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C/J,IFORNIA STATE UNIVERSITY, NORTHRIDGE
ALTERNATIVES FOR TEENAGERS
f'
RELATIVE TO PREGNANCY
A Programmed Instruction
Manual
A project submitted in partial satisfaction of the
requirements for the degree of Master of Science in
Health Science
by
Janet Christine Orr
June, 1976
approved:
G. B. Krishnamurty
Wilfred Sutton, Cnairperson
California State University, Northridge
ii
ACKNOWLEDGEMENTS
I am deeply grateful to each of my committee
members Dr. Wilfred Sutton, Mr. Rao Machiraju and Dr. G. B.
Krisbnamurty.
Each has given me guidance, encouragement and
invaluable consultation throughout my Jl.laster's program.
Special thanks to Jl.lr. Rao Machiraju for his valuable
comments which strengthened my programmed instruction
manual.
I appreciate the efforts of the following:
Ellen
Woolfson for serving as a subject matter specialist; Jane
Hoose for editing this project; Carolyn Filling for drawing
the illustrations and Gwenn Morrison for typing and assisting
in the preparation of this project.
I am deeply indebted to Carol Giuliani and Lee
Johnson for their continuous moral support and guidance.
Also, I wish to acknowledge all of those students
who volunteered as subjects, and directly or indirectly
helped to make this project a reality.
iii
TABLE OF CONTENTS
Page
APPROVAL PAGE •
ii
ACKNOI.J:LEDGMENTS
iii
LIST OF TABLES
v
ABSTRACT.
vi
Chapter
I.
II.
INTRODUCTION
1
The Purpose of the Study
2
Limitations of the Study
2
REVIEW OF LITERATURE
3
Programmed Instruction
3
}futerial Related to Pregnant Teenagers
III.
"Tl'T
.L y •
V.
DEVELOPMENT OF THE PROGRAM
11
28
Procedure
28
Selection of Sample •
32
PROGRAI-1 .
33
The Progro.m
34
Program Changes
89
TI~IE
S~~~RY,
CONCLUSIONS AND
RECO~lliNDATIONS
Summary • .
96
Conclusions
'
. . . . . .. . ......
Recommendations
BIBT.IOGRAPHY
96
97
97
··"'·················•••t
iv
98
LIST OF TABLES
Table
1.
Page
Krishnamurty's Methodology for Individual
Try-Out
. • • .
• • . . . •
v
31
ABSTRACT
ALTERNATIVES FOR TEENAGERS
RELATIVE TO PREGNANCY
A Programmed Instruction
Hanual
by
Janet Christine Orr
Haster of Science in Health Science
June, 1976
The purpose of this study was to develop a progrannned
instruction manual of birth control methods and alternatives for
teenagers relative to pregnancy.
Programmed instruction was used
because it allows the student to participate actively in the
learning process.
The student can learn at her own pace, without
the assistance of an instructor.
The manual is limited to connnon forms of birth control
methods and alternatives for pregnancy.
Alternatives included are
abortion. adoption, and keeping the baby (with/without marriage).
Information about available medical services and financial assistance is provided.
In the early phase of writing the program,
current literature was studied and the program was reviewed by a
subject matter specialist and corrections vJere made,
vi
The method of
Individual Try-Out was used to revise the program to meet needs of
the students.
The progrruu was tried out on one student at a time
and then revised according to her comments.
This process was
continued until the program communicated with two individuals
consecutively.
Eighteen students from North High School in Torrance, California participated in the Individual
1975-·76 school year.
Try~Out
process during the
Students were selected from the target
population and for their outspoken abilities, their previous
abortion histories, and their desire to gain more information in
this area.
The program in its final form is reported in this study.
vii
Chapter I
INTRODUCTION
For many years teenage pregnancies have been a dilemma to
all concerned.
For example, in one local school district, the
Health Department used sixty-two hours of counseling for problem
pregnancies and abortions during a two month reporting period.
Thirty-eight abortions were reported from one high school.
The
largest percentage of these students were ninth and tenth graders
who were still searching to establish their own identities.
Yet,
in this particular school district there was no formalized health
instruction program.
It is necessary for educators to assist pregnant adolescents
and adolescents in general, to reach satisfactory decisions for
themselves, their families, their unborn babies, and the fathers of
the babies.
For adolescents to make wise decisions, they need more
knowledge about their bodies and their emotions, about birth control methods and about alternatives available to them if they
should become pregnant.
For years programmed instruction has been a unique and
effective teaching technique.
Programmed, instruction is a self
teaching method which does not require the assistance of a teacher
or classroom.
It is ¥aluable because it is self pacing and each
student is able to learn at his or her own rate by gaining
irrnnediate feedback to responses.
1
In a school district without a
2
sequential health instruction program, programmed instruction
could be a beneficial way to teach birth control methods. and
alternatives to pregnancy.
The intent of this study was to develop
a programmed instruction manual on birth control methods and
alternatives for pregnancy utilizing the linear and branching
styles of programming.
The process of Individual Try-Out was
followed until the program communicated consecutively with two
individuals.
The Purpose of the Study
The purpose of this study was to develop a programmed
instruction manual of birth control methods and alternatives for
teenagers relative to pregnancy.
Limitations of the Study
The programmed instruction manual of birth control methods
and alternatives for teenagers relative to pregnancy was intended to
be used as a supplement to other forms of instruction in this
area.
However, it could be used as the only means of information.
The manual was limited to common forms of birth control
methods, therefore it does not cover all forms of birth control.
Chapter II
REVIEW OF LITERATURE
Pry_r;rammed
Instt:·ll;~t:_ica
In its present day form programmed instruction has developed
from a complex history of principles, methods and personalities.
The programmed .instruction movement began when Sydney Pressey developed his teaching machine3.
Deterline (8:9) commented that in
the 1920's Pressey's machines were essentially muitiple-choice
testing devices giving the student information on the correctness
of his answers.
Pressey observed that students were learning when
given immediate feedback on their test answers.
Basically a
teaching machine is any device used to present self-instructional
material.
It may be in the form of a punchboard, an electronic
device capable of presenting both visual and printed material, or
it may be a textbook, in which control of the learning process is
acl1ieved through the physical arrangements of the material on the
printed pages,
Lumsdaine (24:5) commented that teaching machines represent
a variation on what car. be called the tutorial or Socratic method
of teaching.
That is, they present the student '"ith programs of
questions and answers, problems to be solved, or exercises to be
performed, plus providing automatic feedback on correctness of
answers.
Thereby, the student is immediately informed of his
progress at each step.
3
4
In 1954 Skinner \'Trote an article entitled "The Science of
Learning and The Art of Teaching" which gave real impetus to the
prograr:uned instruction movement.
He described laboratory techniques
that reliably produce modifications in the behavior of experimental
subjects.
He literally took Pavlov's and Thorndike's "laws of
effects" seriously.
The "laws of effects" state
that the connection
between situation (Stimulus) and behavior (Response) is strengthened
only if some success or satisfaction follows the response.
(30:7)
Deterline (8: 11) stated that organisms learn by a.-::ting on their
environment and by being acted upon in turn'by the consequences of
their actions.
Certain consequences strengthen behavior or increase
the probability that the same response will occur again in the
presence of the same stimuli.
This kind of consequence is called
reinforcement.
Skinner (35:100) stated that once we have arranged the
particular type of consequences called reinforcement, we can shape
behavior of an organism at will.
He said that behavior can be
maintained in given states of strength for long periods of time.
So, reinforcement is important long after an organism has learned
to do something and long after it has acquired behavior.
Skinner's concern with continuous and immediate rei.nforcero.ent closely identifies him with traditional learning psychology.
He also used the language of operant conditioning when describing
the learning process.
(36:92)
According to Hartley, the techniques of programn1ed learning
in the early days followed this format:
5
a.
The learner must work on his own, with a machine or
programmed text.
He must work at his own pace.
He must work through small steps.
These steps must be carefully sequenced.
The learner must respond in some way to each step usually by writing his answer down, or by pressing
an appropriate button.
The learner must receive immediate knowledge of
results concerning the correctness or appropriateness
of his answer.
The program must be tried out and revised on the basis
of the results obtained, so that it was known that the
final version of the program would realize the
achievement of specified objectives with a specified
learner population. (15:279)
b.
c.
d.
e.
f.
g.
Hartley believed that it was the combination of these
tactics into one overall strategy that marked the revolutionary
contribution of programmed learning to education.
Skinner's linear programming is based on three principles:
(1) active responding identifies where the program is leading the
student;
(2) m::i_nimal errors result from good design of inst:ructi_on
and from repeated tryout and revision of the instruction; and (3)
the most important principle of programmed instruction is the
knowledge of results or "reinforcer."
He felt that being "rig1:t"
was adequate enough to serve as a reinforcer.
(23:286)
Skinner, as cited by Hartley, stated:
There is a simple job to be done. The task can be
stated in concrete terms. The necessary te-chniques are
known. Nothing stands in the way but cultural inertia.
(15:278)
In a linear program the student proceeds through the
program in a straight line with fixed instructional sequence.
The frames, or small units of knowledge, move the student steadily
toward the terminal behavior.
A frame introduces one concept at a
6
time.
Linear programs require the student to construct his own
response.
Usually there is a sentence of information (stimulus)
followed by an incomplete but parallel sentence or problem based
on information, and the student is required to fill in the neeessary information (response).
Responses that lead toward desired
terminal behavior are reinforced and rewarded as soon as they occur,
whereas responses that do not lead toward the terminal behavior go
without reinforcement.
All students receive the same information
in a linear program.
Hartley (15:278) states that in the early days of programming,
programmed learning was stressed.
It was characterized by what
learners did when they were faced with a teaching machine or a
programmed text.
Today, the subject matter analysis prior to
developing programmed instruction is being stressed.
Actually,
learning and instruction are both sides of the same coin, but it
serves to make a distinction between the two terms because they have
been interchanged so much in the context of programmed learning.
Another form of programming is Crowder's "instrinsic" or
branching method:
Crowder defined intrinsic programming to mean that his
programs adapt themselves to the needs of the student without the intervention of an extrinsic device such as a computer. The last part of this statement is usually left off.
The learner, within himself, makes the decisions which adapt
the instruction of his needs.
(31:15)
Crowder stated in the article "Automatic Tutoring by
Instrinsic Programming" that it is an individually used, instructorless method of teaching which represents an automation
of the classical process of individual tutoring.
(6:286)
7
According to Pipe, Crowder said teaching is a process of
communication and communication takes place when the student is
choosing between alternatives.
The student's response provides
feedback to the programmer on whether he managed to communicate.
Crowder's view is as follows:
To predictably achieve a desired result one must either
have an infalliable process to bring about the result or
one must have a means of determining whether the result has
been achieved and of taking appropriate action on the basis
of that determination. (31:13)
In other words, the means of determining results achieved means
using multiple choice questions and obtaining feedback through the
student response.
In
(31:13)
the branching method of programmed instruction, the
student is given the material to be learned in a frame usually a
paragraph or less, followed by a multiple choice question.
If the
student makes a correct response to the question, he continues
through the program as he would in a linear program.
If he makes
an incorrect response, he is taken off the main program and onto a
"branch" of the program.
Here, the preceding unit of information
is reviewed; the nature of his error is explained to him; and he
is retested by a multiple choice question.
In the branching program
there is a separate set of correctional materials for each wrong
answer that is included in the multiple choice alternatives.
The
student's path through an intrinsic program is determined by his
pattern of responses.
(6: 286)
TutorTexts or "scrambled books" as they were originally
called were based upon branching programs developed by Crowder.
8
Yhe page numbers in the textbook were assigned essentially at
random, and the student, therefore, could not progress from one
page to the next, except by making an active choice of an answer.
Howeve~
as the work in this area progressed, it was found that the
order of the page numbers was arbitrary.
(6:296)
There are similarities between Skinner's linear programs
and Crov;•der' s intrinsic programs.
Pipe (31: 6) stated that the
general characteristics of programmed instruction were as follows:
(1) small steps or optimally sized increments; (2) active student
participation; (3)
pacing.
i~nediate
knowledge of results; and (4) self
Both appToaches to learning attempt to create a self-
sufficient instTuctional program that will produce mastery of the
subject when used as a primary vehicle of instruction.
Both
techniques utilize active student response, give immediate feedback and allow the student to proceed at his own rate. (6:286)
Intrinsic. programs are similar in format to linear programs until
the student makes an incorrect response.
