Are abstinence-only sex-education programs ineffective?

To follow is an excerpt from the CQ Researcher on "Teen Pregnancy" by Marcia Clemmitt, March 26, 2010
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Over the past few years, the first large-scale, federally funded analyses of abstinence-only sex-ed programs have emerged, and by and large the news has been complex and not terribly encouraging.

Studies overwhelmingly have found little or no evidence that abstinence-only courses change teen sexual behavior in ways that would avert pregnancies or the spread of STDs. But abstinence-education supporters say most studies take a too-narrow view of what constitutes reliable evidence. Some research, they say, has found good effects from abstinence-only programs.

Recent research clearly “shows that the Bush-era approach of abstinence-only funding is dead,” says James Wagoner, president of Advocates for Youth, a Washington, D.C.-based nonprofit group that supports strong informational programs to improve adolescent sexual health.

For example, in 2007 a congressionally mandated study of four federally funded abstinence-only programs, conducted by Mathematica, a Princeton, N.J.-based research company, found that abstinence programs did not prevent children in elementary and middle school from changing behaviors that raise teens' risk of pregnancy. Specifically, it found that upper-elementary and middle-school students who completed abstinence programs were no more likely than those who didn't take the classes to abstain from sex, delay sex or have fewer sexual partners. The result was the same both in schools where there was little information available on sex and contraception outside of the abstinence program and in schools where students got a great deal of such information, in health classes and elsewhere. [Footnote 15]

In November 2009, the Task Force on Community Preventive Services of the federal Centers for Disease Control and Prevention (CDC) reported after analyzing more than 40 abstinence-only strategies that there is “insufficient evidence to determine” whether “group-based abstinence education” effectively prevents pregnancies or STDs.* By contrast, the task force found that evidence shows comprehensive sex education does reduce the number of teens who have sex and the frequency that sexually active teens have sex, their number of partners and their risk of STDs, the panel said. [Footnote 16]

The task force explicitly recommended that comprehensive sex-ed be “delivered to adolescents to promote behaviors that … reduce the risk of pregnancy” and STDs instead of abstinence-only programs. [Footnote 17]

Randomized control trials like the Mathematica study — in which some students were randomly assigned to a specific sex-ed course while another randomly chosen “control” group did not take the course — are considered the gold standard of scientific evidence. But social conservatives who say abstinence-only education is the only morally responsible approach to sex education argue that social-science questions are driven by such diverse multiple factors that randomized trials cannot possibly capture all of the value provided by abstinence education. Other types of research have found significant merit in abstinence education, they say.

“I started with a very skeptical attitude, thinking how in the world could [abstinence education] work, given the culture and the society that kids live in,” said Stanley Weed, founder and senior fellow at the Salt Lake City-based Institute for Research and Evaluation, a nonprofit organization that has analyzed many abstinence-only curricula. But “since that time I have learned that it can work. Not all [abstinence programs] do, but many of them do, and we have learned which ones do, and why." [Footnote 18]

Weed said his analyses found that abstinence programs used in several states substantially decrease the number of students who began having sex within a year after completing the course. In one Virginia district, nine percent of students began having intercourse a year after they finished the abstinence program that Weed studied, compared to an average of 16.4 percent of students in that district who would have been expected to initiate sex by that age, for example. [Footnote 19]

Of the many analysts who commented on their research to the CDC task force, two found “serious limitations” in the panel's conclusions about abstinence-only programs. Notably, the panel unfairly ignored findings that abstinence programs reduce teens' sexual activity because the results didn't come from randomized control trials, wrote Irene Ericksen, a researcher at the Institute for Research and Evaluation, and Danielle Ruedt, a public-health programs coordinator in the Governor's Office for Children and Families in Georgia. And the panel's report also implied that sex ed focusing on contraceptive information “is a superior approach,” a conclusion they said was “not supported by the evidence” examined by the task force. [Footnote 20]

Earlier this year, a randomized control study for the first time showed significant positive results for an abstinence-focused program, according to research led by the University of Pennsylvania's Jemmott. He found that a specific abstinence-only program helped delay the first sexual experience for a group of mostly 12-year-old African-American students in urban schools. Only about a third of the program participants began having sex within the next two years, compared to 42 percent of those who attended a safe-sex program. [Footnote 21]

“This is a rigorous study that means we can now say that it's possible for an abstinence-only intervention to be effective,” said Jemmott. [Footnote 22]

“We now have, for the first time, news that an abstinence intervention can help,” says Albert, of the National Campaign to Prevent Teen and Unplanned Pregnancy. “This course did take an approach that is different” from more traditional abstinence-only programs, he explains. “It did honestly answer questions about contraception, and it did not say ‘delay until marriage.’” Perhaps because of that difference, it “did not reduce condom use.”

Rebecca A. Maynard, a professor of education and social policy at the University of Pennsylvania Graduate School of Education, says the main takeaway from all the recent studies should be that, generally speaking, “abstinence education does no better and no worse than comprehensive” sex education. In fact, neither has been shown to strongly affect teens' behavior, she concludes.

The Mathematica study, for example, showed that “abstinence-only education didn't hurt kids,” she says, while comprehensive sex-ed proponents had long argued that it would, by decreasing condom use. But abstinence-only sex ed also wasn't “the solution to the problem.” In essence, she says, the body of research now available shows “no significant difference” between abstinence-only and abstinence-plus (comprehensive sex education) programs.

That's not surprising, she explains. The content of most abstinence-only programs “overlaps greatly with abstinence-plus” programs. The best courses of both varieties “all have a core of things about values, peer pressure and good decision-making,” while they “diverge only in saying ‘you may not ever’ [in the case of abstinence-only courses] or ‘you may not want to’ [in abstinence-plus].”

Critics' complaints about both kinds of courses are largely caricatures. “Very, very few curricula say, ‘God will strike you dead if you have sex,’ or, on the abstinence-plus side, “‘Just go have fun, and don't think about the consequences,’” Maynard says.

*Comprehensive sex-education — the alternative to abstinence-only curricula and sometimes called abstinence-plus or comprehensive risk reduction — recommends delaying sex but focuses strongly on informing students about condom use and contraception.

The Issues:
*Are abstinence-only sex-education programs ineffective?
*Will Obama's plan to fund only evidence-based sex-ed programs work?
*Does teen parenthood lead to a lifetime of hardship?

For more information see the CQ Researcher report on "Teen Pregnancy" [subscription required] or purchase the CQ Researcher PDF.


Footnotes:
[15] Christopher Trenholm, et al., “Impacts of Four Title V, Section 510 Abstinence Education Programs,” Mathematica Policy Research Inc., April 2007, .
[16] Quoted in Daniel J. DeNoon, “Expert Panel Rejects Abstinence-Only Sex Ed,” WebMD Health News online, Nov. 6, 2009. The Task Force report has not yet been formally released by the Centers for Disease Control and Prevention.
[17] Quoted in ibid.
[18] Quoted in “Hearing on Domestic Abstinence-only Programs: Assessing the Evidence,” transcript, House Committee on Oversight and Government Reform, April 23, 2008.
[19] Quoted in ibid.
[20] Irene Ericksen and Danielle Ruedt, “A Minority Report: Fundamental Concerns About the CDC Meta-Analysis of Group-based Interventions to Prevent Adolescent Pregnancy, HIV, and Other STIs,” Nov. 18, 2009.
[21] For background, see Lewin, “Quick Response to Study of Abstinence Education,” op. cit.
[22] Quoted in ibid.