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Alexandra Fren
Urban Studies Senior Seminar
Professor E. Thomas
30 April 2014
Examining the Economic Consequences of Unintended Teenage Pregnancy and the Intersection
of Poverty and Teenage Pregnancy, in Urban Areas
Introduction
The Center for Disease Control calls the issue of teenage pregnancy “one of its top six
priorities, a “winnable battle” in public health, and of paramount importance to health and
quality of life for our youth”(CDC-About Teen Pregnancy). Teenage pregnancy leads to high
rates of high school dropouts, increased reliance on welfare, increase in crime and general
poverty (Burt 1987, CDC-About Teen Pregnancy 2012). These are all issues that have serious
and detrimental consequences for the nation as a whole, specifically urban areas. Because of the
severity of these problems many solutions have been proposed, in an attempt to both alleviate the
symptoms and mitigate the root cause. From this, a direct correlation between abstinence only
education and an increase in unintended teenage pregnancies has been identified (Kohler). If this
correlation has been proven to exist, why do some areas that have comprehensive sex education
(the opposite of abstinence only sex education) have higher rates of unintended teenage
pregnancy than other areas that also have comprehensive sexual education?
I will explore this question through the use of case studies, examining three
cities-Memphis, Baltimore and Portland. Two of these are high poverty areas (Memphis and
Baltimore) and two of these cities have comprehensive sexual education programs (Baltimore

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and Portland). These case studies will allow me to examine the direct economic effects within
urban areas. Additionally, this intersection will allow me to examine further questions of the role
that unintended teenage pregnancy has on poverty. More specifically, this analysis will seek to
explain or understand the intersection of sex education and poverty within urban areas. It will
allow me to examine the complexity of these issues (teenage pregnancy in relation to poverty), in
metropolitan or urban areas of the United States.
This issue is an important aspect of examining and understanding the urban environment.
Identifying the effects that this issue has, and looking at the impact they have from another
perspective (an economic one), could provide an additional argument for change. Additionally, it
sheds light on a variety of issues that exist within urban communities including urban education,
poverty and crime and lack of access to affordable health care. Another urban issue that this
problem highlights is one of policy construction. If parents in an urban area want their children
to receive more comprehensive sexual education, but the state or national government has stricter
restrictions on what is allowed, there is a significant barrier in what can be accomplished and
changed. Thus, the complexity of how the federal, state and local governments influence political
feasibility in regards to this issue will be examined as well.
To understand these issues I will begin by I examining the economic consequences of
abstinence only reproductive health classes as identified by previous research. To do thiss I will
first need to examine the impacts of unintended teenage pregnancy, and from there I will be able
to determine the compounded economic impact of consequences of abstinence only reproductive
education on a community. To calculate the economic consequences of the different programs in
the three cities, I will use averages so as not to exaggerate or overestimate the economic impact

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of any consequences of unintended pregnancy or sexually transmitted diseases. I will examine
the economic consequences of unintended teenage pregnancy for the teenage mother, for the
community, and more generally, consequences for the future life of the unborn child. From these
economic statements will we be able to offer evidence further supporting the adoption of
comprehensive sexual education programs within schools.
“In 2008, teen pregnancy and childbirth accounted for nearly $11 billion per year in costs
to U.S. taxpayers for increased health care and foster care, increased incarceration rates among
children of teen parents, and lost tax revenue because of lower educational attainment and
income among teen mothers” (CDC-About Teen Pregnancy). This is a national total. I will break
this number down further so that it is more accessible, and provides a stronger argument for
increased use of comprehensive sex education. $11 billion as a country is astronomical, but it
doesn’t provide a good breakdown of where this money is being accounted for. Is this a
disproportionately abstinence-only sexual education problem? Are these numbers higher in high
poverty urban areas? I will examine these questions through the use of the economic model in
my results.
My literature review will provide background information about the effects of teenage
pregnancy and what their economic impacts will be by examining previous research. I will then
use this information to craft a model by which to examine the case studies. The use of case
studies allows me to look more closely at the issue through an urban lense, by examining the
direct effects that unintended teenage pregnancy has has on three separate urban communities.
Additionally, it offers the opportunity to discuss issues of local vs. state vs. national government,
and to consider the effect and importance of cultural atmosphere with a city on political

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feasibility.
Background and Explanation of Issues
A. Description of Reproductive Health Programs
The current atmosphere surrounding reproductive education in the United States includes
two distinct schools of thought about the way that this information should be presented to
students. The two sides of these debates are generally characterized as comprehensive sex
education, and abstinence only sex education. Abstinence only programs are ones that teach
students that abstaining from sex is the only moral approach to sex, until they are married. After
they are married, they are free to engage in healthy, albeit monogamous, sex lives. They do not
typically provide information about contraception. If they do provide information about
contraception it is in regards to STD transmission, in the form of using them to prevent the
spread of HIV, but abstinence is still stressed as the best way to prevent the spread of HIV.
(Collins). Abstinence only programs are most often instituted in states that are politically
considered ‘red’ states. These places ares one that traditionally have republican/conservative
elected officials. Currently, these parties have platforms that value religious issues and family1
values over sexual freedom and reproductive health. This leads them to implement programs that
stress or only cover abstinence as an approach to sexual education, if sexual education is
approached at all (there are some states that do not include a reproductive education course in
their curriculum). States that have abstinence only sex education programs, (and are mandated to
have these programs) are Georgia, Iowa, Kentucky, Minnesota, Mississippi, Montana, North
1
Of the 14 states that stress abstinence when reproductive education is provided, but provide no
information on contraception, 10 states are considered classically ‘red’ (guttmacher)(Election Maps). 2 of
these states, Oklahoma and Texas, provided information on contraceptives when HIV education was
taught (guttmacher).

