Abstinence-only vs.

Comprehensive Sexuality Education Programs

In 1996, the U.S. Congress passed legislation allocating $50 million in federal funds for abstinence-only-until-marriage programs as a part of the welfare reform. The funding for abstinence program has increased since then. In the fiscal year 2006, the federal government provided $178 million for abstinence-only education through Title V, Section 510 of the Social Security Act in 1996, Community-Based Abstinence Education (CBAE) projects, and the Adolescent Family Life Act program (Otta & Santelli, 2007). According to the supporters of the abstinence-only-until-marriage programs, condoms and contraception are not perfect in preventing pregnancy or STIs. The only fully effective method to prevent premarital pregnancy or sexually transmitted infections STIs is abstinence. They believe that abstinence in teenage years is a good preparation for fulfilling sex in later life (Stammers & Ingham, 2000), which is as questionable as the effectiveness of the abstinence-only-until-marriage programs.

It is important to get to the bottom of the controversy surrounding the effectiveness of the abstinence-only-until-marriage programs versus comprehensive sexuality programs because having ineffective programs in place is equally harmful as not having programs at all. We cannot afford to let the debate over superiority of the programs linger on, when STDs are claiming lives and having adverse health impacts. HIV/AIDS epidemic still persists as a serious health concern. Those who are 1324 years of age are at persistent risk for HIV infection in the United States. Unprotected sexual activity is responsible for a majority of HIV/AIDS infections in youth. Half of all new HIV infections and two third of STDs in the U.S occur among young people under the age of 25. CDC estimates that new HIV infections among young people under 30 (aged 1329) was greater than any other age group in 2006. These data confirms that HIV is an epidemic primarily of young people. In 2008, the highest age-specific rates of reported Chlamydia were among females 15 to 19 years of age and 20 to 24 years of age. Age-specific rates among men, was highest in the 20 to 24 year old age group. In 2008, gonorrhea rates continued to be highest among adolescents and young adults. In 2008, the highest rate of gonorrhea was among females between 15 to 19 and 20 to 24 year old. Among men, the rate was highest in those 20 to 24 years of age (CDC, 2009).

The superiority of the aforementioned programs should purely be based on the effectiveness of these programs. At this point in time, there is very little evidence, if any, that suggest the effectiveness of abstinence-only programs. For example, Trenholm et al. (2008) examined the impacts of four abstinence only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). They used the survey data collected in 2005 and early 2006. More than 2,000 teens were randomly assigned either to a sex education program or to a control group. The results show that abstinence-only programs do not have significant impact on teen sexual activity or differences in rates of unprotected sex compared to comprehensive sexual-education programs.

In addition to the ineffectiveness of the abstinence programs, Santelli et al. (2006) find them to be: morally, scientifically, and ethically problematic. They argue even though abstinence is a healthy behavioral option for teens, abstinence-only programs as a sole option for adolescents is problematic, as such programs threaten fundamental human rights to health, information, and life. Ethical issues are raised deliberately by withholding or distorting potentially life-saving information about contraception and STI prevention. Santelli et al. claim about distortion of potentially life-saving information about contraception and STI prevention have been found to be true. An investigation by the Committee on Government Reform in the House of Representatives, in 2004, found that 80% of the curriculum taught in abstinence-onlyuntil marriage programs contained false information about condoms, abortion, and basic scientific facts. They also blur religion and science and present gender stereotypes as fact (U.S HRCGR, 2004).

Bruckner et al. (2005) rightly point out the barriers to knowledge and protection for adolescents created by the abstinence-only programs. They examined the effectiveness of virginity pledges in reducing STD infection rates among young adults ages 1824 years of ages. In 1995, the National Longitudinal Study of Adolescent Health data, a nationally representative study of students enrolled in grades 712 was used to analyze the impact of abstinence-only programs. The follow-up survey was conducted in 20012002, in which, respondents urine samples were tested for Human Papilloma Virus, Chlamydia, Gonorrhea, and Trichomoniasis. The follow up result after six years showed that 88% of young adults that reported taking

virginity pledges as adolescents ultimately broke their promise and engaged in sexual intercourse before marriage. There was no significant difference in STD infection rate among the pledgers compared to the non-pledgers. About 13% of virgins who took a pledge reported engaging in oral or anal sex compared to 2% of virgins that did not take the pledge. Moreover, unlike non-pledgers, sexually active pledgers failed to protect themselves by using condoms at first sex. This suggests that young adolescents that receive abstinence-only education may engage in higher risk behaviors once they initiate sexual activity. The findings concluded that adopting virginity pledges as intervention may not be the optimal approach to preventing STD acquisition among young adults. The analyses demonstrate that abstinence-only programs are ineffective and may cause harm. They argue that the all-or-nothing approach by abstinence-only programs creates additional barriers to knowledge and protection for adolescents.

