cover_story (2006-18)

PREVENTING TEEN PREGNANCY: Knoxville Center for Reproductive Health‘s Rovetti says there has to be a better way.

"This place hasn’t changed since I was in middle school,” Meghan McCoy sighs. Lost in thought, she twists a strand of long blond hair around her finger, surveying the familiar surroundings.

Here in the Fountain City Creamery, time seems to stand still. Across the street in the park, children on a swing-set kick their legs high into the air. An old high-school classmate waves at McCoy from the kitchen, where he’s manning the grill. The woman behind the counter hands her a precariously stacked ice-cream cone—banana-pudding flavor, her favorite—and McCoy lets out a girlish squeal. It’s just like the old days.

McCoy, now 25, has fond recollections of the Creamery from her teenage years. She used to walk here after school every Wednesday and hang out with friends until church. Back then, she notes, the ice-cream cones cost two dollars less than they do today. Her memories of those afternoons are lucid and happy, the kind she hopes to carry with her for the rest of her life.

Other teenage memories, she’d rather forget.

At age 16, McCoy had the world going for her. At the commencement of middle school, she’d been voted “Most Likely to Succeed.” Entering Central High, she quickly established herself as a bright student, talented actress and silk-voiced soprano. By sophomore year, she had a close-knit circle of friends and a boyfriend of nearly eight months. So she couldn’t be pregnant, right?

McCoy confided in a friend that she was two weeks late for her period. The friend offered to drive her to Hope Resource Center after school; she’d heard that they offered free pregnancy tests, and it was just a 10-minute drive away, off Concord Drive. Desperate and feeling like she had no other option, McCoy agreed.

The friend waited in the car while McCoy went inside. The attendant took a urine sample, and an older female counselor with a clipboard ushered McCoy into a small waiting room. After setting a timer for 10 minutes, the counselor began asking questions. The first two, McCoy recalls, were pretty routine: name, address. But recounting the third question, McCoy’s voice raises an octave and her face turns red.

“I’ll never forget it,” she says. “She asked me, ‘How do you think God feels about you having premarital sex?’ I said, ‘I think God cares a lot more about the fact that I’m in pain right now, and the fact that I’m in love.’”

There was still seven minutes on the timer. “She didn’t stop,” McCoy says. “She just kept battering me. Being 16 and being scared that you’re pregnant—worrying what are your parents going to think, not knowing what your boyfriend will do—is terrifying enough. The last thing you need is someone threatening you with the wrath of God, God’s guilt.”

She vividly remembers the instant when the timer went off. The attendant came in and handed her a slip of paper, containing her results. Negative. Too angry to even feel relief, McCoy grabbed her purse and ran out.

Today, she feels proud for sticking up for herself, but she fears for those who may have been more vulnerable to the center’s persuasions. “The biggest thing that hurt me was the realization that there are probably tons of impressionable teenage girls who were defeated by that experience, and that self-righteous defeat is going to affect them for the rest of their lives—the way they see themselves, the way they see their sexuality.”

McCoy’s ice-cream cone is melting, but she doesn’t seem to notice. “She didn’t even have any idea what my circumstances were. Nothing but judgment,” she continues. “What about victims of sexual assault? What a great thing to experience, being raped and then being raped emotionally after that. It makes me ill.”

These days, Hope Resource Center is still running full-speed ahead. It just opened a new location beside the University of Tennessee campus, on Melrose Place, at which students are encouraged to be tested for STDs. An offshoot program of the center, Just Wait, goes into area schools to teach abstinence-only sex education and funds a pro-abstinence billboard campaign each summer.

Inside the original Concord Drive location, in the same waiting room McCoy remembers, business goes on as usual. When MP went in undercover to verify McCoy’s testimony, nothing much seemed to have changed, save a fresh coat of pastel-hued paint on the walls. McCoy remembers the whole clinic as being decorated in shades of brown.

