Let's start with a beyond-dispute premise: We need to do everything possible to prevent unwanted teen pregnancy.
But should pediatricians pre-prescribe “morning-after” pills to girls younger than 17, as the American Academy of Pediatrics has suggested?
Even though I'm the mother of two teen boys, I believe that if I were
instead charged with the health and well-being of two teen girls I'd be
saying “Heck, yeah!”
But who am I to say that other parents would feel the same?
My neighbors are a devoutly churchgoing Hispanic couple with two sons
and a 15-year-old daughter. The father of the family, a cheery Mexican
immigrant who holds fast to traditional conservative religious ideas
about his daughter's reproductive rights — which is to say he probably
doesn't believe she has any — would surely not feel comfortable if he
thought his daughter's physician would give her access to morning-after
pills “just in case.”
You might be saying to yourself that this child is probably an
excellent candidate for becoming one of the 55.7 per 1,000 Hispanic
girls ages 15 to 19 who give birth every year — 80 percent of these
pregnancies are unintended — and you'd be absolutely right.
With this terrible state of affairs, it would seem obvious that
pediatricians should provide explicit, unsolicited counseling about
birth control and emergency pregnancy prevention to teens, and
especially girls, independent of a parent's wishes, right?
Maybe. Especially maybe in communities where teen pregnancies among
minority girls are particularly pervasive. For instance, New York City's
public schools face a powerful mix of high poverty, underinsured
families, and teens who frequently start sexual activity before the age
of 13. The schools are trying pilot programs to provide birth control
and morning-after pills right in school buildings. Health officials
there recently reported that parents are fine with the program.
What we're really witnessing here is the medical establishment's
acknowledgement that way too many parents refuse to admit that in our
highly sexualized society, they are the ones who need to provide their
children with reliable information about safe sex.
Because overall averages of teen pregnancy have been going down for
the last few years, there is an opportunity here to get to the root of
the problem, which is less about what talks doctors should be having
with their minor patients and more about what information should be
shared at home.
Studies have shown that kids of parents who have meaningful and
informative conversations about sex are less likely to engage in risky
behaviors leading to unintended pregnancy and sexually transmitted
diseases.
If the pediatric medical establishment wants to go ahead and codify a
policy that says “talk to your kids about safe sex or we'll do it for
you,” it should do so hand-in-hand with general practitioners who treat
parents.
In other words, as the AAP tells pediatricians to initiate these talks with kids, the American Medical Association and the Centers for Disease Control and Prevention
should ask that physicians screen patients who are parents for their
ability to provide their kids with age-appropriate sex education, give
them a score predicting their child's likelihood to engage in risky
sexual behaviors and provide them the resources to prevent such negative
outcomes.
Another beyond-dispute premise: Efforts to reach kids without
involving their parents in helping them make good choices will
ultimately falter.
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