Crowder's article "On The Differenc.es Between Linec.r and
Intrinsic Programming" explained many of the differences in the
two approaches to learning.
of material.
An obvious difference is the sequencing
Crowder's intrinsic program allows a student to take
a route through the program that is determined by h:ts mm
to each question.
re.s:;:JOn~;e
By contrast, a Skinner program or one
"extrinsically programmed" suggests that the route or sequence of
frames is more rigidly established by the program
the student.
~vTiter
than by
Skinner proceeds with small steps of information to
9
avoid student error since he feels the ultimate obje...:tive is correct
responses.
On the other hand, Crowder believes in optimally
sized increments of information, which then capitalize on each
mistake by providing corrective feedback.
(8:43)
Crowder stated:
In linear programming, the student's response is considered an integral part of the learning process; the
response is induced in order that it may be rewarded and
learning thus occurs. (7:145)
In intrinsic programming, the questions serve
primarily a diagnostic purpose, and the basis of the
technique is the fact that the diagnosis so made can
be promptly utilized to furnish specific remedial
material to the student. (7: 147)
The linear programmer believes the student will learn only those
responses he is rewarded for; whereas, the intrinsic:. programmer
does not pretend to know how the student >vill learn, but he is
strictly interested in whether he learns.
(7 :148) A fixed sequenee
involving student constructed responses is follm..:red in a linear
program.
The intrinsic method tends to make use of multiple choice
questions, and the student path through the program is detenuined
by his responses.
Another method of programmed instruction, called Mathetics,
was conceived by Gilbert.
wora "to learn" (mathein).
Hathetics was derived from the Greek
He chose this name to emphasize "its
uniquely systematic quality and to distinguish it from less
systematic methods of planning the course of human learning." (12:10)
Mathetic programs are characterized by their (1) lack of
bulk; (2) large step size; (3) precise use of mediators; (4)
distinctive format; (5) lavish use of illustrations; (6) great
10
amount of covert responding; (7) virtual absence of immediate confirmation; and (_8) lack of normal-order performance sequence. (12:14)
Gilbert suggested that when preparing a lesson:
Always let your biases be in the direction of assuming too
much about the student repertory. This rule is determined by
the simple fact that if you overestimate the student's repertory, you will discover the error instantly when the lesson is
first tried out. If you err in the other direction, it will be
very difficult to discover it.
(12:14)
¥.:athetics is a production process consisting of several
distinctive stages. In sumnary, these are:
a. Prescription. A description of the behaviors that constitute mastery in some subject-matter domain. The only behaviors made explicit in the prescription are those necessary
to synthesize mastery performance. The behavior repertory that
the prescription represents is called the synthetic repertory
and is roughly equivalent to what is meant by the word "practice:~
as distinguished from "theory."
b. Development of the Domain Theory. In this process the
essential elements of the subject-matter are e..xtracted from
the details and described in behavior terms. A domain theory
is relevant only to the subject-matter reflected in the
prescription. A new prescription is written describing the
analytic observations of a subject-matter master; this is the
behavior we usually mean when we say a student has "understanding" or knows "theory." This new prescription describes
the analytic repertory.
c. Characterization.
In this process an analysis is made
of the behavior properties of the prescribed repertories; a
description is made of the generalizations that are to be
taught, of competition with adequate performance, and of the
behavior available to overcome this competition.
It is from
this information that a plan of the lesson is developed.
d. Exercise Design. The exercises are designed according
to a basic model, and in a sequence consistent with a lesson
plan developed from the characterization.
(12:23)
Hartley stated that modern day programmed instruction takes
its form from four complex and closely-interrelated steps:
a. ¥-nowing where you are going (specifying objectives)
b. Trying to get there by the best means possible (_interrelating task analysis and teaching strategies)
c. Assessing whether you have got there successtully
(evaluation), and
d. Using the results of this assessment to improve
11
the methods used in step (c), (revision).
(15:287)
According to Popham (32:5) it took the enthusiasm of programmed instruction advocates to really get educators talking
about measurable goals.
Mager's book Preparing Instructional
Obiectives was devised initially for programmers but won acceptance
by educators not involved in progranuiled instruction.
Interest in Bloom's Cognitive Taxonomy of Educational
Objective~
had been minimal until programmed instruction enthusiasts
began to press for specificity.
available since 1956.
The cognitive taxonomy has been
In 1964 Krathwohl's Affective Taxonomy of
Educational Obiectives 1>1as published.
Popham (32 :5) stated that
had it not been for programmed instruction enthusiasts both
Tax_g_Eomies might have languished into educational oblivion.
With the growing awareness of the necessity of having
measurable objectives, educators are being made to become more
specific in their instruction.
Educators, thus, are becoming aware
of the value of programmed instruction in helping them to achieve
the specificity.
Application of each of the techniques of programmed
instruction results in a learning package of self-sufficient instructional material for attaining mastery of the particular subject.
Program writers today are borrowing from each method of programmed
instruction to best achieve the instructional goals.
Haterial Related to Pregnant Teenagers
The follmv-ing statistics reveal teenage pregnancy as a
major problem in our society.
12
1.
According to the 1970 Census Bureau report, one-·fifth
of the population was between the ages of 14 and 24 years of age.
(39 :4)
2.
Females are reaching puberty at a younger age.
Klerman
(20:263) reported that in the United States there has been a
decline of the mean age of menarche to 12.8 years for white females
and 12.5 for black females.
3.
According to the National Vital Statistics in 1968,
there \vere 600,816 births to teenage mothers or 17 percent of all
births in the United States.
Of these 600,816 births, 98 pe·ccent
or 591,312 were to mothers 15-19 years of age, and two percent or
9, 504 \vere to mothers under 15 years of age.
4.
(41: 1)
According to National Center for Health Statistics,
there are about 400,000 out of wedlock births annually.
About
half of these births are from single teenagers in the 15-19 age
group.
In other words, there are 22 illegitimate births per 1,000
unt'11arried teenagers.
5.
(17:4)
In 1972 there were approximately 495,000 females
under 20 years of age who delivered a first child.
60 percent of the
15-20 age group \vere married by the time the child was born, but
because most of the marriages were forced, they tended to end in
divorce.
(3: 257)
6.
Furstenberg' ,s studies sho\ved that two-thirds of the
females who marry as a result of pregnancy, divorce ·\vi thin five
years.
(10:340)
7.
Lightner (22:1) reported that approximately 33 percent
13
of all marriages involve teenage brides, and of these about half
are pregnant before ntarriage.
Seventy-five percent of these
marriages will end in divorce.
8.
Among 180 pregnant females studied at the Young Mothers
Clinic of the Yale-New Haven Hospital, seven percent had married
the putative father approximately three months after conception;
17 percent of the young mothers had married the putative father
approximately 16 months postpartum; and 23 percent had married
after 25 months.
By the twenty-fifth month, approximately three-
fourths of the unmarried young mothers were still unmarried.
(20:7.65)
9.
According to Gabrielson (11:2289), there was a higher
rate of attempted suicides among pregnant teenagers than among
non-pregnant teenagers.
In a study of 105 teenage mothers who
were under 17 when they delivered, 14 had attempted or threatened
suicide.
10.
Klerman (20:264) stated that a recent survey revealed
that coital experience among young never-married females rose
from 14 percent at age 15, to 21 percent at age 16, to 27 percent
at age 17, to 37 percent at age 18, and to 46 percent at age 19.
The rate among black females was even higher:
54 percent had had
intercou1:se between the ages of 15 and 19, as compared to 23
percent of the white females.
11.
There has been a steady increase in births to
~mmen
under 20 years of age, even though the number of births has
declined in general.
The Institute of Medicine's study entitled
14
"Infant Death:
An Analysis by Maternal Rish and Health Care"
revealed that the highest mortality rate occurred to infants born
to females under 15; 43.5 infant deaths under one year for every
1,000 live births.
The 15-19 age group revealed 30.5 infant deaths
per 1,000, as compared to an overall rate of 21.9 per 1,000.
(20:265)
12.
In 1968 in New York City over 1Lf2 ,000 births in the
15-19 age group were studied, and it was discovered that the
infant mortality rates rose alarmingly as birth order increased:
24.1 for the first birth between 15 and 19, 49.5 for the second,
37.3 for the third, and 62.2 for the fourth.
13.
(20:265)
A Yale follow-up study found that there were greater
risks of prenatal death and prematurity in the second and subsequent
pregnancies, rather than in the first.
14.
(20:265)
According to Klein (19:271), teenage mothers produced
more premature babies weighing less than five and a half pounds and
more stillbirths.
More babies died within the first month and the
first year of life.
15.
Lightner (22:4) stated that birth defects occur at
a much higher rate in mothers under 18 and over 40 than they do
when the mother is in the 18 to 40 age range.
16.
Young females have a greater tendency to have health
complications with pregnancy.
Braen (3:256) stated that health
complications such as toxemia, anemia, prolonged and/or premature
labor during pregnancy and delivery are common.
17.
According to Braen (3:256), low birth weight and pre-·
15
mature births were common in females under
Also, the infants
17~
were less likely to develop satisfactorily psychologically,
neurologically and intellectually.
18.
The California Therapeutic Abortion Act
in November, 1967.
W3S
enacted
According to the third annual report published
in 1970, 31.6 percent of all legal abortions performed were for
teenagers, while the proportion of teenage live births was only
17 percent.
19.
(38:1)
According to Lightner (22:1), there were 136,000
therapeutic abortions performed in California in 1972, almost
twice the number performed in 1970; approximately 33 percent
involved females 19 and under.
One can understand that teenage pregnancy is an important
problem in our society because today the concept af "singlepregnant teenager", "school-age parent" and "young family" is
being promoted, instead of promoting the negative connotation of
"unwed mother."
(16:487)
Many of these pregnancies could have
been avoided by providing responsible sex education and parenting
information programs in the schools.
As educators we must rid
ourselves of the noti.on that if we deny the existence of sexual
promsicuity that it will go away.
Along with good sex education programs in the schools
Klerman (20:263) suggests a need to change attitudes ia A:rnerica
society in order to move tmvard the prevention of inappropriate: pregnancies.
The term "inappropriate" rather than
11
u:1wanted" is used,
because many of the pregnanc.ies are desired by the teenager.
The
16
pregnancies may not be planned; nevertheless, the child is wanted.
Often, though, the child is wanted not for reasons which will add
positively to the life of the individual girl/woman or to her
child.
Now, more than ever, it is critical that young people are
given relevant information regarding contraception, sex education
and parenting.
An atmosphere mt•.st be created in which teenage
contraception is sanctioned and in which the girl need not feel
that she is "bad" because she is accepting responsibility for her
sexual behavior.
Lightner (22:3) stated that teenagers are
ignorant about the facts of life and grossly misinformed about
contraception.
Furstenberg has documented two assumptions about
the unmarried teenager's attitudes .
•.. (1) many are unwilling to use contraceptives because
either consciously or unconsciously they want to have a
child; (2) even if pregnancies are unwanted, most of these
young people between the ages of 15-19 years are too
fatalistic, apathetic, present-oriented, self-defeating and
filled with inner conflict and the lack of self-worth to use
sophisticated methods of contraception. (10:345)
Ballard (1:350) stated that a female caught with an inappropriate
pregnancy tends to utilize public services to a great extent due
to the lack of knowledge of established avenues of medical care.
In a study conducted by Ballard, he reported that 50 percent of
the patients seen in public clinics had used an effective contraceptive method in the past; 30 percent of the patients had no
knowledge about simple contraceptive methods available without
prescription (foams, jellies and condoms); and 40 percent did not
previously know about the Planned Parenthood affiliate providing
17
such services.
Less than 20 percent ascribed pregnancy to a pure
method failure; 30 percent had had a previous pregnancy; and 50
percent were either using an ineffective method or none at all.
Planned Parenthood reported that 42 percent of new female patients
were under 20 years of age in 1974 as compared to 38 percent in
1971.
There has been a 25 percent increase in girls under 15 years
of age coming to Planned Parenthood clinics.
(17:4)
There still is a reluctance to using contraceptive methods
among teenagers because using them implies preparation and
planning, which they do not want to admit.
Some other reasons for
not using contraceptives are that it is troublesome, or that it
is harmful, or that young people believe that they are too young
to get pregnant.
(17:4)
In a study, the staff of the Maternal and
Infant Care Project at Grady Memorial Hospital in Atlanta, Georgia
found that dispensing contraceptives for birth control was not
acceptable to teenagers.
