Birth Control for Kids?

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When the Portland, Maine, School Committee voted 7-2 Wednesday night to make birth control pills available to middle school girls as young as 11, the response provided the latest evidence that adults still have trouble talking about sex with each other, much less with our kids.

The debate was passionate, as you'd expect over an issue that touches so deeply our concerns about what our kids know and do — and when — and the messages we send them. To school officials and public health advocates who favored the measure, this was a question of confronting reality. Five of the 134 students who visited King Middle School's health center last year admitted they were sexually active; in the last four years, Portland's three middle schools reported 17 pregnancies, not counting miscarriages or unreported pregnancies that ended in abortions.

Parents may be in denial, officials suggested, they may fervently want children to delay sexual activity, but if you know for a fact that kids are having sex then the responsible thing to do is to warn them about sexually transmitted diseases and help prevent them from getting pregnant. The message was not "value neutral": "We do certainly sit down and speak with them about why that's not a good choice," said Portland's school nurse coordinator Amanda Rowe, referring to sexually active students. "But there are some who persist — even though we don't like to think about that — in being sexually active, and they need to be protected."

And while ideally parents should be responsible for transmitting information and values to their children, the school has a responsibility to children whose parents can't or won't do so. One committee member, Sarah Thompson, mother of an eighth grader, admitted that the proposal made her "uncomfortable," but she understood the need. "I know I've done my job as a parent," Thompson said. "[But there] may be a time when she doesn't feel comfortable coming to me [and] not all these kids have a strong parental advocate at home."

Opponents warned of putting girls at greater risk of cancer; of ignoring people's religious beliefs; and most of all, of violating parents' rights to know what their children are doing. Parents would have to consent for their children to be treated at the King Middle School clinic, but the nature of the treatment provided, including prescribing contraception, falls under state laws protecting patient privacy. When talking about children so young, the idea that parents would have no say is galling; they can be pulled over by police if their 11-year-old is not wearing a seat belt, but have no right to know whether she's taking the Pill. Roughly 30% of the country's 1,700 school health clinics offer some form of contraception, but condoms are far more common than prescription contraception.

This was an entirely healthy argument for the school community to have; but the debate occurs against the backdrop of our larger conversation about sex education that is so riddled with political agendas that the opportunity for progress gets lost. Those supporting Comprehensive Sex Education (CSE) are portrayed as being hostile to any discussion of values and indifferent to whether kids start having sex at 9, so long as they use a condom. Abstinence advocates are cast as Puritanical theocrats who warn kids that premarital sex will kill them, a message of fear divorced from fact that leaves kids MORE vulnerable to disease and unwanted pregnancy.

Many parents caught in the middle wrestle with the charge that it sends a mixed message to kids to urge that they delay sex and then approve contraception distribution in middle school. But does it? "It has been shown, over and over again, that this does not increase sexual activity," said Pat Patterson, the medical director of School-Based Health Centers. And most parents, in fact, WANT kids to get both messages; a 2005 survey from the Pew Forum found that 78% want public schools to teach about birth control, and 76% think schools should teach kids to abstain from sex until marriage. Three quarters of high school kids themselves favor that message.

In recent years the "middle ground" has been an approach called Abstinence Plus, which would both stress the value of delaying sexual activity but also provide more comprehensive information than the traditional abstinence programs that now qualify for federal funding. Conservative critics charge that "abstinence plus" doesn't really promote abstinence at all; one Heritage Foundation study argued that the typical "abstinence plus" curriculum devotes six times more space to promoting contraception than promoting abstinence. But you could argue that the evidence points to the value of a combined approach, that far from being mixed, the messages belong together: experts argue that the combination of more kids delaying sexual activity and more use of contraception once they become sexually active has accounted for the drop in teen pregnancies and abortions over the past 15 years. Maine Middle schoolers, like kids all across the country, are already postponing sex longer: The percentage who reported having sexual intercourse dropped from 23% in 1997 to 13% in 2005, according to the Maine Youth Risk Behavior Survey. While rates of sexually transmitted disease remain alarmingly high, the best chance of attacking the problem would transmit the values and the facts together, rather than implying that the two are at odds.