How We Know Abstinence-Only Education Doesn't Work

Abstinence-only education does not reduce teen pregnancy. If it did, decades of research would have demonstrated this many times over. Instead, research results have been overwhelmingly inconclusive or the opposite of what its advocates would like to see.

A method of "education" characterized by limiting what is taught had better yield clear practical benefits. At least then there might be a trade-off between knowledge and behavior.

The Rise of Abstinence-Only Education In the United States

Federal funding for abstinence-only programs began in 1982 with the Adolescent Family Life Act, which was part of the previous year's omnibus spending bill (blue "AFLA" line on the chart below). This sent millions of dollars annually to programs aimed at preventing "adolescent sexual activity and adolescent pregnancy." These programs were encouraged to partner with "religious and charitable" organizations, which led to such a degree of religious involvement that a case went up to the Supreme Court by 1988. In Bowen v. Kendrick (487 U.S. 589), the Court decided that the Act was not unconstitutional on its face, but did note that there appeared to be "impermissible" specific applications, which it called for other courts to examine.

In 1998, a major welfare reform dramatically increased funding for abstinence-only programs (red "Title V" line on chart below). This bill defined an abstinence education program as one which:

1. Has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity
2. Teaches abstinence from sexual activity outside marriage as the expected standard for all school age children
3. 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
4. Teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity
5. Teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects
6. Teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society
7. Teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances
8. Teaches the importance of attaining self-sufficiency before engaging in sexual activity

In 2001, additional federal funding began flowing from the Community Based Abstinence Education program (purple "CBAE" line on the chart below). The overall progression has been from low funding in the 80s and early 90s, medium funding in the late 90s, peak funding in the 00s, and back down to medium funding through at least 2014, thanks to $50 million per year allocated as part of the Affordable Care Act. In other words, the red line holds steady for three more years than this chart depicts:

From http://www.siecus.org/index.cfm?fuseaction=page.viewPage&pageID=1340

Two decades and well over a billion tax dollars later, there is no scientific evidence that programs matching the 8-point definition are effective at reducing teen pregnancy.

An Official Investigation

As part of the Balanced Budget Act of 1997, Congress authorized funds for a scientific study of Title V abstinence-only programs. The U.S. Department of Health and Human Services (HHS) contracted this study out to Mathematica Policy Research, Inc. After years of study, Mathematica submitted its final report to HHS in April, 2007:

http://aspe.hhs.gov/hsp/abstinence07/

To maximize the opportunity for positive, reliable results, this study focused on four school programs that were especially intensive and could be especially well documented:

"All programs offered more than 50 contact hours and lasted for one or more school years, making them relatively intense among programs funded by the Title V, Section 510 grant." (Trenholm, 2007, p. 2)

"These four programs are called 'impact sites' because they had program features and staff capable of supporting a rigorous, experimental-design impact evaluation." (ibid., p. 7)

Over twelve-hundred students were involved in these four programs, with over eight-hundred students in control groups. To measure differences over time, follow-up surveys were given from 42 to 78 months after the surveys given at the beginning of each program (ibid., p. 19). It was just the sort of broad-but-detailed study that would have stood up to scrutiny from critics of abstinence-only education. Some conclusions:

"None of the individual programs had statistically significant impacts on the rate of sexual abstinence, whether measured as either always remaining abstinent or being abstinent during the last 12 months." (ibid., p. 30)

"Program and control group youth also did not differ in the number of partners with whom they had sex." (ibid., p. 31)

"Programs did not affect the age at which sexually experienced youth first engaged in sexual intercourse" (ibid., p. 31)

"Forty percent of program group youth reported that they expected to abstain from sex until marriage compared with 37 percent of control group youth, a difference that is not statistically significant" (ibid., p. 32)

"Across the individual programs, estimated impacts on unprotected sex, measured either at first intercourse or in the last 12 months, were likewise small and statistically insignificant" (ibid., p. 34)

"Ten percent of youth in both the program and control groups reported having been pregnant or gotten someone pregnant, and roughly half of them (five percent overall) reported that they had had a baby." (ibid., p. 35)

"[P]rograms raised the proportion of youth who reported that condoms never prevent HIV from an estimated 17 to 21 percent; the proportion who reported that condoms never prevent chlamydia and gonorrhea from an estimated 14 to 20 percent; and the proportion who reported that condoms never prevent herpes and HPV from an estimated 15 to 23 percent." (ibid. p. 46)

Yikes! These golden examples of abstinence-only education programs failed to alter behaviors or even attitudes. They did, however, increase the number of teens who believed condoms were useless for STI protection.