Likewise, using nationally representative data, Kohler et al. (2008) compared the sexual health risks of adolescents that received abstinence-only and comprehensive sex education to those of adolescents that received no formal sex education. This study assessed the impact of formal sex education programs on teen sexual health. Their findings show that abstinence-only programs had no significant effect in delaying the initiation of sexual activity or in reducing the risk for teen pregnancy and STD, whereas comprehensive sex education programs were significantly associated with reduced risk of teen pregnancy compared with no sex education or with abstinence-only sex education. Unlike in the case of abstinence-only education, which did not reduce the likelihood of engaging in vaginal intercourse, comprehensive sex education was found to be marginally associated with a lower likelihood of reporting having engaged in vaginal intercourse.

Comprehensive sex education programs have been found to be effective. Research (Bruckner et al. 2005; Kirby et al. 2007; Trenholm et al., 2008; Kohler et al., 2008; Mueller et al., 2008) have empirically demonstrated comprehensive sex education to be the most effective when it comes promoting safer sex among teenagers. Abstinence-only programs, in my view, undermine the reality about teen sex, whereas the comprehensive sex education realizes the reality about sexual behavior of teens and is an attempt towards making teenage/pre-marital sex safe. Comprehensive sex education emphasizes the benefits of abstinence and also teaches age-

appropriate, medically accurate information about contraception and disease prevention methods (Hauser, 2005). They have proven to be effective to reduce rate of teen pregnancy and STIs infections, delaying sexual activity, or increasing contraceptive use. They are developmentally appropriate, introduces information on relationships, decision-making, assertiveness, and skill building to resist peer pressure, depending on grade-level. Kirby et al. (2007) reviewed 83 studies that measured the impact of curriculum-based sex and HIV education programs on sexual behavior and mediating factors among adolescents or young adults ages 9 to 24 years anywhere in the world. It examined the evidence supporting both abstinence-only programs and comprehensive sexuality education programs designed to promote abstinence from sexual intercourse. The evidences suggest that the positive impact on behavior of curriculum and group based sex and HIV education programs for adolescents and young adults was quite strong and encouraging. Many comprehensive sexuality education programs demonstrate efficacy in delaying initiation of intercourse, in addition to promoting other protective behaviors such as condom use. Many either delayed or reduced sexual activity or increased condom or contraceptive use or both. Two thirds of the 48 comprehensive sex education programs studied had a significant positive impact on behavior. In contrast, study found no evidence that abstinence only programs demonstrate efficacy in delaying initiation of sexual intercourse (Kirby et al., 2007). Formal sex education has been proven to be effective in reducing adolescents involvement in risky sexual behaviors. Using data from 2002 National Survey of Family Growth survey, Mueller et al. (2008), examined whether there is any association between exposure to formal sex education and three sexual behaviors, namely ever had sexual intercourse, age at first episode of sexual intercourse, and use of birth control at first intercourse. The findings show that receiving formal sex education was associated with not having had sexual intercourse among males and postponing sexual intercourse until age 15 among both females and males. Males attending school that received sex education were also more likely to use birth control the first time they had sexual intercourse, however, no associations were found among females between receipt of sex education and birth control use. The results suggest that receiving formal sex education before first sex was associated with abstaining from sexual intercourse, delaying initiation of sexual intercourse, and greater use of contraception at first sex. The findings suggest that sex education received before first sex by youth in formal settings contributes to this positive outcome. Therefore, sex education should continue to be implemented in schools, community

centers, and churches. Sex education provides youth with the knowledge and skills to make healthy and informed decisions about sex behavior.

