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Abstinence-Only Education Continues to Flourish

If half of U.S. teens are sexually active, why aren't we giving them the full story on contraception and STD prevention?

 

Winter 2002/2003

By Priscilla Pardini

Continued federal funding for abstinence- only-until-marriage sex education programs that leave teens without the facts they need to protect themselves from pregnancy and sexually transmitted diseases appears secure under legislation currently pending in Congress.

At a minimum, lawmakers are expected to reauthorize spending for abstinence-only initiatives at the current funding level of $102 million a year. Opponents of the measure fear spending could go higher.

The move is certain to further boost the growing popularity of such programs, which by law may not include information about contraception beyond failure rates. Instead, abstinence-only programs teach that the expected standard of human sexual activity is "a monogamous relationship within the context of marriage" and that sex outside of marriage is likely to be "psychologically and physically harmful."

The continued funding comes over the objection of scores of medical experts and public health officials representing organizations such as the American Medical Association, the American Academy of Pediatrics, and the American Public Health Association. They say teens - nearly half of whom are sexually active by age 18 - need comprehensive sexuality education programs that not only teach abstinence but also include medically accurate information on preventing pregnancy and STDs. The federal appropriation also disregards the results of opinion polls that overwhelmingly document parental support for comprehensive sex education, as well as a lack of scientific evidence that abstinence- only programs reduce the incidence of sexual intercourse among teens.

Even some moderate Republicans in Congress have begun to question the wisdom of funding abstinence-only sex education, with a number signing on as cosponsors of an alternative bill, the Family Life Education Act. The bill, introduced late last year, proposed spending $100 million a year for five years in federal funds on programs that teach about both abstinence and contraception.

Nevertheless, the Bush administration, determined to fulfill what observers say is clearly a "non-negotiable" campaign promise to the Religious Right, continues to press hard for even more federal funding for abstinence-only initiatives.

"It's very disturbing to me that we are tolerating a government that substitutes ideology for rigorous research findings when it comes to allocating public health and education dollars," said Laurie Schwab Zabin, a professor at the Johns Hopkins University Bloomberg School of Public Health and a researcher in the area of adolescent sexual behavior and pregnancy.

"There's no evidence whatsoever that abstinence education alone is effective with young people. Yet, as long as the Republican Party is controlled by the Radical Right, this is the kind of legislation we can expect."

"It's a great cause for concern," agreed Tamara Kreinin, president and CEO of the Sexuality Information and Education Council of the United States (SIECUS), a nonprofit national organization that promotes comprehensive sexuality education. "The abstinence- only initiative is stronger than ever. And now under the Bush administration, it's become very politically charged. The president is keeping a campaign promise without regard for public health."

FEDERAL DOLLARS

In 1996 a little-publicized and neverdebated provision of the welfare reform law threw the full weight of the federal government behind abstinence-only sex education when $50 million a year for five years became available to states agreeing to teach abstinence. The federal appropriation ballooned to $437.5 million when combined with matching state funds. Five years later, Congress appropriated $20 million more a year (increased to $40 million in 2002) for abstinence-only programs run by community- based programs. (Another $12 million a year in Adolescent Family Life Act funds, had been earmarked for abstinence-only programs since 1997.)

In his 2003 budget, President Bush proposed increasing total federal funding for abstinence-only programs - currently at $102 million a year - to $135 million a year, a figure he said equaled what the federal government spends on family planning services for teenagers. Funding at that level is not likely to be passed by Congress. But a resolution passed by the both the Senate and the House of Representatives on Oct. 16 continued $52 million in funding until Nov. 22. A separate, earlier resolution continued an additional $50 million in funding through the end of the year.

"Beyond that," said William Smith, SIECUS' director of public policy, "It's anyone's guess just how much more money will be spent on these unproven and potentially harmful programs. At best, given the current political climate, we hope to hold the line and have these programs flat-funded at $102 million."

Even given that best-case scenario, the effect of the federal funding on sexuality education to date has been enormous. "All that money is giving abstinence-only programs credibility they don't deserve," said Martha Kempner, SIECUS' associate director. "It looks like the federal government's stamp of approval. People think that if the government is putting money behind it, it must be the right thing to do."

In fact, there is no federal policy on what public schools should be teaching when it comes to sexuality education, the result of the longstanding U.S. tradition of "local control" over schools. Yet, Kempner said it's hard for local school districts, particularly those strapped for cash, to resist abstinenceonly programs. She likened the scenario to "dangling a carrot" in front of a hungry rabbit. "The fact that it's fully funded makes it appealing," she said. "The fact that it's federal funding gives it credibility."

