Birthrate Among Teen-Agers Climbs Sharply : Health: Statistics reignite criticism that pregnancy prevention programs are insufficient and that approach to issue should be re-examined.

A higher proportion of teen-agers are giving birth than at any time since the early 1970s, and the National Center for Health Statistics has attributed the increase to an equally dramatic rise in the proportion of teen-agers who are sexually active.

Among 17-year-old girls, for example, 51% were sexually experienced in 1988, up from 36% in 1980. For 15-year-old girls, the figure rose from 17% to 26%.

The birthrate among teen-agers age 15 to 17 jumped nearly 20% in three years, reversing a 16-year trend of declining or stable rates. Among older teen-agers, the rate rose 7% from 1986 to 1989, the agency said in a report issued in January.

The statistics have reignited criticism that pregnancy prevention programs are insufficient and that the nation’s approach to teen-age sexuality should be re-examined.

“We aren’t giving them any guidance on how to manage their own sexuality through a period when they shouldn’t be having children,” said Judith Senderowitz, executive director of the Center for Population Options, a private organization aimed at preventing teen-age pregnancy. “The overwhelming policy in the United States is to tell kids to say no to sex.”

Senderowitz and several others involved in adolescent pregnancy programs criticized as unrealistic and overly simplistic the federal government’s strategy of promoting abstinence. That philosophy, they say, sets a tone for state, local and private programs and has a chilling effect on other approaches.

“When teen-agers hear ‘Just say no,’ they laugh at that,” said Dan Daley, a policy analyst at the Alan Guttmacher Institute, a nonprofit health research organization in New York. “ ‘Just say no’ does not help a teen-ager who has already been sexually active. . . . One answer for all teen-agers is unrealistic.”

Federal officials argued that their programs go beyond abstinence promotion, funding family planning clinics that serve teen-agers, for example.

“The department feels that adolescents shouldn’t be sexually involved,” said William R. Archer, deputy assistant secretary for population affairs at the Department of Health and Human Services. But he added, “We believe we do a lot more than just say no.”

The federal government’s prevention program, funded under the Adolescent Family Life Act, encourages abstinence by teaching “life skills” that help young people resist peer pressure.

“It’s like social inoculation,” said Archer. “We teach the kids how to make a decision, rather than just giving them information. I do not think we’ve overstated the issue of abstinence. . . . Abstinence is 100% effective” in preventing pregnancy and sexually transmitted diseases.

Several experts outside government pointed to lower teen-age birth rates in European countries, where there is a consensus that young teen-agers should not be sexually active, but a more pragmatic approach to preventing unwanted pregnancies among older teen-agers.

Senderowitz said programs nationwide fail to acknowledge that “it is biologically predictable and normal that young men and women will want to be together sexually.”

Adolescents can be told that abstinence is the best policy at young ages, she said, but also informed how to protect against pregnancy and diseases. Some experts suggest a policy of “outercourse,” she said, which instructs young people to avoid intercourse but discusses masturbation, petting, hugging and other activities short of intercourse.

As a practical matter, the rise in the teen-age birth rate--to 58.1 births per 1,000 women--means tens of thousands more babies born annually to teen-agers.

If the rate for 15- to 17-year-olds had stayed at its 1986 level, for example, there would have been 30,000 fewer births to those women, who are widely considered the least able to care for a child and most likely to give birth to babies with serious health problems.

Stephanie Ventura, a demographer at the National Center for Health Statistics, said teen-age birth rates began a rapid decline in the 1970s, then leveled off in the late ‘70s and early ‘80s. In 1986, the teen-age birth rate was 50.6.

The numbers jumped substantially in each year from 1986 to 1989, the most recent figures available. “Three years in a row is certainly something to take seriously,” she said.

At the same time, Martin O’Connell, chief of the fertility statistics branch at the Census Bureau, said that because the rise in teen-age births coincided with similar increases in rates among all age groups, they should not be seen as an indication that adolescent births will continue to remain high.

Nevertheless, public funding for family planning services dropped by about a third in real dollars over the 1980s, according to the Guttmacher Institute.

While it is impossible to link increasing birth rates among teen-agers directly to success or failure of prevention programs, “the conclusion is unavoidable that (those programs) are not working well enough,” said a staff aide to the House Select Committee on Children, Youth and Families.

Most programs rely on a single strategy, such as condom distribution or abstinence promotion, and those have been unsuccessful at changing behavior, said the aide, who asked not to be named.

“You might show we’ve increased their knowledge. You might show there’s a reported attitude change,” the aide said. “But in terms of actually making a difference in the back seat of that car on Saturday night. . . .”

Programs that show the most promise, she said, combine access to contraceptive services, sex education, workshops on parent--teen-ager communication and social-skills training to help adolescents resist pressure and make responsible decisions.

While most teen-agers have access to sex education in school, social-skills training and other prevention programs reach a small fraction of them, experts said.

Surveys have identified only 327 school-based clinics in the nation’s more than 20,000 secondary schools. Of those clinics, fewer than a third dispense birth control, according to the Center for Population Options.