The young people resisted any coercion
or harrassment regarding the use of birth control method and
rebelled at multiple pelvic examinations.
The staff observed
approximately 800 pregnant girls per year, 16 years old and under,
during the 1960's.
(19:272)
In a recent book Becoming An Unwed Mother,
P~ins
stated that
the problems of self-respect and moral ambivalence
which are raised at each transition to a more permissive
stage of sexual experience ... are handled by culturally
derived evasions and techniques of neutralizing internal
disapprovaL
Unconcern with contraception is such a
technique for it allows a girl to evade recognition of
what she is doing and to sustain a preferred view of
herself .
•... A girl who, in some measure, still adheres to a
standard that excludes sexual intercourse may prefer the
18
risk of possible pregnancy to the more probably risk
of loss of reputation. (20:264)
Klerman (20:264) agreed with Rains' theory.
Society is
responsible for many of the inappropriate pregnancies.
Apparently
the girls' feelings about sexual activity are not strong enough to
prevent her from having intercourse, but her feelings about
morality are strong enough to prevent her from using contraceptives.
A study reported in the American Journal of Public Health
in 1973 for 130 cities of more than 100,000 population revealed
that 64 had contraceptive services and 83 provided sex education.
The study emphasized expansion of sex education programs to include
contraception.
(17:5)
There are researchers who feel that the liberal attitudes
in our society have been the cause of increased numbers of teenage girls becoming sexually permissive.
The women's liberation
movement has allowed women to exercise their freedom of choice.
Furthermore, society no longer is as disapproving of an unmarried
pregnant female.
(17:4)
Some
researchers feel that girls are
motivated to indulge in sex early because of parental neglect,
lack of love, insecurity, ignorance, poverty, violence or
encouragement by our sex-permeated culture.
(4:482)
Few people deny that adolescence is a difficult period for
most young people.
Usually the adolescent's self-:L"'llage is not
very good, and justifiably so, because this is the period during
'>\'"hich they are forming their identity.
Usually the values of their
peers and those of society are conflicting, and this can be confusir1g.
Wittenberg (42:94) stated that i f adolescence is
19
characterized by sex without love, and love without sex, the teenage girl finds herself in a dilemma.
Lightner (22:4) reinforced
what Wittenberg said and adds that teenagers tend to view their
sexual partner as an "object" rather than an individual.
Sometimes
this confusion leads a girl to act out sexually, not fully comprehending the consequences her acts would have on the rest of her
life if she should become pregnant.
This sort of acting out does
not resolve the original problem and may cause additional
probla~s.
Shanas (33:72) stated that there are many psychological
factors involved in a teenage pregnancy.
to prove one's femininity.
First, there is a need
The enjoyment of sexual intercourse or
the achievement of an orgasm is not sufficient proof of femininity.
There is a desire for residual proof of having been loved.
Un-
consciously the adolescent girl harbors a strong desire to produce
a child and, thus, prove herself adequate as a woman.
According
to Blaine (2:49) this unconscious need often manifests itself by
refusal to use a contraceptive device or by "forgetfulness'' in
this regard.
Another psychological factor, according to Shanas (33:72)
is that the females want to trap a desired male.
Becoming preg-
nant constitutes a means of binding a male more closely.
She
feels it increases his obligation to her and, thus, may force him
into marriage.
Shanas continues by commenting that girls become
pregnant out of a deep need for love.
Sometimes
a
young girl will
black out during intercourse because she is not interested in the
sex act, but in the touching communication she is receiving from
20
the other person.
If the love need is not fully satisfied by the
father of her child, then the girl finds fulfillment in loving her
baby.
Most young females are not psychologically mature enough to
assume the responsibilities of adult love and parenting.
It is as
if a baby is raising a baby.
American society has some major problems for the teenager
to handle.
The teenage girl must learn to understand how society
views the role of a woman.
Young girls are continually bombarded
with suggestive information by means of magazines, billboards and
movies.
So as long as the media continues to suggest to the female
that a meaningful role for her is that of a mother and housewife,
then the teenage girl feels that she should try to reach this
pinnacle as soon as possible.
(20:264)
At present, there seems to be a lack of an overriding
societal goal, so some teenagers, like adults, spend their time
in pursuit of individual pleasures, such as sex, drugs, etc.
In addition, adolescents in America are faced with the lack of a
meaningful role in society.
jobs.
They are confronted with unsatisfying
Because of child labor laws and compulsory school attendance,
this has delayed full-time entry into the labor market, which is
defined as adulthood.
For a person to obtain a satisfying job,
more years of education are required, thus keeping the young person
out of the labor market again.
Extension of school has an important
effect on sexual activity and marriage.
In the United States it is
customary for marriage to be delayed until the male can provide a
living, thus sexual activity among teenagers is almost always outside of marriage.
21
It is no wonder with all the obstacles young females face
that some girls do become pregnant.
Years ago, many of the preg-
nant teenagers who carried their babies to term released them for
adoption.
Today, however, most young mothers who give birth, in
or out of wedlock, plan to keep and rear their children themselves.
Smith (37:278) stated that in a study done by Howard he found that
85 percent of the teenage mothers in the United States keep their
babies.
In another study Zelnik and Kantner reported that 18 per-
cent of illegitimate first children of white women are released
for adoption, as compared to two percent of illegitimate first
children of black women.
Getting pregnant while single is not as socially unacceptable as it once was; therefore, more females are keeping their
babies.
Statistics show that single-parent families headed by
never-married women has increased.
According to the Census Bureau
(17:5) in 1974, 317,000 single females were heads of families with
children under the age of six, as compared to 221,000 in 1971.
Unwed fe•11ales confront one problem that still has not changed in
our society, and that is earning enough money to care for herself
and her child.
According to Kazickas (17:5) there are no national
statistics on how many umv-ed females are on welfare, but in 1973
about 45 percent of the families receiving Aid to Families \-Jith
Dependent Children had one or more illegitimate children.
Years ago marriage was almost automatic if a teenage girl
found herself with an unwanted pregnancy.
Many young couples were
I
forced by their parents into a premature marriage for which they
22
were educationally, financially and emotionally unprepared.
Consequently, the rate of suicide attempts was ten times greater
for a pregnant female under 18 versus a non-pregnant female in this
age group.
(3:256)
For a young couple who faces parental coercion
and an inappropriate pregnancy, it is very unlikely that the
marriage will be happy or lasting.
However, for an older and more
mature teenager, marriage may be a valid option.
With marriage no longer the solution to premature pregnancy,
placing the child for adoption can be considered as another alternative.
Adoption is an option, if the girl decides to carry the
baby to term.
A recent survey by the Child Welfare League of
America revealed a 52 percent decline in adoption from 1971 to
1973.
(17:5)
There is almost a social stigma connected with
giving a child up for adoption nowadays.
There is a feeling among
some that the women's liberation movement or "who needs a man"
movement has influenced some females to keep their babies.
Years ago most white teenage mothers gave up their babies
for adoption, but today the trend is that more and more white
teenage mothers are keeping their babies.
This places a new
responsibility on the schools in preparing the young females to
become mothers.
We must remember that this girl is going to go
through an experience for which she has had very little preparation.
A misconception held by many is that in the black culture
it is acceptable for a teenage girl to become pregnant and to
keep the child.
However, according to Smith ()7:279), the minority
23
families do not usually accept the teenage pregnancy, in reality
they are often angry and unaccepting.
Minority families are
concerned with social disgrace, financial burdens, and all the
other problems associated with having an additional member of an
already overburdened family.
According to Shouse (34:161), abortion is being chosen more
frequently.than adoption as an alternative to having the baby.
The
California Therapeutic Abortion Act became effective November, 1967.
It permits pregnancy terminations when the mental or physical
health of the woman may be· impaired by carrying pregnancy to term,
in cases of rape or incest or when the female is under 15 at time
of conception.
A committee of three licensed physicians and
unanimous consent of all is necessary to approve an abortion.
Therapeutic abortion is performed in a hospital by a medical
physician for the purpose of saving the life of the mother.
Because of the legalization of abortion, statistics were
modified temporarily, but recent figures show a new rise in outof-wedlock childbirths among teenagers.
In California alone, the
illegitimate birthrate rose nearly three percent in 1972 and
another three percent in 1973, even as nonwhite illegitimate births
declined.
(37:278)
Some elements in our society continue to act as though
premarital sexual intercourse . is "evil", particularly for a girl.
This idea exists even though premarital intercourse is beginning
at a younger age and the extent is increasing among teenagers.
perfect example of this moralistic attitude, which is completely
A
24
out of touch with today's realities, is former President Nixon's
decision to ignore facts of the report of the CoPxmission on
Population Growth and the American Future which dealt with free
access to birth control and abortion.
(20:264)
On the other hand, there are positive steps being taken
to handle the problem.
Marland, former Commissioner of Education,
established a policy toward equal educational opportunity in
February 29, 1972.
The policy stated that:
••. every girl in the United States has a right to and
a need for the education that will help her prepare herself
for a career, for family information, and for citizenship.
To be married or pregnant is not sufficient cause to deprive
her of an education and the opportunity to become a contributing member of society. Young fathers also require
assistance to enable them to meet the considerable responsibilities which they have assumed. In serving both young
women and young men experiencing or anticipating early
parenthood, we also serve the children involved and promote
a strengthened family structure. (3:258)
In California on September 27, 1974, Governor Reagan signed
a law authorizing the Superintendent of Public Instruction to enter
into agreements with local school districts or county superintendents to provide child development classes, infant care and
parenting information.
(3: 260)
It is an important law because
many social workers sense an increase in child abuse cases among
unmarried mothers.
(17:4)
Klerman (20:265) stresses that every precaution should be
taken to prevent an already pregnant girl from becoming pregnant
again.
Studies have shown that girls who remain in school are
less likely to become pregnant again.
Conversely, if the girls do
not become pregnant it is easier for them to stay in school.
The
25
education of these girls should not be limited to learning the
stereotypical female occupations, but they should be prepared for
the most skilled occupation they can possibly master, whether it
be a secretary or a lawyer.
According to Klein these are reasons for keeping a
pregnant female in a regular school:
No one needs education and a vocation more.
2. A special school requires extra funding not available
in large inner cities. Sequestering 'pregnant girls in special
programs avoids the problem and keeps it out of sight and out
of mind.
3. The girl is deprived of her civil rights. Boys are
not ~~pelled from school as a result of their sexual activity.
4. In many areas there is no transportation to other
schools so that if a girl cannot go to school in her own
neighborhood, she may not be able to go to school at all.
5. The girl is deprived of her peer group, friends, and
significant adults. Teachers and counselors who knew her
and have a positive attitude toward her would support her.
6. The girl is deprived of her extracurricular activities
centered around the school and its extensions, which tend to
include most of a teenager's activities.
7. A visible pregnant girl in t.he classroom is not the
romanticized woman on television or in magazines. She is a
girl with a problem. (19:272)
1.
Pregnancy is major reason for school drop outs or rather
for "push outs" among girls in the United States.
The majority of
the girls do not return to high school after childbirth; thus, they
do not obtain a high school diploma.
(3:256)
It is apparent that
every measure possible should be taken to keep the girl in school
during her pregnancy and after the delivery of the child.
Minor
modifications in a regular school, such as less strenuous physical
education, use of elevators and extra rest periods, can help to
keep a girl in school.
Infant day care centers within the school
setting allow tne mother to learn and not to have to worry about
26
caring for her infant.
In conclusion, the pregnant teenager is not going to disappear from our society.
Statistics show that young females are
becoming sexually active at an early age.
As educators we cannot
remain indifferent to the problem; rather, we must create an
environment which will £aster sexual responsibility and which will
provide for an understanding of the significance of the role of
parenting.
It is our duty to help prevent subsequent inappropriate
pregnancies by providing adequate contraceptive information.
In a sense, schools have been contributing to the pregnancy
problem by notproviding educational information on birth control
methods and parenting.
The educational system has discouraged a
pregnant female from remaining in regular school while pregnant and
has continued to discourage her from returning to school sometimes
by imposing unreasonable waiting periods between delivery and time
of her return.
(3:256)
A pregnant teenager is a girl with an obvious problem.
She is going through normal adolescent development and is also
suffering the crisis of being pregnant.
In adolescence there is
a strong identification with peer group; this could be another
justification for retaining her in the regular school.
