born to teenage mothers, both to provide additional financial assistance to young mothers and as a means to increase young men's sense of parental responsibility. Indeed, parents are obligated to provide support until their children reach age 18, and even if the father's current level of financial assistance is low, his contnbution may increase over time and have long-term positive effects on his children. There is little existing research or program experience to guide new polices in teds area. However, farther efforts shoed be made to encore the effects and effectiveness (short-term and long-term) of child support enforcement among teenage fathers. As a first step, young men should be educated about their child support obligations. In addition, efforts should be made to link child support to education and work require- ments in the fonn of (~) registration tenth the state employment service and (2) participation ~ job training and job search activities as well as work opportunities. At a tUne when an increasing number of states are adopting "workfare" programs for welfare mothers (including the mothers of very young children), it is appropriate to consider similar public jobs programs for the fathers of young children who camlot otherwise fed work and pronde support for their families. The families of adolescent parents should also be encouraged to as- sume responsibility for the support and obligations of their minor chil

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PRIORITIES FOR POLICIES AND PROGRAMS 287 dren, including the children of teenagers under 18. Research suggests that adolescent mothers, especially school-age gratis, who remain in their parents' home and receive support and assistance from their families, fare better In the short term than those who establish independent house- holds. In turn, the children of young mothers benefit from this support and assistance. Program experience in this area is extremely limited, although several states, most notably Wisconsin, have recently enacted statutes requiring grandparent support for the children of adolescent mothers. While it can be assumed that enforcing grandparents' liability win increase the financial resources to teenage parents and their children, there are no data to show whether such provisions will serve the larger purpose of strengthening family bonds and stimulating emotionally supportive parental involvement, or wig have less desirable effects. Aid to Families With Dependent Children Public assistance for adolescent mothers and their children represents an important source of economic secunty when husbands or partners and families are unable to meet the necessary level of financial support. The availability of AFDC and related food stamp and Medicaid benefits has raised controversy over the extent to which it encourages young women to become parents before they are able to become economically self-sufficient. Although there is no evidence that AFDC benefits encourage young women to become sexually active or to become pregnant, there is some evidence that they may influence decisions concerning living arrangements of pregnant and parenting teenagers. The 1984 Deficit Reduction Act amendments to the Somal Security Act established that teenage parents eligible for AFDC and living with their parents must be included In a household grant. Minor mothers living apart from their families, how- ever, are eligible to receive benefits on their OWD . This regulation may constitute an incentive for a teenage mother to establish independent Wing arrangements, thereby ~r~dermining her fan3ily's obligation and ability to provide financial and emotional support. To the extent that 1984 legislative changes governing AFDC eligibility deny income and Medicaid benefits to young mothers and their children if they remain in the parental home, these provisions should be carefully reviewed. Trre- spective of federal action governing AFDC eligibility, the states should explore policy options to allow adolescent parents under age 18 to remain in their families of origin whenever possible until they have completed high school (or the equivalents, until they are able to become

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288 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING economically self-sufficier~t, or both. There is little research evidence to support policies in this area. One possibility, however, is to link the receipt of AFDC benefits by teenage mothers to remaining in their parents' home, except under conditions that pose a physical or emotional hazard to the adolescent or her baby. Enhance Life OptionsforAdolescent Parents Efforts to improve mater- nal and child health outcomes, to improve developmental outcomes among the children of adolescent parents, and to prevent subsequent pregnancy may have little positive eEect until teenagers can be persuaded to "invest in their own Futures." Both the motivation and the means are essential to overcoming the likely negative consequences of early child- beanug. Although many teenage mothers (and fathers) report aspira- tions that are very similar to those of their peers who delay childbearing a nice home, a good job, and a Toning spouse they frequently have ~if~cuity ennsion~g in concrete terms how to make their dreams attainable. Therefore, a fourth important strategy for im- pronng social, economic, and health outcomes for adolescent parents and their children is to enhance their life opportunities. Several approaches appear to be especially promising: Life management training Life planning assistance is important to help teenage parents, both mate and female, establish education, career, and family formation goals for themselves and to identifier pathways to achieving these goals that take account of their parenting responsibili- ties. Similarly, life skills training to help them learn how to manage their everyday lives independently are important to success in pursuing their chosen work and family goals. Teenage parents need to have realistic dress Is of what they can be, in addition to being a parent, and an understanding of how to ~ those dreams, one step at a time. Re- search conclusively demonstrating the impact of life management train- ing on the economic self-sufflaency, marital stability, and parenting skills of teenage parents is not available, and efforts to develop and test mode} programs of this type are needed. Educations support and remediation The detrimental effect of early childbeanng on educational attainment has been clearly demonstrated. Most teenagers who become mothers before they graduate do not finish high school. Similarly, many adolescent fathers who assume parenting

