Congress questions effect of abstinence-only approach

Scientists, others say programs fail to work

On the heels of Centers for Disease Control and Prevention (CDC) data showing that one in four teenage girls has a sexually transmitted disease (STD) and that nearly a third of American girls becomes pregnant as a teenager, scientists and other experts testified about abstinence-only programs at a Congressional hearing.

"For African-American and Latina girls, the [pregnancy] rate is 50%," U.S. Rep. Henry A. Waxman said in an opening statement at the hearing on April 23, 2008. Waxman is chair of the Committee on Oversight and Government Reform, which held a hearing on the topic of "Domestic Abstinence-Only Programs: Assessing the Evidence."

Domestic abstinence-only programs have received more than $1.3 billion in tax funds, plus millions more in state funds, while there is no dedicated source of federal funding for comprehensive classroom sex education, Waxman said.

There is no scientific evidence that abstinence-only programs prevent STDs or pregnancy, Waxman said.

"In fact, the government's own study showed no effect for abstinence-only programs," he said. "In 2007, the Bush Administration released the results of a longitudinal, randomized, controlled study of four federally-funded programs. The investigators found that compared to the control group, the abstinence-only programs had no impact on whether or not participants abstained from sex. They had no impact on the age when teens started having sex. They had no impact on the number of partners. And they had no impact on rates of pregnancy or sexually transmitted disease."

Waxman also noted serious concerns about the abstinence-only programs' contents, including a 2004 report of his that showed false and misleading medical information in the majority of the abstinence-only curricula used most frequently by federal grantees.

AIDS Action of Washington, DC, calls for a complete end to federal funding of abstinence-only education.

"Our goal, and it's not only AIDS Action, but many of our fellow AIDS advocacy and policy organizations, is for zero funding for abstinence-only programs and shifting those funds to promote a comprehensive approach to sex education," says Ronald Johnson, deputy executive director of AIDS Action, which submitted a letter to Waxman for the hearing.

An abstinence-only approach is not effective in preventing HIV infection or STDs, Johnson says." We feel that there are studies that show an abstinence-only approach is not protective, so we favor a comprehensive approach to sex education," Johnson says.

Such an approach would validate the delay of sexual activity, but not focus on abstinence only, he adds.

A comprehensive approach to sex education would include education about safer sex practices and how to negotiate these efforts and how to practice safer sex, Johnson says.

"Particularly when dealing with adolescents, we feel a comprehensive program that includes delaying sexual debut has an important role," Johnson says.

At the Congressional hearing, various experts testified about abstinence-only education and research.

Researchers from the Cochrane Collaboration conducted systematic reviews of studies evaluating the impact of abstinence-only and comprehensive programs on biological and behavioral outcomes related to HIV prevention, testified Harvey V. Fineberg, MD, PhD, president of the Institute of Medicine of The National Academies.1

"In the Cochrane review of abstinence-only programs, no program showed an effect on incidence of unprotected vaginal sex, number of sex partners, condom use, or sexual initiation compared to controls," Fineberg said.

"One evaluation found several significant adverse program effects: abstinence-only participants in this program were more likely than usual-care controls to report sexually transmitted infections, pregnancy, and increased frequency of vaginal sex," Fineberg testified. "Overall, the authors concluded that abstinence-only programs neither reduced nor exacerbated HIV risk among participants in the U.S."

In another evaluation of federally-funded abstinence-only programs, completed in 2007 by Mathematica Policy Research Inc., there was a multi-year, experimentally-based impact evaluation of four federally-funded abstinence-only sex education programs. Participants were randomized to abstinence-only program or control conditions.2

"Based on follow-up data collected 4-6 years after enrollment, youth in the abstinence-only program group were no more likely to have abstained from sex compared to those enrolled in the control group," Fineberg testified. "Among those who reported having had sex, the group receiving abstinence-only education reported having similar numbers of sexual partners and similar timing of onset of sexual debut to those in the control group."2

Further committee testimony came from Margaret J. Blythe, MD, FAAP, FSAM, a pediatrician and professor of pediatrics at Indiana University School of Medicine of Indianapolis, IN. Blythe is the chair for the Committee on Adolescence and discussed the American Academy of Pediatrics' position on abstinence education.

"Comprehensive sexuality education emphasizes abstinence as the best option for adolescents, but also provides age-appropriate, medically accurate discussion and information for the prevention of sexually transmitted infections and unintended pregnancies," Blythe testified.

Blythe further noted that abstinence-only programs are not only ineffective, but may cause harm by providing inadequate and inaccurate information that results in participants' failure to use safer sex practices once intercourse is initiated.

CDC data show that births to teen girls, ages 15 to 19 years, increased by 3%, which is the first increase noted since a decline began 14 years ago, Blythe said.

"A longitudinal analysis of teens and virginity pledges compared 'pledgers' to 'nonpledgers' and found at a six-year follow-up that 88% of pledgers reported experiencing premarital sex and had STI rates that, statistically, were no different from those of nonpledgers," Blythe said.3

Charles Keckler, acting deputy assistant secretary for policy and external affairs for the Administration for Children and Families of the U.S. Department of Health and Human Services (DHHS) spoke before the committee in defense of abstinence-only programs.

"HHS' abstinence education programs are part of a broader strategy to combat teen pregnancy and STDs," Keckler testified. "Over the last five years, the department estimates that it has expended billions of dollars towards this effort."

While recent studies have not shown that abstinence-only programs are successful in reducing pregnancy and STDs, they also have not shown that the programs worsen these outcomes, Keckler noted.

"The administration believes that the abstinence education program sends the healthiest message as it is the only certain way to avoid out-of-wedlock pregnancy, and sexually transmitted diseases," Keckler said. "The great majority of American parents agree: a 2007 poll conducted by the National Campaign to Prevent Teen Pregnancy found that 90% of teens aged 12-19 and 93% of adults agree that it is important for teens to be given a strong message that they should not have sex until they are at least out of high school."

Waxman noted that U.S. taxpayers are showering funds on abstinence-only programs that don't work and ignoring comprehensive sex education programs that can delay sex and protect teens from disease and result in fewer pregnancies.

"We've already spent $1.3 billion on abstinence-only programs," Waxman concluded. "The question we must ask today is whether we can justify pouring millions more into these programs when the weight of the evidence points elsewhere."

References

  1. Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in high-income countries. Cochrane Database Syst Rev. 2007;(4):CD005421.
  2. Trenholm C, Devaney B, Fortson K, et al. Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases. Jrl Policy Analysis Mang. 2008;27(2):255-76.
  3. Bruckner H, Bearman P. After the promise: the STD consequences of adolescent virginity pledges. J Adolesc Health. 2005;36:271-278.