Sexual behavior has historically carried moral and ideological import, particularly when it comes to young people. But it also raises issues of health and safety. So deciding what kinds of information sexual education courses should include is a notoriously controversial task. One school of thought supports "comprehensive sexual education," which promotes abstinence but also includes information about condoms and other forms of contraception in order to educate young people about how to protect themselves if they become sexually active. Others favor programs that emphasize abstaining but provide no information, other than failure rates, on other forms of contraception -- based on the assumption that such details contradict and undermine the abstinence-only message and encourage sexual activity. Whichever school of thought one belongs to, there should be no controversy over the goal of adolescent sexual education programs should be: educating youth on how best to protect themselves against the known risks associated with sexual activity -- such as unplanned pregnancy or sexually transmitted diseases (STDs) -- if they choose to become sexually active. Alarmingly, the current federal approach fails to meet these ends.
Since the 1996 passage of the welfare reform act, the federal government has spent over $800 million on "abstinence-only" education, most of it under the Bush administration.(1) Millions of young Americans, ages nine to eighteen, have participated in these programs. However, according to a comprehensive congressional staff analysis ordered by Rep. Henry Waxman, eleven of the thirteen most widely used abstinence-only curricula funded by the federal abstinence initiative contain scientifically false, misleading, or distorted information about reproductive health.(2) We at ACSH have not reviewed the study that yielded the results reported by Waxman, but if the results are correct, they are cause for concern.
The report points out that abstinence-only programs have not been proven to reduce sexual activity, pregnancy, or STDs (whereas comprehensive programs have), nor have abstinence-only programs been reviewed for accuracy by the federal government. These revelations lend weight to the speculation that these programs are motivated less by a desire to provide adolescents with scientifically accurate tools to make informed decisions about their sexual activity, and more by beliefs about the appropriateness of such activity in young adults. Manipulation of and withholding of facts to support an ideological message have no place in discussions of health risks and disease prevention, and are irresponsible, if not Orwellian, given the potential consequences.
The Waxman report found that many youths participating in federally funded abstinence-only programs have been taught false and outdated information about abortion risks. For example, one curriculum includes such claims as:(3)
--studies show that 5-10% of women will never again be pregnant after having a legal abortion;
--premature birth, a major cause of mental retardation, is increased following abortion of a first pregnancy;
--following abortion, women have a higher risk of tubal and cervical pregnancies;
--following abortion, women are more prone to suicide.
Modern obstetrics texts, however, indicate that abortion does not affect fertility and that common abortion methods have no affect on preterm delivery incidence or premature birth-weight, nor do they heighten the chances of ectopic pregnancies.(4) Regarding increased suicide risks, an expert panel of the American Psychiatric Association does not support these findings, nor does a longitudinal study of women ages fourteen to twenty-one.(5,6)
In a free society, it is certainly acceptable to be against abortion on moral grounds, but it is not acceptable to distort facts about the risks related to abortion and its after-effects.
Waxman's findings also indicate that several curricula exaggerate various contraceptives' rates of failure at preventing both disease transmission and pregnancy. For example, many curricula included such statements as:
--the popular claim that "condoms help prevent the spread of STDs" is not supported by the data;(7)
--condoms fail to prevent HIV approximately 31% of the time;(8)
--the actual ability of condoms to prevent the transmission of HIV is not definitively known.(9)
These statements are in stark contrast with actual findings. The Centers for Disease Control and Prevention (CDC) report that latex condoms, when used consistently and correctly, are highly effective in preventing HIV transmission.(10) Additionally, recent data from both the CDC and the World Health Organization (WHO) indicate that condom usage is associated with reduced acquisition of syphilis and chlamydia by men and women, gonorrhea by women, and urethral infection by men.(11)
Disturbingly, none of the curricula give information on how to select a birth control method and use it effectively and several exaggerate condom failure rates in preventing pregnancy. Many also understate condom effectiveness rates by failing to acknowledge the distinction between "typical" and "perfect" condom use, and by confounding condom failure -- breakage or slippage -- with incorrect and inconsistent use. For the record, condoms have typical-use failure rate of 15% and a perfect-use failure of 2%.(12) With proper education, "perfect" use is an easily attainable goal. According to the WHO, breakage during proper condom use is uncommon.(13)
Among other scientifically erroneous components of federally-funded abstinence-only curricula are the assertions that
--touching another person's genitals can result in pregnancy;(14)
--twenty-four chromosomes from the mother and twenty-four chromosomes from the father combine to make an embryo (the correct number is 23);(15)
