Not Under My Roof (Yet?)

Kelly Connelly

“American girls are more than four times likely to become pregnant and more than two times as likely to have abortions as their Dutch counterparts, even though they have sex at comparable ages,” Amy Schalet writes in her book, Not Under My Roof: Parents, Teens, and the Culture of Sex.

Schalet, a Sociology professor at UMass Amherst, attempts to explain this dramatic difference, and in doing so presents a rather marked contrast between the ways in which American and Dutch parents use different frames to “understand adolescent sexuality and their own responsibility as parents.”

(To understand what a “frame” is in this context, we turn to trusty Wikipedia: “A frame in social theory consists of a schema of interpretation — that is, a collection of anecdotes and stereotypes—that individuals rely on to understand and respond to events. In simpler terms, people build a series of mental filters through biological and cultural influences. They use these filters to make sense of the world. The choices they then make are influenced by their creation of a frame.”)

The book goes into great and interesting detail about these frames (Schalet interviewed nearly 150 parents and teens), so reading the book is strongly suggested to have a better understanding. But, in short, these frames are:

The Dutch frames:

  • normal sexuality,
  • relationship-based sexuality, and
  • self-regulated sexuality

The American frames:

  • hormone-based adolescent sexuality,
  • battle between the sexes, and
  • parent-regulated adolescent sexuality

Illustrating the confidence many Dutch parents have in their teens’ ability to regulate their own sexuality is their use of the term “era an toe zijn” which translates as “being ready.” Schalet writes that the use of this term “demonstrates an assumption that young people are the best judges of when they are ready,” but goes on to say that it is the job of the parents to “remind their children… not to do anything before they feel ready, as well as take the precautions to be ready.”

In addition to the frames mentioned above, one of Schalet’s explanations of the Dutch and American views stood out to me as a reader:

“One reason the two sets of parents [Dutch versus American] view [and manage teenage sexuality differently is that they draw on different models of individualism: given their different assumptions about (self-) control, autonomy, and authority, it makes sense to American parents to view teenage sexuality as a potential drama in the making, while to Dutch parents the ‘normality tale’ is both plausible and desirable.”

In other words, Dutch parents tend to normalize adolescent sexuality while their American counterparts dramatize it.

Equally interesting is Schalet’s assertion that “culture is not destiny.” Prior to the early 1970s, she notes, “neither the general public nor the major institutions of Dutch society accepted sex between unmarried youth as legitimate.”

Which begs a few questions:

  • Would you see a potential similar culture shift in the US to be a positive thing were it to happen?
  • Do you think a culture shift like this would be realistic in our society?
  • What would it take to shift American norms?

Schalet’s book is fascinating for many reasons, not least of which the questions—like those above—it evokes.

Kelly Connelly is the Marketing and Communications Manager at Healthy Teen Network.

President Obama Should Save the Adolescent Family Life Program

Paul Florsheim

Barack Obama, who was born to a teenage mother, may do more damage to the health of future teen mothers and their children than any other president. If Mr. Obama goes through with his current plans to eliminate the Adolescent Family Life Program (AFL), the only federal agency that supports research on services for teen parents, it will have a terrible effect on families who need help the most.

As a researcher in public health in Milwaukee, a city with a high rate of teen childbirth, I see this issue up close. The guiding principle of my work—that children benefit from having two healthy parents who work together to care and provide, regardless of the existence of a romantic relationship—is common sense. However, most young parents need help creating a stable environment for their children. With support from AFL, I have spent my career creating and testing programs that help young expectant mothers and fathers work together as parents and successfully meet the challenges of adolescence. I have seen many young mothers and fathers turn their lives around by avoiding drugs and alcohol, going back to school, finding legitimate jobs, and learning to care for each other and their children.

Policy makers of all stripes agree that the best approach to teen pregnancy is to reduce its occurrence in the first place. But despite our best efforts, babies will continue to be born to teen mothers and fathers. These young families need effective programs to support their health and development, their capacity to function as parents, their educational attainment, and their job readiness. With encouragement and support, they have the capacity to become productive citizens, or even the President of the United States.

AFL supports high-quality, low-cost programs. It explicitly targets goals that put adolescent parents on a path toward becoming well-adjusted, productive members of society: high school completion, delay of second pregnancy, and paternal involvement in childrearing. It requires that scientific methods be used to test the effectiveness of its services so that bureaucracy and waste are minimized. It has concrete achievements, including the reduction of domestic violence and improved parental engagement with their young children.

The AFL program was the brainchild of Orin Hatch, the conservative, budget-cutting senator from Utah. In 1981, when he introduced the program to Congress, Senator Hatch received strong support from his Democratic colleague, Edward Kennedy because both men recognized that without the tools to succeed, teen parents and their children become a drain on society. As a professor of public health, I also know that the quality of services provided to disadvantaged pregnant women is a good predictor of a community’s overall health. When services for pregnant women and young fathers are diminished, it will lead to more broken families, more violence, and more crime.

With a total cost of under $17 million—less than one-twentieth the price of a $350 million F-22 fighter plane—eliminating the AFL will not help balance any books and will likely add to our budget woes by further straining our already overtaxed criminal justice and health care systems. The Obama Administration is arguing that AFL duplicates new programs in the Office of Adolescent Health, namely, the Pregnancy Assistance Fund. This is simply not true. Those programs, which are linked to the Affordable Care Act, are prohibited from supporting research. Abandoning research in this area undermines the progress made over the last three decades.

