Monday, October 29, 2007

Birth Control Pills to Middle School Students

I have received two requests to discuss the issue of a middle school in Maine that has decided to make birth control pills available to students – ranging from ages 11 to 14. One of the two requests threw in the additional claim of “without parental notification”.

The Prima Facie Wrong of Withholding Information

I have written on the subject of parental notification previously in a post Parental Notification. Briefly, I hold that any activity involving a minor that contains the proposition, “Let’s not tell your parents about this. This is our little secret,” is a prima facie wrong. In order for a parent to raise a child, the parent needs information. People who act out of ignorance seldom act wisely. Withholding information from parents makes that job much more difficult.

There is a legitimate concern that the possibility of parental notification may cause a minor to refuse to seek out help when he or she needs it. Instead, they will try to deal with the issue on their own, and hope for the best. Being young, they may not make the wisest decision. Concern for the welfare of the minor, then, would speak for allowing them to seek help without parental notification – the idea being that help without parental notification is better than no help at all.

Here, I am not talking about the case where the parent finds out and then beats the minor. If there is any evidence that a parent has this disposition, then the minor should be removed from that household, not left there while we deal with her issues in secret. I am talking about the minor who is simply too embarrassed to deal with her parents on certain issues – sex naturally being one of those issues.

Experimentation

Ultimately, any policy that we consider should put the welfare of the children first. In putting the welfare of the children first, it is unwise to rely on the superstitious of a bunch of first century tribesmen. Instead, we have a useful tool that will allow us to determine intelligently and rationally which policy best promotes and protects the welfare of the children – the scientific method.

To use this method, we need to allow different regions to experiment, to some degree, with different policies. We then collect data on the effects of these policies. We use this data to form theories that explain the data that we collect from existing policies, and predict what effects we can expect from any changes to those policies. Policies that do not best protect the welfare of the minors should be thrown out.

Some argue that abstinence is the only safe form of behavior – that it has a 0 percent chance of leading to pregnancy or sexually transmitted disease. However, we need a policy that works in the real world, not in some hypothetical world that exists only in the imagination.

The real world is one in which the desire for sex is strongly ingrained. If I estimate that my family tree goes back 100 million generations – back to the time when sex became the sole method of procreation – then the number of ancestors in that family tree is 2x10^100,000,000. This is a huge number. In fact, it is so huge that there must be a great deal of overlap. Some great^nth grandparent shows up on several different branches.

However many individuals that happens to be, I can tell you exactly how many of those ancestors died a virgin. That answer is ‘zero’, because I could not be descendent from any individual who did not have sex.

Given that track record, I suspect that any demand that minors today abstain from sex is merely wishful thinking. Short of surgery, mandatory chemical castration, or some other drastic action, minors will engage in sex. It is a remedy that will work on a fantasy land where the minors are not human, and have not had the same evolutionary history our species has had.

This, however, is a hypothesis. It needs to be tested. The best way to test it is to allow people the opportunity to choose different methods to raise children, and to test those methods. If this hypothesis is correct, it predicts that abstinence programs will show themselves to be unrealistic. They will not have much of an effect in reducing teenage sexual behavior. They might, however, have a great deal of influence on whether minors who teenagers who have sex do so in a way that protects their health and well-being.

Experts

One principle that I have repeated often in this blog is the principle of trusting to experts to decide issues. A reader would be unwise to come to me and ask my opinion as to whether a particular bridge design is structurally sound. My advice would be to consult somebody whose job it is to build bridges and to ask them.

I am going to give the same advice here. I have suggested some theoretical guidelines above. However, the smart (and morally responsible) thing to do is to ask experts on the issue of childhood health – people who have had time to study the research in detail. They have a far richer opportunity than I do to examine the evidence, form theories, and learn what options best promote the future safety and happiness of the largest number of teenagers.

The American Academy of Pediatricians recommend informative sex education that includes information about birth control. The research shows that teenagers are no more likely to have sex when they have this information, but that those who do are at less risk of pregnancy and disease that puts their future (and the future of others) at risk.

