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Carnegie Quarterly - Fall 1994/Winter 1995

Toward A Common Destiny

Contents:

Toward a Common Destiny

Is prejudice inevitable in America? Can young people learn tolerance and respect, instead of misunderstanding and hatred?

At a 1993 conference held under the auspices of the Common Destiny Alliance and supported by Carnegie Corporation, leading scholars in the behavioral and social sciences grappled with these and other questions. Their focus was on current research: what has been proven about the sources of prejudice and which strategies can work to prevent and ameliorate its poisonous impact.

Toward a Common Destiny: Improving Race and Ethnic Relations in America, edited by Willis D. Hawley and Anthony W. Jackson (San Francisco: Jossey-Bass Publishers, 496 pp., $45.00), grew out of that conference. A collection of seventeen papers, it presents the most up-to-date knowledge about the problem of racial and ethnic prejudice in the United States and identifies ways that individuals and organizations can act to reduce intolerance and discrimination. The book is written from a scholarly point of view, combining theoretical and developmental perspectives with studies of effective practices. Its insights may be especially useful to researchers in pointing out an agenda for scientific inquiry, to educators and employers seeking to improve intergroup relations, and to decision makers who now have a more reliable basis for making wise social policy.

Admirably, Toward a Common Destiny is unusually coherent for a collection of essays written by experts in disparate fields. Hawley, a professor of education at the University of Maryland, and Jackson, a program officer at Carnegie Corporation, both express the hope that their volume will rekindle research interest in this field, which has dwindled since the early 1980s -- mainly due to a lack of government and foundation commitment and funding.

In the 1990s, a generation after the Watts Riots and the Civil Rights Act of 1964, race relations are once again a national preoccupation as renewed debate over discrimination and affirmative action rages, and journalists and experts churn out popular books with widely differing views. But as Jackson cautions: "One of the concerns we have is that the discussion of race and ethnic relations be based on knowledge -- not just opinions or anecdotes." Serious study of racial and ethnic bias among young people is of urgent interest because of a growing tendency toward violence in the schools. Conflicts, as Jackson explains, "are exacerbated by the accessibility of weaponry."

America still seems to be a place where the skin color of people is of more interest than what Martin Luther King, Jr., labeled the "content of their character." As a report published by the National Academy of Sciences notes, "The status of black Americans today can best be characterized as a glass that is half full -- if measured by progress since 1939 -- or as a glass that is half empty -- if measured by the persisting disparities between black and white Americans since the early 1970s."°

Hawley echoes: "There's no question that things are getting better . . . but we still have a long way to reach our goal."

Developmental Processes in Children

What is known about how prejudice is acquired? Is it basic to human nature? How do young children pick up messages about people different from themselves? When are the key moments when young people are most open to positive messages about others?

Unfortunately, as Hawley remarks, there is nothing as simple as a vaccine to innoculate children against prejudice. For children, learning to differentiate among objects and to categorize is essential in cognitive development and perhaps, in ancient times, was necessary for survival. From a young age, as they learn the differences between "floor" and "ceiling" or "table'' and "chair," they can also learn to distinguish between "us" and "them." Those first distinctions can be the roots of stereotypic thinking.

But as research demonstrates, there is a positive aspect, too. With early intervention, children can learn to be more "inclusive" in their categorizations. Studies show that the continuous exposure of young children, under favorable conditions, to people who differ from each other in language, culture, or ethnic origins can be influential in countering negative bias. Such positive interactions encourage children to feel greater empathy and to overlook unwarranted distinctions. Parents as well as teachers can play a key role in modeling such positive attitudes.

Hawley notes that most programs that start from the premise that "promoting positive relations among young children has positive consequences" are effective. However, only a limited number of such programs now exist, so that the chances of any but a few children benefiting from them are presently quite low.

Adolescence and Identity Formation

In the developmental chain from early childhood to adolescence, the possibilities multiply for both learning and intensifying prejudice. In fact, adolescence is the critical time for the formation of racial and ethnic identity. Influenced by parents, teachers, peers, and the media, individuals challenge views they internalized earlier, form opinions, make decisions, and may altogether reshape the way they perceive themselves, the world, and their futures.

In an illuminating chapter, "Race, Ethnicity, and the Defiance of Categories," linguistic anthropologist Shirley Brice Heath of Stanford University illustrates how racial and ethnic identification is not clear-cut for many urban youngsters. The young people she interviewed recognize "diversities within diversity"; they see themselves as "of color" or "kinda' all ethnic."

Although some educators believe that group differences should be minimized to reduce tensions, others believe that such an approach is unlikely to foster true "color blindness" and that it is healthier for adolescents to be anchored in an understanding and appreciation of their ethnic and racial background. As Jackson points out, a dialogue between cultures is more authentic when every group is aware of its own culture.

