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Hazards of Teen-Age Pregnancy, Contraception Are Debated

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Washington--Unwanted pregnancy is not the only potential ill effect that sexual activity may have on adolescents' physical and mental health, according to a panel of medical experts who testified last week before a Senate subcommittee hearing on "Health Aspects of Adolescent Sexual Relations."

But several witnesses stressed that of the various possible consequences--such as the side effects of contraceptive devices--none is as threatening to the health of adolescents as the well-documented ramifications of teenage pregnancy. (Studies have shown, for example, that many teenagers whose high-school education is interrupted by pregnancy never return to school.)

The hearing was described by the Subcommittee on Aging, Family, and Human Resources as a routine oversight hearing on Title X of the Public Health Service Act, which funds numerous family planning facilities.

Nevertheless, discussion focused on many of the issues surrounding various Administration and legislative proposals that would involve the government in trying to regulate teen-age sexual activity.

Although it was not the subject of the hearing, witnesses also commented on the regulation proposed recently by the Department of Health and Human Services (hhs). The regulation would require federally funded family-planning clinics to notify the parents of "unemancipated minors" 10 days after they give them a prescription for birth-control devices or pills. That proposal, according to a spokesman for the agency, has generated more than 20,000 letters that range in opinion from greatly in favor to heavily opposed.

The issue of parents' rights in the decision to provide an adolescent with birth-control devices--also addressed in the controversial Family Protection Act introduced in the Senate last fall by Senator Roger Jepsen, Republican of Iowa--was mentioned frequently at the hearing. Speakers agreed that the parental role must be discussed since, as Dr. Adele D. Hofmann, a pediatrician from New York University, noted, "the Administration justifies [the hhs regulation] in large part on the assumption that prescription contraceptives present a major health hazard for teenagers."

If this is true, proponents of the proposal argue, then physicians have the same obligation to notify parents if their children receive prescriptions for these contraceptives as they would if the child needed any other major medical treatment, such as an appendectomy.

No Medical Consensus

According to the physicians testifying, however, the risks posed by the various contraceptive methods are not clear, and for some methods, no medical consensus exists on their nature and magnitude.

Dr. Hofmann, who recently completed a review of the international medical literature on the effects of contraception on adolescents for the World Health Organization, said that her findings indicate that "with the exception of an increased risk of pelvic infections in intra-uterine-device users frequently exposed to sexually transmitted diseases, contraception in adolescents appears to be remarkably safe." Pelvic infections, she said, may impair fertility in women of child-bearing age. The most common of these infections is "pelvic inflammatory disease," an infection of the fallopian tubes.

This risk and other potential hazards of contraceptives, she said, "must be examined in light of the much greater and well-documented health risks to adolescents of pregnancy, a frequent result of sexual activity in the absence of contraception."

Other witnesses, however, said the risks of some contraceptive methods are far from minimal. Dr. John Hillabrand, an obstetrician-gynecologist from Toledo, Ohio, said that it is a "frank disaster" to give birth-control pills to adolescents whose menstrual cycle may still be irregular, since the powerful hormones involved may prevent the establishment of regular ovulation, and hence affect a young woman's chances of bearing children.

But the central issue in the debate on adolescent sexual activity should not be whether contraception or pregnancy poses the greater threat to the health of adolescents, asserted Senator Jeremiah Denton, Republican of Alabama and chairman of the subcommittee. "It's folly to get into such an absurd debate," he said, "because it has nothing to do" with the issue of what the health effects of sexual activity are on adolescents.

"The mounting epidemic of venereal disease alone attests to the fact that there are issues other than pregnancy to consider before an adolescent engages in premarital sexual relations," he noted.

He pointed to the fact that the virus herpes simplex II has reached epidemic proportions and is especially common among teenagers and young adults.

In addition, premature sexual re-lations may jeopardize young people's prospects for a successful marriage later, according to Ray Short, a University of Wisconsin sociologist. Young people who engage in sexual relations "may think they have a good relationship when they don't," Mr. Short said. Refraining from premarital sex, he said, is "a natural protection against getting into a lousy marriage."

Loss of Self-Esteem

Mr. Short said adolescents who have sexual relations feel "fear, guilt, and loss of self-esteem." After they get married, he said, many find it difficult to eliminate these feelings from their sexual relationship.

He cited two reasons for the recent increase in adolescent sexual activity: the media and the ever-present threat of nuclear war. The latter, Mr. Short said, has created a generation that favors immediate gratification, believing that "if I don't have sex now, I may never know what it's like."

The witnesses were not in agreement on the question of whether parents should routinely be notified if their adolescent children are provided with prescription contraceptives.

Dr. Hofmann, who has worked extensively with minority and low-income young people, said that in many such families, the effects of notifying parents could be disastrous for the child.

"My own view," she said, "is that we have abysmally failed our young. They are not equipped to make a reasoned decision. I have to see contraception as a pragmatic option, once a child is sexually active."

Agreeing with Dr. Hofman that parental notification is not always wise, Mr. Short said that he believed that few teenagers are close enough to their parents to make them confide their sexual activities.

Other panel members disagreed, saying parents should be notified in all cases.

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