The 10-minute session included gentle, if insistent, questions about the reporter’s religious background and plans for marriage in addition to requests that abstinence be considered as an option in the future. “We’re all sinners,” the counselor said, hands folded across her lap, “but there’s always time for a fresh start. The Lord wants us to save ourselves for our husbands.”

After leading a prayer, the counselor opened a Bible specially printed for the center. Verses containing arguably pro-abstinence messages were tabbed and highlighted in yellow. Arranged on a table near the door were brochures outlining the physiological changes that occur at each state of fetal growth and graphic descriptions of the abortion process and its risks.

But perhaps the center is just doing what it has to do to get by. As a sign over the receptionist’s desk announces, Hope Resource Center is taxpayer-supported. It receives federal funding through Title V funds, which are available exclusively to abstinence-only educational or motivational programs.

By federal definition, abstinence-only programs are mandated to teach “abstinence from sexual activity outside marriage as the expected standard for all school-age children” and “must not promote contraception and/or condom use.”

The Title V program was implemented in 1997 as part of the welfare-reform act of 1996. It annually allocates millions in federal funds to states in the form of block grants to promote abstinence until marriage. Initially, all states accepted Title V funds except California, which had instituted a statewide abstinence-only effort before federal funding became available and found it to be ineffective. In 2004, Pennsylvania joined California in refusing Title V funding. Other states governments, specifically Arizona and Washington, still accept Title V funds but have ceased matching them with state funds.

According to Yvette Mack, Tennessee’s Title V Abstinence-Only-Until-Marriage coordinator, Tennessee received $993,367 in federal funding for abstinence-only programs during the 2005-2006 fiscal year. Grants are awarded by the Tennessee Department of Health. For the years 2003 through 2006, Hope Resource Center was awarded a dual grant of $317,282 according to records provided by the Sexuality Information and Education Council of the United States (the center did not return MP ’s phone call to either confirm or deny this figure).

Tennessee’s stance on sex education varies from school district to school district, and from school to school within those districts as well. Officially, “Knox County supports a comprehensive abstinence-based education, meaning you give a strong abstinence message first, but if there is need, you can give more comprehensive education,” says Cynthia Hudson, chair of the Knox County Health Department’s KAPPI program (Knox Adolescent Pregnancy Prevention Initiative).

The policy sounds reasonable in theory. But in practice, are sex-educators—most of which, like Hope Resource Center, hail from outside the school system—following through with that secondary “comprehensive” element? Is discussing contraception the same as giving teens the go-ahead to become sexually active without the fear of contracting a disease or becoming pregnant?

To teach safe sex is to acknowledge that teens are having sex, after all, and that reality is an uncomfortable pill for many parents and educators to swallow. It’s easier to subscribe to the notion of “not my child.” But whether through naivety or denial, it’s a dangerous assumption to make; according to the NYU Child Study Center, only about one-third of the parents of sexually experienced 14-year-olds know that their child has had sex.

Numbers don’t lie. According to the National Campaign to Prevent Teen Pregnancy, 46 percent of high-school aged teens in the United States have had sexual intercourse. The country’s teen pregnancy rate is 84 pregnancies per 1,000 females ages 15 thru 19, a much higher rate than in any other developed country (twice as high as in England or Canada, and nine times higher than the Netherlands or Japan). Fifty-six percent result of these pregnancies result in birth; 30 percent result in abortion; and 14 percent result in miscarriage.  Nationwide, about 1 million teenagers become pregnant each year. Eight in ten of the pregnancies are unintended.

Most everyone agrees that sex education, no matter what the variety, needs to start early. A 2004 KAPPI survey of Knox County middle and high-school students showed that 64 percent of teens who become sexually active before their senior year report having their first voluntary sexual intercourse experience at or before the age of 14. Increased social pressures, including heightened exposure to explicit sexual messages in the media, likely contribute to the earlier ages of sexually active teens. 