One
educational task is to assist the pregnant teenager in coping with
her problem and with the world and to teach her that she does have
control over her life --- that she is not a helpless victim.
Also,
the school must help her grow toward independence and find her own
identity.
Two main approaches by educators have emerged -- to
27
provide special classes in regular school setting or to provide
separate facilities for pregnant girls.
(3:258}
Along with sex education, contraceptive information and
parenting skills, concerned individuals and agencies should request
various forms of education to make appropriate changes.
We need
to urge governmental and educational institutions to change
instructional prerequisites for adolescents.
Instruction should be
relevant to the needs and problems which young people are confronted with daily.
Parents can listen to their own advice to
their daughters and look at the pictures to which they are exposed
and then decide whether they are really encouraging these girls to
set unrealistic goals.
Finally, society can try to resolve the
moral conflict of the sexually active girl by openly admitting
that sexual morals have changed.
(19:264)
Chapter III
DEVELOPMENT OF THE PROGRAM
Procedure
To develop a programmed instructional manual, distinct
steps are taken in each phase of its development. i.e.,
1.
2.
3.
4.
· 5.
Statement of behavioral objectives in terms of
what the student shall be able to do after
completion of instruction.
Analysis of the subject matter in terms of
concepts and discriminations.
Preparation of an initial draft in accordance
with the initial behavior of the target
population.
Individual Try-Out of the draft on on~ person
at a time, and revising the same on the basis
of the student's reactions.
Group validation of the final draft by administering it on groups and gathering data.
(14:61)
The program was based on assumptions about the initial
behavior of high school girls.
Some high school girls were
becoming pregnant and many did not realize that there were alternatives to their unwanted pregnancies.
An extensive review of the literature provided educational
material currently being used in the area of birth control,
adoption and abortion.
During the task analysis phase the infor-
mation was organized sequentially to make sure it had a logical
beginning and end.
As frames were developed, they were
w~itten
on
4" x 6" index cards and tried out on students with information
and/or stimuli on the front of the index card and the response on
the back.
Klaus (18:155) stated that in the linear style of
28
29
programming, the material can be tried out in segments as it is
developed.
The author found this to be an excellent method of
organizing and rearranging the sequence of the material.
After completion of the first draft the Individual Try-Out
was carried out and this served as a continual process of program
revision.
The students participated in the Individual Try-Out
of the programmed instructional manual during the 1975-1976 school
year.
Each student was given an appointment and arrangements
were made with other teachers to release volunteer students from
class to serve as try-out subjects.
All of the students were
extremely cooperative and their comments and reactions were noted
and incorporated as the program was revised.
During the preliminary phase, Individual Try-Out was
conducted on five students only.
one to one basis.
Each session was conducted on a
Instructions were given orally at first and then
in written form as the program was revised.
Each student was told
that she was not being tested, but that the program was on trial.
Each was encouraged to tell the programmer anything that was
confusing to her.
Their remarks were recorded and the program was
revised accordingly.
The revised material was then administered
to another individual to obtain further feedback.
This process
continued until the material had communicated to at least two
individuals in a row v7ithout needing further revision.
(21 :153)
Also in this early phase of development, technical editing
was undertaken.
An individual with the Family Planning Clinic
at Harbor Gener.al Hospital, Torrance, served as subject matter
30
specialist.
She reviewed the program for technical accuracy of the
material being presented.
In the early phase ot try-out, outspoken students were
selected so that feedback could be obtained . . Deleting and adding
frames was frequent with terminology being the most common
problem encountered.
For example, the word consequences was
changed to results and contraceptive devices·. to birth. control
methods.
The response to the program was overwhelming.
Once
students heard about the program they volunteered themselves for
try-out.
Students who did not attend physical education regularly
came to school at 7:30 a.m. so they could participate in the
try-out.
Students shared many of their experiences and provided
more material for the program.
Krishnamurty's methodology for Individual Try-Out was
followed.
The process of Individual Try-Out is represented
diagramatically as in Table 1.
(~1:153;
25:8)
Each time the programmed instruction manual was given, the
following instructions were explained to each Individual Try-Out
subject.
1.
The program is being tested not YOU.
Feel free to tell
me anything that does not make sense to you or that is not clear,
2.
If your responses are not correct or you are not
sure of them, please tell me.
3.
If any of the wording is confusing to you, please
4.
The program is intended to provide you with information
tell me.
31
Table 1
Krishnamurty's Methodology
for Individual Try-Out
Start here
1
Try the draft on one
learner at a time
Revise the part(s)
that does not
communicate.
i
Revise frames
that do not
communicate.
1
NO
NO
Does each frame
communicate _ _ _
with the
learner?
YES~
Does the total
p:ogram comm.uni.cate
w1th two learners
consecuti-,.,;rel·-:l?
YES
1
Proceed for group
validation.
32
about birth control methods and alternatives fo:r an unwanted
pregnancy.
Gilbert observed that through this Individual Try-Out
process fewer than ten tries are required to develop a program
~
that will teach 98 percent of the students.
(12:480)
To conclude, Markle stated:
••. No reputable programming concern and no programmer
who comprehends the empirical basis of instructional
improvement by-passes developmental testing. Rather, for
the programrner the variability exists in the time at which
the student is dra~m into the design process. (29: 123)
Selection of Sample
A selected sample of eighteen high school students from
North High School in Torrance, California was used to test the
self-instructional manual.
As Lysaught (25:26) suggested in the
Individual Try-Out phase, students were selected from the target
group of tenth, eleventh and twelveth graders for which the
program was designed.
Students were selected by their outspoken
abilities; their previous abortion histories; and their desire
to gain more information about various birth control methods.
In view of this, the program was revised extensively and
the results of this effort are presented in Chapter IV.
Chapter IV
THE PROGRA.l'I
The actual programmed material is presented in the pages
that follow.
It is a programmed instruction manual about birth
control methods and alternatives for teenagers relative to
pregnancy.
The programmed material is designed for the following
target population:
1.
Teenagers with a problem pregnancy and teenagers
wanting information about birth control methods.
2.
Secondarily, for interested high school boys.
Specifically, the program is designed to achieve the
following objectives:
1.
Upon completion of the programmed instruction manual
of alternatives for teenagers relative to pregnancy, the student
will be able to identify effective birth control methods.
2.
Upon completion of the programmed instruction manual
of alternatives for teenagers relative to pregnancy, the student
will be able to apply the appropriate alternative for a problem
pregnancy in a specific hypothetical situation.
33
34
ALTERNATIVES FOR TEENAGERS
RELATIVE TO PREGNANCY
A Programmed Instruction Manual
35
INSTRUCTIONS TO THE READER
In this manual, you will find the information in small
units, aaUed f:r•ames.
Some frames wiU present information only
and no answers will be required of you.
However, most frames will
ask you to provide answers.
New inf01Wlation wi U be given -to you based on your answers.
By doing this, the material wiU be presented aaaording to yow•
needs.
Unneaessary explanations of information you already know
will be avoided.
In working
yot~
way through the manual, please use the
SHIELD in the baak of the manual to aover the answers until you
are ready to look at them.
As soon as you
down to expose the aorrect answer.
an~wer,
slide the shield
In this way, you aan verify
the aorreatness of your answers immediately.
Because you have to
provide answers throughout the manual, it may appear to be a test.
This is NOT a test but a unique way of learning information.
You
wi ZZ not be graded on how many of yoUL'VJ answers are correct or hovJ
fast you aorrrplete the material.
The only purpose of this manual
is to teach you some faats about birth control and alternative
choices to problem pregnancies.
Read aU of the information presented in each frame very
aarefully.
Make sure you understand the material presented before
proaeeding to the next frame.
Do not skip ahead!
1
36
At the end of the manual. theY'e wiZZ be a shoY't "seZf. . . test"
which 1.:JiZZ help you to determine how much you have Zeamed.
Go ahead!
I hope you wiZZ enjoy going thPough the pyoogPam.
2
37
UNIT I
BIRTH CONTROL METHODS
38
·-··--~---------
------- --·
~----
-----·
Begin here:
Life is full of choices.
Life is full of CHOICES.
Life is full OF CHOICES.
·Life is FULL OF CHOICES.
Life IS FULL OF CHOICES.
LIFE IS FULL OF CHOICES.
The definitions of CHOICE include:
-The right or power to choose;
-Option or an alternative;
-Limits a selection to one of two possibilities.
Sometimes a girl finds herself with a boy in a situation
that gets out of hand.
SHE HAS A CHOICE!
HAVING SEXUAL INTERCOURSE IS A CHOICE
for both the male and FEMALE.
You are on a date with a special boy when you find yourself
in a situation where you're kissing and THEN, all of a sudden, his
hands wander down your body.
YOU ALWAYS HAVE A CHOICE!!!
Say NO, if you are not ready for sexual intercourse.
Say YES, if you are ready to accept the responsibility
for having sexual intercourse.
4
39
The choice is YOURS.
The result of having sexual intercourse
~ithout
using some
form of birth control may be _pregnancy.
PREGNANCY occurs by CHOICE.
If you do not choose to become pregnant, use some form
of birth control.
If you choose to become pregnant, do not use birth control.
The CHOICE is YOURS,
5
40
From here on you have to answer activel-y by completing
bl-anks as and when they appear.
side of the page.
The correct answer is on the right
COVER the correct answer with the SHEILD which
you will find in the back of the manual.
As soon as you
answer~
slide the shield down and compare your answer with the corz•ect
answer given on the right side.
1.
Then continue.
Pregnancy starts when the male sperm
and the female egg unite in the woman's body,
usually in the Fallopian tube.
Once a month one of the woman's
ovaries usually releases an egg.
Sperm is made in the testes and is
carried in the semen that comes out of the
male's penis.
Birth control is an artificial means
of preventing the female egg from becoming
fertilized.
If you do not want to become pregbirth control
nant, use a - - - - _ _ _ _ _ method.
If your answer is:
:
2.
correct~
go to #3.
incorrect~
go to #2.
Correct use of a birth control method
will prevent pregnancy.
Some birth control methods
co
sperm to join, thus pre-
not allow the egg
~nd
venting pregnancy.
6
41
3.
many forms:
rhytlli~.
Birth control methods for females take
such as pill, IUD, diaphragm, foam and
A girl is not likely to become pregnant
if she is using a
birth control
method
---------------------------
A birth control method will protect
against
pregnancy
Cover the correct answer rJi th the SHIELD.
As soon as you
answer, sZide the shield dawn and compare your answer with the
correct one.
4.
You should consider the following points
before deciding on a birth control method:
It's safety
It's effectiveness
It's convenience
It's overall price
Your present health
Your own personal preference
Remember a method that works perfectly
for you may not be suitable for someone else.
There is no ONE method of birth control
that is perfect for every female all the time.
a.
b.
True
False
a
)
7
42
5.
A FEMALE is not likely to become
PREGNANT if she takes RESPONSIBILITY for
PREVENTING a pregnancy by using a ---------
------ method.
birth control
)
8
43
READ each situation CAREFULLY.
Try to imagine what you
would do if faced with the exact same situation.
Your answer will
direct you to the next frame.
6.
Joanne and Bob have been dating for about six months.
At first they only messed around a little but then they began to
have sexual intercourse regularly.
Joanne did not know much about
birth control, but she had heard that it was safe to have sexual
intercourse one week after your period and one week before your
period.
Because she did not really understand about birth control,
she and Bob made love whenever they wanted to.
The first semester
of her senior year she became pregnant.
Joanne was trying to follow the Rhythm method of birth
control.
a.
If you understand the rhythm method and do not
need further information - go to #7.
b.
If you do not understand the rhythm method and
would like more information - tUrn to Page 30.*
7.
a half.
Carol and John have been going together for a year and
He is a freshman in college and she is out of high school
now and working in a local department store.
when John finishes college.
They plan to marry
Carol has been taking the pill, but
every now and then she forgets to take the pill.
Last month she
missed two days and thought she would be alright for that month
*Refers to number at bottom of page of the program.
9
I
'
44
if she took three pills the next day.
They continued having sexual
intercourse without using any other form of birth control.
Carol
became pregnant.
Select one of the following:
a.
She became pregnant because the pill was not
effective.
turn
b.
She became pregnant because she failed to follow
the exact schedule for taking the pills.
8.
to Page 32 - #102
turn to Page 32 - #103
The IUD or intrauterine device is slightly less
effective than the PILL and it is gaining in popularity.
