EDITOR'S NOTE: This is the first in a series of opinion editorials written by University of Cincinnati faculty and staff who took part in a seminar by The OpEd Project, which focuses on increasing the range of voices and quality of ideas we hear in the world. It was funded, in part, by the Scripps Howard Foundation.
CINCINNATI—Ten-year-old Amara* lives in a newly renovated low-income housing project in Cincinnati, which the U.S. Secretary of Housing and Urban Development called a “model for what we should be doing around the country.”
She is one of a dozen girls, between the ages of 7 and 16, participating in “Worth the Wait,” a Life Skills group at the development that combines practical skills—like how to make peanut-butter-and-jelly sandwiches—with building self esteem and encouraging abstinence.
As an African-American living in Cincinnati, Amara is nearly three times as likely to get pregnant by the age of 17 than her white peers, and three times as likely as a pregnant white teen to give birth prematurely.
Despite good intentions, research shows that abstinence education is unlikely to protect Amara from real dangers that surround her every day. Her haunting story serves as a wake-up call about the vulnerability of young girls, especially poor young girls, in our city and in our society.
The high cost of preemies
In December 2013, President Obama re-authorized the Preemie Act, enabling government funding for research and education to help prevent prematurity. It marked one of few bipartisan success stories in Congress in 2013.
Prematurity is the leading cause of infant death in the United States, which ranks 131st out of 184 countries in preterm birth, according to a March of Dimes Foundation and World Health Organization study. Currently, one in nine babies are born prematurely in the U.S.
These alarming statistics are more than just an embarrassment to the U.S. According to a New York Times report, American births are the “costliest in the world,” costing well over $50 billion a year, with premature births costing on average 12 times more than a healthy birth.
Students at UC could advise the government about where to invest new research dollars. And it wouldn’t be on lab-based nutrition studies or demographic surveys. It would be with young women like Amara, who have had to master a very different set of life skills.
‘Hide and go freak’
“I was shocked,” wrote one of my students after her first day with the “Worth the Wait” program. “I had no idea that their living situations would be that extreme, and I couldn’t believe the stories I was hearing.”
Students told me about a game that Amara and her peers play regularly called “Hide and Go Freak.”
Older men ask the young girls to hide, then seek them out to “freak” (which, according to the Rap Dictionary, is slang for having sex). While Amara suggested that some girls seemed to play the game willingly, she and her friends hide in the hope that they won’t be found. For Amara, it was hard to find a safe hiding place.
Her mother’s live-in boyfriend regularly abused her. And, because her brother had been removed from the home after being abused by the same man, Amara was left to suffer the consequences.
According to a recent study in the Psychology of Violence, girls who experience sexual abuse in childhood are “at significantly higher risk to be revictimized in adolescence and adulthood.” In other words, even if Amara is now protected from her mother’s boyfriend, she is likely to be sexually abused again, and more likely to produce an unwanted child that is born preterm.
Reaching beyond the basics
How can the problem of premature birth ever be solved if we don’t start with Amara? We need more than prenatal vitamins to ensure that her future child has a full 40 weeks to develop in utero. The problems run so much deeper.
Instead of pouring millions of dollars into medical research on birth outcomes (we already know that poor women of color are much more likely to give birth prematurely), we need to put that money towards solving the larger social problems that put such women at risk in the first place. Preventing childhood sexual abuse should be at the top of the list.
If we can’t protect our country’s most vulnerable children even before they encounter adolescence, and assure them that their bodies and minds are valued, then we can never solve the problem of prematurity.
To be sure, Obama’s signing of the Preemie Act is a step in the right direction, as are March of Dimes campaigns to tackle prematurity. Research and funding are essential to improving birth outcomes.
But the conversation needs to include an acknowledgement—and outrage—that young girls in our own country, in our own city, are regularly violated by men in their communities.
Encouraging abstinence assumes that these young girls are free to choose whether or not to engage in intercourse. Postponing motherhood until it is truly a choice will result in healthier babies more often carried to term and better prepared to live successful lives.
We need to make sure that these girls are able to safely walk away from violence masked as a game. Until hopscotch and jump rope replace “Hide and Go Freak” in Amara’s housing project, I won’t hold out much hope that we can really solve the economically and socially devastating problem of prematurity in America.
*name changed to protect the privacy of the group participant
Wendy Kline is professor of history at the University of Cincinnati. She is the author of "Bodies of Knowledge: Sexuality, Reproduction, and Women's Health in the Second Wave" and is currently finishing a book on the history of alternative birth in America.