Abstinence Education Grants
and Welfare Reform
Friday, June 6, 1997
David D. Bellis
U.S. General Accounting Office
(First Slide--No. 1)
Good afternoon and, again, welcome to the General Accounting
Office. In recent years, the GAO has reported on teen pregnancy--and programs
designed to prevent pregnancy,-- teen mothers and AFDC,--and community
strategies to help at-risk teens. This afternoon, Ill draw on this work---and
the work of others, and--first--talk briefly about some of the consequences
of teen sexual activity. Then, discuss different approaches local communities
are using to design and deliver abstinence programs.
Teen sexual activity is dangerous. According to
the Institute of Medicine, 5 of the top 10 most frequently reported diseases
are sexually transmitted. Of the 12 million new cases reported annually,
about 3 million are among teens. This means about 13% of our young people
between the ages of 13 and 19 contact a Sexually Transmitted Disease. While
some of these diseases can be cured easily if detected early--such as gonorrhea--others--like
HIV and hepatitis B-- cannot be cured and can be transmitted years after
the initial infection. Because the infected teens are poor users of health
care and many STDs are asymptomatic, often the easy-to-treat diseases go
untreated. Infertility, cancer and even death can follow many of these
infections. The cost of STDs among teens is about $4.25 billion a year.
(Next Slide--No. 2)
Unfortunately, early sexual activity also clusters with
other behaviors that have serious and costly consequences. In a recent
study, sexually active teens were also regular users of alcohol and tobacco
and also reported using marijuana. The cumulative effect of these behaviors
can lead to greater isolation among friends and family--and--a mistrust
of institutions in their community available to help them.
The most tragic consequence of teen sexual behavior is
pregnancy. While recent reports show the hopeful sign of declining pregnancies
among teens, nearly a million young women between 15 and 19--about 12%
of this group--became pregnant in 1992. Not all pregnancies, however, come
to full term. More than a third end in an abortion,--and about half result
in a birth. Most of births to teen mothers occur out-of-wedlock--yet only
between 1 to 3 percent of these infants are placed for adoption. Rates
of child abuse for teen mothers are more than twice that of mothers who
are 20 to 21. In Illinois, for example, 1 in 4 reports of child abuse involve
a teen mother. Approximately 5 percent of the children who remain with
a teen mother will end up in foster care--this at an estimated cost of
$900 million per year.
(Next Slide--No. 3)
Since the majority of the teen mothers are from economically
disadvantaged homes, the birth of a child to a teen can be another blow
to a young and already difficult life. We reported that from 1976 to 1992,
almost half of all single women receiving AFDC were or had been teen mothers.
Almost 8 in 10 young girls who had a child while a teen had at least one
spell on public assistance within 5 years of the childs birth. We also
found this group were less likely to have a high school diploma, eventually
have larger families and never be married. According to a recent study
from the Robin Hood Foundation, the cost to the U.S. taxpayer for adolescent
childbearing is nearly $7 billion a year.
But there is some good news. Adolescents, especially young
teens under 15, are participating in greater numbers in efforts designed
to postpone sexual activity. Further, programs with abstinence as a key
principle have evolved considerably since the early 1980s and they are
(Next Slide--No. 4)
However, trying to describe the diversity of these programs
is reminiscent of the story of the three blind men asked to identify what
theyre touching as they each explored a different part of the same elephant.
We can, nevertheless, talk about these programs in 3 ways--first--the different
settings in which we find abstinence programs--second--the range of content
areas that can be covered, and--third--the different instructional strategies
used to get the message across.
Communities are comprised of different institutions--there
are schools, public and private youth serving agencies and other community
organizations, clinics and medical facilities and--homes. We can look to
all of these for abstinence programs.
(Next Slide--No. 5)
Most teens attend school, and--at one point or another--have
experienced some type of sex education. Estimates are that at least 85%
of our schools teach sex education. Most have been integrated into the
schools health curriculum. By in large, parental support for school sex
education programs is high. It was reported recently that only 2% of the
parents of Virginias high scholars opted out of their schools sex ed
program. Some schools, as Joy Dryfoos points out in her book, Adolescents
At-Risk, offer additional class electives once a teen has completed
the required health education sequence. Other variations exist. Schools
can identify students they believe are at particular risk for negative
outcomes and offer them specially targeted programs. Because many of these
youth are multi-problem teens, programs often target academic areas as
well as other behavioral issues. Schools are also offering "off-school
hour" classes that are open to all students or targeted to specific groups.
Regardless of the scope, schools are currently the mainstay setting for
many of these programs.
