Pregnant Pause

Building a Bridge with Common Sense

2009-11-06T22:31:28Z

Today the CDC released a report on the effectiveness of various approaches to teen pregnancy and HIV/STI prevention. The study was conducted by the Task Force on Community Preventative Services, an independent panel convened by the CDC. The report suggests that such prevention programs are most effective when they combine a clear message on the benefits of postponing sexual activity with medically accurate and comprehensive information on how to reduce the risks of pregnancy and STIs among teens who are having sex--including the use of contraception.

Most of the American public gets this. It's common sense. Yet, today's results are debated by many, with some saying they prove comprehensive sex ed programs work and abstinence education programs don't, and some saying the reverse. This debate arises in part because comprehensive sex ed and abstinence-only actually encompass many, many different programs, with varying levels of effectiveness behind them. The debate is fueled as much by ideology as it is by science and will likely continue for some time to come.

For those practitioners, educators and parents looking for a common-sense way forward in the meantime, I suggest focusing on specific programs rather than programmatic approaches. Some, but not all, comprehensive programs have rigorous evidence of positive impacts. These have been well-summarized. To date, none of the abstinence-only curricula have this level of evidence behind them, although that is not to say there may not be some in the future.

Efforts have their best chance of success if they stay grounded in science, whatever the state of the science is at the time. It's also important to realize that, while the reproductive health education we provide our teens in school is critical, no curriculum, regardless of its underlying ideology, is a silver bullet. Communities that truly care about preventing teen pregnancy need a comprehensive approach that includes not only schools, but also parents, community leaders, the media, and teens themselves.

Weighty Matters

2009-11-05T14:29:42Z

An interesting study by the University of Pittsburgh published in the November issue of Pediatrics found a link between teen girls' body weight (actual and perceived) and their likelihood of engaging in risky sexual behaviors. These included having intercourse before turning 13, having sex with more than four partners, consuming alcohol in connection with sex, and having unprotected sex. The study surveyed 7,200 high school girls, with half reporting that they had ever had sex.

Some key points:

Caucasian girls who believed they were underweight were more likely to have had sex and to have had four or more sexual partners than girls who considered themselves at a normal weight.
Caucasian girls who were actually overweight were less likely to use condoms.
African-American girls who were underweight were less likely to use condoms than those of normal weight, and overweight African-American girls were more likely to report four or more sexual partners.
Latina girls of all weights were more likely to engage in a wide variety of risky sexual behaviors, from lack of condom use and sex before age 13 to having more than four sexual partners during their teens and using alcohol.

]]> Low self-esteem has long gone hand in hand with weight and body issues, but the news here is that the actual weight of these young women isn't at issue: it's their perceived weight. Clearly, the BMI is not a reliable guide in determining a teen's "healthy weight," when "healthy" refers to the mental and not the physical. "Our data suggest that knowing how a girl perceives her weight may be as important as knowing her actual weight," said Aletha Akers, M.D., M.P.H., assistant professor of gynecology and reproductive sciences at the University of Pittsburgh School of Medicine, and one of the doctors who conducted the study.

This is another instance of science bearing out common sense; of course how a girl feels about herself is just as important as what the scale says -- in fact, the two are often inextricably linked. Dr. Akers contends that "This study will contribute to sexual health education prevention efforts, which can be tailored to address how cultural norms regarding body size may influence adolescent sexual decision making." Which would be great -- anything that can assist in better tailoring curricula for the students to whom it's being taught is a step forward. But we need to think a little more deeply...sex education shouldn't just come from schools.

Judy Berman at Salon.com put it best: "But I think it's also important to point out that not all sex education happens in school. If we want girls to feel good enough about themselves that they wait until they're ready, practice safe sex and avoid other risky behaviors, we're also going to have to help them interpret the messages they're getting from more informal sources -- from friends and siblings to magazine and TV."

Indeed. Check out our friends at RespectRX for more information on healthy bodies, healthy minds, and how to help young people learn to love themselves.

And How Are The Children?

2009-11-03T21:48:56Z

This piece is cross-posted from SexReally.com.

Alma Powell, a well-known advocate for youth, opened a grand dinner at the Newseum this week, the U.S. Capitol illuminated behind her, by asking a simple question: "And how are the children?"

