“A new study has shown that contraception, not abstinence, is behind declines in teen pregnancy. Researchers from Columbia University and the Guttmacher Institute took a nation-wide look at why it is that teen pregnancy rates are down. In 1995, there were just under 100 pregnancies for every 1,000 teenage women age 15-19, according to the Guttmacher Institute (the figures vary slightly among the three major sources for teen pregnancy rates – the Guttmacher Institute, the National Center for Health Statistics, and the National Center for Chronic Disease Prevention and Health Promotion).
By 2002, this had gone down to just over 75 per 1,000. According to the new study, 86 percent of the decline is attributable to the use of contraception, while only 14 percent is attributable to abstinence.
Abstinence has only contributed to a small percentage of the overall decline, and none for teens aged 18-19. For those ages 15-17, abstinence was responsible for about 23 percent of the decline, according to the study published in the American Journal of Public Health.”
Just days after Bristol Palin officially became the poster child for her mother’s failed abstinence-only sex education policy, a new report from the CDC revealed that in 2006 Alaska experienced the nation’s fastest growing teen birth rate. While Mississippi suddenly surpassed Texas to earn the dubious leadership distinction, it comes as no surprise that the 10 worst performing states all voted for George W. Bush in 2004.
Overall, teen birth rate jumped in 26 states, combining to reverse a 15-year decline nationwide. But as the AP reported, red states from the ’04 Republican electoral map topped the charts:
Mississippi’s rate was more than 60 percent higher than the national average in 2006, according to new state statistics released Wednesday by the U.S. Centers for Disease Control and Prevention. The teen birth rate for that year in Texas and New Mexico was more than 50 percent higher…
…The lowest teen birth rates continue to be in New England, where three states have rates at roughly half the national average, which is 42 births per 1,000 teen women.
While Mississippi’s increase may or may not be a “statistical blip,” it also suggests a cataclysmic failure of now-orthodox Republican social policies. As ThinkProgress detailed, Mississippi is a leading “hotbed of abstinence education.” More disturbing, the state’s draconian restrictions on abortion – including a mandatory requirement that patients must view an ultrasound image prior to receiving the procedure – have left th entire state of Mississippi with only one abortion clinic.
To be sure, partisan debate over the causes of the worrisome jump in teen births is contentious. Republicans no doubt will point to higher rates among Democratic-leaning African-Americans and Hispanics to excuse the dismal performance in their home states. Democrats will rightly point to the proven record of failure for abstinence-only education programs advocated by President Bush and GOP leaders nationwide.
And as the data consistently show, abstinence-only sex education programs simply don’t work. A recent report by researchers at Johns Hopkins showed that teenagers taking “virginity pledges” engage in the same gamut of sexual practices at virtually identical levels as non-pledgers, only with a much lower use of condoms and other forms of contraception. In April 2007, a study conducted by Mathematica Policy Research Inc. of Princeton, N.J. for the U.S. Administration for Children and Families found that children who took part in abstinence-only programs became sexually active at about the same age and had as many sexual partners as those who participated in broader sex education classes. Despite spending $176 million annually and $1.5 billion in the past decade on abstinence programs nationwide, the United States has recently experienced increasing rates of sexual transmitted diseases and pregnancy among teens. (The 3% jump in teen pregnancy rates is the first increase in 15 years.) It’s no wonder that by June 2008, 22 states opted out of President Bush’s abstinence education program and turned down millions of dollars of federal funding that came with it.
Other recent studies are consistent with the CDC’s findings this week. In 2006, the Guttmacher Institute compiled data showing rates of teen pregnancy and lives births to teen mothers for each state. As it turns out, 9 of the 10 states with the highest teen pregnancy rates voted for Bush in 2004; all 10 with the highest rates of live births among women ages 15 to 19 are reliably Republican. (The Distrct of Columbia is a notable outlier.) Virtually all of them are among the 28 states which continue to receive federal funds for abstinence education. Conversely, 9 of the 10 states with the lowest rates of teen births voted Democratic in 2004; North Dakota was the only red state to crack the top 10. (Sarah Palin’s home state of Alaska was in the middle of the pack at number 23.)
