Hilary Clinton popularized the phrase ‘it takes a village’ a few years back by using it to entitle”her” book (actually written by Barbara Feinman).

Today I participated in my first group visit for pregnant adolecent teens.  I must say I loved the experience.  Included in the group of providers are residents like myself, a family medicine faculty member, a social worker, a nutritionist and one of our extremely competent medical assistants.

Into this healthcare provider mosh-pit are thrown anywhere from 2 to 15 pregnant teenagers.  We sit in a circle and spend the first half-hour talking to them in a group about any of a number of topics germane to teen pregnancy.

We then break up the group and the patients are seen individually.  The residents evaluate their medical issues.  Then the social worker checks in, helping with other issues such as depression, abuse, post-partum care and support networks.  At some point the nutritionist sees them to offer advice on how to take care of themselves and eat right, etc.

The kids really seemed to like the program, and I enjoyed feeling like like I might actually be helping someone instead of just making insurance millionaires richer.

That said, I was struck by how much such a program must cost.  Doctors, each with at least 12 years of education, a social worker with Master’s level education, and a nutritionist with at least as much education as well.  Plus, all of our salaries, the facility, the ultrasound machines, etc.  It’s quite an operation, and all of it costs money.  Just thinking through our collective salaries for that day is an exercise in money-pondering (pun intended).

Sitting there watching these patients, it became clear to me that premarital sex isn’t just some arcane religious dictate.  It costs YOU money.  Think of an average day at work (for those of you still at the grindstone).  Think of all the crap you deal with because of the pressure you feel to afford your life.

Now think of a couple of bored, hormonal, overly-sensual teenagers romping on any horizontal surface they can find.  Think of the fact that, according to ‘Village’ theology, you are partially responsible for the fruit of that short-sighted quest for pleasure.

Teenagers have a hard time thinking about much other than self-pleasure.  I’m not blaming them; I was no different.  But their pursuit of pleasure does need to be met with some societal consternation.  It isn’t judgemental to be critical of promiscous behavior; it shouldn’t take a village very often.

The right thing to do for these sweet but immature and penniless patients is exactly what we did.  But millions of teenagers who aren’t in need of our high-intensity service don’t deserve to be told that their actions don’t matter.  They do.  And often the cost of their actions are unfair to everybody.