Sunday, May 9, 2010

A Critical Look at Abstinence Only Sex Education to Adolescents- Adam T. Hughes

Abstinence only sex education is currently the only federally funded approach to sex education to adolescents in the U.S. This curriculum requires school health teachers to promote abstinence as the only effective method for preventing pregnancy and sexually transmitted infections (STI’s). (1). Beginning in FY98, Title V Section 510 provided $50 million dollars in annual federal support for this type of curriculum, making it standard in most U.S schools. (14) This restricts any education around other health information or options if one chooses behaviors other than abstinence (1). The table below defines abstinence education.

A-H Definition of Abstinence Education
A. Have as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity
B. Teach abstinence from sexual activity outside marriage as the expected standard for all school-age children
C. Teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems
D. Teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity
E. Teach that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects
F. Teach that bearing children out of wedlock is likely to have harmful consequences for the child, the child's parents, and society
G. Teach young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances
H. Teach the importance of attaining self-sufficiency before engaging in sexual activity
Source: Title V, Section 510 (b)(2)(A-H) of the Social Security Act (P.L. 104-193). (14)

Controversy circles this policy as advocates of abstinence only curricula feel that sex before marriage is immoral. They also share that condoms are not an effective way to prevent pregnancy and STI’s, which put adolescents who engage in sexual activity at high risk for these outcomes. Exclusions using this approach include: condom demonstration and distribution, sexual risk reduction, and contraception options. At the time this law took effect 88.7 per 1000 women aged 15-19 in the U.S. became pregnant each year. (15) At the same time, half (9.1 million of 18.9 million) of all STI’s in the U.S. were contracted by people between the ages of 15-24. (16) Abstinence only sex education teaches teens that remaining abstinent until marriage is the only way to avoid both of these health outcomes. (3). The reason for leaving out other related health information and education is the belief that educating adolescents about things like condoms, safer sex, and contraception will encourage and enable adolescents to initiate sex before marriage (2). This approach incorporated a moral construct to sex before marriage to create the norm that connects sex with death, disease and danger (4).Currently there are many studies that claim the abstinence only approach does not effectively prevent adolescents from abstaining from sexual activity. While there are a limited number of studies that refute that claim, most are not peer reviewed or published works (2).

Abstinence only advocates, such as Concerned Women for America, point out that adolescent sex is not only about public health but morality as well. Adolescent sex, according to this organization, contributes to not only illegitimate births and AIDS, but also poverty, increase in crime, and the breakdown of the nuclear family. This idea is shared with many other organizations such as: The Eagle forum, The Family Research Council, The Heritage Foundation, The Medical Institute for Sexual Health (MISH), and many others (2). Since these advocates have been able to draw connections to all these societal downfalls, those against abstinence only sex education face a difficult battle with the conservative right.

Within the last three years, there has been a rise in publications that are finding flaws in abstinence only sex education. Many of these publications argue that this approach leaves adolescents with incomplete, even fragmented information that is inappropriate considering the high rates of pregnancy and STI’s in the U.S. (5). Conservatives and the religious right continue to advocate abstinence only education, but momentum is shifting towards comprehensive, or abstinence plus (another name for comprehensive sex education). The statistics are very uneven and compares sex initiation as a value relative to pregnancy and STI rates, which often times do not match up (6). The most effective and appropriate approach for adolescent sex education is proving to be comprehensive or abstinence plus education.

Critique 1: Leaving Adolescents Uninformed Deters Them of Vital Knowledge

Advocates against abstinence only sex education that promote comprehensive sex education, or abstinence plus, say the current approach leaves adolescents uninformed or misinformed about facts of sex and health information if they choose a behavior other than abstinence (2). Without this knowledge, they are left to navigate sexual activity without understanding ways to reduce risk of pregnancy and STI’s. If an adolescent chooses to engage in sexual behavior before marriage and had only received abstinence only education, that individual will not know how to correctly use a condom Education around these topics is incorporated in comprehensive sex education. Students who have more information have the opportunity to be prepared to handle situations they may find themselves in. (5) Also, studies show that comprehensive sex education does not promote or increase the rates of sex initiation (which is a fear among those opposed to comprehensive sex educations) and does increase teens’ knowledge of how to protect themselves (2). The same idea relates to contraception. If a young women is not empowered with all the information to make informed choices for her own sexual and reproductive health, her risk of pregnancy and STI is increased if she decides to engage in sexual behaviors.

