美國大學提供免費避孕套 懷孕率不降反升?

Giving out free condoms at school is not a surefire way to avoid teenage pregnancy - or it might not be enough.

在校園裏發放免費避孕套並不是一個防止青少年懷孕的穩妥之法--或者說這可能還不夠。

Access to condoms in schools increases teen fertility rates by about 10 per cent, according to a new study by the University Of Notre Dame.

聖母大學的一項最新研究表明，在學校裏能夠獲得避孕套的情況下，青少年們的生育率提高了10%。

However the increase happened in schools where no counseling was provided when condoms were given out - and giving out guidance as well as birth control could have the opposite effect, economists Kasey Buckles and Daniel Hungerman said in the study.

在這份研究中，經濟學家凱茜·巴克爾斯和丹尼爾·亨格曼表示，生育率有所上升的學校在發放避孕套的時候沒有提供諮詢服務，而在提供生育控制措施的同時提供指導會起到正面的效果。

Access to other kinds of birth control, such as the contraceptive pill, IUDs and implants, has been shown to lower teen fertility rates - but condoms might have opposite consequences due to their failure rate as well as the time and frequency at which they're used.

而其他避孕措施，例如避孕藥和植入宮內避孕器，在降低生育率方面確有其效--但是由於破損以及使用時間和次數的原因，避孕套有可能帶來相反的結果。

Buckles and Hungerman looked at 22 school districts located in 12 different states, using data from the 1990s. Times have changed already and teenagers today are overall less likely to have sex and less likely to become pregnant, they wrote. Most of the free condoms programs in the study began in 1992 or 1993 and about two thirds involved mandatory counseling.

巴克爾斯和亨格曼在美國12個州的22個學區進行了調查，使用自20世紀90年代以來的數據。隨着時間的推移，總體而言，如今的青少年發生性行爲次數更少，懷孕機率也更小。研究中涉及的大部分免費避孕套項目開始於1992年或1993年，其中大約三分之二提供強制性諮詢服務。

The 10 per cent increased occurred as a result of schools that gave out condoms without counseling, Buckles and Hungerman said. 'These fertility effects may have been attenuated, or perhaps even reversed, when counseling was mandated as part of condom provision,' they wrote. Teenage girls were also more likely to develop gonorrhea when condoms were given for free - and again, the increase happened as a result of schools giving out condoms without counseling. Access to contraceptives in general has been shown to lower teen fertility, Buckles and Hungerman noted, or in some cases had no effect at all.

巴克爾斯和亨格曼表示，青少年生育率上升10%是因爲學校發放避孕套但沒有提供諮詢服務。但是，提供避孕套時提供強制性諮詢服務可減弱甚至顛倒這種生育率影響。免費提供避孕套也會提高女生患性病的機率，而這也是學校沒有提供諮詢服務導致的。總體而言，避孕措施降低了青少年生育率，但在某些情況下並沒有任何效果。

But condoms might have a different impact because of several factors, such as the fact that their failure rate is more important than that of other contraceptives. Condoms also rely 'more heavily on the male partner', which is an important factor given that an unplanned pregnancy will have different consequences for each gender, Buckle and Hungerman wrote.

但是，由於失效等種種原因，避孕套可能產生不同的效果。鑑於意外懷孕會給雙方造成不同的影響，避孕套也極大地取決於男性一方。使用避孕套的時間也是爲什麼它的效果與其他避孕措施不同的原因。

Free condom programs in schools could have led to two additional births per 1,000 teenage women so far, Buckle and Hungerman found. This could increase to 5 extra births per 1,000 teenage girls if the country's entire high-school-aged population had access to condoms.

目前，巴克爾斯和亨格曼發現，學校的免費避孕套項目導致每1000名女生懷孕次數增加2次。如果全美的高中生都可獲得免費避孕套，將導致每1000名女生的懷孕次數增加5次。

Condom distribution programs could promote the use of condoms over more efficient birth control methods, drive schools to use their resources for condom distribution rather than more effective programs, or might encourage 'risky' sexual behaviors, Buckle and Hungerman wrote. But these findings should be used with caution when reflecting on policy proposals, they added.

此外，避孕法發放項目可能使更多人選擇使用避孕套，而不是其他更有效的避孕措施，從而促使學校開展避孕套發放項目而不是其他更有效的項目，這或許也會慫恿“危險”的性行爲。然而，巴克爾斯和亨格曼表示，在反思政策建議的時候，因謹慎使用這些研究發現。

Health clinics based in schools that offered contraceptives were shown to significantly lower teen fertility in a 2014 study. 'If health clinics can effectively combine contraception access and counseling, this may lead to very different effects than access alone,' Buckle and Hungerman said.

在2014年的研究中，學校醫務室提供避孕藥極大地降低了青少年生育率。巴克爾斯和亨格曼表示，如果醫務室能夠有效結合避孕措施和諮詢服務，將可能產生與僅僅提供避孕措施非常不同的效果。