Teenage Pregnancy, A National Disaster: A Significant Factor In Black Teenage Unemployment Charles H. Wright, MD, FACS Detroit, Michiaan
Pregnancy is an unfortunate event in the life of preteen and teenagers. Yet, it is occurring with increasing frequency among children between the ages of 12 and 16. The magnitude of this growing problem is so great it demands the assistance of all segments of society to find a solution. While it is true that pregnancy is often a social, economic, and psychological burden to the young mother, the outlook for the baby may be even more bleak. Homes and schools are not meeting the needs for rearing and training these unplanned progeny to become productive citizens. Already, some of-them are entering the labor market with few, if any, marketable skills. Preventive measures seem to offer the best prospects for dealing with this human dilemma. Since the majority of the unwed teens under discussion are black, the black physician must apply his talents and resources to finding a workable solution. Spokesmen for the black communityl and the trade union movement2 have taken President Jimmy Carter to task for his failure to keep a campaign promise, full employment for the nation's work force. Their impatience is based, justifiably, upon relatively high unemployment rates, especially among black teenagers. While it is true that the Federal Government should and must share some of the responsibility for improvement in employment, there is no way for the President, alone, to provide the fmal solution to the nation's unemployment woes, in general, nor those of the black teenager, in particular. Any plan to resolve the difficult problems of the unemployed black teenager must confront the rising tide of the pregnant adolescent and early teenager, now, and even more so in the future. For the past quarter century, this writer has practiced obstetrics and gynecology in an urban community with a 95 percent black patient load. From The Department of Obstetrics And Gynecology of the New Center Medical Plaza Group, P.C., (Physicians Group For Comprehensive Health Services of Detroit, Inc.). Requests for reprints should be addressed to Dr. Charles H. Wright, 50 Westminster, Detroit, Ml 48202.
Currently, my partners and I deliver approximately 1,000 babies each year. Well over two thirds of these patients are unmarried and nearly half are 12 to 18 years of age. While the illegitimacy rate has risen each year, the age at which the patient first becomes pregnant has shown an alarming drop. Apparently, our experience is not unique. The New York Health Department reported3 that 30 percent of all births in New York City, during 1976, were illegitimate. The rate among black females was 2'/2 times that of white females of comparable age. The highest rate (in Harlem) was 75 percent. The study revealed that 4,958 cases, in which there had been no legal marriage, were added to the City's welfare rolls. This compared unfavorably with the 1,599 such cases added in 1967 and was six times those 763 added in 1957. According to the National Center for Health Statistics, from 1966 to 1973, the birthrate among older teenagers (18-19) dropped 29 percent, while the rate for younger patients (11-13) rose 29 percent. Illegitimacy rates followed a somewhat similar pattern, 27 and 49 percent, respectively. These rates reflect the increased number of
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 9, 1978
girls born in the 1950s and early 1960s who are now reaching adolescence. Many of them are also illegitimate. Konner4 refers to the precipitous rise in teenage pregnancies as a national disaster, "comparable to a flood (as it is), famine or epidemic." He reported that the number of teenage pregnancies had reached 1,000,000 per year, with the steepest rise among the 11-13 age group. Before recent restrictions by state legislatures, nearly one third of these pregnancies were terminated by voluntary abortion with Medicaid funds. The impact of this new restriction must be anticipated with strong misgivings, by some, unless creative alternatives can be brought into play. The teenagers under discussion make up a significant portion of unemployed black youths about whom so much has been written. Yet, hardly anyone mentions pregnancy as a significant factor in the long-range solution of problems associated with unemployment. The majority of chronically unemployed black teenagers (male and female), especially those involved in pregnancy, have few, if any, marketable skills. Both parties often drop out of school before they learn to read, write, or calculate. Many others who remain in school fail to gain a working relationship with the three Rs. This is due as much to failure of the school system as to other impediments. The cultivation of the human mind must be the first priority of any school system. W.B. Dubois emphasized this in a speech in 1935: Theoretically, the Negro needs neither segregated schools nor mixed schools. What he needs is Education. What he must remember is that there is no magic whether in mixed or in segregated schools. A mixed school with poor and unsympathetic teachers, with hostile public opinion and no teaching of the truth concerning black folk, is bad. A segregated school with ignorant placeholders, inadequate equipment, poor 685