It was an appropriate salutation, delivered to reporters about to receive awards for writing and broadcasting about disadvantaged children and families.

Powell explained that the greeting is used by Masai warriors in Africa as they pass each other on the road. It is their version of "How are you?" --a reminder that an individual is only as good as her or his child, a community only as good as its children.

It occurred to me that night that those who counsel teens and 20-somethings about sex and contraception are trying to convey something similar. One argument they make for using contraception consistently goes something like this: "Think about the baby you might have if you don't. What kind of a life will she or he have?"

So, not how are the children, but how will they be?

]]> It's a legitimate question to ask given the disturbing data on what happens to many babies born to young parents who did not plan for or want them. But sometimes I wonder if it really registers. Adolescents are by nature self-referential. Everything, or nearly everything, revolves around them.

They get the fact that having a baby might muck up their plans for school or getting a job. But can we truly expect them to consider the impact of their carelessness on someone who isn't born yet?

More to the point, how well have we modeled the restraint we expect from them? How consistently do we put the needs of others ahead of our own, as we ask them to do?

Dr. Robert Blum, a Baltimore physician and psychologist who specializes in adolescent development, says by the time young people reach their twenties they are "absolutely" capable of "perspective-taking", jargon for putting themselves in the shoes of someone else. In his opinion, we should be reminding young people about the responsibilities attached to bringing an infant into the world.

I agree with him. But think about the messages we've already sent. We push young people to finish high school and college because they'll make more money, not because it will equip them to make a positive difference in the world. One such mother I know was explicit in her priorities, pasting a newspaper headline on the desks of her two daughters: "The more you learn, the more you earn."

I don't believe for a second that she meant her girls shouldn't be mindful of others. But by not emphasizing altruism with the same fervor she did money, she in fact diminished it.

We ask young people to remember, as they become sexually active, that what they do has consequences beyond today and beyond themselves. In fact, we don't do well at that. Exhibit A: our borrowing and spending habits that helped usher in the recession.

In truth, my beef is more with my generation than theirs. Researchers have documented high levels of volunteer service among the young. As demonstrated by the millions who campaigned for Barack Obama, by those who take part in Teach for America, serve in the Peace Corps, the military and lots of non-profit organizations, young people are at least as civic-minded, if not more so, than we were when we were in our 20s.

Yet young women in their 20s have the highest rate of unplanned pregnancies of any age group: 7 out of every 10 pregnancies. Perhaps we can help them do better by looking at ourselves first.

(Note: Alma Powell chairs America's Promise Alliance, a partnership of corporations, nonprofits, faith-based organizations and advocacy groups focused on improving lives and changing outcomes for children. She spoke at an awards dinner for journalists co-sponsored by the Alliance, the Annie E. Casey Foundation and the Journalism Center for Children and Families at the University of Maryland. Laura Sessions Stepp sits on the advisory board of the Journalism Center.)

Scary Area: Halloween Edition

2009-10-30T16:30:06Z

Some scary things to consider this Halloween:

The teen birth rate is on the rise after 15 straight years of decline.
Fully seven in ten pregnancies among single 20-somethings are unplanned.
More than half of pregnancies reported by unmarried men in their 20s are unplanned.
Rosie O'Donnell is launching a new radio show.
The magic less sex/more contraception formula that drove down the teen pregnancy rate over the past decade plus now seems to have morphed into a more sex/less contraception formula.
3 in ten girls in the United States get pregnant by age 20.
Mariah Carey continues to record and release music.

What are some things that are scaring you? Let us know.

Plump Lips and No Slips

2009-10-29T21:57:40Z

I must admit that I have been a reluctant participant to blogging, but finally something caught my attention. Recently, I had two interactions with a shopping mall that revealed to me the younger generation's--albeit, misguided in my opinion--obsession with looking good. I am a child of the 60's, when mothers routinely reminded us to wear clean underwear and never to leave the house without a slip and girdle when wearing a dress. As an African-American, I was often told to be careful with the selection of the color of my lipstick, so that my lips would not be too pronounced. "The times they are a-changin'".