Comprehensive sex education advocates argue that despite the idea that abstinence only education is morally correct, it is immoral to deny the human right of sexual health information (1). HIV/AIDS and sexual health information has been recognized as a human right and is essential to living the highest standard of health attainable (7) On that basis, ethical and moral standards come into question using the abstinence only approach to sexual education. This is concordant with the argument that restricting information leaves adolescents uneducated about the information needed if one chooses behaviors other than abstinence. The attempt to control behaviors in turn may just be allowing adolescents to slip through the cracks unless they follow the strict guidelines laid down by abstinence only sex education. The public health consequences of this will result in a decrease in consistent correct condom usage and lack of awareness and access to contraception. (6)

Critique 2: Attaching Moral Judgment and Stigma to Sex and Sexuality Causes Shame and Poor Self Esteem

Abstinence only sex education has incorporated a moral construct to sex before marriage to create the norm that connects sex with death, disease and danger. The message being relayed to these adolescents is fear. For example, in the abstinence-promoting evangelical educational video “No Second Chance”, the educator compare sex with Russian roulette and goes as far as saying “the only difference is, in Russian roulette you only have one in six chances of getting killed.” This actually infers that having sex is even more dangerous than a game involving a lethal weapon (4).
Using images of men dying of AIDS has also been seen as a scare tactic to delay sex until marriage. Not only does this stigmatize individuals living with HIV/AIDS, but it infers that if you have sex, you will get AIDS. This obviously and viciously stigmatizes sex. Stigmatizing sex creates a culture of shame and embarrassment around topics of sexual experiences and feelings among adolescents. There is also evidence that bible verses are used to manipulate youth that premarital sex is wrong. In a abstinence only curriculum called “Abstinence Works: A Notebook on Pre-Marital Chastity” there is a bible verse from Deuteronomy starting with “Today I set before you life or death, blessing or curse” with an image of Mother Theresa on one side and a picture of a skeleton on the other. There is clear stigma attached to premarital sex in this campaign. It attaches moral judgment in an explicit manner implying one can be as good as Mother Theresa or as bad as death (4).

Because abstinence only education is aiming at delaying sex until marriage, it not only stigmatizes sex, but sexuality as well. Under Section 510 requirements (the federal law surrounding abstinence only sex education) heterosexual marriage is exclusively the appropriate context for sexual behavior. What is a gay or lesbian adolescent in a state that does not recognize gay marriage going to walk away from this approach? Homosexuality is not explored in depth in abstinence only sex education. The only time it is addressed is when talking about transmission of HIV/AIDS (1). This not only ignores homosexuality as a lifestyle, but infers stigma to being gay is only relative to getting HIV/AIDS. Adolescents who are questioning their sexuality are not in a place to openly and affirming question homosexuality. There are silent judgments made about homosexuals in this approach to sex education. The implied expectation of LGBT adolescents is lifelong abstinence. Since sex and sexuality is an aspect of health and abstinence only education infers lifelong abstinence, this is not conducive to a healthy sexual and reproductive life for LGBT adolescents (4).

Critique 3: Media Works Against Abstinence Only Education

One of the core components of abstinence based sex education is the component of exposure. Advocates for abstinence only education argue that exposing youth to condoms, safer sex practices and contraception will condone sexual behavior. Unfortunately, this is allowing adolescents to receive a portion of their sex education from the media (9). In a study conducted by The Association for Education in journalism and Mass Communication, increasing restrictions of schools because of abstinence only education leaves adolescents to obtain much of their sexual knowledge from the media. This in turn, is informing adolescents about sex without the sexual health aspect (9). Some examples to follow illustrate the disconnect between the education adolescents receive at school and what compliment that information with from the media.