salaries and wretched housing is usually bad. Other things being equal, the mixed school is broader and more natural as a basis for the education of all youth. It gives wider contacts; it inspires greater self confidence and suppresses the inferiority complex. But, other things are seldom equal; in that case, sympathy, knowledge and the truth outweigh all that the mixed school can offer.5
Dubois' admonition is no less viable today. The main responsibility of a system of education is to challenge and train the human mind. When it fails to do this, society, as a whole, suffers; and society, as a whole, is to blame. Armbruster6 echoes Dubois' challenge. He labels many of the so-called reforms that have been infused into modem education as "expensive and unproductive gimmickry" that contribute to mediocrity. He sees these developments as a conspiracy between teacher and student to seek an easy way out. He strongly attacks the assumption apparent in some educational circles that spending large sums of money for expensive plants and sophisticated supplies insures a good education in poor areas. He is also critical of teachers who cheat minoritygroup students by substituting street language for standard English, in the name of relevance. Dr. Kenneth Clark, one of the nation's leading psychologists, was asked recently if he thought that black children are being educated today. My personal opinion is that the quality of education provided for minority children in the segregated, urban public schools of the north has deteriorated. The schools, for the most part, are criminally inferior. They are spawning hundreds of thousands of our young people as functional illiterates each year.7
Of course, the education potential of any school is diminished by such disruptive social influences as single parents with large, unmanageable families, overdoses of television that distract and destroy incentive, and a general decline in pupil motivation that may or may not be related to widespread use of drugs among teenagers. A panel of educators, appointed by the College Entrance Examination Board,8 conducted a study to determine the cause of a severe drop in the levels of Scholastic Aptitude Scores in the past few years. The group's report disclosed that a 14-year drop in SAT 686
scores was due to an "increasing number of minorities, the poor, women, and academically inferior students trying to enter college." An accusing finger was pointed at the secondary schools.9 These difficulties are not peculiar to one state or region. Thus, black communities everywhere must assume a larger responsibility in making sure that students in public schools get a proper education. A closer surveillance of and participation in the activities of the school system by parents are mandatory. Single, teenage parents are illprepared to satisfy this mandate. Many black teenagers, due to their poor education, find it difficult to compete for the highly skilled jobs that may be available. At the same time, many of the less skilled jobs are being lost to mechanization. Too many unemployed teens represent second generation unemployed or underemployed in their families. Thus, they have little or no training or experience in those disciplines related to steady employment. Unless such a worker makes a rapid adjustment to job demands, poor work habits can impede the progress to full employment. 10 Economic opportunities for black teenagers can be improved if members of the black community would invest in the community. It is estimated that the black professional takes millions of dollars from the black community each year. Very little of this money is reinvested in the community from which it is extracted. It has been shown that, for the most part, the dollar changes hands only once in the black community before it departs, forever. This circulation of the coin-of-the-realm must be slowed if it is to help create jobs where they are needed most.
