I’m puzzled, first, by your choice of words. You keep referring to “young women.” The girl in question is not even a teen, let alone a woman. What’s the rush?
Stedman’s medical dictionary defines adolescence as beginning with puberty (for a girl, that’s marked by the onset of menstruation) and ending with completed growth and physical maturity.15 For the NIH, anyone under twenty-one is a child.16 For the World Health Organization, adolescence ends at nineteen.17 While an older adolescent—seventeen, eighteen, or nineteen—may commonly (but technically incorrectly) be called a “young woman,” the individual you’re discussing is nowhere near that. She’s a girl, for heaven’s sake; she has yet to enter puberty!
As a gynecologist, you’re aware that delaying sexual activity is associated with far-ranging benefits: decreased rates of infection with sexually transmitted diseases, higher academic achievement,18 decreased rates of out-of-wedlock pregnancy and birth, decreased single parenthood, increased marital stability, decreased maternal and child poverty, decreased abortion, and decreased depression.19 Yet you don’t mention those, and you seem to assume this girl is going to have intercourse sooner or later, regardless of age or maturity. I wonder, do you believe it’s healthier for her to abstain, at least until after high school? If yes, why don’t you explain those benefits to her mom, and then arm her with strategies that can make a difference?
Naturally, given her experience, this mom’s concerns are understandable. She’s terrified that her daughter could have a child when she did, and wonders if birth control is the answer. What’s astonishing is that you tell her, yes, it is.
How can you do that? Why the automatic reach for a prescription pad? It’s a misguided, hazardous strategy. Even if your advice is heeded and this girl is placed on hormonal contraceptives, she is at significant risk of pregnancy and STI’s.20 Why assume she is incapable of being taught to make smart choices? And what of the adults in her life—at home and in the neighborhood, at school, and possibly church—are they completely powerless? Are they utterly inept? Why would you think so? The mere fact that her mom had the wherewithal to seek your advice speaks against that.
At age twelve, what this girl needs isn’t pills, Dr. Cullins, it’s parenting. There is so much mom can do to keep her on track, and it’s critical for her to hear that from you, a medical authority. Sure, I know how much harder it is—to say nothing of time-consuming—to discuss parenting than write a prescription. But Planned Parenthood promises to educate parents about how to protect the health of loved ones,21 and it claims to have a comprehensive and commonsense approach.22 I’d say in this instance, you failed to provide that service.
Most of us would agree that parents can have some effect on their teen’s behavior, but recent studies overwhelmingly confirm that the impact of parents is profound.23 They demonstrate that good parenting has a “significant, enduring, and protective influence” on adolescent development. The mom who turned to you needs to know what family factors and parenting style can deter risky behavior, moderate the influence of peers, and optimize her daughter’s potential.
I suggest that a “comprehensive and common sense” answer to the query would sound something like this:24 I endorse you for being proactive and seeking advice on protecting your daughter. Rest assured that at twelve, your influence on her is greater than you might imagine.25 What’s critical for your daughter is the parenting she receives. She’ll do best if you model good behavior, and you’re warm, supportive, and hands-on. She needs you to establish firm rules and high expectations.26
Does your daughter’s father live at home27? Teens28 from two-parent families are more likely to delay sexual activity. The research findings are robust: the longer a girl lives without her father at home, the more likely she’ll engage in early sexual activity and experience a teen pregnancy. According to one study, girls whose fathers lived outside the home from an early age29 were seven to eight times more likely to have a teen pregnancy.30
When it comes to your decisions about sex, who is most influential?
