Sunday, May 9, 2010

Fear and Shame Instead of Support and Empowerment: Why Abstinence-Based Sex Education Fails to Change Behavior — Julia Keosaian


In the United States there is a major debate taking place in regards to how schools should educate children on the subject of sexual health. During the Bush Administration, millions of dollars were allocated to abstinence-based sex education. These programs are founded on the notion that teenagers should refrain from sexual activity until marriage and the role of contraception and safe sex are not discussed. The current Obama Administration initially cut Title V funding this past fall (Federal funding for abstinence-based sex education), however the recent health care reform bill reinstated $250 million in funding for 5 years to support exclusive abstinence-only programs (1). Currently, 25 states require that abstinence be stressed in sex education curriculums while no state requires that contraception be stressed (2).

The hallmark of these abstinence-based sex education programs is that sex is an act reserved for married couples. Fundamentally, this notion is based in Christian ideals and removes the possibility for same-sex couples to be part of the conversation about sex. In this way, gay, lesbian, bisexual, and transgendered individuals are excluded from the discussion. Abstinence-based programs focus on scare tactics to teach teens that the consequences of sex outweigh the benefits. These programs are individualistic in nature and rely on the Health Belief Model, which does not account for external social influences. Additionally, these programs teach inaccurate or incomplete information for students who do chose to have premarital sex, putting them at great risk for engaging in risky sex. The following critique will further explore these issues and highlight how comprehensive sex education seeks to resolve these deficiencies.

Examples of Abstinence-Based Education

The A. C. Green Game Plan Program is sponsored by former NBA player A.C. Green’s youth foundation. The program promotes abstinence before marriage and stressed the negative consequences of premarital sex and the benefits of self-control. Currently the program has been instituted in 17 states (3). The Aspire Program is also an abstinence-based model that promotes the value of a loving heterosexual marriage. This marriage ideal is the basis for their curriculum and is presented as the ultimate life goal for all teenagers. The idealization of marriage is founded on the notion that marriage results in a more emotionally secure and happier life. The Aspire Program declares that individuals who are marriage are less lonely and that it provides men and women with “the highest level of fulfillment (4).” With this in mind, the program presents threats to this “marriage ideal.” The essential treat to the marriage ideal is having sex before marriage. Students are encouraged to take “virginity pledges” in order to commit themselves to the goal of remaining abstinent before marriage.

Critique 1: Reliance on the Health Belief Model

Both the Aspire Program and the Game Plan Program are based on the Health Belief Model. This social theory was developed by Rosenstock to explain and predict health-related behaviors (5). This model is comprised of following elements: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. The Health Belief Model suggests that individuals are likely to engage in a health activity (i.e. not smoking) if their perceived susceptibility and the consequence to engaging in the unhealthy behavior are high. At the same time they are also likely to engage in the healthy behavior if the individual perceives the benefits to be favorable and the barriers to be limited. In this way, the models is like a balancing scale of costs and benefits for engaging or refraining from a particular behavior.

The Aspire and Game Plan Programs address each of these issues and attempt to persuade teens to stay abstinent by incorporating each element of the model in their curriculum. These curriculums address the issue of perceived susceptibility by teaching students about (and often exaggerating) the failure rates of contraception and highlight abstinence as the ultimate way to prevent negative health outcomes such as STI infection or pregnancy. The way the data is presented, it is suggested that even if you use condoms, you’re still going to get pregnancy or get a disease. This is a rather fatalistic viewpoint for any teen that has already engage in sexual activity or plans to in the future. The goals of these lessons are to change teens’ feelings about sex and highlight how risky and damaging pre-marital sex can be. A study by Bruckner found that teens’ attitude toward pregnancy had no effect on their pregnancy risk, suggesting that this method of persuading teens to change their attitudes about sex is ineffective (6).

Perceived severity is offered to students by presenting data on sexually transmitted infections, teen pregnancy rates, and HIV/AIDS infection rates. According to their curriculum guidelines the Aspire Program, presents the latest facts and figures regarding the potential consequences of unwed pregnancy and sexually transmitted diseases along with diagrams, charts, and true life stories. Students are encouraged to consider the potential long-term outcomes of different potential consequences of unwed teen pregnancy (9).” One of the major characteristics of adolescents is sense of invincibility. Showing teens scary pictures and graphs might in the moment cause a visceral reaction, but the long-term effects of this method are not empirically supported (7). The use of these types of scare tactics will be discussed in greater detail in the following section.

