Doctors Can’t Cure Social Ills

In the late 1970s, 1 million teenagers - about one in nine 15- to 19-year-old girls - got pregnant each year. I was the Carter administration’s point man on the issue, because in the Washington area we treated it largely as a health matter, and I was secretary of health.

In the mid-1990s, 1 million teenagers - about one in nine 15- to 19-year-old girls - get pregnant each year, and President Clinton has nominated a new surgeon general to attack the problem. I wish him luck, but I fear that by continuing to medicalize teen pregnancy and dumping the issue on the surgeon general - a health post with little staff, no programmatic budgets and no clout in the federal bureaucracy - government ignores the lessons of the past 20 years and is doomed to fail.

Sexual intercourse among teens does create an enormous demand for medical treatment. Many sexually active teens become victims or transmitters of diseases such as AIDS and gonorrhea. Of the million teens who become pregnant each year, about 400,000 have abortions, which for some can create or aggravate mental health problems. Of the more than 500,000 who don’t have abortions or miscarriages, thousands have pregnancies complicated by maternal smoking, drinking or drug abuse and by premature delivery and low-weight babies. The health system is responsible for dealing with medical matters such as these. Biomedical science can also contribute discoveries, such as condoms and other contraceptive devices, that reduce the incidence of pregnancy and curb transmission of sexually transmitted diseases.

But medicalization over 20 years has not reduced teen pregnancy in America, nor has it stemmed the spread of sexually transmitted diseases among teens. Life for American teenagers is not just a bowl of condoms.

Today, more unmarried teens are having children. Almost 80 percent of unmarried women who have a child before finishing high school live in poverty. Teen pregnancy costs the government more than $34 billion a year in welfare payments ($13 billion), Medicaid bills ($15 billion) and food stamps ($6 billion).

The persistence of the problem is a sorry reflection of the social forces at large for the past 20 years: poverty and broken families that lead some teens to seek love and status by having a baby, anything-goes moral standards, the declining authority of family, church and school and a mass culture that treats sex not as a serious personal responsibility - often not even as an act of love - but as a glittering consumer item to be exploited and consumed at the moment of desire.

Our teens grow up in a society where personal discipline is more necessary - and less popular - than ever. And for them, popularity is everything.

Sex education is not simply a medical subject. It is most effective in elementary and secondary schools in tempering promiscuous conduct and teen pregnancy where students share the same values. Parochial schools where children profess the same religious beliefs (whether Christian, Jewish or Muslim) and schools in rural areas where parents share common values are more likely to have effective programs than are large urban schools, where concern for social and religious differences drives school officials to medicalize sex education, and in the process detach teen sexual conduct from human and moral values.

What many call sexual liberation has brought with it unhappy consequences for millions of teens: the pressure to experiment with adult behavior before they are ready, emotionally, economically or morally, to shoulder adult responsibility, and the wrenching disruption of life and education caused by an unintended pregnancy and its consequences. This is not liberation. It is bondage for the childmother and the mother’s child.

Responsibility to deter the conduct that causes teen pregnancy - promiscuity, alcohol or drug use, failure to use a condom, lack of a loving family, lack of hope - rests not with the U.S. surgeon general, federal bureaucrats and politicians. Rather it rests with parents in the first instance, as well as with teachers, social workers, clergy and those who set the moral standards and mores of our times. By medicalizing the teenage pregnancy crisis we have relieved them of their responsibility and trivialized the complexity of the solutions.

Dealing with teenage pregnancy requires a oneon-one discussion of values and morality, something difficult to do for a Washington political appointee. Such discussions best take place between parent and child or (and this is especially important for children with no families) in the privacy of a school counselor’s office, parish house or community or local government social service agency.

For most of us the birth of a child is an occasion of great joy and hope, a consecration of new life. But for hundreds of thousands of teenagers - particularly the majority who are unmarried - the birth of a child can usher in a dismal future of unemployment, poverty, family breakdown, emotional stress, dependency on public agencies, alcohol and drug addiction and health problems for mother and child. Preventing such tragedy and comforting those in such pain requires a lot more than a medical degree and a fancy federal title.

xxxx