But recognizing the importance of strong racial and ethnic identification raises a paradox: How can parents and educators encourage the development of a strong racial and ethnic identity, with the accompanying feelings of pride, connectedness, and self-respect, that does not result in the denigration of other races and groups?

How can ethnicity be supported without encouraging intergroup tensions? How can young people be helped through this sensitive and complicated quandary?

As the contributors point out, there are some answers -- or the beginnings of answers -- but much additional research is needed. As suggested, meaningful intergroup contact on an ongoing basis is the key to positive identification with a particular group and to improved relations with other groups. Single meetings that have more to do with expressing feelings than with working together are not effective, and can even backfire.

Cooperative Learning and Multicultural Education

One technique that does work is cooperative learning. Proven successful in reducing prejudice as well as improving students' academic achievement, cooperative learning emphasizes teamwork. Within small, diverse groups that meet regularly to work on joint projects, group members share equal status and get to know one another as individuals, with friendship an additional benefit. Social contacts, whether in extracurricular school activities, like athletics, or in community-based programs, can also provide young people opportunities for highquality cross-race contacts.

Other findings demonstrate gains from school programs that promote the "ideology of multiculturalism" -- not just for minority youth but for all. If "multicultural competence" is to be a goal of education, what, exactly, does multiculturalism refer to? In general usage, it has become a catch-all term for acceptance of cultures that stand outside of the mainstream. In his chapter, "Multicultural Education and the Modification of Students' Racial Attitudes," James A. Banks, professor of education and director of the Center for Multicultural Education at the University of Washington, Seattle, offers a lucid definition of multicultural education: "A restructuring and transformation of the total school environment so that it reflects the racial and cultural diversity that exists within U.S. society and helps children from diverse groups to experience educational equality."

More than just curricular reform, multicultural education involves using content from a variety of cultures as illustrations in every subject area, teaching students how knowledge is created and influenced, encouraging the development of democratic attitudes and values, and employing techniques to facilitate the academic achievement of students from diverse backgrounds.

Much depends on the teachers. To engage their students in cooperative learning, they need specialized training: to address the needs of a diverse student population, teachers need to be multiculturally literate. As Kenneth Zeichner, professor of teacher education at the University of Wisconsin, writes in his essay, "Preparing Educators for Cross-Cultural Teaching," very little is being done to prepare teachers to work with culturally and linguistically diverse students. He charges that teacher education for diversity necessitates significant change at the teacher training institutes.

In the book's final section, Hawley and four other contributors collaborate to present a set of thirteen principles of program design, to be used either to evaluate existing programs or as guidelines for creating new ones. The first principle, which Hawley emphasizes, is that context means a lot. Strategies should address both institutional and individual sources of prejudice in the situations in which participants live, learn, and work.

Other principles emphasize the importance of the involvement of those in authority, careful training, the inclusion and consideration of all racial and ethnic groups, and ongoing evaluation of outcomes.

More Questions for Research

Editors Hawley and Jackson, along with all of the contributing scholars, assert the need for ongoing, serious research to create a solid foundation for new programs to foster positive intergroup relations. Most of the important studies are now fifteen years old and require updating to take into consideration societal changes. Significantly, much previous research focuses on black-white relations, without addressing multicultural identities and settings.

Aspiring "to achieve a common destiny worth striving for," Jackson focuses the research agenda on young people and opportunities in school and other places they frequent. He believes there is much to be learned from young people themselves about how they have already found ways to get along with others. "It's important to draw lessons from them," he explains, "and not just impose on them."

What patterns of contact already exist, and how can they be replicated on larger scales? Why are some children more successful than others in developing complex, integrated identities? What is the impact of the environment? How can a holistic approach to effective educational policy be designed? Can intergroup relations be improved without also addressing the basic economic and social inequalities of American society? In his essay, Jackson targets several priority areas for future research: curriculum, school organization, teacher development, student assessment, school governance, and the involvement of parents and community leaders.

Both Hawley and Jackson express optimism about chances for positive change. "It's inevitable," Jackson says, "that people from diverse backgrounds will need to be involved and engaged with each other. . . . New strategies can be crafted to create good relations. There's nothing on the horizon that makes it seem that negative outcomes are inevitable." Hawley agrees, adding: "There's no question if we put any effort into it, things would get better."

Jackson's own experience as an adolescent underlines his hopeful point of view. Growing up in California, he encountered "culture shock" when he switched from elementary school -- which was 95 percent African-American -- to middle school -- which was 95 percent Anglo-American. That he quickly formed friendships, which proved to be long-lasting, with students from different cultures made him realize that conflicts were avoidable. "There's got to be a way to have cross-cultural positive relationships extended on a larger scale."