Perceived benefits are discussed throughout the lesson plans. The Game Plan Program has an entire section in the curriculum entitled, “Winning the Prize” that teaches students “the positive benefits of marriage.” The Aspire Program “makes the connection between abstinence, academic achievement, and future life outcomes (9).” While some of the benefits of remaining abstinent are based in fact (no risk or STIs or pregnancy) the benefits of marriage seem exaggerated and based on religion. These programs instruct teens to focus on their future life goals and stress that pre-marital sex will get in the way of these goals. Research has shown that teens’ ability to plan and look at long-term future goals is not necessarily within their developmental capacity, making this teaching practice very limited (10).

Perceived barriers are offered as lack of support from friends, peers groups, or partners. These programs teach students to consider who they are friends with and if their morals are in keeping with their own. The Game Plan Program covers the role of peer pressure and offers that teens should chose their friends carefully, suggesting that they should surround themselves with other teens who are pledging to be abstinent. This suggestion is an ineffective tactic to use with youth, as it is basically telling teens who they should be friends with. Research does in fact stress the importance of social influences (i.e. peers and parents) on teens engaging in safe sex practices (11). But here again, this model is individualistic and places pressure on teens to chose their friends, rather than change the overall peer or social norm in regards to teen sex.

Critique 2: Use of Fear and Shame

As previously discussed, the use of scare tactics is present throughout abstinence-based sex education teachings. According to the Aspire curriculum, pre-marital sex can cause the following conditions: relationship instability, inhibit ones ability to have a healthy marriage, emotional harm, and a lack of respect within the relationship (4). This method of teaching attempts to force teens to base their decision to have sex on rational thought about the potential negative outcomes of pre-martial sex.

During adolescents, teens develop a super-human sense of invincibility that can not only contribute to them engaging in risk behavior, but also alter their perception of the consequences of behavior (13). Teaching teens about the “evil” nature of pre-marital sex or how easy it is to get a sexually transmitted disease, most likely will not resonate with teens. They might think, “this would never happen to me” or “my partner doesn’t look diseased.” Often for teens, messages that instill fear have the opposite effect on their behavior. Besides having a strong sense of invulnerability, teenager years are defined by a desire to be independent and rebellious.

This cost-benefit approach to sex education has been shown to no effect on the behavior of teens. Results show that even when teens report a high cost of engaging in pre-marital sex, they still have sex (12). This indicates that outside factors such as peer groups and social influence play a major role in decision-making for teens. Research involving hypothetical situations has shown little difference in adolescent results compared to adults (13). Health outcome statistics and observations of teen behavior show that teenagers are more likely to engage in risky behaviors. These results indicate that teens have the capacity to make rational decisions but this ability is not manifested in reality. This suggests the power and influence of social and environmental factors on teen behavior and that they are capable of overpowering cognitive reasoning in teens.

Critique 3: Lack of Realistic Skill-Building and Dismissal of Social Influences

Not surprisingly, data shows that teens are in fact having sex (14). A study by Rosenbaum found that teens that pledged abstinence were no less likely to be sexually active than teen who did not (15). Abstinence-based sex education programs like Aspire and Game Plan fail to equip teens with the skills necessary to properly use contraception when they engage in sexual activities. Research show that effective programs incorporate comprehensive sex education and skill building (22). Abstinence-based sex education programs present only one limited lifestyle option for teens: abstinence until heterosexual marriage. By having only one method of protecting themselves from pregnancy and STIs, teens are not prepared for when they do eventually have sex. Additionally, teens might chose to engage in non-intercourse sexual activities which would still put them at risk for sexually transmitted infections (16).

As stated in Bandura’s Theory of Self-Efficacy, believing that you have the ability to perform an action influences the likelihood that you will engage in the activity (17). Bandura’s theory recognized the importance of experience, modeling, social influences, and physiological factors (i.e. getting stressed about the activity). Because abstinence-based sex education does not prepare teens to use contraception, when teens do engage in sex, they lack the skills and knowledge to successfully use contraception.