Since the current approach does not address condom usage, adolescents have received information on that from movies such as American Pie. In this movie, four friends make a pact to lose their virginity by graduation. Though condoms were seen throughout the movie by the boys, the only time a condom was shown actually attached to a sexual encounter was given to the boy by a young woman. This enhances the stereotype that contraception and safer sex is the responsibility of women only. Also, because the main character, Jim, ejaculated prematurely during sex, his prom date told him to put on two condoms so he could “last” Longer (9). This information is incorrect as it is shown that wearing two condoms at the same time increase the risk of the condom breaking (10).

Another example focuses on the media depiction of teen pregnancy. In a rapper DMX’s song Shorty was Da Bomb, he spoke about how the rubber (condom) bust. He insinuated she was a dishonest person because she said she was four months pregnant and he found out she was six months pregnant. Because of his perceived dishonesty of the girl, he abandoned her. He ended the song saying she would be ok because “Shorty [his penis] was the bomb”. This educates young men that pregnancy is the woman’s responsibility and abandoning a young woman you impregnate is acceptable, considering you are a good lover (9). These unhealthy and even inaccurate portrayals of sex in the media supplemented by restricted information by schools leave adolescents with mixed messages and unacceptable behaviors to base their decision making on. If comprehensive sex education was implemented and taught of the shared responsibility of teen pregnancy, adolescents would be able to distinguish the unhealthy portrayal of this song, without that education, this song is all they have to draw from.

A study on sex in the media done by Kaiser Family Foundation has found there is increasing evidence that exposure to sexual content on television is contributing to many aspects of adolescents sexual knowledge, beliefs, expectations, attitudes, and behaviors. (17) This points out the flaw of abstinence only education that assumes adolescents will not receive messages about premarital sex if they are not taught in the school. The same study indicates that television would be an excellent venue to socially market sexual health information in a productive manner.

Revised Approach

The strongest aspect of the approach criticized is that it promotes the one fool proof behavior that prevents pregnancy and STI’s. What the approach lacks is all the information teens need beyond abstinence education, without moral judgment and stigma. A revised approach would incorporate a three-tiered system. The foundation of this approach would be the incorporation of comprehensive sex education across all public schools in the country including a repeal of Section 510. The comprehensive sex education would still be grounded in delay of sex, but incorporate communication with sex partner, condom negotiation skills, contraception, and testing options. This approach would be supplemented by incorporating sex-positive messages in the education using the stigma/labeling theory. The third tier of this approach would be a large scale social media campaign accessible to adolescents that celebrate sex and sexuality while still providing education on the reality of decision making and consequences.

The purpose of this approach is to remove the aspects of the approach being criticized. Adolescents would receive vital health information so they are empowered to make informed choices around their own sexual and reproductive health. Sex positive messages would replace morally judging/stigmatic messages to be inclusive to all sexual and gender identities as well as decrease the taboo of premarital sex to open dialogue with adolescents. Lastly the social media campaign would be a widespread comprehensive series that would work to combat the sex messages sent to adolescents through mainstream media. The expected outcomes of this approach would be an increase in condom usage, decrease in unwanted pregnancy, and a decrease in STI rates among adolescents.

Defense of Approach 1:Incorporation of Comprehensive Sex Education

Incorporating comprehensive sex education, or abstinence, will provide adolescents with the information to make informed decisions surrounding their sexual and reproductive health. As mentioned earlier, most of the studies tracking programs that implemented this approach reported no significant increase in sex initiation (8). Using this approach, empowering adolescents with health information is not perceived as condoning rather than acknowledging the reality that some adolescents will choose behaviors other than abstinence and ensuring that they have the knowledge to make those decisions when in real life situations.

Specific topics included in comprehensive sex education would include consistent correct condom usage, condom negotiation skills, contraception options for women, contraception responsibility for males, as well as safer sex risk reduction. Condoms would be made available in the nurse’s office of schools to provide free availability for condoms. To access a condom, students would need to demonstrate correct usage on a condom demonstrator before being given condoms. School nurses would not be restricted to what information and resources they can distribute to young women about contraception and pregnancy options. All of these components would leave the adolescent with a full scope of information to aid them in decision making. Federal funding would be solely towards comprehensive sex education and abstinence only education would be stopped.

