The Policy’s Fatal Flaw

While the Norplant for Consenting Teens policy may work, there is deep problem with the policy. The policy is a overly drastic solution to the problem. Teenagers need more information about reproduction and contraception. They currently do not know where to go for more information. Unfortunately the society is not open to discuss important reproductive and contraceptive topics with teenagers. As a result, one in three female teenagers will not use a form of contraception the first time they have intercourse and, one in five teenagers do not use any form of contraception.

Over half the teens polled incorrectly thought that they needed parental permission to buy over the counter contraceptive devices. Teenagers have cornered the market in contraception failure, e.g., their average failure rate for an oral contraceptive is 11% compared to the average for women over 20 is about 5%. Likewise, sexually active teenagers wait between thirteen to fourteen months after they started having intercourse to come to a family planning clinic. Sadly, in 1981 the most common reason for teenagers making their first clinic visit was their fear of being pregnant.

Sexual education offers hard-to-get information to teenagers. As a consequence, teenagers participating in sexual education programs are more likely to use a contraceptive when having intercourse and will use contraceptives more effectively. They will also abstain from sexual intercourse for longer periods of time. Since 80% of sexually active teenage males indicated that they believe they first had intercourse at too young an age, this phenomenon seems to be in the interests of teenagers.

Unfortunately the sexual education in the United States is inadequate. Over half of all teens do not take a sexual education course until after they have become sexually active. On average secondary schools only offer six and a half hours a year on all sexual education topics, and less than two of those hours covers contraception and STD prevention.

Deterring teenage pregnancies generally improves the socioeconomic situation of the teens, regardless of race, religion, or economic situation. Several discriminatory policies that employ Norplant may exist. However, the Norplant for Consenting Teens policy is not such a policy. The Norplant for Consenting Teens policy affects all teenagers, unlike policies such as the one proposed in Kansas, that only affects women on welfare. Since the pregnancy rate among black teenagers is much higher than other ethnic groups, the policy helps the black community more. By improving education and the economic situation of black teenagers, the policy will offer them better socio-economic opportunities by helping reduce the rate of unwanted or unexpected pregnancies, just like giving out free birth control helps everyone. Why would this supposed discriminatory agenda specify bettering the education and the over all standard of living of those whom it intends to ‘victimize’? This policy hardly fulfills a true eugenicist program because it is more likely for the targeted group to prosper under these conditions.

Second, having more children does not entail having a healthier community or ensures the survival of that community. To presume that women of a community should breed, regardless of the adverse consequences these women and their children must face, does not seriously demonstrate concern for members of that community. Having a healthy society, or a fit population, requires that the offspring have enough resources available to thrive. Coincidentally, by allowing young members of a community to avoid situations that will inhibit their ability to acquire resources and to avoid perpetuating this disadvantage, the Norplant for Consenting Teens program promotes healthier communities. This is true for any community, regardless of race.

It is important to recognize the Norplant for Consenting Teens policy does not specify that it is the only contraceptive method available to teenagers. As mentioned earlier, provided their costs are affordable, other effective methods could be used, e.g., Depo-Provera. The policy never suggested that no other contraceptive methods should be available to teenagers. Since synthetic hormone birth control methods do not protect against STDs and AIDS, the government should not solely promote this form of contraception. Programs to encourage condom use exist for this purpose.

While it would be optimal that all synthetic hormone contraception birth control methods cost the same, contraceptive costs will probably always affect women. It may be a governmental obligation to supply women with affordable contraception, but this does not entail that the government should supply women with every possible form regardless of cost or effectiveness. This is just not practical considering real world costs. However, subsidizing long term synthetic hormone contraception may help broaden the contraceptive choices for teenage women. Presently, oral contraception is the most common teenage contraceptive choice. When cost was not a factor, 48% of the teenagers chose Norplant instead. This high rate suggests that the excessive cost of Norplant is denying some teenage women access to their first choice of synthetic hormone contraception.