It con-
sists of a soft, flexible plastic device, usually a figure seven
or spiral design, that is placed inside the uterus by a doctor.
is left in place as long as the female does not want to become
pregnant.
a.
If you would like more information about IUD's -
tu:f>'a to Page 38.
b. If you are not interested in learning more ahout
IUD's - go to #9.
9.
Rank the following birth control methods
in order of effectiveness.
(Most effective to
least effective.)
a.
b.
c.
d.
IUD
Rhythm
Pill
No method
c
a
b
d
10
It
45
10.
Cathy and Steve went to the local family planning
clinic for information about birth control.
wanted a baby at this time in their lives.
Neither one of them
Steve was off to
college in a few months and Cathy was learning keypunch.
Cathy did not like the "pill" or the IUD because she
felt not enough was known about either one.
Years ago Cathy's
mother had used a diaphragm and was very satisfied with it.
Cathy
was very interested in the diaphragm method and she got all the
information she needed at the clinic to make her decision.
Before
leaving the clinic she made an appointment with the doctor to get
fitted with a diaphragm.
a.
If you would Zike to know how a diaphrcan works
turn to Page 40.
)
11
46
Cover the correct answers with the SHIELD.
answer the
question~
As soon as you
sZide the shield down and compare your answer
with the correct one.
11.
Match the following birth control methods with their.
description.
BIRTH CONTROL
METHODS
DESCRIPTION
__ 1.
Another application of contraceptive jelly is required with
each intercourse.
2.
Inserted 6 hours before sexual
intercourse occurs.
3.
Inserted into uterus by a doctor
and left in place as long as you
do not want children.
4.
5.
A. Rhythm
1. D
B. Pill
2. D
C. IUD
3.
D. Diaphragm
4. B
Taken for 20 or 21 days in a row,
as directed by a doctor.
l ,
c
5. c
6. A
7.
D
8. B
6.
Based on not having sexual intercourse during the
female's fertile period.
7.
Left in place at least 6 hours after sexual
intercourse.
8.
Taken orally whether sexual intercourse takes
place or not.
9.
Based on regular menstrual cycles.
10.
ANSWERS
9. A
10. D
~
device which is placed in the vagina and fits
over the cervix.
If your answers are correct~ go to #12.
If you missed~ go back a:ad revie1v the method that you are not
cZear about.
Rhythm
- turn to Page 30
PiZZ
- turn to Page 33
IUD
-turn to Page 38
Diaphragm - turn to Page 40
12
47
12.
Judy and Tom are deeply in love.
They worked out an
understanding about sexual intercourse because neither of them
wants a baby.
Each of them decided to take an active part in using
birth control.
He wears a rubber on his penis and she puts foam in
her vagina before intercourse.
They are more relaxed about love-
making because they know that they are protected from an unwanted
pregnancy.
a.
If
you agree with Judy and Tom's decision to take
responsibility and prevent a pregnancy - turn to Page 45.
b.
If
you disagree with Judy and Tom's decision go to Page 1 and reread.
Then turn EO Page 45.
13.
RUBBER (condom) and foam used TOGETHER by a couple are
very effective in preventing pregnancy.
If the condom breaks or
comes off during intercourse, the foam will kill the sperm that
escape from the condom.
Diaphragm and condom used TOGETHER rank
even higher in effectiveness.
That is because the diaphragm is more
effective than foam.
A BIG advantage of using rubbers and foam is that you
can buy them both at the drugstore without a prescription or without
seeing your doctor to use these methods.
14.
CONDOM (rubber) - it places the responsibility for
contraception on the male rather than the female.
It provides a
high degree of protection if used correctly and consistently.
It
becomes more effective when used in combination with a diaphragm or
foam.
13
48
The condom is a strong sheath-like device which fits
over the penis.
It fits like a tight glove over the penis when
the penis is erect.
It is put on shortly before intercourse and
removed immediately or shortly after intercourse.
It catches the
fluid (semen) that comes out of the penis and stops the sperm and
egg from uniting.
Condoms may rupture if several years old or they
may be damaged before using, therefore losing their effectiveness.
Always check the condom for tears and holes before using it.
Make sure to cover the correct answers with the SHIELD
prior to answering the following.
Caution should be taken 'ivhen the
male is withdrawing his penis from the vagina,
because the condom might slip off of the
penis
If the condom breaks during
intercourse, the foam will kill the sperm
that escapes from the condom.
a.
b.
15.
True
False
a
Condom is another name for
rubber
Condoms should be checked for
tears and holes before using.
a.
b.
True
False
a
14
49
For contraceptive effectiveness, the
condom should be put on
a.
into the vagina
b.
into the vagina
c.
before the penis is inserted
after the penis has been inserted
just before climax
a
Condoms may be purchased at a
drugstore
The condom fits over the
penis, thus
a. it prevents the depositing of
sperm in the vagina
b. it prevents sperm from reaching
the uterus after depositing sperm in the vagina
a
Condoms are very effective when
used in combination with a diaphragm or
----
foam
If your answers are correct, go to #16.
If you missed, turn back to #13 and try again.
16.
Two other birth control methods for males are
withdrawal and vasectomy.
Withdrawal is "pulling out" the penis just before a
male has a climax, so that the sperm will not get into the vagina.
This method does not work, because he cannot tell exactly when the
sperm are being released.
Vasectomy is a permanent method of birth control.
Because of this, it is not recommended for young males.
15
50
Refer to the figure and answer the foU(JU)ing.
---+-----vasectomy- removal of a
portion of
the vas deferens
penis
testis - sperm formed
here
The tube carrying the sperm from the
testes is the
----~-------------------
vas deferens
A simple operation to make a man
sterile is called
17.
---------------------
vasectemy
Arrange the following birth
control methods in order of effectiveness.
(most effective to least effective.)
a.
b.
c.
d.
e.
f.
D:iaphragn and contraceptive jelly
Foam
IUD
Rhythm
Pill
No method
16
e
c
a
b
d
f
51
18.
Which of the follm.ring birth control
methods would be appropriate for a young male
witho~
!! family.
a.
b.
c.
Vasectomy
Condom
Withdrawal
b
Which of the following birth control
methods is most effective for a man who already
has as many children as he wants?
a.
b.
c.
Condom
Vasectomy
Withdrawal
b
If your answers are correct, turn to the next page.
If you missed, go back to #13 and review info:rrnation on
. maZe contraceptives.
17
52
UNIT II
ALTERNATIVES FOR PREGNANCY
53
IT'S YOUR RIGHT TO DECIDE
What to do about an unwanted pregnancy.
19.
There are three legal alternatives
if a girl finds herself with a pregnancy.
Ob-
tain a therapeutic abortion under California
law; carry the pregnancy to term and keep the
baby (with/without
rr~rriage)
or give the baby
up for adoption.
A teenager has three choices if
she finds herself with a pregnancy.
legal abortion
adoption
keeping the baby
(with/without
marriage)
a.
b.
c.
20.
Vicki goes to the school nurse,
begs her for confidence' then confesses s.he
thin~s
she may be pregnant.
The Nurse
sends Vicki to the Los Angeles County
Health Department where she has a pregnancy test.
A pregnancy test means Vicki
will be asked for a urine sample.
A day
later she returns to the Health Department and is told she is pregnant.
19
54
Vicki has three alternatives to
this problem.
abortion
adoption
keeping the baby
(with/without
marriage)
a.
b.
c.
21.
Vicki decides to keep the baby.
She obtains proof of pregnancy signed by the
doctor at the Health Department and goes to
apply for a Hedi-Cal card.
Before leaving
the Health Department she finds out where
to go for medical care for herself and her
baby-to-be.
On the application for Medi-
Cal card, she will be asked for the name of
the father.
She will have to sign a
sworn
statement to that effect to be forwarded to
the DA's office for possible suit for child
support.
If she does not sign, no card.
You will be asked the name of
the __________on the Hedi-Cal card appli-
father
cation.
You will have to sign a sworn
statement to be forwarded to the DA's office
for possible su.it for
child support
----
20
55
22.
Vicki can give the baby the
father' s name if she wants.
Medi ·-Cal will
take care of all expenses connected with her
pregnancy.
At present Welfare will pay
$237/month until the baby is born.
Then the
mother will receive the same amount until
the child teaches 21 years of age or until
he or she goes to college.
She is also
eligible for food stamps if she lives alone
with he!:' baby.
All of this is assuming she cannot find a job or marry.
23.
If Vicki had decided to give the
baby up for adoption and wanted to stay in a
home for unwed mothers during her last three
months, Medi-Cal will pay for the expenses.
Such homes for unwed mothers include St.
Anne's, Children's Home Society of California
and Florence Crittenton Home.
Welfare will pay a pregnant
teenager
-----
a month.
$237
St. Anne's, Florence Crittenton
Home and Children's Home Society of California are homes for unwed mothers.
a.
b.
True
False
a
21
56
If the mother cannot find a job
or marry, she will continue to receive
$237/month until the child is
21
years of
age or goes to college.
24.
The following are additional places that can assist
and give services for an unwanted pregnancy.
Los Angeles County Health Department
South Bay Free Clinic
Family Planning Clinic-Harbor General Hospital
Your own medical doctor
25.
Vicki's other choice is abortion.
to stop an unwanted pregnancy.
Abortion ;ls a way
Since an abortion is an operation,
it should be done ONLY BY A MEDICAL DOCTOR.
Upon proof of pregnancy at Los Angeles County Health
Department, Vicki will be given three names of local medical
doctors who perform abortions at a local hospital and who will
accept Medi-Cal card for their payment.
The Medi-Cal card is valid for the therapeutic
abortion and whatever is necessary to start her on
program (Pills, IUD, etc.).
a
contraceptive
The Medi-Cal card is good
for~
month only.
Birth control counseling is required by Los Angeles
County Health Department if either individual is under 18 years of
age.
22
57
Teenagers do not need the consent
of their
parent~
26.
to have an abortion.
An abortion is performed in a
hospital by a
doctor
Medi-Cal card is good for
if she decides on a thera-
one month
peutic abortion.
counseling is
birth control
required by L. A. County Health Department
if either individual is under 18.
Name three places you can get
help and services if you are faced with an
um.;anted pregnancy.
Your own physician
L. A. County
Health Dept.
South Bay Free
Clinic
Planned Parenthood
Family Planning
Clinic
St. Anne's
Florence Crittenton
Children's Home
Society of
California
1.
2.
3.
If your answers are
27.
incorrect~
reread
#23~
#24 and #25.
As a young girl, Valerie always bugged her parents
about buying her things and they usually gave in and bought her
what she wanted.
When she entered--hig-h
23
schoolslie was-anxious
58
to get a boyfriend.
a boy.
However, she did not feel pretty enouglt to get
So when she did find a boyfriend, she just let him love her
all the way.
She became pregnant when she was 16.
What do you feel this girl should do about the
pregnancy?
a.
Get married and have the baby - turn to Page
b.
c.
d.
Give baby up for adoption - turn to #28.
Obtain a legal abortion - t·u.rn to #29.
Remain single and keep the baby - turn to Page 49 3
49~
#116.
#117.
28.
ADOPTION - if you do not believe in abortion and feel
that she should carry the baby until delivery, then adoption would
be a wise choice.
Just think whether you are wanting to keep him :15or
YOURSELF, or for him!
The mother must evaluate if she can give
the baby the quality of life it deserves.
The BABY has RIGHTS too.
A female who decides upon adoption should not feel she is abandoning
the baby.
Most women who decide upon adoption really love the
baby they give up.
Adoptive parents should make the child feel
proud that he or she is adopted.
When the final forms are signed for adoption, the
mother's role ends.
She no longer can make decisions for her
baby or affect its life in any way.
If you are pregnant and want. to give the greatest
love gift of all •.•••.• A BABY- give it to a couple that wants a
child.
Go to #29 and read about Abo.rtion
24
59
29.
ABORTION - in California, the Therapeutic Abortion Law
made abortion. LEGAL.
Abortion is the commonest method of birth control in
the ·world.
There are RISKS involved with abortion so it must not
be considered just another means of contraception.
Under 10 weeks of pregnancy - most common technique
is a D anc C or Dilation and Curettage.
The abortion is done by
artifically stretching the cervix and then removing the baby
(embryo or fetus) and adjoining tissues from the uterus.
Most of
the pain that accompanies an abortion is due to dilation.
Before the cervix is stretched, it has an opening
the diameter of a broom straw.
