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Less Sex, More Babies

Guttmacher Study Targets Hispanic Adolescents for "Family Planning"

BY CHRISTOPHER ZEHNDER

Because Hispanic adolescents "are projected to make up one-half of the state's adolescents by 2020, it is important to determine how cultural and health policy-relevant factors are linked to this group's use of family-planning services." So said, in the formal language of sociology, a study by the Alan Guttmacher Institute, published in 2004 -- "A Comparison of Hispanic and White Adolescent Females' Use of Family Planning Services in California." A lapidary title, to be sure, but fitting, perhaps, for what some would think a very tendentious organization; for Guttmacher is the research wing of Planned Parenthood International.

And given Guttmacher's ties to Planned Parenthood, few would be surprised at the conclusion offered by "A Comparision, etc." "Our findings," said the study, "point to a need for family planning programs to target Hispanic adolescents and to send a clear message that contraceptive services are available and should be used before a woman ever becomes pregnant." To come to this conclusion, between November 2000 and September 2001, Guttmacher conducted a random-digit dial telephone survey of 55,000 households from every county in California, interviewing adults and adolescents. The number of "white" and Hispanic female adolescents, ages 14-17, surveyed was 5,801. The study then selected from this group a "subset" of 1,156 white females and 473 Latinas.

I myself conducted an unscientific survey of Hispanic groups in June and July of this year. My choice of groups was somewhat random; from the internet, I culled the names of Latino political, cultural, business, and religious groups and asked their representatives what they thought about the results of the study. A few of these groups were Catholic; most were not. In all, I spoke to ten groups.

One respondent, Harry Pachon, professor of public policy at the University of Southern California in Los Angeles and president/CEO of the Tomás Rivera Policy Institute, asked, relevant to the entire study, whether it controlled for income. "Typical research controls for income and education, the two major socio-economic status factors," he said. "The relevant comparison would be between low income whites and low income Latinos." According to Guttmacher, the study took into account such variables as "age, race or ethnicity, parental citizenship or immigration status, language spoken at home, health insurance status, poverty status, parental education and the regular source of primary health care." But, said the study, "none of these variables were significantly associated with adolescents' use of family planning services within the past year."

However, without referring to such control factors (and while demurring that they did not have studies ready to hand), most of my respondents found believable what the study calls its "context" -- that "Hispanic adolescents have a birthrate that is three times that of whites (83 vs. 25 per 1,000)" and that "while the overall adolescent birthrate in the state has decreased during the past decade, the rate of decrease among Hispanics has been lower than that among whites."

Why is the birthrate among Hispana adolescents higher than that among white adolescents? The Guttmacher study ascribes it, not to greater sexual activity among Hispana adolescents, but to the fact that they are less likely than white adolescents to use planning services." (Indeed, the study notes, "Hispanic adolescents in our study had a somewhat lower rate of sexual experience than did whites." Other researchers, said the study, "have found a slightly higher rate of sexual experience among Hispanic adolescents than among whites." But this may be because "these researchers included adolescents aged 15-19, whereas we focused on 14-17-year-olds.")

But why are Latina adolescents less likely to use family planning services? Guttmacher ascribes it to "cultural norms within Hispanic families, which often forbid adolescents from having sexual intercourse before marriage." For Latino families, the study says, "sexual activity among unmarried young persons is considered culturally unacceptable ... and even harmful to the reputation of young females." For this reason, the study hypothesizes, the "messages Hispanic adolescents receive about sexuality from their parents, especially from their mothers, may focus more on abstinence than on pregnancy prevention. These messages may deter unpregnant Hispanic adolescents from seeking family planning services because this would imply that they are sexually active."

Harry Pachon, however, said he would caution about "throwing out the blanket cultural explanation" like Guttmacher does. He favored "social economic factors" as an explanation of the higher pregnancy rate among Hispana adolescents. Pachon said that Hispanic teenagers in the United States, torn between the wider culture and their families' traditional Hispanic culture, are "particularly vulnerable to social problems. It's like they lose their cultural anchors," he said. But this happens, said Pachon, because of Hispanics' lower economic status; in the "family environments immigrant families may typically have, where both the father and the mother are working, the supervision of the child is maybe not as present as it could be."