]]> I purchased some gloss (I thought) a few months ago and had stored it away with other makeup. Recently, I retrieved the tube of shiny cream and applied it with confidence that I was going to look fabulous. While I looked the way I wanted, I felt awful. From the moment the cream touched my lips, my lips were stinging as if a hundreds bees had landed there...stingers first. I was convinced that the cream had sat too long in my make-up drawers. This past Monday, while shopping at a Midwest mall, I stopped at the Estee Lauder counter to let them know that their gloss product had malfunctioned. The woman seemed concerned and perplexed and asked to see the product if I had it with me. Of course, I gladly turned it over to her to watch her giggle a little as she told me the product had done exactly what it was supposed to do, because it was a "plumper". A what? I asked. Yes, some women use "plumpers" to make their lips fuller. The product works by irritating the skin and the irritation makes the lips swell and...ta da....you have plump lips. Why?????

From this very confusing encounter I went in search of a slip to wear with a dress made of very sheer material. From one end of the mall to another, each store had either no slips or very few XS slips for a woman who needs an extra-large. I remember when there would be rack upon rack of varied colored slips in a wide range of sizes. Yes, readers, I even tried a big ladies store, Lane Bryant, just positive that, for us larger ladies, modesty was still in fashion. NOPE...no slips. Finally, at Sears, I found one.

But all of this caused me to ponder whether plump lips and no slips represent just one of the factors that have contributed to this new hook-up culture. Why do young women want lips that once were the symbol of street walkers? Is it necessary to show everything under a garment, when a little modesty would improve the appearance of the dress and the image of the girl? What's happened to modesty, illusion, and imagination? A little more of all three may be the beginning of a culture of self respect and personal responsibility and an end the culture of being hooked up and knocked up.

Perception, Reality, and Teen Pregnancy

2009-10-27T22:36:28Z

Public opinion polling shows that two-thirds of adults (67%) believe most teen mothers come from homes below the federal poverty threshold. A full 70% of adults believe that most teen mothers come from single parent homes.

Not true.

According to new analysis of the National Longitudinal Study of Adolescent Health conducted by our wonderful friends at Child Trends and released today by The National Campaign, only 28% of those who report having given birth or fathered a child as a teen lived in families below the poverty level. Only 30% of those teen parents said they were living with a single parent (39% said they lived with both biological parents and 19% said they lived with one biological parent and one step-parent).

]]> Of course it remains true that teens from poor households have a disproportionally high rate of teen childbearing, and income and family status are important risk factors too. But it's also true that more than half of teen parents come from two-parent families and live well above (200% or more) the poverty line.

So what does this mean? Well, for starters it means that public opinion does not equal public fact. But it also means that no one is immune from the reality of teen pregnancy. Good kids from good families in good neighborhoods can--and do--get pregnant and have babies as teens. It also means that efforts and interventions to prevent teen pregnancy can't be one-size-fits-all.

In a country where nearly 3 out of 10 girls get pregnant as teens, it's impossible to limit the problem to any one income group or type of family structure (or race, or ethnicity, or religion, or any other classification). Every teenager who has sex and doesn't use protection carefully and correctly is at risk.

For more on this data and analysis, check out Science Says #41: Socio-Economic and Family Characteristics of Teen Childbearing.

There's an App For That...

2009-10-27T01:25:17Z

In case you haven't seen the Campaign's newest publication, I highly recommend it. And not just because I work here.

As someone who is admittedly ALWAYS attached to some form of media, the format for these helpful tips really strikes a chord with me. While I generally make my contribution to the Campaign's work by keeping my nose buried in some piece of legislation (light reading, anyone?) this got me thinking about the work that my colleagues on the other side of the office do to figure out all the ways we can reach folks through digital media.

These types of projects are becoming increasingly popular with our partners who work on teen pregnancy prevention. The Birds and Bees Text Line, which is sponsored by the Adolescent Pregnancy Prevention Campaign of North Carolina and has garnered national media attention, and the text messaging contest that FutureNet in Iowa held earlier this year are just a couple examples.

Are your organizations, states, or communities doing innovative work to connect with those of us who are tethered to our handheld devices? How are you using digital media to advance pregnancy planning and prevention? Are you sending text message reminders for people to take their pill? Texting appointment reminders? Let us know what you're doing!