“Statistically speaking, the majority of sexual activity starts to happen by the freshman year [of high school],” says Kristina Kirkland, the matter-of-fact director of STARS (Students Teaching and Respecting Sexuality). “It’s important to get to these students before sexual activity begins.”

Kirkland is sitting behind her desk at Florence Crittenton, a non-profit agency that focuses on family foster home care, residential treatment services for adolescent girls, and its pilot program, STARS. Her office is a cheerful pastiche of art and notes given to her by the young women she helps. Outside the window, a weeping willow sways in the April sunshine.

STARS, which currently operates in 14 area schools, takes a unique approach to abstinence-based education. It trains high-school students to give presentations in area middle schools, to seventh and eighth graders, on the benefits of staying or becoming abstinent. The presentation leaders are abstinent themselves—for religious and other personal reasons—although some haven’t always been. They may be pregnant or mothering themselves and desiring to show younger students the consequences of their actions.

“The high-school students are closer in age, using the same language, speaking the lingo. They’re more like older brothers and sisters,” Kirkland explains. “The middle-schoolers think they understand them better, and they probably do.”

During a typical session, such as the one MP sat in on at Bearden Middle School, the presenters address a variety of issues ranging from peer pressure to STDs to pregnancy. Today, the presenters are Kaitlyn Dehart and Jessy Dawson, two 16-year-old sophomores at Karns High School. The two young women became friends through Girl Scouts and recently teamed up with STARS to share with younger students their belief in abstinence-until-marriage. This is their first presentation.

“I’m waiting because I’m a Christian,” Dawson says to the class. A silver cross dangles from her neck. She pushes a lock of brown hair behind her ear and continues with confidence, “I believe I’m good enough for someone to wait for me.”

Dawson explains that she does have a boyfriend, who she’s been dating for six months, but that he’s OK with her decision. When they go out, they go out with a group—especially when they go to the movies, she says. They try to stay in well-lit areas, and they steer clear of couches and bedrooms. When they’re hanging out at Dawson’s house, she likes to have her mother around for supervision.

“Guys are easily aroused,” adds the dark-featured Dehart, tracing a triangle from her shoulders to the top of her thighs. “You’ve got to protect your diamond zone.”

The interactive classroom activities are so fast-paced and creative, it’s easy to forget that they are also, at their essence, scare tactics. A line of students at the front of the classroom mix and mingle cups of colored water, each representing a different STD, until even the virgin in the group’s water is a murky brown. “Eww!” a roly-poly boy in the front row exclaims. In another, a glasses-wearing girl passes a red construction-paper heart down a line of students, who each tear off a piece as it passes. By the time it gets to her final sexual partner, her hypothetical husband, there’s only a small piece left. Theatrically, the girl shrugs at him and hangs her head.

The kids in the class seem captivated, alternately giggling and raising their hands with questions that range from precocious to naive. “Can you get Herpes without having sex?” asks one lanky, outspoken student. “Can you get it from a toilet seat?” quips another.

The high-school leaders answer each inquiry with technical precision, unless it concerns one off-limits subject: contraception. If a question about contraception does come up, they turn it over to Kirkland, who’ll usually request that the student speak with her in private after class. And even then, the subject is described in terms of failure rates. Condoms break, and birth control doesn’t protect against STDs.

It’s not that STARS is at risk of losing federal funding; it doesn’t get any because contraception is discussed during training sessions with the high-school presenters. STARS doesn’t talk about avenues toward safe sex because, if it did, it probably wouldn’t be invited back.

“We wouldn’t last long if we talked about contraceptives,” Kirkland says, back in her office. “It wouldn’t fly with teachers, it wouldn’t fly with principals, and it certainly wouldn’t fly with parents.”

Getting parents comfortable with the idea of sex education in the first place, she says, is the main obstacle STARS faces. “They ask, ‘What are you teaching my child about sex?’ Well, everything you’re not teaching your child about sex.”

Kirkland notes that, according to KAPPI surveys, only 10 percent of students say they feel comfortable going to their parents with questions about sex. “I try to allay their fears, because they believe that if they go talk to their parents about sex, they’ll assume they’re having sex.”

