Journal Issue: The Next Generation of Antipoverty Policies Volume 17 Number 2 Fall 2007
Abstinence and Pregnancy Prevention for Young Adults
One potentially powerful strategy to reduce poverty among families with children is to promote both abstinence among unmarried teenagers and effective contraception use among teens and young adults who are sexually active but do not intend to become pregnant. The number of potentially affected individuals is large, and the risk of poverty is great when young women have nonmarital births. In 2004, nearly 1.5 million infants—more than one in three newborns—in the United States were born to unmarried women. Most of these women were aged twenty-five or younger; one-quarter were teens (table 1). Most of these births were first births, and few children were born to unmarried women who had previously given birth within marriage.22 Only a small share (12.5 percent in the early 1990s) of unmarried women who become pregnant marry before they give birth.23
The Fragile Families Study indicates that roughly half of unmarried mothers and fathers are living together when their child is born; roughly another one-third are in some type of romantic (or visiting) relationship.24 Most of these couples view marriage favorably, and most believe that they are likely to marry. For many, however, maintaining a relationship requires overcoming a variety of obstacles, such as poverty, unemployment, physical and mental health problems, substance abuse, high male incarceration rates, and a lack of trust between partners. Not surprisingly, these nonmarital unions tend to be unstable.25 Within one year of the child’s birth, 15 percent of cohabiting couples had married and 21 percent were no longer in a romantic relationship. Among romantically involved couples who were not living together, only 5 percent had married and 49 percent had split up. Five years after the child’s birth, 29 percent of cohabiting couples had married and 42 percent had separated. Correspondingly, 7 percent of visiting couples had married and 74 percent had split up.26 Other studies also find that the marriage prospects for women who give birth out of wedlock are dim. By one set of estimates, just under half marry within the next ten years and just over one-third will be married when they have their second child.27
The good news is that childbearing among teenagers has declined since 1990.28 To the extent that the policy environment of the past fifteen years has contributed to that decline, it seems prudent to build on rather than replace existing policies. Favorable trends in teen birth rates appear to be due to the combined effects of delayed sexual debut and more effective use of contraception.29 It would thus be useful to maintain a balance between promoting abstinence among teens and encouraging wise contraceptive practices among sexually active young adults who do not wish to become pregnant.
Using the 2004 cohort size of fifteen- to nineteen- year-old females and data on sexual experience rates, contraceptive use, and birth rates, we explored how policies that delay sexual activity and improve contraception use would play out in terms of teen and nonmarital births. Other things being equal, delaying first intercourse for one year would lower the share of twelve- to nineteen-year-olds at risk for pregnancy and birth by about 9 percentage points. The delay would reduce the number of teen births, at present rates, by about 81,000 a year—a proportional decline of 24 percent (figure 1). Because almost all of these births would have been to unmarried teens, the share of all teen births to single mothers would fall from 82 percent to 78 percent.
Combining policies that delay sexual activity for one year with policies that stress abstinence and increase the likelihood that sexually active young adults who do not intend to become pregnant use effective methods of contraception could substantially increase these benefits. For example, if half of those not now using contraception were to become consistent users of condoms, the pill, an injectable form of contraception, or an implant, the number of unintended births would fall roughly another 60,000 a year, or 14 percent. And the estimated share of all teen births to single mothers would fall another 5 percentage points, to about 73 percent of all teen births.
Influencing the nonmarital childbearing of young adults, though, is a challenge because only half of all women in this country marry by age twenty-five, whereas most become sexually active during their teen years. The gap between the average age of first intercourse (seventeen) and the age at first marriage (twenty-five) is seven years.30 Still, it should be possible to improve the ability of young adult women to avoid many of the 40 percent of births (439,000 births) that are unintended and occur predominantly to unmarried women.31 These unintended births constitute more than one-third of all nonmarital births.32 Even if they achieve half the success rate in preventing unintended births assumed in the above projections for teens, policy initiatives that enable sexually active young adults to avoid unintended pregnancies could mean about 40,000 fewer nonmarital births each year.
