Bouncing out of a bus, an attractive young woman confidently proclaims: "I intend to be President." A second young woman, toiling over a word processor and surrounded by books, declares: "I intend to go back to school." Finally, a third young woman is shown standing over her stove. She is very, very pregnant. "I intended to have a family," she says. "But not this soon."
Prepared for television, magazines and newspapers and radio, variations of this script are part of a $100,000 public-education and media campaign unveiled here this week by the American College of Obstetricians and Gynecologists, and designed to combat a national unintended pregnancy rate of 3.3 million annually and a teen-age pregnancy rate that is among the highest of developed countries.
While well received by test audiences, the group's Dr. Luella Klein revealed in announcing the program, three major television networks have declined to air the messages on grounds that the subject matter was too controversial.
Klein said the ad campaign had drawn positive responses from Cable News Network, Lifetime Cable, many Spanish-speaking local stations and a number of women's magazines. But CBS, ABC and NBC rejected outright ACOG's requests to air the spots, Klein said.
"Birth control and contraception are a very controversial issue," said George Schweitzer, CBS vice president for communications, in explaining that network's decision not to broadcast the ACOG announcements.
"We do not provide public service time or paid commercial time to organizations or individuals who want to espouse a particular point of view."
In the view of his network, Schweitzer said: "The issue of birth control and contraception is best left to our news and public-affairs coverage, where both sides of the issue are well represented. It is well covered in news and public affairs at all times of the day on the network and local level, with a focus on the balance of the story."
ABC's Jeff Tolvin, director of the business information, said: "What you have to understand is that we are not taking issue with birth control; we are saying this is not consistent with our public-service announcement policy. This proposed spot involves the discussion of a controversial issue of national public importance, which we feel is not suitable for a public-service announcement."
Said Tolvin: " We feel that type of a controversial issue is best treated either on a news program or in an advocacy (paid) commercial."
At NBC, press spokesman Stan Appenzeller said Thursday the network would not air the ACOG messages because "it is controversial, and it is against our policy of not airing controversial spots."
But Klein, for one, was clearly unsatisfied with this response. "Frankly," she said, "I have a great feeling of disappointment, almost despair. It's hard to believe that they should define as controversial something that 90% of the American public believes belongs in the public schools."
Either News or Ad
Klein said she had written network executives "reminding them that their attitudes are of the '60s."
She said she found the networks' reticence to air the ACOG messages curious in light of the type of programming that dominates commercial television.
"We really feel that television pervades our lives," Klein said. "Television especially sets the tone for much of the behavior in the country, including sexual behavior. Many teen-agers feel that sex life is like what they see on TV--all this instant intimacy and bedroom scenes, but no mention of pregnancy or sexual responsibility.
"My own feeling is that what they see on television between the sheets needs some context of sexual responsibility. You see all this sexuality, but you never see the results of the sexuality."
Said Klein, taking a stab at one sometimes-steamy CBS program: "We all know that sex sells programs. 'Dallas' is not a story about a town."
Klein, immediate past president of the OB/gyn organization of 25,000 physicians and director of the new public-education campaign, also discussed the background of the project. "About 36 million women every year face the problem of preventing an unintended pregnancy," Without contraception, she said, "the average sexually active woman would face 14 births or 31 abortions during her reproductive years." And, she added, "this would be a mind-boggling disruption of her life."
About one-half of the 6-million-plus pregnancies in the United States every year are unintended, said Klein. In turn, one-half of those unintended pregnancies are terminated each year by abortion.
Poll of Attitudes
But as Klein and her OB/gyn colleagues discovered in commissioning a Gallup poll of attitudes toward contraception last January, doubts, fears and confusion about the safety and risks of contraception continue to plague an alarming number of women. Of 1,000 women and 500 men surveyed, Klein said, 76% of the women and 62% of the men felt there was "substantial risk" in using oral contraceptives.