Helen Torres of the Los Angeles-based Hispanas Organized for Political Equality, said she thought the "lack of health insurance in the Hispanic community is probably more on target" as a cause of adolescent pregnancy among Latinas than are cultural norms. "I think the cultural norms are important," she said, "but there is 33 percent of Latinas who have no health insurance. And understanding how to use the healthcare system is a point of education most whites have. Even white poor girls know how to access the system more than would an immigrant girl."

However, Ken Johnson-Mondragón, director of research and publications for the Stockton-based Instituo Fé y Vida (a Catholic institute for Hispanic youth and young adult ministry), pointed to cultural factors as influential on the sexual habits, or lack thereof, of Latina adolescents. Referring to the Guttmacher finding that Hispanic girls between 14 and 17 years of age are less sexually active than their white peers, Johnson-Mondragón cited studies "that have shown," he said, "that Hispanic adolescents who continue to speak Spanish regularly (a sign of lower adaptation to the dominant culture of the U.S.) are less likely to be sexually active than either White teens or Hispanic teens that use mostly English."

Diverse studies, said Johnson-Mondragón, point to other factors for the higher rate of pregnancy among Hispanic girls compared to their white peers. Hispanic girls who do have sex, said Johnson-Mondragón, tend to engage in it more frequently than white girls, while white adolescent girls "are significantly more likely to engage in oral sex" than are sexually active Hispanic girls, who are "more likely to engage in sexual intercourse." Some studies have shown that while most sexually active white and Hispanic girls report using some form of contraception whenever they have intercourse, "a sizable minority (between 10 and 15 percent) of sexually active Hispanic girls report never having used contraception during sex," said Johnson-Mondragón. Among sexually active Hispanas who speak predominately Spanish, the percentage of those who say they have never used any form of contraception is much higher, 30 to 40 percent.

Based on the evidence of such studies, Johnson-Mondragón opined that Hispanic cultural norms may include cultural attitudes opposed to oral sex and sex outside of marriage. And while "the reasons why a significant minority of sexually active Hispanic girls has never used any form contraception cannot be determined from available survey data," Johnson-Mondragón said his own pastoral experience suggests some possible explanations. Since Hispanic culture emphasizes abstinence, "obtaining or using some form of contraception," said Johnson Mondragón, "would involve planning to engage in sex," against which a girl's guilt feelings might rebel. So, "instead, the sex 'just happens' in the heat of the moment, without premeditation or contraception." Girls too, he said, might have heard that "many forms of 'contraception' prevent implantation of a fertilized egg, which is a form of abortion. The prevailing Hispanic attitudes against abortion are also reflected in the lower abortion rate among Hispanic girls that have become pregnant, when compared to their white and black counterparts." And, finally, "anecdotal evidence," said Johnson-Mondragón, "suggests that some Hispanic girls may be so uninformed about sexual activity that they do not even realize they are doing anything that could result in pregnancy. This appears to be more likely among the Spanish language dominant girls who are recent immigrants to the U.S., and whose families believe they are protecting them from harm by delaying to provide them information about sex."

Raquel Donoso, associate director of the San Francisco-based Latino Issues Forum, said Hispanic women "are less likely to have sex and less likely to have multiple sex partners -- but yet we are more likely to become pregnant from the sexual encounters that do happen." Why? It's not necessarily because young women who try to follow the abstinence path "make a mistake they are not prepared for," she said. "There are family norms and religious norms where it is not necessarily the norm to talk about family planning practices or seek them out. The message in the Latino culture is not, I think, 'if you are having sex, protect yourself.' I feel as a woman who grew up in a Latino household, where we went to Catholic school, the messages were more clear around abstinence."

