THE RELIGIOUS CONSULTATION
on population, reproductive health & ethics

New York Times, June 1, 2004

Abstinence-Only: Does It Work?

BYLINE: By JANE E. BRODY

Sex education in American middle and high schools has taken on new meaning. At institutions that accept government money, teachers must advocate abstinence until marriage as the only certain way to prevent unplanned pregnancies and sexually transmitted diseases, and may not mention contraception except to point out the failure rates of various methods.

On its face, this may seem perfectly logical, because if a teenager refrains from sexual activity, it is highly improbable that either pregnancy or an S.T.D. can result. But is the policy realistic?

Experts who have spent decades studying teenage sexual activity have gathered ample evidence to refute the basic premise of abstinence-only sex education. They say this approach is not adequate to protect youngsters from unwanted pregnancies and disease.

''There is nothing in any peer-reviewed scientific journal to suggest that teaching abstinence-only is effective in getting teens to delay sexual activity,'' said one expert, Cynthia Dailard, a lawyer and senior public policy associate at the Alan Guttmacher Institute, a nonprofit organization devoted to advancing sexual and reproductive health and rights.

In contrast, Ms. Dailard has reported, considerable evidence shows that sex education promoting abstinence, but also providing information on the benefits of contraception for those who do not remain abstinent, does delay the start of sexual activity. Such programs also reduce the incidence of teenage pregnancies and S.T.D.'s, she has found.

Furthermore, she and others who have reviewed the findings of many carefully done studies are worried about the effects of the abstinence-only approach on teenagers who do become sexually active. If teenagers are given no information about birth control, or only negative information, the studies indicate that they are less likely to use any method of protection, and are thus more likely to become pregnant or contract a sexually transmitted disease than are teenagers who are well informed about condoms and other contraceptive options.

One national study, published in 2001 in The American Journal of Sociology, found that while some teenagers who promised to remain abstinent until marriage delayed sexual activity by an average of 18 months, they were more likely to have unprotected sex when they broke their pledge than those who had never pledged virginity in the first place.

And Columbia University researchers reported in March that in a national study of teenagers who pledged not to have sex before marriage, a majority did not live up to their vows. The adolescents also developed sexually transmitted diseases at about the same rate as teenagers who had not made virginity pledges.

Abstinence-only advocates say that to teach abstinence along with information on contraception is to provide a mixed message: Don't do it, but if you do, protect yourself.

Tobe Goldberg, a parent and member of the Human Sexuality Curriculum Advisory Committee in Maple Grove, Minn.., refutes this belief with the following fictional example of what she regards as short-sighted thinking: ''My son and I were walking along the street. He began crossing against the light. Since I know that what he doesn't know can't hurt him, I didn't say anything. I wish I could have him back now.''

Another concern is how teenagers define sex. Programs that advocate abstinence do not specify what constitutes sexual activity. To many teenage girls, having oral or even anal sex means they are still virgins. But though they cannot become pregnant this way, they are still at risk for sexually transmitted diseases.

The Government's View

The push for abstinence-only sex education began in 1998 with the implementation of the Welfare Reform Act of 1996. That law offered states matching money for school programs that taught youngsters to wait until marriage to initiate sexual activity and that said nothing about the usefulness of contraception.

Although authorization for the law expired in 2002, Congress has continued to provide interim financing for it and has allocated more money to myriad community organizations that teach abstinence-only. Over half a billion tax dollars have been spent on abstinence-only education since 1996 . In this fiscal year, the government is spending $140 million on this approach, and President Bush is asking for $273 million for fiscal 2005.

Advocates of abstinence-only education often say it has resulted in a decline in teenage pregnancy and childbirth, pointing to the fact that the rate of teenage pregnancies (births plus abortions) is at its lowest level in 30 years.

But that rate peaked eight years before abstinence-only education came to the fore and has been declining steadily ever since. And children born to teenage girls still account for 11.5 percent of all births in the United States.

From 1991 to 2001, the proportion of American teenagers who had had sex decreased, according to a 2002 study by the Centers for Disease Control and Prevention. During the same period, condom use among sexually active teenagers increased by 19 percent for boys and 35 percent for girls, the study found.

According to research by the Guttmacher Institute, 25 percent of a decline in teenage pregnancies between 1988 and 1995 resulted from a drop in the proportion of youngsters who had ever had sex, but 75 percent of the decline was due to improved contraceptive use among those who were sexually active.

Still, the rate of teenage pregnancy in this country remains much higher than in most other developed countries. It is double the rates in England, Wales and Canada; about four times the rates in Sweden and France; and eight times the rate in Japan.

Compared with their peers in some other countries, sexually active teenagers in the United States are also less likely to use contraceptives, and when they do, they are less likely to use the most effective forms of birth control, according to data gathered by the Guttmacher Institute.

Moreover, the rates of S.T.D.'s among American teenagers is much higher than in other developed countries.

In the last decade, there were approximately 800,000 to 900,000 adolescent pregnancies a year, two-thirds of them resulting in births, and three million new cases of S.T.D.'s among adolescents. One-fourth of sexually active teenagers will have an S.T.D. before they are old enough to vote.

About one-half of unplanned teenage pregnancies result from failures to use any contraception, researchers find, and the other half from ineffective contraceptive use.

President Bush, in speaking to high school students in South Carolina two years ago, said that ''abstinence works every time,'' which is true if it is perfectly adhered to. But, as Ms. Dailard noted last December in The Guttmacher Report on Public Policy, ''People who intend to remain abstinent may 'slip' and have sex unexpectedly.''

Ms. Dailard cited a recent study by the American Psychological Association, which found that more than 60 percent of college students who had pledged virginity during their middle or high school years had broken their vow to remain abstinent until marriage.

''Researchers have never measured the typical use-effectiveness of abstinence,'' she wrote. ''Therefore, it is not known how frequently abstinence fails in the real world or how effective it is compared with other contraceptive methods.''

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