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Abstinence programs

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“”As long as I was in Washington, I never met anybody that I thought was good enough, who knew enough, or who loved enough, to make sexual decisions for anybody else. [..] We've tried ignorance for a thousand years, it's time we try education.
—Joycelyn EldersWikipedia[1]

Abstinence programs (also known as "oops-only misinformation") are US governmental mandates requiring the teaching of sexual abstinence in preference to proven sex education techniques. There are also mandates affecting international HIV/AIDS funding programs, but these are not addressed here.

Origins and policies

Girls have cooties!!

There has been much debate in the United States about how to combat teen pregnancy and sexually transmitted diseases (STDs). In general, religious conservatives favor either leaving any education out of the schools, or implementing so-called "abstinence-only" programs. Liberals tend to favor more comprehensive sex-education. But what actually works?

Since 1996, the U.S. has been increasing funds directed towards abstinence education. To qualify for funding, programs must meet the so-called "A-H" criteria, the first of which states that a program must "[h]ave as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity."[2] A later statute commissioned a scientific evaluation of the efficacy of four typical and common abstinence programs.[3]

Efficacy: The abstinence from evidence is not evidence for abstinence

Unfortunately, abstinence has its limitations.

A report by the conservative Heritage Foundation issued in 2002 cited the efficacy of abstinence programs. Examination of the references shows references that contain preliminary data,[4] are small in scale and scope, or lack statistical significance. There also appears to be an over-reliance on a single author and a single institute.[5]

In a 2004 report commissioned by Democratic Congressman Henry Waxman, funded programs were examined for scientific accuracy. Although these programs are funded by the federal government under the Title V "A-H" criteria, they are not examined for accuracy. A majority of the programs were found to contain serious inaccuracies. For example, condom effectiveness was routinely dismissed, often by citing discredited studies.[6] Programs often contained inaccurate information about abortion, including that abortion causes sterility in 10% of cases.[7] The Waxman Report contains further details of frank distortions and lies.

When abstinence programs failed to reduce the teenage birthrate, the Bush administration instructed the US Centers for Disease Control to stop gathering data, and also forced them to shelve a project identifying those sex education programs which worked, after they found that none of the successful ones were "abstinence-only".[8]

The House Oversight Committee charged the Bush administration with favoring politics over science in choosing abstinence programs. Testimony from bipartisan officials in July 2007, including four current or former Surgeons General, accused government officials of pressuring them to misrepresent science, including sex education, for political purposes.[9] Additionally, some abstinence programs are openly sexist and misleading.[10]

Studies have consistently failed to show success from abstinence-only programs but have shown positive results from contraceptive use.[11]One of the more amusing aspects of abstinence education, the "virginity pledge", has been shown to be an abject failure.[12][13]

The most recent, and most damning, evidence comes in a large-scale study commissioned by the federal government and released in early 2007. The executive summary states that "[f]indings 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."[14]

In the 2010 the CDC found a massive regional disparity in the rates of teen pregnancy with states that stress abstinence only faring worse than those with comprehensive sex education.[15]

Not content with domestic failure of abstinence programs, President George W. Bush pushed for abstinence programs in Africa (under the President’s Emergency Plan for AIDS Relief, PEPFAR) in an attempt to ignore prevent the spread of AIDS.[16] The funding ranged from a high $260 million per year in 2008 to the current 2016 low of less than $50 million.[16] The abstinence program proved to be ineffective in Africa, just like in the US: surprise![16] One wonders how many people abstinence education killed.

Sexism

One may notice that the many of the most vocal advocates of abstinence, being socially conservative, have "traditional" views of gender relations and believe that the abstinence programs should be aimed, mostly, at women. This is because men seeking sex are often seen as "Boys being boys"[note 1], whereas it is supposedly the women's "place" to refrain from sex. This often leads to sexual women being demonized as a "means to an end", the end being scaring other women away from the idea of sex, whereas sexual men are often let off the hook or, at the very least, not being penalized/shamed to the same degree.

Summary

The latest study has called into question American public health policy[17] Like any other public health intervention, sex education must be based on sound scientific evidence. While some politics inevitably creeps into public policy decisions, science must be the determining factor. There is no proof that abstinence-only programs succeed at their stated mission; any scientific approach to public health policy would scrap them in favor of proven interventions.