Donoso sees that Hispanic women in general are reluctant to use birth control in part "because the Catholic religion is such a big part of our culture. A lot of women have told us," she said, "that they don't use birth control or are less inclined to use birth control because it is something the Catholic Church does not agree with. From the research that we have done, there are, on the one hand, a lot of women who do agree with the teaching of the Church in regards to contraception while others are kind of grappling with the realities of their situation. Sometimes both parents are working and trying to put food on the table and realizing how hard it would be to have a larger family."

Helen Torres suggested another perspective: that while among Hispanics sex before marriage may be "taboo," pregnancy is not. "What I find," she said, "is that once a male gets a female pregnant, there's such an embracing of the coming of that child. There's not a stigma that you got pregnant, though there is a stigma that you're having sex. But once you are pregnant, there is a real coming together of the family in support." Others I interviewed noted the same phenomenon.

And while there are increasingly more Hispanic children in the foster system, said Torres, "an additional taboo" among Hispanics is "giving up a child for adoption." This reluctance, she said, stems "from a variety of reasons, from economics, to religious, to just downright understanding of how we're raised -- that the family is the core structure and you do everything and anything to protect it and keep it together."

Patrick Osio, the editor of HispanicVista.com, who said, "I'm a father and a grandfather" as if he were laying out his credentials, said he saw cultural and religious mores as the source of the higher pregnancy rate among adolescent Hispanas. "I think that in the Hispanic community," he said, "one of the two great sins is sexual activity before marriage. But a greater sin than that would be abortion." Osio said Hispanics still have a sense that artificial contraception is immoral, but he cautioned against over-generalizing. There are lower income and upper income Hispanics, he said, who would have very different attitudes towards contraception.

A Southern California crisis pregnancy counselor, Astrid Bennet of Hispanics for Life, said she thought it significant that the Guttmacher study referred to birthrate rather than pregnancy rate when comparing Hispanic and white adolescent girls. "This is an important distinction to make," she said, "because people might think the birthrate is going down, but that doesn't mean the pregnancy rate is down." Hispanic girls, opined Bennett, "probably have a higher birthrate because they're probably more open to life and in tune with traditional values. I think white adolescent girls, their parents are probably already familiar with the choice rhetoric and contraceptive mentality and, probably, more comfortable with abortion. Not so Latinas."

But Hispanic girls are becoming more accepting of abortion, said Bennett. They've already become more accepting of contraception. "It is very much in use in Latin American countries," she said. Then there is in the United States, she said, the influence of the ready availability of contraceptive services, "especially in the schools. Girls are being told their parents are ignorant, and so they are creating a rift between generations." Still, said Bennett, "girls at home, I think, are being taught traditional values, and they are being taught that sex is for marriage; so there is still a conscience there that we can work with and tap into."

The Guttmacher study's conclusion -- that there is a "need for family planning programs to target Hispanic adolescents" -- Bennett said, is "racist." The study "makes it seem like more Latinos are a threat to the state." But, she said, the conclusion is "totally congruent with the history of Planned Parenthood, whose founder, Margaret Sanger, had a eugenic philosophy."

Most of the others I spoke with, however, welcomed the study's conclusion. Harry Pachon said he thought it "a very solid recommendation. And, in a way, how could you be against that recommendation? I think that's a very positive, very action oriented recommendation, and I commend them for that." But didn't he worry that the study was unduly targeting Hispanics? (After all it presents its conclusion as "imperative" because of the exploding growth of Hispanic adolescents in the state.) "Not when it's a positive program," he said. "Single parenthood is a tremendous financial burden and a tremendous life burden for somebody who hasn't graduated high school."

Raquel Donoso, while not disagreeing with the substance of the conclusion, thought the solution was too simple. In the Hispanic community, she said, you cannot "just direct messages toward adolescents without taking into account the entire family," though "that's the way it's done within the mainstream. I think it's not just a matter of increasing the amount of information Latinas have about the contraception pill or condoms; it's more about increasing the dialogue parents have with their children around these issues."

