In 1996 the newly Republican Congress approved nearly$440 million in public funds over five years to teach celibacy. The law comes upfor renewal next year. The local programs supported under this legislation teachthat abstinence is the only appropriate way to prevent pregnancy and sexuallytransmitted diseases (STDs). Indeed, the limited information aboutcontraceptives permitted in such classes emphasizes contraceptive failure rates.Under the program's key elements, states may only fund classes that teach that:
Premarital sex is wrong. It is "likely" to be both psychologically and physically damaging.
Sex is for the self-sufficient. Sexual activity is appropriate upon the attainment of "self-sufficiency"--presumably a measure of economic status. Since the law is silent on the definition of self-sufficiency, the income that a couple needs to achieve before sexual relations become appropriate is ambiguous.
Abstinence is ageless. Only the married should have sex. Since marriage has been occurring later in life, abstinence is not limited to adolescents. In 1998 the median age at first marriage was nearly 27 for men and 25 for women; in addition, older divorced and widowed individuals should abstain until they remarry.
When it embraced abstinence-only education, however, Congress missed abasic fact: There was no evidence that it would work. Indeed, when the NationalCampaign to Prevent Teen Pregnancy reviewed evaluations of "abstinence only"programs, it found that "there do not currently exist any abstinence-onlyprograms with reasonably strong evidence that they actually delay the initiationof sex or reduce its frequency."
Complete formal evaluations of these programs funded through the 1996law will not be generally available until 2003--a year after the program comes upfor reauthorization. That's unfortunate because it's not at all clear that theabstinence-only approach will prove superior to more flexible ones at delayingonset of sexual activity, discouraging activity with multiple partners, andpreventing pregnancy and disease. Other approaches to teaching humansexuality--variously called "abstinence plus," "abstinence based," and "safe sex"education--stress the value of abstinence, especially for younger teens, todiffering degrees but also provide age-appropriate information aboutcontraception.
The difficulty with abstinence-only education, of course, is that by definitionit is an all-or-nothing enterprise. Teenagers who have heard only the abstinencepitch and who then become sexually active are very likely to be at greater risk,since they will have had no education on practicing safe sex. Because of concernsabout the need for effective education strategies in this era of sexuallytransmitted diseases, the American Medical Association, the National Institutesof Health, the American Academy of Pediatrics, and the Institute of Medicine haveall recently issued reports questioning Congress's 1996 allocation and theapproach it supported.
The sponsors of the provision were the conservatives who took control ofCongress in 1994. The bill was promoted by Republicans such as Lauch Faircloth ofNorth Carolina and Rick Santorum of Pennsylvania in the Senate and Jim Talent ofMissouri in the House. Conservative family groups lobbied hard for its enactmentand succeeded in keeping abstinence education strictly defined. The win whettedconservative appetites for more funding. They modified an earlier program, the1981 Adolescent Family Life Act (AFLA), so that its broader abstinence-educationlanguage now conforms to the more restrictive 1996 brand of abstinence. Thatrevision provided about $9 million of AFLA's annual funding. Led by RepublicanCongressman Ernest Istook, Jr., of Oklahoma, legislators also okayed another $50million in 2000 for a virtually identical program. Congress even delayed theimplementation date so that the incoming Bush administration rather than thelame-duck Clinton team would write the regulations for disbursement of the newmonies.
The latest $50 million comes with new stipulations. Entities thatreceive the monies for abstinence education must not provide other sex-educationclasses that counsel alternatives to abstinence. So even if a sponsor teaches"abstinence only" to 12-year-olds, its program cannot be funded if it includescontraceptive information in classes for older teens. The provision is analogousto the Bush administration's "global gag rule," which denies federal funds tointernational family-planning groups if they so much as mention abortion anywhereelse in their program activities [see "The Sound of Silence" on page A21].
All told, as of fiscal year 2002, about $533 million in state and federal fundshas been earmarked for abstinence-only sex-ed programs just since 1996. Thelegislative sponsors, ordinarily considered fiscal conservatives, are using taxdollars on an unproven approach. Ironically, in an era of devolution and budgetrestraint, here is a new, federally engineered program for local schools. Ifanything, the drive to expand abstinence-only sex education is accelerating.Testifying before the Senate in April, Tommy Thompson, secretary of the U.S.Department of Health and Human Services, suggested that abstinence-only educationis underfunded.
Recent research suggests that some abstinence strategies may help delay theonset of sexual activity, particularly among the youngest adolescents. But theabstinence-only approach can backfire when aimed at older teens.
A comparison of in-school youths who took a "virginitypledge" and those who did not found that some virginity pledgers were at greaterrisk when they first engaged in sexual intercourse. The pledge--to abstain fromsex until marriage--did delay first intercourse on average by nearly 18 months.However, pledging had no effect among teens who were 18 or older and alsocontributed to health risks for those who became sexually active.
