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.

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.

Women who use Norplant for over a year report that they like it for its effectiveness, convenience, and lack of serious side effects. This convenience is also appreciated among teenage users. Over seven out of ten (71%) teenagers using Norplant stated that they chose the contraceptive method because they would not have to remember to take pills daily, and 48% also referred to the contraceptive methods’ ease of use. Likewise from 74% to 86% of Norplant using teenagers reported being satisfied with the contraceptive method. This contrasts with the 39% reported satisfaction rate of oral contraceptive using teenagers. The ease of use and effectiveness probably accounts for the high level of satisfaction among long term synthetic hormone contraceptive users, adolescent or otherwise.

The cost over five years makes long term synthetic hormone contraception the most economical form of birth control.  For example, the average cost of oral contraceptives and doctor’s visits over five years is about $1,400. Currently Depo-Provera ( or “Depo shot“) costs $1,000 for five years of effectiveness and Norplant generally costs about between $500 to $700. However, the cost of Norplant in other countries is significantly less — always under $120, and the cost should have been substantially lowered in 1995. The actual cost to make and market the device is sixteen dollars. Because of the difference in potential cost and that most teens do not care about the convenience in reversing contraceptive methods, Norplant presently is more desirable than Depo-Provera (commonly called “Depo Shot“)for a cost-effective teenage pregnancy deterring policy.

There is an obvious argument for supplying teenagers with subsidized Norplant systems. This policy will protecting the health, welfare, and future of the teenagers. Most teens do not intend to become pregnant. Becoming pregnant subjects the mother to many health risks. Likewise, since teenage parenting generally subjects mothers to a higher risk of socioeconomic disadvantage throughout their lives, most teenagers do not want to become pregnant. Supplying teenagers with Norplant systems is a win — win situation. The state will drastically reduce the number of teenage pregnancies and consequently the costs spent on them. Teenagers will have fewer health risks, better educational opportunities, and better career options, than if they did not have access to contraception and become teenage parents.

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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This year ten million teenagers will perform 126 million acts of sexual intercourse. In 1988, by the age of fifteen, 27% of unmarried young women had sexual intercourse and by the age of nineteen, 75% of women had intercourse at least once. Moreover, teenage sexual activity has been steadily increasing. For example, from 1982 to 1988 the rate for fifteen year old girls has increased from 19% to 27%. In 1993, 32% of ninth grade girls, ages 13 to 14, have had intercourse and about 7% of female high school seniors have had four or more sexual partners. America is not plagued by sex-crazed teenage women — their male counterparts are just as active.  In 1989, 33% of males by the age of fifteen, 50% by sixteen, and 86% by nineteen have had intercourse. Overall, the average age for intercourse is getting lower and the number of partners is increasing.
There is a large ethnic variance in the rates of sexual activity among teenagers. Prior to 1989, 81% Black males, 60% Hispanic males, and 57% White males, ages 15 to 19, had intercourse at least once. Female rates are: 61%, 49%, and 52% respectively. The rates have increased since the recording of this information. Planned Parenthood is the best place to learn about any birth control, and IUD Birth Control in particular. Offices are located in every major city.

Likewise, the average age for first intercourse varies over ethnic and social situations. The average age for first intercourse for a white male is 15.9 years old, while for a black male, it is 14.4 years old. A 1981 study showed that the average age for first intercourse for an urban black was 11.8 years old. The date of the study suggests that the average age has probably gone down.
It is important to note though that the bulk of the increase of teenage pregnancies in the United States is not due to urban conditions or the sexual behavior of ethnic minorities. While these groups have a higher than average pregnancy rate, their rates have leveled off and their small number does not greatly influence the national rate. Teenagers living at the poverty rate or up to 200% over the poverty rate are primarily responsible for the large increase in the national rate. This increase suggests that the principal explanation of the relatively high pregnancy rate in the United States is from factors that influence the entire country, and not specific groups.

This high rate of teenage sexual behavior involves great social costs. Each year, more than one million teenagers will become pregnant (1,014,620 were reported in 1987). By the age of eighteen, about one in four young women (23%) will become pregnant and by the age of twenty, the rate increases to over four in ten (44%). Sadly, 92% of all pregnancies among unmarried teenagers are unintended. Furthermore, one in five teenagers who experience pregnancy will become pregnant again within the next year. The rate of a second pregnancy occurring two years after a pregnancy increases to a little over three in ten. Teenagers are becoming unintendedly pregnant at a higher rate than any other group of women.
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