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Dakota, Ohio, Tennessee, and Utah (Guttmacher).
Comprehensive sex ed programs are those that educate students about the options
available for contraception and educate them about the prevention of unintended pregnancy and
the contraction of STDs in their adolescent years. It presents abstinence as an option, in addition
to contraceptives. Comprehensive sexual education programs are not ones that push
contraceptives onto students, and are not “pro-sex” (in that they do not actively encourage
adolescents to engage in sexual behaviors) just as they are not “anti-abstinence”. Comprehensive
programs are, as their name indicates, meant to comprehensively provide all of the options
available (Collins). Arguments for comprehensive sexual education programs argue that
teenagers who are exposed to abstinence only sex ed are not less likely to engage in sexual
behaviors simply because they were told not to (Collins). Because they are not less likely to
engage in these behaviors, but do not have any other information about preventing pregnancy
and STDs, the rates of these are higher in states that have abstinence only education (Kohler
2008, Luker 2006). Additionally, there is substantive research that states that receiving
comprehensive sexual education does not encourage adolescents to engage in sexual behavior
earlier than they would have if they had been in an abstinence only class (Kohler). The states that
have mandated reproductive education programs and provide information about contraceptives
are Delaware, Maine, Maryland, Nevada, New Jersey, New Mexico, North Carolina, Oregon,
Rhode Island, South Carolina, Vermont, West Virginia, and the District of Columbia2
(Guttmacher).
2
These states, combined with the states that mandate abstinence only sex education, only total 23. The
other 28 states(this total includes District of Columbia) may have abstinence or comprehensive or
abstinence only education, but reproductive education is not mandated within these states, so they will
not be used in this study.

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B. Consequences of Abstinence Only Reproductive Education
Abstinence only sex ed programs are ones that provide information to their students that
focuses solely on the continuous avoidance of intercourse (vaginal, oral and anal) as a means to
prevent pregnancy, in addition to the transmission of STD’s. Abstinence-only sexual education
programs advocate for the advoidance of sexual intercouse until marriage because it is the only
100% effective method for protection against pregnancy and STD’s. There are additional moral
and family planning issues involved as a substantive part of the debate. The problem with this
narrative is that very few Americans that receive this education wait until marriage to begin
having intercourse. We can determine this by examining data on median age for first intercourse
in contrast with data on median age for first marriages. The median age at which women first
engage in sexual intercouse, as of 2007, is 17.4 years, but the median age of first marriage is 25.3
years (Santelli). Obviously, 17 years of age is within the typical range of ages for high school
students (which is composed of adolescents typically aged 14-19). This means most women are
engaging in sexual intercourse during their high school years-before most have married.
Additionally because the median first age is that of a high school aged woman, it is even more
important that women are exposed to this information-when it will be useful in helping them
protect themselves from unintended pregnancy and contraction of sexually transmitted diseases.
There is also a gap in these numbers for young men. In a study by Guttmacher Institute, close to
60% of young men aged 15-19 said that they had engaged in sexual intercourse, but less than 5%
of these young men had ever been married (Singh) Additionally, for young women surveyed,
roughly 50% of women aged 15-19 said they had engaged in sexual intercourse, with
approximately only 10% having ever been married (Singh). Historically, this gap has not been so

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wide. In 1970, the difference between median age at first intercouse and median age at first
marriage was only a year (note that there was still in fact, a gap) (Santelli). During the 1970’s it
was less detrimental for an abstinence only program to be employed, because the disparity in
ages was not quite as severe. In modern times, where adolescents are not engaging in sexual
behavior at roughly the same time they are getting married, comprehensive sexual education
becomes key. This is because of the increased risks associated with abstinence only sexual
education.
There is significant higher risk for contracting an STD or becoming pregnant during the
adolescent years. Adolescents have the highest number of unintentional pregnancies (Santelli).
Furthermore, the number of STD’s unintended pregnancies is higher among teenagers who are
taught abstinence only (Kohler 2008, Eng 1997). This may be because they are unaware of the
risks of intercourse (the chances of becoming pregnant or contracting an STD are under assumed
or unknown by those with this education), or they believe in myths they have heard because they
do not have access to credible knowledge , but they are still largely engaging in sexual3
behaviors.
C. Economic Consequences of Unintended Pregnancy and Contraction of Sexually Transmitted
Diseases
It is important for us to look at the economic consequences of these issues, and not just
the birth rates because birth rates, just as any other economic indicator, can not tell the full story
of teenage pregnancy. Because of the nature of the numbers, birth rates can seem misleading. In
ones mind, a difference between 60 unintended pregnancies and 70 unintended pregnancies in
3
An example of these myths would be using two condoms to increase pregnancy prevention when really
this increases the likeliness of breakage, thus increasing the risk of STD contraction or unintended
pregnancy.

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every 1,000 may not seem large. However, when you apply this to a city of population of
500,000, this increase of 10 in 1,000 amounts to an increase of 5,000 more teenage pregnancies.
Birth rates have the potential to make teenage pregnancy seem like less of an issue than it really
is. By examining the economic impact of teen pregnancy on teenage mothers, their children and
the public more generally (and by association abstinence only sex education), I am able to
provide an additional counter pointer against abstinence only sex education, or alternatively,
another pro in the favor of comprehensive sexual education.
The economic impacts of unintended pregnancy and sexually transmitted diseases will be
widespread, and not every single consequence will apply to every individual that contracts an, in
the same way that not every adolescent who is enrolled in an abstinence only sexual education
program is going to become pregnant or contract an STD. Additionally, while I believe that the
effects of STDs are significant and should be combated, for the purpose of this paper, our focus
will be more heavily on the economic consequences of unintended teenage pregnancy, as these
impacts are more significant and more long term.
There are significant consequences for unintended teenage pregnancy within a
community. Some of the most common economic consequences of unintended pregnancy are:
increased rates of adolescents on welfare, increased rates of young women dropping out of
middle or high school, and increased rates of single mother families (Burt 1986; CDC 2014;
thenationalcampaign.com). All of these are measurable within a community, and each has a
quantifiable economic impact. There will be additional impacts that are more specific to each
individual involved. For teenage mothers, the economic consequences are significant. Teenage
mothers are less likely to finish high school than their non-pregnant counterparts-only about 50%