Programs like Aspire and Game Plan misrepresent the facts on condoms and other forms of birth control. Reviews of abstinence-only sex education curricula revealed that 11 out of 13 programs taught inaccurate information (18). This is not surprising considering that most of abstinence-only education funding is not required to provide scientifically accurate information. These programs teach teens that contraception may not prevent STIs and pregnancy, and overemphasize failure rates. These programs fail to address the fact that contraception prevention rates increase with practice and proper use. By actually teaching students how to use condoms or exploring the various methods of birth control can help change the rates of typical use of contraception for teens.

Proposed Intervention

There is a plethora of sexual education programs aimed at reducing and preventing risky sexual behaviors and health outcomes. These programs focus on knowledge and empowerment, rather than fear and A guideline for evaluating these programs was developed by the National Campaign to Prevent Teen Pregnancy, which specify ten essential components of effective programs. These components include: (1) the need for theoretically-based programs; (2) clear messages about safe sex practices; (3) modeling, skill building; (4) address social pressures; (5) utilize a variety of teaching methods; (6) last a sufficient amount of time; (7) provide accurate information; (8) age and culturally appropriate; (9) focused on one or more outcome; (10) taught be trained and motivated instructors (19). These elements are greatly lack in the abstinence-based sex education and the program examples described above. The following proposal addressed the failings of abstinence-based programs and offers comprehensive sex education as a solution to achieving real behavior outcomes.

Use of Multiple Teaching Methods

As previously discussed, the Aspire and Game Plan Programs based their curriculum on the Health Belief Model, which is ineffective for an adolescent population. Teens do not simply make their decisions based simply on the costs and benefits of an action. There is a complex network of influences outside the individual that influence behavior and shape thought. Social Cognitive Theory suggests that individuals’ behavior is influenced by their social and peer group (11). The Theory of Self-Efficacy also supports this idea (20). In regards to contraception use, if a teen’s peer group support and use condoms, they are more likely to use condoms themselves. A belief in ones ability to properly use contraception also greatly influences the likelihood to practice safe sex. If a teen is nervous about using a condom and doesn’t know how to discuss the topic with their partner, they may not use any protection.

Effective sex education programs should address this issue through in class condom demonstrations and role-playing. Teens can work with their peers to create skits or scenarios that touch on sexual health-related topics. These topics include how to say no to sex and how to discuss contraception with a partner. In addition to Social Cognitive Theory, these programs also utilize a model of social influence and attempt to create a social norm within the classroom and peer groups that support safe sex practices.

Through skill building, teens can develop high self-efficacy in practicing safe sex. Comprehensive sex education programs do not have to necessarily support teens having sex, but they can provide the skills that teens will need and prepare then for when they do decide the have sex.

Support and Empower

Understanding the impact of a teen’s peer groups is essential in developing successful intervention and prevention programs. The influence of peers is pervasive throughout this developmental phase and can manifest in decision-making and risk taking. In recent years, there has been a wave of peer-centered educational programs that capitalize on the influence of peers on teen behavior. For example, the Positive Youth Development movement focuses on healthy peer relationships and empowering teens (2).1 These programs have taken research and knowledge about adolescents’ influences and factors affecting behavior and used it to create an evidence-based program. Research emphasizes the need for programs to focus less on changing teens internally (i.e. cognitive abilities) but more on their external influences. Programs like these are essential to providing teen with support and uniting them together through the emotional ups and downs of adolescence.

Instead of pushing one ideal of marriage on students, sex education programs should support teens to think about and reflect on their own personal values. Teachers should encourage students to talk with their parents and find out what their family’s ideal are in regards to sex and contraception. Programs should offer support to parents on how to talk to their children about sex effectively and how they can transmit their ideals onto their children. Research has shown that strong parental support can have protective effect on risky teen behavior.

Accurately and Appropriately Educate

Research shows that teaching clear and accurate information in regards to sex is essential in providing students with the knowledge to make healthy decisions (22). As previously discussed, giving teens a full and accurate understanding of information regarding contraception will help to increase their self-efficacy and in turn make them more likely to practice safe sex. Teaching accurate information about contraception and its effectiveness will help to empower students to make the right contraception choice (whether it is abstinence or a form of birth control). Depo-Provera has nearly perfect rates of effectiveness (0.30% chance of pregnancy with typical use) and is not impacted by improper use, because it is administered by a trained physician. IUDs are also highly effective in preventing pregnancy (0.80% chance of pregnancy with typical use). Research indicates that teens that have positive attitudes about contraception are more likely to use it (6).


