Teen Pregnancy Prevention Programs and African-American Girls

Background: Teen Pregnancy Rates and Risk Factors

Compared to only a few decades ago, American society has become more open and accepting of teenage pregnancy. Pregnant teens are no longer hidden away with relatives. More importantly, many school and community groups have adopted honest and aggressive strategies to address the growing incidence of teenage pregnancy.

This paper evaluates the effectiveness of four different types of programs in preventing pregnancy in teenage girls. These programs include sex education in schools, one-on-one conversations between patient and health care worker in a clinical setting, service learning programs, and youth development programs. Particular emphasis is placed on the effectiveness of these programs in preventing pregnancy among African-American teenage girls.

The first part of this paper provides an overview of teen pregnancy statistics, both throughout the United States and among African-American teenagers in particular. The next part identifies the factors behind rising pregnancy rates among Black teenagers. In the third and main part, the paper examines the diverse programs and policies being implemented to help stop teenage pregnancy, then evaluates whether these programs address the unique factors that contribute to teen pregnancy in African-American teens. The conclusion argues that pregnancy rates among Black teens continue to rise because these programs do not adequately address the special factors behind pregnancies in this group, and that more policies must be enacted to address factors like poverty and school dropout rates.

Overall, teenage pregnancies in the United States have declined since 1991. However, studies such as Singh and Darroch (2000) have shown that a full 40% of all young women become pregnant before they turn 20 years old. Furthermore, 25% of sexually active teenagers contract a sexually transmitted disease every year. Despite the steady decrease, the United States still has the highest pregnancy and birth rate among industrialized nations.

Numerous studies have examined the causes of teenage pregnancy in the United States. In a longitudinal study, Harding (2003) found a strong link between neighborhood poverty and a teen's tendency to drop out of high school, engage in risky sexual behavior, and experience teen pregnancy. Teen pregnancies were much more common in high-poverty neighborhoods than in more affluent ones. Harding (2003) found that this causal link remained strong even when different family backgrounds were taken into account.

Other studies, however, suggest that family relations play a stronger role than neighborhood poverty. Moore and Chase-Lansdale (2001) found that African-American adolescents in poor neighborhoods have a greater probability of engaging in early sexual activity compared to their peers in more affluent households. However, the study also identified factors that create differences in sexual activity within disadvantaged neighborhoods.

Moore and Chase-Lansdale (2001) found, for example, that African-American teenagers who enjoy strong bonds with their parents were more likely to abstain from early sexual behavior. This was particularly true for teenage females who had close relationships with their mothers.

Furthermore, Moore and Chase-Lansdale (2001) found that Black teenage girls who experienced pregnancy were "significantly less likely" to be living in intact families. Rather, they often lived in single-parent households. Girls who did engage in risky sexual activity and experienced pregnancy also reported more "alienating mother-daughter relationships." Their mothers were often less communicative, and as a result, the daughters felt more distant from them.

Moore and Chase-Lansdale (2001) also found that girls who lived with cohabiting adults were four times more likely to engage in early sexual behavior. However, this trend was countered among girls who reported close relationships with their mothers.

The Moore and Chase-Lansdale (2001) findings contrast with the conclusions of the Harding (2003) study. Harding concluded that the poverty in a young teenage girl's environment was the strongest predictor of early sexual activity and eventual pregnancy. For Harding, these correlations held true even when familial ties were taken into consideration. Since Harding conducted a longitudinal study comparing two sample groups, his findings are supported by solid research methodology.

However, the conclusions of Harding's study are challenged when researchers focus on race. Moore and Chase-Lansdale (2001) found that within poor African-American communities, there were still significant differences in rates of early sexual activity and teen pregnancy. In these cases, the greatest predictor of pregnancy was the teenage girl's relationship with her mother. Those who enjoyed close relationships with their mothers were far less likely to become pregnant, even when other factors were taken into consideration.

