A friend, who is a family physician, recently wrote to me and said, of abstinence-based sex education, “It doesn’t work.” Is he right, or wrong?
Here’s the full text of my friend’s comments:
Under our previous administration, our nation was pushed to refrain from teaching our youth how to prevent pregnancies, instead only preaching abstinence.
It doesn’t work.
Every study done has found that the best way to prevent unplanned pregnancies – and to reduce promiscuity, and to delay initiation of sexual activity among youth – is a comprehensive program of giving good information, without judgment, and providing access to contraception.
Under our previous administrations, we were given the enforced ideology of pretending that teenagers’ hormones and behaviors could be changed by preaching at them.
How many abortions resulted from this? We will never know.
Well, first of all, under President Bush’s administration, the number of abortions went down significantly. But, to the point, my friend is simply wrong when he says that “every study done has found the best way to prevent unplanned pregnancies . . . is a comprehensive program.
Now, there are some studies that show this. You can find them here.
But, there are a number of studies that validating the efficacy of abstinence-centered education. You can find them here.
Here are the details of a few:
1. Weed S., Ericksen I.H., Lewis A., Grant G.E., & Wibberly K.H. (2008). An abstinence program’s impact on cognitive mediators and sexual initiation. American Journal Health Behavior, 32(1):60-73.
• Statistically Significant Results: Of the comparison group 16.4% had initiated sexual intercourse after one year. In the program group 9.2% had initiated sexual intercourse, indicating that virgin program students were 46% as likely to initiate sexual intercourse as the virgins in the comparison group after one year.
2. Jemmott III, J.B., Jemmott, L.S. & Fong, G.T. (2006). Efficacy of an abstinence intervention over 24 months: a randomized controlled trial with young adolescents. Presentation at XVI International AIDS Conference, Toronto, Canada; Aug. 13-18, 2006.
• Statistically Significant Results: At baseline, 23.4% reported ever having sexual intercourse, whereas at 24-month follow-up, 57% reported ever having sexual intercourse. Logistical regression revealed that adolescents who received the abstinence intervention were less likely to report ever having sexual intercourse at 24-month follow-up than were those in the health-control intervention (p=.02), the safer-sex intervention (p=.007), or the comprehensive intervention (p=.05), controlling for baseline behavior, gender, and age.
3. Denny, G., & Young, M. (2006). An evaluation of an abstinence-only sex education curriculum: An 18-month follow-up. Journal of School Health, 76 8): 414-422.
• Statistically Significant Results: For the upper elementary age group, at 18-month follow-up, the treatment group was less likely to report participation in sexual intercourse in the last month. At the middle school at 18-month follow-up there were significant differences (p<.05) between the treatment group and comparison group with the treatment group less likely to report participation in sexual intercourse ever and in the last month. At the high school level there were statistically significant differences between treatment and comparison groups with students in the Sex Can Wait group less likely to report participation in sexual intercourse, ever and in the last month.
4. Weed, S.E., Ericksen I.H., & Birch P.J. (2005). An evaluation of the Heritage Keepers Abstinence Education Program. Evaluating abstinence education programs: Improving implementation and assessing impact. Washington DC: DHHS, Office of Population Affairs and the Administration for Children and Families.
• Statistically Significant Results: Of the program students who were virgin at the pretest and who also answered the follow-up sex question, 14.5 percent, had sex between the pre and follow-up. Of the virgin comparison students, 26.5 percent initiated sex between pre and follow-up. The results from the study indicate that program virgins were about one-half as likely (odds ratio=.539) as comparison group virgins to initiate sex by the 12 month follow-up, after controlling for pretest differences.
You can find the details and citations on another ten studies here.
And, you may find these commentaries, comparing and contrasting abstinence-based and comprehensive sex education, very useful:
- Assessing the Evidence: Comparing the Research of Comprehensive Sex Education and Abstinence-Centered Education.
- Another Look at the Evidence: Abstinence and Comprehensive Sex Education in Our Schools.
Now, we can debate the merits and demerits of each of these data, but it is intellectually dishonest, and frankly, wrong, to say of abstinence-based education that “it doesn’t work.”
However, it’s quite another question to ask if one or the other is the best approach.
In that vein, I’m not a fan of either exclusively abstinence-based sex education or comprehensive sex education (as currently practiced and taught).
A recent content analysis authorized by the U.S. Department of Health and Human Services analyzed nine comprehensive sex education curricula and nine abstinence-based sex education curricula.
The analysis measured the percentage of text in each curriculum that was devoted to different topics or themes. The results were quite interesting.