Beyond that, Kempner said many abstinence-only programs have become less controversial over the last few years. Abstinence-only advocates "have listened to the criticism," she said. "Some of the blatantly inaccurate information and the overtly religious references are gone. Overall, it's a less controversial product."

As a result, the number of school-based abstinence-only programs is increasing. According to the Alan Guttmacher Institute, a not-for-profit corporation that conducts research on reproductive and public health, more than two out of three public school districts have policies on sexuality education. The vast majority - 86 percent - require that abstinence be promoted. Of those, 35 percent require abstinence-only-until-marriage programs. That compares to roughly 25 percent six years ago.

"It's very discouraging," said Evelyn Shalom, a health educator who teaches a comprehensive sex education course at Ridgewood High School in Ridgewood, New Jersey. "What the abstinence- only programs are attempting to do is put the most absurd kind of Band-Aid on this huge problem."

NEED AS GREAT AS EVER

Despite a decline in adolescent sexual activity, pregnancy, birth, and abortion rates, U.S. teens are still in great need of sexuality education. According to the 2001 Youth Risk Behavior Survey released in October by the U. S. Centers for Disease Control and Prevention, 45.6 percent of high school students nationally reported having had sexual intercourse at least once, compared with 54.1 percent in 1991. (According to the 2001 Milwaukee Public Schools' Youth Risk Behavior Survey, 57 percent of district high school students reported having had intercourse at least once.)

Lloyd Kolbe, director of the CDC's Adolescent and School Health Program, called the decline in sexual activity "encouraging." But he also noted that "too many students continue to engage in behavior that places them at risk of unintended pregnancy, HIV infection, and other sexually transmitted diseases." Statistics bear him out. The CDC's own data, for example, estimate that between 800,000 and 900,000 adolescents 19 years of age or younger become pregnant in the U.S. every year. The Guttmacher Institute reports that roughly 4 million new STD infections occur in U. S. teens annually. And when it comes to HIV, half of the 40,000 Americans infected each year are young people under the age of 25, according to the United Nations.

The impact of those numbers isn't lost on Shalom, the health education instructor. "We're waging an uphill battle," she said. "Abstinence is part of the message, of course. But in a class of 28, if even two students are putting themselves at risk, shouldn't I be working with those kids, too? When we have two kids with severe learning disabilities in a class, we don't say, 'Too bad for you. I'm just dealing with the other kids.' As teachers we have a responsibility to deal with everyone."

HISTORY OF SEX ED

Not necessarily, say advocates of the abstinence-only movement, which traces its roots to efforts in the late 1960s to ban any form of sex education in schools. Then, sex education programs were being described by the Christian Crusade and other conservative groups as "smut" and "raw sex." The John Birch Society termed the effort to teach about sexuality "a filthy Communist plot." Phyllis Schlafly, leader of the far-right Eagle Forum, argued that sexuality education resulted in an increase in sexual activity among teens.

Still, sex education programs proliferated in public schools, in large part due to newly emerging evidence that such programs didn't promote sex but in fact helped delay sexual activity and reduce teen pregnancy rates. By 1983, human growth and development courses that included lessons on reproduction and contraception, as well as the importance of responsibility and good decision-making, had become the norm. Such courses were given a big boost in 1986, when U.S. Surgeon General C. Everett Koop, citing the threat of AIDS, issued a report calling for comprehensive AIDS and sexuality education in all public schools, beginning as early as the third grade.

But if the report by Koop, a Reagan appointee, helped promote sexuality education, it also forced the Right to rethink its opposition strategies. With AIDS in the picture, even the most conservative opponents of sex education found it difficult to justify banning sex education. Instead, the Right came up with a new tactic: control how it was taught. The result was abstinence-only sexuality education.

ABSTINENCE-ONLY VS. COMPREHENSIVE SEX ED

According to the federal government, abstinence-only programs must stress "the social, physiological, and health gains to be realized by abstaining from sexual activity." Specifically, they teach that abstinence is the "only certain way" to avoid pregnancy and STDs and teach young people strategies they can use to reject sexual advances. The only discussion of contraception centers on failure rates.

Abstinence-only messages are disseminated in any number of ways, including media campaigns, peer education programs, chastity or abstinence rallies, national speakers, and traditional classroom curricula. In some cases, the abstinence-only message is the only one students receive. In other cases, abstinence- only programs are presented as a supplement to a more comprehensive district health curriculum.

In order to qualify for federal funds, abstinence-only programs must adhere to an eight-point definition included in the 1996 welfare reform law. (see box on p. 14.) As a result, many focus on the "morality" of remaining abstinent as well as the dire consequences of premarital sex. Their goal: to scare or shame teens into remaining abstinent until marriage. Some programs, for example, focus almost exclusively on STDs. Others suggest that using condoms may put teens' lives at risk. Others link sex before marriage to emotional illness.

