Adolescent Pregnancy

In the July 2005 issue of Pediatrics the American Academy of Pediatrics (AAP) has released a Clinical Report on Adolescence Pregnancy (“Adolescent Pregnancy: Current Trends and Issues”). This report implies that it is the result of, or at least is representative of, a membership-wide consensus. It is not, and it must be noted that the AAP’s process for producing such documents falls to a small number (6) of appointed committee members.

Troubling in this report is the fact that essential science-based data are omitted. The carefully studied and widely reported evidence of the effectiveness of abstinence education in Uganda is not even mentioned. A study published in Adolescence and Family Health (April 2005) by Dr. Robert Lerner reported that participants in Best Friends, an abstinence program, were 6.5 times more likely to remain sexually abstinent, nearly twice as likely to abstain from drinking alcohol, 8 times more likely to abstain from drug use and more than twice as likely to refrain from smoking. Self report by girls in the program indicated an 80% reduction in the likelihood that they would have premarital sex. Even more telling is the fact that the majority of the references in the AAP Report date from before 2000, so that even the opinion presented in this report is based on information that is not the most current.

In its dismissal of consistent abstinence education, the Report surprisingly, and in the opinion of the Board of the American College of Pediatricians, inappropriately downplays the other consequences and serious dangers of premarital sexual activity, such as sexually transmitted diseases including AIDS, depression, and depression-related suicide. The Report implies that premarital teenage pregnancy is the sole threat of adolescent sexual activity

Of particular concern to health professionals is the fact that the 2005 Report excludes an important statement that was presented as a recommendation in the AAP’s 1998 Report: “Abstinence counseling is an important role for all pediatricians”. The American College of Pediatricians is certain that providing this support consistently to teens is essential in preventing adolescent pregnancy and other associated problems. While the 2005 AAP Report invites physicians to encourage teens to delay sexual activity, it dilutes and even contradicts this message by also recommending “that all adolescents have knowledge of and access to contraception, including barrier methods and emergency contraception supplies”. Of note and by way of comparison, the AAP does not promote safe (safer) drinking, tobacco or other drug use. Since the evidence is clear that even “safer” sex is not safe enough and that children are its continuing victims, the public should ask why it is that organizations such as the AAP and Planned Parenthood continue to promote a failed education message that does nothing to protect the health and well-being of our children.

The American College of Pediatricians continues to recommend abstinence education as the only method of publicly helping adolescents safely deal with issues of sexuality.