Research completed by Douglas Kirby, a respected sex researcher of ETR Associates concluded that STI/HIV education programs in the schools he studied can delay sex; reduce the frequency of sex, increase condom and contraceptive use, and decrease pregnancy or childbearing. (6) This clearly refutes the ideas attached to comprehensive sex education as “enabling and condoning”. There were also indicators that many programs that implement comprehensive sex education lack fidelity and that if funding was dispersed to ensure fidelity, sexual risk taking among adolescents would decrease. The Ideology believing that restricting information to adolescents will have better outcomes than if the information is made available is flawed based on this research.

Another study was conducted in New York City and Chicago public schools. In NYC schools, condoms were made available; in contrast, Chicago schools followed abstinence based education. The conclusions were clear. Reports of sexual activity were equal in New York compared to Chicago. New York students reported higher rates of condom usage at last intercourse as well as higher condom usage for participants who had three or more sex partners over the last six months. This points out the inaccuracy that if you give adolescents more information, rates of sexual activity will rise. (8)

Defense 2: Re-framing Sex and Sexuality

Since the years of abstinence only sex education has attached fear, death and disease to sex, a revised approach will have to work to diminish this stigma (4). Curriculums that are comprehensive sex education will also incorporate positive labels and images about sex and sexuality. This aspect of the new approach follows Howard S. Becker’s labeling theory. Becker states how people’s perceptions about something are affected by the labels or stigma that is attached to it (11). Abstinence only used this theory to attempt to scare adolescents away from pre marital sex by attaching many negative labels and stigma to sex and sexuality. This same approach would be implemented, however the labels attached to sex and sexuality would all be positive and healthy. Words such as love, compassion, commitment, sharing, and communication would replace the death, disease, and danger that preceded them. If sex is looked at in positive and healthy light, adolescents will have ownership over it versus viewing sex as deviant behavior that an adolescent must suppress. There would be no more negative imagery linked to sex to decrease moral judgment about behaviors other than abstinence. This would improve health outcomes because adolescents will not feel inhibited to communicate openly about sex which in turn would increase their knowledge about sex and safer sex options. (7)

Another purpose to using labeling theory would be inclusive and affirming to LGBT adolescents. Currently under abstinence only sex education homosexuality is only mentioned in relation to HIV/AIDS (4). That stigma coupled with the marriage only ideology indoctrinates adolescents with stigma attached to homosexuality. Ideas of freedom and individualism and choice would be attached to sexual orientation and gender identity. This would prevent the marginalization and ostracization of LGBT adolescents in school setting sex education. This affirmation could positively affect the sexual health outcomes of these individuals because, again, their choice would not be labeled as deviant behavior. This would create self esteem and an ability to communicate freely about sex and sexuality.

Defense 3: Social Marketing Campaign

Despite the incorporation of comprehensive sex and sexuality into schools, mainstream media will still be reaching individuals with unhealthy and sometimes incorrect sex messages. To make this new approach complete, the federal government also must implement a large scale media marketing campaign around healthy sex and sexuality geared towards adolescents. This campaign would be based on social marketing principles. Social Marketing goes a step beyond health promotion/education. The campaign is not simply selling the health information (12). The information that is intended to be sold is attached to “non tangibles” that connect with the target audience (13). These non tangibles are attitudes, ideas, lifestyles that are desired and reach the target audience beyond the scope of the information you are “selling”. In a sense you are selling the idea, attitude or lifestyle through buy-in of the health information.

Television is a very effective venue to run a social media campaign around sex and sexuality. (17) Extensive research would be conducted to accurately identify what non tangibles connect with adolescents. Once identified, a series would be created that targets three different cohorts among adolescents: males, females, and LGBT adolescents. These ads would run concordantly with the same television shows that project inaccurate and sometimes incorrect information. The ads would address sex in the media and “debunk” myths and misconceptions adolescents may have. The male cohort would receive messages including contraception and safer sex is not solely the woman’s responsibility. The young women’s series would incorporate messages including communicating with partners around safer behaviors and decision making. The LGBT series would be affirming of relationships and same sex relationships and include condom usage and other safer sex messages.