With STARS, the critical information is at least making its way to the teens, even if it is within the parameters of an abstinence-based curriculum. But with almost half of all high school students reporting that they’re sexually active, Kirkland admits with a hint of frustration, “It’s just not realistic.”

Others strongly agree, including Mark Huffman, vice president of education and training of the Planned Parenthood Association (PPA) of Middle and East Tennessee. He points to several studies that have proven abstinence-only programs to be less successful than comprehensive sex education programs in preventing pregnancy and STDs. An effective program, wrote leading adolescent sexuality researcher Douglas Kirby, Ph.D., “provides clear messages about sex and protection against STDs or pregnancy.”

Huffman clarifies that the inclusion of such messages as part of a comprehensive curriculum, as PPA endorses, doesn’t mean discouraging abstinence. “Teens should be encouraged to postpone sexual intercourse and taught that sexual activity that begins too early can have some negative consequences,” he says. “Where we part ways with other programs in this area is we rely on teaching methods and curriculums that are actually proven to result in teens postponing sexual intercourse and teens that are having sexual intercourse using safer methods. We believe that teens need and deserve full information to make healthy choices.”

Huffman traces the success of comprehensive sex education to the nature of the adolescent psyche. For example, during a recent PPA visit to a boys’ group home, the issue of condoms came up. The boys, some of whom were sexually active, explained that they didn’t bother to use condoms during sexual intercourse because “a lady came to our school and told us they don’t work.”

“There’s a difference between what you’re saying and the effect of what you’re saying,” Huffman says. “The effect of some of the better comprehensive programs is that more kids are abstaining, and the effect of the abstinence programs is that you have more STDs and pregnancies. Why are we sacrificing the results to feel better about what we say?”

PPA does receive a minimal amount of federal funding, but it goes toward its adolescent health program and does not consist of Title V funds. Huffman declines comment on individual abstinence-only institutions, but says, “In terms of those political decisions, we do know that abstinence-only funding is largely based on ideological persuasion rather than looking at sound science, and that’s our main beef. We also know that many folks who receive abstinence-only funds take a slant that is largely based on fear and shame around sexuality, and we don’t believe those are valid pedagogical methods.” 

Jenny Fairchild, PPA community educator for the Knoxville area, calls it “a touchy situation.” Though she offers sex education programs to Knox County schools, very few enlist her services. “The attitude here in Knoxville seems to be somewhat punitive toward those that support planned parenthood or comprehensive sex education.”

Instead, she caters mostly to community and church groups, some of whom request that she focus on an abstinence-based curriculum. That’s fine with her, she says. Any knowledge is better than no knowledge at all. “Young people need to be aware of how their body works, and the belief that if kids know about sex they’re going to have it is just not true. If they are going to have sex no matter what anyone says, here are some things they can do.”

Teens do, and will continue to, have sex. And as long as teens are having sex, there will be unplanned pregnancies.

It’s class change at a Knoxville-area high school, which requested that its name remain anonymous to protect the privacy of its students. From the hustle and bustle of the hallway, 11 young women emerge and file into a cinderblock-walled meeting room, following the lead of Kim Irwin, director of Florence Crittenton’s CAPS (Child and Parenting Skills) program.

Noticing that there are only nine chairs around the table, Irwin playfully chirps, “Give the pregnant girl a seat!” A redhead with a sizable bulge beneath her black T-shirt eases herself into the last remaining chair, while her boyfriend takes a seat on the floor.

As everyone gets settled, Irwin smiles broadly and eases into conversation. “Anyone do anything fun over the weekend?”

“I got a prom dress,” one girl says. Her bag of Cheetos makes a metallic crunching noise as she fishes around in it absentmindedly.

Some of the teens in the room are pregnant; others have already given birth. CAPS visits schools like this regularly, not only in Knox but in Anderson, Campbell, Claiborne, Monroe and Union counties as well. This school year alone, the program has provided maternal education to 141 young and expecting mothers.