Percentage of teens who answered
Source: The National Campaign to Prevent Teen and Unplanned Pregnancy, www.teenpregnancy.org/September 2001
Even without dad in the home, your attitude toward teen sex and rules you make about dating can influence your daughter to delay sexual behavior.31
But before delving in to those issues, mom, know this: your daughter needs you. Instead of visits to the gynecologist, schedule special time together, just the two of you, and talk. Strengthen your connection with her. She wants a close and confidential relationship 32 with you, not her health care provider.33
Ask your daughter about her life—how things are going at home, school, and with friends. Is there anything bothering her? What can you do to help? Find out what she’s looking forward to—not years from now (for the next few years she’s probably not planning so far in advance) but for her birthday, Christmas, or summer vacation. What does it mean to her to become a teenager? What does she think it will be like in 8th grade, or 11th? Every child wants to feel that their thoughts and dreams are important.
Speak about what you’ve learned from your own experiences, and communicate your values. It’s at least as important as talking about contraceptives, if not more. Affirm that your daughter is precious to you, while explaining why it would have been smarter to give birth to her under different circumstances. It’s not that you regret having her—to the contrary!—but if you could do it again, you’d have had her—the same daughter, not different in any way—when you were an adult, married to her father.
You could say something like:I want to speak with you about something really important. When I was young, I made the biggest mistake in my life. I began having sex too early. I didn’t think it out. I didn’t know what I do now—that anytime you have intercourse, even if you are using contraception, you could get pregnant. Or maybe I knew it but did it anyway. Having a baby when you’re not ready is like falling off a cliff. I want you and my grandkids to have an easier time. So I’m going to keep reminding you: there’s a cliff out there. And I’m going to do all I can to make sure you don’t get near it.
Teens often misperceive what adults think and feel; make sure your daughter is certain about your values and expectations—these will impact her behavior. Yes—she may object vigorously, but studies show that high parental expectations are associated with postponing sex.34
If your daughter perceives her relationship with you is good, and your disapproval of teen sex is absolutely clear, it can have a powerful effect on her behavior. One study based on data from almost 8,000 mother-teen pairs35 found that the more liberal teens think their mothers’ sexual opinions are, the more likely they are to have had sex and the more sexual partners they are likely to have.36
“Girls who reported closer relationships with their mothers were less likely to have had sexual intercourse. They were more likely to report a history of sexual intercourse when their mothers communicated frequently about sexual topics and when daughters perceived their mothers as being more approving of premarital sex. Daughters were less likely to be sexually active when their mothers reported more discussions related to the negative consequences of premarital sex and to delaying sexual intercourse for moral reasons.”37, 38
If you have religious beliefs about teen sex, mom, you must convey those to your daughter. Even more protective is your daughter’s devoutness: religiousness in adolescence is associated not only with lower rates of teen sex, but also lower incidence of binge drinking, marijuana use, and cigarette smoking.39 Guilt is a powerful variable, in that if a teen believes teen sex is wrong, it limits their behavior significantly. 40 Sex educators who are so big on removing sex from morality remove the guilt factor. But parents should not be afraid of it, as long as the child understands it is the timing of sex, not sex itself, that is the issue. For every thing, there is a season.
Monitoring, knowing your daughter’s whereabouts, activities, an
d friends, is critical. Know her friends—aside from you and her father, they have the greatest influence on her sexual decisions. Evidence is overwhelming that monitoring is protective, with benefits persisting into late adolescence.41 It should come across to her as evidence of your concern and care, not mistrust.
Factors Most Affecting Teens’ Decisions About Whether to Have Sex
A perception of a low-level of monitoring is associated with sexual risk behaviors and, among low-income African American female teens, with getting pregnant, as well as gonorrhea, Chlamydia, and Trichomonas infections.42 Your daughter should know it’s important to you to know where she is, who she’s with, and what she’s doing.
