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"MOM, I'M PREGNANT..."

...three little words parents of teenage girls dread to hear.
The amazing thing to many adults is that these words are
heard at all when there has never been better access
to  information and birth control products ...

Learning about your unwed daughter's pregnancy certainly puts a new spin on things. Your comfortable denial that she could be sexually active comes to a screeching halt. This shock -- which is not insignificant -- is soon intensified by fear about the dangerous potential consequences of teen sex. According to the Centers for Disease Control, the number of AIDS cases among 13 to 24 year olds has nearly doubled since 1990 and experts warn that teenage girls are now the fastest growing HIV- positive group.

Right now in this country, at least half of the unmarried teens between the ages of 15 and 19 have had sexual intercourse. Even more frightening is the fact that 30 percent of the adolescent girls who have had sex have also had four or more partners. National statistics show that most of the increase in sexual activity occurred among white, middle-class teens.

At the local level, however; the number of Hispanic mothers under 18 has increased 37.5 percent just since 1990. Although they accounted for half of all teen moms in 1992, there were also increases in white (11.5 percent) and Black (9.8 percent) teen pregnancies, as well.

Are teen pregnancy rates rising? It depends upon your perspective. Teen pregnancy statistics -- calculated by adding all the births, abortions and miscarriages -- indicate that a higher proportion of teens are engaging in sexual activity, but the overall pregnancy rate is staying about the same. In fact, none of the "experts" seem to be able to agree on whether we have an "epidemic," what the causes are, or how to stop it.

Decades of Teen Pregnancies

This is not the first time the nation has attempted to tackle the issue of teen pregnancies. In the 1950's, for example, teen birthrates hit an all-time high, but then most of the teenagers were married. In the 1970's, teen births soared as the baby-boom generation moved into adolescence. By 1976, teenage parenthood was characterized as an "epidemic."

Believe it or not, in 1978, the House Select Committee on Population held hearings on teen pregnancy and the Carter administration established the Office of Adolescent Pregnancy Programs to deal with the problems of early childbearing.

By 1980, teenage childbearing was recognized as a major social problem. Verbal battles broke out between proponents of abstinence and advocates of birth control as reports indicated that the US had the highest unwed teen pregnancy rate, abortion rate and birthrate among the world's developed nations.

By 1987, the birthrate began climbing again. The National Research Council published a report, Risking the Future, which urged early contraceptive use as a major strategy for reducing the incidence of teen pregnancies.

Now in the 1990's, experts continue to debate the issue, but at least a consensus is finally developing that sex-education programs that combine an abstinence message with birth control information are the most effective. Atlanta researchers report that teen pregnancy rates actually declined among inner-city teens who received birth control information in school together with advice to postpone sexual activity until they are older.

Let's face it; the proportion of births outside marriage -- for women of all ages -- has been rising in America since the mid-1970's -- an overwhelming 61 percent increase in just two decades. One out of every four women who had a baby in 1990 was not married. For women under age 20, however, the out-of-wedlock child bearing rate skyrocketed a whopping 127 percent over the same twenty years.

This represents a major change in social mores. There is obviously less stigma attached to having children out of wedlock today than there was two generations ago. Hollywood certainly provides an endless parade of unmarried parent "role models."

The mass media bombards young people with an amazing array of sexual stimuli and sexual themes, not to mention de-facto "how to" instruction in R-rated movies now showing on prime time TV. Adolescents will certainly not gain clear standards for what is sexually mature/sexually responsible behavior by watching TV; they need positive role models in their own family who can help point out the fallacies and fairy tales in what passes for drama today.

By almost any standards, it appears that whatever we're doing to stop teen pregnancy is not working. While folks debate the role of schools in sexuality education, our youngsters are getting wildly conflicting messages about what is appropriate behavior and what is not. They are hearing the media's siren call that sex and sexiness are highly prized and desirable traits at the same time they hear warnings that premarital sex is somehow bad or sinful.