The Corporation, Jackson explains, is considering initiating a program of grantmaking to stimulate new research in intergroup relations focusing on children and adolescents. It may try to develop collaborations with foundations and government agencies to stimulate both research and program development.

As several contributors to Toward a Common Destiny maintain, the dearth ofresearch and the indifference of policymakers to what is known about the formation of racial attitudes is foolhardy. Much is at stake. In the year 2020, about 46 percent of the nation's school-age youths will be of color. Understanding the origins of bias and working to eliminate it -- breaking the cycle of distrust, prejudice, and violence -- may determine whether the nation is strengthened or its very fabric is torn.

-- Sandee Brawarsky

For information:
Anthony W. Jackson, Carnegie Corporation of New York, and Willis D. Hawley, Dean, College of Education and Professor of Education, University of Maryland, College Park, MD 20742.

War Without End, Without Winners

It is all too evocative of the Sixties: an unwinnable war; the face of the enemy ever mutable; muddled strategy and tactics that rely on outmoded assumptions of behavior; millions of dollars in government spending becoming billions, while deaths mount by the thousands. This is no Vietnam, however. A quarter-century after the height of that conflict, the United States is mired in a home-front campaign to end the scourge of addiction to illegal drugs. While perhaps clearer in intent, with ostensibly stronger public support, this campaign, too, risks massive failure. Increasingly, the evidence indicates that government funds and personnel are being misdirected into programs that simply do not work.

In a new study, Keeping Score 1995: What We Are Getting for Our Federal Drug Control Dollars, Drug Strategies, a Washington, D.C.-based organization, scrutinizes the effectiveness of the principal components of federal drug control policy.° Its findings confirm what Drug Strategies president Mathea Falco suggested three years ago in her Corporation-supported book on drug policy -- that tax dollars intended to curb the use of illicit drugs by controlling their supply are for the most part being spent futilely. Illegal drugs are more readily available, at lower prices, than ever before.î

Consumption of illegal addictive drugs such as cocaine, heroin, and marijuana has grown since 1993, after a decade of gradual decline. According to a National Household Survey, 24.4 million Americans -- one in eight -- used illicit drugs in 1993. Of those, some 2.7 million were "hard-core" users addicted to cocaine and heroin. While no ethnic group or economic class is immune to the threat of drug addiction, the most vulnerable populations are the young and uneducated.

Probably the most discouraging trend, says Falco, is the growth of drug use among the young. Since 1991, marijuana use among eighth-graders has more than doubled. And while the effects of drug addiction are well documented -- absenteeism and accidents in the workplace, deterioration of family structures, and violent crime -- both teenagers and adults have become more tolerant of casual drug use, failing to recognize the risk of full-blown addiction.

Focusing On Demand

A drug policy focused on demand rather than supply would give more support to public awareness campaigns and to programs that effectively dissuade youngsters from taking up illicit drugs. Just as important, with such a policy shift, more effort could be put into treatment programs for the approximately 6 million existing addicts, only one-fourth of whom have such access, unless they pay for private treatment.

The image of the "typical" drug addict is curiously Janus-faced. On the one hand, he (or she) may be a career criminal, for the link of illegal drugs to violent crime is all too apparent. "Drug-related crime," now an uncomfortably familiar and broad term, ranges from petty theft that pays for drug purchases to violent behavior resulting from drug abuse to street warfare among gangs battling for turf in the market for illegal drugs.

Among the 12 million people arrested for all crimes each year, those testing positive for the use of illicit drugs (usually cocaine) has ranged between 50 and 70 percent over the past eight years, according to a Drug Use Forecasting report.

Criminologists associate the rapid expansion of drug dealing since the mid-1980s with the escalating homicide rate.

At the same time, the federal drug control program that now concentrates almost half its resources on domestic law enforcement produces a different image of the addict-as-criminal. A 1994 U.S. Department of Justice study showed that one in five federal prisoners is a low-level nonviolent drug offender with no previous record. This growing segment of the prison population is the outcome of mandatory sentencing for possession of small amounts of drugs such as crack cocaine. The consequent overcrowding of prisons has led to the early parole of other inmates, including those convicted of violent crimes. Meanwhile, "unhardened" offenders may not necessarily obtain access to treatment programs while serving their sentences. So the cycle of drugs and crime makes its way from the streets to prison and back again.