Prevention The problems discussed above are made more insoluble by the mass production of babies by an irresponsible segment of the population. Unless this tide is turned, the number of unemployed and unemployable will reach unmanageable proportions, if it has not already done so. Instead of measures of prevention, recent developments have served to encourage this teen output. These include widespread adulation for the mother-to-be, showers for the babyto-be, increased rights and privileges
for the father-to-be, and alterations of the baby's birth certificate to "legitimize" the offspring. In a special, two-part Sunday feature, the Detroit News I looked at teenage pregnancy from the points of view of both the male and female. Both articles dealt, superficially, with the problems produced by teen pregnancies. Prevention was not mentioned, and the bleak prospects of the babies were only hinted at superficially. The sexually active teenager, or one contemplating enlistment in the ranks, will find little in the articles to deter him or her from becoming one of the "babies having babies." As a matter of fact, just the opposite may be the case. Such developments as these have undermined respect for the marriage contract and reduced it to the status of an endangered institution. Abortion was offered, in some circles, as one answer to this problem. With the reduction in Medicaid funds for abortion, it cannot (and never could) be considered the answer. On the contrary, easy, free abortions have produced an alarming casualness in many teenagers, causing some of them to adopt abortion as the method of choice for birth control. A few of our patients have demanded three abortions within a 12-month period. The eventual effect of such attitudes is causing some psychiatrists sleepless nights. It is difficult to enter into meaningful discussions with groups that can do something about this problem. Perhaps it is an idea whose time has not come. Two experiences will serve to explain this conclusion. An effort was made to introduce the topic 'pregnancy prevention in the teenager' to a group of social workers, mostly women. The speaker was accused of being a male chauvinist and was shouted down. On another occasion, the subject was presented before a group of black obstetricians'2 for an open discussion. They, too, rejected the opportunity to examine the problem, with less heat but equal finality. The physicians took the position that they had no right to impose their "moral persuasion" on someone else and deny woman her "God-given right" to motherhood. Despite the laissez faire attitude of these two groups, the fact remains that we are faced with a national catastrophe that demands our undivided attention.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 9, 1978
Society, as a whole, must bear a large part of the responsibility for this unfortunate state of affairs. This social system denies the black female teenager, perhaps more than any other group, the satisfaction of feeling that she belongs. She controls practically nothing and has very little that she can call her own. There is one thing that she can acquire, however, even at age 11, over which she will have complete control-a baby. Until society provides her with acceptable substitutes, no preventive measure will be successful.
Outlook The consequences of unlimited, escalating teenage pregnancies may be seen from several points of view, all frightful. Let us consider two, maternal and fetal.
Maternal Pregnancy in 11 to 18-year-old children denies them a vital phase of their normal maturation process. Suddenly they are required to pretend that they are adults. The pregnancy may add more stress to a domestic scene that is already threatened by a variety of destructive forces. The economic burden of these unplanned, unnecessary pregnancies, whether terminated or carried to term, is enormous and wasteful. As a rule, the pregnant teen receives poor prenatal care, increasing the risk of maternal morbidity and mortality.
Fetal Poor prenatal care is a threat to the welfare of the fetus, increasing the chances for physical, neurological, and psychological deficits. Such deficits are accentuated by the stressful, often hostile, environment in which the newborn develops. Child neglect and abuse are common experiences among these children, as reflected in the records of Emergency Rooms and pediatric services of hospitals that treat children. Many children do not survive this perinatal abuse. Those who survive are subjected to a different form of abuse early in their lives. Due to the ruptured family structure into which many of these babies are born, televiewing is a significant part of their daily fare. Not only has TV been shown to inhibit a child's tendency to read, write and converse, but may promote aggressive behavior and cause
them to imitate the acts of violence seen on the TV screen. The ten-member National PTA Television Commission, starting in 1976, heard 50,000 pages of transcript testimony from 505 witnesses before reaching its alarming conclusions: National awareness must be aroused to the enormity of the problem of television violence. TV violence has a negative effect on children's ability to learn, may encourage paranoia, distorts real life, causes children to become apathetic or desensitized and diminishes the quality of life. There is clear evidence of a causal relationship between TV violence and antisocial behavior. The problem is national in scope and demands urgent, vigilant solutions.13
When this crop of youngsters enter school, they bring their problems to a system already handicapped by low budgets, beleaguered teachers, and disinterested parents, only a few of the many causes of the shameful rate of functional illiteracy among our youth. Francis Ward13 paints a dismal picture of this social scene: Nearly an entire generation of our youth has become useless, expendable, nonfunctional, non-productive human waste material, because the system refuses to educate them or provide for them or their parents. Now that the expendables have become a social liability, the same system of racism and exploitation that created the situation seems to be cranking up for their disposal. 13
Evidence to support Ward's harsh appraisal is abundant. A recent survey of New York City's prison population may reflect, in microcosm, the national scene. In January 1977, prison inmates included 1,100 who were between 16 and 20 years of age. Of these, 90 to 95 percent of them were incarcerated for murder, assault, or armed robbery. During 1976, 16,000 teenagers were arrested in New York City for serious crimes. Prison officials report that the majority of these youthful criminals came from homes where the father was absent or ineffective. The black physician must assume a larger role in the quest for an answer to this serious and complicated problem. We have closer contact with these children than any other professional, except the teacher. A joint venture among these two groups and whatever other resources the community has to offer should yield meaningful courses in sex
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 9, 1978
education, tailored to the particular needs of the situation. Since many of these youngsters are repeaters, the physician's role in limiting family size can be crucial. Cultural institutions that reflect a positive black image must be created where none exist and expanded in those areas where they have been started. Such programs should be made available to black youth through all avenues of contact, encouraging their participation at all levels. Traditionally, the physician has felt that his responsibility ended when he helped to deliver a healthy baby into the world. When we see what an unhealthy world does to some of these babies, our priorities must be reordered. This situation is critical and demands our best effort. The problems we face are too complex for any one man to solve, even if he were the President of the United States.