And as with so many measures of social pathology, teenage birth rates are highest in exactly those states that voted for George W. Bush in 2004. Analyses over the past two years revealed that Red State America lags in health care, working conditions, and effectiveness of education systems. Divorce and murder rates, too, are generally highest in the states Republicans call home.”
“More government money has been spent on the cause of sexual abstinence in Texas than any other state, but it still has the third-highest teen birth rate in the country and the highest percentage of teen mothers giving birth more than once.
The rate of student pregnancies in Austin high schools has increased 57 percent since the 2005-06 school year, and rates of sexually transmitted diseases are rising among Travis County teens.
Now some school districts — including Austin — are moving from so-called abstinence-only instruction to a more comprehensive sex education curriculum, also called “abstinence-plus,” which has been taught in few Texas schools.
“We mainly did it because of our pregnancy rate,” said Whitney Self, lead teacher for health and physical education at the Hays Consolidated Independent School District. “We don’t think abstinence-only is working.”
Roy Knight, Lufkin Independent School District superintendent, echoed that view.
“Our data says that what we’re doing isn’t working, and our community is ready for us to do something different,” said Knight, adding that his district’s adoption of an abstinence-plus curriculum was “absolutely driven” by a teen pregnancy rate that is higher than the state average.
Both approaches to sex education teach that refraining from sexual activity is the safest choice for teens.
But abstinence-only gives limited information about contraceptives and condoms and tends to downplay their effectiveness, while abstinence-plus stresses the importance of using such protection if teens are sexually active.”
“Teenagers who pledged to avoid sex until marriage were as likely to have intercourse as other U.S. adolescents, according to a survey of conduct mostly in 1990s.
Teens who took the pledge also were less likely to use birth control pills or condoms than those making no promise, according to the research in the January issue of Pediatrics. The results show that teens need information on safe sex and pregnancy prevention even if they vow to refrain, a study author said.
The pledges, made orally or in writing, are viewed by advocates as buttressing federally funded education programs that say avoiding pre-marital sex rather than using protection will curb pregnancy and sexually transmitted diseases. President George W. Bush’s administration more than doubled the budget for abstinence-only education programs since 1999 to $204 million thisfiscal year. More than a dozen states have rejected federal money rather than limit what is taught.
“The results suggest that the virginity pledge does not change sexual behavior,” wrote authorJanet Rosenbaum, a postdoctoral fellow in the department of population, family and reproductive health at Johns Hopkins University in Baltimore. “Clinicians should provide birth control information to all adolescents, especially abstinence-only sex education participants.”
Today’s study relied on surveys of students in 1996, when Congress authorized increased funding for abstinence-only education as part of an overhaul of welfare, and 2001. A Congressionally authorized report in 2007 on the program in that bill, Title V, also found students were no more likely to abstain. That program gets about $50 million a year. Research published in June found that virginity pledges decreased sexual activity in students ages 12 to 17.”
“The researchers found that 82 percent of those who had taken the oath denied five years later having done so. Fifty-three percent of the teens in the pledge group said they had engaged in premarital sex compared with 57 percent of those who hadn’t taken the pledge. Forty-six percent of those who had pledged abstinence reported using birth control most of the time, compared with 52 percent of those who didn’t pledge.”
The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed a 3% increase from 2005 to 2006. From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines. However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world. Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.
Proponents of comprehensive sex education, which include the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and the American College Health Association, argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.
The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse. In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not. Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.
Criticism of abstinence-only sex education in the U.S. Congress
Two major studies by Congress have increased the volume of criticism surrounding abstinence-only education.
In 2004, U.S. Congressman Henry Waxman of California released a report that provides several examples of inaccurate information being included in federally funded abstinence-only sex education programs. This report bolstered the claims of those arguing that abstinence-only programs deprive teenagers of critical information about sexuality. The claimed errors included:
- misrepresenting the failure rates of contraceptives
- misrepresenting the effectiveness of condoms in preventing HIV transmission, including the citation of a discredited 1993 study by Dr. Susan Weller, when the federal government had acknowledged it was inaccurate in 1997 and larger and more recent studies that did not have the problems of Weller’s study were available
- false claims that abortion increases the risk of infertility, premature birth for subsequent pregnancies, and ectopic pregnancy
- treating stereotypes about gender roles as scientific fact
- other scientific errors, e.g. stating that “twenty-four chromosomes from the mother and twenty-four chromosomes from the father join to create this new individual” (the actual number is 23).