Rethinking Policy

The public is beginning to sense that the strategy of trying to control drugs at their source is not working. In the results of a survey accompanying the Drug Strategies report, 1,003 respondents indicated a desire for a balance among treatment, law enforcement, and interdiction programs to curb drug use. When given limited choices, however, the survey group indicated a preference for treatment and education programs, along with drug-law enforcement. Are they instinctively on the right track?

Evidence suggests that they are. In fact, as Keeping Score reports, drug treatment programs are the most cost-effective way of curing the drug scourge. Reduction of cocaine consumption by 1 percent can be achieved by spending $34 million on treatment programs. Alternative measures to put the same damper on cocaine use are far more costly: $246 million worth of domestic law enforcement, $366 million on interdiction, and a whopping $783 million on source-country control.

Anecdotal evidence by the survey respondents confirms in more qualitative terms what spending figures show quantitatively. Nearly half -- 49 percent -- of the respondents said they knew someone addicted to illegal drugs. Of those addicts who did not receive treatment, only one in five was reported as doing "very well" in life, while three out of five were not doing well. Contrast that to friends and relatives who had become addicted but had undergone treatment. Nearly one in three was reported as doing well. Where the treatment had been successful, the figure rose to 57 percent.

Drug Strategies points out that simply reallocating tax dollars to the apparently more effective drug-control strategies will not accomplish reduction of demand. Treatment programs should be community based, for it is only through strong components of the community -- job and educational opportunities, decent housing, a support network of family and friends -- that values contradicting the appeal of the drug culture can be found.

In all phases of the federal program, a more stringent audit of programs now in effect, with measurement of their cost-effectiveness, should lead to better choices of strategy, the report suggests. Hitting drug suppliers where it hurts -- curbing money-laundering activities both at home and internationally -- may be more effective than seizing shipments and arresting dealers at the far end of the distribution chain. Required treatment for all arrestees testing positive for drugs may cumulatively make a deeper dent in the crime-and-drug culture than the strategy of merely imposing mandatory sentences, particularly where prospects for rehabilitation in prison are dim.

Getting the Message

Are policymakers getting the message? Current and proposed federal budgets allocate two-thirds of spending to attempts to control the supply of illicit drugs, while already skimpy demand-control measures such as school and community education programs have been hit by budget recisions in the current fiscal year. Concerned readers are given the chance to participate in the dialogue. The format of the study, which is the first of an annual series (with the 1996 report scheduled for next February), incorporates a return form on which readers can rate various government programs for their effectiveness in curbing consumption of illicit drugs. Drug Strategies will include a compilation of these views in its next report, as it continues to keep score.

-- Maggie McComas

For information:
Mathea Falco, President, Drug Strategies, 2445 M Street, NW, Suite 480, Washington, DC 20037; phone (202) 663-6090; fax (202) 663-6110.

Schools That Do More Than Teach

Why Johnny can't read -- or write, or do his sums -- is just as much a concern of parents and community leaders today as it was nearly four decades ago when the Soviet Union's surprise launch of Sputnik turned the spotlight on the country's deficits in education, particularly in math and science. But today, schools are increasingly called on to fill a more comprehensive role in the development of productive adults. In addition to providing instruction, they must help to close the gaps left by the erosion of traditional family and social structures through a variety of school-based or school-related social services, especially health care.

In what might seem to be an idealized scenario, the familiar neighborhood school is transformed into a "full-service" institution, where a conventional -- or innovative -- daytime curriculum for youngsters is only one activity in what amounts to a community center serving a broader population than children and youth. These are ambitious objectives, to be sure, but not beyond possibility even in the current dampened climate for new public spending, as author Joy G. Dryfoos points out in her most recent book.

The number of schools nationwide that might qualify as models of "full service" is still small. The most common social service facility, often the core of a more extensive network of services, is the school-based health clinic. These clinics provide essential health care services for children from disadvantaged social environments. They address health-related problems that directly bear on a child's success in school and later life: teen pregnancy, substance abuse, and violent and suicidal behaviors.

An Old Idea

The idea of locating social services, in particular health clinics, within a school setting is a surprisingly old one. In tracing the history of such ventures, Dryfoos links their use to societal needs -- from the outbreak of smallpox in the 1870s to the great wave of immigration at the turn of the century (and the consequent need to screen new arrivals for infectious disease) to the current threat of substance abuse and sexually transmitted diseases among teenage populations.

Dryfoos's approach in examining both narrow and broad programs of in-school services is essentially descriptive and anecdotal in the best narrative sense. Drawing on studies of successful programs and the recommendations of experts in educational reform, adolescent development, and family welfare, she outlines her vision of the "model" full-service school -- whose services range from crisis intervention for families under the greatest strain to social skills training for young people preparing for the adult world.

