Journal of Community Health Vol. 11, No. I, Spring 1986

S E R V I C E S A N D E D U C A T I O N A L A P P R O A C H E S T O A D O L E S C E N T P R E G N A N C Y

Stanley Harris, M.D.

ABSTRACT: A historical review of adolescent pregnancy might be helpful if it could be studied for a particular conntry or in our own country for a particular state or city. Early information would for the most part be unreliable and where available, highly prejudicial.

By providing contraceptives, family planning, counseling and abortion it was believed that teenage pregnancy could be prevented. It cannot be said that these techniques have failed. Maturing and self- discipline, however, are required to use the services properly that have been provided. Yet, nei ther maturity nor self-discipline is a major component of the adolescent life style.

As more knowledge and unders tanding of adolescent preg- nancy has become available, it has become apparent that this informa- tion has to be integrated into a comprehensive health care program. The Bronx Committee for the Community's Health, an incorporated group of eleven community health centers, is a unique model in the formation of a comprehensive, coordinated and accessible health care delivery system.

A sixteen-week curriculum for 10-13 year olds, the Very hn- portant Person (V.I.P.) program, teaches youngsters about develop- mental changes dnr ing puberty, and about reproductive physiology. There is an effort to promote health education for parents and chil- d ren and to involve the parents in as many activities as possible in the schools, and in the community.

There must be continued education for the nation's black leaders to enable them to relate specifically to the expressed needs and desires of black teens and their families. Continued efforts must be expended for political and legislative support to follow through on these initiatives until resuhs can be evaluated and normal, heahhy de- velopment of black teenagers can be assured.

INTRODUCTION

A historical review of approaches to adolescent pregnancy is helpful in understanding the origin of contemporary efforts around this issue. It will also help define directions for the future.

The earliest approach to ferreting out the cause of teen preg-

Stanley Harris, M.D. is Project Director of Monteliore Comprehensive Care Center. Montefiore Hospital Medical Center.

Address requests fi~r reprints to Dr. Stanley Harris, Montefiore Colnprehensive Care ('enter, 230 East 162nd Street, Bronx, N.Y. ]0457.

© 198(i Human Sciences Press 31

32 JOURNAL OF COMMUNITY HEALTH

nancy was to identify a common pathology. An underlying psychosis, it was suggested, caused young unmarried women to become pregnant. What was interesting, of course, was that as soon as these young women married, pregnancy was no longer psychotic behavior, but rather normal and expected. This research has never substantiated a causal relation- ship between adolescent pregnancy and psychosis.

The next strategy was a preventive one, free contraception and confidential family planning and counseling were provided. Unfortu- nately, however, successful use of contraception required maturity and self-discipline, characteristics which many male and female teenagers have not developed.

The emphasis then shifted to designing programs to provide ex- tensive support for expectant mothers (as well as fathers), both during and after the pregnancy. More recently, this concept has been extended to programs that enable teens to continue their education throughout pregnancy, receive good medical and prenatal care and find day care facilities for their newborn infant or toddler. In some cases, the facility was attached to the high school that the mother was attending.

T H E VERY I M P O R T A N T P E R S O N (VIP) P R O G R A M

The evolution of understanding of the causes of adolescent preg- nancy and the experience of treating these youngsters led to the concept of service integration. A comprehensive and coordinated health care delivery system which would offer both accessibility and continuity for adolescents arid their children was needed. The emergence of the Bronx Committee for the Community's Health in New York City, an incor- porated group of eleven community health centers, was a national leader in the formation of such a system.

The Bronx Committee's development of primary care services is located within school settings and linked to other health providers. It offers unique opportunities for meeting the health care and counseling needs of many adolescents, including those who are pregnant.

Regardless of the delivery model, if future programs are to be effective, they must have education as a major component. This educa- tional component must be multi-focal, beginning with the education of medical professionals. Medical education curricula and residency train- ing programs must provide an in-depth exposure to the issues of adoles- cent development. The health profession must be encouraged to develop sensitivity to the needs of adolescents and be able to assist them in coping with their problems, including pregnancy.

Stanley Harris 33

Health education, discussions of human sexuality and normal development must be integrated into the health maintenance services provided to preteens and their parents. This concept has been developed at the Montefiore Comprehensive Health Care Center in the Bronx. A sixteen week curriculum for 10 to 13 year olds, the Very Important Per- son (VIP) Program, teaches youngsters about developmental changes in puberty and reproduction physiology (Table 1). It also includes discus- sions of issues such as self-esteem, decision making, peer relationships and parental communication. Both the youngsters and their parents are delighted with the new sense of control one can exert over one's sexuality and one's ability to distinguish reality from the influence of media and advertising.

T A B L E 1

The Very hnportant Person Program Curriculum

1. Orientation 2. Introduction 3. Self-esteem 4. ]:'uberty to self-esteem (continued) Male

5. Puberty 6. (A) Gender 6. (B) ( ;ender 7. l)ecisioli Feniale Roles and Roles and Making (I)

Relationships Relationships

8. Fihn ".,~..m I 9. Reproductive I0. Menstruation 11. Decision Norm,d?" Physiology Making (II)

Parenting

12. Decision 13. Birth Control 14. Decision 15. CommulfiCa- Making ( i l l ) Making (IV) tion and Parenting E(lu(:ation Rehtlitinships

lind (]at'eel

16. Pregnancy Alternatives and Review

The [oilowing poem was written by Ms. Margaret Bennet, mother of one of the first participants in the VIP Program. It summarizes the philosophy and intent of the program which is to help these young adolescents to buikl their self-esteem. It has been accepted as the theme of the program.

VIP PROGRAM THEME

I warn to travel as lar as I can go. I wan* to reach the joy Omt's in my soul,

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And change the limitations that I know And feel my mind and spirit grow. I want to live. "To be." and hear the truths inside of me That say I am a V.I.P.

Finally, we mus t be p r e p a r e d to conf ron t ou r fears, anxieties, and ignorance, and make clear distinctions between emot ions and ou r t rue mora l convictions. T h e r e mus t be cont inued educat ion for the na- tion's Black leaders, including political and legislative representat ives, which will enable them to 1) fully under s t and adolescent pregnancy , part icularly in relat ion to Black teens and their parents, and 2) insure their cont inued suppor t for the comprehens ive initiatives that are striv- ing to deal effectively with adolescent pregnancy.