During the abortion it is
stretched to the diameter of a man's thumb to accommodate the
doctor's instruments.
Once the cervix is dilated, the doctor may use an
instrument called a curette to remove the contents.
Or he may
use a vaccum pump to remove the uterine contents by suction.
In the suction technique, after dilation a glass or plastic tube
is inserted into the uterus and the pregnancy tissue is sucked
out into a large jar.
D and C is somewhat more painful and longer procedure, and is nearly always done under a general anesthetic.
Suction takes about five minutes, can be done under local
anesthesia and there is less chance of perforating the uterus.
25
60
Between 10 and 14 weeks of pregnancy - this is the nevernever land in which doctors feel unsure about the best way to
terminate a pregnancy.
14 to 20th week of pregnancy - a saline induced abortion
is administered.
This involves removal of some of the amniotic
fluid, the liquid in
-.;~hich
the fetus lives before birth, and
replacement by a salt solution.
This will destroy the fetus and
the mother will go into labor and pass the fetus.
IT MAY BE HAZARDOUS TO YOUR HEALTH!
Abortion risks.
Even under the best of circumstances the
procedure itself always carries a risk.
Risk is small when done
earlL and risk increases as pregnancy advances.
Infection of the reproductive tract may develop and prevent
future childbearing.
possibility.
Perforation of the uterus is another
Repeated abortions may cause a woman to have an
increased incidence of spontaneous abortion and/or premature
delivery in subsequent pregnancies.
It is difficult to measure the psychological effects
of an abortion.
It is safer to practice birth control and not
use abortion as a means of contraception.
Abortion cost.
D and C or suction techniques range in
price from $90 to $175, depending upon the kind of anesthetic
used.
Saline procedure requires 2-3 day stay in the hospital.
26
61
It costs $350.
After saline is injected, the girl will expel the
fetus on the average of 12-24 hours later.
During this time she
will experience labor.
30.
The two most common techniques
used to terminate a pregnancy under 10
\veeks are
a.
b.
c.
A
suction and saline
saline and D and C
suction and D and C
----
c
abortion involves
more risk and is usually performed after
saline
the 14th week of pregnancy.
Abortion is the most common
form of birth control in the world.
a.
b.
True
False
a
A female will experience labor
with a
--------
abortion.
saline
Abortion risk is small when
done early and the risk increases as
pregnancy advances.
a.
b.
True
False.
If your answers are
31.
her family.
a
incorrect~
go back and reread #29.
Rhonda's boyfriend was living at her house, with
&'Landa did not use any form of birth control and it
was not long before she became pregnant.
27
She did not tell he;r
62
boyfriend or her parents.
She looked in the phone book and made an
appointment at the Family Planning Clinic at Harbor General
Hospital.
After disCllssing the situation with a counselor at the
Clinic, she decided upon an abortion.
Two months later her boy-
friend dropped her and moved out.
At the Clinic she learned about birth control methods.
She is now on the Pill so as to prevent a pregnancy from oc.curring
again - until she is ready, that is.
Select one of the following:
Go
1.
Rhonda did the right thing having an abortion.
2.
Rhonda should have told her boyfriend and then he
to #32.
would have had to marry her.
32.
Go to #33.
When conception takes plac.e, there becomes two human
beings to be concerned about.
HAS RIGHTS ALSO!!
caring for a child.
The mother and the BABY.
THE BABY
A young girl does not have the proper means for
She may want it while she is carrying it, but
what about after she has it?
Will she want to feed it, clothe it,
stay home at night and c.are for it, and so on?
In this situation
it would be absolutely unfair to the baby.
Go to #34.
33.
Maybe she should have told her boyfriend, BUT to
use an unwanted pregnancy to get him to marry her is wrong.
Marriage is not the solution to an unwanted pregnancy.
28
63
THitiK of the BABY!
and WANTED.
Every baby should be planned for
A couple must evaluate i f they can give the baby the
quality of life it deserves.
34.
sex.
At 15 years of age, Mary had tried drugs, alcohol and
Nothing seemed to fulfill her needs.
She was having an unhappy
home life mainly because her grandmother had filled her full of
lies about her parents.
She had a free spirit which could not be
controlled and she rebelled against all forms of laws.
rebelling she got pregnant.
In her
Mary decided to have the child,
because she did not believe in abortion or adoption.
She turned
16 years old a week after her baby was born.
Do you feel Mary's decision
was fair to the child?
a.
b.
Yes
No
b
If your answer was ineorreet go to #32 and read it again.
35.
If you should become pregnant
before you really are ready and want to be,
your three choices are:
Adoption
Abortion
Keeping the
baby (with/
without
marriage)
a.
b.
c.
Turn to Self-Test on Page 50.
29
64
RHYTHM METHOD is the practice of not haying sexual
course during the girl•s fertile period.
inter~
The fertile period is the
time in the girl's menstrual cycle when the egg is most likely to
be in the Fallopian tube.
It is at this time that a female may
become pregnant if she has sexual intercourse.
The length of the period and the menstrual flow varies
from person to person.
During the days of the menstrual flow, a
new egg begins to mature in the ovary.
Between 12 and 16 days
after the beginning of the menstrual period, an egg is released
from the ovary.
This process is called ovulation.
The egg
enters the Fallopian tube and begins its passage toward
th~
uterus.
The rhythm method is not very dependable because it is
based upon a regular menstrual cycle.
Before using the rhythm
method, a female should keep an accurate record of the length
of her menstrual cycles for a year.
Be sure and see your medical doctor first, if you decide
to use the rhythm method regularly as your only means of birth
control.
He can help you work it out.
This is very important
because you want a method that you know you can depend on.
)
30
65
101.
The egg is fertilized in the:
a.
b.
c.
d.
ovary
Fallopian tube
uterus
vagina
b
The rhythm method means:
a. having sexual intercourse
during the fertile period.
b. not having sexual intercourse during the fertile period.
b
If a girl's menstrual cycle
is every 30 days, ovulation occurs between
_______ and _____ days, after the beginning
12 and 16 days
ave. - 14th
of the menstrual period.
The rhythm method is based
on
- - - - -menstrual
cycles
regular
The rhythm method would be
considered:
a.
an effective birth control
method.
b. the relatively ineffective
birth control method.
b
Given possible variation in the
length of the menstrual cycle from month to
month, it is evident that, in any female,
the day of the cycle which ovulation would
occur:
a.
b.
If
is the same
differs
yoUP~ansruers
b
are correct go to Page 9, #7
If your answers are incorrect, turn back to Page 30 and
begin aga-in.
31
66
102.
OH, come on now!
You were led to this answer because you cannot
accept the fact that the girl failed.
exact schedule for taking the pills.
She did not follow her
Remember she missed two days
and thought she would be alright for the month if she took three
pills the next day.
IT DOES NOT WORK THAT WAY!!!
The pill must be taken EVERY day for 20 or 21 days,
whichever schedule you are on.
day.
It does not mean you can skip a
If this should happen, use foam/condom or some other means
of birth control for that month.
Turn to Page 33 for more information
about the PILL.
103.
Correct!
You understand that the pill must be taken every day
for 20 or 21 days, whichever schedule you are on.
It does not
mean you can skip a day and still receive full protection.
If
you should forget two or more pills then use some other form of
birth control for that month.
If you want more information about the
Page 33.
If not., go to #8 on Page 10.
32
PILL~
turn to
67
THE PILL.
Of the methods practiced by the woman, it is
the most effective method of birth control.
The pill must be
taken for 20 or 21 consecutive days, as directed by your medical
doctor.
20 Day Schedule
The pill stops the ovaries
June
s
zs
T
L:?
3o
w
31
from releasing an egg each month,
T
1
F
s
so that there is never an egg in
CDJ 0
the Fallopian tube to be fertilized
0 (j) (6)(:) ® ®®
@@@@@@@
@ @ @ @ 22
25 26 27 @129
by the sperm.
Usually the first pill is
23 j24
taken 5 days after the start of her
30
menstrual period.
(Day 1).
She
takes one pill every day until she
L ___.j
Length of period
Day 1 - June 2
Last pill - June 21
Menstrual Flow Begins June 24
Day 1 - June 28
has taken 20 or 21 pills.
Then
she stops taking the pills and
within 2 or 3 days her next period
should begin.
The pill must be
taken whether sexual intercourse
takes place or not.
The pill will regulate an irregular menstrual cycle.
Side
effects may be felt by the user, so any unusual signs or discomfort should be mentioned to your physician.
A big disadvantage of the pill is remembering to take a
pill every day.
It is easy to remember if you connect taking the
pill with some other daily activity, such as brushing your teeth.
33
68
If
~ou
forget two or more pills you wi.ll run the risk of getting
pregnant, therefore you should use another method of contraception
until your next period.
Go to #104
If
this is your second time through this
material~
go to #105
34
69
104.
Once menstruation begins, on
what day should the first pill be taken?
5th
How frequently are the pills
·daily
taken?
The menstrual flow should
begin ___ or ___ days after taking the
last pill_.
2 - 3
If a female forgets 2 or more
pills, she should use some other form of
birth control for that month.
a.
b.
True
False
If your answers are
If you
105.
missed~
a
correct~
go to #106.
reread Page 33 and try again.
The pill is taken
a.
b.
c.
whenever you want
daily
every other day
b
Refer to picture of calendar
on Page
33~
How many days are the
--.-t11('"t
P.J..-L..LO
taken?
20
Refer to calendar
on Page 33.
On what day should the menstrual flow begin?
If you forgot two or more pills,
you will lose that month's protection.
a.
b.
True
False
Go to #106
35
June 25
70
106.
The Pill must be taken, as
directed, whether
intercourse
--------~-------------
occurs or not.
The Pill is first taken on Day
5 following the beginning of the menstrual
flow.
a.
b.
True.
False
a
The Pill may be obtained from
the clinic or by a prescription from a
doctor.
a.
b.
True
False
a
The Pill is considered:
a.
an effective method of
b.
an ineffective method of
birth control.
birth control.
a
The Pill will regulate an
irregular menstrual cycle.
a.
b.
True
False
a
If pregnancy occurs during the
use of the pill, it is usually because:
a.
the individual failed to
take pills regularly as per schedule.
b.
the pill failed.
If your answers are
If you
information.
missed~
correct~
a
go to #107
go to Page 33 and
36
~1REFULLY
reread the
71
l
2 13 4 5 6 1 I
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31 1 2 3 4
107.
l
indicates length of menstrual
period.
a.
What day should the first
pill be taken?
7
b.
On a 20 day
schedule~
what
is the last day of the calendar that the
pill should be taken?
c.
26
What day of the calendar
should next menstrual flow begin?
If your answers are
If you
missed~
correct~
29
go to #8 on Page 10.
turn to Page 33 and STUDY the calendar.
Then try again!
37
72
IUD is a very effective method of birth control.
some uncertainty as to exactly how the IUD works.
There is
It is felt that
the IUD does not allow the egg to become attached to the uterine
wall, thus preventing pregnancy.
IUD's come in different shapes and
sizes, both for females who have had children
and for those who have not.
Sometimes young
females and those who have not had _children,
are unable to retain the IUD and it is
expelled by the uterus.
108.
The IUD is made of:
a.
b.
inflexible material
flexible material
b
The size of an IUD is proportional to the size of the female's uterus.
a.
b.
True
False
a
An IUD is placed inside the
doctor
uterus by a -----------------The IUD is placed
inside the:
a.
b.
c.
d.
vagina
ovary
uterus
Fallopian tube
38
c
73
After the IUD is put in place by a physician, the woman
should examine herself in two weeks to be sure it is still in
place.
Thereafter, examine after each menstrual period.
This is
done by inserting a finger into the vagina to feel the threads
attached to the device.
This can be felt from the cervix opening
or entrance to the uterus.
It is common to have cramps and heavy menstrual flow after
having an IUD inserted.
Other side effects may be noticed and
if they continue you should consult your doctor.
109.
If side effects, other than
cramps and heavy menstrual flow occur,
consult a
doctor
----------------Check after each
---------
menstrual
period
to make sure that the IUD is in place.
The IUD can be checked by:
a. inserting a finger into the
uterus and feeling the end of the device.
b. inserting a finger into the
vagina to feel threads attached to device.
If your answers are
If you
missed~
correct~
go to #9 on Page 10.
reread IUD information above.
39
b
74
DIAPHRAGM - it is a round cup-shaped device made of rubber,
stretched across a bendable rim.