The model naturally varies according to identified needs of the school and community population, taking into account the accessibility of services in the community and the willingness of contracting agencies to provide services within the school. But the result is a kind of settlement house within a school.

Meeting Adolescent Needs

How great is the actual need for "full-service" schools? Concentrating her survey on middle school and high school populations, Dryfoos figures that, of the seven million young people categorized as being at high risk, only about one-tenth have access to health and social services in the school setting, primarily through the 600 schools in which clinics have been established. "Very needy" are the 16,250 schools in which more than half the students qualify for free or subsidized lunches. Of these, she says, 6,500 have such overwhelmingly large populations of poor students that they should be given top priority in the establishment of clinics and social service centers.

Dryfoos's study is particularly helpful in describing how communities can muster the financial support required to transform existing institutions or construct entirely new ones. Two full-service schools described in some detail, Salome Ure®a Middle Academies (SUMA) in New York City and Hanshaw Middle School in Modesto, California, were literally built from scratch, their innovative curricula and networks of in-school social services developed in conjunction with the commitment of capital expenditures for new buildings by local school authorities. In order to offer programs that would make them full-service schools, each sought additional resources from public, private, and not-for-profit institutions.

The full-service program at SUMA, a new middle school in upper Manhattan, was made possible by foundation grants and public programs collected through the Children's Aid Society. The annual budget of $800,000 funds a health center, a family resource center, social services, and an after-school program. With an enrollment of 1,200, that works out to less than $1,000 per student, a veritable bargain in the cost-burdened structure of public education.

Such broad community support is not typical. A subtle barrier to making the full-service school a reality is the failure of educators and community leaders to elaborate in detail their vision of what the new institution should be and then adequately follow through by seeking technical assistance to set up the management structures needed to run such complex programs. They must design appropriate systems of accounting, quality control, medical protocols (in the case of health clinics), personnel management and community outreach. Ordinary school administration will not do.

Future Prospects

Nonetheless, in the case where a school system adopts only a limited approach to providing social services, incremental funds may be more readily available and outside agencies more willing to provide services on the school site than educators might expect. Medicaid funds may be tapped to establish school-based health services, for example, where there is a sufficient proportion of eligible students in a school system, provided administrators painstakingly construct the program to meet bureaucratic requirements of managed care and thereafter successfully wrestle with complicated billing procedures.

Other public sources of funds are available for different programs. The U.S. Department of Education distributes more than $6 billion annually to school districts for special programs that serve needy populations. State and county health agencies may provide both funding and personnel for school clinics. In the private sector, individuals, industry, and nonprofit organizations have provided significant resources for programs to assure quality education, from industrialist Eugene Lang's "I Have a Dream" incentive program to keep disadvantaged students on the college-bound track, to business "partnerships" that help orient students to the workplace. These might be tapped.

Individual and community initiatives such as these can do much to enrich the school years of at-risk children. But the large-scale installation of even narrowly defined social services that Dryfoos envisions would require a massive injection of public funds. To initiate the 16,000 health clinics that she says are needed would cost a minimum of $1.6 billion, a significant amount of which could be redirected from existing federal programs.

Although the political pendulum in Washington has swung since Dryfoos completed her study, and the fiscal purse strings are consequently tighter than ever, she remains upbeat about the prospects for innovation. "Adversity brings people together," she observes. The close cooperation among teachers and administrators, public officials, community leaders, and parents that is required for full-service schools under the best of conditions may actually blossom when the environment seems rather hostile to new investment in social capital. "Public outrage over program cuts and politicians' insensitivity to the needs of families and children are making people more determined than ever to change the institutions they can," says Dryfoos. She hopes that her book will provide not only practical information but also inspiration for community organizations and public agencies that have not been extensively involved in school-based social service programs before.

-- Maggie McComas

For information:
Joy G. Dryfoos, 20 Circle Drive, Hastings-on-Hudson, NY 10706. See also, Adolescents at Risk, by Joy Dryfoos (New York: Oxford University Press, 1990).

Full-Service Schools: Ideal As Reality

In her study of schools that offer an extensive array of "add-on" social service programs, author Joy Dryfoos found two particularly outstanding models of service to their communities. Located at opposite ends of the country -- New York City and Modesto, California -- these schools may differ in the structure of their services, but they have in common the fact that both were created "from scratch," with new principals and new facilities, and are situated in poor neighborhoods with large ethnic and immigrant populations.

Salome UreËa

Located in upper Manhattan, Washington Heights' new middle school, IS 218, or Salome UreËa (SUMA), named after a Latina poet, is the serendipitous product of two re-sources that came together in the late 1980s: a round of capital spending by the city's School Construction Authority and a commitment by the Children's Aid Society (CAS), one of the city's oldest and largest nonprofit social service agencies.

