Teen Pregnancy Prevention: Dr. Michael Carrera's Success Story

Dr. Michael Carrera's teen pregnancy prevention programs have met with extraordinary success — not only in reducing the rate of teen pregnancy, but in improving the lives of their young participants.

As director of the National Adolescent Sexuality Training Center at the Children's Aid Society, Carrera heads a pioneering program that includes not only family and sexuality education, but also six other components that cultivate health and well-being: academic assistance, job training, mental health services, self-expression training, instruction in individual sports that can be played throughout the life cycle, and medical and dental services.

It takes a lot of time to cover this much ground. Young people begin the program at age 11 and continue it until they graduate from high school, attending workshops six days a week, 50 weeks a year. It's this intense dedication to the myriad aspects of healthy development that's made Carrera's program such a remarkable success.

Choice! Magazine spoke with Dr. Carrera to learn more about this program, and to hear his thoughts on the current state of sexuality education in the U.S.

You joined the Children's Aid Society (CAS) in 1970 and began holding workshops about pregnancy prevention for young people and their families in underserved communities. But after several years you found that just offering sex education classes was not enough to accomplish your goals. Why?

When it came to the translation of cognition to behavior, there was a disconnect. I realized that we needed to look at all the things that made a young person whole, which included their sexuality and sexual expression, but also many other things.

What changes did you make and why?

We had to identify the forces and factors that influenced the entire lives of young people we were serving. And the best way to do that was to ask them what they wanted and needed. They came up with the first six components of the program. I added the last component, medical and dental services, because everyone needs his or her own health care provider.

We also knew we needed all the services for them available right there, because we found that eight out of every 10 referrals we made, they wouldn't follow through. And it was the young people with the most needs who were least likely to follow up on the referral.

If we were to make it work, there had to be a long-term commitment to these kids. I knew how long it took with my own children to get a point across, and that it wasn't going to be different for any other children.

Have you had measurable success?

We participated in a three-year independent evaluation of our program. Nine hundred forty-one low-income teens, ages 13 to 15, at 12 sites in seven U.S. cities, were tested against comparable teens in other communities. We found several statistically significant outcomes for the young people in our program: young women were better able to avoid coercive sex, SAT and PSAT test scores were higher, births among girls were reduced by 50 percent, sexuality-related knowledge gains were 83 percent higher, the percentage of girls using effective contraception was two times higher, and the onset of sexual contact was delayed.

Speaking of abstinence-only programs, should we be concerned about what kids are learning in these courses?

One thing these programs do is turn kids off to learning about their own sexuality. Abstinence-only programs tell young people that if they have sexual contact before they are married, they are likely to suffer physical and emotional harm. But do the math. We know the average onset of puberty is 11 or 12, and the average age for a first marriage is 27. This causes a real disconnect for young people. It also tells them that they need to get married so they can have sex.

These programs assume that young people cannot process comprehensive information when it comes to their own sexuality, or that if we fully discuss this information with them, it will encourage them to become sexually active. It amuses me when I hear this rationale, because it sure doesn't apply to cleaning their rooms, doing their homework, behaving respectfully, or eating healthier. If only we were that powerful!

The truth is there is no confusion among young people when you say to them, as we all do, that "genital sexual contact early in your teen years is not appropriate and not called for, but there are other ways to express your sexuality that are very satisfying; let's talk about those. And if you do make the personal choice that you are going to behave in some way other than what we are talking about, here's the way you can make sure you are not going to get hurt or hurt someone else." It's the grownups who are confused, not the young people. They are rarely confused by that.

That's alarming considering that our federal government only funds abstinence-only programs.

While that's true, I think it's important to note that our program has been privately funded for 20 years. We have learned that a good idea gets support, so even though the climate changes from administration to administration, we have been able to steadily attract support both locally and nationally. I think that is very important for groups such as Planned Parenthood, because it says there is support to mount and fund programs like this even though abstinence-only programs are taking up the government's money.

It's interesting that two years ago, we heard from the president that social programs that were science-based would be receiving government support. We at the CAS are still waiting for our support — we are one of the few programs that have fulfilled that requirement. Unfortunately, many groups are willing to take whatever position they need to take to get funding — unlike Planned Parenthood, which, like us, remains faithful to its no-compromise position on the provision of reproductive health services to young people.