To be sure, other abstinence-only programs present a more positive message. They include lessons designed to improve decision-making skills and boost self-esteem. Some also include information on sexual terminology, puberty, and reproductive health. A number of programs encourage students to sign a "virginity pledge" as a way of delaying intercourse until marriage.

On the other hand, comprehensive sex education programs - sometimes described as "abstinence-plus" - also stress the value of abstinence and teach young people how to reject sexual advances. But they recognize and address, as well, the fact that almost half of U.S. teens are sexually active. As a result, comprehensive programs provide teenagers with information on the health benefits and side effects of contraceptives as a means to prevent pregnancy and reduce the risk of contracting STDs, including HIV/AIDS.

Truly comprehensive sexuality education programs begin in the early grades and continue through high school and cover a broad range of concepts that include human development, relationships, personal skills, sexual behavior, and sexual health. Lessons are age-appropriate. Children in the primary grades, for example, might be taught about inappropriate touching. Fourth graders are introduced to the human reproductive system. In middle school, students begin learning about contraception, and in high school, about the responsibilities and consequences inherent in sexual relationships.

WHAT THE RESEARCH SAYS

Despite charges from abstinenceonly advocates that teaching about contraception makes it more likely that teens will become sexually active, study after study has determined just the opposite.

"All the evidence points to the fact that programs that are comprehensive in their coverage, interactive and nondidactic in their approach, and that provide access to services not only reduce teen pregnancy, but also contribute to abstinence or at least wiser sex behavior," said Zabin, the Johns Hopkins public health researcher. On the other hand, "There's not a single scientific study that demonstrates that abstinence- only programs have done anything to cut down on teen sexual activity."

In fact, researchers at Columbia University determined that although abstinence- only programs that called upon teens to sign pledges vowing to remain virgins until they marry worked for some teens, those who broke their pledges were one-third less likely to use contraceptives when they engaged in sexual activity than teens who did not sign pledges. According to researcher Peter Bearman, who reviewed the so-called "pledge card" programs, "There is no long-term benefit to pledging in terms of pregnancy reduction, unless pledgers use contraception at first intercourse. Therefore it seems obvious to me that all adolescents should learn how to protect themselves."

Zabin said abstinence-only programs come up short because they fail to equip teens with the information they need to make a series of complex decisions about their sexual behavior over time. Teens need to understand, she said, that decisions such as whether or not to become sexually active, use contraception, or terminate a pregnancy should not be viewed as singular "events," but rather as part of a "long process" that defines their sexual behavior.

Like virtually everyone working in the field of adolescent sexual behavior, Zabin supports abstinence. "We need to talk about the responsibility that's involved in engaging in sex, and hope that with honesty, good education, and mentoring we can help young people postpone intercourse," she said. But Zabin points out that "For young people who do engage in the sex act, a comprehensive program can ... reduce the frequency of intercourse, pregnancy, abortion, unintended childbearing, and STDs."

A MODEL PROGRAM

That's the route Shalom takes in her classes for ninth and 12th graders at Ridgewood High School. Because the students have been studying human growth and development since elementary school, they are well-versed in the basics and "hungry for knowledge." Shalom said the students approach even the most sophisticated subject matter with maturity. "I can say any word - intercourse, oral sex - and there's not a giggle, not a smile on a kid's face."

Shalom, who also helps run a peer counselor program at Ridgewood and trains other teachers through the Network for Family Life Education, urges her students to abstain from sexual intercourse and instead "enjoy being a kid" as long as possible. "But I also tell them, if you're considering having sex, don't just think about how it will feel to do it. Also think about how you'll feel standing naked in front of someone else, or how you'll feel if you break up the next day."

Shalom's lesson on birth control involves letting her students touch contraceptive jelly and observe her rolling a condom onto a test tube. "They see how complicated it is, and then they imagine themselves doing it," she said. Her goal: to give her students the factual information and time they need to "discuss, wonder, argue, think out loud, and come up with their own views."

She's convinced her approach is more likely to convince teens to delay sex than programs that preach abstinence or "tell kids about all the bad things that are going to befall them later" [if they do have sex]. "I know that doesn't work," she said.

BROAD PUBLIC SUPPORT

Like Shalom, most Americans support comprehensive sex education programs. According to research by the Henry J. Kaiser Family Foundation, 81 percent of the general public and 65 percent of parents believe that sex education should not just encourage abstinence, but also provide teens with information on birth control.

When it comes to sex education teachers, more than 90 percent also believe that students need information about contraception. Yet, due to the proliferation of abstinence-only programs, more teachers are being forced instead to focus on abstinence than ever before. (See related story, page 16).

