In the past few years, many communities have tried various initiatives aimed at preventing teen pregnancy. No single approach works for every child or every school, but experts say that the most effective measures consist of a combination of education, health care and--most important--strong parental support.
Once controversial, it has become the norm in American schools. In a 1989 survey of 4,241 teachers around the country by the Alan Guttmacher Institute, 93 percent said their schools offered sex or AIDS education in some form. In recent polls, more than 85 percent of the American public said they approved of such instruction, compared with 69 percent in 1965. Despite this widespread support, there is little scientific evidence that sex education by itself makes any difference in the pregnancy rate. That doesn't mean it's ineffective--just that the effect is hard to measure because the content of classes varies widely. In the Guttmacher survey, 86 percent of the teachers said they recommended abstinence as the best alternative to pregnancy and AIDS prevention. But fewer than half said they discussed where to get birth control.
The 162 clinics in 33 states are usually located within a high school or in an adjacent building. Fourteen percent are in junior-high or middle schools. Clinics offer comprehensive health services, including family planning. Students are either given prescriptions for contraceptives or are referred to a separate birth-control clinic. Studies show that in cities with school-based clinics, teens are more likely to use birth control. At the first such clinic, in St. Paul, Minn., the teenage birthrate dropped 50 percent between 1976 and 1984 and has stayed relatively low since then. The clinics appear to be especially effective in poor, urban areas where teens' access to health care is limited, according to the Center for Population Options. In one Baltimore study, girls enrolled in a school-based clinic postponed the age of first intercourse longer than girls who were not enrolled.
Despite these efforts, the teenage birthrate in this country has remained the highest among Western nations for a decade. Frustration with such limited successes has led to drastic measures. To stop repeat births, a health official in Denton, Md., has proposed paying teenage mothers $1 for every day they don't get pregnant again. If that idea works, $365 a year may seem like a small price to pay to get a life back on track.