How might delayed childbearing affect poverty, particularly among children? One study estimated that delaying childbearing among teens would increase median family income by a factor of 1.5 to 2.2 and reduce poverty rates by even more.33 It could also substantially reduce the number of abortions, which are especially common among nevermarried women and teens. In 1994, for example, 34 percent of pregnancies to women under age twenty-five were estimated to have ended in abortion, as did 31 percent of the more than 2 million pregnancies of unmarried women.34
The task confronting policymakers is to fashion programs that will alter current behavior of teens and young adults. Evidence on the effectiveness of programs to delay sexual debut of particular groups of youth is limited and not overly encouraging.35 Yet recent trends in teen sexual activity, contraceptive use, and births suggest that something in the public policy arena or the larger culture, or both, produced favorable change beginning in the 1990s.
Our recommendation, therefore, is to continue full-bore with efforts by parents, schools, and community groups to encourage abstinence among teenagers, support the use of effective contraception among sexually active young adults, and emphasize the message that pregnancies are 99 percent preventable. In particular, we recommend that all school systems offer health and sex education, beginning no later than middle school, whose primary message is that unintended pregnancies are not only highly preventable, but also have substantial costs for the pregnant woman, the father, the child, and society in general.36 We also recommend that school systems (as well as parents and community groups) educate young people about methods to prevent unintended pregnancies, as well as life-threatening sexually transmitted diseases.
Simply knowing about and having access to contraception does not guarantee a high compliance rate among sexually active teens and young adults. It is thus important to challenge the social norms and cultural views that nonmarital childbearing is an expected stage in the life course, especially among lowincome populations, where these beliefs have taken hold most strongly.37 School-based programs, as well as public education campaigns, should emphasize the importance of bearing children within the security provided by a marital relationship. A child-focused message may be particularly effective. That is, children’s economic, social, and psychological well-being is greatly enhanced when they have married parents.
Because almost all youth in this country already receive some form of education about sexual behavior and health as part of their schooling, enacting this recommendation would, in most cases, require refining the course content and extending the time devoted to this goal.38 Consistent with the overwhelming desire of parents that their teenage children remain abstinent, most programs now promote abstinence as the healthiest and most socially appropriate behavior.39 Then, with varying emphases, these programs teach young people strategies for developing healthy relationships with peers, resisting negative peer pressure, communicating with parents and other important adults in their lives, and setting and pursuing realistic life goals.40 Supplementing this course content with relationship skills training for couples is likely to make the programs more effective. For example, young women with good negotiating skills may be better able to say no to unwanted sexual advances or to insist that their male partners use contraception. And teenage boys need to hear the message that if they father a child, they will be responsible for paying child support for many years. Boys, like girls, also need to be aware of the negative consequences for children reared in single-parent homes.
The major policy challenge is to learn which information in these courses is helpful, and which is not helpful, in supporting teens to remain abstinent or to return to an abstinent lifestyle. A key goal is to identify a menu of “best practices” from the current array of courses. Ideally, the federal government could provide school districts with tested curriculum models, though it could probably not do so in the near future. There are several sources of guidance about programs and practices judged to be effective in reducing pregnancy risk. The evidence supporting the effectiveness of various programs is far from conclusive, though.41 Before dismissing the findings, however, it is useful to consider that virtually no program has been tested in a truly experimental setting, where the comparison group is “treatment free.” Moreover, because the programs tend to be low in cost, even small effects that are hard to detect with the small samples typical of research in this area are likely to be cost effective. The estimated costs of such a policy would be quite modest and well below the expected savings to taxpayers. For example, in a steady state, taxpayers incur yearly net costs of over $20,000 per teenage parent, whereas the annual estimated cost of a biweekly health and sex education class would be less than $200 per student.42 If such a universal program initiative succeeded in cutting the teenage birth rate in half, the estimated return on the investment would be about 20 percent.43
We are reluctant to promote comprehensive interventions, such as the community centered Carrera program for at-risk youth. In addition to sex education (which includes information about abstinence and contraception), the Carrera program focuses on career exploration, employment assistance, academic tutoring, art workshops, sports activities, and comprehensive health care.44 Such programs, though useful, are costly and have myriad goals other than preventing teen pregnancy and childbearing. Moreover, their success in preventing teen pregnancies and births has been mixed.45 Clearly, more research on program and curriculum effectiveness is needed. In the meantime, communities and school districts will need to sort through the many home-grown and commercial curricula now in use and tailor programs to perceived local needs.