I asked Donoso whether she feared the study might be promoting a policy directed specifically at limiting the Hispanic population. Such discriminatory policies, she said, "are a concern we have as an organization because one issue we work on is environment. A lot of mainstream environmental groups are talking about population growth and controlling population growth in a context that does seem filled with fear and is not constructive about what is going to happen in California. I think we have to be careful how the message is depicted, who it's coming from, and what the underlying themes may be." But Donoso said she was not worried about the Alan Guttmacher Institute. "We have worked with them on different issues," she said, "and that's probably not where they're coming from."

Still, Donoso said that, given the changing population of California, "we do need to be sure we are providing services and information so that not only a small group of people is getting it. In terms of reproductive health issues, it is important to make sure that women have the information they need to do what they want -- whether that is to have a larger family or not."

Helen Torres said she agreed with the Guttmacher recommendation as long as it was seen as part of a larger, more holistic health care approach. "As a Latino organization, we didn't get into this to control the numbers of Latinos," she said. "We think it's great there's a population of them. But when a young Latina gets pregnant, her life options and the barriers she's facing -- she is most likely not to have health insurance, she is most likely not to finish high school and go on to college. The barriers are so much more in front of her and against her than if she was able not to get pregnant."

But doesn't she worry that the Guttmacher study is saying, basically, "look at those Hispanics, see what funny ways they have -- their population sure is growing, so let's hand them condoms..." "It's interesting you bring that up," she said. "I was trying to find out who some of the authors were. You can't always tell by someone's surname that he is Latino or not, and it looks like there were maybe two Latinas who were part of the study. I would hope that was not the case. I would try to be the optimistic person and say, look, this is a study that really points to the need for comprehensive sexual education and a holistic approach that includes the expansion of healthcare services to our Latinas, so that they have all the choices."

But regardless of what might have or might have not been Guttmacher's hidden intentions, Ken Johnson-Mondragón indicated that the study's recommendation of more family planning programs to target Hispanics is based on some faulty premises. He disagreed with the study's contention that "parental attitudes toward adolescents' sexual behavior are likely to differ between whites and Hispanics: sexual activity among unmarried young persons is considered culturally unacceptable among Hispanics and even harmful to the reputation of young females." This claim leads the study to opine that "the messages that Hispanic adolescents receive about sexuality from their parents, especially from their mothers, may focus more on abstinence than on pregnancy prevention."

According to Johnson-Mondragón, the Guttmacher claim is faulty because "other studies have shown that the majority of both white and Hispanic parents believe that sexual activity among 14 to 17 year-old teens is not acceptable, with little or no difference between white and Hispanic parents on this point." It is for this reason, said Johnson-Mondragón, "I believe the inference made here in the Guttmacher report is speculative at best. I am not sure what basis they have for singling out the messages Hispanic girls get from their mothers, but there is certainly no evidence for this conclusion in the California Health Interview Survey data" cited in the Guttmacher report.

On the basis of, at least, these claims, Johnson-Mondragón said, "there is no evidence for the need to target Hispanic adolescents with messages about the availability of family planing programs, services, or products." As for those relatively rare teens who may be getting pregnant out of ignorance of "what constitutes sexual activity," there might be a need "to improve their awareness about what they are doing, and the moral, social, economic, physical, and emotional consequences of their actions," said Johnson-Mondragón. "However, this does not equate to a need for providing information about the availability of contraceptive services."

It is finally difficult, "if not impossible, to assess the impact of a particular approach to sex education [whether it be abstinence or contraceptive services] through surveys," said Johnson-Mondragón, since "adolescents get so many contradictory messages about sex from every source imaginable." The Guttmacher report, he said, "appears to be ignoring the actual results of the California Health Interview Survey data and relying on unnamed 'previous studies' when the Survey results do not support the agenda of targeting Hispanic adolescents with messages about the benefits of contraceptive services in order to combat a perceived emphasis among their parents on the abstinence approach to sexual education."

If reports like the Alan Guttmacher Institute's are successful, Hispanics in California will be the losers. "The likely impact," said Johnson-Mondragón, would be "that Hispanic teens will become more confused about the moral, social, and emotional dimensions of sexual activity, and we may see increased sexual activity at younger ages, perhaps reaching the levels seen among their white adolescent peers."

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