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Positions papers on reproductive health care for adolescents
208
SOCIETY FOR A D O L E S C E N T MEDICINE
if we are to enhance the awareness of all our youth. In addition, sex education within the schools does not reach those youth who have dropped out or who are truant frequently. One national survey of high school principals in 1978 found that only 36% of high schools offered a separate sex education course. Much instruction on sexuality and reproduction takes place only in the context of health or biology classes. One must question the effectiveness of all this instruction in light of some of the previously discussed data. The Adolescent Father
The welfare of the unmarried adolescent father and his importance in decisions regarding the outcome of the pregnancy are significant but often neglected issues. As suggested by Pannor and others, the active involvement of the male partner can be of considerable emotional benefit to the pregnant teenager [26]. There is still insufficient information regarding the psychosocial morbidity the teenage male suffers for fathering an unwanted child. There is similar need to study the adolescent male who is not yet a father, as well as the adolescent male who has not become sexually active. As pointed out in the study by Cvetkovich and Grote, the three groups--fathers, sexually active nonfathers, and virg i n s - m a y differ sufficiently with respect to variables such as self-concept, sex-role concepts, family
JOURNAL OF A D O L E S C E N T H E A L T H CARE Vol. 4, No. 3
orientation, and religious orientation to permit identification of important determinants of responsible sexual behavior by a systematic examination of various components of sexual as well as nonsexual identity.
Summary There are no simple solutions to the problems associated with adolescent sexual activity. As a Society dedicated to "promoting the development, synthesis, and dissemination of scientific and scholarly knowledge unique to developmental and health care needs of adolescents," we encourage continued scientific focus on the issues related to adolescent reproduction. The positions of the Society of Adolescent Medicine on reproductive health care for adolescents follow and represent the views of the membership. Obviously, unanimous concurrence on such sensitive issues is impossible and the differing opinions by some of the membership are recognized and respected.
The Ad Hac Committee on Reproductive Health Richard E. Kreipe, M.D. Catherine MacDonald, M.D. Elizabeth R. McAnarney, M.D., Chairman The Committee"would like to extend its gratitude for Adele D. Hofmann, M.D. who assisted the Committee in the final wording of the Position Statements.
Positions Papers on Reproductive Health Care for Adolescents Adolescent Sexuality The Society for Adolescent Medicine hereby resolves to support and encourage the development of responsibility toward sexuality, on tlie part of all adolescents; to support and encourage an awareness and acceptance by adults of sexuality in all children and adolescents; and to support and encourage an
approach to adolescent reproductive health care that promotes health as well as prevents disease.
Sex Education The Society for Adolescent Medicine hereby resolves that all States should mandate the teaching of Health and Sex Education from kindergarten through the
September 1983
12th grade, as part of the overall curriculum in schools; that the content of this education should include discussions of sexuality, reproduction, fertility, contraception, abortion, parenting, and sexually transm i r e d diseases; that school personnel responsible for teaching health and sex education should have proper training in the biological, psychological, and moral aspects of h u m a n sexuality; and that parents should be integrally involved in the development and implementation of the sex education curriculum planned for their children.
POSITION PAPERS
209
enting. There should be increased interest in studying the role and needs of the teenaged father and in providing services even w h e n there will not be a continuing relationship with the teenaged m o t h e r or the offspring.
Abortion
The Society for Adolescent Medicine hereby resolves that contraceptive education, counseling, and services should be made available to all male and female adolescents desiring such education, counseling and services on the adolescents' o w n consent without legal or financial barriers. While parental involvem e n t should be encouraged, this should not be required through either consent or notification mandates.
The Society for Adolescent Medicine hereby resolves that medical abortion should remain a legal, availabie alternative to continuing a pregnancy; that the adolescent should have freedom of access to abortion services without legal and fir,ancial barriers; and that the decision to terminate a p r e g n a n t3' should rest with the pregnant adolescent in concert with the advice and counsel of her physician. While the involvement of significant others should be strongly encouraged, particularly for immature and still dep e n d e n t minors, m a n d a t o r y parental consent and/ or notification should not be required. Moreover, w h e n determination of maturity is necessary, that determination is best made by a knowledgeable health professional.
Adolescent Childbearing and ChiIdrearing
Sexually Transmitted Diseases
The Society for Adolescent Medicine hereby resolves that pregnancy detection and subsequent prenatal health, counseling, educational and postnatal services (including child care), should be available and accessible to adolescents w h o choose to continue their pregnancies, without legal or financial barriers. These services should be extended to include the adolescent's partner and family, if she desires, and should include counseling on adoption and/or par-
The Society for Adolescent Medicine hereby resolves that no barriers should prevent adolescents from obtaining timely education, counseling, and/or health services for the prevention, diagnosis or treatment of sexually transmitted diseases; and that minors should have access to such education, counseling and health services on their o w n consent without the requirement of either mandatory parental consent or parental notification.
