Many concerned parties, including policy makers, tax payers, parents, scholars and program providers, want to identify programs that could bring about large reductions in unintended adolescent pregnancy and parenthood. For at least two decades now, varied approaches to prevention and intervention have been tried in the United States. As suggested by the conceptual model in Figure 1, there are several points at which prevention programs can be targeted. Interventions have been attempted to delay the initiation of sexual activity, to improve contraceptive use among sexually active adolescents, to (in some cases) influence pregnancy resolution decisions among those who become pregnant, and to reduce or delay subsequent births. Some programs are less direct, focusing on issues like life options, in the belief that adolescents who perceive better educational, occupational, and economic opportunities for themselves will seek to postpone parenthood. Prevention programs are often school-based because students are an accessible and somewhat captive audience; however, programs are also based in clinics and agencies, and sometimes they are based in churches, provided directly to families, or embedded in a community wide intervention context that includes all of the above.
Unfortunately, no evaluations point to remarkably successful adolescent pregnancy prevention programs that stand out as having large, sustained and clearly documented impacts. Most of the programs have been small, short-term projects implemented without a theoretical basis or even a clear operational model, without a design based on prior scientific studies, and without rigorous evaluations. Because there usually is not a scientifically rigorous evaluation plan, it is unclear whether many programs are effective. Some programs appear to be effective, but more often no effects have been shown.
Family life or sex education in the public schools, which traditionally has consisted largely of providing factual information at the secondary school level, is the most general or pervasive approach to preventing pregnancy among adolescents. The effects of sex education as offered in the public schools continue to be widely debated, however. Recent perspectives range from the view that school sex education is wrong or has simply failed, to the view that too little is being provided too late. The evidence shows that traditional sex education, as it has been offered in the United States, increases sexual knowledge, but it has little or no effect on whether or not teens initiate sex or use contraception. Consequently, traditional school sex education usually is found to be unrelated to adolescent pregnancy or births. The most consistent and clear finding is that sex education does not cause adolescents to initiate sex when they would not otherwise have done so.
School-based clinics, which typically provide comprehensive adolescent health services but not necessarily contraceptive services, have not shown convincing evidence of success at reducing adolescent pregnancies or births. One apparent exception, the Self Center in Baltimore, Maryland, linked school-based sex education with the provision of contraceptive services at a nearby facility. However, school-based programs do not reach older non-teen partners or school drop-outs.
Studies show a relationship between the presence and use of contraceptive services by adolescents, and lower pregnancies and birth rates. Family planning services reduce unwanted births by preventing pregnancy and, in some instances, by providing access to abortion.
Compared with traditional knowledge-based sex education, more focused behavioral-skills types of sex education have recently shown more promising results, for example, Postponing Sexual Involvement and Reducing the Risk. Based on social learning theory, skills-oriented prevention programs combine the traditional informational approach with skill building activities. These are active rather than passive strategies, that help adolescents to personalize sexual issues and develop specific negotiation and refusal skills needed in sexual relations. Activities are used that teach about social and media pressures, modeling, and communication/negotiation with respect to both sexual behavior and contraceptive use. Such programs have been shown to result in short delays in onset of sexual intercourse among some groups, and to have moderate effects on improving contraceptive protection among those who are sexually active.
Programs that focus on educational and employment outcomes do not generally examine sexual and fertility outcomes. Several studies, however, provide evidence suggesting that such approaches may be helpful in preventing adolescent pregnancy or childbearing. Specifically, children who attended the enriched Perry Pre-School Program were found to have lower birth rates more than a dozen years later; and high school youth in the intensive Philadelphia site of the Quantum Opportunities Program experienced lower birth rates. Finally, evidence from the School/Community Program for Sexual Risk Reduction Among Teens in Denmark, South Carolina indicates that a community-wide education, services, and media campaign can reduce adolescent fertility.