Organized responses to adolescent sexual and reproductive behavior.

Parents and other adults have long tried to influence and control the sexual behavior of adolescents, especially young women, through admonitions, curfews, limitations on dating and forced marriage. The last two decades have seen the proliferation of organized interventions that parallel and supplement individual efforts to reduce teenage sexual activity and its negative consequences. Many of these interventions have focused either on trying to persuade adolescents, particularly young women, to abstain from sexual activity or on providing remedial services to pregnant teenagers and adolescent parents. Both of these approaches have instinctual appeal, but neither has been effective enough or perhaps intensive enough to have a major impact. On the other hand, there is evidence that some programs have succeeded in reducing levels of unprotected sexual behavior and pregnancy among young people who participate in them. The most effective programs typically combine innovative instructional techniques with informati on about methods to prevent pregnancy and STD transmission; some also facilitate adolescents' access to contraceptive services. Such programs are still relatively rare, however, and have yet to be implemented on a national scale.

Different Approaches

Programs designed to provide special services to pregnant teenagers who decide to give birth are perhaps the oldest form of organized intervention. Originally, these programs primarily entailed providing residential care for pregnant young women outside their home communities until they gave birth and, usually, relinquished their babies for adoption. As it has become the norm for pregnant adolescents to continue to live at home, attend school and keep their babies, these programs have evolved. They now concentrate on providing both necessary medical services, to ensure that young women receive adequate prenatal care so they will have healthy birth outcomes, and support services, to help adolescent mothers stay in school and learn skills they need as parents. Not all pregnant adolescents have access to coordinated services and support, however, because these programs are quite intensive and therefore costly.

Meanwhile, many family planning clinics and almost all school systems now offer sex education aimed at increasing young people's knowledge about reproduction. Some of these programs also provide information about contraception and STD transmission, and include lessons in communication skills. Programs associated with family planning clinics facilitate teenagers' access to medical contraceptive services, and a few schools have opened clinics that provide contraceptive and STD services or have implemented programs to make condoms available to students.

During the last decade, policies and programs designed to encourage abstinence among unmarried teenagers have become increasingly popular. Some of these programs have attempted to accomplish this objective by giving young people encouragement, offering moral support and teaching interpersonal skills to resist pressures to become sexually active. (236) Others have sought to convince teenagers that sex before marriage is immoral and have emphasized the negative consequences of sexual intercourse, while occasionally withholding or distorting information about the availability and effectiveness of contraceptives. (237)

On a broader scale, community and service organizations have implemented interventions aimed at increasing the life options of disadvantaged young people through, for example, role models and mentoring, community service projects, job training and activities aimed at reducing risky behaviors. Such interventions are expected indirectly to reduce levels of unintended teenage pregnancy and childbearing and sexually transmitted infections, in the belief that teenagers who are more positive about their futures are less likely to participate in risk-taking behaviors, including risky sexual practices.

Several model communitywide programs for high-risk, inner-city populations have linked substance abuse prevention with delinquency prevention, pregnancy prevention or educational achievement. (238)