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of teen mothers receive a high school diploma by 22 years of age, versus approximately 90% of
women who had not given birth during adolescence (CDC). Because teenage mothers are more
likely to not finish high school, they deny themselves access to higher paying jobs, because they
do not have the necessary education. This results in lower pay, lower likelihood of having health
insurance (low-paying jobs do not typically offer health insurance options to their employees),
and longer hours required to work to support a family-this results in time spent away from their
families, which has more direct consequences on their children. The culmination of these issues
is that women who become pregnant in their adolescence and choose to keep the child are more
likely to enter or remain in poverty (Sum).
Economic consequences for the father vary extensively depending on the father’s
involvement in the birth of a child and whether or not they remain in the child’s life past birth.
Because of this I will not be including data about them in my economic analysis. Teenage fathers
are largely able to avoid economic consequences of impregnating someone during their
adolescence if they do not take responsibility for the child, and the mother does not take legal
recourse against them. If the father is involved, he will have two options-to raise the child with
the mother, or to simply provide financial support. In the first situation, where the father helps
the mother raise the child, there are similar, if less magnified economic effects to those that
teenage mothers experience. The percentage of teenage fathers that drop out to support the
mother of their child and their child varies based on many factors. For example, teenage fathers
that marry the women they have impregnated are more likely to drop out of high school than
those who do not marry the women they have impregnated. Factors such as race, religion, and
age have been shown to be corollary in the relationship of whether or not a teenage father will

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move in and marry with the adolescent woman he has impregnated (Marsiglio). If a teenage
father does drop out of school, he will face similar economic costs as teenage mothers.
Economic impacts for the community are widespread, and not as easily pinpointed. Some
of the economic impacts of a teenage pregnancy include higher rates of citizens on welfare,
decreased education level of the workforce, subsidization of health care costs and increases in
poverty and crime (CDC 2014, thenationalcampaign.com, Burt 1986). Teenage mothers have a
“34% chance of being on welfare after an unintended pregnancy”, which can most likely be
explained by the loss of economic opportunities that would have been afforded to them if they
had completed their education (Burt). Decreased education levels of the workforce can be
explained by the idea that only 50% of adolescent mothers will graduate from high school. A less
educated workforce leads to a less effective workforce. Another consequence of having a less
educated workforce, is that uneducated teenage mothers will often be working low income jobs
that offer little or no health insurance (Sum). This can lead to high rates of women on Medicaid
or to debilitating illness, for women who choose to ignore their health problems because they
can’t afford to go to the doctor. This either perpetuates poverty, leads to increased healthcare
prices for others because of tax subsidization, increased taxes for Medicaid, or to an even further
decreased functioning of the workforce because these women are ill and thus not working at full
capacity. These all have negative effects on the economic vitality of the community. Fourth,
there are many ways that unintended teenage pregnancy can lead to an increase in crime and
poverty. If women are not making livable wages, they will be living at or below the poverty line
unless they are receiving considerable support from an outside source (be it their families or help
from the father of their child). Those living in poverty are more likely to turn towards to crime to

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support themselves, and crime, nor poverty in general, is a good economic indicator for a
community (CDC-About Teen Pregnancy).
For the children of adolescent mothers, the economic repercussions will be felt for the
majority of their lives. Children born to adolescent mothers should expect to face more issues
than children not born to teenage mothers. “Children born to teen mothers often do not have an
even start in life. They are more likely to grow up in a poor and mother-only family, to live in a
poor or underclass neighborhood, and to experience high risks to both their health status and
potential school achievement” (Maynard). They are more likely to be incarcerated at some point
in their lives, and they are more likely to drop out of high school than children not born to
adolescent mothers. 10.3% of those born to mothers under the age of 17 will be incarcerated in
their lives, as compared to 3.8% of those born to mothers aged above 18 (Maynard).
Additionally, “only 77% of children born to adolescent mothers complete high school by early
adulthood compared to 89% of the comparison group” (Maynard).
It is important to consider that not all adolescents that become pregnant face the same
socioeconomic, cultural or religious boundaries. Some teenage adolescents will be more heavily
affected by a teenage pregnancy. If they must pay for a pregnancy and future child fully by
themselves (they have no support from their parents), then the economic consequences will be
greater, both for themselves and the community. If they have strong religious beliefs, or a
community culture that is very opposed to teenage pregnancy, they may lose support from their
parents both monetarily and emotionally. It is necessary to consider that not every case is the
same when looking at statistical and economic impacts.
Finally, it is important to consider, as a side note that one quarter of all contracted STD’s

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are contracted by adolescents (NAP). The most common economic consequences of sexually
transmitted diseases are: increased rates of hospitalizations and subsequent medical costs leading
to unpayable bills, lost workplace time due to STD related illness, and death (NAP)​. ​While I will
not be evaluating STDs in my economic analysis, they are a significant part of the sexual
education problem in urban areas.
D. How Comprehensive Sexual Education Prevents Unintended Pregnancy and increased rates of
STD’s
Comprehensive sexual education programs work by providing teenagers with the
information that they need to safely participate in sexual activities. Comprehensive sexual
education that works and is efficient provides information on birth control/contraceptives.
Statistics and studies show that teenagers are going to have sex regardless of the type of
reproductive health program they are taught. We saw this through the disparity in age at first
intercourse and age at first marriage. Because of this, comprehensive sexual education programs
are more effective at preventing unintended teenage pregnancy and sexually transmitted diseases.
Comprehensive sexual education provides teenagers with resources and information about how
to make healthier decisions, so that if they do have sex, they are more likely to use birth
control/contraceptives, driving down rates of teenage pregnancy and STD’s.
The biggest counter-argument against this statement is that comprehensive sexual
education programs encourage adolescents to engage in sexual behaviors, whereas if they have
been in an abstinence only sexual education class, they would not be encouraged to engage in
these behaviors, because these teach abstinence from sex only (Collins). Many advocates for
abstinence only education claim that comprehensive sexual education sparks curiosity in