The new building was designed to serve as a community center as well as a school, with such features as "zoned" areas, outdoor lighting to assure safe accessibility at night for community functions, and air conditioning as an antidote to New York's sweltering summers. The innovative educational structure of four "academies" not only gives students an early anchor for their lives, but it also provides a natural framework for after-school programs, which, in addition to offering traditional tutoring, direct students to special projects in their areas of interest, from the performing arts to business.

From the outset, SUMA acknowledged the strong ethnic base of the community, and its programs consequently reflect the population's particular needs. Dominican community organizations were consulted in planning after-school and family programs; the celebration of the Dominican national holiday was occasion for a school fair. Language training beyond the middle school curriculum is multidimensional: students and parents have taught local precinct police officers Spanish, while parents are enrolled in English as a Second Language classes at the family institute.

While the value of an institution such as SUMA seems obvious, the establishment of this "full-service" school came about only through an extraordinary level of commitment and cooperation among a voluntary agency, a local school district, and community-based organizations. Its success has depended in large measure on the effectiveness of an unusual administrative structure in which responsibilities are shared by the school principal and the cas community school site director.

Hanshaw

Another approach to full service was employed by Hanshaw Middle School in Modesto, a northern California city of 175,000 whose socioeconomic foundation of traditional agriculture has evolved into modern agribusiness, its changing labor force reflecting a new ethnic mix. The vision of its founding principal Chuck Vidal, Hanshaw was designed after he conducted a door-to-door survey of residents in the disadvantaged neighborhood where a new school was to be built. Among the population of poor Hispanics and recent immigrants from Cambodia and Laos, many students were deficient in English. Yet family ambitions ran high: Parents wanted their children to go to a school that would put them on the college track. In 1991 Hanshaw started up in its new $13 million campus-like complex, featuring specialized facilities for music, arts, and crafts as well as auditoriums and a gymnasium. Vidal installed an interdisciplinary curriculum that features team teaching and cooperative learning among students. Their college goals are reinforced by links to several campuses in the California State University system, each university supporting a designated student group and welcoming the students to campus visits.

From the start, Hanshaw's primary focus was quality education. As student and community needs became clearer, social services were added, along with a school nurse, a mental health clinician, and aides to assist the immigrant populations. But Hanshaw had no coordinated approach to providing full services until it secured two operational grants from California's Healthy Start program, which requires a 25 percent match by applicant localities.

With its state grant complemented by resources from community agencies, Hanshaw set a budget of $400,000 per year for three years, con-centrating its resources on a center for health and dental care and an interagency case management team linking students and families to a variety of social service agencies. Hanshaw appears to be living up to its full-service concept; the key measure of success will be whether its first graduates reach the ranks of higher education.

A New Social Norm...All Pregnancies Intended

Despite the promise of modern medicine and technology, Americans are still a long way from fully controlling their reproductive lives. This shortfall became obvious in the early 1980s as statistics showed that the United States had higher rates of unintended pregnancy than several other Western democracies. In the most recent estimate, nearly 60 percent of pregnancies in this country were either mistimed or completely unwanted. The rates of births from such pregnancies, having declined in the 1970s, increased in the 1980s, particularly among the poor. In fact, by 1988, a full 44 percent of births were the result of unintended pregnancy. By the basic measure of being able to decide whether and when to have children, Americans -- especially American women -- were experiencing a disturbing lack of control over their own freedom and destiny.

Moved in part by these data, the Institute of Medicine of the National Academy of Sciences established a thirteen-member Committee on Unintended Pregnancy, consisting mainly of researchers and physicians and chaired by Leon Eisenberg, professor emeritus of social medicine at Harvard Medical School. Drawing on a wide range of sources, and with the support of Carnegie Corporation, the U.S. Public Health Service, and the Robert Wood Johnson Foundation, the committee has produced a report, The Best Intentions: Unwanted Pregnancy and the Well- Being of Children and Families (Washington, D.C.: National Academy Press, 380 pp., $29.95). Sarah S. Brown was senior study director and, with Eisenberg, coeditor of the report.

In 1987 -- the latest year for which the statistics are available -- of the 5.4 million pregnancies that were estimated to have occurred, about 3.1 million were unintended. Of those, some 1.6 million ended in abortion, and 1.5 million resulted in a live birth.

Although adolescent pregnancy has captured much attention, the report repeatedly emphasizes that women of all age groups experience unintended pregnancies. For example, over three-fourths of all pregnancies in women age forty and over are unintended. Even among married women, four in ten pregnancies were mistimed or unwanted. The rates of unintendedness are especially high among unmarried and low-income women, at either end of the reproductive age span, and among black women.

