Reproductive Roulette

In 1996 the newly Republican Congress approved nearly
$440 million in public funds over five years to teach celibacy. The law comes up
for renewal next year. The local programs supported under this legislation teach
that abstinence is the only appropriate way to prevent pregnancy and sexually
transmitted diseases (STDs). Indeed, the limited information about
contraceptives permitted in such classes emphasizes contraceptive failure rates.
Under the program's key elements, states may only fund classes that teach that:

  • Premarital sex is wrong. It is "likely" to be both
    psychologically and physically damaging.

  • Sex is for the self-sufficient. Sexual activity is appropriate upon
    the attainment of "self-sufficiency"--presumably a measure of economic status.
    Since the law is silent on the definition of self-sufficiency, the income that a
    couple needs to achieve before sexual relations become appropriate is ambiguous.

  • Abstinence is ageless. Only the married should have sex. Since
    marriage has been occurring later in life, abstinence is not limited to
    adolescents. In 1998 the median age at first marriage was nearly 27 for men and 25
    for women; in addition, older divorced and widowed individuals should abstain
    until they remarry.
  • When it embraced abstinence-only education, however, Congress missed a
    basic fact: There was no evidence that it would work. Indeed, when the National
    Campaign to Prevent Teen Pregnancy reviewed evaluations of "abstinence only"
    programs, it found that "there do not currently exist any abstinence-only
    programs with reasonably strong evidence that they actually delay the initiation
    of sex or reduce its frequency."

    Complete formal evaluations of these programs funded through the 1996
    law will not be generally available until 2003--a year after the program comes up
    for reauthorization. That's unfortunate because it's not at all clear that the
    abstinence-only approach will prove superior to more flexible ones at delaying
    onset of sexual activity, discouraging activity with multiple partners, and
    preventing pregnancy and disease. Other approaches to teaching human
    sexuality--variously called "abstinence plus," "abstinence based," and "safe sex"
    education--stress the value of abstinence, especially for younger teens, to
    differing degrees but also provide age-appropriate information about

    The difficulty with abstinence-only education, of course, is that by definition
    it is an all-or-nothing enterprise. Teenagers who have heard only the abstinence
    pitch and who then become sexually active are very likely to be at greater risk,
    since they will have had no education on practicing safe sex. Because of concerns
    about the need for effective education strategies in this era of sexually
    transmitted diseases, the American Medical Association, the National Institutes
    of Health, the American Academy of Pediatrics, and the Institute of Medicine have
    all recently issued reports questioning Congress's 1996 allocation and the
    approach it supported.

    The sponsors of the provision were the conservatives who took control of
    Congress in 1994. The bill was promoted by Republicans such as Lauch Faircloth of
    North Carolina and Rick Santorum of Pennsylvania in the Senate and Jim Talent of
    Missouri in the House. Conservative family groups lobbied hard for its enactment
    and succeeded in keeping abstinence education strictly defined. The win whetted
    conservative appetites for more funding. They modified an earlier program, the
    1981 Adolescent Family Life Act (AFLA), so that its broader abstinence-education
    language now conforms to the more restrictive 1996 brand of abstinence. That
    revision provided about $9 million of AFLA's annual funding. Led by Republican
    Congressman Ernest Istook, Jr., of Oklahoma, legislators also okayed another $50
    million in 2000 for a virtually identical program. Congress even delayed the
    implementation date so that the incoming Bush administration rather than the
    lame-duck Clinton team would write the regulations for disbursement of the new

    The latest $50 million comes with new stipulations. Entities that
    receive the monies for abstinence education must not provide other sex-education
    classes that counsel alternatives to abstinence. So even if a sponsor teaches
    "abstinence only" to 12-year-olds, its program cannot be funded if it includes
    contraceptive information in classes for older teens. The provision is analogous
    to the Bush administration's "global gag rule," which denies federal funds to
    international family-planning groups if they so much as mention abortion anywhere
    else in their program activities [see "The Sound of Silence" on page A21].

    All told, as of fiscal year 2002, about $533 million in state and federal funds
    has been earmarked for abstinence-only sex-ed programs just since 1996. The
    legislative sponsors, ordinarily considered fiscal conservatives, are using tax
    dollars on an unproven approach. Ironically, in an era of devolution and budget
    restraint, here is a new, federally engineered program for local schools. If
    anything, the drive to expand abstinence-only sex education is accelerating.
    Testifying before the Senate in April, Tommy Thompson, secretary of the U.S.
    Department of Health and Human Services, suggested that abstinence-only education
    is underfunded.

    Recent research suggests that some abstinence strategies may help delay the
    onset of sexual activity, particularly among the youngest adolescents. But the
    abstinence-only approach can backfire when aimed at older teens.

  • A comparison of in-school youths who took a "virginity
    pledge" and those who did not found that some virginity pledgers were at greater
    risk when they first engaged in sexual intercourse. The pledge--to abstain from
    sex until marriage--did delay first intercourse on average by nearly 18 months.
    However, pledging had no effect among teens who were 18 or older and also
    contributed to health risks for those who became sexually active.