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adolescents and leads to sexual experimentation. In a study conducted by Kirby, a review of 48
studies on comprehensive reproductive health programs showed strong evidence that
comprehensive sex education does not cause increased rates of sexual activity (Kirby). These
studies showed that “some of them reduced sexual activity, or increased rates of condom use or
other contraceptives, or both (avert.org).
E. Community Impacts of Unintended Teenage Pregnancy and Sexually Transmitted Diseases
​Impacts felt in a community due to unintended pregnancy and sexually transmitted
diseases vary between community based on how socially accepted it is to have a child as a
teenager, which is further complicated by whether to not the pregnancy was intentional and
whether or not the child will be born in or out of wedlock. The levels of social acceptance will
depend on religious values held in that community, levels of previous prevalence, etc. It is
impossible to generally conclude what the impacts are within communities because the cultural
climate is vastly different within different communities.
The community impact and social consequences of STD’s is dependent on the
community also, but with less variance between areas. Because most sexually transmitted
diseases are treatable, and they do not outwardly reveal themselves to others, their biggest social
impact is due to stigma. If individuals with sexually transmitted diseases that are not HIV do not
choose to reveal that they have an infection, the social consequences are insignificant. For
individuals living with HIV, the impacts are somewhat different. The stigma associated with
living with HIV/AIDs is much higher than that of any other STD because it is not curable and
can have dramatic life consequences. These levels will be increased or decreased based on
prevalence of the illness in the area, and also on what programs or campaigns the city or

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organizations within the area have put into place to try and educate people about and reduce
stigma around the illness.
From an outside perspective, the community and social impacts are more easily
measured. High levels of teenage pregnancy and high levels of contracted sexually transmitted
diseases does not make a city appear healthy or economically prosperous. Having high levels of
these forces a city to allocate higher levels of its resources to dealing with these issues meaning
that it can not use these resources elsewhere. The lower the levels of teenage pregnancies and
sexually transmitted diseases a city has, the healthier it seems. Community impacts and
community culture will be important things to consider when examining solutions for each case
study that I examine. Taking into consideration the religious, cultural, economic and social
dynamics of areas will be important when determining if solutions are politically feasible. These
will have a direct impact on whether or not a solution is feasible for an area. While ideally,
suggestions for improvements could be made very generally, I am aware that in some cases it
would be unlikely for a community to adopt a radically different program than the one they
currently have in place.
Methods
To examine the intersection of sex education and poverty, and to examine the negative
economic effects of abstinence only sex education, I will look at three case studies of urban areas
to highlight differences and look for possible explanations, and to measure the impacy of
abstinence only sex education.The three cities will include one that has an abstinence only sex
education program, and then two cities with comprehensive programs-one that has high levels of

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poverty and one that has low levels of poverty. I will look at these two cities to see if there is an
explainable difference between the city with high levels of poverty and the city with low levels
of poverty in regards to teenage birth rates. If there is not an explainable difference, I will pose
further questions, and offer explanations as to what possible reasons for this lack of explanation
could be.
Obviously these case studies will not be universally applicable to all cities in America, as
every city within the country is different in terms of racial and socioeconomic demographics,
cultural values and norms, importance of religion, and various other factors. Because the
atmosphere within none of these cities will be exactly the same as it is elsewhere, I will be able
to make specific recommendations for each city, and then general recommendations based on the
general attitudes and atmospheres surrounding sexual education in the United States.
To examine this, I will look at a general economic model which will highlight the key
economic effects of teenage pregnancy, and measure how exacerbated these effects are within
the three case study cities. From there, I will draw conclusions about what can and should be
done, and what these results mean.
A. Methods for Case Study
To create an economic model that will be used for the cities, I must identify which factors
will be used in the calculations, and then assign a monetary value to each of these consequences
of unintended teenage pregnancy. I will examine the consequences for mothers, and the
community as a whole. For mothers, I will consider the economic impacts of them dropping out
of school, because the additional repercussions come out of this initial impact. I will discuss the
economic consequences of this initial consequence. Adolescent women who become

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unintentionally pregnant, but have the support of their families, the fathers of their child, and the
community around them, are much less likely to drop out of school because they do not feel
emotional and economic pressures to do so. These women will have lower economic impacts.
While the economic impact of the child is not considered in my economic analysis, it is
important to consider the consequences for these children. For the future child there are
increasingly high dropout rates, incarceration rates, likelihood of unemployment and likelihood
to themselves birth a child during their adolescence. These are all increased risks, in addition to
lower school achievement and having more health problems (CDC).
Finally, for the community as a whole, I must consider all of the effects that teenage
pregnancy has on the community through indirect actions, but also must consider the direct
effect it has on individuals, and how those effects in turn affect the community. I will discuss
then, the effects of the individual consequences for the mother, father and future child, and how
those feed into the economic effect on the community. Additionally, I will examine how welfare
reliance, poorly educated workforces, and high healthcare costs affect a community
economically.
To determine economic impact, I will need to estimate numbers for each of the impacts that I
highlighted in the section on economic consequences of unintended teenage pregnancy. It is
estimated that 50% of teenage mothers will not graduate from high school. For numerical and
economic purposes of calculating impact, I will divide all provided rates of teenage pregnancy in
half, assuming that, based on statistics, half of these women will not graduate from high school.4
4
There are several important things to consider when we are taking this number at half of its value. The
socioeconomic status of an area will affect whether or not the number of women who do not graduate
high school in area is truly 50%. If an area is more affluent this percentage may be lower, whereas if there
are high levels of poverty, where when women become pregnant there families are less likely to be able