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PRIORITIES FOR POLICIES AND PROGRAMS 289 responsibiiines often find it difficult to complete their education. The relationship between school performance, school attendance, and ado- lescent childbearing is complex. Many teenagers who become parents are at risk of dropping out of high school or have left school before they became pregnant. Parenthood for these young people may represerlt a more positive immediate experience than education. For those who have consistently failed ~ the classroom, there is understandably little incen- tive to return. Yet adolescent parents must be made to recognize that Hmshing school is essential to fulfilling their other aspirations for home, family, and work. In some cases, regular classrooms and mainstream educational programs may not be appropriate. Many of these young people need intensive remedial education and self-paced instruction to be successful. Alternative school programs, including high school equiva- lencyr courses, represent one option; others may include home instruc- tion or TV instruction to meet the special needs of these high-nsk students. Accordingly, the panel urges that a broad array of special education programs and servicesforpregrzantandparenting teenagers be developed and implemented to assist these young people in completing their education. Employment programs Regardless of the availability of child sup- port, older pregnant and parenting teenagers (18- and 19-year-olds) need employment services that provide job training and assist In job place- ment. Those under age 18 need services that emphasize the importance of completing high school, while eIlhaIlcing their later employability and transition from school to work. Younger teenagers may benefit from information concerning career alternatives and job requirements, job readiness and job search skids, and temporary or part-time work experience. As with employment programs that are aimed at preven- tion, those sensing pregnant and parenting teenagers need to take into account the related service needs of these young people, including child care, transportation, counseling, etc., which can significantly affect their participation and outcomes. Many existing youth employment programs have excluded teenage parents because of their special needs. In this regard, the problems of adolescent fathers require special attention. Employment opportunities are so inadequate and earnings are so low for many young men, especially m~nonties, who have been reared in poverty and who lack education, job training, and work expenence,

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290 ADOLESCENT SEXUALITY PREGNANCY AND CHILDBEARING that they are not able to participate in their childrer~'s support. To encourage teenage fathers to become economically responsible for their offspring and to form self-sufficient two-parent fa:Tulies requires that opportunities be available to them to enhance their employability and earnings. The panel concludes that efforts should be continued to strengthen and expar2d age-appropnate employment programs for pregnant girls and teenage parents, both male andiemale. Child care services Research confirms that young parents who have access to and use child care in their families or In their community are more likely to finish high school and to enter thejob market. Studies also suggest that some child care services can positively affect the parent-child relationship-for both mothers and fathers. In general, there is a short- age of organized child care services, especially infant care, and sernces that are geared to the special needs of adolescent parents are few. For many teenage parents who have working parents themselves, family care is unavailable. For teenagers to appropnate~y use child care, these serv- ices must be conveniently located; they must have hours of operation that are compatible with school schedules; they must be affordable; and they must provide emotional support and guidance to young parents who may not Filly understand their roles and responsibilities. Some schools and employment training programs are experimenting with on- site child care. Such facilities have the potential for responding to the special needs of adolescents. Neighborhood-based family care and center care can similarly provide the necessary services to help teenagers remair in school or enter the job market and enhance their parenting behavior. The pane] recommends that support be rovidedfor the development, impZe- mentation, and evaluation of mode] child care programs that are targeted to the needs of teenage parents. Schools and other community organizations should place high priority on establishing and maintaining these servicesfor the children of adolescents. Comprehensive care programs The expenence of comprehensive care programs for pregnant and parenting teenagers has been mixed. While these programs have frequently produced positive short-term outcomes In a number of areas-education, work, parenting, health