Why are American rates of unintended pregnancy so high? The report explores several explanations: problems of contraceptive availability and access; personal and interpersonal factors; and socioeconomic and cultural influences.

In 1988, slightly less than half of all unintended pregnancies occurred among women who said they used some form of reversible (nonsterilization) contraception and slightly more than half occurred among women using no contraception, despite having no intention of becoming pregnant. That means that, among 21 million women using contraception, there were 1.5 million unintended pregnancies. Only 6.7 percent of women of reproductive age did not intend pregnancy and did not use contraception; yet they accounted for 53 percent of all unintended pregnancies. Clearly, couples often move between these two states of practicing and not practicing contraception.

The imperfections of (and recent advances in) contraception in real life are summarized in the report, as are the accounts of persisting misinformation about basic issues of human biology and reproductive health. For example, a 1993 Gallup poll found that four in ten Americans believe that the health risks of the pill are greater than those of childbearing.

Whether school-based programs help to dispel ignorance and adequately educate youngsters is examined. A rigorous study in 1984 found that, while certain well-regarded sex education programs did increase knowledge about reproductive health, they did not change sexual behavior or contraceptive use. Ten years later, however, a review by the same scholar found that the more recent generation of programs did achieve four benefits: delay in the initiation of intercourse, reduction in the frequency of intercourse, decrease in the number of sexual partners, and increase in the use of contraceptives.

Federal support for family planning under Title X of the Public Health Service Act has been declining in relation to inflation, and access to the contraceptive methods that require a medical visit (such as a prescription for the pill) can be difficult.

Mixed Messages

The new report finds there are many missed opportunities in contacts between the public and the providers of services, who could make contraception and knowledge about the importance of avoiding unintended pregnancy more readily available.

Avoiding pregnancy is not a simple matter, and, particularly among younger adolescents, appreciable ambivalence and confusion may impede the careful and consistent use of contraception. In one passage the report summarizes the work of several researchers who find that "although many adolescents are not motivated to become pregnant -- that is, they may not fully 'intend' to become pregnant -- they are insufficiently motivated to avoid pregnancy." As pointed out in the report, most teens on welfare do use contraception (83 percent), although not consistently -- and most often they use a relatively effective method like the pill or an intrauterine device (75 percent). However, most are also pregnant again within a relatively short period of time.

A pregnant teenager captured the essence of this dynamic: "I didn't plan it, and then again I kind of knew what was going on because I wasn't, like, really taking the pills like I was supposed to. I couldn't remember every day to take the pill. And I still don't."

One scholar quoted in the report notes, "Few if any societies exhibit a more perverse combination of permissiveness and prudishness in their treatment of sexual issues." The popular media are "filled with sexual material, while, on the other hand, there is a noted absence of equal attention to contraception, responsible personal behavior, and values in sexual expression." This puzzling conflict can impede the transmission of accurate information about contraception and avoiding unintended pregnancy.

A further impediment remains the heated national debate over abortion, which has spilled over into related areas of contraceptive services and information and even school-based family life education.

Reducing the Rates

The committee learned of literally hundreds of state and local programs that in some way address the problem of unintended pregnancy. Only twenty-three of them, all targeting adolescents, have been evaluated rigorously. A closer look at these shows that the way to influence reproductive and contraceptive behavior is not well understood. Still, among several conclusions to be drawn are these:

The committee recommends a national campaign of education, action, and research to reduce unintended pregnancy. It remarks on the shared value of most Americans that children should be born into welcoming families who have planned for them and celebrate their arrival. It notes, "Most of the men and women at risk of unintended pregnancy are beyond adolescence and many are married, and for this large majority, the primary prevention strategy should be increasing contraceptive use. However, the committee unequivocally supports abstinence as one of the many methods available to prevent pregnancy."

In addition, "Although there are some who object, for example, to comprehensive, high-quality sexuality education in schools or to helping all sexually active individuals gain access to contraception, these are minority views in many communities and should not be allowed to paralyze efforts to mount major public health campaigns, such as the one outlined here."

A final recommendation is that an independent, public-private consortium of national leaders be formed to head the campaign, along the lines of the Partnership for a Drug-Free America or the National Commission to Prevent Infant Mortality. These leaders would have the credibility and political appeal to help create a new national norm -- that all pregnancies should be intended -- consciously and clearly desired at the time of conception.

--Victor Chen

For information:
Sarah S. Brown, Senior Staff Officer, Division of Health Promotion and Disease Prevention, Institute of Medicine, National Academy of Sciences, 2101 Constitution Avenue, NW., Washington, D.C. 20418; and Leon Eisenberg, Maude and Lillian Presley Professor of Social Medicine and professor of psychiatry emeritus, Department of Social Medicine, Harvard Medical School, Boston, MA 02115.