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From there, I can calculate economic impacts for the consequences that arise from not graduating
high school due to an unintended teenage pregnancy.
The numbers used to calculate the cost by mothers, fathers, their children, and the
community as a whole, to the community, will be calculated in a number of steps. We will not
have a nice whole number to examine in the end because of the inaccuracies from combining
several numbers. Rather, taking each number for its value, and making more general statements
about overall trends in the data will provide a stronger argument. This is because none of the data
can be taken at complete face value, as everything is an estimate. For mothers the numbers we
will consider are SNAP benefits, the differences in possible incomes due to education levels, and
the costs of healthcare. When discussing the economy, I will take into consideration generally
previously stated numbers and make claims about what these numbers mean for the community
as a whole. This is lost economic activity, lost workplace investment and an increase in tax
dollars collected and spent. With the reversal of these issues, these communities could see an
increase in economic activity, and flourish.
B. How The Cities Were Chosen
In picking the three cities that would be used as case studies, a matching process was
used. The first city that was identified was Memphis, in Southwest Tennessee. Memphis has one
of the highest rates of high school dropouts due to teen pregnancy in the United States
(CROW-Shelby County Teen Pregnancy and Parents Needs Assessment). It exists in a state
where the sexual education provided in public schools is abstinence only, and when discussing
the prevention of HIV the importance of abstinence is stressed, and the concept of condoms is
to support them, then the percentage may be higher. Because of this, while 50% may not be fully
accurate, I will use it as a good median value.

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ignored (Guttmacher). The population of Memphis is 655,155. The city also has a 20.6% rate of
the general population that is below the poverty line, with 17.2% of families below the poverty
line (US Census-Memphis).
Because this study will examine the intersection of sexual education in public schools
and its economic impact on an urban community, the other case study should be a city where the
public schools have a comprehensive sex education program to contrast the economic impact
against the economic impact of sex ed programs. To control for the possible effect that poverty
could have on the measures that will be used to determine economic impact, two cities will be
chosen, one with a poverty level comparable to that of Memphis, and one with a healthier
poverty level. Both cities will have similar population sizes to Memphis, and both will have
comprehensive sex education programs in their public schools.
Selecting the cities began by narrowing the list of states down to those that offer
comprehensive sex ed that covers contraception and HIV, not just abstinence. The states that
offer comprehensive sex education are Delaware, Maine, Maryland, Nevada, New Jersey, New
Mexico, North Carolina, Oregon, Rhode Island, Vermont, West Virginia. (South Carolina and
District of Columbia were removed from the list because even though they offer information
about contraceptives, they do not offer information about HIV)(Guttmacher). From this
narrowed down list, a list of cities for each state was compiled, and states without a city of
between 500,000 and 800,000 (150,000 plus/minus Memphis’ population of 650,000). This
removed Delaware, Maine, New Jersey, Rhode Island, Vermont and West Virginia. This left
Maryland, Nevada, New Mexico, North Carolina and Oregon to be analyzed (US Census).
Cities in these 5 states that fell in the 500,000 to 800,000 are Baltimore(MD), Las

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Vegas(NV), Albuquerque(NM), Charlotte(NC), and Portland(OR). Baltimore has a population of
621,342, 19.3% of its population is below the poverty line, and 15.4% of its families are below
the poverty line. Las Vegas has a population of 596,424, 8.9% of the population was below the
poverty line and 6.6% of families were below the line. Albuquerque has a population of 555,417
with 13.5% of the population below the poverty line with 10% of families below the poverty
line. Charlotte has a population of 775,202 with 10.6% of the population below the poverty line
with 7.8% of families below the poverty line. Portland has a population of 583,776 with 13.1%
of the population below the poverty line with 8.5% of families below the poverty line. As a
reminder, the population of Memphis is 655,155 with 20.6% of the population below the poverty
line and 17.2% of families below the poverty line (US Census).
From this, these 5 cities can be divided into two groups, those with poverty levels similar
to Memphis, and those that are economically more prosperous. The only city with similar
poverty levels to Memphis is Baltimore. Because of this, Baltimore will be one of the 3 cities
used as a case study, in addition to Memphis. The final city will be selected from the remaining
four cities-Las Vegas, Albuquerque, Charlotte and Portland. To determine which one to choose,
variables of, which has the population size closest to Memphis, which has lowest poverty levels,
and which has the most unbiased sexual education program. From this, Portland was chosen (US
Census-Portland, Guttmacher).
Results and Discussion of Cases
C.History of Sex Education in Tennessee, Oregon and Maryland
History of Sex Education in Memphis City Schools

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Tennessee state law requires school districts within the state to promote abstinence from
sexual activity not within the confines of a marriage. However, the state largely leaves the
execution of this class up to the school district (NCSL-State Policies). Memphis has an
abstinence only sexual education program. However, there are many caveats to the requirements
of this class. Reproductive Health classes are only required in Tennessee if “the teen pregnancy
rate in any county exceeds 19.5 pregnancies per 1,000 females aged 11 through 18” (NCSL-State
Policies). Additionally, the law “prohibits instruction and distribution of materials that promote
“gateway sexual activity”(NCSL-State Policies). The most recent change came in 2012, making
it even harder for students to get access to reproductive health, even if it is just abstinence only
sex ed. Memphis City Schools reformed their sexual education program so that parents
signatures are required for students to receive sex ed and information on HIV/STDs. This allows
parents to opt out of the abstinence only sex education provided to students making the epidemic
of unintended teenage pregnancy and STDs even greater as adolescents may no longer receiving
any credible information, especially if their parents are not educating them (MCS Opt Out).
Memphis City Schools teach a program called Family Life Education which places an "emphasis
on abstinence from sexual relations outside of marriage" (NCSL-State Policies). The current
state of sex ed in Memphis City Schools is the bare minimum, that is only taught when deemed
absolutely necessary, and from there, parents must give their permission. The teenage pregnancy
rate in Memphis (ages 15-19) is 87.6 per 1,000 adolescent girls (CROW-Shelby County Teen
Pregnancy and Parents Needs Assessment). This is nearly 5 times more than the national rate of
29.4 births per 1,000 girls (CDC). The rate is also higher than the state average, which has an
average of 71.7 births per 1,000 adolescents (TNStateHealthDept).