--problems such as jealousy, poverty, heartbreak, sexual violence, loss of honesty, and embarrassment, among others, can be eliminated by being abstinent until marriage;(16)
--half of homosexual male teens have tested positive for HIV;(17)
--HIV can be transmitted via sweat and tears.(18)
There is no scientific support for any of these assertions. In particular, according to the CDC, contact with saliva, sweat, and tears has never been shown to transmit HIV.(19)
In addition to distorted or blatantly erroneous science and the purposeful omission of irrefutable science, many federally-funded abstinence-only curricula present value-based, disputable material as fact. For example, some clearly perpetuate gender stereotypes by stating that "women gauge their happiness and judge their success by their relationships" while "men's happiness and success hinge on their accomplishments."(20) On a list of the "5 Major Needs of Men," one curriculum includes "domestic support, sexual fulfillment, and physical attractiveness." The "5 Major Needs of Women" include "financial support, affection, and conversation."(21) Another curriculum includes a tale of a knight who rescues a princess from a dragon. The princess advises the knight to kill the dragon with a noose or with poison instead of the bolder method of attacking with a sword, and the alternative means work but leave the knight feeling "ashamed." The knight ultimately chooses to marry a village maiden, but "only after making sure she knew nothing about nooses or poison." The curriculum concludes: "Moral of the story: Occasional suggestions and assistance may be alright, but too much of it will lessen a man's confidence or even turn him away from his princess."(22)
Other moralism offered as scientific fact in some programs includes a description of the forty-three-day-old fetus is a "thinking person" and a description of sex within marriage as "the expected standard of human sexual activity."(23,24) Some of the curricula explicitly blur the line between science and religion. For example, in a newsletter accompanying one curriculum, an author states that in modern times we are no longer valued "as spiritual beings made by a loving Creator." The section signs off: "in His service."(25)
Subjectivity has no place in discussions of risk, which is not a matter of opinion but of fact. One could go so far as to view elements of these abstinence-only programs as a modern equivalent of the old claim that masturbation causes blindness, a scare tactic used to discourage a safe behavior that was widely viewed as immoral. Sexual education programs should not be forums for imposing such beliefs but for reporting facts in an unbiased manner.
While no one would dispute that abstinence from sexual activity of any kind is the most effective means of preventing both pregnancy and the transmission of STDs and, as such, should be part of every sexual education program, promoting abstinence is clearly not enough. The latest national study shows that many adolescents are already having sex. Among females, 30% of fifteen- to seventeen-year-olds and 69% of eighteen- to nineteen-year-olds have had sexual intercourse. Among males in the same age groups, the percentages are 31 and 64%, respectively.(26) That said, not only do the current federal programs fail to provide these adolescents with the information and tools they need to protect themselves -- tools that have been scientifically proven to work -- but the programs may actually put adolescents at greater risk.
Effective decisions result from having accurate information, which millions of young Americans do not. There is no excuse not to use the best science we have to protect young people, making abstinence the best option, but not the only one.
2 The Content of Federally Funded Abstinence-Only Education Programs. http://www.democrats.reform.house.gov/Documents/20041201102153-50247.pdf
3 Me, My World, My Future, 157.
4 F. Gary Cunningham et al., Williams Obstetrics 21st Edition, 877 (2001).
5 N.E. Adler et al., Psychological Factors in Abortion: A Review, American Psychologist, 1194-1204,1202 (Oct 1992).
6 S.Edwards, Abortion Study Finds No Long-Term Ill Effects on Emotional Well-Being, Family Planning Perspectives, 193-4 (July-Aug, 1997).
7 A.C. Green's Game Plan Coach's Clipboard [Teacher's Manual], 34.
8 Why kNOw, 91.
9 I'm in Charge of the FACTS (middle school curriculum), 111.
10 U.S. Centers for Disease Control and Prevention, Male Latex Condoms and Sexually Transmitted Diseases (Jan 2003) http://www.cdc.gov/std
11 K. Holmes et al., Effectiveness of Condoms in Preventing Sexually Transmitted
Infections, Bulletin of the World Health Organization, 454 (June 2004) www.who.int/mediacentre/factsheets/fs243/en/
12 WHO, Effectiveness of Male Latex Condoms in Protecting Against Pregnancy and Sexually Transmitted Infection (June 2003) http://www.who.int/mediacentre/factsheet/fs243/en/
13 WHO, Effectiveness of Male Latex Condoms in Protecting Against Pregnancy and Sexually Transmitted Infection (June 2003) http://www.who.int/mediacentre/factsheet/fs243/en/
14 Sexual Health Today, slide 52, p. 112, Comments.
15 Why kNOw, 166.
16 Choosing the Best Path, 19.
17 Middle School FACTS, 112-113.
18 WAIT Training, 219.
19 CDC, Which Bodily Fluids Transmit HIV? (Dec 15, 2003) www.cdc.gov/hiv/pubs/faq/faq37.htm
20 Why kNOw, 122.
21 WAIT Training, 199.
22 Choosing the Best Inc., Choosing the Best Soulmate, 51 (2003).
23 Me, My World, My Future: Teaching Manual, 77.
24 This requirement is part of the federal definition of abstinence-only programs. Section 510(b) of Title V of the Social Security Act, P.L. 104-193.
25 Why kNOw, In the kNOw (2004).
Aubrey Stimola is a research intern at the American Council on Science and Health.