References
States. In: Chilman C5, ed. Adolescent pregnancy and childbearing: findings from research. U.S. D H H S (NIH) 81-2077, 1981:4. 6. U.S. Department oi Health and H u m a n Services. Childbearing and abortion patter/',samong teenagers--U.S., 1978. Morbldityand MortalityWeekly Report 1981;30:611-7.(HH5 Pub.
Contraception
1. Mc_AnameyER, Roghmann KJ, Adams BN, et al. Obstetric, neonatal, and psychosocialoutcome of pregnant adolescents. Pediatrics 1978;61:199-205. 2. Felite ME, Granados JL, Antes IG, et al. The young pregnant teenager. Impactof comprehensiveprenatal care.J Adol Health Care 1981;I:'t93-7. 3. San'el PM, Davis C. The young unwed primipara. A study of 100 cases with a 5 year followup. Am I Obstet Gynecol 1966;95:722-5. 4. Card J, Wise L. Teenage mothers and fathers: the impact of early childbearing on the parents' personal and professional lives. Faro Plann Perspect 1978;10:199-205. 5. CampbeLlAA. Trends in .~eenagechildbearing in the United
No. (CDC) 81-8017). 7. Cates W. Adolescent abortion in the United States. J Adol Health Care 1980;1:18-25. 8. Zelnik M, Kantner JF. Sexual activity,contraceptive use and pregnancy among metropolitan-area teenagers: 1971-1979. Faro Plann Perspect 1980;12:230-7. 9. Zelnik M, Kantner JF. Sexual and contraceptive experience of young unmarried w o m e n in the United States, 1976 and
1971. Fam P/ann Perspect 1977;9:55-9.
210
SOCIETY FOR ADOLESCENT MEDICINE
10. Alan Gut~n,acher Institute. Teenage pregnancy: the problem that hasn t gone away. New York: The Alan Guttmacher Institute, 1981:40. I1. Richmond JB. Healthy people: the Surgeon General's report on health promotion and disease prevention. U.S. DHEW (PHS) 79-5507I, 1979:49. 12. Coulam CB. Pituitary adenoma and oral contraceptives: a case-control study. Fertil Steril 1979;31:25-8. 13. Boyd JT, Doll R. A study of aetioIogy of carcinoma of the cervix and uterus. Br J Cancer 1964;28:419. 14. Gjorgov AN. Barrier contraceptive practice and male infertility as related factors to breast cancer in married women. Preliminary results. Oncology 1978;35:97-100. 15. Cvetkovich G, Grote B. Psychosocial development and the social problem of teenage illegitimacy. In: Chilman CS, ed. Adolescent and childbearing: findings from research. U.s.pregnan~lH) 81-2077, I98I:21. DHHS 16. Drake LW, Nederlander C, Mercier RG. Sexual assertiveness training for adolescents. In: Rigg CA, Shearin RB, eds. Adolescent medicine: present and future concepts. Chicago: Year Book Medical Publishers, 1980. 17. Tortes A, Forrest }D, Eisman S. Telling parents: clinic policies
JOURNAL OF ADOLESCENT
H E A L T H C A R E Vol. 4, No. 3
and adolescents' use of family planning and abortion services. ]:am Plann Pempect 1980;12:284-92. 18. Zabin L, Kantner J, Zelnik M. The risk of adolescent pregnancy in the first months of intercourse. ]:am Plann Perspect 1979;11:215-22. 19. Hofmann AD. A rational policy toward consent and confidentialityin adolescent health cane. J Adol Health Cane 1980;1:917. 20. Spanier GB. Sources of sex information and premarital sexual behavior. J Sex Res 1977;13:73-88. 21. Freeman EW, Rickels K. Huggins GR, et al. Adolescent contraceptive use: comparisons of male and female attitudes and information. Am ] Public Health 1980;70:790-7. 22. Alan Guttmacher Institute. op cit, p. 38. 23. Yates GL. Parent education and community support: key factor's for success. Transitions 1981;4:3--6. 24. LewisRA. Parents and peers: Socialization agents in the coital behavior of young adults. } Sex Res 1973;9:156-90. 25. Alan Guttmacher Institute. op cit, p. 39. 26. Pannor R, Massarik F, Evans B. The unmarried father. New York: Springer, 1971.