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History of Sex Education in Portland Schools
Oregon state law stipulates comprehensive sexual education programs, with the most
recent update to the law occurring in 2009 (NCSL-State Policies). The law is comprehensive and
inclusive, highlighting healthy relationships, consent and pregnancy prevention. Excerpts from
the two page provisions state that stand out from other programs include “abstinence may not be
taught to the exclusion of other material and instruction on contraception and disease reduction
measures. Human sexuality education courses shall acknowledge the value of abstinence while
not devaluing or ignoring those students who have had or are having sexual intercourse” and
“discussion about the characteristics of the emotional, physical and psychological aspects of a
healthy relationship and a discussion about the benefits of delaying pregnancy beyond the
adolescent years as a means to better ensure a healthy future for parents and their children” and
finally, “Teach students that no form of sexual expression is acceptable when the expression
physically or emotionally harms oneself or others and teach students not to make unwanted
physical and verbal sexual advances, how to decline unwanted sexual advances or accept the
refusal of unwanted sexual advances. Students shall be taught that it is wrong to take advantage
of or to exploit another person. Materials and information shall be presented in a manner
sensitive to the fact that there are students who have experienced sexual abuse”
(DeptofEdOregon). Many of these provisions go above and beyond the basic requirements of
comprehensive sexual education.
Teen pregnancy rates in Portland are only 16 in every 1,000 adolescents (Public Health5
Division-Oregon). This is only slightly higher than the state average of 13.5 per 1,000. This is
5
This number was taken from the Oregon Government’s Public Health website. The site updates the
numbers continuously as they gather new information, and there may be fluctuations within the data
throughout a year. This number was taken in March of 2014.

22. Fren 22
about half lower the national average of 29.4 per 1000.
History of Sex Education in Baltimore Schools
Baltimore schools follow the guidelines provided by the state of Maryland. Sexual
education is taught as a part of a seven part comprehensive sex education program. The
information presented on the Maryland State Department of Education website is vague, stating,
“Students will demonstrate the ability to use human development knowledge, social skills, and
health enhancing strategies to promote positive relationships and healthy growth and
development throughout the life cycle” (Maryland State Department of Education). This
statement is vague, but Maryland Public Schools ​are required to teach comprehensive sexual
education (Guttmacher). So why does Baltimore still have high rates of teen pregnancy (these are
admittedly still lower than those of states with abstinence only education), if it has implemented
a comprehensive sex ed program? It is possible that this is because the school system teaches
their students about these behaviors for only one day out of the year. It is interesting that moving
from a program of abstinence only education to a program that teaches comprehensive sex
education, even if only for one day, has associated lower rates of teenage pregnancy. The teen
pregnancy rate in Baltimore (ages 15-19) is 66 per 1,000 adolescent girls (Healthy Babies). This
is 1.5 times the national rate. Interestingly enough, the rate in Baltimore is double that of the rest
of the state of Maryland. This may indicate that teenage pregnancy rates are affected by whether
or not they are in a rural, suburban or urban area.
D. Examining the Economic Impact of Abstinence Only Sex Education Through Case Studies
(Memphis, Baltimore, and Portland)
Teen pregnancy has a high opportunity cost. The Supplemental Nutrition Assistance Program

23. Fren 23
(SNAP), more commonly referred to as food stamps, has a per individual cost of $1,699.20
(USDA-SNAP Eligibility). SNAP is paid for through federal taxes and is thus a direct drain on
the national economy. Individuals that qualify for SNAP benefits must be at or below their
poverty thresholds. The numbers for these are $1,681 a month for a two person family home,
$2,116 for a three person family (USDA-Snap Eligibility). To get a better idea of what these
numbers mean, a two person family would need to make below $20,172 a year to qualify for
SNAP. A three person family would need to make below $25,392 a year to qualify for SNAP.
Teenage mothers that drop out of high school are significantly more likely to be in poverty,
because their earning potential is so significantly decreased.
To illustrate this we can examine wage potentials for individuals based on education. On
average, adults with a high school diploma make an average of $651 a week, and have
unemployment rates of 7.5% (Employment Projections). At $651 a week, you have an average of
$33,852, which is above the poverty line meaning, on average, those with a high school diploma
would not qualify for SNAP. It is important to stress that these numbers are averages, and it is
possible that those with a high school diploma may not make this. Additionally, these numbers
do not account for part-time employment, which is where a significant portion of the working
poor finds employment. For an individual who did not complete high school, the average wage
earnings are $472 a week or $24,544 (Employment Projections). This instantly qualifies three
person families, but not two person families, for SNAP. However, there are other things to
consider here. These numbers are averages only for individuals working full-time jobs. We know
that many individuals who did not obtain a high school diploma are working in the service
industry in part time employment, earning minimum wage salaries, or not working at all (Sum).

24. Fren 24
An individual working in part time positions, and making minimum wage pay (federal levels of
minimum wage) must work 53 hours a week to not qualify for SNAP benefits . This is an6
unfortunate reality for many individuals who dropped out of high school because of unintended
teenage pregnancy. A large number of teenage mothers will qualify for and collect welfare,
specifically SNAP benefits. For simplification of numbers, I will claim that all mothers who drop
out of high school will need SNAP benefits. I will also take into consideration income lost due to
lack of educational attainment. There is a difference of $9,308 per individual of lost income for
every year that they do not receive a high school education (Employment Projections). This is
lost economic input for a community, that could have been used as an investment in the
economy. Additionally, a decrease in SNAP reliance and decreased healthcare costs that must be
subsidized by the community, would mean federal taxes could be spent solving other problems.
The costs of unpayable healthcare realized by teenage mothers are astronomical. For
teenage mothers who are dropping out of high school and entering the workforce at a low paying
job, health insurance from a job is often not a reality. This lack of health insurance leads to a
multitude of other problems, including high levels of women on Medicaid, or levels of
unresolved health issues for mothers that choose to sacrifice their health to avoid debt. By
preventing unintended teenage pregnancy we could have reduced Medicaid costs in the United
States.
D. Economic Impact of Abstinence Only Sex Education in Memphis
The high rate of teenage pregnancy in Memphis is so alarming that it has garnered
national attention. In 2011, nearly 20% of teenage women at one Memphis city high school, 90
6
At this time the Federal Minimum Wage is $7.25.

