TEENAGE girls in Baltimore may soon start giving somber new meaning to an old love song: "I've got you under my skin."
Beginning this month, public and private organizations in the city are collaborating on a program to give sexually active teens Norplant, a five-year contraceptive that is surgically implanted in the upper arm. Officials hope the program, offered at clinics in public schools, will reduce the city's teen pregnancy rate, one of the highest in the country. A separate program in the District of Columbia will give Norplant to 50 teenagers in the city's poorest neighborhoods.
Unlike earlier controversies surrounding Norplant, in which judges ordered the contraceptive for women convicted of child abuse, these school-based programs are voluntary. Even so, they raise difficult questions: Can 12- and 13-year-olds truly give "informed consent"? Can they understand that side effects are numerous and that the drug offers no protection against AIDS? And can medical researchers prove that the drug is safe for young bodies barely into puberty?
Baltimore and Washington are not the only cities searching for new solutions to a seemingly intractable problem. Other respected advocates for the family are also considering ways to reduce the teen-pregnancy rate, which results in nearly half a million births a year.
One advocate, Justice Richard Neely of the West Virginia Supreme Court of Appeals, proposes giving teenagers a financial incentive to use Norplant. A 12-year-old, he suggests, might be paid $500 to get Norplant and $150 a year after that.
Although critics charge that incentives like these are racist, Justice Neely points out that the underclass in his state, West Virginia, is almost all white. Calling himself "credible as a nonracist," he says, "I am speaking for heartland America, where the underclass is growing by leaps and bounds.
"We have got to make a major statement that illegitimacy is a serious problem," Neely adds. "It's not just one of those things that we can be nonjudgmental and amiable about. It's time to go back to saying, `If you get pregnant you have done something wrong, and if you get your girlfriend pregnant you have really done something wrong.' "
Jay Belsky, a professor of human development at Penn State University, prefers a different kind of financial incentive for teenage girls. He proposes setting up a "future-oriented deferred gratification system" in areas with high rates of teen pregnancy. Beginning in seventh grade, he explains, "Every four, six, or nine months, all female students could get a visual and hand-across-the-tummy examination to determine whether or not they're pregnant. If not, they would receive a payment, perhaps $25, with a matching payment going into an escrow account." Every time they came in, the payment would be increased - $50, $75, $100 - as would the matching escrow payment.
If the girls graduate without getting pregnant, all the money in the escrow account would be theirs, Professor Belsky says. "Should they choose to invest it in post-high school education, it would be matched - perhaps even doubled or tripled. These girls would come to discover that not getting pregnant had short-term and long-term monetary benefits."
Opponents might argue that these incentives encourage abortion. But Belsky's aim is to encourage abstinence and responsibility, messages that have until now met with little success.
For both Neely and Belsky, the lack of public money poses problems. But as Neely notes, teenage pregnancies involve higher risks and thus higher costs. Incentives to prevent pregnancy would require less money than medical and welfare payments.
Whatever role Norplant might play for teenage girls, it can hardly be viewed as a panacea. It also leaves an important question unanswered: Where are the programs and incentives to help teenage boys, the partners of these girls? Until young men and young women alike understand the consequences of too-early childbearing - and the educational and economic rewards that come from postponing parenthood - Norplant remains only the latest quick fix for a problem whose solution depends more on new attitudes than
on new technology.