The diaphragm is placed up into
the vagina so that it fits over the cervix (entrance to the
uterus).
/
In order for a diaphragm to be effective, contraceptive
jelly should be used.
Cover the inside of the cup (dome) and
the rim with the contraceptive jelly, before putting it into
the vagina.
40
75
The contraceptive jelly and the diaphragm work together
to keep the sperm from swimming up through the cervix into the
Fallopian tubes to reach the egg.
A diaphragm can be obtained from a medical doctor - he
fits you with the correct size and teaches you how to insert it
properly into the vagina to cover the cervix.
Diaphragm and
contraceptive jelly should be inserted within 6 hours before
sexual intercourse takes place.
The diaphragm acts as a barrier and the contraceptive
jelly immobilizes and kills the sperm.
This is an effective
method, but like foam and condom, it must be PUT IN BEFORE
HAVING SEXUAL INTERCOURSE.
The diaphragm should be inserted up to six hours pefore_
sexual intercourse.
Leave the diaphragm in for at least six
hours_ after you have sexual intercourse.
This will give the
contraceptive jelly·enough time to kill the sperm.
110.
The minimum period of time the
diaphragm and contraceptive jelly should
remain in position within the vagina
following sexual intercourse is:
a.
b.
c.
at least 4 hours
at least 6 hours
at least 8 hours
b
To be effective, the diaphragm
is used along with
-------
41
contraceptive
jelly
76
The diaphragm is placed into
the vagina so that it fits over the
-----
cervix
The sperm are prevented from
entering the uterus by:
a.
b.
c.
d.
111.
rubber cup-shaped device
rubber rim of diaphragm
contraceptive jelly
all of the above are correct
d
The diaphragm alone does not
provide good enough protection against pregnancy.
Therefore the diaphragm method
should consist of the use of a
plus
-------
diaphragm
contraceptive
------jelly.
The contraceptive jelly should
cover the
------------------- and
the
------------- of the diaphragm.
dome
rim
The diaphragm must be the
----------
size in order to be effective.
correct
The diaphragm should be inserted how many hours before sexual intercourse takes place?
within
six
hours
The diaphragm works in preventing pregnancy by:
a. preventing the sperm from
being deposited in the vagina
b. preventing the sperm from
getting past the cervix and into the uterus
b
If your answers are incorrect" turn back to Page 40 and
reread the information.
Then try again.
42
77
The diaphragm and contraceptive jelly should be inserted
into the vagina 6 hours before sexual intercourse takes place.
If the sexual
intercourse
takes place after
.
.
- - -six
- hours, a
second application of contraceptive jelly is necessary.
Another
application is required each time intercourse is repeated.
This is
necessary regardless of how little time the diaphragm has been in
place.
DON'T TAKE THE DIAPHRAGH OUT TO ADD MORE JELLY
USE THE APPLICATOR!
Be careful not to dislodge the diaphragm from its proper
position when adding more contraceptive jelly.
The diaphragm
may become dislodged during sexual intercourse.
Dislodging the diaphragm from its proper position is a
potential cause of failure of the diaphragm method over which the
individual has little or no control.
The diaphragm MUST be left in the vagina at least 6 hours
after sexual intercourse, in order to be effective.
Six hours or more after sexual intercourse, take the
diaphragm out and wash it and put it away until the next time.
If you use the diaphragm method, you do not have to bother with
it until you need it.
It is a very effective method of birth
control.
112.
With each intercourse,
application of contraceptive jelly is
necessary.
43
another
78
Do not take the diaphragm out
to add more contraceptive jelly.
a.
b.
True
False
a
the diaphragm
dislodging
out of its proper position is cause of
failure of the diaphragm method.
How many hours must the
diaphragm be left in place after interat least 6
hours
course?
If your> answers are correct, go to #11 on Page 12.
If you missed, go back to Page 42 and reread information.
Then try again.
44
79
FOAM is a birth control that can be
DRUGSTORE.
purchased at the
You do not have to go to the medical doctor in order to
get it.
Foam, jelly and cream are called spermicidal preparations.
The only basic difference between them is the te.xture.
The tubes and/or containers of foam come with an applicator.
The applicator is filled with foam then inserted into the vagina, like
you would insert a tampon.
Next, the plunger on the applicator is
depressed and the foam is forced into the upper part of the vagina.
Sexual intercourse distributes .the foam throughout the vagina and
over the cervix.
Foam should be placed into the vagina not more than one
hour before sexual intercourse.
they get to the egg.
It works by killing sperm before
If a male uses a condom and a female uses
foam, the protection against pregnancy is very high.
However,
when foam is used alone it is less effective, but still it is more
effective than the Rhythm method.
The shorter the period of time between insertion of foam
into the vagina and sexual intercourse the better.
However, foam
can be effective up to an hour after insertion.
When using foam, it is recommended not to douche for at
least 6 hours after intercourse.
Douching dilutes and removes
the foam.
Foam prevents pregnancy in two ways:
(1) it blocks the
cervix and prevents sperm from getting pas~the cervix and into
45
80
the uterus; (2) it actively innnobilizes or stops the sperm and then
kills the sperm.
113.
Foam should be inserted into
the vagina:
a. not more than one hour
before intercourse
b. not more than three hours
before intercourse
c. not more than six hours
before intercourse
d. it does not matter
a
You do not need a medical
doctor's prescription for foam and it can
be purchased at the
drugstore
------
Foam and condom make a very
effective birth control.
a.
b.
True
False
a
The foam preparation is
released from the
applicat~
;!()
J.
a.
b.
c.
~
~~
~
throughout the entire vagina
near the cervix only
only at the entrance to
the vagina.
b
Foam is distributed throughout
the vagina by
sexual
intercourse
------
If your ansu,,eros are correct., go to #114.
If you missed., go back to Page 45 and reread the
infox~aation.
)
46
81
114.
Match the following:
1. Not using enough of
the foam preparation
2. Not reapplying after
each intercourse
3. Douching 2 hours
after having sexual
intercourse
A. improper procedure, girl's
error
B. factor over
which girl
has little
or no
control
4. Survival of sperm due
to incomplete distribution of foam
preparation duting
sexual intercourse.
115.
1.
A
2.
A
3.
A
4.
B
If a douche is desired
follo·wing sexual intercourse:
a. it may be taken any time
folluwing intercourse
b. it should be taken within
the first 6 hours following intercourse
c. it should be taken 6 or
more hours after sexual intercourse
Which of the
followi~g
c
birth
control methods can be purchased at a
drugstore without a prescription?
a.
b.
c.
d.
IUD
foam
diaphragm
pill
b
Foam should be inserted into
the vagina not more than
---
before intercourse.
one hour
)
47
82
Foam is applied near the
---
cervix
inside the va·gina and then distributed throughout the vagina by
sexual
intercourse
~---.,.---
Every time you have sexual
intercourse you need to reapply foam.
a.
b.
True
False
a
The shorter the period of time
between insertion of foam and sexual intercourse the more effective the foam. is.
a.
b.
True
False
a
Foam and condom make an effective birth control method.
a.
b.
True
False
a
If your answers are
If you
missed~
correct~
go to #13.
turn to Page 45 and try again.
48
83
116.
Marriage is not the solution to the problem of an
unwanted pregnancy.
THI11{ of the baby and the quality of life
it deserves.
A recent survey showed that two-thirds of the girls
who marry as a result of pregnancy, will divorce within five
years.
A baby should be a present you give yourself.
Other-
wise it will always be around to haunt you.
HAVE A BABY BY CHOICE, NOT BY CHANCE.
Practice
birth control until you are ready to have a child.
to
TUPYL
117.
Remain single and keep the baby.
Page 25, _#29.
You were probably
lead to this choice because you felt if she married it would end
in divorce.
Marriage or not is not the issue!
The issue is the
BABY and its right as a human being.
Every child should be a wanted child.
Usually a
teenager does not have the capability to raise a child.
They are
not in a position financially to raise a child either.
HAVE A BABY BY CHOICE, NOT BY CHANCE.
Practice
birth control until you are ready to have a baby.
Turn
49
to
Page 25, iJ29.
84
SELF-TEST
Read each question carefully.
Select the most appropriate
ansvJer to the question and write it on a separate sheet of paper,
1.
Which of the following birth control methods is the MOST
effective?
a.
b.
c.
d.
e.
2.
W11ich of the following birth control methods is the
effective?
a.
b.
c.
d.
e.
3.
b.
c.
d.
IUD
Rhythm
Pill
Foam and condom
Diaphragm and contraceptive jelly
An immature 18 year old girl who is eager to find
a husband at the local junior college.
A 16 year old girl who searches for love by having
sexual intercourse with every boy she goes out with.
Neither situation.
Both situations.
Diaphragm and contraceptive jelly should be inserted in the
vagina:
a.
b.
c.
d.
5.
LE~ST
For •N'hicn situation do you think an abortion or adoption would
be most appropriate, if a pregnancy occured?
a.
4.
IUD
Rhythm
Pill
Foam and condom
Diaphragm and contraceptive jelly
Within two hours before sexual intercourse
Within four hours before sexual intercourse
Within six hours before sexual intercourse
It does not matter
Foam is put into the vagina:
a.
b.
c.
Not more than one hour before sexual intercourse
Not more than two hours before sexual intercourse
Not more than six hours before sexual intercourse
50
85
6.
'~en two people care about each other, and take responsibility
for what might happen, sexual intercourse can be beautiful.
That is, if they decide to have sexual intercourse, then they
have to think of how they would support a baby if the girl got
pregnant. If they did not want to worry about a baby, then they
should use a rubber and foam OR the girl should get something
from the clinic or her doctor to keep her from getting pregnant."
a.
b.
7.
I agree
I disagree
List the methods of birth control in order as to how effective
they are - begin with the most effective to the least dependable.
(Refer to Question 1 fo1:· methods.)
a.
b.
c.
d.
e.
8.
Which of the following female birth control methods can be
purchased at a drugstore without a prescription?
a.
b.
c.
d.
9.
IUD
Foam
Diaphragm
Pill
Lisa was a junior in high school when she became pregnant. She
told her mother and father and they did not get mad. Things
worked out really cool - her parents paid for half of the cost
of the abortion and Lisa and her boyfriend had to pay the rest.
Lisa is now in her senior year and still going with the same
boyfriend.
What is your reaction to this situation?
a.
b.
10.
I fe:el she did the right thing.
I think they should have married and kept the child.
are the three alternatives if a girl should find herself
with a pregnancy?
T~at
a.
b.
c.
51
86
11.
Which of the following is the most recommended birth control
method for a young male without a family?
a.
b.
c.
12.
Match the word in the right column with the description in
the left column.
1.
2.
3.
4.
5.
13.
An alternative a girl should
select if immature and not
capable of raising a child.
It is taken orally to prevent
pregnancy by stopping ovulation.
The union of a male sperm and
a female egg cell.
Abstinence during the female's
fertile period.
A plastic device inserted into
the uterus.
A. Fertilization
B.
IUD
C.
Pill
D.
Rhythm method
E.
Abortion/Adoption
Suppose your girlfriend came to you and told you she was
pregnant. How would you advise her?
a.
b.
c.
d.
e.
14.
Withdrawal
Condom
Vasectomy
Have the baby and give it up for adoption
Remain single and raise baby alone
Obtain a legal abortion as soon as possible
Get married to her boyfriend and have the baby
Help my girlfriend cope with her decision whatever
it is
June and John have been going together for one year. He is
a freshman in college and she is out of high school and
working in a local department store. They planned to marry
when John finished college. However, June got pregnant
before either of them wanted a child.
What should they do?
a.
b.
c.
d.
June should have an abortion
June should have the child and give it up for
adoption
June and John should get married
June should have the child, but not marry John
52
87
1
2
L?
4
6 7
11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31 1 2 3 4
15.
3
..JL_j!J 10
...__ _ _ _ _·. . ~·!
indicates length of menstrual period.
1.
What day should the first pill be taken?
2.
On a 20 day schedule, what is the last day of the
calendar that the pill should be taken?
3.
What day of the calendar should next menstrual flow
begin?
Turn to next page for
correct answers.
53
88
ANSWERS TO SELF-TEST
1.
2.
3.
4.
5.
6.
c
b
d
c
a
a
7.
Pill
IUD
Diaphragm/Jelly
Foam and condom
Rhythm
8.
9.
b
a
10.
adoption
abortion
keep the baby (with/without marriage)
11.
b
12.