Community-based organizations--such as the YM and YWCA
and the Girl and Boy Scouts, and other more locally-based agencies can
offer these programs. These organizations must rely on their existing membership
and their standing in the community to attract teens. In addition, religious
organizations such as Catholic Charities and local churches of all denominations
are playing a more active role in developing youth support programs. Church-based
organizations often recruit not only from their own members but through
other neighborhood organizations.
(Next Slide--No. 6)
Though controversial, clinics can offer abstinence programs.
In a recent GAO study, we reported that the goal of most school-based
health centers was to provide primary care, physical exams and injury treatment
with a growing number of centers offering immunization and mental health
services. In addition, we found many school health centers provided a variety
of reproductive services--though the majority did not distribute contraceptives.
Establishing these types of centers can cause turmoil in communities but
we found sites that sought open communication among all interested parties
could overcome many of the communities concerns.
An often forgotten setting for this type of intervention
is the home. The work of David Olds and his colleagues and an earlier GAO
report have shown that delivering preventive services in the home can be
an effective strategy--especially for teen mothers. Home visiting may have
some interesting applications for abstinence programs. Using the relatively
safe environment of the home, program staff work with teens on a variety
of health and risk issues. Research has shown that this approach can delay
the birth of additional children. The majority of these efforts, however,
are part of broader programs for teens and often are linked to other service
sites such as hospitals and schools.
(Next Slide--No. 7)
Most programs--regardless of the setting--use commercially
developed curriculum packages. Some sites have adapted their program content
from a number of different packages. While some efforts focus on a limited
number of content areas, most cover a variety of different topics. Generally,
the foundation is fact-based information on health and reproduction and
the risks associated with not only early sex, but with other behaviors
as well--such as drug and alcohol use. Abstinence programs usually stress
personal responsibility and exercises designed to build self-esteem. This
is reinforced with strategies on how to "say no",, and other techniques
to resist the pressures to engage in sex. Programs also offer information
on responsible adult behavior--including job or career possibilities. Some
programs actively enlist the help of parents to bridge the gap between
a school or center and the home.
Most curricula organize their content material in such
a way that programs will use a number of different teaching strategies.
In addition to direct presentation by a teacher or leader, most programs
use a variety of reinforcing and skill practicing techniques--such as role
playing or skits--to give teens the opportunity to explore new behaviors
and get feed-back from other participants. These techniques help develop
peer support and foster group cohesiveness. The use of role models--either
older teens or volunteer adults--can further reinforce program goals.
(Next Slide--No. 8)
The number of different experiences a program can provide
a teen is only limited by a developers imagination. Programs have attempted
to mix what kids would call "fun stuff" with the programs other materials.
Special outings to parks, museums, and cultural events can reinforce the
sense of belonging to a positive peer group and, at the same time, offer
an experience that might otherwise be unavailable. Programs have also offered
financial incentives both for consistent participation and for meeting
the goals of the program itself. These can come as a monthly allowance
or be held out as a long-range reward in the form of scholarships.
As a final thought... there is no "magic bullet" to meet
the challenges ahead. However--as we look at some encouraging trends in
the national data and begin to systematically shift through what we know
about programs for teens--I am reminded of how fortunate I was to grow
up in a seemingly easier--and less dangerous time. And in the shadow of
a New York institution. There--a wise and frequently quoted scholar resided--extolling
wisdom that often eluded even him.
Yogis words seem fitting for todays topic. In this case,
"not knowing where were going" or not stopping long enough to put into
practice what weve learned--can make the "somewhere else" a place wed
not wish for our nations children . . . and that would surely include
my familys four teenagers.
"Abstinence Education Grants and Welfare Reform"
The Consequences of Teen Sexual Behavior and How Teens Get Help
What are the consequences and costs of teen sexual behavior?
What are the different characteristics of abstinence programs?
Consequences of Teen Sexual Activity
Early Activity Associated With Other Serious Health Risks
--Of teens who are sexually experienced:
--66% consumed alcohol on a regular basis
--69% smoked cigarettes regularly
--87% used marijuana
Consequences of Teen Sexual Activity
Public Costs Associated With Teen Births
--Over 80% of teen mothers are from poor/low income homes
--$7.0 billion in supports costs for teen births
--Almost 50% of welfare recipients had a child as a teen
--77% of teens who give birth enter welfare system within 5 years
Programs Approaches Vary
--Targeted classes or groups
--After school programs
Menu of Program Content Areas
--Health and reproduction
--Self esteem building/Personal responsibility
--Career options/Pre-employment skills
--Building resistance skills/Other risk factors
--Enhance school performance
Other Program Considerations
--Cultural and special activities
Return to Abstinence Education