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Teenage pregnancy historic low { March 7 2004 } Original Source Link: (May no longer be active)
http://www.nytimes.com/2004/03/07/nyregion/07TEEN.htmlhttp://www.nytimes.com/2004/03/07/nyregion/07TEEN.html
March 7, 2004
YOUNG LOVE, NEW CAUTION
Behind Fall in Pregnancy, a New Teenage Culture of Restraint
By NINA BERNSTEIN
Alberto and Jasmine are 16-year-old sweethearts, or were until that day in November when Jasmine, who planned to be a virgin until marriage, learned in the halls of DeWitt Clinton High School in the Bronx that Alberto was "messing around."
She raged, she wept and she broke up with him. He apologized, he cried and she took him back. Then she suggested they cut school and have sex — "to keep him," she explained tearfully.
It could have been one of the oldest stories in the book, except for the real-life ending: Alberto said no.
Though he is just one teenager — short and freckled, with close-cropped kinky hair, a Hispanic surname and an electric smile — his personal decision speaks to the underlying causes of an extraordinary demographic shift.
The teenage pregnancy rate in America, which rose sharply between 1986 and 1991 to huge public alarm, has fallen steadily for a decade with little fanfare, to below any level previously recorded in the United States. And though pregnancy prevention efforts have long focused almost exclusively on girls, it is boys whose behavior shows the most startling changes.
More than half of all male high school students reported in 2001 that they were virgins, up from 39 percent in 1990. Among the sexually active, condom use has soared to 65 percent, and nearly 73 percent among black male students. The trends are similar, if less pronounced, for female students, who remain slightly less likely than boys to report that they have had sex. Nowhere are the changes more surprising than in poor minority neighborhoods in Harlem and the Bronx, which a decade ago were seen as centers of a national epidemic of teenage pregnancy.
Researchers often sum up the findings in one tidy phrase: "less sex, more contraception." But there is nothing simple about their puzzlement over the reasons.
"The default position is 'Yahoo, let's have sex,' " said Sarah Brown, director of the private, nonprofit National Campaign to Prevent Teen Pregnancy. "It takes some motivation in a highly sexualized culture for teenagers not to have sex. To use contraception takes a lot of motivation."
"I think there's something very profound going on. I don't think anybody understands in depth this change in teen culture."
Experts can rattle off a litany of possible reasons for the turnaround: the fear of AIDS, and the impact of AIDS-prevention education; the introduction of injectable forms of birth control; changes in welfare policy and crackdowns on fathers for child support; the rise of a more religious and conservative generation of teenagers; an economic boom with more opportunities; and an array of new youth programs, especially those stressing both abstinence and contraception.
Even advocates of these developments agree that they cannot account for the shift, or predict how long it will last. Yet the cultural changes now at work are quite astonishing when viewed up close, in the lives of teenagers themselves. In their topsy-turvy world of explicit sex and elusive intimacy, young people yearning for human contact are distilling new codes of conduct from a volatile blend of sex education, popular culture and family experience.
The patterns and contradictions unfold in the secret life of Alberto R. and Jasmine O., in an all-boys discussion group at a Harlem school clinic, and in the cellphone riffs and sidewalk banter of many other teenagers.
The range of attitudes toward sex is striking. Two high school buddies, Toby M. and Manuel R., are miles apart in their sexual choices at 18, though both are veterans of the same cutting-edge reproductive health program for boys at their Harlem public high school, Bread and Roses Integrated Arts.
Toby, lanky and talkative, counts five partners since he lost his virginity in the seventh grade, with a girl his own age: 12. "I wasn't stupid," he insisted. "We did it correctly. We used a condom."
His buddy Manuel, who mentions that his stepsister gave birth at 12, says he intends to forgo sex until marriage, as his Pentecostal church demands. But in explaining his abstinence, he also credits the safe-sex pamphlets his older sister sneaked home from a Planned Parenthood clinic, and the Lifetime channel they watched together.
"Every other movie on that channel is, like, a teenage mother crying or a woman getting beat," he explained. "And my older sister, who is sexually active, we'd just be watching TV and she'd be, like, 'You do know how that happens, don't you?' "
Outside, where students from several high schools flow to the West 135th Street subway stops on Edgecombe Avenue, the spirit of hip-hop music videos prevails.
"All the dudes, like now, we're strapping up," boasted a 15-year-old in a fashionably flat-billed cap, within earshot of a group of girls. Another boy of 15 quoted a different expression for using a condom: "I wrapped the rubber tighter," from a song by the rap star Jay-Z. The lyric is not part of a paean to safe sex, just a contemporary take on a timeless theme: Women cannot be trusted.