Out of the 13 grant-receiving programs examined in the 2004 study, the only two not containing “major errors and distortions” were Sex Can Wait and Managing Pressures before Marriage, each of which was used by five grantees, making them two of the least widely used programs in the study. With the exception of the FACTS program, also used by 5 grantees, the programs found to contain serious errors were more widely used, ranging in usage level from 7 grantees (the Navigator and Why kNOw programs) to 32 grantees (the Choosing the Best Life program). Three of the top five most widely used programs, including the top two, used versions of the same textbook, Choosing the Best, from either 2003 (Choosing the Best Life) or 2001 (Choosing the Best Path — the second most widely used program with 28 grantees — and Choosing the Best Way, the fifth most widely used program with 11 grantees).
In 2007, a study ordered by Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex in their teenage years as those who did not. From 1999 to 2006, the study tracked more than 2,000 students from age 11 or 12 to age 16; the study included students who had participated in one of four abstinence education programs, as well as a control group who had not participated in such a program. By age 16, about half of each group students in the abstinence-only program as well as students in the control group were still abstinent. Abstinence program participants who became sexually active during the 7-year study period reported having similar numbers of sexual partners as their peers of the same age; moreover, they had sex for the first time at about the same age as other students. The study also found that students who took part in the abstinence-only programs were just as likely to use contraception when they did have sex as those who did not participate. Abstinence-only education advocates claim the study was too narrow, began when abstinence-only curricula were in their infancy, and ignored other studies that have shown positive effects.
Criticism of abstinence-only sex education by the scientific and medical communities
Abstinence-only education has been criticized in official statements by the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the Society for Adolescent Medicine, the American College Health Association,the American Academy of Pediatrics, and the American Public Health Association, which all maintain that sex education needs to be comprehensive to be effective.
The AMA “urges schools to implement comprehensive… sexuality education programs that… include an integrated strategy for making condoms available to students and for providing both factual information and skill-building related to reproductive biology, sexual abstinence, sexual responsibility, contraceptives including condoms, alternatives in birth control, and other issues aimed at prevention of pregnancy and sexual transmission of diseases… [and] opposes the sole use of abstinence-only education…”
The American Academy of Pediatrics states that “Abstinence-only programs have not demonstrated successful outcomes with regard to delayed initiation of sexual activity or use of safer sex practices… Programs that encourage abstinence as the best option for adolescents, but offer a discussion of HIV prevention and contraception as the best approach for adolescents who are sexually active, have been shown to delay the initiation of sexual activity and increase the proportion of sexually active adolescents who reported using birth control.”
On August 4, 2007, the British Medical Journal published an editorial concluding that there is “no evidence” that abstinence-only sex education programs “reduce risky sexual behaviours, incidence of sexually transmitted infections, or pregnancy” in “high income countries”.
A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that abstinence-only programs delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners. According to the study author:
“Even though there does not exist strong evidence that any particular abstinence program is effective at delaying sex or reducing sexual behavior, one should not conclude that all abstinence programs are ineffective. After all, programs are diverse, fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs have provided modestly encouraging results. In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination.”
Joycelyn Elders, former Surgeon General of the United States, is a notable critic of abstinence-only sex education. She was among the interviewees Penn & Teller included in their Bullshit! episode on the subject.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, argues that abstinence-only sex education leads to the opposite of the intended results by spreading ignorance regarding sexually transmitted diseases and the proper use of contraceptives to prevent both infections and pregnancy.
- Birth rates among U.S. teens had increased in 2006 and 2007, following large declines from 1991 to 2005.
- About one-third of adolescents had not received instructions on methods of birth control before age 18.
- In 2004, there were about 745,000 pregnancies among females younger than 20, including an estimated 16,000 pregnancies among girls between 10 and 14.
- In 2006, about one million young people aged 10 to 24 were reported to have chlamydia, gonorrhea, or syphilis. Nearly one-quarter of females aged 15 to 19, and 45% of females aged 20 to 24, had a human papillomavirus infection during 2003 and 2004.
- In 2006, the majority of new diagnoses of HIV infection among young people occurred among males and those aged 20 to 24.