On average, abstinence curricula devoted 53.7% of their page content to abstinence-related material and 3.7% to discussion about the use of condoms and contraception to reduce the risks of pregnancy and STDs.
Conversely, comprehensive sex education curricula devoted an amazingly low 4.7% of their page content to abstinence-related material and 57% to the use of condoms and contraception to reduce the risks of pregnancy and STDs.
So, what do I feel is more appropriate? It’s called abstinence-plus sex education or ABC sex education.
This approach takes a standard (and proven) public health approach that utilizes the principles of primary and secondary prevention (whether of non-marital pregnancy, early initiation of non-marital sexual activity, or sexually-transmitted infections [STI’s]).
Let’s take STI’s as an example and compare and contrast the public health approaches demonstrated in the U.S. taken to the H1N1 Swine Flu pandemic and the STI epidemic:
For brevity, let me us the observations of my colleague, Diane Foley, MD:
I have watched with interest the attention given to preventing the spread of swine flu. Every day there are email alerts sent to my office with updated guidelines detailing the suggested approach should someone present with flu-like symptoms.
Don’t get me wrong – preventing the spread of the flu is very important and any death from this disease is significant, but we are talking about a process that has infected (and been fatal to surprisingly fewer people that we see with the seasonal flu).
The current approach to swine flu is primary prevention by isolating people who are sick – stay home, keep your sick children home.
The next approach is to adhere to careful hand washing and decrease the spread of germs by covering your mouth when coughing.
Lastly, medication is available that is very effective for those who test positive for the virus.
Why is it that a similar level of concern and coordinated approach is not being taken for the epidemic of sexually transmitted infections currently occurring in the U.S.?
In contrast to the (limited) cases . . . of swine flu, more than 50,000 people EVERY DAY are diagnosed with a sexually transmitted infections.
Almost half of these are young adults between the ages of 15 and 24.
The National Prevention Information Network, in coordination with the Center for Disease Control, states: “The most reliable ways to avoid becoming infected with or transmitting STDs are; abstain from sexual intercourse (i.e., oral, vaginal, or anal sex) or be in a long-term, mutually monogamous relationship with an uninfected partner.”
Teaching children and teenagers about the benefits of abstinence (from sexual activity) is primary prevention, yet the 2010 budget released last week by the White House does not include federal funding for abstinence-centered programs.
Current rhetoric dictates it is unrealistic to expect teens to be abstinent.
Is that because adults themselves are unable to follow the same standards?
Teaching risk reduction methods such as the consistent use of condoms is important but should not be the primary approach.
Are we going to be forced to censor the best method of prevention, the only 100% effective way to avoid sexually transmitted infections and pregnancy because we don’t think teens will listen?
It appears to me that we are underestimating our youth.
If that is the case, maybe we should just stop telling people who are sick with flu-like symptoms to stay home – they won’t want to do it anyway.
Diane’s point, with which I agree, is that we should take a primary and a secondary approach with sex education, using the ABC approach that has proven so very effective in Uganda.
The primary prevention part of the ABC program teaches:
- Abstinence from sexual activity until marriage and
- Be faithful within the marriage relationship. (or, feel free to substitute “life-long mutually monogamous sexual relationship with a non-infected partner” for “marriage”).
- The secondary prevention part of the ABC program teaches condom and/or contraceptive usage for those who choose promiscuity (or, feel free to substitute “to not have a life-long mutually monogamous sexual relationship with a non-infected partner” for “marriage”).
According to the 2007 Youth Behavior and Risk Survey, only 48% of teens say they have ever engaged in some sort of sexual activity by the time they graduate from high school and only 40% of them say they are currently sexually active so MOST young people are choosing to remain sexually abstinent at least until they are out of high school. More details on this fact here.
I believe we need to encourage these kids with education that spends far more than 4.7% of the time talking about abstinence.
Abstinence education is risk elimination. It is virtually 100% effective and thus an amazing primary prevention.
Comprehensive sex-education, on the other hand, is risk reduction and thus secondary prevention.
In my opinion, BOTH are important and necessary for the appropriate age-directed education of our youth.
Abstinence education currently is funded through Title V and CBAE funds disbursed through the Family and Youth Services Bureau.
Unfortunately, these funds ARE the ones that President Obama has cut from the 2010 budget thereby eliminating the primary prevention message for sexually transmitted infections and non-marital pregnancy.
President Clinton and President Bush did not decrease Title X comprehensive sex education dollars. Conversely, I don’t think President Obama should decrease abstinence-centered education dollars. More on that debate here.
Simply put, I don’t think it’s appropriate to rely on education that devotes <5% of its content to abstinence to be the primary prevention message for the epidemic of STIs and non-marital pregnancy.