E
c
A
D
B
13.
14.
15.
c, a, or e
a, b
9
28
31
How well did you do?
Three errors or less •••••••••.• THE END.
MOre than three errors •.•••••••••
Go baak to Page 1.
54
89
P:r:ogra.~
Changes
The program was reviewed by a subject matter specialist
and committee members..
Suggestions from the subject matter
specialists were,incorporated into the program and then the Individual Try-Out was conducted with the target population.
The
suggestions by the subject matter specialists consisted primarily
of revisions to the subject matter for factual accuracy.
These
changes are:
Frame 3:
The sentence reading "Birth control is also called
family planning and contraceptive devices." was deleted from the
program.
The subject matter specialist did not want the program to
perpetuate the idea that birth control and family planning were the
same.
In her profession, it was difficult to discuss family
planning, if the individual related it to birth control alone.
Frame 7:
The original sentence was "Last month she missed
a day and thought she would be alright for that month if she took
two pills the next day."
The subject matter specialist suggested
the statement would be more accurate if "a day" was changed to
"two days" and "two pills" was rephrased to read "three pills."
Frame 8:
The original sentence was "It consists of a soft,
flexible plastic device, usually a loop, ring, bow or spiral
design •••••••.• "
Intrauterine devices (loop, ring and bow) were
eliminated because they are obsolete.
was revised as follmvs:
Therefore, the sentence
"It consists of a soft, flexible plastic
device, usually a figure seven or spiral design ••••••••• ''
Frame 25:
The subject matter specialist suggested the
90
following significant information be added to the program.
"Teen-
agers do not need the consent of their parents to have an abortion."
Page 4:
Since the word "sex" could be interpreted to mean
gender or the sexual act, a committee member recommended it be
changed to read "sexual intercourse."
·Page 30:
For accuracy, the subject matter specialist
stated that the phrase "around the 14th day" be changed to
the 12th and 16th day."
follows:
"bet~:veen
Therefore, the sentence was revised as
"Between 12 and 16 days after the beginning of the
menstrual period, an egg is released from the ovary."
Page 39:
Originally it read:
"After the IUD is put in
place by a physician, you should examine yourself once a week to
be sure it is still in place."
Because this was an incorrect
statement it was revised as follows:
"After the IUD is put in
place by a physician, the woman should examine herself in two weeks
to be sure it is still in place.
Thereafter, examine after each
menstrual period."
Page 39:
Originally the sentence read:
"It is common
to have cramps and heavy menstrual flow for several months after
having an IUD iaserted."
The subject matter specialist commented
that the phrase "for several months" was incorrect and should be
eliminated.
The sentence 1:vas revised to read:
"It is co:nnnon to
have cramps and heavy menstrual flow after having an IUD inserted.''
Page 40:
The original sentence was "Cover the inside of
the cup and the rim with the contraceptive jelly, before putting
it into the vagina."
The subject matter specialist suggested the
91
word "dome" be added after cup.
It was revised as :t;ollows:
"Cover
the inside of the cup (dome) and the rim with the contraceptive
jelly, before putting it into the vagina."
The Individual Try-Out process was administered to eighteen
high school students and resulted in the following modifications:
Frame 10:
several subjects.
"understand."
The word "understand" did not communicate to
The programmer substituted the work "know" ;!;or
There were no further comments.
Frame 13:
The original sentence was "A rubber or condom
and foam and/or diaphragm used TOGETHER by a couple are
100% effective in preventing pregnancy."
The subjects found this
sentence confusing since it combined two ideas.
read:
a~most
It was revised to
"RUBBER (condom) and foam used TOGETHER by a couple are
very effective in preventing pregnancy.
If the condom breaks or
comes off during intercourse, the foam will kill the sperm that
escape from the condom.
Diaphragm and condom used TOGETHER rank
even higher in effectiveness.
This is because the diaphragm is
more effective than foam."
Frame 16:
follows:
Originally vasectomy information read as
"Vasectomy is a permanent method of birth control.
It is
a simple operation performed in a doctor's office to make the man
sterile.
It involves cutting and tying the tubes (vas deferens),
thus preventing the sperm from getting into the ejaculation.
"Many men find vasectomy to be highly acceptable method
for assuming responsibility for prevention of pregnancy.
However,
it is not recommended for young males since it is irreversible."
92
The information did not communicate to the subjects so it was
revised and presented in a diagram.
There were no further comments
by subjects.
Frame 16:
The subjects found the word "ejaculation" to be
too difficult of a word.
One subject suggested the word "climax.''
The statement was revised using the word "climax" instead of
"ejaculation."
Frame 17:
Upon student request, the word "rank" was
replaced with the word "arrange" to bring about specificity in the
instructions.
Frame 18:
The original sentence read:
"Which of the follow ....
ing birth control methods would be effective for a young male without a family?"
A subject felt that the word "effective" suggested
that the answer was vasectomy.
Therefore, the word "effective"
was eliminated and replaced with the word "appropriate."
Frame 18:
The original sentence read:
"Which of the
following birth control methods is most effective for a man who has
had a family?"
Since it was the intention of the programmer to
indicate that a man has had as many children as he wanted, rather
than the "concept of family," it was rephrased in the following
"~fuich
manner:
of the following birth control methods is most
effective for a man who already has as many children as he wants?"
Frame 19:
Subjects found the \vord "lawful" ambiguous so the
programmer replaced it with the word "legal."
Apparently the word
"legal" communicated to the subjects because there were no further
comments.
93
Frame 29:
" •••• and then removing the pregnancy tissue
(fetus, placenta and membranes} from the uterus. 11
The words
(fetus, placenta and membranes) were not easily understood by the
subjects.
It was revised in the following manner:
" ••.• and then
removing the baby (embryo or fetus} and adjoining tissues from
the uterus."
Frame 29:
The original sentence was "After saline is
injected, the girl will expel the fetus in 12-24 hours."
A subject
who had aborted 26 hours later suggested the word ''average" be
added before 12-24 hours.
The sentence was revised as follows:
"After saline is injected, the girl will expel the fetus on the
average of 12-24 hours later."
Frame 30:
The preceding frame provided extensive
mation about abortions.
infor~
Several subjects commented that there was
too much information without any questions.
Frame 30 to allow student participation.
The programmer added
It reads as follows:
The two most common techniques used to
terminate a pregnancy under 10 weeks are
a.
b.
c.
A
suction and saline
saline and D and C
suction and D and C
------ abortion
c
involves more
risk and is usually performed after the 14th
week of pregnancy.
saline
Abortion is the most common form of
birth control in the world.
a.
b.
True
False
a
94
A female will experience labor with
a
------abortion.
saline
Abortion risk is small when done
early and the risk increases as pregnancy
advances.
a.
b.
True
False
Page 5:
Since the phrase "contraceptive devices" did not
communicate to the subjects, it was sub.stituted to "birth control."
There were no further comments by subjects.
Question 3:
The question read:
Ovulation is the process by which
a mature egg is freed from ovary
the menstrual flow begins
a mature egg is fertilized
a mature egg is carried to the uterus
a.
b.
c.
d.
The question lead partially to the terminal behavior, therefore it
was deleted.
Question 12:
Originally this matching question had the
words in the left column and the descriptions in the right column.
A subject suggested it would read easier if the descriptions were
in the left column and the words in the right.
It was revised
accordingly.
Question 13:
The original question read:
Suppose your girlfriend came to you and told you she was
pregnant.
a.
b.
c.
de.
How would you advise her?
Have the baby and give it up for adoption
Remain single and raise baby alone
Obtain a legal abortion as soon as possible
Get married to her boyfriend and have the baby
95
· One subject felt that she did not wish to advise her girlfriend,
but would be supportive of her.
reads as follows:
whatever it is."
"e.
Selection "e'' was added, and it
Help my girlfriend cope with her decision
Chapter V
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Summary
The purpose of this study was to develop a programmed
instruction manual of birth control methods and alternatives for
teenagers relative to pregnancy.
After an extensive review of the literature, the development of the program began.
The method of Individual Try-Out was
followed in developing the programmed instruction manual.
This
process involved trying out the program on one person at a time
and then revising the material according to the individual's
comments.
Once students were drawn into the program design
process, the program took its final shape and form.
Individual
Try-Out process continued to clarify the program until the material
communicated with two individuals consecutively.
Technical editing
also was undertaken by a subject matter specialist at this time.
Eighteen students from North High School in Torrance,
California participated in the Individual Try-Out of the programmed instruction manual during the 1975-76 school year.
Students selected from the target population were chosen for their
outspoken abilities, their previous abortion histories, and their
desire to gain more information in this area.
The program was revised extensively during the Individual
Try-Out phase and the final results can be found in Chapter IV.
96
97
Conclusions
Students response to the program was positive.
Students
stated they gained pertinent information and enjoyed the opportunity of .participating in development of the program.
The method
of programmed instruction proved to be an exciting way of learning
for high school age students.
It was rewarding for the programmer
to listen to student's share their experiences and to watch the
learning process occur.
The average length of time required to
complete the program was between 30 and 45 minutes.
Recommendations
On the basis of this study, it is recommended that
programmed instruction be used in other aspects of health education.
It was an excellent technique for handling a sensitive subject
area, such as birth control and abortion.
It is recommended that group validaticn be carried
out prior to administering this program to the target population
at large.
BIBLIOGRAPHY
1.
Ballard, w. M. and Edwin M. Gold, '~edical and Health Aspects
of Reproduction in the Adolescent," Clinical Obstetrics and
Gynecology, 2:338-365, 1971.
2.
Blaine, Graham B. M. D. Youth and the Hazards of Influence.
New York and London: Harper and Row, Publisher, 1966.
3.
Braen, Bernard B. and Janet Bell Forbush, "School-Age
Parenthood- A National Overview, 11 Journal of School Health,
Vol. XLV, No. 5, May 1975, 256-260.
4.
Brief: "Abortion," Journal of the National Medical Association,
6:481-485, 1971. Reprinted from Public Health Currents,
(Sept.-Oct., 1971), Ross Laboratories, Columbus, Ohio.
5.
Brunswich, Ann, 11 Adolescent Health, Sex and Fertility,"
American Journal of Public Health, 61:711-729, April, 1971.
6.
Crowder, Norman A., "Automatic Tutoring by Intrinsic Programming," Teaching Machines and Programmed Learning -A
Source Book, ed. A. A. Lumsdaine and R. Glaser (Washington,
D. C.: Department of Audio Visual Instruction, National
Education Association, 1960), pp. 286-298.
7.
"On the Differences Between Linear and Intrinsic
Programming," Educational Technology, ed. John P. DeCecco
(New York: Holt, Rinehart and Winston, 1964), pp. 142152.
An Introduction To Programmed Instruction.
Prentice-Hall, Inc., 1962.
8.
Deterline, Hilliam A.
Englewood Cliffs:
9.
Espich, James E. and Bill Williams. Developing Programmed
Instructional Materials. Belmont: Fearo.n Publishers, 1967.
10.
Furstenberg, Frank F., "Preventing Unwanted Pregnancies Among
Adolescents, 11 Journal of Health and Social Behavior,
12:340-347, 1971.
11.
Gabrielson, I. W., L. V. Klerman, J. B. Currie, N. C. Tyler,
and J. F. Jekel, ''Suicide Attempts in a Population Pregnant
as Teenagers," American Journal of Public Health, 60:22892301, December, 1970.
12.
Gilbert, Thomas F., "Mathetics- An Explicit Theory For The
Design of Teaching Programmes," Recall Review· of Educational
Cybernetics and Applied Linguistics, ed. Klaus Bung (supplement 1; London: Longmac, March, 1969), pp. 5-138.
98
99
13.
Gilbert, Thomas F., "On the Relevance of Laboratory Investigation
of Learning to Self-Instructional Prqgramming, Teaching
~fuchines and Programmed Learning, ed. A. A. Lunsdaine and R.
Glaser (Washington, D.C.: Department of Audio-Visual
Instruction, National Education Association, 1960).
14.
Green, Edward J., "The Process of Instructional Programming,"
The Sixty-sixth Year Book of the National Society for the
Study of Education,ed. Phil C. Lange (Chicago: The University of Chicago Press, 1967).
15.
Hartley, James, "Programmed Instruction 1954-1974: A Review,"
Progr&~~ed Learning and Educational Technology Journal of
APLET, Vol. II, No. 6, November 1974, 278-286.
16.
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