Every Monday evening the Young Men's Clinic (YMC) at Columbia Presbyterian Medical Center in New York City attempts to encourage young men to reflect more thoroughly on a variety of issues related to their own reproductive and sexual health, as well as to the health of the young women in the community surrounding the medical center. The center's staff conducted pilot tests involving aggressive outreach to those community sites where young men congregated. The response of such ventures into the life space of young people has been extraordinary. In the clinic, by creating broad menus (including recreational videos, condom distribution, social service, group education), multiple points of entry into family planning service are generated. To forge stronger linkages among programs, YMC staff and volunteer medical students are outposted to key service groups in the community. YMC staff seek out adult influentials in the lives of the young men in the nearby community. Involving young men successfully in family planning requires that more expansive definitions of the male's role be considered. Sensitizing youths to the seriousness of early, unplanned pregnancy, bolstering support for decisions not to have sexual relations, and creating situations for open, nonjudgmental discussion of the effects of peer pressure (and how to combat it) are steps in the right direction. To create such opportinities, clinic staff need to go out to where youths are. They need to become useful on youths' terms. They need to make connections with the adults and youths who have the power and time to influence those beliefs and attitudes that ultimately contribute to responsible and caring family planning behavior.
The recently released findings of a large scale study indicate that developed countries which have accepting attitudes toward teenage sexuality and toward the provision of family planning services for adolescents generally have much lower adolescent pregnancy rates than the US; these findings are stimulating renewed efforts to make sex education and family planning services more readily available to adolescents in the US. The study, undertaken by the Alan Guttmacher Institute, consisted of a statistical analysis of factors associated with adolescent fertility in 37 developed countries and an in-depth comparative analysis of the US and 5 other developed countries (Sweden, France, Netherlands, England and Wales, and Canada). The study confirmed that the US had a higher adolescent pregnancy, abortion, and childbirth rate than almost all other developed countries. Among adolescents 15-19 years of age the pregnancy rate in the US was 96/1000. Respective rates for the Netherlands, Sweden, France, Canada, and England and Wales were 14, 35, 43, 44, and 45. The study failed to confirm many commonly proffered explanations for the high US rates. For example, the discrepancy between the US and the other 5 countries cannot be attributed to the high pregnancy rate among black teenagers in the US as the rate for white teenagers alone (83/1000) is much higher than the rate in the other 5 countries. Neither can the high US rate be attributed to the availability of welfare benefits; welfare benefits in the other countries tend to be higher. Nor can the high US rates be attributed to greater recourse to abortion in the other countries (the abortion rate is higher among adolescents in the the US then in the 5 countries) or to to high US unemployment rate (teenage unemployment is a serious problem in all the other countries). Factors which were common to all 5 countries but lacking in the US included an open attitude toward adolescent sexuality, easy access for teenagers to free and confidential family planning services, a tendency to promote oral contraceptives as an ideal method for teenagers, and, with the exception of the Netherlands, a national policy promoting sex education in the schools. Surprisingly, both the US press and public responded positively to the results of the study. The press extensively and favorably reported the results of the study, and many groups and individuals renewed their efforts to promote sex education and family planning services for adolescents. The response indicates that the majority of the public favors a more open attitude toward adolescent sexuality.