In my view, abstinence-only programs cannot be effective, as urge to have sex is quite natural. Plus, the context, in which, teens grow play a large role in determining whether or not they will engage in pre-marital sex. In a country like the U.S., where children are exposed to television and internet from where they get early doses of sexually explicit information, and where moving on from one boy friend or girl friend is considered normal, practicing abstinence is both biologically difficult and morally unwarranted. Adhering to abstinence-only programs creates more problems than it solves. I truly believe that abstinence-only programs are nothing but an effort to promote a religious vision of sexual morality, which fails to take into the consideration the context that we live in. Practically speaking, it is quite not possible to practice abstinence in the current context. For abstinence-only programs to work as anticipated by the supporters of the program society has to be conservative, in which, moving on from one partner to another be seen as sexual impurity, which is not the case in the U.S. In the absence of lack of value attached to sexual purity, the recruits of the abstinence-only programs do not really have the real incentives to stick to the pledges they take. In many countries in the developing world, celibacy is held in high regards. Those practicing celibacy are considered to have good character and they are the ones that are most sought after for marriages, which is obviously not the case in the U.S. In other words, the context required for abstinence-only programs to work is simply not there. That could be the reason why most parents do not find comprehensive sex education to be problematic. Public opinion polls suggest strong support for education about contraception and for access to contraception for sexually active adolescents. A nationwide poll conducted among parents of middle school and high school children found great support for sex education in school. Almost 90% believed it was very or somewhat important that sex education be taught in school, compared to only 7% of parents did not want sex education to be taught in school. Only 15% of the parents wanted an abstinence-only form of sex education (Santelli et al., 2006). Basically, there is no support for abstinence-only programs among the parents in the U.S. The issue, however, is not only about whether there is a support or not for the program, but whether or not the program put in place can achieve the desired results. In the case of abstinence-only programs, there is simply no evidence to show that these programs work. There is no consistent

evidence to suggest that millions spent by the federal government on abstinence-only education has had any positive effect (Jayson, 2009). Relying on abstinence-only programs even after knowing the fact that they do not work would be nothing less than undermining of the risks associated with unsafe sex. Socioeconomic costs of such risks, which if calculated, could over run the budget of the abstinence programs. Given the available evidence, it would be most appropriate to allocate resources towards comprehensive sex education programs.

It is, thus, best to provide comprehensive sex education that will help teenagers engage in safer sex than to falsely assume that teenagers can live without sex, for which, the context simply does not exist.

References: Bruckner, H., Bearman, P. (2005). After the promise: The STD consequences of adolescent virginity pledges. Journal of Adolescent Health, 36(4), 269-270. Centers for Disease Control and Prevention. (2009). Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services. Hauser, D. (2005). Teens Deserve More than Abstinence-only Education. Virtual mentor; OpEd. Ethics Journal of the American Medical Association, 7 (10). Jayson, S. (2009). Obama budget cuts funds for abstinence-only sex education. USA Today. Retrieved on November 7th 2010, from < http://usatoday.com > Kirby, D. B., Laris, B. A, Rolleri, L. A. (2007). Sex and HIV Programs: Their Impact on Sexual Behaviors of Young People throughout the World.Journal of Adolescent Health, 40, 206-217. Kohler, P. K., Manhart, L. E., Lafferty, W. E. (2008). Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy. Journal of Adolescent Health, 42, 344351. Mueller, T. E., Gavin, L. E., Kulkarni, A. (2008). The Association Between Sex Education and Youths Engagement in Sexual Intercourse, Age at First Intercourse, and Birth Control Use at First Sex. Journal of Adolescent Health, 42 (1), 89-96. Otta, M. A., Santelli, J. S. (2007). Abstinence and abstinence-only education. Current Opinion in Obstetrics & Gynecology, 19 (5), 446-452.

Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health, 38, 7281. Stammers, T., & Ingham, R. (2000). For and against: Doctors should advise adolescents to abstain from sex. BMJ: British Medical Journal, 321(7275); 1520-1522. Trenholm, C., Devaney, B., Fortson, K., Clark, M., Quay, L. and Wheeler, J. (2008). Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases. Journal of Policy Analysis and Management, 27 (2): 255276. United States House of Representatives Committee on Government Reform, Minority Staff Special Investigations Division (U.S HRCGR). (2004). The content of federally funded abstinence-only education programs.