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When Sandra Landry, RN, was a young hospital nurse, she treated a patient she would never forget: a 12-year-old girl in heavy labor. As Landry wheeled her into the delivery room, the girl clutched her teddy bear and cried from the gurney, "But my mommy told me never to kiss a boy, and I didn’t!"

Today, Landry works as health and wellness administrator in the Department of Education in Orange County, Calif. – not far from the hospital where the 12-year-old gave birth. Although it happened 20 years ago, not much has changed. At least, not in Landry's opinion.

Nor in Sue Collins’, FNP, RN, a nurse practitioner who estimates she sees at least five 12- to 15-year-old pregnant girls each month during her rounds at North Country Community Health Center, a federal- and state-funded clinic in Flagstaff, Ariz.

Just say whoa!

"I’m not sure they even know what they’ve done," Collins said. "The realities of being responsible for your sexual behaviors are just not there. And a lot of school systems are struggling with parents who don’t want to do anything but just say no."

The most recent statistics from the national Centers for Disease Control and Prevention show a slight decline in sexual activity among teen-agers, from 54 percent in 1991 to 48 percent in 1997. But these numbers reflect only the behavior of teen-agers 15 and older. What about younger teen-agers, particularly in places like Flagstaff, where early teen pregnancy has been cited as a public health issue?

A study published in the Journal of the American Medical Association in 1997 reported that 17 percent of a national sample of thousands of seventh- and eighth-graders reported having had intercourse. That figure is in line with a 1993 study on sexually active seventh-graders by the California Office of Family Planning. When researchers zeroed in on middle school students in Santa Clara County (the heart of fast-paced Silicon Valley), the rate jumped several points higher – to one in five.

Maturing younger

Early puberty is a big part of the equation. As a substantial proportion of American girls enter puberty as early as 9 and 10 years of age, feelings and urges are being awakened that, years ago, simply didn’t manifest until years later.

"Menses used to begin at 18 or 19 and now it’s coming at a much earlier age," said Beverly Whipple, Ph.D., RN, FAAN, president of the American Association of Sex Educators, Counselors and Therapists. "Adolescence is much prolonged. People are getting married much later. So we do know that there’s a much longer time between hormonal surges and marriage."

Although a lot of research has been done on the effectiveness of sex education on older teens, the evidence is inconclusive when it comes to younger ones, according to Douglas Kirby, Ph.D., a national expert in the field.

"We don’t have much good evidence that it delays the onset of intercourse," said Kirby, research director of ETR Associates, a nonprofit health education organization in Scotts Valley, Calif. One of the main reasons, he says, is because relatively few seventh- and eighth-graders actually initiate sex.

Sex education varies

A wide disparity exists between the states in the way sex education is presented to teen-agers. In Texas, for example, school districts are not required to provide such instruction and, if they do, state law mandates that it be based on an abstinence-only approach.

"We begin in the fourth grade with puberty education because research and statistics show that our kids are stronger and bigger and developing earlier than they used to," explained Paula Mashek, president of the Texas Association of School Nurses. "We stress that parents need to begin talking to their children and that elementary school is not too early to begin – to give their values and the need for abstinence. Just like the goals of no alcohol and no drugs."

On the other end of the spectrum is California, where "one of the best-kept secrets" is the Family Code, giving adolescents 12 and older the right to pregnancy-related services by their own consent.

"Nobody wants to talk about it," said Jan Treat, MN, PHN, RN, chief of clinical services in the Office of Family Planning, California Department of Health Services. "That’s one of the biggest barriers we have. The kids don’t know about it, many people in private practice are uncomfortable with it, and parents don’t like it."

In fact, many California school nurses still believe that they are required to report sexually related health matters. "We have had occasions where a teen has been in the school nurse’s office crying, ‘Don’t call my parents, don’t call my parents!’ and the nurse calls us, wanting to know what to do," said Kathy Kneer, head of the state public affairs office for Planned Parenthood in Sacramento. "We say, ‘No, you can’t call the parents.’ "