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New data cast doubt on abstinence-only programs
Health advocates push for comprehensive sex ed
In 1997, federal block grant funding for abstinence-only sexuality education went into effect. Despite limited research on the efficacy of such programs, many states applied for a portion of the $50 million in federal dollars.
Findings from a just-released analysis of four abstinence-only education programs indicate that such programs do not keep teens from having sex. Such programs neither increase nor decrease the likelihood that if teens do have sex, they will use a condom, the analysis concludes.1
Abstinence-only programs as they are known today were initiated in 1996 when the federal government attached a provision to the welfare reform law. Known as the Personal Responsibility and Work Opportunity Reconciliation Act, the legislation established federal dollars for abstinence-only-until-marriage programs. Programs that receive such funding are prohibited from discussing methods of contraception, including condoms, except in the context of failure rates.
The program, detailed under Section 510(b) of Title V of the Social Security Act, dedicates $50 million per year to be distributed among states that choose to participate. States that take the funds are required by law to match every four federal dollars with three state-raised dollars for a total of $87.5 million annually, and $787.5 million for the eight years from fiscal year 1998 through 2006.2 More than 700 Title V, Section 510 programs now receive funding for programs that teach abstinence from sexual activity outside of marriage.3 There also are hundreds of additional programs outside the Title V, Section 510 program that receive support from the federal government or the private sector, according to the Department of Health and Human Services.3
Federal abstinence funds under the Title V grant come up for congressional renewal this summer. Reproductive health advocates are calling for changes in the funding. "Sex education is the beginning of a lifelong spectrum of reproductive health care; like any other component of health care, it must be truthful, comprehensive, and widely available," says Mary Jane Gallagher, president and CEO of the National Family Planning and Reproductive Health Care Association. "We hope Congress will eliminate funding for ineffective abstinence-only programs and work instead to equip young people with the knowledge to make responsible, informed decisions about their sexual health."
Advocates for Youth, an adolescent health advocacy group, has mounted a major campaign to mobilize young people across America to urge congressional members to "start funding programs that work," says James Wagoner, president. The group has run three full-page ads in Roll Call, the congressional newspaper, and has sent out alerts to its activists to contact congressional members to urge them to cut funding for the abstinence-only programs, he reports.
Review the research
The new analysis, authorized by Congress in 1997 and performed by Mathematica Policy Research of Princeton, NJ, is a multiyear evaluation of four Title V, Section 510 abstinence education programs. The study evaluates behavioral outcomes as well as knowledge of risks associated with teen sexual activity by participants in the four programs. (The full report online is available at www.mathematica-mpr.com; click on the link under "Abstinence Education Programs: New Report Examines Behavioral and Other Impacts.") For its report, Mathematica looked at 2,057 students in four abstinence programs:
The first two programs serve middle school students; the latter two primarily serve elementary students. The study looked at students enrolled in the programs, as well as students from the same communities who did not participate in the programs.
The study followed up with youths four to six years after they received the intervention in an elementary or middle school program, comparing those who participated in an abstinence program with peers in a control group that received "services as usual" provided by their school. Students were an average age of 11 to 12 when entering the programs in 1999. Most participated in the programs for one to three years.
Mathematica performed a follow-up survey in late 2005 and early 2006, with the average age of participants at 16.5. Results indicated about half of the students in the abstinence programs and an equal number from the control group reported that they remained abstinent.
According to Mathematica, the programs improved identification of sexually transmitted diseases (STDs) though had no overall impact on knowledge of unprotected sex risks and the consequences of STDs. Both program and control group youth had a good understanding of the risks of pregnancy but a less clear understanding of STDs and their health consequences.
"Although a high proportion of youth reported that having unprotected sex just once could result in an STD, 47% of sexually active youth had unprotected sex in the previous 12 months," report authors state. "Moreover, on a scale measuring their understanding of the health consequences of STDs, youth on average got only about half of the answers correct; on a scale measuring STD identification, youth were correct only about two-thirds of the time."1
Taking the next step
What is the next step for abstinence-only programs? One finding from the study indicates that while peer support for abstinence may be protective in middle school, it erodes sharply during the teen years. Programs may want to consider including a peer support component in their activities due to this finding, observes Christopher Trenholm, senior researcher at Mathematica and program director for the project.
Also, aiming abstinence-only messages solely at people at young ages may not be sufficient. The programs included in the current analysis were targeted solely at middle school youth and did not continue to serve students as they entered high school. Delivering abstinence education programs in middle school may not be enough to sustain changes in attitudes and behaviors, the report suggests.
Not every state has participated in the Title V program. Eight states, including California (which never accepted the funding), Connecticut, Maine, Montana, New Jersey, Ohio, Rhode Island, and Wisconsin, have rejected the funding. (Check what your state is spending on abstinence-only programs. Go to www.siecus.org/policy/states/index.html for SIECUS State Profiles, which provides an overview of abstinence-only-until-marriage programs and their intersection with U.S. sexuality education programs. The online publication, now in its third edition, includes individual profiles of every state and the District of Columbia. Click on individual states for detailed information.)
As of CTU press time, the Title V program was set to expire on June 30, 2007. Reproductive health advocates intend to keep the focus on the need for support of comprehensive sex education programs that teach not only the benefits of abstinence, but prepare young people to be safe if and when they do become sexually active.
"We will continue to put pressure on Congress to de-fund these [abstinence] programs and to finally fund comprehensive sex education," says Wagoner. Research has shown that when teens have comprehensive sex education that includes science-based information about abstinence and contraception, they have better sexual health outcomes, he says. "They delay sexual initiation and, when they become sexually active, they use contraception better and have fewer partners," Wagoner says.