Today’s lesson is on Sudden Infant Death Syndrome (SIDS). At the beginning of the session, the teens are asked to complete a brief true-false quiz on their knowledge of the subject. They’ll retake it at the end of the session, after which Irwin will collect both results. Irwin says that the quizzes are usually between 64 and 66 percent correct at the beginning and 96 to 97 percent correct at the end.

But there’s more than technical information being imparted. This session, which also includes three of the young women’s boyfriends, gives the students a chance to exchange ideas, as well as experiences and fears.

One boyfriend, whose girlfriend is due in 19 days, is nervous about the possibility of a C-section: “When the doctor told us, she freaked out. She almost started crying,” he says. A strawberry-blonde mother is frustrated with her pediatrician: “You ask her a question, and she acts like it’s killing her to answer,” she explains. The question-and-answer period jumps from topic to topic, and when the class-change bell rings, the students seem reluctant to leave.

“Teen pregnancy can be so alienating,” Irwin explains as the last student passes out the door. “You walk down the hall, and there’s nobody like you. These sessions remind them that they’re not alone.”

Such feelings of loneliness, alienation and judgment can be the most damaging emotions for pregnant teen mothers to experience. And for the babies the young women are carrying, it can be downright dangerous.

In October of 2000, a 14-year-old Townsend girl managed to conceal her pregnancy until she finally gave birth alone in her house. Terrified and ashamed, she put the baby in a box and left it in a neighbor’s shed, where it eventually died of severe dehydration. When the baby’s corpse was discovered, the young mother was charged with first-degree murder and sentenced to state custody.

The tragic event inspired two Blount County women, Shawna McConnell and Lisa Yount, to push forward legislation that would give young mothers with unwanted babies an alternative to abandonment. The Safe Haven Law was passed in July 2001, permitting mothers to surrender their newborn babies, who may be up to 72 hours old, to designated hospitals with no questions asked.

Shannon McCloud, executive director of the resulting organization Safe Secret Place, explains, “Before the law passed in 2001, parents of unwanted newborns who took their babies into a hospital could still be charged with criminal abandonment. This law protects her. She can remain anonymous—simply hand the baby over, and the baby’s safe, and no one knows her secret.”

Secret Safe Place is privately funded, with small donations coming from Blount and Knox County governments, but McCloud would like to have state funding eventually. She also hopes more schools will invite her to visit and share the program’s message; so far, she’s visited only a small number of high schools in various counties and will visit her first middle school in May. “I hope that will change in the future. I don’t think any school system wants to have one of their students abandon a baby,” she says.

High school and middle school students comprise the critical demographic. McCloud doesn’t have numbers on how many babies have been saved by the law in Tennessee, since the Department of Human Services, which takes custody of the surrendered babies, isn’t required to keep those types of records. But since 1999, the Secret Safe Place program claims that over 500 newborns have been brought in nationwide.

“We really work to reach young women who might be hiding a pregnancy because, for whatever reason, they’re too scared to tell anyone,” McCloud says. “Those are the women who are most at risk of leaving their baby in a dumpster.”

Other methods of safely negating an unwanted pregnancy are, for teenagers, more difficult to traverse. In the state of Tennessee, like most states in the South, pregnant teens seeking an abortion must have single-parent consent. Furthermore, the parent must accompany the teen to the clinic and verify their identity with appropriate documentation. “In Tennessee a minor does not need parental consent to get pregnant, and they don’t need parental consent to show up in a hospital and have a baby, but they do need parental consent to get an abortion,” says Corrine Rovetti, director of the Knoxville Center for Reproductive Health. Around 5 percent of the women seeking abortions at Rovetti’s center are minors.

Between her firm but gentle manner, bottomless eyes and reassuring words, Rovetti could pass for a motherly presence herself. But she does encourage parental involvement: “Initially, a teen may feel that there’s no way she can tell a parent—they think they’ll get killed or kicked out—but most of the time, we talk with them and help them realize that their worst-case scenario probably will not happen.”