Soon the girls on the block were protesting that spin on the familiar double standard. They complained that except for docile types deemed "wifey material," girls risk being branded as "slides," "hos" or "skeezers," while the boy having sex with them is called a "player" and wins high-fives from his friends.
In a field mired in ideology, the voices of such teenagers challenge all camps. From the right, critics of comprehensive sex education argue that it gives young people a dangerously mixed message: Don't have sex, but if you do, protect yourself. From the left, opponents of abstinence-only education say it is based on a lie: Sex before marriage will only hurt you.
But these teenagers cannot escape mixed messages about sex, or the complications of deciding if, when and how to sample it. They are picking from a new multiple-choice menu, where virginity and oral sex can coexist and erotic rap makes the case for condoms. And between the lines, they are feeling all the old emotional conflicts: jealousy, ambition, loneliness, love.
A Couple's Complex Dance
They met freshman year, in a third-floor biology classroom. Alberto asked Jasmine, "If there was a fire here right now, how would you get out?" She replied, "I would jump out the window."
She was the one ready to take a romantic risk, as girls, who mature before boys, often are. After a few weeks of friendship, she asked Alberto to a movie. Days later, they confessed that they liked each other. Soon they were cuddling at the movies, kissing in school corridors, holding hands in the street.
In an earlier era, one thing might have led to another. But their romantic dance was unfolding to a different tune.
Alberto's favorite class was sex education. One day last fall, he teased Jasmine by saying he wished he were still a sperm inside his father, and that "me and my stupid self would not never have swum up the long tunnel and swam toward the mysterious, great white ball."
Jasmine laughed. Later, she repeated the line to a girlfriend as they waited in the Montefiore Medical Center's health clinic on DeWitt Clinton's second floor. Some students, like Jasmine, were waiting for asthma prescriptions or athletic checkups; others were there for birth control, pregnancy tests or screening for a sexually transmitted disease.
"My boyfriend's crazy," joked Jasmine, a slim, pretty girl who tries to keep her long hair sleek and blond like Britney Spears's. "I want to be a psychiatrist, so we're good together."
They were good together, too, because they shared a desire to remain virgins until marriage. But their reasons owed more to family experience than to formal education, more to TV shows than to church sermons.
Both were born to Puerto Rican parents in the Bronx in 1987, the year the United States surgeon general, C. Everett Koop, defied his fellow conservatives and ordered a sexually explicit report on AIDS sent to every household in the nation. Dr. Koop had less success in his push for sex education in third grade; Alberto was in junior high before he had his first lesson about H.I.V. But by then he already knew that his maternal grandmother, a heroin addict, had died of AIDS at age 40.
As long as Alberto could remember, his mother had warned him not to have sex, and to use a condom if he did. The consequences of unintended births are part of the fabric of his life. His father was 17 when Alberto was born and has mostly been in prison on drug charges ever since. His stepbrother dropped out of school at 17, fathered a child and could not find work. His mother, a nurse, and his stepfather, a hospital clerk, lived together unmarried for a dozen years and produced four children, including twins, now 5.
Alberto had a different vision of his future, one that the rising expectations of the 1990's seemed to put within reach. He wanted to be a dentist, he said, like the kind woman who fixed his teeth at a Bronx-Lebanon Hospital Center clinic when he was a child.
Jasmine, like Alberto, had a grab bag of reasons for wanting to keep her virginity "until I'm married or until I feel ready." But she hinted that her idea of feeling ready was evolving. Early in her sophomore year, when she and Alberto split up for a few months and she had a relationship with another boy, sex seemed like a real possibility.
"I was going to, but then we broke up," she recalled. "I want to lose it to whoever I'm going to be with forever. That's what I want, but it's hard."
Some of her reasons for holding off defy conventional categories. "If I do have sex before I'm married," she said, "then the honeymoon won't be all exciting like you see on TV - so romantic and like a big deal."
Almost in the same breath, she vowed that when she turned 18, "I'll get that thing you put in the arm that prevents you from having children for five years." Without knowing the name of the birth control device she had in mind - apparently Norplant - she expected to keep her fertility under control, and knew her professional goals depended on it.
Unlike Alberto's family, Jasmine's is religious. But she considers religion part of a growing rift with her parents. Her father is over 80, a retired bodega owner who speaks no English and is, Jasmine complains, "obsessed with God." She says he forced her to attend his Pentecostal church until she was 13, when she rebelled. Still, Jasmine describes her attachment to virginity as "sort of religious" because, she said, "I believe in the Bible."