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PRIORITIES FOR POLICIES AND PROGRAMS 291 behavior, and so on there is no evidence of their having significant long-term positive effects. Indeed, the special needs of teenage parents are many, and coordination of supports and services to respond to those needs is difficult without a centralized case management capability. In addition, because most teenage parents have expenenced frustration and failure, they often require intensive, individualized attention, encour- agement, and assistance to overcome the complex problems they face. Comprehensive care programs have sought to do this by providing or brokering a mix of services appropriate to the special needs and circum- stances of indiv3 duel teenagers. These programs are expensive, and eval- uations have not yielded much insight concerning the value or benefit of the van ous program components, either singly or ~ combination. In the absence of more complete understanding of how particular aspects and components of comprehensive care programs work and the extent of their potential benefit to clients beyond the period of participation, large new expenditures for interventions of this type are not warranted. Nevertheless, we recognize that many teenage parents need a variety of supports and services that are riot available unthm their families. Simply putting these services in place in the community will not ensure that teenagers wiD benefit Tom them. Many high-nsk adolescent par- ents require intensive individualized attention and care in order to have their basic needs met, to help them locate and take advantage of available public aide private services, and to help them fillEll their aspirations. The pane] urges that public and voluntary community agencies explore ways of developing and evaluating case management capabilities to help adolescent parents obtain necessary supports and services. Promote the Social, Emotional, and Intellectual Development of the Children of Adolescent Parents The children of adolescent parents are espec~aDy vulnerable to behavior disorders, problems In school adjustment, lower mtedigence and achievement scores, and retention ~ grade. These diffi- culi~es are only partly the Sect reset of their mothers' young age =d lack of schooling. They are also affected by poverty, poor nutrition, low birthweight, andlivingm a s3mgI-parent household, many of which are closely associated with adolescent childbearing. Special supports and services are needed by many adolescent parents to prevent or overcome these difficulties and to promote their children's healthy somal, emo- tional, and cognitive development.

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292 ADOLESCEAi-T SEXUALITY PREGNANCy AND CHILDBEARING One intervention in particular has the potential for ~rthenng this strategy. Parenting education Parenting education has been shown to im- prove young parents' knowledge of children's patterns of growth and development and appropriate child care, as wed as to help them learn techniques for stimulating infant response and development. Such pro- grams should be available to teenage parents, both male and female, and should be sensitive, not only to the developmental requirements of infants and toddlers, but to the developmental matunty and capabilities of the young parents. Teenagers who have not grown up ir1 supportive, ennch~g families may have little positive basis for modeling their own parenting behavior. The pane] urges that parenting education for teenage parents, especially those from severely disadvantaged backgrounds, receive special attention and emphasis. Schools and other community organizations should place high pnority on the development, implementation, and evaluation of these programs. CONCLUSION As we stated at the beg~namg of this chapter, the panel's framework for policy and program development is organized around three funda- mentai goals: the East is reduction of adolescent pregnancy; the second is provision of alternatives tO adolescent childbeanng and parenting; the third is promotion of positive outcomes for adolescent parents and their children. For each of these goals, several strategies and specific interven- tion approaches have been presented. It is important tO recognize that none of these interventions alone can solve the complex problems of adolescent pregnancy and childbeanug; nor can any single strategy ad- dress the special needs and characteristics of aD youth at risk of untimely and unintended pregnancy and birth. In presenting several strategies for achieving each of these goals, we have med tO take account of the diversity of the adolescent population of their different values, differ- ent social, economic, and CU]tUI~ backgrounds, different ages and stages of development, different communities and support systems, and differ- ent dreams for the fixture. The strategies toward each goal are interde- pendent. They are not mutually exclusive. Providing young people Ninth

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PRIORITIES FOR POLICIES AND PROGRAMS 293 the ability to avoid pregnancy and childbearing or to cope with early unplanned parenthood and helping them develop the will and the will- ingness to do so are both important. Neither alone is sufficient. As we have stressed throughout this report, there are no easy answers or quick fixes. Those seeking simple new solutions will 6~d there is really very little that is new or simple. Any efforts to alleviate the problems of adolescent pregnancy and childbeanug will ultimately re- quire a sustained, coordinated commitment by policy makers, service providers, parents, and teenagers themselves. Everyone can be touched by the problems; everyone can indeed, must contribute tO the solu tiOIl. The problems of adolescent pregnancy and childbearing are solidly rooted in many of the forces and pnnc~ples that shape our sonety- ~ndiv~dualism, family autonomy, and free enterpnse. As a nation, we have no coherent policy in this area because we have no unitary view of these issues or approach to addressing them, and because we have been unable to deSIle an appropriate public role ~ decisions regarding the initiation of sexual activity, contraception, pregnancy resolution, and parenting. This ambiguity and disagreement will not be easily resolved. Nor should it. We are a diverse society of individuals, families, and communities with diffenug values, traditions, and cultures. In shoe, the panel believes that a number of actions should continue to be taken sunultaneously. They must involve government at all levels as well as the private sector, including business and labor, religious groups, special interests, and the media. Some represent immediate steps that can yield shon-term results; others wiD require a longer-ter~ investment of time and resources. This report represents one step in a continuing, incremental process. As a scientific group, we have staved to clarify the issues, sharpen awareness of crucial decision points, and bring knowledge to bear on the trade-offs and complementani~es among different political and ideolog~- cal positions. Perhaps our most important contnbution is to ~nfo~u the continuing debate concerning this salient and often divisive issue of the limits of scenic understanding.

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