    According to researchers Peter Bearman and Hannah Brueckner, who tracked those
    pledgers who had intercourse during the study period, "the estimated odds for
    contraceptive use for pledgers are about one-third lower than for others." The
    researchers noted that "pledgers are less likely to be prepared for an experience
    that they have promised to forego." They also found that "pledging does not work
    for adolescents at all ages" and that the efficacy of the pledge in some schools
    depended on its being uncommon: "Once the pledge becomes normative, it ceases to
    have an effect." Thus "policy makers should recognize that the pledge works
    because not everyone is pledging."

  • Another study compared an "abstinence" program with a "safer sex" program
    that involved 659 African-American middle-school adolescents and found that among
    those who already were sexually active when the courses began, participants in
    the "safer sex" program reported less-frequent sexual intercourse and
    less-frequent unprotected sex one year after the program. Further, when the
    abstinence group was compared with a control group, it reported less sexual
    activity at three months following the intervention, but this distinction
    evaporated over time.

  • A study conducted by Edward J. Saunders and colleagues at the University
    of Iowa School of Social Work compared survey responses from participants in a
    comprehensive sex-education program that promoted abstinence but allowed
    contraceptive information with survey responses from participants in an
    abstinence-unless-married program and found that the former program was more
    successful in imparting knowledge about AIDS and other STDs. In addition, while
    the authors suggested that program comparisons should be viewed cautiously
    because of differences in the age of the participants, the length of the
    programs, and a range of other variables, they noted that the program that
    offered contraceptive information also appeared to be more successful than the
    abstinence-unless-married program in "promoting communication between parents
    and youth about sex."
  • In contrast, evaluations of programs that combine abstinence education
    with contraceptive information find that they can help delay the onset of
    intercourse without a concomitant concern about health risks, and that they also
    reduce the frequency of intercourse and the number of partners.

    By now, it's clear that the weight of the evidence suggests that
    contraceptive information is not inherently harmful and that abstinence curricula
    can embrace contraceptive messages. Parents want both. A national study by the
    Kaiser Family Foundation recently found that 97 percent of the surveyed parents
    of 7th- through 12th-graders want their child's sex-education program to cover
    abstinence. But these parents also want lessons on how to use condoms (85
    percent) and on birth control generally (90 percent). State and local surveys
    also have found strong support for information about both abstinence and birth

    Another problem is that one person's sexual activity is another's celibacy.
    The National Centers for Disease Control (CDC) holds that abstinence means
    "refraining from practicing sexual activities that involve vaginal, anal, or oral
    intercourse." Yet many of today's youth disagree.

  • One out of four college students in a national poll
    responded that a person who is abstinent can practice anal intercourse.

  • Three out of five college students who responded to a poll at one
    midwestern school consider that a person who practices oral sex is not "having
    sex"; the same poll found that nearly one out of five believe that a person who
    practices anal sex is not "having sex."

  • A study of nearly 300 teenagers from 12 to 18 years old in rural
    midwestern communities found that "adolescents have very broad definitions of what
    sexual behaviors one can participate in and still be considered a virgin."

  • Oral sex did not count as "sex" among 40 percent of the 723 teenagers
    surveyed by Seventeen magazine in the fall of 1999.
  • Of course, abstinence programs do not promote oral or anal sex. But
    teenagers are famous for creative interpretations of rules. "Technical virgins"
    who don't practice safe oral or anal sex are more likely to contract sexually
    transmitted diseases than are sexually active ones who know what they are doing
    and act to prevent infection. This is no modest matter: Nearly three million new
    cases of STDs occur among teenagers each year.

    What to do about the gap between language and sexual practices of
    youth? A basic first step is to get a better grasp on how youths understand key
    terms such as abstinence, virginity, and sexual intercourse. The CDC,
    in the national Youth Risk Behavior Survey, asks about sexual intercourse but
    does not define it; the question has remained unchanged since 1990. As difficult
    as doing so may be politically, it behooves educators to encourage local
    assessments about the meaning young people in their community ascribe to these
    words. All sides of the abstinence-education spectrum should welcome this reality
    check. It may be that blunt language is necessary to communicate the CDC
    definition of abstinence and, as well, to ensure safe-sex practices.

    Policy makers may be oblivious to the disconnect educators face in teaching
    abstinence-education programs and assume that "abstinence is abstinence." These
    nuances are important. It is sensible to encourage adolescents to delay premature
    sexual activity; but we should not subsidize abstinence-only programs if, at the
    same time, they increase the risks faced by those who either don't delay or don't
    delay as long. Congress needs to make these connections and appreciate these
    distinctions when it explores the 1996 abstinence-only education program in 2002.

    All conscientious sex-education programs discourage promiscuity and encourage
    teens to delay sexual activity. But it is wildly naive to think that all or even
    most unmarried people will refrain from having sex, and it is self-defeating not
    to teach students contraception and disease-prevention. As reauthorization
    approaches, policy makers should lose their innocence, ask hard questions, and
    not remain virgins on the topic of sex education.

    To read the fully annotated version of this article go to