This article consists of excerpts from a speach made on October 19th at the 1986 annual meeting of the Association of Planned Parenthood Professionals by Dr. Luella Klein, President of the American College of Obstetricians and Gynecologists (ACOG) between 1984-85. The speaker described the reaction of US television network to the ACOG's request that the networks air a public service announcement encouraging responsible sexual behavior among the nation's young people. In 1984 the ACOG initiated a public information program aimed at reducing the high number of unwanted births among young people. The ACOG with the help of an advertising agency developed a 27-second public service announcement stressing responsible parenthood and informing young people that they could write or call for further information. A booklet, entitled "Facts," was prepared for distribution to those who inquired. It advised young people to consider postponing sexual intercourse but to use the most effective methods of contraception if they decided to be sexually active. Oral contraceptives for females and condoms for males were recommended as the most effective methods. When the 3 major television networks, i.e., the American Broadcasting Company (ABC), the National Broadcasting Company (NBC), and the Columbia Broadcasting System (CBS), were requested to carry the announcement, all 3 networks claimed the announcement was too controversial to air. These same networks do not hesitate to show blatant, irresponsible sexual behavior repeatedly during their entertainment programming, and commercials with sexual innuendos are routinely accepted for airing by the networks. In July, 1986, the ACOG called a news conference in New York City to inform the news media about the rejection of the announcement by the networks. The conference stimulated considerable interest, and the story was carried by many newspapers and by radio and television news programs. Many of the news accounts of the story contained the public service announcement itself. As a result, young people began calling and writing for the booklet. Editorials critical of the networks' handling of the ACOG request appeared in numerous publications. The author then wrote to the presidents of each network asking them to reconsider the ACOG request. The presidents of ABC and CBS flatly rejected the request, but the president of NBC agreed to meet with the ACOG to work out an acceptable announcement. The networks must be encouraged to promote a more responsible and realistic image of sexual behavior than the image currently being conveyed in television programs and ads.
A conference titled "The Missing Ingredient: Involving Young Men in Family Planning," sponsored by the Center for Population Options, took place in November 1985 in Washington, D.C. Richard Brookman, M.D., director of adolescent medicine at the Medical College of Virginia, spoke on male adolescent development and ways to facilitate the delivery of health services to male teens. Excerpts from his presentation are presented here. Brookman explains the physical, emotional, and psychological changes taking place in adolescent male youths and the relevance of these changes to providing services for this population. Early, middle, and late adolescence are defined. The characteristics and special problems of each of these time periods are discussed to aid the health care worker in dealing effectively with this population. Practical suggestions are given concerning the sexual education of and providing medical services for the male adolescent.
Attitudes toward teenage sexuality are markedly different in Sweden and the US. The more accepting attitude toward adolescent sexuality and the greater availability of family planning information and services may explain why Sweden has a lower adolescent pregnancy, abortion, and childbirth rate than the US. In contrast to the situation in the US, the Swedish mass media presents a realistic view of sexuality to the youth of the nation. It stresses the responsible use of contraception and the need to protect against sexually transmitted diseases in both its entertainment and educational shows. No commercials are aired on Swedish TV; therefore, Swedish youth are not exposed to the blatant and irresponsible image of sex frequently conveyed by commercials in the US. Moreover, in Sweden, parents accept the fact that their older teenagers will engage in sexual activity and help their children prepare for this activity. As a result, teenagers are reassured that their parents understand their feelings and emotions. These teenagers, in turn, are likely to accept their parents' advice about engaging in responsible sexual behavior. In contrast, in societies like the US, which are nonaccepting of adolescent sexual behavior, teenagers are likely to feel their parents and the larger society do not understand their feelings. These teenagers are likely to reject parental or societal advice on sexual matters. Sweden's accepting attitude toward adolescent sexuality is relatively recent. Prior to the 1960s, attitudes in Sweden were similar to those of present day American society. Eventually the government, the schools, and the parents recognized that they were creating a breach between the generations, and they gradually adopted a more realistic and accepting stance on sexual matters. By 1970, all Swedish children were receiving sex education in school. Television programing in sex education began in the 1960s. The broad distribution of printed sex education materials also began in the 1960s. Young people in Sweden are not totally protected from exposure to negative sexual protrayals. Pornography is common. In 1970, following the parliamentary repeal of an old law prohibiting pornography, mass produced pornography began to appear in Sweden. A broad based campaign against pornography lead to the passage in 1980 of a law prohibiting child pornography. Currently, legislation is being considered which would regulate sexual violence in films, tapes, and television and control the printing of sadistic pornographic pictures. In line with past traditions, Swedes believe it is possible to maintain an open attitude about sexual matters while prohibiting the portrayal of sexual exploitation and sexual violence.