Abstinence-based sex education is inherently flawed because it relies on the Health Belief model that fails to take into account the unique cognitive development on process specific to adolescents. These programs rely on fear and shame to motivate students to abstain from sex. By eliminating a real conversation about contraception and its usefulness in practicing safe sex, teens do not gain the skills and confidence necessary for when they do engage in sexual activity. Comprehensive sex education is an excellent and research-based method of empowering youth to make healthy choices in regards to sex. The positive behavioral outcomes of these programs have been widely shown in the literature and offer a real and effective alternative to abstinence-based sex education.


(1) Stein R. Health bill restores $250 million in abstinence-education funds. Washington Post. March 27, 2010. Available from:

(2) The Guttmacher Institute. State policies in brief: Sex and STI/HIV infection. 2010 Available from:

(3) Siecus. Sexuality education and abstinence-only-until-marriage programs in the states: an overview. 2010 Available from:

(4) Abstinence and Marriage Partnership. Aspire program. [cited April 15, 2010] Available from:

(5) National Cancer Institute. Theory at a Glance: A Guide for Health Promotion Practice. Part 2. Bethesda, MD: National Cancer Institute, 2005, pp. 9-21 (NIH Publication No. 05-3896). [cited April 16, 2010] Available at:

(6)Bruckner H, Martin A, Bearman PS. Ambivalence and Pregnancy: Adolescents’ attitudes, contraceptive use and pregnancy. Persectives on Sexual and Reproductive Health. 2004, 36(6): 248-257.

(7) Kirby D. Do abstinence-only programs delay the initiation of sex among young people and reduce teen pregnancy? The National Campaign to Prevent Teen Pregnancy. [cited April 15, 2010] Available from:

(8) A.C. Green Youth Foundation. Abstinence education. [cited April 16, 2010] Available from:

(9) Phelps S. Aspire CBAE 13 Themes Table of Compliance. [cited April 22, 2010] available from

(10) Steinberg L. Cognitive and affective development in adolescence. Trends Cogn Sci. 2005 Feb;9(2):69-74.

(11) Jessor R. Risk behavior in adolescence: a psychosocial framework for understanding and action. J Adolesc Health. 1991 Dec;12(8):597-605.

(12)Deputa DP, Henry DB, Shoeny ME, Slavick JT. Adolescent sexual behavior and attitudes a cost and benefit approach J Adolesc Health. 38:35-43.

(13) Steinberg L. Cognitive and affective development in adolescence. Trends Cogn Sci. 2005 Feb;9(2):69-74.

(14) The Alan Guttmacher Institute. Facts on American Teens' Sexual and Reproductive Health. [cited April 28, 2010] Available from:

(15) Rosenbaum JE. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers. Pediatrics. 2009 Jan; 123(1): e110-e120.

(16) Brückner H, Bearman P. After the promise: the STD consequences of adolescent virginity pledges. J Adolesc Health. 2005 Apr;36(4):271-8.

(17) Bandura, Albert (2001), "Social cognitive theory: An agentic perspective", Annual Review of Psychology 52: 1–26

(18) United States House of Representatives Committee on government reform, minority staff special investigations divisions, The Content of Federally Funded Abstinence-Only Education Programs. Prerpared for Rep. Henry A Waxman, December 2004. Available from:

(19) Kirby D. 10 Characteristics of effective sex and HIV education programs. The National Campaign to Prevent Teen Pregnancy. [cited April 1, 2010] Available from:

(20) Gloppen KM, David-Ferdon C, Bates J. Confidence as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health. 2010 Mar;46(3 Suppl):S42-58.

(21) Catalano RF, Hawkins JD, Berglund ML, Pollard JA, Arthur MW. Prevention science and positive youth development: competitive or cooperative frameworks? J Adolesc Health. 2002 Dec;31(6 Suppl):230-9.

(22) Advocated for Youth. Science and Success, second edition: sex education and other programs that work to prevent teen pregnancy, HIV and sexually transmitted infections. [cited April 21, 2010] Available from:

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