Education Programs

Thus, for disadvantaged young Black women, the quality of the family unit assumes greater importance, especially when the teen lives in an impoverished neighborhood. Strong, close-knit families serve as a buffer, protecting many teens from negative neighborhood influences. These close relationships also come into play even for teens who are already sexually active. Moore and Chase-Lansdale (2001) additionally found that teenage girls who have close relationships with their mothers are more likely to practice safe sex by using contraception and having fewer sexual partners.

To be effective for all teens, pregnancy prevention programs need to address the special factors that give rise to pregnancy among African-American teenage girls. The following sections discuss the main types of pregnancy and safe-sex programs currently being implemented and evaluate how these programs respond to the unique needs of the African-American community.

There is a multitude of teenage pregnancy prevention programs currently being implemented in the United States. Many programs receive public and federal funding, while others are privately financed. These programs can be grouped under four main types: education programs, health care, service learning, and youth development programs.

The majority of education programs focus on teaching teenagers about safe sex and HIV prevention. Many emphasize abstinence as the safest method for preventing pregnancy and sexually transmitted disease. Many such programs are taught as part of the regular school curriculum; others are conducted after school hours; and still others are delivered by experts and volunteers in juvenile detention centers and homeless shelters.

There is wide diversity among the types of education programs. Advocates of abstinence-only education, for example, argue that contraception-based education has failed to stem the tide of pregnancy and sexually transmitted disease among high school students. Napier (1999) argues that abstinence-only programs are the more effective solution. Programs such as the Best Friends program match a teenage girl with an adult mentor. Weekly one-on-one and group meetings teach girls self-respect and decision-making skills intended to form the basis of a sexually abstinent lifestyle. The Best Friends program also emphasizes avoiding drugs and alcohol, which are considered risk factors for early sexual activity.

Other cities have implemented similar programs, such as Project Reality. This program offers a "values-based" curriculum that espouses abstinence until marriage as the wise and moral choice. Similar to Best Friends, Project Reality offers participants weekly group lessons on substance abuse and human sexuality. In addition, Project Reality also addresses the "cultural influences" that promote teenage sexual activity, including television programs and movies that portray teenage sex as desirable, normal, and generally free from consequences (Napier 1999).

Other programs focus more on prevention rather than abstinence alone. Many HIV education programs emphasize condom use, and most public schools offer more comprehensive sex and HIV education that goes beyond abstinence. Different age-appropriate programs have also been implemented in middle schools and high schools around the country. These school programs have been successful in delaying teenage sexual activity and, by extension, teen pregnancy.

Many studies report that education programs have been successful in encouraging abstinence or safer sex. However, an evaluation of the content of these programs reveals that both abstinence and safe-sex education do little to promote stronger family ties among disadvantaged families — even though strong mother-daughter bonds are the greatest predictor of delayed sexual activity for African-American teenage girls.

Thus, while abstinence and safe-sex education help address teenage pregnancy in general, the effectiveness of these programs is diminished when race is taken into consideration. School districts in poor neighborhoods often have strained budgets and may lack resources for supplementary programs like sex education. Additionally, many African-American teens in low-income neighborhoods are forced to drop out of school due to poverty, making school-based programs irrelevant to them. Many teens who must work to augment family income will also not have time for after-school or community education programs.

While education programs serve an invaluable function, particularly in HIV and AIDS prevention, they do not address the lack of strong family ties. As the Moore and Chase-Lansdale (2001) study demonstrates, strong ties between mother and daughter and stable family relationships serve as a powerful buffer against sexual activity, even in low-income neighborhoods. Overall, education programs by themselves are not sufficient to prevent pregnancy among African-American teenage girls.

Service Learning Programs

Because of their healthcare focus, many of these programs emphasize educating patients about sexually transmitted diseases. In one program, for example, a nurse spends ten to twenty minutes discussing diseases such as chlamydia, using illustrated pamphlets. The nurse then demonstrates how to use a condom, and role-playing exercises help teenage girls develop skills to convince their partners to use condoms (Boekeloo et al. 1999).