SOCIETY FOR A D O L E S C E N T MEDICINE
if we are to enhance the awareness of all our youth. In addition, sex education within the schools does not reach those youth who have dropped out or who are truant frequently. One national survey of high school principals in 1978 found that only 36% of high schools offered a separate sex education course. Much instruction on sexuality and reproduction takes place only in the context of health or biology classes. One must question the effectiveness of all this instruction in light of some of the previously discussed data. The Adolescent Father
The welfare of the unmarried adolescent father and his importance in decisions regarding the outcome of the pregnancy are significant but often neglected issues. As suggested by Pannor and others, the active involvement of the male partner can be of considerable emotional benefit to the pregnant teenager [26]. There is still insufficient information regarding the psychosocial morbidity the teenage male suffers for fathering an unwanted child. There is similar need to study the adolescent male who is not yet a father, as well as the adolescent male who has not become sexually active. As pointed out in the study by Cvetkovich and Grote, the three groups--fathers, sexually active nonfathers, and virg i n s - m a y differ sufficiently with respect to variables such as self-concept, sex-role concepts, family
JOURNAL OF A D O L E S C E N T H E A L T H CARE Vol. 4, No. 3
orientation, and religious orientation to permit identification of important determinants of responsible sexual behavior by a systematic examination of various components of sexual as well as nonsexual identity.
Summary There are no simple solutions to the problems associated with adolescent sexual activity. As a Society dedicated to "promoting the development, synthesis, and dissemination of scientific and scholarly knowledge unique to developmental and health care needs of adolescents," we encourage continued scientific focus on the issues related to adolescent reproduction. The positions of the Society of Adolescent Medicine on reproductive health care for adolescents follow and represent the views of the membership. Obviously, unanimous concurrence on such sensitive issues is impossible and the differing opinions by some of the membership are recognized and respected.
The Ad Hac Committee on Reproductive Health Richard E. Kreipe, M.D. Catherine MacDonald, M.D. Elizabeth R. McAnarney, M.D., Chairman The Committee"would like to extend its gratitude for Adele D. Hofmann, M.D. who assisted the Committee in the final wording of the Position Statements.
Positions Papers on Reproductive Health Care for Adolescents Adolescent Sexuality The Society for Adolescent Medicine hereby resolves to support and encourage the development of responsibility toward sexuality, on tlie part of all adolescents; to support and encourage an awareness and acceptance by adults of sexuality in all children and adolescents; and to support and encourage an
approach to adolescent reproductive health care that promotes health as well as prevents disease.
Sex Education The Society for Adolescent Medicine hereby resolves that all States should mandate the teaching of Health and Sex Education from kindergarten through the
September 1983
12th grade, as part of the overall curriculum in schools; that the content of this education should include discussions of sexuality, reproduction, fertility, contraception, abortion, parenting, and sexually transm i r e d diseases; that school personnel responsible for teaching health and sex education should have proper training in the biological, psychological, and moral aspects of h u m a n sexuality; and that parents should be integrally involved in the development and implementation of the sex education curriculum planned for their children.
POSITION PAPERS
209
enting. There should be increased interest in studying the role and needs of the teenaged father and in providing services even w h e n there will not be a continuing relationship with the teenaged m o t h e r or the offspring.
Abortion
The Society for Adolescent Medicine hereby resolves that contraceptive education, counseling, and services should be made available to all male and female adolescents desiring such education, counseling and services on the adolescents' o w n consent without legal or financial barriers. While parental involvem e n t should be encouraged, this should not be required through either consent or notification mandates.
The Society for Adolescent Medicine hereby resolves that medical abortion should remain a legal, availabie alternative to continuing a pregnancy; that the adolescent should have freedom of access to abortion services without legal and fir,ancial barriers; and that the decision to terminate a p r e g n a n t3' should rest with the pregnant adolescent in concert with the advice and counsel of her physician. While the involvement of significant others should be strongly encouraged, particularly for immature and still dep e n d e n t minors, m a n d a t o r y parental consent and/ or notification should not be required. Moreover, w h e n determination of maturity is necessary, that determination is best made by a knowledgeable health professional.
Adolescent Childbearing and ChiIdrearing
Sexually Transmitted Diseases
The Society for Adolescent Medicine hereby resolves that pregnancy detection and subsequent prenatal health, counseling, educational and postnatal services (including child care), should be available and accessible to adolescents w h o choose to continue their pregnancies, without legal or financial barriers. These services should be extended to include the adolescent's partner and family, if she desires, and should include counseling on adoption and/or par-
The Society for Adolescent Medicine hereby resolves that no barriers should prevent adolescents from obtaining timely education, counseling, and/or health services for the prevention, diagnosis or treatment of sexually transmitted diseases; and that minors should have access to such education, counseling and health services on their o w n consent without the requirement of either mandatory parental consent or parental notification.