Literature Cited 1. Seifullah AA: Leaders seek meeting with President Carter. Bilalian News, November 25, 1977, p 3 2. Wilkins R: The changing character of black's problem, New York Times, September 2, 1977 3. Kihss P: 30% of all New York City births are illegitimate. New York Times, September 29, 1977, p 39 4. Konner MG: Adolescent pregnancy. New York Times, September 24, 1977 5. Weinberg M, Dubois WB: A Reader. New York Metropolitan Applied Research Center and Harper & Row, 1970, p 288 6. Armbruster FE, Bracken P: Our Children's Crippled Future. New York, Quadrangle Books, 1977 7. Clark K: Are black children being educated today? Dawn Magazine 5:4, 1977 8. Fiske B: Dip in SAT Score Laid to Student Caliber, College Board and Educational Testing Service Report. New York Times, August 24, 1977, p 61 9. King W: Stiffer teacher tests upset blacks in South Carolina. New York Times, June 24, 1977 10. Wilkins R: Historical finderfor black jobless rate. New York Times, September 21, 1977 11. Russell RL: Early teen pregnancy: The newest status symbol? The Sunday News, Detroit, September 25, 1977, p 10 12. Non-organic causes of Pelvic Pain, and discussion ensuing presentation of paper, Ob-Gyn Section for the National Medical Association Convention, Los Angeles, California, August 4, 1977 13. Ward F: Black youth, an endangered species. First World 1 :22, 1977 14. Harris R: A reporter at large-crime in New York. New Yorker Magazine, September 26, 1977, p 92
687
Pregnancy is an unfortunate event in the life of preteen and teenagers. Yet, it is occurring with increasing frequency among children between the ages of 12 and 16. The magnitude of this growing problem is so great it demands the assistance of all segments of society to find a solution. While it is true that pregnancy is often a social, economic, and psychological burden to the young mother, the outlook for the baby may be even more bleak. Homes and schools are not meeting the needs for rearing and training these unplanned progeny to become productive citizens. Already, some of-them are entering the labor market with few, if any, marketable skills. Preventive measures seem to offer the best prospects for dealing with this human dilemma. Since the majority of the unwed teens under discussion are black, the black physician must apply his talents and resources to finding a workable solution. Spokesmen for the black communityl and the trade union movement2 have taken President Jimmy Carter to task for his failure to keep a campaign promise, full employment for the nation's work force. Their impatience is based, justifiably, upon relatively high unemployment rates, especially among black teenagers. While it is true that the Federal Government should and must share some of the responsibility for improvement in employment, there is no way for the President, alone, to provide the fmal solution to the nation's unemployment woes, in general, nor those of the black teenager, in particular. Any plan to resolve the difficult problems of the unemployed black teenager must confront the rising tide of the pregnant adolescent and early teenager, now, and even more so in the future. For the past quarter century, this writer has practiced obstetrics and gynecology in an urban community with a 95 percent black patient load. From The Department of Obstetrics And Gynecology of the New Center Medical Plaza Group, P.C., (Physicians Group For Comprehensive Health Services of Detroit, Inc.). Requests for reprints should be addressed to Dr. Charles H. Wright, 50 Westminster, Detroit, Ml 48202.
