Buried among the many changes to health programs in this year’s federal budget was an important one for young people. Congress added new funding for abstinence-only-until-marriage programs, bringing the annual total to $90 million. And then in July, the Department of Health and Human Services announced it would end funding for the Office of Adolescent Health’s evidence-based Teen Pregnancy Prevention program next year.
That program’s mission is to test and evaluate new and old prevention programs based on the best available science. But there’s no testing needed before the office shuts down to evaluate abstinence-only education. Research about abstinence-only programs is already quite clear, as we document in two new scientific papers in the Journal of Adolescent Health. They don’t work, and they don’t prepare young people for life.
Abstinence-only now has a new name: “sexual risk avoidance.” A new name doesn’t fix the fundamental problem. Abstinence-only programs do not prepare young people for life — and they do a poor job of preparing them to avoid sex. My training in pediatrics and medical ethics suggests that we instead should give young people all the information they need to protect themselves and to promote lifelong healthy sexuality.
To be sure, abstinence from sexual activity can be a healthy choice for many young people. Some adolescents believe that sex before marriage is wrong. Many more feel they are not ready for a sexual relationship. Most are not planning on getting married anytime soon. And while some adults think abstinence until marriage programs are the only moral choice for sex education, these programs fall short of the standards of medical ethics by limiting access to important health information. The government shouldn’t be in the business of promoting an unrealistic and ineffective solution to adolescent sexual and reproductive health — particularly one that has been so overwhelmingly repudiated by health professionals and parents.
The scientific evidence is clear. While abstinence is theoretically effective in preventing pregnancy, in actual practice, intentions to abstain from sexual activity often fail. Early abstinence-only programs often contained medically inaccurate information. The most recent authoritative review of the scientific evidence comes from the Centers for Disease Control and Prevention. The CDC examined scientific evaluations from 66 comprehensive risk reduction programs and 23 abstinence-only programs. The CDC found inconclusive evidence that abstinence-only programs helped young people delay sexual initiation; nor did they change other behaviors. In contrast, CDC found comprehensive programs had favorable effects on multiple adolescent behaviors, including sexual initiation, number of sex partners, frequency of sexual activity, use of protection (condoms, oral contraceptives, or both), frequency of unprotected sexual activity, sexually transmitted infections and pregnancy.
In other words, comprehensive sexuality education helps young people remain abstinent, while abstinence-only education does not.
The goal of abstinence until marriage also is increasingly improbable, given the rising age at marriage around the globe. Young people in rich and poor countries are increasingly delaying marriage — often so young women and young men can complete education goals and begin careers — before starting a family. For young women, the median age at first marriage in the United States is 26.5 — almost nine years after they initiate sexual intercourse. For young men, the median age of marriage is nearly 30 years, 12 years after the median age at first sexual experience. Health education during adolescence forms the foundation of knowledge and skills that are needed for many years to come.
Since 1982, the government has spent more $2 billion on domestic abstinence-only education programs. Federal funding guidelines for these programs have required an exclusive focus on abstinence, forbidding accurate information of condoms and contraception, sexual orientation and other aspects of human sexuality. Some states began refusing the funding in the mid-2000s so they could provide their constituents with the comprehensive and medically accurate information they needed; by 2009, nearly half of U.S. states were refusing abstinence-only dollars. In 2010, Congress shifted the focus of federal funding to evidence-based teen pregnancy prevention programs. But abstinence-only funding persisted — given renewed support from a conservative Congress after 2010.
Mainstream health professional groups, such as the American Academy of Pediatrics and the Society of Adolescent Health and Medicine, have come out strongly against abstinence-only approaches and in support of education that promotes health sexuality. This is not surprising, given the emphasis in medical ethics on providing patients with all the information they need to make wise choices. Pediatricians feel the same way about educating children and adolescents.
Physicians aren’t the only ones who believe that adolescents should not be limited to abstinence education. Abstinence-only has been rejected by many mainline and progressive churches. National surveys demonstrate strong support among parents for sexuality education that gives young people all the information they need to protect their health. The adolescents that I work with think the same; they want all the information they can get. As the father of two adolescent males, I am with them.
The weight of scientific evidence is clear. Parents, health professionals, church folks, educators and young people — we all need to stand up and tell Congress and the president to stop spending on useless and harmful programs. Young people need straight talk about sex.
John Santelli is a professor of pediatrics and public health at Columbia University, a past president of the Society for Adolescent Health and Medicine and a Public Voices fellow. He wrote this piece for The Washington Post.