What's more, support for comprehensive sex education crosses all political and ideological lines. Only 13 percent of Republicans, for example, favor abstinence-only sex education programs, according to a 2002 poll of registered voters commissioned by the Othmer Institute, the research arm of Planned Parenthood of New York. (A total of 8 percent of Democrats and 9 percent of Independents said they preferred an abstinence-only approach.) In addition, 84 percent of respondents who identified themselves as antichoice agreed that all students should receive age-appropriate, medically accurate sex education that begins in the early grades and continues through the 12th grade.

"Whether it's people against abortion, those living in religious pockets in the South - whatever the demographic- support for comprehensive sex ed is extremely high," said Carla Goldstein, the institute's director. "This is a real common ground issue, and the Bush administration and proponents of abstinence- only really are totally out of touch with what Americans want for their children and their neighbors' children."

GROWING AWARENESS

To be sure, sexuality education in general has become less controversial. SIECUS documented only 75 public controversies over the issue in 30 states during the 2000-'01 school year, the lowest number since SIECUS began tracking them in 1992 and only half as many as in 1999-2000. Kempner attributes that partly to the fact that in the past most such controversies grew out of efforts to offer comprehensive programs that conservatives said included too much information. With more districts adopting abstinence-only programs, that's increasingly less of an issue.

The lack of controversy can likely be traced as well to confusion over abstinence- only education. The Othmer Institute found that almost half of all voters assume that abstinence-only programs teach about birth control and disease prevention. Thirty-five percent of respondents said they did not believe that teachers teaching an abstinenceonly program could not discuss other types of contraception as well. "When average Americans hear about a policy with an abstinence message, they support it," said Goldstein. "But what they don't necessarily hear is the abstinenceonly part. Once you get them to understand what the policy means, people are very angry and think it's fool-headed - like sticking your head in the sand and not taking responsibility."

Dana Czuczka, associate director of Planned Parenthood of New York City, notes that in 1996 funding for abstinence- only programs were "snuck in overnight in the welfare reform bill." She believes a better-informed, more engaged public will ultimately bring about change. "Clearly, the data is in our favor, and people care about this issue."

Bill Albert, director of communications at the non-profit National Campaign to Prevent Teen Pregnancy, is struck by the irony surrounding the federal funding for abstinence-only programs. "The primary hallmark of the welfare reform bill was to give power and money back to the states for innovation," he said. "Except when it came to sex education. Then they put all kinds of strings on how it was spent."

Looking ahead, William Smith, director of public policy for SIECUS, said he was encouraged by the introduction of the Family Life Education Act. Although given the current political climate the bill had no chance of becoming law, it garnered 88 co-sponsors and bipartisan support. "It was a very proactive bill that influenced the debate," said Smith, who sees the bill as a good starting point for future legislation. Already, state laws modeled after the bill's provisions have been enacted in Maine and Minnesota.

REASON FOR OPTIMISM

There have been other bright spots in efforts to rein in the growth of the abstinence-only movement. Last February, Secretary of State Colin L. Powell made headlines when he strongly advocated condom use to prevent the spread of AIDS. "It is important that the whole international community come together, speak candidly about it, forget about taboos, forget about conservative ideas with respect to what you should tell young people about," Powell told an MTV music channel audience. "It's the lives of young people that are put at risk by unsafe sex. And, therefore, protect yourself."

Also breaking publicly with the Bush administration was then-U.S. Surgeon General David Satcher, who issued a report in June 2001 advocating that teens receive thorough and accurate sex education, including information on contraception. Given the Bush administration's stand on topics such as abstinence- only sex education, the president was forced to go outside the public health community to replace Satcher, whose term expired last February, with trauma surgeon Dr. Richard H. Carmona. Carmona has no track record on sexuality education, and has not identified the issue as a priority.

And in July, in the first-ever challenge to a federally-funded abstinenceonly program, a federal district issued a temporary restraining order prohibiting the State of Louisiana from using federal and state dollars to fund religious activities included in the Governor's Program on Abstinence. The activities included skits promoting abstinence with Jesus as a character. The American Civil Liberties Union, which brought the lawsuit, called the court's decision "a wakeup call that this practice is unacceptable." Although the state of Louisiana has appealed the district court order, a hearing on an ACLU request for a permanent injunction is scheduled for February.

Still, it's hard not to get discouraged, said SIECUS' Kreinin, with "our elected officials so out of step with public health, with science, and with the American public on this issue." The stakes, she said, have never been higher. "Teen pregnancy is a tragedy, and AIDS is a death sentence."

Winter 2002/2003