This article presents the problem of age differences between minors and their sexual partners. Understanding age differences is critical in finding solutions and formulating public policy. The Alan Guttmacher Institute (AGI) studies showed that sexually active women in general have older sexual partners. However, minor aged women are more likely to have sexual partners very close to their age. State laws impose criminal liability on sexual activities in cases where the specified age difference between the minor and his or her sexual partner is of 3 or 4 years. The age of consent ranges from ages 14 to 18 years. Moreover, complex social issues such as teens being involved with adult men require complex responses that stand a reasonable chance of doing more good than harm.
Emergency contraception (EC) involves women taking a high dose of regular oral contraceptives very shortly after unprotected intercourse. Specifically, emergency contraceptive pills (ECPs) can prevent pregnancy if taken within 72 hours of intercourse in cases of known or suspected contraception failure or when no contraception was used. Adherence to this approach is now widely accepted as capable of dramatically contributing toward the reduction of unintended pregnancies and subsequent abortions. However, in the media and in political debates, ECPs are often confused with mifepristone (RU-486), which is clearly an abortion-inducing drug. The misconception that EC is a method of abortion must be corrected. For example, in some cases, pharmacists refuse to fill prescriptions for ECPs, presumably because they believe they are facilitating abortion. Wal-Mart, one of the country's largest drug retailers, has decided to not sell ECPs. A concerted public education effort is needed to make more people both aware and properly informed of EC in the US. Educational efforts targeted to physicians and women over the past several years appear to have already resulted in a marked increase in the knowledge and use of EC nationwide. Those efforts were likely bolstered by the 1998 US Food and Drug Administration approval, for the first time, of an oral contraception regimen to be packaged and marketed in the US specifically for postcoital use.
This paper sheds lights on long-standing issues and new proposals on family planning and adoption promotion. The spate of bills promoting adoption in Title X family planning clinics and federally funded health centers by opponents of family planning programs raise a significant concern in the family planning community. This concern gave rise to questions on the nature of adoption counseling that should be offered to pregnant women in government-funded programs and the extent to which family planning programs should assume the duties of adoption agencies. Budgetary constraints also raise a serious question on the degree to which family planning funds should be rechanneled to serve this purpose. One more immediate issue, however, is the fact that two of the proposed strategies deny women facing pregnancy crisis the right to informed decision on their options by preventing family planning providers to discuss on abortion. Other measures set include the revival of the abortion "gag rule" previously imposed by the Reagan and Bush administrations and promoting a program of direct federal subsidy to organizations which provide counseling to women provided that these organizations shall provide full information on pregnancy options.
States have moved swiftly to start materializing the Children's Health Insurance Program (CHIP). The program enacted in 1997 hopes to cover millions of uninsured American children targeting children up to age 19 in families with incomes 200% below the federal poverty line. All 50 states and the District of Columbia have secured federal approval for the program whose coverage includes family planning services and supplies for enrolled adolescents. Their plans gave the program an enormous potential to help meet the reproductive health care needs of 2.7 million uninsured teenagers. However, with the low number of individuals enrolled than expected, the federal and state governments, initiated efforts to develop more extensive and aggressive outreach activities to boost CHIP enrollment.
Since 1970, the Title X family planning program of the US Public Health Service act has helped low-income American women avoid unintended pregnancies, abortions, and unwanted births. In addition to averting a million pregnancies (and half as many abortions) each year, the 4400 Title X clinics provide an array of reproductive health services. Funding for the program, however, has never recovered from Reagan-era cuts, and President Clinton's proposal for a $25 million increase will only begin to allow the program to achieve Clinton-administration objectives. The clinics face a financial challenge in maintaining the full range of contraceptive choices, especially in light of the high up-front costs of long-acting contraceptives, such as Depo-Provera, which can consume 50% of a budget for 15% of the clients. New diagnostic technologies have made routine screening desirable but expensive, and clinics must struggle to maintain quality of care. Title X clinics also have a clear need to expand their service capacity to reach the million low-income women who continue to risk unintended pregnancy and to serve low-income salaried workers without health insurance. Currently, two-thirds of Title X clients are so impoverished that their care is totally subsidized, and only 20% are covered by Medicaid. A portion of the $25 million increase has also been earmarked to promote reproductive health among the hard-to-reach population, such as substance abusers and the homeless, and to expand service provision to males. While the increase is needed, it represents only a portion of the cost of facing these challenges.
