The contraception paradox - comparison between US, UK and Swedish teenage pregnancies

Public Interest, Fall, 1993 by Jessica Gress-Wright

THE DEBATE over contraception is an old one. In 1916, Margaret Sanger, the founder of Planned Parenthood, was thrown in jail for offering advice and contraceptives to married women in Brooklyn. But the present controversy over giving contraceptives to teenagers dates, like so much else in the American culture wars, from the early 1970s, when contraceptives first became available to teens through publicly funded family planning programs.

As births to unwed teens rose throughout the 1970s, conservatives increasingly resented the thought that they were paying taxes to support programs that encouraged the sexual misbehavior of their own children. This resentment found formal expression in January 1981, when Richard Schweiker, President Reagan's newly appointed Secretary of Health and Human Services, declared that doctors treating unmarried teenagers under Medicaid sheould not be permitted to prescribe contraceptives. This statement aroused such sharp criticism that Schweiker was silenced. His Assistant Secretary of Health, Dr. Edward Brant, Jr., was soon at pains to reassure the public (and the interest groups responsible for much of the outcry) that the government considered support of family planning services a "necessity."

Such support is not cheap. Since 1970, the federal Office for Family Planning has spent more than $4 billion to provide women with physical exams, counseling, and contraceptives. Federally funded programs serve 4.5 million women today, of whom a million and a half are teens. Services are provided through 5,100 family planning agencies, of which the oldest and largest is Planned Parenthood. Through its network of 691 affiliated clinics, Planned Parenthood offers contraceptive counseling and prescriptions to over a million clients, while its education programs serve another million. To conservatives, Planned Parenthood's influence, public funding, and stand on teenage sex have made it the very symbol of deliberate decadence. Catholics United for Life once wrote that "Planned Parenthood is anti-life and anti-family and opposes all our Christian values."

While there are obvious differences of opinion here, liberals and conservatives do share some common ground. Both sides agree that raising children is not something to be undertaken lightly. Both sides also agree that it is best if teenagers delay reproduction. The disagreement is over how.

Preventing pregnancy, controlling sex

Sex education programs, such as those sponsored by Planned Parenthood, seek to delay reproduction by preventing pregnancy rather than preventing sex. Advocates of such programs assume that sex among teenagers is commonplace and neither can nor should be stopped. In this view, the better the sex education and the easier the access to contraceptives, the lower the rate of teenage pregnancy.

Conservatives, particularly among the religious right, seek to delay reproduction by controlling sex. They argue that the federal policy of making counseling and contraceptives easily available has done nothing to stabilize, much less reduce, teenage pregnancy. Indeed, they argue, the policy has had the perverse effect of increasing teen pregnancy. Distributing contraceptives encourages early and inappropriate sex, they say, by adding tacit adult approval to already existing social pressures. Moreover, since teens are such poor users of contraceptives, more sexual intercourse results in more pregnancies, while the moral assumptions implicit in the contraceptive approach guarantee that many of these pregnancies will end in abortion.

Sex in Sweden

As the contraception debate rages on, the pregnancy rate continues to rise. Around one million teens--10 percent of American teenage girls--become pregnant each year. Conservatives point to this and argue that the polices of the past two decades have been a miserable failure, while liberals argue that what is needed is more--not less--of the same.

Evidence from other countries, however, suggests that both sides are mistaken. Consider the case of Sweden. Unlike the U.S., Sweden has low and even falling rates of teen pregnancy and abortion. Yet Sweden does not have abstinence programs like those advocated in America--quite the opposite.

In 1974, the Swedish sex-education curriculum was officially revised. Under the new curriculum, commitment was still stressed, but "panegyrics to marriage" were dropped. The curriculum also eliminated "the general recommendation of restraint when young." The curricular reform commission, accommodating and encouraging changes already taking place in popular opinion, directed that teachers emphasize to students that sex is natural; that a person without a developed sexuality is deficient; that premarital sex is to be expected; that cohabitation and childbearing outside of marriage are acceptable; and that even adultery is tolerable. The new curriculum constituted a decisive repudiation of all Judeo-Christian teaching on sex.

Unsurprisingly, perhaps, surveys have found Swedish teens to be quite sexually active. A 1976 study in Stockholm found that 80 percent of boys and 89 percent of girls were sexually experienced by age nineteen. Other studies have come up with figures of around 80 percent for both sexes.