Carroll County Times

Esther Cepeda: Parents' guidance better than doctors'

Let's start with a beyond-dispute premise: We need to do everything possible to prevent unwanted teen pregnancy.

But should pediatricians pre-prescribe "morning-after" pills to girls younger than 17, as the American Academy of Pediatrics has suggested?

Even though I'm the mother of two teen boys, I believe that if I were instead charged with the health and well-being of two teen girls I'd be saying "Heck, yeah."

But who am I to say that other parents would feel the same way, even if for the sake of the greater common good?

My next-door neighbors are a devoutly churchgoing Hispanic couple with two sons and a 15-year-old daughter.

The father of the family, a cheery Mexican immigrant who holds fast to traditional conservative religious ideas about his daughter's reproductive rights - which is to say he probably doesn't believe she has any - would surely not feel comfortable if he thought his daughter's physician would give her access to morning-after pills "just in case."

You might be saying to yourself that this child is probably an excellent candidate for becoming one of the 55.7 per 1,000 Hispanic girls ages 15 to 19 who give birth every year - 80 percent of these pregnancies are unintended - and you'd be absolutely right. The overall teen birth rate in Cook County, Ill., is an astonishing 49 per 1,000 compared to the national benchmark of 22 per 1,000.

With this terrible state of affairs, it would seem obvious that pediatricians should take matters into their own hands and provide explicit, unsolicited counseling about birth control and emergency pregnancy prevention to teens, and especially girls, independent of a parent's wishes, right?

Maybe. Especially maybe in communities where teen pregnancies among minority girls are particularly pervasive. For instance, New York City's public schools face a powerful mix of high poverty, underinsured families and teens who frequently start sexual activity before the age of 13.

The schools are trying pilot programs to provide birth control and morning-after pills right in school buildings. Health officials there recently reported that parents are fine with the program.

But more widely, I think some parents would find a way to take their children to doctors with a reputation for ignoring the academy's guidance. Like those parents who believe routine vaccinations will irreparably harm their children, there would be some girls who would spend their adolescence without any pediatric care at all.

What we're really witnessing here is the medical establishment's acknowledgement that way too many parents refuse to admit that in our highly sexualized society, they are the ones who need to provide their children with reliable information about safe sex.

Because overall averages of teen pregnancy have been going down for the last few years, there is an opportunity here to get to the root of the problem, which is less about what talks doctors should be having with their minor patients and more about what information should be shared at home.

Studies such as "Paternal Influences on Adolescent Sexual Risk Behaviors: A Structured Literature Review," which appeared in the official journal of the American Academy of Pediatrics in October, have shown that kids of parents who have respectful, meaningful and informative conversations about sex are less likely to engage in risky behaviors leading to unintended pregnancy and sexually transmitted diseases.

If the pediatric medical establishment wants to go ahead and codify a policy that says "talk to your kids about safe sex or we'll do it for you," it should do so hand-in-hand with general practitioners who treat parents.

In other words, as the AAP tells pediatricians to initiate these talks with kids, the American Medical Association and the Centers for Disease Control and Prevention should ask that physicians screen patients who are parents for their ability to provide their kids with age-appropriate sex education, give them a score predicting their child's likelihood to engage in risky sexual behaviors and provide them the resources to prevent such negative outcomes.

Here's another beyond-dispute premise: Efforts to reach kids without involving their parents in helping them make good choices will ultimately falter.