References
States. In: Chilman C5, ed. Adolescent pregnancy and childbearing: findings from research. U.S. D H H S (NIH) 81-2077, 1981:4. 6. U.S. Department oi Health and H u m a n Services. Childbearing and abortion patter/',samong teenagers--U.S., 1978. Morbldityand MortalityWeekly Report 1981;30:611-7.(HH5 Pub.
Contraception
1. Mc_AnameyER, Roghmann KJ, Adams BN, et al. Obstetric, neonatal, and psychosocialoutcome of pregnant adolescents. Pediatrics 1978;61:199-205. 2. Felite ME, Granados JL, Antes IG, et al. The young pregnant teenager. Impactof comprehensiveprenatal care.J Adol Health Care 1981;I:'t93-7. 3. San'el PM, Davis C. The young unwed primipara. A study of 100 cases with a 5 year followup. Am I Obstet Gynecol 1966;95:722-5. 4. Card J, Wise L. Teenage mothers and fathers: the impact of early childbearing on the parents' personal and professional lives. Faro Plann Perspect 1978;10:199-205. 5. CampbeLlAA. Trends in .~eenagechildbearing in the United
No. (CDC) 81-8017). 7. Cates W. Adolescent abortion in the United States. J Adol Health Care 1980;1:18-25. 8. Zelnik M, Kantner JF. Sexual activity,contraceptive use and pregnancy among metropolitan-area teenagers: 1971-1979. Faro Plann Perspect 1980;12:230-7. 9. Zelnik M, Kantner JF. Sexual and contraceptive experience of young unmarried w o m e n in the United States, 1976 and
1971. Fam P/ann Perspect 1977;9:55-9.
210
SOCIETY FOR ADOLESCENT MEDICINE
10. Alan Gut~n,acher Institute. Teenage pregnancy: the problem that hasn t gone away. New York: The Alan Guttmacher Institute, 1981:40. I1. Richmond JB. Healthy people: the Surgeon General's report on health promotion and disease prevention. U.S. DHEW (PHS) 79-5507I, 1979:49. 12. Coulam CB. Pituitary adenoma and oral contraceptives: a case-control study. Fertil Steril 1979;31:25-8. 13. Boyd JT, Doll R. A study of aetioIogy of carcinoma of the cervix and uterus. Br J Cancer 1964;28:419. 14. Gjorgov AN. Barrier contraceptive practice and male infertility as related factors to breast cancer in married women. Preliminary results. Oncology 1978;35:97-100. 15. Cvetkovich G, Grote B. Psychosocial development and the social problem of teenage illegitimacy. In: Chilman CS, ed. Adolescent and childbearing: findings from research. U.s.pregnan~lH) 81-2077, I98I:21. DHHS 16. Drake LW, Nederlander C, Mercier RG. Sexual assertiveness training for adolescents. In: Rigg CA, Shearin RB, eds. Adolescent medicine: present and future concepts. Chicago: Year Book Medical Publishers, 1980. 17. Tortes A, Forrest }D, Eisman S. Telling parents: clinic policies
JOURNAL OF ADOLESCENT
H E A L T H C A R E Vol. 4, No. 3
and adolescents' use of family planning and abortion services. ]:am Plann Pempect 1980;12:284-92. 18. Zabin L, Kantner J, Zelnik M. The risk of adolescent pregnancy in the first months of intercourse. ]:am Plann Perspect 1979;11:215-22. 19. Hofmann AD. A rational policy toward consent and confidentialityin adolescent health cane. J Adol Health Cane 1980;1:917. 20. Spanier GB. Sources of sex information and premarital sexual behavior. J Sex Res 1977;13:73-88. 21. Freeman EW, Rickels K. Huggins GR, et al. Adolescent contraceptive use: comparisons of male and female attitudes and information. Am ] Public Health 1980;70:790-7. 22. Alan Guttmacher Institute. op cit, p. 38. 23. Yates GL. Parent education and community support: key factor's for success. Transitions 1981;4:3--6. 24. LewisRA. Parents and peers: Socialization agents in the coital behavior of young adults. } Sex Res 1973;9:156-90. 25. Alan Guttmacher Institute. op cit, p. 39. 26. Pannor R, Massarik F, Evans B. The unmarried father. New York: Springer, 1971.