25. Fren 25
out of 508 girls, gave birth or were pregnant at the end of the year (Eng). This story drew
significant negative attention to the school and the city of Memphis as a whole. It shocked
people. But should it have? Tennessee as a whole has one of the top ten highest rates of teen
pregnancy, and Shelby County, where Memphis resides, has one of the highest count rates in the
state (Guttmacher, CROW). Memphis is not a good place to be an adolescent woman-with high
rates of teenage pregnancy coupled with high rates of infant mortality. The teen pregnancy
situation in Memphis is so bad that “in 2011, Tennessee was one of 17 states that received
funding from the US Department of Health and Human Services, Office of Adolescent Health to
design, implement, and evaluate a system of care aimed at supporting pregnant teens and
improving outcomes for teen parents. Tennessee is unique in that, rather than dispersing the
federal funds to several counties, the State chose to concentrate all of the federal monies on
streamlining the coordination of community-based pregnancy and parenting services in Shelby
County, coordinated by the Shelby County Office of Early Childhood and Youth” (CROW-Teen
Pregnancy and Parenting Success Grant). The situation in Memphis is so dire that the state
decided to funnel all of the money it received into the city. What is the economic consequence
of these problems?
The teenage pregnancy rate in Memphis is 87.6 per 1,000 adolescent girls. Women in
Memphis aged 13-19 compose 9.6% of Memphis’s total population of 646,889, meaning 62,101
of population is women aged 13-19 (US Census-Memphis). Using the Memphis pregnancy rate,
we can determine that there are approximately 5,440 teenage pregnancies in Memphis every
year. Assuming half of these women will drop out of high school leaves us with 2,720 adolescent
women dropping out of high school due to an unintended teenage pregnancy, every single year.

26. Fren 26
If all of these women rely on SNAP to supplement their income, they have a collective cost of
$4,621,824 to taxpayers. Unintended teenage pregnancy in Memphis creates a loss of
$25,317,760 in revenue that could have been earned if not for differences in realized wages.
There would be decreased number of teenagers relying on Medicaid if teenage pregnancy rates
were lower, which would decrease economic community burden.
The general demographic composition of Memphis is important to consider when
thinking about these rates of pregnancy. Demographically, Memphis is a majority African
American city. The 2010 census data shows Memphis as 62.6% African American, 31.7%
White, 5% Latino/Hispanic, 1% other/multiple races (US Census-Memphis). These numbers are
important to consider because African American males have the highest chance of fathering a
child during adolescence, but also the lowest likelihood of living with and supporting their child
after its birth.15% of African American males lived with their child as compared with “48
percent of Hispanics, 58 percent of disadvantaged whites and 77 percent of non-disadvantaged
whites”(Marsiglio). Secondly, there are significantly high rates of poverty in the city of
Memphis- ​17.2% of families and 20.6% of the population are below the poverty line, including
30.1% of individuals below the age of 18 (US Census-Memphis). Individuals who live in poverty
are more likely to drop out of high school because they have no other choice-they do not have
the emotional or economic support of their families. Thus, it is possible that 50% calculations
may have been a bit conservative when looking at Memphis.
E. Economic Impact of Comprehensive Sex Education in Baltimore
“Anyone who lives in Baltimore, reads the paper, or watches the local news knows that
there is a significant teen pregnancy issue in the City. Young girls with babies are ubiquitous,

27. Fren 27
day care programs in high schools are fairly common, and the children of teen parents often end
up in the news as either victims or perpetrators of crime. It has been this way for decades, and
there have been numerous attempts to address the issue. Baltimore has a higher than expected
teen pregnancy rate, and as such, has garnered attention from government. Several non profit
agencies within the area have taken up this issue, or been founded as a means to combat the
issue. Baltimore has a high level of teen pregnancy, but also has a high rate of youth poverty, and
is racially diverse (US Census-Baltimore, Baltimore Health). We know that rates are high here,
so we can expect the economic impact to be higher here as well. After I determine the economic
impact, I will need to consider the racial and economic composition of the city, and determine if
the high prevalence of teen pregnancy, even in the presence of comprehensive sexual education,
can be explained.
The teenage pregnancy rate in Baltimore is 66 per 1,000 adolescent girls. Baltimore
women aged 13-19 compose 9.5% of Baltimore’s 620,961 population (US Census-Baltimore),
meaning there are 58,991 women in Baltimore that are of the age where they could become
teenage mothers. This means there are approximately 3,893 young women that become pregnant
each year in Baltimore. Assuming that half of these young women will drop out of high school
leaves us with 1,947 young women who drop out of high school, every single year. If all of these
young women that drop out of high school receive SNAP benefits, the economic effect of these
pregnancies is $3,308,342. This is a difference of $1,313,482 from Memphis. Because these
young women are forced to drop out of high school they are losing out on $18,122,676 in lost
wages because of the education gap. This is a difference of $7,195,084 from Memphis.
Decreases in Medicaid would be present here as well, if teenage pregnancy rates were to