Schools offer a place where most all of the teenagers will be and because of its pedagogical function, it is ideal for sexual education. By incorporating sexual education into the curriculum of public schools, teenagers will have a regulated and reliable source of information in an environment that they are more comfortable in. Comprehensive sexual education programs are very successful at increasing teenager’s knowledge of reproduction and contraception. If the government implements a comprehensive sex education program and subsidizes Norplant for teenagers within public schools, the policy could have educated teenagers consenting to have inexpensive Norplant birth control systems. Furthermore, since the public schools traffic a large proportion of the teenagers in the United States, the program would probably either give teenagers a better standard of living for the same cost that we are spending on teenage pregnancies or save the government in social service costs.

Objections
There are four common objections to the public policies similar to the proposed ‘Norplant for Consenting Teens’ policy. The first two objections, the message objection and the morality objection, argue against any governmental subsidized contraception and sexual education, respectively. The other two objections, the eugenics objection and the reproductive choice argument, object to the particular use of Norplant in a public policy.

The message objection states that the government is sending the wrong message to teenagers with this program. By subsidizing Norplant birth control, teenagers are simply ‘equipped for sex’ and the policy complacently ignores important moral issues about sexuality. This policy effectively encourages teenagers to become sexually active and implies that they are not responsible for their actions. The government should not send such messages because it directly attacks the moral fiber of the country.

The message objection is correct in that the policy may project a message to teenagers. What that message states is hard to interpret. With education about contraception and the health consequences of unprotected sexual behavior, the message may be that the government is concerned about the health of teenagers. Furthermore, the message states that the government is aware that some teenagers will act sexually and that it wants to help protect their health and welfare too. Reducing the cost of birth control methods shows that the government is willing to help sexual teenagers act more responsibly. Finally, with public icons making books that promote unsafe sexual practices, it is hard to believe that any message that the policy gives is worse than the media messages that bombard teenagers every day.

One problem with the proposed policy is difficulty in getting informed consent from a teenager. We have no assurance that the teenager knows all the options she has, like IUD birth control, or that she understands what the drug actually does. Somehow we need a comprehensive method for making certain that teenagers know about their bodies, different forms of contraception, and the implication of each one’s use.  For example, we cannot assume that all teenagers understand that Norplant does not protect against sexually transmitted diseases (STDs). A responsible Norplant for Teens program must offer detailed sexual education and counseling.

The second problem with a consent driven Norplant for Teens program is that the sexual education and the Norplant services must be accessible for teenagers. If the program is not accessible to the majority of teenagers, then it will not benefit them no matter how good the program is. There is good evidence that placing such a program in traditional clinics would not target the majority of teenagers. Studies have shown that in both the United States and England, many teenagers believe that the clinics are not meant for them. Both male and female teenagers have reported that they feel uncomfortable in these clinics. Likewise, 38.7% of boys polled incorrectly thought that parental permission was needed to go to the clinic. In order for a Norplant for Consenting Teens program to work, it must occur in an environment that has access to most all teenagers and makes them feel comfortable.

Each year, babies born to teenage mothers will cost the government six billion dollars in social services over the next twenty years. That the cost is spread out over the years actually makes the situation worse, considering the figure does not account for inflation. Meanwhile, the taxpayers’ cost caused by teenage pregnancies over five years will well exceed $30 billion.

This is still $9 billion more than in a very poor Norplant scenario. Furthermore, the difference between the costs will grow further apart with time. The difference in cost is even more alarming when you remember that both female and male teenagers are sexually active. The number of sexually active females should be much lower than accounted for. To keep the scenario very poor, however, this high number could assume that many non-active females will also opt to get a Norplant birth control system.

A common concern about a Norplant birth control subsidy program, or just the drug itself, is that it will encourage teenagers to avoid using condoms and visit attending health clinics less regularly. Presently no information confirms this hypothesis. However, evidence suggests that condom birth control use does not significantly differ from teenage Norplant users and their oral contraceptive using peers. Norplant use does not seem to affect the teenage attendance of health clinics either. Neither the number of follow-up clinic visits, the rate of duration of the follow-up, nor the rate of return significantly varied between observed Norplant using teenagers and their oral contraceptive using counterparts. This evidence suggests that the increase in the use of Norplant in teenagers would not likely affect their condom use or their regular attendance of clinics.