She also believes in girl power. Her mother, 53, a school-crossing guard, once tried to throw away Jasmine's favorite belt, the silver one inscribed BITCH. Jasmine insists it is actually a defiant acronym for Beautiful, Intelligent, Talented, Caring and Honest - something that her pop-star idol, Christina Aguilera, might wear.
She does not talk to her parents about anything, she declared, least of all sex. "They criticize too much," she said.
Instead, she used to talk to a half sister in her 50's who lived upstate and had taught her how to swim. But last April, the half sister died. Family feuds barred Jasmine from the funeral. The same month, Alberto's grandfather died. Then his father emerged from prison, but barely had time to meet Jasmine before being sent back to jail again.
The couple comforted each other all spring and summer. "I love you so much," Alberto wrote in their photo album in July. "I can't wait to see you in a big white dress."
But in the meantime, to express their love - and satisfy their curiosity - they tried oral sex once. It was Jasmine's suggestion, "to see how it feels," she said. Alberto wore a condom, and his little brothers and sisters kept pestering from behind the closed door.
Both agreed that oral sex does not count as having sex. "It was boring," Jasmine confessed, then amended her verdict: "Since me and him were not having sex I was like, all right, at least do that. It made me feel closer to him."
Alberto said, "It's not too appealing to me." But he understood why Jasmine had the idea. "It's everywhere now," he said. "MTV, B.E.T. It's like, even on the Disney Channel, there's movies on that. It's not like back then."
Switching Signals
Twelve years ago, when Alberto and Jasmine were children, long-smoldering public concern about teenage pregnancy erupted across America, focused on low-income minority city neighborhoods like theirs. Teenage childbearing was denounced as a core cause of poverty and all its ills, from crime and drug addiction to bad schools and welfare dependence. By 1995, curbing the reproductive behavior of girls in these communities was accepted as an urgent goal of public policy.
But the data lagged behind reality: In hindsight, it is now clear that teenage pregnancy had already begun its decline in 1991, well before welfare changes and the economic boom, and well after the first round of sex education programs. Paradoxically, the public outcry was peaking just as researchers like Frank Furstenberg, a sociologist at the University of Pennsylvania, began to believe that the ill effects of early childbearing had been overstated, because contributing factors, like poverty and school failure, had been confused with consequences.
The uproar over teenage childbearing probably reinforced what was already under way, Mr. Furstenberg said: Poor teenagers were adapting to a new timetable for growing up. They were trying to manage the growing gap between the typical onset of sexual activity and an economically viable adulthood. That challenge was not new, but the gap had been getting longer and more perilous year by year, and early marriage - the oldest answer to unintended pregnancy - had all but vanished as a prospect by the 1990's.
In the mid-20th century, if a teenage girl like Jasmine became pregnant, she might expect to marry Alberto. The couple could hope to make ends meet with factory work or other well-paying jobs that did not demand a higher education. But the more the outlook for such jobs dimmed, and the more expenses like rent and child care outpaced the income such a family could command, the further marriage retreated.
By the 1990's, more young people at the bottom were getting the picture, sociologists say. Like Alberto, many saw how relatives had been caught in the backwash of change. At the same time, they saw rising numbers of black and Hispanic students going to college. Both prospects raised the stakes of postponing parenthood.
Despite the political drumbeat for marriage, despite adolescent dreams of white dresses, the proportion of teenage births that occurred out of wedlock continued to rise. About 79 percent of births to women age 15 to 19 are nonmarital now, up from 67 percent in 1990, and from 21 percent in 1965.
But as avoiding early parenthood became more desirable, more low-income teenagers were being primed to try a mix of better contraception and strategies to delay intercourse - strategies that now range from pledges of virginity to oral sex.
"From the ground up," Mr. Furstenberg said, "kids are getting quite different signals from the signals that were there 25 years ago."
Toby, for example, the third child of a poor, young single mother, was 9 or 10 the day his aunt wrote ABSTINENCE in chalk across a big easel. His mother timidly talked about the birds and the bees, then put a condom in his wallet. Finally he understood the joking admonition his grandmother used to make whenever his older brother left for a night out: "Wear a sombrero!"
It was that older brother, now 26, who provided the condoms Toby used in middle school. "I was trying to have sex to be in that in-crowd," Toby confessed.
