Abstinence-only education problematic, group says

Group urges comprehensive sexual health education

The Society for Adolescent Medicine (SAM) issued a position statement rejecting current administration policy promoting abstinence-only education for young people, urging U.S. educators to present abstinence as one important option in an overall sexual health prevention strategy.

"We believe that current federal abstinence-only-until-marriage policy is ethically problematic, as it excludes accurate information about contraception, misinforms by overemphasizing or misstating the risks of contraception, and fails to require the use of scientifically accurate information while promoting approaches of questionable value," the authors write in "Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine," released in January in The Journal of Adolescent Health (2006; 38:83-87).

Lead author John Santelli, MD, MPH, of the Heilbrunn department of population and family health, Mailman School of Public Health, Columbia University in New York, writes that abstinence from sexual intercourse represents a healthy choice for teen-agers, and acknowledges that teen-agers remaining abstinent, at least through high school, is strongly supported by parents and even by adolescents themselves.

"However, few Americans remain abstinent until marriage, many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents," he writes. "Abstinence as a behavioral goal is not the same as abstinence-only education programs. Abstinence from sexual intercourse, while theoretically fully protective, often fails to protect against pregnancy and disease in actual practice because abstinence is not maintained."

SAM urges the abandonment of abstinence only as a basis for health policy and programs, calling the presentation of abstinence-only or abstinence-until-marriage messages as a sole option for teen-agers "flawed from scientific and medical ethics viewpoints," providing misinformation and withholding information needed to make informed choices.

In addition, the SAM paper suggests, federally funded abstinence-until-marriage programs discriminate against gay, lesbian, bisexual, transgender, and questioning youth, as federal law limits the definition of marriage to heterosexual couples.

Abstinence-only vs. SAM recommendations

Under Section 510 of the Social Security Act, originally enacted in 1996, abstinence education is defined by an eight-point description as an educational or motivational program that:

• has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;

• teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;

• teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;

• teaches that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of human sexual activity;

• teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;

• teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child's parents, and society;

• teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and

• teaches the importance of attaining self-sufficiency before engaging in sexual activity.

The society's position, summarized in the paper, is that:

• Abstinence is a healthy choice for adolescents. The choice for abstinence should not be coerced. SAM supports a comprehensive approach to sexual risk reduction including abstinence as well as correct and consistent use of condoms and contraception among teens who choose to be sexually active;

• Efforts to promote abstinence should be provided within health education programs that provide adolescents with complete and accurate information about sexual health, including information about concepts of healthy sexuality; sexual orientation and tolerance; personal responsibility; risks of HIV and other STIs and unwanted pregnancy; access to reproductive health care; and benefits and risks of condoms and other contraceptive methods;

• Individualized counseling about abstinence and sexual risk reduction are important components of clinical care for teen-agers;

• Health educators and clinicians caring for adolescents should promote social and cultural sensitivity to sexually active youth and gay, lesbian, bisexual, transgendered, and questioning youth. Health education curricula should also reflect such sensitivity;

• Governments and schools should eliminate censorship of information related to human sexual health;

• Government policy regarding sexual and reproductive health education should be science-based. Governments should increase support for evaluation of programs to promote abstinence and reduce sexual risk, including school-based interventions, media efforts, and clinic-based interventions. Such evaluations should utilize rigorous research methods and should assess the behavioral impact as well as STIs and pregnancy outcomes. The results of such evaluations should be made available to the public in an expeditious manner;

• Current U.S. federal law and guidelines regarding abstinence-only funding are ethically flawed and interfere with fundamental human rights. Current federal funding requirements as outlined in Subsections A-H of Section 510 of the Social Security Act should be repealed. Current funding for abstinence-only programs should be replaced with funding for programs that offer comprehensive, medically accurate sexuality education.

Position paper lauded, criticized

Advocates of comprehensive sexual health education praised the SAM paper, calling abstinence only "bad science."

"We have 8 million young people under the age of 19 who are sexually active, yet 79% of junior high and 45% of high school teachers fail to teach about condoms. No wonder we have the highest rates of teen pregnancy and sexually transmitted disease in the developed world," says James Wagoner, president of the national organization Advocates for Youth.

"The [SAM] report is not anti-abstinence. It clearly supports abstinence as a strategy to protect young people's sexual health. But the report makes clear that, to be effective, abstinence education needs to be delivered in a comprehensive context along with information on condoms and birth control."

Supporters of abstinence-only education, however, disagree.

"With skyrocketing STD rates and conclusive research, which shows that contraception does not offer protections against all STDs, we need to be wise in the counsel we give young people," says Jessemyn Pekari, communications director for the Abstinence Clearinghouse, headquartered in Sioux Falls, SD. Abstinence Clearinghouse's position is that abstinence is not "a healthy choice," it is 'the only healthy choice" for the sexual health of adolescents, she says.


Santelli J, et al. Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine. Available on-line at www.adolescenthealth.org/PositionPaper_Abstinence_only_edu_policies_and_programs.pdf.


  • Society for Adolescent Medicine, 1916 NW Copper Oaks Circle, Blue Springs, MO 64015. Phone: (816) 224-8010. Web site: www.adolescenthealth.org.