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Abstract
Sex education has been shown to increase adolescents' knowledge about sexuality but has no substantial effect on pregnancy rates among adolescents.1 The availability of federal family-planning clinics providing services for adolescents has been correlated with a decreased birth rate and an increased abortion rate but not a decreased pregnancy rate among adolescents.2 Finally, school-based health clinics offering contraceptive services have not convincingly been shown to reduce pregnancy rates among adolescents.3 The programs that have been successful in reducing pregnancy rates among adolescents have emphasized abstinence from premarital sexual activity.4,5 An emphasis on abstinence is not the same as "just say no" but, rather, requires a program of integrated, longitudinal strategies that encourage the development of healthy values throughout preadolescence and adolescence. The current use of misoprostol as an antiulcer agent, the ease of administration at home, and the exceedingly low cost of the drug could promote a similar pattern of use in the United States. Since Jain and Mishell found only a 43 percent incidence of complete abortion, unsupervised use would result in many incomplete abortions, which could initially go unrecognized and result in uterine bleeding or intrauterine infection. William L. Toffler M.D. John M. Young M.D. John K. Jain M.D. Daniel R. Mishell Jr., M.D. Allan Rosenfield M.D. Hope Heart Institute, Seattle, WA 98122-5798 University of Utah Medical School, Salt Lake City, UT 84132 Institute for Research and Evaluation, Salt Lake City, UT 84118 Oregon Health Sciences University, Portland, OR 97201 Northwest Texas Hospital, Amarillo, TX 79175 University of Southern California School of Medicine, Los Angeles, CA 90033 Columbia University School of Public Health, New York, NY 10032