He was speaking in a small group of high school seniors assembled by Brad Kerner, a health educator assigned to their school four years ago by the Young Men's Clinic, a project of the Columbia School of Public Health and New York-Presbyterian Hospital. The project itself testifies to a more open sexual culture and the realization that adults can help boys, too, prevent pregnancy.
Toby grew up without a father, and met him only once, at 16, in a fast-food restaurant. "His reason for not seeing me? 'I forgot where you lived,' " Toby recalled. "I almost threw him through Burger King's plate glass window." Toby's sister had a miscarriage at 17, and a son a year later.
"She was like, 'No one loves me, I'm going to have a child who will love me,' " he said, citing a classic motive for teenage pregnancy - one unyielding to contraceptive education. Toby, too, experienced the costs: He gave up his Boys Club scholarship to a prep school in Maine because the birth precipitated a family financial crisis. And since he helps care for his nephew, now 3, and newborn niece, he added, "I know what the sleepless nights are like."
His friend Manuel, the Pentecostal church member who practices abstinence, suggested another reason pregnancy is down: "More people know about oral sex now. They're doing that instead."
Research on the subject is scant. But there is indirect support for Manuel's idea that oral sex - which he rejects for himself - is more likely to serve as a substitute for intercourse among his peers than it did in the late 1980's.
In 1995, half of 15- to 19-year-old males reported having received oral sex, according to the National Survey of Adolescent Males, up from 44 percent in 1988. The steepest increase by far was among black teenagers, to 57 percent, from 25 percent in 1988; the prevalence among white teenagers, in contrast, was unchanged at 50 percent. Blacks of both sexes between 15 and 17 also showed the steepest decrease in sexual intercourse: a 28 percent decline from 1991 to 2001, according to a recent analysis by the federal Centers for Disease Control and Prevention.
Demographers point out that American teenage-pregnancy rates are still 2 to 10 times higher than those in other Western countries, which have had the same pattern of spike and fall since AIDS erupted. But better contraceptive practices and delays in first intercourse have contributed about equally to a 35 percent decline in birth rates among 15- to 17-year-olds in the United States, and to an even more impressive 46 percent decline among non-Hispanic blacks that age, according to the C.D.C. analysis of several studies.
A Turnabout for Boys
If AIDS contributed to greater sexual caution, the mystery is why teenage pregnancy and childbirth spiked from 1986 to 1991, when awareness of the threat of H.I.V. was growing.
Some explanations focus on a time lag. Research suggests that formal AIDS-prevention education, like the message of vulnerability conveyed by child-support enforcement, can reduce sexual activity and increase condom use among boys, if it reaches them before they become sexually active.
But the full impact of these messages on pregnancy rates could only be seen as the first wave of young boys exposed to them, like Toby's older brother, reached late adolescence and passed into their 20's. Teenage pregnancy rates (which closely follow adult fertility trends) are driven by 18- and 19-year-old women and their partners, including men in their 20's, who are responsible for far more pregnancies than younger people.
"Over the decade, we moved from a view of men, 'Oh, you can't do anything with them,' to a recognition that lo and behold, all the trend data indicate that guys are the ones who have changed their behavior the most," said Freya Sonenstein, who directed the groundbreaking National Survey of Adolescent Males in 1988 and 1995.
Not that teenagers always tell the truth, especially about a subject as loaded as sex, she allowed. But objective measures have confirmed those trends, and the willingness of more boys to admit being virgins is itself a signal of cultural change.
Of course, girls, too, have played a role in the declining pregnancy rate, research shows, especially those who have turned to Depo-Provera, a hormonal birth control shot introduced in 1993, which seems especially popular with teenagers most likely to become pregnant: girls 17 or younger who already have one child.
The surprise is that a growing percentage of boys use condoms even when their partner is on hormonal birth control, including the pill and the patch.
"The pill shifted responsibility and accountability for contraception onto women," said Kristin Luker, a sociology professor at the University of California, Berkeley. "AIDS has created a powerful incentive for both people to take responsibility."
It is hard to overestimate the influence of AIDS, but its effects are not as simple as one might think. While the epidemic led to a fear of sex and increased education about its risks, it also touched off a barrage of explicit sexual discussion and imagery that reverberates 24 hours a day in television, movies, music and on the Internet.
Doug Kirby is one of many researchers on teenage pregnancy who are somewhat mystified by the result. "There's so much more sex in the media," he said. "But the percent of young people who have sex is going down. I wonder, is there just simple saturation? Is sex not quite so off limits, so titillating?"
