The following letter was sent to Nancy Pelosi and Harry Reid by a group of prominent researchers in adolescent reproductive and sexual health urging and end to funding of abstinence only programs:
Dear Congresswoman Nancy Pelosi and Senator Harry Reid,
As a group of leading scientists who have recently conducted research on adolescents, reproductive health, and abstinence-only education, we are writing to express our strong concern about increasing federal support for abstinence-only education (AOE) programs. This federal support includes monies going to states (Section 510 of the Social Security Act) and those going directly to community and faith-based organizations (the Community-Based Abstinence Education program). Recent reports in professional publications by the authors of this letter have highlighted multiple deficiencies in federal abstinence-only programs. As such, we are surprised and dismayed that the Congress is proposing to extend and even increase funding for these programs. In this letter we identify key problems with abstinence-only education. We also have attached recent scientific reports that are pertinent to the debate over these programs. We note that many of these studies have used nationally-representative data from surveys sponsored by the National Institutes of Health or the Centers for Disease Control and Prevention.
The federal programs promoting AOE have prompted multiple scientific and ethical critiques. These critiques were summarized in a January 2006 paper by Santelli, Ott and others. By design, abstinence programs restrict information about condoms and contraception – information that may be critical to protecting the health of young people and to preventing unplanned pregnancy, HIV infection, and infection with other sexually transmitted organisms. They ignore the health needs of sexually active youth and youth who are gay, lesbian, bisexual, transgendered, and questioning for counseling, health care services, and risk reduction education. Withholding lifesaving information from young people is contrary to the standards of medical ethics and to many international human rights conventions. International treaties and human rights statements support the rights of adolescents to seek and receive information vital to their health. Governments have an obligation to provide accurate information to adolescents and adolescents have a right to expect health education provided in public schools to be scientifically accurate and complete.
Rigorous evaluations of AOE programs find little evidence of efficacy for federally-sponsored abstinence education. Several weeks ago Dr. Douglas Kirby, working with the National Campaign to Prevent Teen and Unplanned Pregnancy, released a comprehensive review of prevention programs for youth (Emerging Answers 2007). This review found that none of the well-designed evaluations of abstinence-only programs presented strong evidence of an impact on abstinence behaviors. (By contrast, Kirby finds clear evidence that many comprehensive sexuality education programs, which include information on both abstinence and contraception, do help young people delay initiation of intercourse.) The large-scale Mathematica evaluation of the Section 510 program, released in April 2007, found no measurable impact on increasing abstinence or delaying sexual initiation among participating youth or on other behaviors such as condom use. This well funded and very well conducted evaluation examined four exemplary local programs, tracking youth over four years. One of the few measurable impacts of the programs was a decrease in adolescent confidence regarding the ability of condoms to prevent HIV and other sexually transmitted diseases. Similar results on program efficacy were found by Underhill, who reviewed abstinence-only programs in a spring 2007 systematic review.
Virginity pledging, one aspect of abstinence programming, appears to have little long-term benefit in preventing outcomes such as sexually transmitted infections, although prevention of these infections is a stated goal of the programs. A spring 2005 longitudinal study by Bruckner and Bearman found that abstinence pledgers, when compared to non-pledgers, experienced similar rates of sexually transmitted infection. Pledgers did delay sexual intercourse for a limited period, but when they did start having sex, they were less likely to use condoms. They were also less likely to seek reproductive health care compared to non-pledgers.
Abstinence until marriage is another stated goal of the federal program; however, evidence from the past several decades indicates that establishing abstinence until marriage as normative behavior would be a highly challenging policy goal. Teitler has shown that over the past 40 years, the median age at first intercourse has dropped (and stabilized) to age 17 in most developed countries. (more…)