Sidebars and Footnotes

About the Editors

The author and coauthor of numerous books and articles dealing with school desegregation, teacher education, educational policy, and urban politics, Willis D. Hawley has also taught at Yale, Duke, and Vanderbilt universities. At Vanderbilt he was dean of Peabody College and later director of the Center for Education and Human Development Policy at the Institute for Public Policy Studies. He has served as a consultant to such public agencies as the U.S. Department of Health, Education and Welfare and the Senate Committee on Labor and Human Resources, and is currently an advisor to the U.S. Department of Education. He also directs the Common Destiny Alliance, a coalition of national organizations and scholars interested in improving intergroup relations.

Anthony W. Jackson joined Carnegie Corporation as a program officer in 1989 to develop a grant-making program in the area of early adolescent education. He also served as director of education for adolescents for the Carnegie Council on Adolescent Development. Earlier in his career, he was a senior professional staff member of the House Select Committee on Children, Youth and Families and worked as a legislative aide for representative Ted Weiss. (D-NY).

° A Common Destiny, by J. Jaynes and R. Williams (Washington, D.C.: National Academy of Sciences, 1989).

° Keeping Score: What we are Getting for Our Federal Drug Control Dollars, Drug Strategies, 1995. Complimentary copies available from Drug Strategies, Washington, D.C.

î The Making of a Drug-Free America: Programs that Work, by Mathea Falco. Revised edition, paperback, $12.00 (New York: Times Books, October 1994). To order call 1-800-733-3000.

A New National Assembly

Carnegie Corporation News

New Occasional Paper

The Corporation recently published an occasional paper, Radical Surgery: What's Next for America's Health Care, by Joseph A. Califano, Jr. Stating that individual dignity and national integrity are at risk in America's struggle to provide affordable and high-quality health care for its citizens, Califano believes that radical changes must occur in the way Americans think about health, life, and death.

Califano urges an examination of the nation's preoccupation with curing illness at the expense of health promotion and disease prevention and recommends that the public immediately join the health care debate.

Califano is founding chairman and president of the Center on Addiction and Substance Abuse at Columbia University. The paper is based on a speech he delivered to the Corporation's annual trustee dinner, on January 12, 1995. Copies are available free on request from the Corporation.

New Meeting Paper

Now available from the Corporation is a new meeting paper, American Policy Toward Africa: The Building of Constituencies, by Howard Wolpe. The paper synthesizes the proceeding of a meeting convened to examine the implications of the changing policy environments in the United States and African countries for U.S. foreign policymaking toward Africa. Participants at the March 6, 1995, conference in New York included Corporation grantees and other resource persons from both Africa and the United States. Copies are available free on request.

Staff News

On December 31, 1994, Elena O. Nightingale retired as special advisor to the president and senior program officer. Joining the Corporation on July 1, 1983, she has played a key role in many of its programs. Among other activities, she worked in program planning and grantmaking in health, particularly in the prevention of childhood injury and in drug abuse and violence. She has been senior advisor to the Carnegie Council on Adolescent Development and coeditor of Promoting the Health of Adolescents: New Directions for the Twenty-first Century (Oxford University Press, 1993).

In October 1994, Vivien Stewart was named senior advisor to the president. She continues in her role as chair of the Education and Healthy Development of Children and Youth program.

On November 1, 1994, Suzanne Wood joined the Corporation as a program officer in the Preventing Deadly Conflict program, formerly known as the Cooperative Security program. From 1991 to 1994, Ms. Wood served as deputy director of the Salzburg Seminar. Earlier she was the director of development at the Atlantic Council of the United States and a consultant, editor, and writer at the World Bank on economic issues in agricultural development in African countries.

Ms. Wood received a B.A. degree in international affairs and English at Lewis and Clark College and an M.A. degree in international relations at Paul Nitze School of Advanced International Studies at Johns Hopkins University in Washington, D.C., and Bologna, Italy.on request.

Carnegie Quarterly

Fall 1994 - Winter 1995

Carnegie Corporation of New York
437 Madison Avenue
New York, New York 10022

Phone (212) 371-3200, Fax (212) 754-4073

Editor, Avery Russell
Assistants, Anne S. McCook, Laura A. Clark, and Lynn Jordan
Illustrations, p. 1, 19th century watercolor, artist unknown; p. 4, reprinted from p. 14, Keeping Score, by Drug Strategies; p. 7, Joy Dryfoos; p. 10, Burt Silverman.