According to researchers Peter Bearman and Hannah Brueckner, who tracked thosepledgers who had intercourse during the study period, "the estimated odds forcontraceptive use for pledgers are about one-third lower than for others." Theresearchers noted that "pledgers are less likely to be prepared for an experiencethat they have promised to forego." They also found that "pledging does not workfor adolescents at all ages" and that the efficacy of the pledge in some schoolsdepended on its being uncommon: "Once the pledge becomes normative, it ceases tohave an effect." Thus "policy makers should recognize that the pledge worksbecause not everyone is pledging."
Another study compared an "abstinence" program with a "safer sex" programthat involved 659 African-American middle-school adolescents and found that amongthose who already were sexually active when the courses began, participants inthe "safer sex" program reported less-frequent sexual intercourse andless-frequent unprotected sex one year after the program. Further, when theabstinence group was compared with a control group, it reported less sexualactivity at three months following the intervention, but this distinctionevaporated over time.
A study conducted by Edward J. Saunders and colleagues at the Universityof Iowa School of Social Work compared survey responses from participants in acomprehensive sex-education program that promoted abstinence but allowedcontraceptive information with survey responses from participants in anabstinence-unless-married program and found that the former program was moresuccessful in imparting knowledge about AIDS and other STDs. In addition, whilethe authors suggested that program comparisons should be viewed cautiouslybecause of differences in the age of the participants, the length of theprograms, and a range of other variables, they noted that the program thatoffered contraceptive information also appeared to be more successful than theabstinence-unless-married program in "promoting communication between parentsand youth about sex."
In contrast, evaluations of programs that combine abstinence educationwith contraceptive information find that they can help delay the onset ofintercourse without a concomitant concern about health risks, and that they alsoreduce the frequency of intercourse and the number of partners.
By now, it's clear that the weight of the evidence suggests thatcontraceptive information is not inherently harmful and that abstinence curriculacan embrace contraceptive messages. Parents want both. A national study by theKaiser Family Foundation recently found that 97 percent of the surveyed parentsof 7th- through 12th-graders want their child's sex-education program to coverabstinence. But these parents also want lessons on how to use condoms (85percent) and on birth control generally (90 percent). State and local surveysalso have found strong support for information about both abstinence and birthcontrol.
Another problem is that one person's sexual activity is another's celibacy.The National Centers for Disease Control (CDC) holds that abstinence means"refraining from practicing sexual activities that involve vaginal, anal, or oralintercourse." Yet many of today's youth disagree.
One out of four college students in a national pollresponded that a person who is abstinent can practice anal intercourse.
Three out of five college students who responded to a poll at onemidwestern school consider that a person who practices oral sex is not "havingsex"; the same poll found that nearly one out of five believe that a person whopractices anal sex is not "having sex."
A study of nearly 300 teenagers from 12 to 18 years old in ruralmidwestern communities found that "adolescents have very broad definitions of whatsexual behaviors one can participate in and still be considered a virgin."
Oral sex did not count as "sex" among 40 percent of the 723 teenagerssurveyed by Seventeen magazine in the fall of 1999.
Of course, abstinence programs do not promote oral or anal sex. Butteenagers are famous for creative interpretations of rules. "Technical virgins"who don't practice safe oral or anal sex are more likely to contract sexuallytransmitted diseases than are sexually active ones who know what they are doingand act to prevent infection. This is no modest matter: Nearly three million newcases of STDs occur among teenagers each year.
What to do about the gap between language and sexual practices ofyouth? A basic first step is to get a better grasp on how youths understand keyterms such as abstinence, virginity, and sexual intercourse. The CDC,in the national Youth Risk Behavior Survey, asks about sexual intercourse butdoes not define it; the question has remained unchanged since 1990. As difficultas doing so may be politically, it behooves educators to encourage localassessments about the meaning young people in their community ascribe to thesewords. All sides of the abstinence-education spectrum should welcome this realitycheck. It may be that blunt language is necessary to communicate the CDCdefinition of abstinence and, as well, to ensure safe-sex practices.
Policy makers may be oblivious to the disconnect educators face in teachingabstinence-education programs and assume that "abstinence is abstinence." Thesenuances are important. It is sensible to encourage adolescents to delay prematuresexual activity; but we should not subsidize abstinence-only programs if, at thesame time, they increase the risks faced by those who either don't delay or don'tdelay as long. Congress needs to make these connections and appreciate thesedistinctions when it explores the 1996 abstinence-only education program in 2002.
All conscientious sex-education programs discourage promiscuity and encourageteens to delay sexual activity. But it is wildly naive to think that all or evenmost unmarried people will refrain from having sex, and it is self-defeating notto teach students contraception and disease-prevention. As reauthorizationapproaches, policy makers should lose their innocence, ask hard questions, andnot remain virgins on the topic of sex education.
To read the fully annotated version of this article go to http://www.clasp.org/pubs/teens/reproductive_healthtanf_teens.htm
