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Abstinence-Only Education Programs and their Effect on the STD rate in the United States
Image retrieved from: www.unmarriedamerica.org/members/news/2005/August-News/abstinence_only.htm
For years, there has been an ongoing controversy about what is considered appropriate sex education in public schools. There are two known approaches to sex education in school. There is the abstinence-only until marriage approach and there is the comprehensive sex education approach (also known as “abstinence-plus.”) Traditionally, “abstinence education is defined as an education or motivational program that has the exclusive purpose of combine social, psychological, and health gains to remaining abstinent, teaches abstinence from sex outside of marriage as the expected standard, and the only certain way to avoid health risk such as STDs. Comprehensive sex education is the teaching that stresses abstinence as the only sure way to avoid STDs and pregnancy, but also provides information on “safe” sex such as contraceptives and condom use.
There have been several studies and evaluations to determine the success or failure of these abstinence-only programs and how they affect teens’ sexual behavior and in turn, the growing rate of STDs. Some of the research conducted have been sponsored by political or religious groups and don’t provide a full account of all the appropriate and accurate information available, and results of studies have been skewed by various groups to favor their view points. The only way to accurately see if abstinence-only education has a positive effect in preventing STDs and risky sexual behavior is to look at the issues people in the advocacy groups present, and then evaluate them based on scientific research in peer reviewed journals of the students enrolled in these programs.
STDs in America
One of the most terrifying and frightening public health threats today is the alarming rate and spread of STDs among young people. STD stands for sexually transmitted disease and is also commonly referred to as STI, sexually transmitted infection. Some STDs are viruses, and are therefore incurable posing a major threat to the state of the public’s health, and even the STDs that are treatable, if left unattended for too long can have serious and life threatening effects. According to the website http://www.sexedlibrary.org/stds.html, an information website sponsored by the SIECUS, there are more than 25 diseases spread through sexual activity one of which is HIV/AIDS, one of the newest and deadliest diseases around. As of 2004, there are shocking numbers related to the STD prevalence in the United States.
· There are 19 million new STD cases reported every year in the United States alone
· One half of all of these cases were among young people ages 15-24
· 65 million people live with an incurable STD
· Less than half adults ages 18-44 have ever been tested for an STD including HIV/AIDS
These numbers have grown since 2004 and are raising questions about the education students are receiving regarding sexual health. The United States has the highest STD rate of any industrialized nation and is coincidently the only one that utilizes the abstinence-only approach to sexual education. One of the problems related to the prevention of these diseases is the stigma they produce and the attitudes people have toward communicating about sex and disease that come with it. People are uninformed about types of STDs, ways they are transmitted and effective protection against them. Analysis of these programs will help confirm or disprove the popular belief that abstinence-only programs are effective in preventing the spread of these STDs.
Views of the Public
In order to understand the controversies of the two opposing programs, the advocates’ views must be considered. This often polarizing issue causes organizations to often fuse scientific evidence with moral and ethical beliefs. While each group’s purpose is to reduce sexual behavior and the spread of STDs, they make different claims to the program’s achievements and the means by which it is effective and offer evidence that sometimes is altered or biased to fit with their motives.
Abstinence-Only Until Marriage Advocates
For the most part, these groups are generally more conservative and often have a morally based, pro-life agenda as well. These circumstances often shape their bias toward a “purity” focused campaign. Abstinent-only advocates include groups such as Eagle Forum, Family Research Council, Medical Institute of Sexual Health (MISH), and the National Coalition of Abstinence Education. Two of the biggest and most active participants are the Concerned Women for America and the Heritage Foundation.
Concerned Women for America www.cwfa.org/main.asp
This organization is the nation’s largest public policy women’s organization that states they are, “dedicated to helping members across the country bring biblical principles into all level of public policy.” The website publishes many articles criticizing comprehensive sex education program and praising the success of the abstinence-only approach. Their purpose is to prevent teens from having premarital sex by instilling moral values through these programs. The rationale behind the effectiveness of this is that since abstinence is the only proven way to avoid STDs 100%, it is what should be taught to teens in school because that is the safest approach. They claim that there is a “positive response” from teens that undergo these programs. It refers to studies that say abstinent programs have cut sexual activity in half and polls that show parents want abstinence to be taught to their kids in school. The evidence supporting this though is weak as several claims are not cited, and the few studies that are cited are all from the Heritage Foundation, another conservative organization with an abstinence-only agenda. There are many accusations toward comprehensive sex education programs that they are groups that benefit from teen promiscuity such as Planned Parenthood and only advocate condom use to increase their business. It is also the belief of the Concerned Women for America and other abstinence-only groups that condoms aren’t effective in protecting against most STDs and that comprehensive sex education misleads teens to think they are completely effective.
Comprehensive Sex Education Advocates
Generally claimed by conservatives to be pro-choice and liberal, many of these advocates include groups that support women’s rights such as abortion, but also include several medical organizations. Advocates include SIECUS, Planned Parenthood, American Academy of Pediatrics, American College of Obstetricians and Gynocologists, American Medical Association, American Public Health Association, National Education Association, National Medical Association, National School Boards Association, and Society for Adolescent Medicine.
Advocates for Youth www.advocatesforyouth.org/
Advocates for Youth is a group that helps efforts to help young people make decisions about sexual health. They believe that each teen is capable of making informed decisions about sex and in order to ensure safety from STDs, it is important to provide them with medically accurate information about the physical and emotional risks of sex as well as information about condoms and contraceptives so that, if they do decide to engage in sexual intercourse, they do it by the safest mean possible. The claims made by comprehensive sex education advocates reject the notion that many abstinence-only advocates have that increased discussion of sex will lead to increased sexual activity. They also claim that with increased knowledge, there will be increased condom use, therefore, resulting in less STD transmission. The evidence cited by this and other groups come from a wide range of studies and evaluations conducted by medical researchers. The motives behind these groups are to allow teens to make informed decisions regarding their sexual health and to prevent the future spread of STDs by educating about the consequences.
