What can be done to curb the high rate of teen-age pregnancy in Washington, where roughly one-fourth of all births are to teens?
Advocates of school-based health clinics say such clinics are highly effective in reducing teen pregnancies. In St. Paul, Minn., there has been a 56 percent reduction in birthrates, and the school dropout rate among teen mothers has declined by about 35 percent since clinics were introduced. The Center for Population Options reported that in the West Dallas Youth Clinic some 30 percent of the patients were found to have undiagnosed health problems, an indication of the additional benefits of the clinics. There are now 48 clinics nationwide, with 60 in the planning stages.
There are a variety of reasons why school-based clinics are successful in reducing teen pregnancy. They provide comprehensive health services to a highly underserved population within close proximity to the one institution they attend on an almost daily basis -- the school. The services are offered by health practitioners who are known to and trusted by students at modest or no cost. Many teen-agers, especially poor teen-agers, do not receive the most basic medical care, preventive or otherwise.
Last May, the Mayor's Blue Ribbon Panel on Teen-Age Pregnancy Prevention recommended that comprehensive clinics be established in high schools in the four quadrants of the city, especially in those areas where teen pregnancy is a problem. The clinics would offer primary health care to male and female adolescents, including health screening and physical examinations for jobs, school and athletic programs, family planning and health education, as well as job training information and referral. We recognized the critical link between education, training and job opportunities and teen pregnancy prevention.
Fully aware of the importance of parental involvement, we proposed that family members be involved with the clinic programs. Moreover, we proposed that clinic staff work with preexisting services within the school and community, and conduct community outreach with individuals and organizations that work with youths. We wanted to involve the broadest cross section of the community.
Unfortunately, the critics seem to ignore the broader array of health and social services provided by such clinics, preferring to focus entirely on the family planning aspects. Recently, Education Secretary William Bennett told a Baltimore audience of the Education Writers of America that "clinics legitimate sexual activity" and cause an "abdication of moral authority." Post columnist William Raspberry agreed. "Some of us will insist . . . that when it comes to sex," he wrote, "the only acceptable instruction the adults can offer to adolescents is: don't." Last December several local ministers and "Right to Life" advocates criticized a proposal to open a comprehensive health clinic at Anacostia High School in an area that has one of the highest rates of teen pregnancy in the city. Recently the Alexandria school board voted against opening a clinic at T. C. Williams High School.
These and other opponents offer little practical advice on how to solve this crisis affecting millions of American teen-agers. While it is easy to invoke moral platitudes and suggest that adults should advise teen-agers to abstain from having sex, the fact is they don't. The Alan Guttmacher Institute reports that some 12 million of the 29 million people between the ages of 13 and 19 have had sexual intercourse. During the 1970s, sexual activity among unmarried women aged 15 to 19 living in metropolitan areas rose by two-thirds. The increase was most dramatic among whites, especially those aged 15 to 17, whose rate of sexual activity doubled.
The mayor's advisory panel conducted hearings for teen-agers in high schools in each of the city's eight wards to get their views on the causes, consequences and proposed solutions to teen pregnancy. Countless students told us that the influences of the mass media are pervasive; that the family life education class offered in the schools is inadequate; that they have few opportunities to communicate with adults about sensitive matters (in fact, most said they had no adult with whom they could talk about sex). Most said they could not talk to their parents about it. The school-based clinic could be a significant starting point in filling some of this void.
While I strongly encourage teen-agers to postpone sexual involvement until they are emotionally mature enough to handle the responsibilities associated with it, including the possibility of pregnancy, many teen-agers will continue to be sexually active. It is the responsibility of adults to make certain that they have access to family-planning counseling, so they can avoid unplanned and unwanted pregnancies. To do otherwise is extremely costly. The Center for Population Options reported that in 1985 the public costs of teen-age pregnancy were $18.84 billion -- costs associated with AFDC, Medicaid and food stamps. Other consequences for the teen-ager include infant mortality, low education attainment, high unemployment and a one-way ticket into poverty.
It is time to bring some sobriety to the discussion of teen pregnancy prevention and to consider implementing the school-based clinics in Washington. Critics who dismiss them as a method that merely sanctions immorality and yet offer no practical alternatives do a serious disservice to our youths.