Rovetti also recognizes that there are exceptions to every rule. “We understand that there are some circumstances in which it is not in the teen’s best interest to reveal a pregnancy to a parent,” she says.

In this case, a judicial bypass may be sought through the court system—an option taken by about 1 percent of Rovetti’s minor patients.

Rovetti describes the process as intimidating, and somewhat misguided. “Through the judicial bypass system, a juvenile judge determines if the teen is mature enough to proceed with an abortion,” she explains. “The irony of this process is that if the judge decides that the teen is not sufficiently mature to handle this five-minute medically safe procedure, she is condemned to continue the pregnancy. One has to ask the question as to how in the world he or she can then consider her mature enough to maintain a healthy pregnancy, go through labor and delivery, and then raise a child? And realizing that she can make all these decisions without the consent of the parent!”

Rovetti points out how entangled the issue of abortion is with abstinence-only education. “I just find that whole approach dangerous. It’s foolish and it’s ignorant, because we are not providing our teens with the valuable and vital information they need to protect themselves from pregnancy and sexually transmitted diseases,” she says.

As did the representatives from PPA, Rovetti points to studies that have been done that disprove the effectiveness of abstinence-only education. “As a developed country, we still have the highest rates of teen pregnancy and sexually transmitted disease,” she says. “That’s a travesty. It’s frightening. I can’t overemphasize enough what a dangerous approach the abstinence-only program is.”

Despite its detractors, federal funding available to abstinence-only sex education continues to balloon. President Bush’s proposed budget for the 2007 fiscal year requests an increase of 15 percent toward these programs. If the request goes through, funds allocated for abstinence-only education will reach $204 million annually. Total federal tax-dollars spent on abstinence-only education will surpass $1.1 billion.

Addendums to the previous standards of the abstinence-only curriculum were added earlier this year as well. The curriculum must now also teach “that the expected standard for sexual activity is within the context of a mutually monogamous marriage relationship between a man and a woman” and “that non-marital sex can undermine the capacity for healthy marriage, love and commitment.” Such mandates have been criticized by individuals and organizations who feel they are insensitive to members of the lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth, sexually-active but unmarried couples, and young people who are or who have been victims of sexual abuse.

California responded to the debate over sex education by passing a state law in 2003 that emphasizes medical accuracy in sex education, permits discussing contraceptives if age-appropriate, and is inclusive of both LGBTQ and disabled individuals.

That such a law could be passed in Tennessee is doubtful. Even increased opportunities for comprehensive sex education seem unlikely at this point. There’s a fine line between condoning an action and accepting it as reality, and it’s a line that many schools catering to a majority-religious and majority-conservative community fear to tread.

Perhaps a more cumbersome, longer-term resolution must be made before any legislative changes can be exacted. It involves a grander ideological shift, in which we reconsider not only our reactions to sexual activity, but to our perceptions of sexuality itself.

As PPA’s Mark Huffman points out, sexuality is a large part of all our lives, a force so pervasive that it transcends anything that can possibly be said about it in a classroom. It’s not just about recognizing sex, it’s about recognizing gender, and acknowledging how both affect our approach to the world. “If we could do truly comprehensive sex education, there would be lessons in social studies about gender discrimination. There would be lessons in biology about brain chemistry….” His ideal curriculum goes on and on. 

If such a thing could be accomplished, then a redefinition of formal sex education would already be in the making. Sex education would no longer be about feeling ashamed of what the body can do, or feeling scared of its actions’ consequences. It would be about developing an appreciation for the body and about knowing why the body needs to be protected.

In the most basic sense, every sex education curriculum is trying to accomplish the same feat—even if through varying means. As Huffman puts it, “What we share in common with just about anyone doing sex education is this: We believe teens need to be making healthy decisions.” It may sound like an overly simplistic common ground, but it’s not a bad place to start.