Currently, my partners and I deliver approximately 1,000 babies each year. Well over two thirds of these patients are unmarried and nearly half are 12 to 18 years of age. While the illegitimacy rate has risen each year, the age at which the patient first becomes pregnant has shown an alarming drop. Apparently, our experience is not unique. The New York Health Department reported3 that 30 percent of all births in New York City, during 1976, were illegitimate. The rate among black females was 2'/2 times that of white females of comparable age. The highest rate (in Harlem) was 75 percent. The study revealed that 4,958 cases, in which there had been no legal marriage, were added to the City's welfare rolls. This compared unfavorably with the 1,599 such cases added in 1967 and was six times those 763 added in 1957. According to the National Center for Health Statistics, from 1966 to 1973, the birthrate among older teenagers (18-19) dropped 29 percent, while the rate for younger patients (11-13) rose 29 percent. Illegitimacy rates followed a somewhat similar pattern, 27 and 49 percent, respectively. These rates reflect the increased number of
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 9, 1978
girls born in the 1950s and early 1960s who are now reaching adolescence. Many of them are also illegitimate. Konner4 refers to the precipitous rise in teenage pregnancies as a national disaster, "comparable to a flood (as it is), famine or epidemic." He reported that the number of teenage pregnancies had reached 1,000,000 per year, with the steepest rise among the 11-13 age group. Before recent restrictions by state legislatures, nearly one third of these pregnancies were terminated by voluntary abortion with Medicaid funds. The impact of this new restriction must be anticipated with strong misgivings, by some, unless creative alternatives can be brought into play. The teenagers under discussion make up a significant portion of unemployed black youths about whom so much has been written. Yet, hardly anyone mentions pregnancy as a significant factor in the long-range solution of problems associated with unemployment. The majority of chronically unemployed black teenagers (male and female), especially those involved in pregnancy, have few, if any, marketable skills. Both parties often drop out of school before they learn to read, write, or calculate. Many others who remain in school fail to gain a working relationship with the three Rs. This is due as much to failure of the school system as to other impediments. The cultivation of the human mind must be the first priority of any school system. W.B. Dubois emphasized this in a speech in 1935: Theoretically, the Negro needs neither segregated schools nor mixed schools. What he needs is Education. What he must remember is that there is no magic whether in mixed or in segregated schools. A mixed school with poor and unsympathetic teachers, with hostile public opinion and no teaching of the truth concerning black folk, is bad. A segregated school with ignorant placeholders, inadequate equipment, poor 685
salaries and wretched housing is usually bad. Other things being equal, the mixed school is broader and more natural as a basis for the education of all youth. It gives wider contacts; it inspires greater self confidence and suppresses the inferiority complex. But, other things are seldom equal; in that case, sympathy, knowledge and the truth outweigh all that the mixed school can offer.5
Dubois' admonition is no less viable today. The main responsibility of a system of education is to challenge and train the human mind. When it fails to do this, society, as a whole, suffers; and society, as a whole, is to blame. Armbruster6 echoes Dubois' challenge. He labels many of the so-called reforms that have been infused into modem education as "expensive and unproductive gimmickry" that contribute to mediocrity. He sees these developments as a conspiracy between teacher and student to seek an easy way out. He strongly attacks the assumption apparent in some educational circles that spending large sums of money for expensive plants and sophisticated supplies insures a good education in poor areas. He is also critical of teachers who cheat minoritygroup students by substituting street language for standard English, in the name of relevance. Dr. Kenneth Clark, one of the nation's leading psychologists, was asked recently if he thought that black children are being educated today. My personal opinion is that the quality of education provided for minority children in the segregated, urban public schools of the north has deteriorated. The schools, for the most part, are criminally inferior. They are spawning hundreds of thousands of our young people as functional illiterates each year.7
Of course, the education potential of any school is diminished by such disruptive social influences as single parents with large, unmanageable families, overdoses of television that distract and destroy incentive, and a general decline in pupil motivation that may or may not be related to widespread use of drugs among teenagers. A panel of educators, appointed by the College Entrance Examination Board,8 conducted a study to determine the cause of a severe drop in the levels of Scholastic Aptitude Scores in the past few years. The group's report disclosed that a 14-year drop in SAT 686
scores was due to an "increasing number of minorities, the poor, women, and academically inferior students trying to enter college." An accusing finger was pointed at the secondary schools.9 These difficulties are not peculiar to one state or region. Thus, black communities everywhere must assume a larger responsibility in making sure that students in public schools get a proper education. A closer surveillance of and participation in the activities of the school system by parents are mandatory. Single, teenage parents are illprepared to satisfy this mandate. Many black teenagers, due to their poor education, find it difficult to compete for the highly skilled jobs that may be available. At the same time, many of the less skilled jobs are being lost to mechanization. Too many unemployed teens represent second generation unemployed or underemployed in their families. Thus, they have little or no training or experience in those disciplines related to steady employment. Unless such a worker makes a rapid adjustment to job demands, poor work habits can impede the progress to full employment. 10 Economic opportunities for black teenagers can be improved if members of the black community would invest in the community. It is estimated that the black professional takes millions of dollars from the black community each year. Very little of this money is reinvested in the community from which it is extracted. It has been shown that, for the most part, the dollar changes hands only once in the black community before it departs, forever. This circulation of the coin-of-the-realm must be slowed if it is to help create jobs where they are needed most.
