Begin here: In 1990 nearly 10 percent of Baltimore girls aged 15 to 17, almost all unmarried, gave birth. That is why in 1993 the city is embarking on a program to make Norplant, a long-term (five-year) contraceptive implant, available to teen-age girls at school clinics and elsewhere.
The case against the program can be put concisely: By substituting chemical protection for moral restraint, it sends a message of resignation regarding behavior once considered deviant and reprehensible but now redefined, in the name of "realism," as normal.
The case for the program can be put even more concisely: Rebecca (not her real name).
She is wearing sneakers, clean jeans and a lavender sweatshirt. She sniffles constantly, the consequence of a cold, or perhaps of the substance abuse (sniffing paint thinner, as well as using PCP and alcohol) that got her sent to a residential treatment center. There she heard about Norplant from a public-health official.
Now at a hospital clinic she is listening impassively as a nurse gives her all the information necessary for informed consent for the insertion in her upper arm, by a 10-minute procedure, of six matchstick-size capsules.
Rebecca, who has been sexually active for two years, is told that the implant will not protect her until after her next period, which is two weeks away, and she is asked if she needs a supply of condoms for the interval. Oh, yes, she says emphatically.
She is 13.
Now, consider some numbers provided by Douglas Besharov and Karen Gardiner in the American Enterprise journal.
This year 10 million teen-agers will engage in 126 million acts of sexual intercourse resulting in more than one million pregnancies, 406,000 abortions, 134,000 miscarriages and 490,000 births, about 64 percent (313,000) of them illegitimate. In 1988, 11,000 American babies were born to females under 15. In 1990, 32 percent of ninth-grade females (14 and 15) had sexual intercourse. Seventeen percent of 12th-grade girls have had four or more partners.
Such numbers suggest that any message communicated by a Norplant program will not have a measurable effect on the mores an age in which more teen-agers are having sex more often and at an earlier age, and much of the increase has been among middle-class teen-agers, most of them white. Rebecca, by the way, is white.
The question is how to limit the social costs of all this, given the fact that (in Besharov and Gardiner's words) "adolescents who cannot remember to hang up their bath towels may be just as unlikely to use contraceptives." Norplant is "teen-ager proof" because it requires neither a daily action (as with the pill) nor foresight (as with a diaphragm) nor a partner's cooperation (as with condoms).
Times have changed? Yes, but let's be clear about how. Forty years ago teen-age pregnancy rates were higher than today. However, most pregnancies occurred in, or were promptly followed by, marriage.
Today few teen-agers who become pregnant wanted to. (A study suggests that the "wantedness" rate is higher for whites than for blacks.) But for those who do become pregnant, incentives and social reinforcements are apt to be markedly different for whites and blacks.
A white suburban teen-ager who becomes pregnant is apt to get an abortion and go on to college. A black inner-city teen-ager's pregnancy is not apt to disrupt similar expectations.
Many inner-city female teen-agers have not seen a man in the role of economic and emotional provider for a family. And given the savage harvest of homicide, drugs and jail, the cohort of marriageable inner-city males is small. Furthermore, the pregnant teen-ager is apt to have a supportive matriarchy to rely on if she decides to have the baby resulting from the unwanted pregnancy.
But the prospects for such babies are at best problematic. Better the unwanted pregnancy had not occurred. And Norplant may be the most feasible preventive.
Norplant has been embroiled elsewhere in controversial welfare and criminal-justice policies raising questions of morally or legally dubious coercion. There have been proposals for monetary incentives or sanctions for unmarried welfare mothers to agree to implants. Judges have proposed implants in lieu of prison for women convicted of drug or child abuse.
But leaving aside the question of when it might be acceptable for society to encourage Norplant use, Baltimore's evolving program seems careful, consensual and needed. And those black activists who profess to see Norplant as a "genocidal" attack on black fertility should answer this:
What is more dangerous to the flourishing of black America, Norplant for teen-agers or a growing number of black adolescents headed for a life in poverty because they were born into poverty to a single mother whose life chances were blighted by a pregnancy at age 15?
9- George F. Will is a syndicated columnist.