Ps--if you're interested in learning more about how social media and mobile technology can be used to prevent teen pregnancy, check out our new youtube playlist of highlights from our June 26th conference "Taming the Media Monster: Teens and Sex in the Digital Age."

Recognizing Sheldon Segal

2009-10-23T15:04:20Z

Sheldon J. Segal is no longer with us. Segal, 83, died October 17 at his home in Woods Hole, MA. Although his work helped millions of women all over the world, he labored and died in relative anonymity.

What gives?

Segal is credited with leading the team that developed the contraceptive implant Norplant. He was also instrumental in the development of the Mirena intrauterine device and copper-bearing IUDs. In other words, Segal played a critical role in what the Centers for Disease Control and Prevention calls one of the greatest public health achievements of the past 100 years---contraception.

You might have missed this news because the front page of several major newspapers featured other such absolutely essential fare as the fight for airplane overhead space (USA Today) and a new opus from Stephen King (Wall Street Journal).

What gives?

Rest in peace, Sheldon Segal, and thank you.

Meaningful Health Reform - for Whom?

2009-10-21T21:30:09Z

Women currently account for 51% of the overall U.S. population, according to the U.S. Census Bureau. To be precise, there were 154,135,120 women and 149,924,604 men in the United States in 2008. We also know that women, more often than not, are responsible for making decisions about their families' health care.

While I think it would be hard to make the leap that 51 percent of the programs and benefits of health reform should be directly targeted toward women, it's not a stretch to argue that health reform should address the health care needs of women and their families. That includes pregnancy planning and prevention.

Unplanned pregnancies are closely linked to a number of negative health, social, and economic consequences. Family planning services--counseling, gynecological care and screenings, prescription drugs and devices, and related outpatient services--are a cost-effective way to make progress on preventing unplanned pregnancy and improving health outcomes for women and families. As such, family planning should be classified as a preventive benefit with the same cost-sharing protections afforded to other designated preventive benefits in any essential benefit package that is created within the context of health reform.

For health reform to work, it has to be meaningful for everyone, including 51 percent of the U.S. population.

Without "Let's Listen," "Let's Talk" Falls Flat

2009-10-19T21:30:50Z

Why is it that some people are better listeners than others? You can tell when someone is listening to you--really listening--when they're actually taking in what you're saying, considering it, and perhaps not even having a response at the ready--not simply planning their next conversational move. Listening is a form of respect, and one that is easily mowed over by the desire to get one's own point across. Like a monologue masquerading as a dialogue.

Since October is "Let's Talk" month (see Bill Albert's post from earlier this month), maybe the added attention will get some parents to move from wanting to talk with their teens about love, sex and relationships to actually doing it. But a critical part of this conversation--and really any conversation with someone you care about--has to be the listening part. We've heard from teens for over a decade now that they are afraid to ask their parents about sex and contraception because they are convinced that mom or dad will freak out and assume that their teen is already 'doing it.' Or that it will be so embarrassing their heads will explode.

]]> But a real conversation about this topic includes just as much listening as it does talking. We at the Campaign urge parents to be clear about their values and expectations--and to understand that if you don't explicitly tell your teen what your values are and why you hold them, you can't expect them to just know what they are by osmosis. So, yes--talk. But also ask questions. And listen to the answers. Whether you start the conversation, or your teen does, let your teen know that you're glad he or she trusts you enough to talk about these topics with you. And that you respect him or her enough to listen to their questions and concerns without assuming the worst or jumping to conclusions.

There is no script or 'right' conversation for every family. We have tips, brochures, and resources aplenty to help parents get the ball rolling, but ultimately it's your own views and values that will shape the first conversation with your teen about love and sex, and the (hopefully) many other conversations to come. Perhaps one way to teach our teens about respect in their romantic lives is to demonstrate it by really listening in our own conversations with them.

What do you think? Any stories to share about talking with your teens about sex? Helplful ideas for other parents? We want to hear from you.

Piano Stairs and Toothpaste

2009-10-15T20:54:03Z

Watching the video above I am reminded of the challenge we face in the world of reproductive health—a world I am still getting to know—of trying to make adherence fun. The piano stairs do a fabulous job of enticing people to walk and work off a few extra calories. Fun can change behavior for the better.