These health-care programs have several key advantages over other pregnancy prevention approaches. The one-on-one format encourages greater openness for more reserved teens who might be embarrassed in group settings. Clinicians also have more time to devote to the individual needs of their teen patients. Furthermore, although teenage girls are the primary targets of many pregnancy-prevention programs, healthcare programs can also prevent teen pregnancy by educating male adolescents.

However, the success of these programs is once again tempered by factors of race and income. Recent budget cuts in social spending have forced many clinics in inner cities and low-income neighborhoods to close. Since teens in low-income neighborhoods face a higher risk of teen pregnancy (Harding 2003), the growing scarcity of community health clinics is itself a factor increasing pregnancy rates among teenagers.

Additionally, clinics in low-income minority neighborhoods were few in number to begin with. Those that did exist were hampered by poor funding, which limited staffing and prevented many from distributing free contraception.

These health-care programs also require considerable investment on the part of the teen patient in terms of time and effort. Many teens would not feel comfortable visiting a clinic, particularly when they have work obligations or fear being recognized. Finally, like education programs, health-care programs do not address the lack of strong ties between mothers and daughters. Because of this limited, healthcare-focused approach, clinical programs have achieved only limited success in reducing pregnancy among African-American teenage girls.

Service learning programs involve teens in civic activities in their communities. Teens may participate in volunteer programs such as tutoring younger children, helping maintain parks, assisting clinic and hospital personnel, and working in nursing and retirement homes. Most participants engage voluntarily, though some also receive class credit for their service (O'Donnell et al. 1999). Many schools make an extra effort to connect community activities to current coursework.

Of all intervention programs, service learning programs show the strongest evidence for reducing teen pregnancy rates while teens are enrolled. Evaluations of these programs in locations across the country have demonstrated that active service programs reduced rates of pregnancy or sexual activity among area teenagers (O'Donnell et al. 1999).

One of the earliest service programs was the Teen Outreach Program (TOP), instituted in several locations around the country with the help of local schools. TOP participants spent 46 hours performing various community services, ranging from tutoring to working in nursing homes. Statistics showed that program participants had lower pregnancy rates during the school year compared to a control group. As an added benefit, TOP participants also reported lower rates of school failure (O'Donnell et al. 1999).

Researchers have suggested several reasons for the effectiveness of service learning programs. Some posit that volunteer activities help teens focus on the future, particularly when the activities are matched to students' interests — those interested in teaching are placed in tutoring programs, while students interested in construction help with public facilities. Corollary to this, such activities may also help keep teens engaged in school. The increased focus on academics encourages teens to consider the consequences of risky sexual behavior, and many are inspired by the difference they can make in others' lives. Together, these factors motivate teens to avoid pregnancy and stay in school.

Many of these programs have the added benefit of being privately funded or requiring very few public resources, making them easier to implement in the low-income areas where teen pregnancy rates are highest.

Another important factor behind the success of volunteer programs is the positive relationships many teens form with program facilitators. Many teens find caring mentors and close friends among their facilitators. These teens report that such relationships help them develop self-esteem and feel more comfortable relating to peers and adults (O'Donnell et al. 1999).

This last factor has significant implications for the success of service learning programs in African-American communities and low-income neighborhoods. In these areas, the lack of a strong relationship with a parent contributes significantly to teen pregnancy. Because many low-income and single parents must work longer hours, many teens grow up feeling alienated and without adequate parental guidance. Mentor relationships could help address this alienation by providing a positive adult role model. Although the bond between mother and child would be difficult to replicate, a strong, caring relationship with a mentor could help to fill the void.

Conclusion

These programs can be adapted further to suit the needs of minority neighborhoods. Community leaders could make a special effort to recruit minority women to serve as mentors and volunteers. The presence of successful professional women could provide additional inspiration and motivation to teenage girls who need a strong female minority role model.

In conclusion, many of the current pregnancy prevention programs have yet to take into account the unique needs of low-income, African-American teens. However, current efforts such as service-oriented programs could be easily adapted to benefit minority communities that continue to experience elevated rates of teenage pregnancy.

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