A few months ago, I was asked to see a patient on one of our
hospital’s labor and delivery wards. As I entered the room I saw a
child, the same age as my 13-year-old daughter, sitting on the sofa
with a baby in her arms.

"How lovely," I thought. "She’s already holding her little brother
or sister." But a moment later, I noticed that the girl was in a
hospital gown with an IV pole at her side. I realized she was the
patient, and she was holding her newborn baby.

Unintended teenage pregnancies are a product of something gone awry
in our society, in our schools and most importantly in our homes.

Seven of every 100 teenage girls (ages 15-19) become pregnant every
year, or four of every 10 girls become pregnant before they reach the
age of 20, according to the National Campaign to Prevent Teen and
Unplanned Pregnancy. A third of teen pregnancies end in abortion.

The impact of these teenage pregnancies is huge on both the mother
and the baby. Pregnant teens are more likely to drop out of high school
and even less likely to go to college; most turn to government
assistance.

The baby is more likely to have developmental disabilities, and a
baby girl born to a teen is more likely to become a teen mother
herself, according to Pediatrics, the journal of the American Academy
of Pediatrics.

All in all, teen pregnancies cost the U.S. taxpayers $9 billion
dollars each year, the National Campaign to Prevent Teen and Unplanned
Pregnancy reports.

I was initially flustered as to how to address my young patient:
"Ms. or Mrs. or …" I used her first name. I asked my usual questions,
but there were judgmental questions eating away at me. How did this
happen? And a question for her parents, whom I met the next day — how
did you let this happen? And a question for our society — how did we
allow this to happen?

The causes of teenage pregnancy are many, ranging from influence of
peers, the media, alcohol and drugs, as well as lack of knowledge and
availability of contraceptives.

I like to blame the media.

A 2008 Rand study found teenagers who watch lots of sexual content
on television are twice as likely to become pregnant or impregnate
someone over a course of three years compared with those who watched
less sexual content.

But there is more to it. Not too long after I met the 13-year-old
mother, I began a difficult conversation with my 16-year-old daughter.
I’m not worried that we don’t talk to our children about questions of
sexuality. My wife covers the ground in routine bedside chats, and I
had brought up the teenage mother one evening over the dinner table.

But as my eldest matures, I have been feeling an increased sense of urgency that I have these conversations myself.

So I began: "Do they teach you about drugs, alcohol … contraception in your school?”

"Well, in fifth-grade health they did."

"Do you think they should in high school … talk about teenage pregnancies?"

"Yeah, I guess they should," she said, rolling her eyes, not sure where I was heading.

I didn’t know, either, but I kept going. I read up on what type of
conversations parents should have with their children about sex.

When I was growing up, I recall, my parents had a one-time "big
talk" with me after we all sat down together to watch on TV a health
special by Dr. Timothy Johnson on sex among adolescents. I listened,
had no questions and was relieved when the program and our conversation
were over.

Now as a parent and a doctor, I’m pretty sure such one-time talks
about sex aren’t worth much. A recent study by the Rand corporation
titled "Beyond the Big Talk" piqued my attention.

In a randomized controlled trial, Rand researchers conducted
anonymous surveys of parents at 13 workplaces and their teenage
children. They found that if parents had repeated conversations about
sex with their teenagers, the kids felt closer and more able to
communicate with their parents.

Why does this matter? Because it is this perceived closeness that is
the glue that holds together parent-adolescent relationship. When the
glue is tight, the evidence by a number of surveys, such as a 1997
National Longitudinal Study on Adolescent Health, shows that teenagers
are less likely to initiate intercourse at a younger age and more
likely to use contraception.

In the old days, some, like my parents, feared repeated
conversations would encourage or lead to greater sexual exploration or
encounters. This is a myth. "The overwhelming weight of scientific
evidence suggests that addressing abstinence and contraception does not
hasten the onset of sex, increase the frequency of sex or increase the
number of sexual partners," according to studies compiled the National
Campaign to Prevent Teen and Unplanned Pregnancy.

In addition to parent conversations, our schools and federal
programs can play a critical role in helping to drop the teenage
pregnancy rate. Congress will be debating whether to spend million of
federal dollars for abstinence-only programs. The overwhelming
scientific evidence is that such programs do not work — rather
comprehensive sex education with abstinence first is by far more
effective.

Since 1995 the teenage pregnancy rate has been declining, except for
a blip upward last year. Researchers attributed the decade-long decline
to increased contraceptive use and delayed sexual activity possibly
from the fears of contracting HIV.

So, on another occasion, I asked my 16-year-old daughter if she had
seen contraceptives, like birth control pills or condoms, in any of her
science or health classes.

"No, not that I can remember," she said.

Not surprisingly, some of the states with the highest teen pregnancy
rates, such as Mississippi, Texas and Tennessee, also lack mandatory
requirements for sex education in school.

As we continue to battle teen pregnancies, we must not lose sight of
the cultural and demographic factors that play a role, and how we can
use the tools of conversation and sex education.

Some weeks ago, I was called to see another patient who had just
delivered a baby. To my initial relief, this time she was a 17 year
old. Then, my patient told me it was her second pregnancy.

More of Dr. Jain’s writings can be found at www.mjain.net.