According to the best available evidence, other options put more children at risk. This means that whatever might motivate people to promote other options, it is not the best interests of the children. Indeed, they are willing to sacrifice the future safety and happiness of some children in order to obtain this other value, whatever it is. This causes me to ask, “What could be so important?”

The will, of course, insist that they do care about minors. They simply dispute the science that says that the health of children is better protected in a system that teaches about birth control and disease prevention.

But why do they believe it? They certainly do not believe it because best available evidence tells them that it is true. The best available evidence tells them that this is false. They have to ignore the best available evidence in order to embrace their conclusion. Yet, somebody who truly cares about the welfare of minors will loathe to throw out the best available evidence – evidence that directly shows, “If you pursue this option, more minors will suffer harm.”

The Maine Case

The points that I have raised above do not speak specifically to making birth control available to younger teens without parental consent. I do not know of any research that addresses that issue specifically. However, that research will determine how I judge the matter. I am not inclined to pull an answer out of the air and declare that it is ‘the right answer’ when I have no way of defending it one way or the other.

Where we are ignorant, that is where we need to collect data. We collect that data by allowing each community to do what they think is best and measure the results, then go with whatever result best protects the health and well-being of minors. There is no more moral option than this.

In the absence of information, the only morally responsible conclusion to draw is, “I don’t know.” To feign certainly in the absence of evidence is arrogant and presumptuous and, worse, in this case, it shows a disregard for the potential young victims of those who pretend to a level of certainty they cannot justify.

Summary

So, a prima facie right on the part of parents says that the burden of proof is on those who wish to override this presumption. Without good evidence that minors, on the whole, are better off there is no good reason to deny parents information that is useful in guiding their children. In general, professional pediatricians seem to agree that there is sufficient evidence in favor of sex education in general. However, there is no good information on the specific program of making birth control pills available to middle school students. So the presumption in favor of parental notification remains.

If some community wishes to participate in an experiment to determine the effectiveness of such a program, they should be permitted to do so. However, the experiment should be set up according to the best scientific practices to get useful information. For example, parents agree to participate without foreknowledge as to whether they will belong to the control group or study group, and are assigned randomly. This will help to ensure that the experiment collects the best and most useful information possible.

The reason for participating in such an experiment is that the information will better enable us to design programs that do the best job humanly possible of securing the future safety and well-being of teenagers.

2 comments:

Eneasz said...

I know individual examples don't mean anything per se, but when they acuratly reflect the overall data they can make for powerful illustrative tools.

Lubbock County, Texas, has had an abstinance-only curriculum since 1995. State-wide, teen-pregnancy rates have dropped, but not for Lubbock. It now has one of the highest teen-pregnancy rates in the state. Rates of STDs have soared as well, with gonorrhea and chlamydia rates that are twice the national average.

The best way to get your kids pregnant and infected with STDs is to send them to an abstinance-only school.

http://www.washingtonpost.com/ac2/wp-dyn/A19148-2003Jan20?language=printer

Sheldon said...

Here is some more ancedotal material to think over, from my own personal experience.

I was raised in a very religious home, where "sex only belongs in marriage" was taught to me. When I was in middle school, I was a hormonally charged and rebellious boy with a girlfriend. My parents prohibited this relationship, but it didn't matter to me. Of course, I wanted to have sex with this girl of the same age of 13-14. Lucky for me, but especially lucky for her, she resisted my cajoling.
Moral of the story. Teens often do the exact opposite of what you tell them.

Flash forward to the future. I had the short experience of being a teacher in an inner city school. In one of my freshman classes was a very immature girl who I learned had one baby at home. Later in the year it became obvious that she was pregnant with another.

Would it not be in the interests of this girl, her children, and society at large to prevent these types of situations? Even if it might over-ride parental rights?

Could it be the best way to shape responsible young adults is to give them the best advice, while also giving them the tools to make better decisions, if they won't make the best ones?