In the movie “Summer of ’42,” a memoir about the coming of age during World War II, the 15-year-old protagonist goes into a pharmacy to buy condoms. The boy hems, haws and buys an ice cream he does not want, then endures a painfully funny interrogation about what brand and how many he requires. Finally, he lies to the druggist that the condoms are for his older brother.
“Do you know what these are used for?” the druggist asks.
“Sure,” the boy replies. “You fill them up with water and then you throw them off the roof.”
While not quite the taboo topic of 50 years ago, contraception remains a powerful teen concern.
A young mother on the North Side says her 15-year-old boyfriend was not much different than the boy portrayed in “Summer of ’42.”
“He was too embarrassed to buy condoms,” she says. “He would use them if his brother gave them to him.”
Unlike their counterparts in Western Europe, American youngsters have unprotected sex at alarming rates. They consistently fail to use effective birth control because it’s not readily available or because they are too naive, too embarrassed or too irresponsible.
The problem is part attitude, part access. And until it is addressed realistically, the nation will continue to pay the high price of children having children.
Amanda, a 19-year-old mother of a 3-year-old son, offers a good example of how youngsters’ minds and bodies work. Her mother put her on the pill, but she secretly stopped taking it because it made her gain weight and feel nauseous, she says. So what did she and her boyfriend do instead? It depended.
“He did pull out” during sex, Amanda recalls. “Me, being as young as I was, I thought that was effective.”
Since she gave birth to Orlando Jr., Amanda and her boyfriend use contraceptives “religiously.” She has not had another baby.
Unfortunately, far too many teen mothers repeat their mistake and continue to have unprotected sex. Nearly a fifth of teen mothers will give birth again within a year; within two years, that jumps to 7 out of 10.
Can increased contraception use cut into the teen pregnancy rate? The research says yes.
Three-quarters of unintended teen pregnancies involve adolescents who do not use birth control. Contraception failure rates are much higher among teens than adults because youngsters are less conscientious and girls are more fertile than women.
The unlikely good news is that more youngsters are using birth control than in the past. Sexual activity among youngsters has skyrocketed in the last 20 years, yet pregnancy rates have not grown proportionately because of birth control.
But the rise in use has failed to offset the problems caused by teens who don’t use contraceptives.
In most of Western Europe, teenagers have sex about as often as their American peers but get pregnant at a fraction of the rate. Governments there heavily subsidize contraception education, and the use of birth control is expected among adolescents.
Sweden, for instance, has an official sex-education curriculum in its schools that covers all grade levels, and the schools are linked with clinics that provide birth control to adolescents.
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That link was established in 1975 when the country liberalized abortion laws and feared an increase in teenage abortions. Since then, birth and abortion rates for teens have fallen sharply. In 1991, Sweden’s teen birthrate of 13 per 1,000 teenagers was nearly one-fifth that of the United States.
In much of the U.S., teenagers don’t seek birth control until well after they’ve become sexually active-too often not until the young women are pregnant. And many parents, unaware of their children’s sexual behavior, either fail to talk to their kids about contraception or prohibit them from getting it.
“The more they tell you no (to sex), the more you want to,” says Katrina Page, 17, whose first baby is due in June. “You ask about birth control and your parents say, `No. You’re not ready for it.’ “
Margarette was on the pill for four years until she stopped menstruating and feared that the drug was disturbing her system. So she and her boyfriend turned to condoms.
“A friend gave us a manila folder full of condoms, and we would pass them out to friends,” Margarette says. But when the condoms ran out, she had sex anyway.
Margarette, 21, is trying to raise a 2-year-old daughter, work part time and take classes at Truman College. And she’s on Norplant.
Norplant, a five-year contraceptive surgically implanted in a woman’s arm, is the most effective form of reversible birth control. But it, too, has its drawbacks. For one thing, it’s expensive, about $365 per insertion. And to some critics, it smacks of more draconian methods of population control.
After Paquin High School in Baltimore began dispensing Norplant last year, some African-American leaders deemed it a cop-out for a society too lazy and uncaring to address the underlying social conditions and behavior causing teenage births. Others likened it to genocide.
“They’re doing social engineering,” says Baltimore councilman Carl Stokes. “The agenda (behind Norplant) is not to help these children. The issue is people saying, `I’m tired of paying for these girls and their babies and I’m not going to pay for them anymore. I’ll give you $400 to inject this in their arms to save me a lifetime of paying $400 a month for them (in welfare payments).’ “
Surgeon General Joycelyn Elders, who visited Paquin High, fumes at such accusations.
“Black people don’t want their children born to children,” says Elders, the first African-American surgeon general. “They do not want them growing up poor, ignorant slaves. And whoever goes around talking about genocide is someone who likes to see people in slavery.”