Presently forty-three states cover Norplant under Medicaid. The irony of the situation is that by the time the state is willing to pay for a Norplant system for a teenager, she has already given birth. Due to the costs of that child the mother has now become eligible for Medicaid benefits, which coincidentally include subsidized Norplant. Once the state subsidizes a good form of birth control for the teenager, the damage has already been done. The teenager and her child are dependent on social services. Instead of this ad hoc policy, why doesn’t the state supply teenagers with contraceptives before they become pregnant and consequently incur great social costs?

For the first three years the system is 99.7% effective at preventing pregnancy, while the rate drops to 99.3% by the fifth year of use. Currently Norplant systems cost about $365 per system plus a doctor’s fee.  The most common side effect of Norplant is irregular menstrual bleeding. One woman in eleven will discontinue Norplant during the first year because of this effect. On average, these women have the implants removed after about seven months of use. Irregular menstrual bleeding caused by Norplant tends to lessen within nine to twelve months of use. Weight gain, headaches, and nervousness are also reported side effects. Because Norplant is a progestin, it has most all the side effects related to their use, i.e., it has the same effects associated with Depo-Provera.
Since Norplant systems are implants that release small doses of progestin, unlike Depo-Provera, the implants must be removed when the doses expire. The Norplant removal procedure is more difficult than the implants’ insertion. Removing Norplant systems generally takes about thirty minutes. Of the women having the Norplant implants removed, 19% of the procedures will take over an hour and 24% of the women polled reported the pain as ‘significant’. Pain usually occurs when the insertion border is too deep. Improvements in the implantation and removal techniques have reduced this problem. For example, the Emory Method of Norplant removal has diminished the removal time to under ten minutes. Likewise if Norplant was developed as a one or two rod system, instead of six sticks, the removal procedure would be easier and less painful.

The future of many children of teenagers looks bleak from before they are even born. Thirty three percent of all pregnant teenagers receive inadequate prenatal care, since they either start late in the pregnancy or have too few medical visits. Because of teenage lifestyles, later prenatal care, and poor nutrition, both mothers and children are more likely to have health complications. While affluent pregnant teens are less likely to have these symptoms, they still display several of the symptoms.

Once the children of teenagers are born, the home environment for these future children is not optimal. Two-thirds of all teenage births are to unmarried women. These mothers will probably not receive a high school diploma — only about half graduate from high school by the age of thirty. Eighty-four percent of fathers of children born to teenage mothers live apart from their children and only one-third report visiting their child at least once a week one year after the child’s birth. Sixty-one percent of teenage mothers living apart from the child’s father report that the father offers inadequate support for the child. Finally, when children live in poverty with a single teenage mother, they are at greater risk for lower academic and intellectual accomplishment, problems with self control, and social behavior problems than children of older mothers.   These problems are primarily due to the effects of a single parent household, a larger family size, and lower maternal education. Teenage parents often struggle to complete a high school education and thus face poor career opportunities. Consequently they are disproportionately poor and usually are dependent on public support. The vast number of teenage pregnancies translates into large social costs. Public funds pay for at least half of all teenage births. Births, however, are not the sole cost to the state. Within five years, 77% of all teenage mothers will go on welfare. Furthermore, 43% of all welfare recipients started their families as unmarried teenagers. In 1989, the government spent over twenty-one billion dollars for social, welfare, and health services for families begun by teenagers. Furthermore, babies born to teenagers in that year will cost the government at least six billion dollars over the next twenty years. Even more disturbing is that teenage motherhood and teenage fatherhood both tend to perpetuate themselves from one generation to the next, i.e., children of teenage parents tend to become teenage pareants. Thus, the teenage pregnancy rate that is occurring in the United States is creating spiraling costs for government spending.

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