Teen birthrates have fallen 13 years in a row, but the most recent decline was so small that many observers now are worried that the downward trend will stall or reverse itself. In the wake of this news, at least two "holistic" approaches to teen pregnancy prevention are vying for attention. One approach says "relationship skills" should be added to sex-education programs.
Sex education "has always taught [teens] what to avoid -- and we need to continue that -- but it's not enough," said Marline Pearson, co-author of a report for the National Campaign to Prevent Teen Pregnancy. "[W]e need to look beyond the goal of managing the health risks of sex to the goal of building healthy relationships," said Mrs. Pearson, who wrote the report with Barbara Dafoe Whitehead, co-director of the National Marriage Project at Rutgers University.
Another "holistic" approach that is seeking new markets, including Washington, D.C., is psychologist Michael A. Carrera's adolescent pregnancy prevention program. Mr. Carrera's approach, developed with the Children's Aid Society and known as the CAS-Carrera model, includes sex-education classes as part of a range of social services provided to low-income children from fifth grade through high school. The respected program, which is replicated in 20 states, has been shown to delay sexual debut and reduce teen pregnancy among its participants.
"The work we're doing is a pure youth-development model," Mr. Carrera said at a recent event by the DC Campaign to Prevent Teen Pregnancy. The best way to discourage teen pregnancy, he said, is to "move from fragmentation [of services] to wholeness."
Teen childbearing is viewed as a national problem because of its links to poverty, welfare, fatherlessness, low educational attainment, and mental and physical health problems. For 13 years, Americans have heard good news about U.S. teen birthrates. In 1991, teen birthrates peaked with nearly 62 births per 1,000 teenage girls and a total of nearly 532,000 births. After that, birthrates fell every year, reaching 41 births per 1,000 teenage girls in 2004, according to preliminary data from the National Center for Health Statistics (NCHS).
However, the 2004 birthrate was only 1 percent lower than the rate for 2003, and the number of teen births rose slightly, from 421,241 in 2003 to 422,197 in 2004. These figures give pause to researchers like Jennifer Manlove at Child Trends Inc.
"Is this just a slight stabilization before future declines, or are we on the brink of new increases in teen birthrates?" she asked.
The increases in teen births occurred among those younger than 15, teens 18 and 19, and among Hispanic girls, Child Trends said in its latest "Facts At a Glance" report on birth trends.
In their new report, "Making a Love Connection," National Campaign to Prevent Teen Pregnancy board members William Galston and Stephen Goldsmith said it's time to recognize teens' hunger for relationship skills.
Information about developing healthy relationships "has been the missing ingredient" in teen pregnancy prevention programs, they wrote in the report's introduction. "Teens hear about biology and body parts," but are "hardly ever told how to achieve responsible and respectful relationships."
In addition, they wrote, teens aren't taught that there's a "simple formula" that can help them fulfill their goals in life. This "sequence for success" is to "graduate from high school (at least), don't have a baby until you are married, and don't marry during the teen years."
Mrs. Pearson, who teaches social science in Wisconsin and has written a relationship skills curriculum called "Love U2," says teens are eager to hear more about love, intimacy, trust, respect, commitment and the emotional and ethical consequences of sex.
They already know "a messed-up love life can certainly mess up other parts of your life," she said. They want to know how to "navigate their relationships without prematurely sexualizing them."
The national campaign's report notes that one of the allowable uses of the federal government's new $100 million healthy marriage funding is to teach relationship skills in high school. With the CAS-Carrera model, the goal is to create a long-term environment to give young people the tools and the motivation to make wise choices for themselves, such as avoiding parenthood until they are at least in their 20s, Mr. Carrera said.
Teaching young people the facts of life are important, "but it becomes diluted once they leave you unless it's linked to other things that make them who they are, totally," he said.
The CAS-Carrera model offers daily services in several areas: education, employment, family life and sexuality education, art, sports, and mental, physical, reproductive and dental health care. The year-round program, which also serves the children's families, is underwritten with public and private funds and is offered at no cost to participants.
The CAS-Carrera program doesn't teach sex apart from life, but as a part of life, Mr. Carrera said. If the children are well-educated, in good health, are prepped for college and the job market, understand banking and have "sexual literacy," they'll choose good paths for themselves "because there's something at stake here," he said.
The CAS-Carrera program has two sites in Baltimore, and Mr. Carrera said he is eager to find one in a D.C. neighborhood. Some foundations have promised financial support, and "we're now ready," he said.
The District's teen birthrate rate remains one of the highest in the nation, with 60.3 births per 1,000 teenage girls in 2003, NCHS data show. This is a 45 percent drop since 1991, but "we've got to do more to motivate D.C. teens," said Brenda Rhodes Miller, executive director of the DC Campaign to Prevent Teen Pregnancy, adding that her group is working to bring the CAS-Carrera program to the area.