Prevention The problems discussed above are made more insoluble by the mass production of babies by an irresponsible segment of the population. Unless this tide is turned, the number of unemployed and unemployable will reach unmanageable proportions, if it has not already done so. Instead of measures of prevention, recent developments have served to encourage this teen output. These include widespread adulation for the mother-to-be, showers for the babyto-be, increased rights and privileges
for the father-to-be, and alterations of the baby's birth certificate to "legitimize" the offspring. In a special, two-part Sunday feature, the Detroit News I looked at teenage pregnancy from the points of view of both the male and female. Both articles dealt, superficially, with the problems produced by teen pregnancies. Prevention was not mentioned, and the bleak prospects of the babies were only hinted at superficially. The sexually active teenager, or one contemplating enlistment in the ranks, will find little in the articles to deter him or her from becoming one of the "babies having babies." As a matter of fact, just the opposite may be the case. Such developments as these have undermined respect for the marriage contract and reduced it to the status of an endangered institution. Abortion was offered, in some circles, as one answer to this problem. With the reduction in Medicaid funds for abortion, it cannot (and never could) be considered the answer. On the contrary, easy, free abortions have produced an alarming casualness in many teenagers, causing some of them to adopt abortion as the method of choice for birth control. A few of our patients have demanded three abortions within a 12-month period. The eventual effect of such attitudes is causing some psychiatrists sleepless nights. It is difficult to enter into meaningful discussions with groups that can do something about this problem. Perhaps it is an idea whose time has not come. Two experiences will serve to explain this conclusion. An effort was made to introduce the topic 'pregnancy prevention in the teenager' to a group of social workers, mostly women. The speaker was accused of being a male chauvinist and was shouted down. On another occasion, the subject was presented before a group of black obstetricians'2 for an open discussion. They, too, rejected the opportunity to examine the problem, with less heat but equal finality. The physicians took the position that they had no right to impose their "moral persuasion" on someone else and deny woman her "God-given right" to motherhood. Despite the laissez faire attitude of these two groups, the fact remains that we are faced with a national catastrophe that demands our undivided attention.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 9, 1978
Society, as a whole, must bear a large part of the responsibility for this unfortunate state of affairs. This social system denies the black female teenager, perhaps more than any other group, the satisfaction of feeling that she belongs. She controls practically nothing and has very little that she can call her own. There is one thing that she can acquire, however, even at age 11, over which she will have complete control-a baby. Until society provides her with acceptable substitutes, no preventive measure will be successful.
Outlook The consequences of unlimited, escalating teenage pregnancies may be seen from several points of view, all frightful. Let us consider two, maternal and fetal.
Maternal Pregnancy in 11 to 18-year-old children denies them a vital phase of their normal maturation process. Suddenly they are required to pretend that they are adults. The pregnancy may add more stress to a domestic scene that is already threatened by a variety of destructive forces. The economic burden of these unplanned, unnecessary pregnancies, whether terminated or carried to term, is enormous and wasteful. As a rule, the pregnant teen receives poor prenatal care, increasing the risk of maternal morbidity and mortality.
