Date: September 6th, 2018

Pat Paluzzi

As I step down from my role as President and CEO of Healthy Teen Network, I find myself reflecting on the changes in the adolescent and sexual health fields I have seen over the past 20 years. I want to share some of my thoughts.

I know that some individuals and agencies prefer to frame adolescent reproductive and sexual health concerns as public health or financial issues—and these are valid, however limited, frames. At the root of the issue is a lack of equity and respect for all youth in this country, which lends to the persistent high rates of disparities across diverse racial, ethnic, gender identity, and sexual orientation lines. We will never truly close these gaps without addressing this country’s social inequities. This is a herculean task, but today’s young people are more in tune with and willing to address issues of inequity. We need to encourage and support them and then get out of their way.

Framing teen pregnancy as solely a behavioral issue means that each young person is solely responsible for their pregnancy and pregnancy outcomes. And while there is some personal responsibility that must be considered, where youth live, learn and play has tremendous influence on the level of ‘choice’ and personal agency they experience. The World Health Organization recognized and promoted the concept of social determinants of health over 20 years ago, but here in the U.S., the concept is just now gaining traction. We are on the right track, but we must challenge ourselves even more to consider how we can best address the myriad of issues that intersect in young people’s lives and impact their health and well-being.

As proponents of using data to inform practice, we must truly engage youth in the development and design of messages, resources, and delivery mechanisms that resonate with their needs and their current patterns of information consumption. The advances in technology over the past 20 years are mind-boggling and the progression is only gaining speed. At Healthy Teen Network, we are engaging in digital focus groups, which has made it tremendously easier to engage and truly utilize youth voice. We are learning a lot from these focus groups, which is definitely shaping how we think about delivering, sex ed to youth. And while I don’t think we should give up on schools completely, I do believe we must spend equal effort developing and testing alternative forms for providing sex ed to youth. Our education system is broken, and sex ed will not be a priority for a long time to come, if ever.

We know that risk taking is normative in adolescence, and much of our work is to empower youth to take risks with fewer dire consequences. But risk taking should not end at 25. Much is learned from risk taking (think of researchers and what we gain from their trial and error approach to learning). Innovation is risk taking. Challenging the dominant paradigm is risk taking. Being the lone voice in a room that defends a social norm or defies an accepted ‘truth’ is risk taking. If we are going to work to address issues affecting adolescents, we must take risks.

I have worked in the field of reproductive health in some capacity since 1971. I have seen the introduction of the pill, the legalization of abortion, the implementation of the so called ‘gag rule’ internationally come and go depending on the party in the White House. I have witnessed big gains for minorities of all kinds, such as the end of miscegenation and segregation laws and homosexuality declassified as mental illness. All of these and many more changes came because people stood strong and demanded them. Getting that next contract because you don’t speak out against those who incite hate is a short lived and cowardly approach to doing business and living life. Remembering why we do this work—to support and empower young people—should keep us on the right path.

I realize that nothing I have to offer is new, and much of it sounds incredibly idealistic—something you might not expect after so many years working in this field. But in spite of our current circumstances, I believe risk-taking, empowered people, young and old, can and will make a difference. Our work matters—A LOT!


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About the Author

Patricia Paluzzi, CNM, DrPH, President and CEO of Healthy Teen Network, has been active in the fields of reproductive, and maternal and child health for over 40 years, as a clinician, researcher, administrator, and advocate. Her clinical and content expertise spans the full scope of midwifery care, substance abuse, intimate partner violence, high-risk maternal child health (including pregnant teens), incorporating men into clinical services, and trauma-informed approaches.

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