See also

Other resources

Notes

  1. ↑ Now they just make it a zero sum game: Any success of the boys is caused by the women's failure at chastity, and women's success of being abstinent will lead to all boys being "losers".

References

  1. ↑ Penn & Teller: Bullshit!, episode 4.10, Abstinence
  2. ↑ Christopher Trenholm,Barbara Devaney,Ken Fortson,Lisa Quay,Justin Wheeler,Melissa Clark. Impacts of Four Title V, Section 510 Abstinence Education Programs. Final Report, April 2007. Submitted by statute to the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation.
  3. ↑ United States House of Representatives Committee on Government Reform—Minority Staff, Special Investigations Division (December 2004). The content of federally-funded abstinence-only education programs (PDF)
  4. ↑ Stan E. Weed, Title V Abstinence Education Programs: Phase I Interim Evaluation Report to Arkansas Department of Health, Institute for Research and Evaluation, October 15, 2001
  5. ↑ Stan E. Weed, The Institute for Research and Evaluation
  6. ↑ Susan Weller, A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV, Social Science and Medicine, 1635–44 (June 1993).
  7. ↑ cf 2
  8. ↑ Union of Concerned Scientists (2004) "Scientific Integrity in Policy Making: An Investigation into the Bush Administration's Misuse of Science"
  9. ↑ http://web.archive.org/web/20070301063926/http://oversight.house.gov/features/politics_and_science/example_abstinence.htm
  10. ↑ http://www.washingtonpost.com/wp-dyn/articles/A26623-2004Dec1_2.html
  11. ↑ John S. Santelli, MD, MPH, Laura Duberstein Lindberg, PhD, Lawrence B. Finer, PhD and Susheela Singh, PhD.Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use.January 2007, Vol 97, No. 1 | American Journal of Public Health 150-156. Joshua R. Mann, MD, MPH and Curtis Stine, MD.THE ROLES OF ABSTINENCE AND CONTRACEPTION IN DECLINING PREGNANCY RATES. June 2007, Vol 97, No. 6 | American Journal of Public Health 969. Letter regarding contribution of abstinence and contraception to declining teen pregnancy rates. John S. Santelli, Laura Duberstein Lindberg, Lawrence B. Finer, and Susheela Singh SANTELLI ET AL. RESPOND Am J Public Health, Jun 2007; 97: 969 - 970. Study found decreasing teen pregnancy rates associated with contraceptive use. One letter criticized methodology, response from authors destroyed counter-argument.
  12. ↑ Reborn a virgin: adolescents' retracting of virginity pledges and sexual histories.Rosenbaum JE.American Journal of Public Health. 96(6):1098-103, 2006 Jun. CONCLUSIONS: Adolescents who initiate sexual activity are likely to recant virginity pledges, whereas those who take pledges are likely to recant their sexual histories. Thus, evaluations of sexual abstinence programs are vulnerable to unreliable data. In addition, virginity pledgers may incorrectly assess the sexually transmitted disease risks associated with their prepledge sexual behavior.
  13. ↑ Kristen Underhill, Paul Montgomery, Don OperarioSexual abstinence only programmes to prevent HIV infection in high income countries: systematic review.BMJ 2007;335:248, (published 26 July 2007)
  14. ↑ cf 1
  15. ↑ http://thehill.com/blogs/healthwatch/state-issues/125059-cdc-finds-stark-regional-disparities-in-teen-pregnancy-rates
  16. ↑ 16.0 16.1 16.2 Stanford HIV study casts doubt on abstinence efforts in Africa by Erin Allday (May 2, 2016 Updated: May 2, 2016 5:08pm) San Francisco Chronicle.
  17. ↑ http://www.nytimes.com/2007/07/18/education/18abstain.html?_r=1&oref=slogin

Appendix I: A-H Definition of Abstinence Education for Title V, Section 510 Programs

A: Have as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity
B: Teach abstinence from sexual activity outside marriage as the expected standard for all school-age children
C: 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
D: Teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity
E: Teach that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects
F: Teach that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society
G: Teach young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances
H: Teach the importance of attaining self-sufficiency before engaging in sexual activity
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