Newsflash: More unsupervised time, with groups of peers or with a member of the opposite sex, is associated with sexual behavior.43 Do we really need studies to confirm the obvious? Mom, reduce your daughter’s opportunities for sexual encounters. You may want to consider enrolling your daughter in a program for teens that encourages abstinence; some have a proven track record. For example, junior high and middle school-aged girls in the Best Friends program are six and a half times less likely to have sex compared to their peers in D.C. Public Schools .44
Dr. Cullins, your advice is contradicted by twenty-five years of research on the teen brain and on parenting. You instruct this mom to step back, but one study after the next tells her to step in. You say you respect your daughter’s decisions; they say make your expectations clear and enforce them. You emphasize her relationship with a health provider, but it’s her relationship with her mother and her father that’s critical. Your approach is based on the notion that parents thwart a child’s development—that if kids were left alone, free of our rules and expectations, they’d thrive. But the opposite is true.
The “Facts” of Life
Do you see how this racket works? The experts tell your daughter: If you can answer “yes” to these questions, you may be “ready.” They tell you: you may want her to wait, but be realistic: your daughter will probably have sex before she graduates from high school.
When you wince and groan, they reply: Trust us. We’ve studied adolescent sexuality, and understand your daughter’s biological, psychological, and social development. Sure, it’s hard for you to see her growing up so fast. But it will be harder to see her pregnant. Your job, mom and dad—even if adolescent sexual behavior conflicts with your values—is to share that with her, and then make sure she knows about obtaining and using “protection.”45
“Children are sexual and think sexual thoughts and do sexual things,” Mom and Dad must “accept and honor [their] child’s erotic potential.”102
—Talking With Your Child About Sex: Questions and Answers for Children from Birth to Puberty by sex ed matriarch and SIECUS founder Mary Calderone
We’re not talking only condoms. In her book Beyond the Big Talk: Every Parent’s Guide to Raising Sexually Healthy Teens—From Middle School to High School and Beyond, former SIECUS president Debra Haffner writes that teens need to know “that they cannot swallow ejaculate or have oral sex during menstruation. If these topics seem too embarrassing to discuss, consider how awkward it would be helping your teen with oral gonorrhea or, worse, HIV.”46
Uh . . . okay. . . thanks for sharing! And parents, take note of something else: if you can’t stay cool and calm during these explicit talks, aside from the risk to your child of disease and pregnancy, the experts warn, you’ll pay a hefty price: your child will go elsewhere for help. That’s right, she’ll turn to a friend, teacher, or online stranger with her questions and concerns, and it will be completely beyond your control. Well, that’s what you get for foisting your hang-ups on your child’s healthy sexual curiosity.
Wait ... what was that they were saying about scare tactics?
What should parents do? Have they no choice but to defer to the “experts”? Are they really the bumbling morons described by educators, the greatest obstacle to their child’s healthy sexuality? Is there no other option but to take a deep breath, squelch their gut feelings, whisper a prayer, and try to speak “openly” with their thirteen-year-old about “sex play” and its accompanying risks?
Yes, parents have a choice. They can reject this madness. They can listen to their gut feelings, because their intuition is correct: No way! This is too much, too soon! We know our daughter, and she’s not the self-aware, perfectly rational, disciplined person your model assumes, who already knows who she is and what she wants. She’s not a mini adult47 who can fully analyze a complex decision and consider the risks and consequences. The answer is not “information,” it’s giving her a chance to grow up. Our obligation is to teach and guide and, yes, sometimes judge her, not to stand by and watch as she determines her own “readiness”! Thanks for your opinions, “experts,” but no thanks.
Parents can make that choice and share it with their child. They can calmly but firmly put up a big red light for their sons and daughters regarding sexual behavior during adolescence. And they can rest easy, because they—and not SIECUS, Planned Parenthood, or Advocates for Youth—have the up-to-date, medically-accurate facts on their side.