The rhetorical skirmishes over Norplant reflect how touchy contraception can be.
Many experts assert that society should accept that older teens are going to have sex and make sure that all teens are informed about and have access to birth control. But they are fighting those parents, educators and clergy who assert that teens must remain abstinent and that distributing birth control undermines their efforts.
Many young people who embrace the abstinence message in theory have trouble following through when it’s time to say no. Like their counterparts 20 and 40 years ago, today’s adolescents are curious about sex and driven by biology. Unlike the previous generations, however, some face extreme pressure to lose, not keep, their virginity.
“Everybody’s having sex,” says Margarette, who had an abortion at 14 and gave birth to a daughter four years later. “In my freshman year, I was the only virgin I knew of. My friends would say, `Oh, my God, you’re a virgin. I can’t believe it.’ I thought, `Maybe I’m doing something wrong. Maybe I ought to do it.’ “
Margarette was 12 when she first started feeling this way. By the time she was nearly 14, she had heard enough. A friend set her up with a boy to lose her virginity.
“One of my friends was teased so bad because she was a virgin that she said, `My uncle molested me, so there.’ “
Gwen Horton, a counselor at Marillac House on the West Side, says too many young men see relationships with girls only as an avenue to sex. The normal rites of dating and courtship have all but disappeared.
“There’s an unwritten language that if you are involved with a girl, then you are having sex,” says Horton, whose social-service agency helps teen mothers and runs pregnancy-prevention programs for girls and boys.
Most sex between teens takes place at the boy’s home after school while his parents are at work, according to a study by the Carnegie Council on Adolescent Development. But as they have always done, youngsters who want to can find a time and the place to be alone.
Amanda, who got pregnant at 15, says she and her boyfriend would cut classes and go to her house in the middle of the day. Tina, also pregnant at 15, would sneak out nights to be with her friends and a boyfriend. And there’s always the car.
Many of the men who link up with teenage girls are significantly older, which makes getting together easier but resisting harder.
“I got pregnant the first time I had sex,” says Antoinette Burt, 14. “I felt real pressured. . . . I said, `No,’ but it’s so hard because he’s bigger than me.”
Another concern is that young men still view birth control as a female responsibility, and some just plain refuse.
“At first, he was using condoms and one day he decided not to use it and bam, I got pregnant,” says Maria, 17, whose son is almost 2 1/2 years old. “He just didn’t like the way the condoms felt. You know how men are. . . .
“I said, `OK, take it off.’
“My mom never told me about birth control or when to do it and when not to do it. I didn’t learn about it in school.”
Despite the popular perception that every public school passes out condoms with textbooks, distribution of contraceptives is relatively rare. About 415 middle or high schools have on-site health clinics that deal with sexuality issues; of these, 375 distribute condoms or other forms of birth control, according to a 1993 survey by ETR Associates, a California publishing and research firm.
Opinion polls consistently show that at least two-thirds of Americans favor schools making birth control available. But conflicts are common.
When schools in Washington, D.C., which has a teen birthrate nearly double the national average, decided to provide condoms, parents picketed and forced officials to modify their approach. In New York, a three-year struggle that reached the state appellate court ended in January when the school board scaled back its condom-distribution plan. Now parents can veto whether their children may request condoms from high school teachers.
European countries, which are much smaller and more homogeneous, generally have national policies on birth control. In the U.S., federal and state legislators view contraception as strictly a local issue, resulting in a range of policies.
A clinic at Crane High School on Chicago’s West Side gives its students condoms, the pill, diaphragms, Norplant and Depo-Provera (a three-month contraceptive in the form of a shot). But just blocks away at Marshall High, students get nothing from the health clinic. No suburban schools distribute state-funded birth control, according to the Ounce of Prevention Fund, which oversees Illinois’ contraception programs.
At Crane, one of only four Chicago schools to dispense contraceptive devices, the bright health clinic with glass ceiling and plush chairs provides a welcome contrast to the school’s drab corridors.
A nurse practitioner is on duty from the start of the school day until 4 p.m., and two part-time doctors work one or two afternoons a week. Students can make appointments or drop in between classes.
Youngsters seeking contraceptives for the first time undergo a health exam to see if they have a sexually transmitted disease. They are given a range of birth-control options and counseled on which method would work best.
Before they leave, the students must schedule a follow-up appointment to renew their supply of contraceptives and discuss whether the device was effective.
Obtaining birth control outside of schools may not be as easy for teens as some people think. A recent survey in the District of Columbia showed that adolescent girls trying to buy condoms ran into a series of hurdles large and small.
