A Maryland health official’s proposal to pay girls not to get pregnant has reopened a national debate about the merits of offering girls money to postpone motherhood.
Under the proposal, promoted by John Grant, the health officer for Caroline County, girls who have already been pregnant would be paid $30 a month if they avoided future pregnancies and attended regularly scheduled meetings.
The program, if adopted by the county’s commissioners in June, would be the first of its kind in the country to be directly funded with public money.
The concept, although not new, has continued to be controversial.
At least three Planned Parenthood affiliates--in Denver and in San Mateo and Santa Clara counties in California--are using private donations to operate similar programs.
And a task force on teenage pregnancy formed by the Governor’s office in Colorado used grant money it received from the U.S. Department of Health and Human Services to finance two additional programs.
Supporters of the programs argue that the payments, typically a dollar for each day a participant does not become pregnant, are merely a carrot to entice the girl to attend sessions on health, parenting skills, the job market, and enhancing her self-esteem.
The payment, Dr. Grant said, is “just the token inducement that gets them into the real program.”
Added Toni Guy, a community educator for Planned Parenthood of San Mateo County, which has sponsored an incentive program for a year: “We’re not paying them to not get pregnant. We’re paying them to make a change.”
But critics of the programs charge that the payments are a short-term solution to an intractable social problem.
“This is an ill-advised short cut to counter the inevitable results of early teenage sexual activity,” said Gary L. Bauer, the president of the Family Research Council, a conservative advocacy group, and the former domestic-policy adviser to President Reagan.
‘Cost Effective’
Supporters argue that teenage pregnancy is a health problem that requires unusual preventive measures. They note that girls who have become pregnant once are at a higher risk of becoming pregnant a second time and that teenage mothers are more likely to deliver babies with health defects.
“I admire people who say, ‘Let’s try something to save young girls’ lives,”’ said Molly Yard, the president of the National Organization for Women. “Not doing anything [about adolescent pregnancy] is the worst thing we can do.”
Echoing that sentiment, Dr. Grant said, “If [the program] prevents even one premature birth, it will be cost-effective.”
The Maryland pediatrician, who calls his proposal a “classic behavioral-modification model,” has asked the county for $5,000 to make payments to 15 girls between the ages of 15 and 19.
Enrollment in the program, which would be voluntary, would be limited to girls who have given birth, miscarried, or had an abortion, he said. The girls would be allowed to stay in the program until they graduated from high school.
Dr. Grant said the girls would receive their monthly payment of $30 if they did not get pregnant a second time and if they attended all required meetings, which would be scheduled either weekly or monthly.
The experiences of the first incentive program in the country, established in 1985 in Denver by Planned Parenthood of the Rocky Mountains, suggest that the model may hold promise, advocates say.
Of the nearly 70 girls who have gone through the program, fewer than one-fifth have gotten pregnant a second time. In contrast, experts said, at least 37 percent to 50 percent of similarly disadvantaged teenagers become pregnant a second time.
But even supporters acknowledge that there has not been enough evaluation of incentive programs to show that they work.
And, they acknowledge, because participation in the programs is voluntary, girls who want to avoid a second pregnancy are the most likely to sign up.
‘Trivializes the Problems’
Although Planned Parenthood affiliates have been at the forefront of creating incentive programs, such efforts are given a lukewarm reception by their national representatives.
David Andrews, the executive vice president of the Planned Parenthood Federation of America, said dollar-a-day programs “trivialize the problem of teenage pregnancy.”
“It assumes that individuals in a free society can be paid to do something we don’t want to do if we are paid the right price,” he said. “I am troubled by that.”
“My view,” he added, “is that there must be other ways to get teenagers educated about these issues.”
Others argue that public money should not be used for incentive programs since they may indirectly promote values that some disagree with.
“These programs aren’t saying, ‘We think premarital sex is immoral,’” said Lisa M. Swan, the editor of a publication produced by the Eagle Forum, a conservative advocacy group. She said her organization also opposes privately funded incentive programs.
Observers, such as Marc J. Roberts, a professor of political economy and health policy at Harvard University, note that the government is, in essense, providing incentives to teenagers to have babies.
He and others note that, while the federal goverment is unwilling to pay for abortions, it will pay for the delivery of a poor woman’s baby. And government payments to poor women rise with the size of their families, offering yet another incentive to have a child, he asserted.
“The basic fact is that the government is already putting a price on behavior, in a number of ways,” Mr. Roberts said.
