By Freya Sonenstein, visiting fellow, Public Policy Institute of California
This opinion article appeared in the San Diego Union Tribune on July 4, 2001
The smoke has yet to clear from the heated debate sparked by the surgeon general's new "Call to Action" that asks communities to give young people thorough and medically accurate sex education.
Usually, when straight talk about sexual activity is forced into the political arena, efforts to have constructive conversations and build common ground disintegrate quickly. But could the tide be changing? If so, we now have an opportunity to improve the sexual and reproductive health of all of our youth, not just young women but young men, too. After all, it takes two to conceive a child or catch a sexually transmitted disease.
Despite this obvious fact, most efforts to prevent teen pregnancy are geared only to girls. For young men, the crux of the problem is that they just don't get the encouragement, information, skills, and health care that more and more experts now agree are essential to curbing teen pregnancy and sexually transmitted disease. As a nation, we too often forget that the average American teen-age male heads into manhood ill-prepared for responsible sexual behavior, a healthy adult lifestyle, and satisfying family relationships.
New data confirm that most boys sowing their wild oats as teens are living dangerously. Deaths from motor vehicle accidents, physical fights, and weapons are more than twice as high among male teen-agers than among females. And close to half of teen-age males receive no information in school about preventing pregnancy and sexually transmitted diseases before they initiate sex for the first time. More than half have not been taught how to say "not yet" to sex before they say "yes." Few sons report talking to mom or dad about sexually transmitted diseases or birth control options.
Even access to health care and sex advice is far from easy to get. In 1995, three out of 10 male teens had not had a physical exam in the last year, and more than two-thirds of those who did had not discussed a sexual or reproductive health issue with a physician or a nurse. Half of all men in their 20s had not had a physical exam, and frank talk with a health-care provider was just as rare even though unattached male 20-somethings are at remarkably high risk for unintended paternity and sexually transmitted disease.
How can we put young men's sexual and reproductive health in a larger context?
Only an array of coordinated services can hope to succeed. These services should provide straight talk about sex, screening and health care, and training in how to make decisions and communicate with partners and peers. They should be delivered with strong doses of positive self-imagery and motivation in a variety of settings that young men feel are friendly and trustworthy.
The best way to fill this difficult prescription may be to build on community collaborations between health providers and community organizations with long-standing experience working with young men. In east Los Angeles, the Bienvenidos Children's Center collaborates with The National Latino Fatherhood and Family Institute headed by Jerry Tello to nurture "Hombres Jovenes con Palabra" -- loosely translated as "young men who are responsible, who keep their word." Building on indigenous Latino culture, this program includes a life skills curriculum that helps young men assume responsibility for themselves, their families, and communities. Workshops are held throughout the community, in schools, camps, other community agencies, and community recreation centers. The program is also developing a men's health clinic.
Young women also benefit from such programs. Who wouldn't want reduced exposure to disease and lowered risk of unintended pregnancy? Down the line, better communication and negotiation between partners can only help both partners mature and become better spouses and parents, too.
By reducing sexually transmitted diseases or unintended pregnancies and births, investments in sexual and reproductive health services for men will pay for themselves. Taxpayers now foot bills for the health costs of sexually transmitted diseases and births among people with no private insurance, as well as the costs of collecting child support and establishing paternity for the children of unmarrieds.
Modest inroads have been made in reducing pregnancies and births among teen-agers in the past few years. Going the distance requires addressing the sexual and reproductive health needs of both young men and young women.