Only 13 percent of the stores had signs clearly showing where the items were stocked. More than a third kept them behind a counter. And girls asking for help met with resistance or got a lecture from store clerks 40 percent of the time.
When teenage girls use contraception (keeping in mind that 3 out of 10 consistently do not), the pill and condoms are their most common choices. About 64 percent of sexually active 15- to 19-year-olds who use anything use the pill, and another 21 percent use condoms.
But some girls are bothered by side effects of the pill, and others are still held back by myths, such as that it causes cancer. In fact, the pill has certain benefits for some women, according to research, including making menstruation more regular and lowering the risks of some cancers.
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“The side effects of weight gain, nausea, headaches and breast tenderness are common among women initiating use of the pill,” says Dr. Michael Zinaman, an associate professor of obstetrics and gynecology at Loyola University Medical Center. “They are also typically short-lived with time and continued use.”
Zinaman, who directs Loyola’s division of reproductive endocrinology and infertility, said today’s pills have lower doses of the female hormones estrogen and progestin, resulting in fewer side effects than women encountered even a few years ago.
“Adverse effects are generally overstated and poorly understood by patients and, in some cases, by physicians,” Zinaman says. “The pill really hasn’t gotten fair treatment in the media either.”
Some women, maybe 2 or 3 percent, are unsuited for the pill because it can cause severe headaches or vomiting. The pill also may adversely affect growth in the youngest girls, Zinaman says.
But the vast majority of women view the slight side effects as a reasonable tradeoff, he says.
What’s too often lacking, the doctor says, is counseling and education for young women who use birth control. If a teenager knows what the pill is going to do to her body, she may be more willing to wait out the side effects until she adjusts. And she’ll be less likely to skip a pill.
Take the case of Margarette, who stopped taking the pill when she stopped menstruating. That is not unusual for women and can be corrected with a slight change in dosage, Zinaman says. It doesn’t take much time and doesn’t cost much.
Young men, meanwhile, will have to rely on condoms for the foreseeable future. Developing a long-term male contraceptive is trickier because it must neutralize more than a million sperm produced daily, rather than just blocking ovulation of one egg a month in females. Besides that, to put it bluntly, men historically have less of an interest in birth control than women-no secret to people spending research dollars.
For the most part, health fears play a minor role in the use of contraception. According to surveys, teenagers don’t use birth control for the same reasons they didn’t 10, 20 or 40 years ago: They didn’t plan to have sex, they didn’t think pregnancy would occur, their partner didn’t want to use it, they didn’t know where to get it, they didn’t feel comfortable going into a strange clinic, they just didn’t get around to it.
In Europe “there’s a general spirit that sexuality is a healthy, normal function for which you have to assume personal responsibility,” says Henry David of the Transnational Family Research Institute in Maryland. “The approach to sex is much more pragmatic compared to the moralistic view in the United States.”
David just completed a study showing that Danish teenagers get pregnant at about a quarter of the rate of American teens. The rest of Scandinavia has similar numbers. Even Britain, with a long history of sexual conservatism, has much lower teen birthrates.
Racial, ethnic and income differences do not explain the disparities, as many Americans think. White middle-class girls in the U.S. are far more likely to get pregnant than their European peers. And Europeans have much lower abortion rates.
Each country addresses teen sexuality differently. In Denmark, all youngsters are taken to family planning clinics when they enter the 9th grade and taught how to use contraceptives. The Dutch government heavily subsidizes mobile educational teams that work for private groups, and birth control is openly discussed in the media. Britain and France provide young people with free contraceptives.
“I’ve been in Europe about a thousand times professionally, and the one thing that is not comparable is the education of these kids,” Zinaman says. “They understand their bodies completely. Their parents are so much more open about human sexuality. They’re much less puritanical.
“A very common theme there is that there’s nothing wrong with my body. I want to use it. I want to protect it. It’s the way their kids are raised.
“Kids here, on the other hand, just don’t know what they’re doing and are left to find out on their own.”
In Europe as in the United States, research shows sex and contraception education do little to affect the age of first intercourse, or “sexual debut,” as they call it in Scandinavia. Western Europeans generally oppose sex for early adolescents, those 13, 14 and 15 years old, because they are not yet mature or responsible enough, David says.
But for older teens, sex is not seen as shameful or sinful. Also, the media promote sexual responsibility far more than in the U.S. This does not lead to promiscuity, David says, but to monogamous relationships.
“We have to stop being so ambivalent ourselves about contraception,” he says. “The soap operas, the television dramas, they’re always having sex but the word `contraception’ is never mentioned.
“Parents and teachers have to face it that sex is something that has been with us since Adam and Eve.”
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Next: Life after motherhood.