Research and Evaluations of Abstinence-Only Programs
Over the years, there have been several efforts made by both groups of advocates to determine the legitimacy of the current abstinence-only programs and the effectiveness they have in preventing teen sex and STDs. According to a study conducted by Mathematica Policy Research (Trenholm et al. 2007), there were little to no differences found in the long term impact of these programs. The control group and the group going through the program showed identical sexual activity and showed no difference in the rates of unprotected sex, number of sexual partners and sexual debut. There was a slight increase of knowledge of STDs among the program group but less of a perceived effectiveness of condoms. This could be because many abstinence-only groups are vehemently against the discussion of condoms as protective factors against STDs since many STDs are capable of transmission through skin-to-skin contact such as HPV and genital warts.
There was also an evaluation of sex education programs done by Surgeon General David Satcher (2001) that concluded that since about half of American teens are sexually active, it is unrealistic to be promoting abstinence-only messages in classrooms. He instead stresses the need to increase awareness, implement interventions, and expand research to provide a foundation of promoting sexual health that is consistent with science.
Other evaluations have been done on abstinence-only programs (Christopher and Roosa, 1990; St Pierre et al, 1995; Kirby et al, 1997; Kirby, 2001), but it is difficult to measure the success of these programs these programs because of the lack of accurate measuring devices. Some reasons for this include the pre-post test designs which occur over a long period of time in which teens engaged in the study develop different attitudes towards abstinence. Another reason is that it is difficult to control for unobservable behavior and often times people with abstinent focus views will be more willing to participate in a study. It is also challenging to collect data for such a study because of the problem that present themselves during follow ups and the collection of data since teenagers are not always a reliable source of adequate information.
An evaluation conducted of both abstinence and comprehensive sex education programs (Collins et al. 2002) found that the education policy has been more focused on political and moral goals than it has on the public health outcomes. It has found that research strongly supports both the teaching of abstinence and basic health information as the most accurate ways to reduce the risk of disease. The evaluation also suggests at the end that federal funding should be directed toward teaching youths to protect themselves, especially those who are already at risk, and the means by which they can do this (i.e. condom use.)
It is obvious that there is an immediate problem in the United States with the increased rate of STDs becoming a more daunting threat every day. The main prevention method used, in the form of abstinence-only education being taught in public schools, is not working to help this cause. Other industrialized countries in Western Europe and Canada have managed to keep the rates of STDs like Chlamydia and Gonorrhea down, in comparison to the United States, by teaching comprehensive sex education curriculum and providing students in public schools with adequate information they need to protect themselves (Weinstock et al. 2000.)
Evaluations and studies have been conducted to assess the curricula and the claims that abstinence-only programs present as well as that for comprehensive sex education programs, and it has consistently been found that while abstinence-only programs aren’t necessarily harming students as some of its liberal counterparts believe, it is making no positive contribution toward the prevention of the spread of STDs. These programs are not only not changing the behavior of students in the form of reducing the number of their sexual partners, delaying sexual debut, and changing the opinions they have toward abstinence and sex, but often times lead students to believe that condoms will not help protect them. Programs that are established with a bias and are not based on complete scientific information are not adequate in producing the results necessary for tackling the STD epidemic. If students believe that condoms will not help them, as many abstinence-only programs stress, they will be less likely to use protection, and much more likely to contract STDs.
When evaluating education programs such as these, it is important to take to audience, and the nature of this evaluation into consideration. When collecting data from a group of students, especially regarding their sexual activity, it is nearly impossible to produce an adequate representation of their behavior since it produces so many stigmas. Without knowing the number teens that have been teen that have been tested for STDs and even knowing the number of people that pay attention to sex education lectures, it is nearly impossible to tell if these programs are actually serving their intended purpose, but based on the evaluations so far, abstinence-only programs are unrealistic, misinformed, and unproductive in preventing STDs by educating teens.
Christopher FS, Roosa MW. (1990) An evaluation of an adolescent pregnancy prevention program: is "just say no" enough?. Family Relations , 39:68-72.
Collins, C., Alagiri, P., & Summers, T. (2002). Abstinence only vs. comprehensive sex education: What are the arguments? What is the evidence? AIDS Policy Research Center & Center for AIDS Prevention Studies, AIDS Research Institute, University of California, San Francisco. http://ari.ucsf.edu/pdf/abstinence.pdf
Kirby D et al. (1997) The impact of the postponing sexual involvement curriculum among youths in California. Family Planning Perspectives, 29(3):100-108.
Kirby D. (2001) Emerging answers: research findings on program to reduce teen pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy.
Satcher, D. (2001). Th e Surgeon General’s call to action to promote sexual health and responsible sexual behavior. Retrieved from http://www.surgeongeneral.gov/library/sexualhealth/call.htm
St. Pierre TL et al. (1995) A 27-month evaluation of a sexual activity prevention program in Boys & Girls Clubs across the nation. Family Relations, 44:69-77.
Trenholm C, Devaney B, Fortson K, Quay L, Wheeler J, Clark M. Impacts of four Title V, Section 510 abstinence education programs: final report. Princeton, NJ: Mathematica Policy Research, April 2007.
Weinstock, Hillard, Stuart Berman, and Willard Cates, Jr. Sexually Transmitted Diseases Among American Youth: Incidence and Prevalence Estimates, 2000. Perspectives on Sexual and Reproductive Health, vol. 36, no.1, 2004, pp. 6.10.
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