Peter Bearman, a sociologist at Columbia University, has another explanation, culled from one of his controlled research studies on teenage pregnancy: Forming any opinion at all about sex and pregnancy makes teenagers better at contraception. And "culturally, kids are thinking about sex more, developing attitudes about it," he said.
Toby and Manuel's classmate Ali A., a basketball shooting guard who lost his virginity at 14, says he is tired of thinking about sex. Of sex on TV, he said, "It's all hyped." Shaking his cornrow braids, he declared: "It's not about sex no more. We try to enjoy our lives now. Not to have the stress."
The stress for this generation comes not just from the risks of sex in the age of AIDS and child support, but also from the challenge of maintaining relationships, said Susan Wilson, director of the Network for Family Life Education, an academic group. It sponsors a national newsletter, Sex Etc., written by teenagers, who show remarkable agreement across lines of race and class.
"They want to get away from the clinical aspect of sexuality," she said. "They all want to learn more about relationships, intimacy, talking to your partners, love."
Trying to Save Face
As they transplanted their romance back to school last fall, Jasmine worried how Alberto would deal with the peer pressure that still celebrates boys for being "players" and condemns girls who play along. But she devised a strategy to save Alberto's reputation without compromising her own, a way to negotiate the double standard's fine line.
"I told him not to lie and say he has had sex with me," she explained in late October. "Just say, 'We've been going out for seven months, so what do you think?' So he doesn't have to be embarrassed in front of his friends."
She was still blissfully unaware that her young man had begun to stray.
At first, Erica was just one of Alberto's friends. They were in the same photography class. Erica loved a Harry Potter book that Jasmine despised, and Alberto suddenly wanted to read it. Erica let him sip her vanilla latte, and he discovered that he did not hate coffee after all.
One afternoon, hanging out at Erica's house after school, he said, they started "kissing and touching." They carried on like that for two weeks. Then Jasmine found out.
She was willing to take Alberto back, but only on the condition that he never talk to Erica again, not even look at her. And she tried a new way to secure his love: offering sex.
" 'Cause he knows how important it is to me, if I had sex with him, it would be harder for him to leave me, harder for him to hurt me," she said between sobs. "But he was, like, 'No.' "
Alberto told her she would end up thinking the only reason he had come back to her was to have sex. But his refusal added to Jasmine's suspicions. And a day later she knew he had broken his promise: One of her "spies" had spotted him outside school, getting Chinese food with a girl who fit Erica's description.
Steeled "to act cool," Jasmine went to his house in the Castle Hill section of the Bronx for a new showdown that would leave her with her pride. She pulled out his trove of photographs from the summer, retrieving memories of her golden skin and small bikini.
"You love me, right?" she said. "You want to be with me forever, right?"
Yes, Alberto kept saying, yes.
"Yeah, well, I don't want to be with you another year, another day, another hour," Jasmine declared, grabbing the pictures and bursting into tears.
"He starts crying," she recalled the next day, "how he don't deserve me. Hugging me, saying he was sorry. I was like, 'Alberto, let me leave.' "
Five days later, she was in a better mood, and Alberto was at her side. "I took out all my anger," she exulted. "I had a fight today with the girl."
As Jasmine and Alberto described it, Jasmine had confronted her rival right in front of the school. Jasmine punched her in the face. And soon they were in an all-out, hair-pulling fistfight, as other students cheered, "Go! Fight, fight!"
Only Alberto tried to stop it. He conceded he felt sorry for Erica, who was suspended for fighting. "But," he added, "I like Jasmine better."
There were dividends for Alberto, too. "In the school, everybody was, like, congratulating me." His male cousins now call him a pimp, he said, meaning "a guy who has a lot of girls."
The reality was different. "Me and him are on a break," Jasmine said. "My rules are neither of us can mess with anyone else and he can't see that girl. I'm sort of, like, testing him."
By New Year's, Alberto had passed Jasmine's test, and they were officially sweethearts again. But Jasmine had new doubts as Valentine's Day approached. "It's boring," she complained. "Then again, I know me and him don't want to be without each other."
Ten days ago, she heard that Alberto was spicing up the public version of their stale romance by bragging to his friends about their lovemaking. On the advice of the girls on her swim team, she countered his invention by spreading one of her own, disparaging his sexual performance.
Underneath the raunchy tit for tat was emotional turmoil, which erupted during a telephone call. Jasmine called Alberto a loser. Alberto declared the relationship dead.
Jasmine agreed. Or maybe not. "If he calls to say he's sorry," she asked, "should I take him back?"
Copyright 2004 The New York Times Company
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