The challenge for us is that contraception is not so fun. Even the names of contraception methods—an opportunity for fun—are usually horrible.

Perhaps we can take some cues from toothpaste. Bill Smith, in his recent Social Marketing Quarterly article "The Power of the Product P, or Why Toothpaste Is So Important to Behavior Change," says that what we need to affect change is a product like toothpaste, not ideas. "An idea, like 'health is good,' 'exercise works,' or even 'environmentalism' is the affirmation of a belief, not a social marketing product," Smith wrote. And only a product can be effectively marketed. "Toothpaste," he went on to write, "is a product that helps us achieve our marketing goal of behavior change (bushing teeth)."

We don't try to get people to brush their teeth without toothpaste, but we do ask them to take HIV tests and obtain birth control without compensating them for the stigma they experience. "All we have to do is invent products and services that are as good as toothpaste, update them regularly to keep people interested, price them competitively, put them everywhere, and then tell people how cool they are," Smith challenged. Are we up for the challenge?

Where's the toothpaste?

How "Teen" Is Nineteen?

2009-10-13T21:21:44Z

This piece is cross-posted from SexReally.com, where it was posted on Friday, October 9th.

Even before it hits the newsstands, November's Teen Vogue has people talking.

Why? Because the cover displays two 19-year-old supermodels, one of whom, Jourdan Dunn, is pregnant.

Critics say Dunn shouldn't be there because she is a role model for teen girls. She makes pregnancy look cool - and there are way too many pregnant teens already.

I'm going to raise a different issue. Why is either model - Dunn or Chanel Iman - on the cover? Vogue, I could see, but Teen Vogue? Though technically teenagers, Dunn and Iman have a lot more in common with 20- and 30-something women than girls who just got their braces removed.

]]> Both can vote. Both have successful careers that presumably allow them to buy a house (and much more). Both are old enough to ditch their designer digs for war fatigues and head off to fight in Afghanistan if the spirit moves them. Dunn has a steady partner of several years who is the father of her child.

Of course, celebrity culture said goodbye to childhood years ago. Teen Vogue, like so many teen publications, encourages 13- and 14-year-olds to look years older than they are. But that's another column.

What I'm asking with this column is why we do just the reverse as children move into their late teens and even early 20s? Why do we trivialize, even infantilize, young adults?

It's difficult for older adults to talk coherently about 18- to 29-year-olds because, as William Galston, a senior fellow at the Brookings Institution, has noted, the traditional markers of adulthood no longer apply. Young adults today live longer with parents that they did in generations past. They marry later, have children at older ages and move from job to job more frequently.

Several years ago, I wrote an article about the tendency among some health officials and researchers to think of young people, even up to age 34, as adolescents. Jeanne Brooks-Gunn, a developmental psychology professor at Columbia University, told me she disagreed with the trend.

"It's very disrespectful," she said. "Twenty-year-olds aren't teenagers. Cognitively, emotionally, they're like adults."

She has a point. And that point makes me wonder, does being treated like a teenager mean a young adult tends to think of herself or himself as still a teenager? Does thinking that way influence the choices that he or she makes in, say, sex partners and using protection from pregnancy and disease? Could this in any way contribute to the high rate of unplanned pregnancy among 20-somethings?

What do you think?

Photography to Prevent Teen Pregnancy?

2009-10-09T16:48:25Z

Photos are often used to document a trip or special event; they capture fleeting moments in time, and often pieces of art as well. A team of teens in Bayfield, CO are using photos in a slightly different way through a specific technique called photovoice. The goal of the EPIC team (which stands for Every Pregnancy is Considered) is to improve the lives of teens in their small town. To do so they are using photographs of everyday occurrences to document the strengths and weaknesses they see in their community.

The photo above seems simple enough--a nice snow covered playground. To the artist however, the park is an example of how there are plenty of community resources dedicated to smaller children in the community, but the teens lack a fun, safe space of their own, and they're just a little too big for the playground. The other photos in the exhibit include pictures of family members who are important to the teens, fun things to do in other surrounding towns that are hard to access without reliable transportation, and how the teens entertain themselves in their town.

