Why abstinence only sex education is a waste of money

Since 1992, the federal government has spent close to $1 billion on abstinence-only sex education, despite growing evidence that these ideology-based programs are ineffective in delaying the onset of sexual activity, preventing teen pregnancy and the spread of sexually-transmitted disease among teens.

Meanwhile, comprehensive sex education—the kind where teens are given information about both abstinence and contraceptives—has received virtually no federal funding.

That’s why it was so encouraging when President Obama released his budget earlier this year and the $50 million per year since 1996 that’s been devoted to abstinence-only programs was missing. It looked like this ill-conceived emphasis on “Just Say No” sex education had finally ended.

Except it hasn’t. It turns out that Senator Orrin Hatch attached $50 million a year for 5 years into the health care bill; it made the cut to the final version, and funding for abstinence-only sex education has been reborn. It’s not clear why the funding stayed in the final legislation—reports are that it was used as a sweetener to score the votes of socially-conservative Democrats—but now $250 million is once again available for states that agree to offer only the most restrictive no-sex-before-marriage curriculum.

According to the Department of Health and Human Services, abstinence programs must meet eight criteria (the so-called A-H criteria) to receive funding, including that they:

• Teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems
• Teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity
• Teach that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects

To its credit, the health care bill also allocates (for the first time) $75 million a year for 5 years for states to provide comprehensive sex education programs. That’s good news. But when every penny counts and health officials are making a commitment to evidence-based practice, why are we pumping money into ideology-driven sex education programs that so clearly don’t work and may even cause harm?

The emphasis on abstinence-only sex education officially took off in 1996 when funding for such programs was tacked onto Clinton’s welfare reform legislation. Also included was a Congressional mandate for a long-term study of abstinence programs to measure how effective they were in impacting teen sexual practices as compared to no sex education at all. In 2007, the authors of this mandated study issued a report with the following conclusion:

“Findings indicate that youth in the program group were no more likely than control group youth to have abstained from sex and, among those who reported having had sex, they had similar numbers of sexual partners and had initiated sex at the same mean age.”

More evidence that abstinence-only education doesn’t work can be found by looking at the latest statistics on teen childbirth rates. The April 4 issue of the Archives of Pediatric and Adolescent Medicine includes the finding that after 14 years of steadily declining, teenage childbirth rates actually increased in 2006 and 2007. And that follows a full decade of increased emphasis through federal and state funding for abstinence-only sex education programs.

The same alarming rise is seen for sexually-transmitted diseases and HIV. The Centers for Disease Control and Prevention (CDC) estimates that 19 million new STD infections occur every year in this country, with approximately 48 percent of these new infections occurring in young people ages 15 to 24. Yet, this age group represents only 25 percent of the sexually active population in the United States.

Conservatives respond to attacks on abstinence-only programs by pointing to a recent study in the Archives of Pediatric and Adolescent Health that showed that abstinence-based sex education delayed onset of sexual intercourse in young teens more than interventions that focused solely on condoms or on comprehensive interventions. The problem is that the programs included in the Archives study do not meet the government’s A-H criteria and therefore wouldn’t be eligible for federal funding. The programs also focused on students in sixth and seventh grade; that’s 11 to 13-year-olds—a group that is less likely to be sexually active.

Meanwhile, there are wider consequences of continued funding for abstinence-only sex education. For one, the government’s implied support for these programs gives fodder to those conservatives who believe it is morally wrong to teach teens about personal responsibility, sexuality, and about using contraceptives to avoid pregnancy and disease.

In Wisconsin, for example, the governor recently signed a law that requires any school that provides sex education to adopt programs that use a comprehensive curriculum, including information about birth control and sexually transmitted disease as well as abstinence. The law also specifically bans abstinence-only programs. In response, Scott Southworth, a district attorney from Juneau County, called the sex education law a “sick and shameful piece of legislation” that encourages sex among minors. Southworth sent a letter to some Wisconsin school districts warning them that the new law essentially forces them to “instruct children on sex-for-pleasure,” and exposes teachers to the risk of criminal liability.

“Forcing our schools to instruct children on how to utilize contraceptives encourages our children to engage in sexual behavior, whether as a victim or an offender.”

“It is akin to teaching children about alcohol use, then instructing them on how to make mixed alcoholic drinks.”

What is so maddening about folks like Southworth and others who insist on abstinence-only sex education is that they seem to live in a fantasy world where chaste teenagers can be taught to “just say no” to premarital sex. In the 2007 report on abstinence-only programs that was submitted to HHS, the authors report that “about half of all high school youth report having had sex, and more than one in five report having had four or more partners by the time they graduate from high school. One-quarter of sexually active adolescents nationwide have an STD, and many STDs are lifelong viral infections with no cure.”

Insisting that schools provide an abstinence-only curriculum is not only hopelessly naïve; it is also categorically unfair to young people, according to the authors of a Journal of Adolescent Health review article on abstinence policies and programs:

“We believe that abstinence-only education programs, as defined by federal funding requirements, are morally problematic, by withholding information and promoting questionable and inaccurate opinions. Abstinence-only programs threaten fundamental rights to health, information, and life.”

If they need any more evidence that teenagers must have comprehensive sex education, Mr. Southworth and his ilk should spend time (as I did last weekend with my 15-year-old daughter) watching a marathon of MTV’s “16 and Pregnant.” A reality TV show produced in partnership with the National Campaign to Prevent Teen and Unplanned Pregnancy, each episode provides the graphic saga of a young girl’s pregnancy and subsequent birth of her baby. These are not sugar-coated tales and most of the girls (and the baby’s fathers) seem to have been woefully uninformed about how to prevent pregnancy—and clearly they were not practicing abstinence. The episodes are cautionary tales that likely have a much realer impact on teen behavior than abstinence-only programs.

In the end, by including $250 million for abstinence-only education in the health care bill, the federal government is promoting a public health intervention that has been proven to be ineffective at best. Abstinence-only education is a serious disservice to our young people. It leaves them terribly conflicted and dangerously uninformed about how to prevent pregnancy and STDs. With a well-designed comprehensive curriculum kids can be taught about the very real benefits of delaying sexual activity and given support in their efforts to “Just Say No.” But if they do choose to have sex—as many teens eventually do—they need accurate and practical information about condoms and other contraceptives to avoid pregnancy and disease.

Withholding this kind of information from teens is coercive and ineffectual. It’s time to face reality and stop wasting any more money on interventions that clearly don’t work.

Naomi Freundlich is a senior research associate of The Century Foundation who blogs at Health Beat, where this post originally appeared.

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