Sex education programs may explain the basic "plumbing" and the physiological mechanisms of reproduction, but they often neglect to encourage sexually-active teens to utilize the contraceptive techniques they have been taught.

The abstinence message -- the one that most adults would prefer to pass along to their teenagers -- is not being warmly received. The appeal for premarital abstinence is most likely to be accepted when it comes from within a stable family structure where parents successfully practice the values they preach.

Research shows that to suggest that the consequences of an unwanted pregnancy is somehow a "punishment" for failing to follow a particular code of morality is an exercise in futility. The problem, according to the experts, is not that teens reject the values of adults around them, but that they copy them all too well.

Who's The Father?

Very little attention is paid to the men who are involved in these unplanned pregnancies. One startling fact that has surfaced in recent studies is that the majority of fathers of babies born to adolescents females are not adolescents at all; they are men over age 20.

Of the teen births reported in Vital Statistics of the US (1988), 71 percent involved a teenage partner and an adult partner over age 20.3. As impossible as it seems to believe, the younger the mother, the greater the age gap; if the mother is 12 years old or younger, the father averages 22 years of age. For mothers in junior high, the fathers average nearly five years older. Fathers are about four years older than mothers of high school age.

Aside from the obvious power differential and the potential for psychological or physical coercion, these adult/youth sex patterns have profound implications for the spread of sexually transmitted diseases. This suggests that prevention and intervention programs should target males as well as females and that separate strategies are needed for younger and for older adolescents.

Whose Problem?

Motivating these youngsters to delay experimentation is difficult to accomplish in an arena where no one seems able to agree who should be doing the motivating, or what the role of our schools should be in this process.

Many experts believe that a teenager's decision about whether to engage in sex or to wait is tied to their self-esteem. They point out that teens who are active in academic as well as extracurricular activities and who have a strong desire to go on to college may be more likely to defer sex until they achieve their other, more long-range goals.

What are the ideal roles for parents and schools to play in both the basic sex education process and in the prevention of teen pregnancies? Does the current incidence of teen pregnancies signal a further decay in family and social values...and what can -- or should -- we as a society do about it?

These are incredibly tough social issues that deserve thoughtful debate and consideration as we approach the 21st century.

These days, parents are tired. Everyone is working harder and working longer just to get by. That makes it more difficult to keep a close eye on what their teenagers are doing. Consequently, parents might be slower to notice a change in their daughter's friends or a change in behavior patterns, and one-on-one conversations just seem to keep getting put off.

There is no question that we are seeing many more sexually active teens in the practice. Kids today are products of better health care, they develop earlier, and their bodies send false signals that they are ready for sex at an earlier age. These youngsters are amazingly independent about some things; they go to clinics, they share medications and they share information. So, it is hard to keep absolute statistics about how many young people are treated for sexually transmitted diseases and how many use birth control for example, without their parent's knowledge. In spite of this, teens are still getting pregnant.

AIDS and sexually transmitted diseases are not the only dangers related to teen pregnancies. We see more gestational diabetes, toxemia, increased problems with blood pressure, kideys and nutrition in young mothers. We also see more underweight babies because the placentas in young girls are not rich in nutrients. And, unfortunately, some of these problems outlast the pregnancy.

There are so many impacts following the announcement that a unwed teen is pregnant. We have heard so much about the 'Sandwich Generation' -- daughters who care for aging parents and their own children at the same time. The addition of a grandchild introduces still one more level -- sort of a double-decker sandwich -- in their multi-generational care responsibilities. When a teenager decides to 'keep' her baby, is it more often than not the teen's mother who does the keeping.

We are seeing more support from the young fathers. On one hand that shows an acceptance of responsibility; on the other hand, the relationship between the young, unmarried parents often does not turn out to provide a stable family environment, and there is often no effort to prevent future unwanted pregnancies, so the cycle continues.