The team of talented artists presented at the Colorado Organization on Adolescent Pregnancy, Parenting, and Prevention's annual conference in Denver, CO. The teens and photos certainly stole the show, and it was great to hear from them directly what they thought might help prevent risky adolescent behavior in their town. The most striking part of the presentation is that it is not just teens telling you what they think--the images allow you to have a sneak peak into their lives. They had a few ideas for what the community might do: a mobile health clinic, a teen center, and reliable, low-cost transportation to nearby towns were a few of the suggestions.

Have you ever used photovoice? How could photovoice serve your community?

Parents: Talking is Job #2

2009-10-07T20:20:51Z

If it's Tuesday, it must be Belgium. If it's October, it must be "Let's Talk" month.

This is the time of year when parents are poked and prodded to pontificate about sex. Specifically, October is the month that parents are--steady on friends--encouraged to talk to their kids about sex. Don't get me wrong, encouraging often-recalcitrant parents to talk to their kids about sex is the right thing to do. Still, it has always struck me as a classic case of putting the cart before the proverbial horse.

Why? My sense is that not a single parent in America will talk to their kids about sex if they believe that what they have to say will fall on deaf ears; if what they have to say will have absolutely no effect on their beloved offspring's decisions about sex.

]]> It seems to me that before we encourage parents to talk to their kids about sex and related issues, we must first convince parents that they matter on this particular set of issues. Considering the in-your-face nature of the present-day culture, it is not surprising that many parents feel that their influence over their kids' decisions about sex has been lost to the influence of peers and popular culture. Given that, our first job should be to fill parents in on the good news--when it comes to teens' decisions about sex, parents matter far more than they know.

Don't take my middle-aged- stuck-in-Washington, DC-not-as-trim-as-I-once-was word on it. We at The National Campaign to Prevent Teen and Unplanned Pregnancy have conducted periodic national public opinion surveys on a variety of topics. A decade-plus of polling has made one thing crystal clear: teens say parents most influence their decisions about sex--more than peers, popular culture, or the media.

If you're not inclined to believe public opinion polling then simply review the growing stack of quality social science research that reaches essentially the same conclusion.

Of course--exhibit A from the duh file--it's not just s-e-x that parents should be talking about with their kids. One could even argue that sex is number four or five on the list. What about helping young people understand the characteristics of a healthy relationship and the warning signs of an unhealthy one? How about helping teens understand that if sex is the price of a close relationship, it's best to find someone else? How about discussing whether you believe if sex should be associated with commitment?

A final thought--exhibit B from the duh file. Helping your kids navigate the tricky six-river confluence of love, relationships, sex, contraception, pregnancy, and family formation cannot, must not, be limited to one month. This is an 18-year plus conversation friends. When you signed up for this parent gig you signed up for the good, the bad, and the ugly. And you signed up for life.

Parents: It's October. You matter a lot. Now stop reading and start talking. Your kids are waiting.

This piece is cross-posted from the parent portal of the South Carolina Campaign to Prevent Teen Pregnancy's website.

The Clock is Ticking, Levi Johnston

2009-10-06T17:49:56Z

With Billy Mays (R.I.P.) gone and that Shamwow creep lying low after felony battery charges, the path is clear for a new kind of pitchman - one that has no discernible talents and the screen presence of rock. That's right, folks - Levi Johnston is on the scene and he's using the last two seconds of his 15 minutes of fame to sell... nuts?

In a new spot for Wonderful Pistachio's "Get Crackin'" campaign, Johnston - the Alaska teen who fathered a son with Sarah Palin's daughter Bristol - approaches the camera as his ever-present bodyguard, Tank Jones, surveys the scene. Once Tank gives the "all clear" sign, Johnston cracks open and eats a pistachio as the voiceover, nodding to the only reason anybody knows Johnston's name, says, "Now Levi Johnston does it with protection."

What do you think? Is the ad funny or is it making a joke out of a very serious situation? Can sexual innuendo about teenagers help you forget about last April's pistachio salmonella contamination recall or does it just make you feel even more sick to your stomach? Is there anything you would buy based on an endorsement from Levi Johnston? Post your comments below.

UPDATE: I think I just threw up in my mouth a little bit.