Abstinence only sex education is an outdated approach that needs revision. Some aspects of this approach are potentially damaging to certain groups among adolescents. It is unethical to withhold vital health information to a group with the idea it will prevent certain behaviors. The moral judgment and stigma that has been incorporated in abstinence only sex messages are inappropriate and inaccurate. If adolescents do not receive accurate information from appropriate sources, they are going to get the information elsewhere and that source may misinform individuals.

Incorporation of comprehensive sex education is a wise approach. Research points to no evidence that this approach increases sex initiation and sexual activity. Replacing negative messages and teaching fear with positive messages and healthy communication is an important step in revising the approach to adolescent sex education. Marginalizing populations within this group is an unhealthy approach to teaching healthy behaviors. Combating portrayals of sex in the media through social marketing coupled with comprehensive sex education and positive labeling is a healthier more appropriate direction to work towards in the years to come.

1. Santelli, J; Ott, M; Lyon, M; Rogers, J; Summers D; Schleifer, R. Abstinence and Abstinence Only Education: A Review of U.S. Policies and Programs. Journal of Adolescent Health. Vol. 38 (2006) 72-81
2. Collins, C; Alagiri, J.D; Summers, T. Abstinence Only vs. Comprehensive Sex Education: What are the Arguments? What is the Evidence? AIDS Research Institute, University of California, San Francisco. Policy Monograph Series, March 2002.
3. Administration for Children and Families. Fact Sheet: Community Based Abstinence Education Programs.
4. Rose, Susan. Going Too Far? Sex, Sin, and Social Policy. Social Forces, Volume 84 Number 2, December 2005.
5. Constantine, N.A. Converging Evidence Leaves Policy Behind: Sex Education in the United States. Journal of Adolescent Health, Vol. 42 issue 4. April 2008: pp 324-326
6. Kirby, D. The Impact of Schools and School Programs Upon Adolescent Sexual Behavior. The Journal of Sex Research. Volume 39, Number 1, February 2002: pp27-33.
7. Kirby, D. Do Abstinence Only Programs Delay the Inititation of Sex Among Young People and Reduce Unintended Pregnancy?, National Campaign to Prevent Teen Pregnancy. Washington D.C (2002)
8. Guttmacher, S; Lieberman, L; Ward, D; Freudenberg, N; Radosh, A; Des Jarlaid, D. Condom Availability in New York City Public High Schools. American Journal of Public Health, Vol 87, issue 9.
9. Hust, S,J; Brown, J,D; L’Engle, K, L. Boys Will Be Boys and Girls Better Be Prepared: An Analysis of the Rare Sexual Health Messages in Young Adolescents’ Media. Association for Education in Journalism and Mass Communication. Vol 11: 3-23, 2008.
10. Be Safer, Use Condoms Fact Sheet. January, 2007.
11. Becker, Howard S. The Other Side: Perspectives on Deviance. Copyright 1964 by The Free Press of Glencoe A Divison of the MacMillan Company
12. Lefebvre, C, R; Flora, J, A. Social Marketing and Public Health Intervention. Health Education Quarterly. Vol. 15(3): 299-315 (Fall 1988)
13. What is Health Marketing? Center For Disease Control and Prevention.
14. Impacts of Four Title V, Section 510 Abstinence Education Programs, 2007. Meredith Kelsey.
15. U.S. Teen Pregnancies Births, and Abortions: National and State Trends and Trends by Race, Ethnicity. Guttmacher Institute. January 2010.
16. Facts on American Teens’ Sexual and Reproductive Health. Guttmacher Institute. January 2010.
17. Kunkel, D; Keren, E; Finnerty, K; Biely, E; Donnerstein, E. Sex on TV: 4. Kaiser Family Foundation. November 2005.

Labels: , ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home