28. Fren 28
decrease.
The demographic composition of Baltimore is significantly different from the
composition of the young women who are giving birth within the city. The 2010 Census data
shows the city as being 63% African American, 29% White, and 4% Latino/Hispanic. These
percentages are numerically very similar to the composition of Memphis (US Census). 19.3% of
its population is below the poverty line, and 15.4% of its families are below the poverty line,
which is again, very similar to that of Memphis. Because Baltimore and Memphis are so similar
in composition, we can see that poverty has a direct affect on teen pregnancy rates-this will be
even further confirmed when I examine Portland. Because of this, I know that there will be
several factors involved in eradicating teenage pregnancy. “Poverty is both a risk factor for and a
consequence of teen births (Baltimore Health).
The program currently in place in Baltimore could be expanded. It is currently only a one
day a year program, and it is not taking full advantage of the comprehensive capabilities allowed
to is.
F. Economic Impact of Comprehensive Sex Education and Empowerment Education in Portland
The atmosphere surrounding teenage pregnancy is much different that that within
Memphis or Baltimore. Because there is significantly less teenage pregnancy here, the situation
is not under a microscope like it is in Memphis, nor are there significant numbers of nonprofits
that have been established to combat the high rates of pregnancy. Instead the largest
controversies surrounding the issue are often associated with those that are not in support of
comprehensive sexual education. When Portland and its teenage pregnancy issue come up in the
news, it is most often stories of parents or community members that are anti-planned parenthood

29. Fren 29
and anti-comprehensive sexual education, for reasons previously discussed, that are protesting
some aspect of the program. The teen pregnancy rate is low here, half that of the national
average. Because of this the atmosphere surrounding the issue is generally calm-the city, and the
state are handling the issue well.
As stated previously, the teenage pregnancy rate in Portland is 16 in every 1,000
adolescent girls. Adolescent women aged 13-19 compose 7.9% of Portlands total population of
583,776 (US Census-Portland). This means that there are 46,118 adolescent women capable of
becoming adolescent mothers in Portland. Using this number, and the rate of 16 in every 1,000,
we can determine that there are 738 cases of teenage pregnancy. This is significantly lower than
both Memphis and Baltimore (4,702 less and 3,155 less, respectively). Of these 738 cases we can
say that roughly 50% of these students will drop out of high school meaning 369 adolescent
women drop out of school in Portland, per year.
If all of these women rely on SNAP to supplement their income, they have a collective cost of
$627,005 to taxpayers. This is significantly lower than both Memphis ($3,994,819 less) and
Baltimore ($2,681,337 less). Unintended teenage pregnancy in Portland creates a loss of
$3,434,652 in revenue that could have been earned if not for differences in realized wages.​ ​The
same information that has been stated about decreases in Medicaid rates would apply to Portland
as well.
Portland is demographically very different from Baltimore and Memphis. The city is
77.78% White, 6.37% African American, 6.37% Asian, 3.55% Other (US Census). These
numbers are significantly different from that of Memphis and Baltimore, where the predominant
race is African American. 1​3.1% of the population and 8.5% of families are below the poverty

30. Fren 30
line within Portland city limits. It is important to note that poverty levels are lower within in
Portland. But can this be explained as a cause, or an effect, of decreased teenage pregnancy
rates?
Conclusion
Based on these numbers, it is apparent that there is a relationship between sexual
education within a city, and the rate of teenage pregnancy. Memphis, the city with an abstinence
only sexual education program, that parents have to opt-in to, has incredibly high rates of
teenage pregnancy, with significant costs resulting from them. Baltimore has a ‘comprehensive’
sexual education program, but it only occurs for one day a year when adolescents are in school.
The city does have a decrease in the rates of Memphis, resulting in a cummulative economic
difference of close to $8,000,000 invested. However, these numbers are not as substantially
lower as they should be. Because of this, further examination of the intersection of poverty and
sexual education in this situation is necessary.
Within Memphis, I believe that a switch from the abstinence only sexual education
programs that are currently employed, where parents must opt-in to have their children receive
this information, to a more comprehensive one is necessary in combatting the problem within
Memphis. Making the transition from the current program to one that discusses all of the options
with students in a healthy, positive manner will not be an easy transition. The political feasibility
is low because of the conflicting capabilities of local, state and national governments. The state
dictates that schools must teach programs about abstinence when they teach programs at all.
However, between 60-80% of Memphis parents believe that their children should be getting
more information about the ways to prevent pregnancy and STD’s-including both the use of

31. Fren 31
contraceptives and abstinence (CROW-Memphis Parents Say Sex Education Matters!). If the
parents of the city organized, they could change the type of program being taught to their
children.
In Baltimore, an increase in the length and frequency of the program would provide
substantive decreases in the number of unintended pregnancies, as evidenced by Portland. The
current program is taught one day a year, and the effects are apparent. Baltimore has rates of
teenage pregnancy closer to Memphis than that of Portland, and this should definitely not be the
case in an area where the policy to allow for better sex education is already in place. This is such
an easily fixable problem, and not taking the steps to rectifying this through an increased
educational program is irresponsible. Here, the political feasibility of solving this issue is high.
In Portland, a city where the comprehensive sexual education program is well developed,
and empowering for its students, there is a significant decrease in the amount of teenage
pregnancies. This results in huge economic gains from where the city would be if it had a
abstinence only sexual education, as evidenced by Memphis. Additionally, we can see that
repetition, accuracy and breadth of information all play a part in the effectiveness of these
programs. Because of the high numbers in Baltimore, but also because of the low numbers in
Portland, I believe that poverty plays a role in the intersection of effectiveness of a sexual
education program. Poverty is not solely a cause, nor is it solely an effect of teenage pregnancy.
The duality of this issue creates a cycle in which teenage pregnancy leads to more poverty which
leads to more teenage pregnancy. One of the ways to break up this cycle is through effective
reproductive health education. By limiting the number of adolescents without access to the
knowledge they need to not get pregnant, we can decrease the number of unintended teenage

32. Fren 32
pregnancies. By reducing this number, we can reduce poverty, which will prevent future
unintended teenage pregnancies. By making the switch from abstinence only, to a program that
embraces comprehensive sexual education, and portrays sexual relationships in a healthy,
empowering way, the United States can reduce its rates of unintended teenage pregnancy, and as
a consequence, reduce its poverty rates as well.

33. Fren 33
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