The Price of Pregnancy Prevention

A dollar for every day

by John Knight, editor; illustration by Claire Longfield, guest artist

Before Mercedes Hernandez-Queen, now a freshman at University of Denver, entered high school, she knew she didn’t want to get pregnant. Not only had she seen her uncle struggle with raising a child as a teenager, but her older brother had fathered twins while he was still in high school and one of the infants died in premature childbirth. Raised by a single mother, she knows the strain an unplanned child put on a young family and didn’t care that teen pregnancy was an accepted circumstance and prevalent among students at Sheridan High School in Colorado Springs. She had made up her mind.

Within the first month of classes, Hernandez-Queen was invited by a classmate to attend an after-school sexual education course. She decided to give it a try and showed up at 3:00 p.m. to the Dollar a Day program at Planned Parenthood. The class, administered by Planned Parenthood of the Rocky Mountains (PPRM), lives up to its name: it pays high school girls a dollar for every day they don’t get pregnant. It offers sessions once a week as an alternative to the mandatory abstinence-only curriculum at most public schools in the city. 

While Hernandez-Queen didn’t mind the money, that wasn’t the reason she became a firm member of the Colorado Springs Dollar a Day program for her four years in high school. 

“I did not join the program for the monetary incentive,” she says. “I think a couple girls did at first, but it’s more than that. I liked that it was an open space to talk about anything that was going on in school. It wasn’t just sex education—it was a resource.”

Once a week, Hernandez-Queen met with a dozen other high-school girls and one PPRM facilitator for one hour. After snacks, each girl shared her highs and lows of the day. Then the group discussed one of a variety of topics, slowly covering everything from birth control and abstinence to communication techniques and anatomy. At the end of each course, every girl received her seven dollars as she told the group one good decision she would make the following week.

Now a Dollar a Day graduate, Hernandez-Queen is studying biology and Spanish. She is the first member of her family to attend college and dreams of being a doctor and delivering premature babies, like her niece. She doesn’t know where she would be without Dollar a Day, but is certain things would be different.

“It changed my life drastically,” she says. “I know I can say no to having sex, I know how to stand up for myself as a person. It has empowered me to be who I am and I know I can really do anything.”

Between 1980 and 1990, occurences of teen pregnancy rose to record numbers in the United States, and the issue came to the attention of Dr. Jeffery Dolgan, who began to see what he calls “a stream of thirteen-year-olds with babies.” At the time, Dolgan was the director of the Denver Children’s Home, an orphanage that cares for neglected, abused and poverty-stricken children. As he saw more and more pregnant teenagers, he grew increasingly doubtful of the effectiveness of pregnancy prevention programs in low-income communities. He found that despite all of the seemingly obvious reasons not to have a child as a teenager, a naïve desire to have a baby often outweighed these considerations for young women.

“The girls had very weak refusal skills,” Dolgan remembers, “And their babies represented a major wish that would give them something they didn’t have.” 

So, in 1984, Dolgan met with a group of teen mothers and posed a question directly to them: “What would it take for you not to have another baby?” A brief pause followed before a couple of girls offered their solution.

“You could pay us,” they said.

So he did. After negotiating a pilot program with PPRM, Dolgan began paying teen mothers seven dollars each week they didn’t get pregnant again. The catch was weekly meetings to discuss life skills, childcare, and mental and physical health. Although there were often men—probably boyfriends—lurking outside the health station waiting to take the measly sum, not a single girl in the first 1986 pilot program gave birth to another child. 

When Dolgan, who is now the senior psychologist at the Denver Children’s Hospital, first proposed the Dollar a Day program to Planned Parenthood, his ideas were not received with open arms. According to Dolgan, Faye Wattleton, then the national president of Planned Parenthood, told him that his program was essentially “prostitution in reverse” and that she would not support it.

“It just seems unusual to a lot of people to use money as an incentive,” says Dolgan. “People think the motivation to live a healthy life should be intrinsic. But the monetary aspect is more symbolic. It is a token of adult investment in helping these kids get through their teen years without having a child.”

There are now seven Dollar a Day programs operating in Colorado (five in Denver, one in Colorado Springs, and one in Durango), paying a combined eighty-four at-risk teenage girls not to get pregnant. The program, now entirely administered by PPRM, boasts almost 100 percent effectiveness in its mission to prevent pregnancy. Most of the girls who graduate from the program continue on to higher education and very few drop out once becoming an established group member.

“I remember one girl,” says Hernandez-Queen, “who after two or three sessions stopped going and we found out three months later she was pregnant. I think she dropped out before graduation.” The probability that a girl will drop out of high school, forgo college, live below the poverty line, and become pregnant at least once more almost triples if she has a child before the age of sixteen—not to mention raising the child on her own or only with the help of her mother, the baby’s grandmother.

 In 1991, 118 teenage girls (age fifteen to nineteen) of every 1,000 became pregnant, the highest rate of teen pregnancy of any developed nation. As the problem gained national attention, the Clinton administration threw millions of dollars into abstinence-only-until-marriage programs, which the Bush administration broadened. Simultaneously, there was a considerable push by privately funded non-profits like Planned Parenthood to offer comprehensive sex-education programs and promote contraceptive use. As a result, teen pregnancy rates have decreased by almost 17 percent since 1991. In the past two years, however, rates have ticked up again, calling into question the long-term adequacy of the programs in place.