The “Deficit Super Committee” of the US Congress was expected to act on the President’s proposed 2012 budget, which cuts the AFL entirely. The Super Committee did not return with any recommendations to make budget cuts, and the government is currently operating under a continuing resolution (CR). If Congress does not act, Health and Human Services Secretary Sebelius will make the cut by default. When the AFL was last in danger of being eliminated, Eunice Kennedy Shriver wrote a letter to the New York Times (1988) defending this program because it “gives so many teenagers a new sense of purpose, a new basis for self-esteem, a strengthened relationship with their families and an understanding of why they should care for themselves and others.” Ms. Shriver, a tireless advocate for science and children, was persuasive because saving the AFL program was the right thing to do.

Despite her youth, Ann Dunham, Mr. Obama’s mother, garnered the support she needed to help her son make the most of opportunities when they came. Knowing the odds against Ms. Dunham and her son, the President was extremely lucky. I have worked with hundreds of teenage mothers and fathers, and many of their children are not so fortunate. They are no less deserving.

Paul Florsheim is Chair of the Faculty at the Joseph Zilber School of Public Health, University of Wisconsin Milwaukee

Failure to Increase Access to Emergency Contraception a Failure for All

Gina Desiderio

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius failed to accept the Food and Drug Administration (FDA) recommendation to make Plan B One-Step emergency contraception available without a prescription for people under 17. Emergency contraception will continue to be available for women under 17 with a prescription, and behind the counter, once age is verified, for those 17 and older.

This decision appears to be politically motivated rather than based in science and research. The FDA had been expected to approve over-the-counter availability of Plan B One-Step, without an age restriction, based on its thorough and careful review of the data on usage. However, Sebelius, in an unprecedented action, overrode the FDA’s recommendation.

“We are surprised and disappointed in Sebelius’ unfounded decision. The Obama administration’s previous commitment to science has been a positive force in the field of adolescent sexual and reproductive health,” says Dr. Pat Paluzzi, President/CEO of Healthy Teen Network. “This decision, however, indicates a move away from science as a measured means of forming policy and programs.”

Although there are many highly effective birth control options to choose from, none is 100% effective, even if used correctly. Sometimes errors are made—a condom breaks, a birth control pill is forgotten. At other times, sexual intercourse is unplanned or unwanted. In any of these instances, an unintended pregnancy might occur. If used within 120 hours of unprotected intercourse, emergency contraception provides a second chance to prevent pregnancy. Proper use of emergency contraception can reduce the risk of pregnancy, thereby reducing the need for abortions.

“Critics have expressed concern that adolescents’ access to and use of emergency contraception will increase sexual promiscuity and risky sexual behavior, as well as increase rates of sexually transmitted infections (STIs). However, research has shown that advance provisioning and ease of access to emergency contraception does not affect adolescents’ sexual behavior, nor increase their risk of STIs,” notes Paluzzi.

Emergency contraception is most effective if used within the first 24 hours following sexual activity. The time sensitive nature of its effectiveness makes widespread availability a critical issue for all women and men. Without over-the-counter access to emergency contraception, those 17 and older are dependent on pharmacist availability (to verify age), and those 16 and younger are dependent on first obtaining a prescription, as well as pharmacist availability. Increased access to emergency contraception could reduce the number of unintended and/or terminated pregnancies that occur in this country each year. Therefore, emergency contraception should be widely and easily available to all whom can safely use it.

Healthy Teen Network continues to work to support adolescents’ access to reproductive and sexual health services. “We concur with our colleagues that this is a major setback for access to critical health services and does indeed impact everyone. Unfortunately, this decision leaves us exactly where we were when the Bush administration limited access. We can only hope the public’s outrage at this decision will force yet another review, and future decisions will be based in science,” remarks Paluzzi.

Gina Desiderio is the Director of Marketing and Communications at Healthy Teen Network.

HP 2020: What the New Indicators Mean for Our Work

Pat Paluzzi

October 31st at the American Public Health Association (APHA) Annual Meeting, Dr. Howard Koh, Assistant Secretary for Health at Department of Health and Human Services (DHHS), announced the leading health indicators for the next decade. Healthy People 2020 indicators provide national focus on a set of health issues affecting the United States, which will receive heavy emphasis within the public health sector over the next 10 years.

These issues are:

  • access to health services;
  • clinical preventive services, environmental quality;
  • injury and violence;
  • maternal, infant, and child health;
  • mental health;
  • nutrition,
  • physical activity and obesity;
  • oral health (which made this list for the first time);
  • reproductive and sexual health;
  • social determinants (a theme that Koh said has galvanized decision-makers);
  • substance abuse;
  • and tobacco.

Many of these indicators are directly related to our work and present great opportunity for moving our work forward in new ways. The combination of reproductive and sexual health with social determinants can mean new/renewed attention on what those of us who work with young people know—that social determinants heavily impact any success we may have in reducing risky behaviors associated with teen pregnancy, STIs and HIV, and/or supporting teen parents and their children.

At APHA, session presenter Gail Christopher, Vice President for Programs at the W.K. Kellogg Foundation, noted that education and closing graduation disparity gaps will be a critical focus as work moves forward. This is also very good news for those of us focused on pregnant and parenting teens. We know that education attainment among teen parents can alter a life course and provide a way out of poverty for teen parents and their children.

How will these indicators play into the work you do?

Pat Paluzzi is President/CEO of Healthy Teen Network.

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