Adolescent Pregnancy Prevention

By Melissa Ludtke

Here was a man out of place. A slender man dressed in a stylish business suit, he sat by himself, night after night, in the bustling entryway of the Dunlevy Milbank Center in the middle of Harlem. His narrow face bore a trusting smile that masked a dogged purpose. He was trying to teach a course on human sexuality for neighborhood parents, and often nobody came. But he kept showing up. Michael Carrera, professor and prophet, understood that as a white man and an outsider he needed the parents' support if he wanted to come to their community to help their kids. "Involving parents is a show of respect," he declares. "It says they are valuable, their kids are valuable, their family is valuable." After a few months, families knew Carrera wasn't going away and that he was there to help. A few began to listen and, soon, their kids listened too.

Carrera holds the Thomas Hunter Chair of Health Sciences at Hunter College. But it is some 50 blocks uptown, in Harlem neighborhoods, where nearly 1 out of every 4 babies is born to a teenage mother, that Carrera's teaching is put to its sternest test in the Family Life Education and Adolescent Sexuality Program, which he created. Pregnancy-prevention courses, Carrera argues, are generally too narrow in focus to succeed. His approach is holistic, born of a simple premise: Give young people a sense of their own promise, and they will not be as likely to disrupt their lives with an early pregnancy.

But this simple premise is difficult to execute. "To move kids from fatalism to industriousness," says Carrera, "the intervention needs to be complex and longstanding." After those initial months of intense scrutiny and understandable suspicion, Carrera managed to assemble 22 girls and boys, ranging in age from 13 to 16, and a smaller group of parents for courses on family life and sex education. "The kids are riddled with mythology about these things. There is a real need to inform," he says. Before long, the youngsters were not only learning but also receiving a range of support services from adults who were willing to make a long-term commitment. "For too many of these kids, adults have disappeared on them," says Carrera, who has remained personally involved with each of the kids and their families during the past five years.

Physicians from a local hospital provide comprehensive health care. Tutors recruited from the Junior League help with homework, and employment counselors place the kids in summer jobs. "Many employers have stereotypes of black urban youth," says Mary Kay Penn, who manages the Milbank program. "It is very hard to persuade them to take these kids on, even when we pay the salary." But last summer Penn placed 75 of the kids in jobs, and Carrera added a silk-screening program so they could learn to design and sell T shirts.

Though contraception is available -- prescribed by a doctor with parental consent -- Carrera knows that access to birth control is not enough. "When kids are empowered with information and stimulated by hope for the future, it has a contraceptive effect," says Carrera. "Education. Employment. Their own bank accounts. Good health. Family involvement. Self-esteem. These are also contraceptives. It's the total fabric that is important." Carrera also teaches them how to play sports, like squash, that rely on individual discipline and control. "Whenever you posit a single solution to a complex problem, you are not as successful as you can be."

Success in Carrera's program brings a substantial reward. Under an agreement made with former Hunter College President Donna Shalala, students who graduate from high school and complete Carrera's program are guaranteed admission to Hunter. So far, 15 participants, teens and parents, have enrolled; Shavon Glover, a mother at 15, before she met Carrera, was the first. "I always had college in the back of my mind, but I didn't think I could do it," Glover says. "When I met Mike, everything started lifting up."

Since his initial success at the Milbank Center, Carrera has expanded his program to include two other community centers in Harlem, one of which is in a predominantly Hispanic neighborhood. Carrera receives financial support from New York City's Childrens Aid Society and devotes many hours each week to fund raising from private as well as public sources. The cost for each teenager is about $1,500 a year, and the paid staff members are all indigenous to the community. "Most adolescent pregnancy programs are headed by white female social workers," says Cary Dixon, a 48-year-old black man who teaches the family-life course to boys at the Frederick Douglass housing project.

Dixon serves as a crucial role model, particularly for the many boys who don't have fathers at home. "When I grew up, families were there to teach kids that there are certain boundaries," he recalls. "Now there is no discipline in their lives. Kids' lives are like basketball played without lines." He believes Carrera's approach holds promise. "By keeping these kids on a clear education track, by having them understand the importance of delaying pregnancy and by including parents, Mike is doing what others aren't," he says.

In all, about 225 kids and 75 parents are participating in Carrera's three Harlem-based programs. Carrera's track record is impressive. In four years only two girls have become pregnant and, as far as the counselors can tell from their intimate weekly individual discussions with the kids, only one boy has fathered a child. "This is not a value-free program," he explains. "We have a message that delaying sexual activity is good. We are taking a stand." This year the Childrens Aid Society is establishing the Stern National Training Center for Family Life Education in Manhattan, where Carrera will teach his techniques to others searching for ways to cope with adolescent pregnancy in their community.

"The message is that if you expect changes in kids, you have to be in for the long haul," Carrera warns. "That is necessary to overcome the myths and go up against the stereotypes that surround these kids' lives." So far, Carrera has managed against great odds to outlast all those who said it can't be done. To do it, he had to learn how to overcome the everyday frustrations that inevitably accompany adolescent struggles. He calls his technique "patient endurance."

But Carrera also is energized by memories of his own youthful struggles and of adults who helped him find his way. His beliefs in the power of family and of public service are woven from the fibers of his childhood. Born a half- century ago in the Bronx to immigrant parents, a house painter and a patternmaker, he found his role models in an attentive and extended Italian family. "I found there is strength in family," says Carrera, who was the first in his family to graduate from college, and ultimately earned a doctorate from Columbia University. Along the way he taught junior high students in the Bronx, and there he discovered his calling. "It was clear to me how poorly these kids were treated," he recalls. "I saw how responsive they were to being around a caring adult, how that would get them turned on to other things, such as learning."

Now that he can, Carrera gratefully gives something back to kids. "These kids don't often have someone saying they can do things. Instead there always seem to be barriers put in their way," he says. "So we're going to be the ones to say, 'We're glad you're here. You can do it.' "