The issue of teen pregnancy usually conjures images of a girl - barely out of elementary school, it seems - with a bulging belly.
But for every pregnant girl there's a boy or man who helped put her in that situation. He's "pregnant," too. And, advocates say, males need just as much counseling and attention as females on relationships, pregnancy prevention, and, if a baby is born, responsible parenting.
Nationwide, programs aimed at the guys are proliferating.
* In Des Moines, Iowa, one called It Takes Two blends stand-up comedy and motivational speaking to capture teen boys' attention. One skit, "GI Joe and Barbie Go on a Date," illustrates gender roles in male-female communication.
* In Philadelphia, the Responsive Fathers Program gathers boys into a series of school assemblies with male role models - teachers, staff, and volunteer fathers - to share experiences and puncture myths about "maleness."
* In Greensboro, N.C., a program called Wise Guys stresses abstinence from sexual activity. Small groups of middle-school-aged boys are gathered weekly in schools, where organizers focus on values, communication, and sexuality.
"We're in one of these swings where men and fathers are hot, and we have a more sophisticated generation of programs," says Freya Sonenstein, lead researcher for the book "Involving Males in Preventing Teen Pregnancy," released yesterday by the Urban Institute. "They're not just hiring an outreach worker to bring someone into a clinic with pink walls."
Indeed, getting guys in the door isn't always easy. Since they're not the ones who actually get pregnant, they usually feel they have less at stake when they become sexually active. Some programs operate in boys' clubs, whose primary attraction is recreation. Others are centered in clinics, where boys go for sports physicals and other health issues. Some gather groups in juvenile detention centers, where a high percentage of residents already have children, to work on parenting skills and preventing future pregnancies.
Success is hard to gauge. The teen pregnancy rate has dipped, and the average age of first intercourse for both boys and girls has gone up slightly, but both trends could be the result of various factors. The dramatic rise in condom use since 1979 may be as much a result of AIDS as a desire to prevent pregnancy.
In her book, Ms. Sonenstein focuses on 24 programs that have been around for at least a few years. Programs come and go, she says, but the ones that last are ones that can continue to drum up enough funding to survive.
Still, sometimes it's the anecdotal evidence that lets program directors know they're reaching kids. Tom Klaus, who runs It Takes Two in Des Moines, pulls out a letter from a boy who said he had "messed up" in his relationship with his girlfriend, and that It Takes Two "helped me think about the situation and make changes in my life."
Since 1993, It Takes Two has been replicated 23 times in nine states, and one of the programs is "abstinence only" - that is, there's no talk about contraception. Increasingly, more of the programs aimed at boys may go that route, as states tap new federal grants designated just for abstinence-only programs.
As with programs for girls, the question of whether to discuss birth control depends entirely on the audience, say experts on teen pregnancy. For teens who haven't become sexually active, abstinence is the appropriate focus. But for others, especially older teens, who are more likely to be having sex and may already even be parents, it's essential to talk about ways to protect against sexually transmitted diseases and unwanted pregnancy, say advocates of the "comprehensive" approach to sex education, which includes discussion of abstinence as well as birth control.
For many activists, the debate about whether to discuss birth control overshadows other important elements of programs. "A lot of boys know about condoms, but not a lot about what it means to be a man," says Sarah Brown, director of the National Campaign to Prevent Teen Pregnancy.
Greg Patton, director of the Responsive Fathers Program in Philadelphia, combats the notion that there aren't enough positive male role models - even in the inner city, where absent fatherhood is rampant. In Mr. Patton's program, boys learn that many of the men in their lives - teachers, principals, janitors - are people with families who are examples of responsible manhood.
"These kids attach low value to sex," says Patton, who was himself a teen father whose in-laws forced him to take responsibility for his daughter. "They think they can get their girlfriend pregnant and she can just collect welfare."