Fetal Poor prenatal care is a threat to the welfare of the fetus, increasing the chances for physical, neurological, and psychological deficits. Such deficits are accentuated by the stressful, often hostile, environment in which the newborn develops. Child neglect and abuse are common experiences among these children, as reflected in the records of Emergency Rooms and pediatric services of hospitals that treat children. Many children do not survive this perinatal abuse. Those who survive are subjected to a different form of abuse early in their lives. Due to the ruptured family structure into which many of these babies are born, televiewing is a significant part of their daily fare. Not only has TV been shown to inhibit a child's tendency to read, write and converse, but may promote aggressive behavior and cause
them to imitate the acts of violence seen on the TV screen. The ten-member National PTA Television Commission, starting in 1976, heard 50,000 pages of transcript testimony from 505 witnesses before reaching its alarming conclusions: National awareness must be aroused to the enormity of the problem of television violence. TV violence has a negative effect on children's ability to learn, may encourage paranoia, distorts real life, causes children to become apathetic or desensitized and diminishes the quality of life. There is clear evidence of a causal relationship between TV violence and antisocial behavior. The problem is national in scope and demands urgent, vigilant solutions.13
When this crop of youngsters enter school, they bring their problems to a system already handicapped by low budgets, beleaguered teachers, and disinterested parents, only a few of the many causes of the shameful rate of functional illiteracy among our youth. Francis Ward13 paints a dismal picture of this social scene: Nearly an entire generation of our youth has become useless, expendable, nonfunctional, non-productive human waste material, because the system refuses to educate them or provide for them or their parents. Now that the expendables have become a social liability, the same system of racism and exploitation that created the situation seems to be cranking up for their disposal. 13
Evidence to support Ward's harsh appraisal is abundant. A recent survey of New York City's prison population may reflect, in microcosm, the national scene. In January 1977, prison inmates included 1,100 who were between 16 and 20 years of age. Of these, 90 to 95 percent of them were incarcerated for murder, assault, or armed robbery. During 1976, 16,000 teenagers were arrested in New York City for serious crimes. Prison officials report that the majority of these youthful criminals came from homes where the father was absent or ineffective. The black physician must assume a larger role in the quest for an answer to this serious and complicated problem. We have closer contact with these children than any other professional, except the teacher. A joint venture among these two groups and whatever other resources the community has to offer should yield meaningful courses in sex
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 9, 1978
education, tailored to the particular needs of the situation. Since many of these youngsters are repeaters, the physician's role in limiting family size can be crucial. Cultural institutions that reflect a positive black image must be created where none exist and expanded in those areas where they have been started. Such programs should be made available to black youth through all avenues of contact, encouraging their participation at all levels. Traditionally, the physician has felt that his responsibility ended when he helped to deliver a healthy baby into the world. When we see what an unhealthy world does to some of these babies, our priorities must be reordered. This situation is critical and demands our best effort. The problems we face are too complex for any one man to solve, even if he were the President of the United States.
Literature Cited 1. Seifullah AA: Leaders seek meeting with President Carter. Bilalian News, November 25, 1977, p 3 2. Wilkins R: The changing character of black's problem, New York Times, September 2, 1977 3. Kihss P: 30% of all New York City births are illegitimate. New York Times, September 29, 1977, p 39 4. Konner MG: Adolescent pregnancy. New York Times, September 24, 1977 5. Weinberg M, Dubois WB: A Reader. New York Metropolitan Applied Research Center and Harper & Row, 1970, p 288 6. Armbruster FE, Bracken P: Our Children's Crippled Future. New York, Quadrangle Books, 1977 7. Clark K: Are black children being educated today? Dawn Magazine 5:4, 1977 8. Fiske B: Dip in SAT Score Laid to Student Caliber, College Board and Educational Testing Service Report. New York Times, August 24, 1977, p 61 9. King W: Stiffer teacher tests upset blacks in South Carolina. New York Times, June 24, 1977 10. Wilkins R: Historical finderfor black jobless rate. New York Times, September 21, 1977 11. Russell RL: Early teen pregnancy: The newest status symbol? The Sunday News, Detroit, September 25, 1977, p 10 12. Non-organic causes of Pelvic Pain, and discussion ensuing presentation of paper, Ob-Gyn Section for the National Medical Association Convention, Los Angeles, California, August 4, 1977 13. Ward F: Black youth, an endangered species. First World 1 :22, 1977 14. Harris R: A reporter at large-crime in New York. New Yorker Magazine, September 26, 1977, p 92
687