"Even among college-educated women," Klein said, 31% of the female respondents cited cancer as a potential hazard of birth control pills, 23% feared blood clots and 12% termed high-blood pressure a significant risk. (In fact, said AGOC's Laurie Hall, for otherwise healthy women under 35 who are non-smokers, oral contraception "not only does not cause cancer, but can prevent certain types of cancer, among them endometrial and ovarian." Oral contraception, Hall added, "also can discourage certain types of benign breast disease.")
"In general," Klein said, "we found that the public greatly underestimated the safety of contraception and overestimated the safety of pregnancy."
Specifically, she went on, only 16% of women and 22% of men correctly guessed that the risks of dying from childbirth are higher than the risks of dying from birth control pills. (ACOG's Hall said "there are about 500 pill-related deaths each year, about five for every 100,000 users. If no pill user smoked and no one over age 35 used the pill, the rate would drop to about .7 deaths per 100,000 users. This compares to about 10 maternal deaths for each 100,000 births per year.")
The same poll also contained other information that Klein found surprising. Ninety percent of all respondents said children should have sex education, with 81% indicating that sex education should be taught by junior high school, and 54% by elementary school.
"Only 6%," Klein said, calling that figure "a very vocal minority," "felt that sex education did not belong in the schools."
In addition, 74% of women polled and 76% of men said contraceptive services should be available to sexually active teen-agers. But nearly the same number--62% of women and 60% of men--said parents should be notified if their teen-agers were to request contraceptives.
The results of the Gallup study bolstered the conviction at ACOG that there was a need for a nationwide public-information program on unintended pregnancies.
For one thing, Klein said after reviewing the Gallup poll findings, "Obviously, Americans . . . are asking for help in giving their children good information to help avoid pregnancies for their daughters."
But her own medical colleagues, said practicing obstetrician-gynecologist Klein, "have failed to speak out clearly and consistently about the safety of contraceptives compared with the risk of pregnancy while using no method of birth control."
And Klein faulted "each media flurry" that follows "any reports of complications" attributed to any method of contraception. Over and over, she said, "the headlines emphasized the negative."
"I intend," as the new ACOG media program is known, was developed by the Martin Janis Co. in Chicago. The mandate from ACOG, that agency's Paul Bickman said, was to produce a multimedia program that was at once "scientifically accurate, upbeat and not overly clinical." The final products, narrated in both Spanish and English and tested with what Bickman dubbed the "shopping mall intercept" method, achieved "extremely favorable" results.
"Not only did the message get across," Bickman said, but when asked if they would call the toll-free 1-800-INTENDS telephone number to obtain a free copy of "The Facts," ACOG's contraceptive information booklet, almost one-half said yes.
In contrast, Bickman said, an offer of a free recipe book might bring a response of 2 1/2 to 5%.
Bickman said he was encouraged also by the overwhelming response to the shopping-mall question, "Would your mother freak out if she saw you watching this ad?" The vast majority of respondents, he said, said no.
Klein shook her head disconsolately when asked why she thought "contraception" might be viewed as such a dirty word. "I don't understand it," she said. "I think the fact that we have such a high number of unintended pregnancies is because of this attitude."
Both Klein and ACOG spokesman Morton Lebow agreed that the "I intend" campaign would serve as a complement to existing programs undertaken by such groups as the Planned Parenthood Federation of America. Klein lamented, however, that "even though there are many sex-education programs in the country, less than 10% tell where to get birth control."
Said Klein: "We feel that birth control is abortion prevention."
Some of the 4,000 family planning clinics around the country have agreed to distribute ACOG's "The Facts" booklet, Klein said, and the health departments of Tennessee and Illinois have announced their cooperation with the new program.
Klein said the timing of the campaign in part derived from her own experiences last year as president of ACOG. "I think when I was president," she said, "I was most interested in the fact that there are so many women who are afraid of contraception. I think we need to destroy the myth that a contraceptive is more dangerous than having a baby."