State Studies

A number of states have run evaluations on their own abstinence only programs. Unfortunately, these state studies haven't generally been models of scientific rigor. No control group, or no follow-up, or both! Although abstinence-only education failed to come out looking good in any of the studies, opponents of abstinence-only education should not rely on desired results that come from shoddy methods. Advocates for Youth put together a summary of these state studies here:

Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact

Two of these studies did include both a control group and a follow-up. California's 17-months-later follow-up found that program students were no less likely than control students to have become sexually active, pregnant, or infected (Kirby, 1997). The program was cancelled based on these results. Missouri's smaller study had similar findings (Hauser, 2004).

Abstinence Until Ready

In 2010 a rigorous scientific study came out that showed a positive effect for abstinence education:

Efficacy of a Theory-Based Abstinence-Only Intervention Over 24 Months: A Randomized Controlled Trial With Young Adolescents

But there's a catch. This abstinence program deliberately did not match up with federal standards for abstinence-only education:

"It was not designed to meet federal criteria for abstinence-only programs. For instance, the target behavior was abstaining from vaginal, anal, and oral intercourse until a time later in life when the adolescent is more prepared to handle the consequences of sex. The intervention did not contain inaccurate information, portray sex in a negative light, or use a moralistic tone. The training and curriculum manual explicitly instructed the facilitators not to disparage the efficacy of condoms or allow the view that condoms are ineffective to go uncorrected. The results of this trial should not be taken to mean that all abstinence-only interventions are efficacious. This trial tested a theory-based abstinence-only intervention that would not meet federal criteria for abstinence programs and that is not vulnerable to many criticisms that have been leveled against interventions that meet federal criteria." (Jemmott, 2010)

The study's authors suggested a role for this kind of modified abstinence education program: an improvement over federally-defined abstinence education in communities that will not allow comprehensive sex education. It still lacks much of the information of comprehensive programs, but at least it doesn't encourage false and fearful beliefs...which evidently don't help anyway.

Correlations

Good news! Teen pregnancies, teen abortions, and births to teens have been falling:

Can this be attributed to abstinence-only programs? Perhaps the studies above are accurate within their particular contexts, but are missing out on big picture trends. If the states that require or emphasize abstinence-only education are generally the states with lower pregnancy rates, then it might be worth looking further into abstinence-only education. Someone did, in fact, look for this pattern.

Using information on state laws and policies in 2005, researchers assigned each state with relevant laws or policies a level from 3 to 0 (Stanger-Hall, 2011):

• Level Three - abstinence-only education, according to federal guidelines.
• Level Two - abstinence stressed, but discussion of contraception methods not forbidden.
• Level One - abstinence covered as part of comprehensive sex education.
• Level Zero - abstinence not specifically mentioned in sex education.

How did the states do?

So much for abstinence-only showing promise in the big picture. Here are comparison charts for pregnancies, abortions, and births (ibid.):

As far as teen pregnancy goes, abstinence-only education may actually be worse than sex ed that never mentions abstinence as an option!

Conclusion

Other issues aside, abstinence-only education does not improve teen abstinence. Its advocates should at the very least be seeking to reform it to be more like the "Theory-Based Abstinence-Only Intervention" mentioned above that went against federal guidelines and showed promise. Personally, I suspect the focus on postponing all sex until marriage is so unrealistic (and not even a worthy ideal) that teen audiences are lost to the positive message that it's OK to wait until both people are ready to make a considered, responsible choice.

References

Kirby, D., Korpi, M., Barth, R.P., Cagampang, H.H. (May/June 1997). The impact of the postponing sexual involvement curriculum among youths in California. Family Planning Perspectives, 29(3). Retrieved from http://www.guttmacher.org/pubs/journals/2910097.html

Hauser, D. (2004) Five years of abstinence-only-until-marriage education: Assessing the impact. Retrieved from http://www.advocatesforyouth.org/storage/advfy/documents/stateevaluations.pdf

Jemmott, J.B., Jemmott, L.S., Fong, G.T. (2010) Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Pediatrics & Adolescent Medicine, 164(2), 152-159. Retrieved from http://dx.doi.org/10.1001/archpediatrics.2009.267

Stanger-Hall, K.F., Hall, D.W. (October 2011). Abstinence-only education and teen pregnancy rates: Why we need comprehensive sex education in the U.S. Plos ONE. Retrieved from http://www.plosone.org/article/info:doi/10.1371/journal.pone.0024658

Trenholm, C., Devaney, B., Fortson, K., et al. (April 2007). Impacts of four Title V, Section 510 abstinence education programs final report. Retrieved from http://aspe.hhs.gov/hsp/abstinence07/