Newsflash: Teens Are Not Miniature Adults, in Mind or Body
In September 2003, some of the nation’s most accomplished developmental neuroscientists gathered in New York City. They met for two days to share their research in a field that did not exist a decade earlier. The conference title: “Adolescent Brain Development: A Period of Vulnerabilities and Opportunities.”48
Until the mid-1990s, the study of brain development focused on the fetus, infant, and toddler. By age two, the brain reaches close to 80 percent of its adult weight,49 and so those years were considered the critical periods of development; future maturation was considered almost insignificant. But research was limited, because healthy children could not be ethically examined with x-rays or CT scans, techniques that use radiation.50 Investigators had to rely on animal studies and cadavers.51
Enter magnetic resonance imaging (MRI). This technique, invented in the 1970s, produces “exquisitely accurate”52 images of brain structure without using radiation. Even more exciting, real-time images of the brain at work—doing a math problem, recalling an event, feeling pleasure or fear—were available with the advent of functional MRI (fMRI). With the elimination of health risks, MRI and fMRI permitted observation of healthy children and teens, revolutionizing the study of brain and behavioral development.
“Given the pronounced developmental changes occurring in [the adolescent brain] . . . it would be extraordinary if adolescents did not differ from other aged individuals in their behavior.”70
—Linda Patia Spear, Ph.D.
For researchers, the biggest surprise came when they looked inside the heads of adolescents. They discovered that brain maturation does not end in early childhood; it simply pauses for some years, only to restart with vigor at the onset of puberty. During the second decade of life and into the third, a period of “explosive growth and restructuring” takes place. There is a “dramatic metamorphosis of the brain,” writes one of the leading developmental psychologists in this young field. “The magnitude of these brain alterations is difficult to fathom.”53
Think of it as Extreme Makeover: Teen Brain Edition. Due to this massive transformation, adolescence is a period of life with distinct vulnerabilities and opportunities.
We are now certain that the adolescent brain functions differently from an adult’s. The importance of this discovery, say some of the country’s eminent neurobiologists, should not be understated.54
Dr. Jay Giedd, chief of brain imaging in child psychiatry at the National Institute of Mental Health, has used Magnetic Resonance Imaging (MRI)s to peer into the heads of 1,800 kids, gaining a real-time view of the brain at work.55 He scanned normal volunteers every two years during childhood, adolescence, and sometimes beyond. At first he planned to stop at age eighteen or twenty, but he discovered that was too soon: remodeling of some brain regions continues into the
third decade of life. Dr Giedd and others found that an area called the prefrontal cortex (PFC) is the last to mature: it may not completely develop until the mid-twenties. “Avis must have some pretty sophisticated neuroscientists,” he jokes, referring to the company’s refusal to rent a car to drivers under the age of twenty-five.
The PFC is located behind the forehead, and is responsible for the executive functions of the brain: judging, reasoning, decision-making, self-evaluation, planning, suppression of impulses, and weighing the consequences of one’s decisions. “It allows us to act on the basis of reason,” explains Daniel Weinberger, Director of the Clinical Brain Disorders Laboratory at the NIH.57 The PFC is like the Chief Executive Officer (CEO), and it is the final region to mature. Of course, parents don’t need to have their kids’ brains scanned to know they’re capable of goofy and thoughtless behavior, but it’s nice when science confirms what moms and dads have always known.
AFY tells parents: “Most teens, ages 13 to 17 will: Attain cognitive maturity—the ability to make decisions based on knowledge of options and their consequences.”56
If the CEO isn’t fully on the job yet, how are adolescents at making decisions, especially ones involving risk? That’s a critical question: the rates of death, disability and health problems of teens is 200 percent to 300 percent higher than in children, due primarily to their poor control of behavior and emotion.58 A portion of this burden is a consequence of sexual activity: pregnancy, sexually transmitted infections, and emotional turmoil. In devising an effective public health response to this crisis, the process of adolescent decision-making 59 must be examined.
Again, thanks to the new technology, we have a window through which we can observe, measure, and record the brain at work. The “neurobiology of decision making”60 indicates that making choices relies on at least twelve different brain regions. These areas include cognitive and affective circuits, meaning decisions are based on both thought and emotion.
You're Teaching My Child What? Page 7