“Share the Facts…”

I feel strongly that it is the responsibility of parents to initiate -- and then to maintain -- an open dialogue with their youngsters about the realities and consequences of sexual activity in today's world... and that goes for boys as well as girls. This can only be accomplished by creating a trusting environment in which a teen will feel comfortable discussing this intensely personal topic with one or both parents.

Discussions about sex should adequately cover the topic, and that means including accurate information about sexually transmitted diseases, abstinence, and birth control to prevent unwanted outcomes if they absolutely insist on engaging in sex. Again, I feel very strongly that if a teenager has already made the decision to be sexually active, contraceptive options must be available and this needs to be stressed by parents.

Studies have shown that teens are NOT more sexually active when contraception is available to them. So, in my opinion, the first role of parents and school sex-ed programs should be to educate youngsters about the dangers and consequences of sexual activity and secondly, to educate about preventing transmittal of disease and pregnancy.

“Problem Behavior?”

Many researchers make the assumption that adolescent sexual activity is a 'problem behavior' -- the same as drug use and delinquency. In reality, becoming sexually active is a normal aspect of human development. Experimentation is one means by which adolescents accomplish the developmental task of incorporating their sexuality into their self-concept. The problem is that, as parents, we just wish they wouldn't 'develop' quite so early. The fact is that adolescents are strangers in their own bodies and dealing with a strong biological drive is a very difficult task.

There is no question that sexual mores have changed in this country, as is evidenced by TV programming, movies and in literature. As a society, if we didn't approve of it, we'd find a way to stop it. We'd do whatever societies do to affect change. So, obviously, we're tolerating it. Therefore, you have to suspend disbelief to say that sex is somehow wrong or sinful. We don't seem to have a clear picture of what is right and what is wrong these days.

From the perspective of our young people -- who have one foot in childhood and one in adulthood -- they don't stop to employ situational ethics; they don't stop to think, `Well, sex is OK in this context but not in that one.' Just ask a teenager...they consider themselves bulletproof. Nothing `bad' is going to happen to them. It's a constant trial and error process; deciding which values to keep and which to discard. Very often, the decision about sex is not how or whether, but when and how often.

I strongly believe that sex education in our schools should continue, but I'd go a step further. Sexuality -- and all the attendant consequences -- is part of our society's current events. In government class, for example, we cannot suddenly exempt discussion of AIDS or teen pregnancy...these are news, too. Sex shouldn't just be taught in health class, but should cross classroom barriers.

Some parents, obviously, are doing a better job of talking to their kids about sex than others. Some are just too embarrassed to acknowledge their own sexuality with their teens; it's sort of a boundary thing. Let's have a reality check on this subject; our teens need every approach possible to help them make this difficult transition into adulthood: from home, church, school and 'street' smarts, too.

On a very basic level, one of our jobs as parents is to teach them to consider the consequences of their actions, or S.T.P...Stop, Think, Plan...just long enough to consider the consequences. When it comes to making a decision about becoming sexually active, we have to convince them not to make such a critical decision in a moment of passion. We're not asking them to ignore their bodies, we're just telling them to activate their brains.

 

When It Happens at Your House...

When faced with the realities of an unwed teenaged daughter's pregnancy,
 several actions are very important:

  • Set anger and disappointment aside and offer your support to the new "extended family" by creating multi-generational involvement.

  • Make sure she gets continuing medical care throughout her pregnancy and that she understands the importance of proper nutrition for herself and the baby.

  • Insist, at whatever cost, that the young mother continue her education.

  • Provide stern guidance aimed at promoting the young mother's independence and acceptance of personal responsibility.

 

 

 

 
     
 
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Randy A. Birken, M.D., F.A.C.S., F.A.C.O.G.
Texas Medical Arts Tower
17070 Red Oak Drive, Suite 201 A - Houston, TX 77090
Office: 281.893.1246  Fax: 281.444.6259

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