- From 2004 to 2006, about 100,000 females aged 10 to 24 visited a hospital emergency department for nonfatal sexual assault, including 30,000 females aged 10 to 14.
- Hispanic teens aged 15 to 19 are much more likely to become pregnant (132.8 births per 1,000 females) than non-Hispanic blacks (128 per 1,000) and non-Hispanic whites (45.2 per 1,000)
- Non-Hispanic black youth in all age groups have the highest rates of new HIV and AIDS diagnoses.
|“||This report identifies a number of concerns regarding the sexual and reproductive health of our nation’s young people… It is disheartening that after years of improvement with respect to teen pregnancy and sexually transmitted diseases, we now see signs that progress is stalling and many of these trends are going in the wrong direction||”|
— Janet Collins, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion, CDC Morbidity and Mortality Weekly Report, July 17
“The weight of the evidence from peer-reviewed scientific journals clearly shows that some comprehensive sex education programs can reduce behavior that puts young people at risk of HIV, STIs and unintended pregnancy, and that these programs do not promote earlier onset of sexual activity or an increased number of sexual partners among adolescents. By contrast, little if any credible research exists to substantiate the claims that abstinence-only programming leads to positive behavior change among youth.”
“In July 2001, Surgeon General David Satcher released a Call to Action on promoting sexual health. Reviewing the evidence on comprehensive approaches to sex education, the Surgeon General found that the ‘evidence gives strong support to the conclusion that providing information about contraception does not increase adolescent sexual activity…[and that] some of these evaluated programs increased condom use or contraceptive use more generally for adolescents who were sexually active.’ ”
“In the previous chapter, it was noted that abstinence-only advocates have attributed declines in teen pregnancy in the 1990s to an increased practice of abstinence. Comprehensive sexuality advocates argue that, in fact, most of the decrease in the teen pregnancy rate was due to lower pregnancy rates among sexually experienced young women. An analysis of the decline in teen pregnancy in the 1990s published by the Alan Guttmacher Institute shows that approximately 25% of the decrease was due to a lower proportion of teenagers who were sexually experienced, while 75% of the decrease can be attributed to lowered pregnancy rates among those young women who were sexually experienced.”
“Recent Research on Abstinence-Only and More-Comprehensive Sexuality Education Messages”Promising the Future: Virginity Pledges and First Intercourse,” by researchers at Columbia University, found that programs that encourage students to take a virginity pledge promising to abstain from sex until marriage helped delay the initiation of intercourse in some teenagers. However, teens who broke their pledge were one-third less likely than non-pledgers to use contraceptives once they became sexually active. American Journal of Sociology, 2001. (“Recent Findings from the ‘Add Health’ Survey: Teens and Sexual Activity,” TGR, August 2001)Emerging Answers, authored by Douglas Kirby of ETR Associates, examined a wide range of interventions designed to reduce teen pregnancy and childbearing, including sexuality education programs. Analyzing the outcome evaluations of programs that met rigorous research standards, Kirby found that comprehensive sexuality education programs that urge teens to postpone having intercourse but also discuss contraception do not accelerate the onset of sex, increase the frequency of sex or increase the number of partners—as critics of sex education have long alleged—but can increase the use of contraception when teens become sexually active. At the same time, the report concludes that there is no reliable evidence to date supporting the effectiveness of abstinence-only education. National Campaign to Prevent Teen Pregnancy, 2001. These findings were echoed in Call to Action to Promote Sexual Health and Responsible Sexual Behavior, issued by U.S. Surgeon General David Satcher in June 2001.”Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents,” by researchers at Princeton University, the University of Pennsylvania and the University of Waterloo, reports the results of the first-ever randomized, controlled trial comparing an abstinence-only program with a safer-sex initiative designed to reduce the risk for HIV infection through condom use and with a control group that received health education unrelated to sexual behavior. After one year, the abstinence group reported similar levels of sexual activity as the safer-sex group and the control group. For teenagers who were already sexually active at the inception of the program, there was less sexual activity reported among the safer-sex group than among the abstinence or control group. Those in the safer-sex group also reported less frequent unprotected sex than did those in the abstinence and control groups. Journal of the American Medical Association,1998.”