Under the Obama administration, the U.S. is shifting gears on teen pregnancy prevention. Everyone is still on-message that abstinence should be the core message of any federally funded program, but comprehensive sex education is about to get a boost from the federal government.
This year's federal budget is devoting more than $114 million to what it calls an "evidence-based approach." Abstinence-only programs will still be funded, but most of the money will go to communities that choose programs that have shown they reduce teen pregnancy.
Few have more experience with teen sexuality education and adolescent development than Michael Carrera, a well-known expert in the field. His interest in preventing teen pregnancy goes back to his experiences as a junior high school teacher in the Bronx 50 years ago.
"In those days, there was something called dating and courting," Carrera says. "I learned that if you spoke about sexuality to young people, they sat still."
In 1984, after years of study in what was then an emerging field, Carrera started a number of after-school programs that were sponsored by New York City's Children's Aid Society. Those programs are now incorporated into a number of curriculums in the U.S.
He's had to raise funding for these programs through national foundations. Now, schools and community groups that want to try Carrera's model can apply for federal funding under the Replication of Evidence-based Programs. Carrera's is one of 28 programs approved for funding, because it's proven to get children to delay sex.
In Washington, D.C., Carrera's model is being phased into the curriculum of the Arts and Technology Academy, a public charter school in one of the city's poorest neighborhoods.
Teacher Aarti Shastry's fifth-grade Family Life and Sexuality education class is playing a game that challenges students' ideas about gender. She asks a group of girls: Who talks more in conversations, males or females? The girls huddle and debate for a few seconds before answering, "Females!" Shastry tells them that's not correct; researchers have observed males and females in conversation and determined that men talk more, while women tend to do the listening.
Students begin the Carrera program at a fairly early age. After a series of failures, Carrera says, he discovered that if you wait until children are teenagers, it's too late. Older boys and girls in the program had not only already begun to have sex, but had also already developed pretty hardened views about relationships and the roles of males and females that were hard to break down.
Carrera's sexuality education classes are intended to be age-appropriate. Older kids at the Academy, for example, study diagrams of male and female anatomy and get frank explanations about reproductive functions and relationships.
From working a long time in poor communities, Carrera also learned that he couldn't just deal with poverty and sexuality if he wanted to reach them. The young people who came to the program had other issues -- with family, peers and self-image.
"They brought them all with them, including their thirst for knowledge about sexuality and their interests in being with other girls and boys," Carrera says. "I concluded that the way to get the sexuality message to stick was to link it with all the other things that made them whole young people."
Giving young people information about sex is not the same thing as giving them permission to have sex, Carrera points out. "Sexual ignorance is not bliss. You do not make responsible decisions in the dark."
Besides, recent studies have shown that not all teen pregnancies are unplanned. Thus the program goes beyond sexuality to make young people aware of what options are available in life besides having children. That's why Carrera's program has a job club where students learn about the world of work, get a stipend and keep a bank account. There are also opportunities for self-expression through music, art and athletics, which are activities they can pursue for a lifetime -- and activities that are known to delay sex.
Evidence Of Success
Susan Philliber, an independent evaluator, has seen the difference between teenagers in Carrera's New York City program and other teenagers in the city. Her team followed them for four years through the high-risk years of high school. In the Carrera group, 10 percent of the girls got pregnant; in the control group, it was 22 percent.
"That's more than double the percentage -- and impressive," Philliber says.
The program also offers comprehensive medical, dental and mental health care that includes reproductive health care. Philliber says a girl in the program is not only more likely to use contraceptives, but also use protection against sexually transmitted infections.
"She's saying, 'I want this protection. I don't want any risk here. I'm in school. I want to think about other things,' " Philliber says.
But Philliber warns that the program doesn't work for everyone. The boys who were the most difficult to engage were the ones who had already been sexually active. "These were high-risk little boys," she says. Philliber continues to monitor and evaluate Carrera's program.
A Proven But Complex Model
It's hard to find people who don't like the Carrera model, including Ron Haskins of the Brookings Institution. He was a senior adviser to President George W. Bush at a time when abstinence-only programs were hotly debated. Haskin admires Carrera, but wonders if communities are really able to faithfully adapt the program.
"Imagine the organization and the funding that you have to have to do all the things Carrera does in his original model," Haskin says. Communities would have to supply help with schoolwork, organized athletics, field trips, college prep and more. "I would think there'll be some communities without adequate resources -- it'll be very difficult for them to implement all aspects of the Carrera program."
Carrera's program costs about $2,500 per student. Even those who admire Carrera's work say the administration's approach may create something of a straitjacket for people who want to try other ideas.
For the time being, there are other programs on the administration's list for communities to choose -- programs for middle-class, white, Hispanic and black children, though few are as comprehensive as Carrera's.