For years, the debate has raged over the best method of sex education, and, until recently, abstinence-only programs have had the upper-hand in federal funding. Even though pregnancy rates have decreased 17 percent in the past fifteen years, however, the number of sexually active teens has only dropped by 5 percent, suggesting that contraceptive education is more effective than urging teenagers to abstain. Furthermore, one in four sexually active teenage girls has an STI and by age twenty-five, one in two adults (male and female) has one. Since abstinence programs (the only type of sexual education available to students in Colorado Springs public schools) do not advocate contraceptive use, those teens who do decide to have sex may not know how to do so responsibly.

Cecile Richards, the president of the Planned Parenthood Federation of America, claims that STI statistics show that “the national policy of promoting abstinence-only programs is a $1.5 billion failure, and teenage girls are paying the real price.”

Recently, the Obama administration has come down forcibly on Richards’s side; the President’s 2010 budget proposal includes a redirection of all abstinence-only-until-marriage funding towards “evidence-based” models. True, evidence-based is a loose term, but since the majority of the evidence available suggests that comprehensive models of sexual education are most effective, these are the programs that stand to gain from the new budget—at least $115 million. 

But Diane Foley, the Colorado Springs director of Education for a Lifetime (EFL, the program that administers the abstinence-only curriculum in the Colorado Springs public schools) says that comprehensive sex education programs are not enough. “The only thing contraceptive education helps with is the physical consequences of sexual activity.” Not only do condoms offer inadequate protection against STIs, claims Foley, but more importantly, teen sexual activity can have permanently damaging effects that should be considered in the fight against teen pregnancy. 

Each year, about twenty public schools in Colorado Springs invite EFL to teach semester-long courses with an emphasis on abstinence from all sexual activity until marriage. The holistic health program is founded upon two maxims. First, the earlier one starts to have sex, the greater his or her chances are of contracting a disease or becoming pregnant; and second (a comparatively unknown premise), statistics suggest that having sex before marriage decreases the chances of a successful marriage. 

Foley says that although the majority (90 percent) of teenagers want a happy marriage in the future, most “young adults are not taught about healthy relationships.” The concept of gradually getting to know someone and deciding about a physical relationship together, Foley says, “is totally messed up by the hook-up culture.” The touch-and-go standard permits quick, physically driven relationships that, on average, last no longer than six months. “What they are really doing,” says Foley about teenagers who are just hooking up, “is practicing divorce.”

This sentiment is based largely in an understanding of hormone release during periods of sexual intimacy. At these times, a hormone called oxytocin is released in the hypothalamus of the brain, a region that has recently been    correlated to the formation of emotional attachment. Each time you’re aroused, oxytocin is released, creating an emotional bond with whatever got the juices flowing. Since the hormone reacts most intensely with estrogen, Foley notes that it is typically young women who suffer the most psychological trauma in hook-up relationships. The hormone, according to Foley, is not only partly responsible for “the addictive behavior of sexual activity,” but “the purpose of it is to promote bonding within marriage.” The hook-up culture conditions young adults to easily break an emotional bond that many believe should be reserved for marriage. 

The abstinence-only programs therefore seek to show teens that engaging in any sexual activity (not just having sex) is a choice that may not be the healthiest one available. But Foley believes that it is contradictory to give teens condoms while simultaneously dissuading them from all sexual activity. “I think that encourages kids to have sex,” she says. Nevertheless, in an education program like EFL that stresses that sexual activity is a choice, there is little hope for preventing pregnancy or any transmittance of STIs if those who do decide to have sex are not encouraged to use contraceptives.

Foley still believes there is a place for abstinence-only programs, despite the president’s budget proposal. As a safeguard against federal funding cuts, EFL receives a considerable amount of funding from private donors. Federal budget cuts will not eliminate the program, but will force Foley and other abstinence directors to abandon much of their advertising on TV and roadside billboards. “Teenagers need to know that these are the things that will help them to have the healthiest relationship possible in the future…we do a lot more than just say ‘Don’t have sex.’”

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ach year in the US, an estimated 750,000 teenage girls become pregnant. In 2008, the Guttmacher Institute reported that most abstinence programs did not delay the initiation of sexual activity among adolescents. In fact, the University of Washington found that teens in abstinence-only programs were 50 percent more likely to become pregnant than those who had comprehensive sex education. 

Hernandez-Queen says that she doesn’t have anything against abstinence-only programs, but she is adamant that it not be the only option for adolescents. “Some people don’t know what else to do if they’re not practicing abstinence,” she says, “so Planned Parenthood gives them the resources they need if that’s not the choice that they make.”

Contrary to the implications of Dollar a Day’s name, the program is fundamentally holistic. Monica Macafferty, a PPRM spokesperson, says that the program is often unfairly pigeonholed as one that does not address the psychological aspects of teen sexual activity, much as abstinence-only programs are often depicted as overly simplistic or naïve. 

“We are not just giving people the information to make their own decisions,” says Macafferty. “We’re teaching them how to protect themselves from disease and pregnancy and also teaching them about abstinence…For many of these girls, they don’t know any other options—it’s empowering in that sense because we are showing them a different way.”

Although paying adolescents not to get pregnant may seem like an almost counter-intuitive approach to health, the total cost is still significantly less for society than if those eighty-four girls had all had children. Services like Medicare, health clinics, and welfare all cost society a significant sum, and $84 a day is comparatively small change. 

“Some could say this is a very modest investment,” says Macafferty, “not to mention the opportunities it opens up to the girls.” And given young women like Hernandez-Queen, who may someday be caring for premature babies (planned or unplanned) rather than struggling to provide for their own, the gains seem well worth the investment. 

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