Sexual health education programs are typically described as either abstinence-only or comprehensive. Comprehensive or “abstinence-based” programs encourage abstinence as the most effective way to prevent pregnancy and sexually transmitted disease, alongside teaching about contraception. Abstinence-only policies require teaching abstinence as the “expected standard” for youth to prevent pregnancy and disease, and do not address contraception.
Abstinence-only programs often describe the choice of engaging in sex before marriage as immoral, whereas programs on the comprehensive end of the spectrum tend to explain sexual behaviors in terms of their health risk and omit judgment for personal values.
To make things complicated, any given program or policy exists somewhere on the spectrum between these two descriptions. This is one reason why it’s been so challenging for the public to determine what works and what doesn’t.
Now you ask these questions:
1. Does abstinence-only education work?
2. Is comprehensive better?, and
3. Does talking about contraception encourage teens to have sex?
“Emerging Answers 2007,” by Douglas Kirby, systematically answers all these questions.
1. No. The review found that abstinence programs consistently fail to delay the age of initiation of sex, hasten the return to abstinence, or reduce the number of sexual partners.
2. Yes. It concluded that most comprehensive programs have a long-lasting positive impact on teen sexual behaviors. Comprehensive programs can delay initiation of sex, reduce numbers of sexual partners, and increase condom and contraception use.
3. No. Absolutely no comprehensive programs were found to hasten the age of initiation or increase the frequency of sex. The author proposes this approach does not send a mixed message to youth, but is effective and realistic, particularly relevant in schools where teen pregnancy is visible to the students.
In further support of point No. 1, a federally authorized evaluation of abstinence-before-marriage Title V programs (Trenholm et al.), which received $50 million annually in federal funding for years, found that students who completed these programs were no more likely to remain abstinent as students from a control group. The two groups had similar numbers of sexual partners and students had initiated sex at the same mean age (14.9 years).
In the heat of Utah’s HB 363 debate, Gayle Ruzicka of the Utah Eagle Forum, cited a study that shows “abstinence-only is what works”. The study by Jemmot et al. did find that their “abstinence-only” intervention reduced the number of students initiating in sex compared to a control group. However, this intervention best fits our comprehensive definition, since instructors were allowed to teach “the efficacy of condoms”, were to refute “the view that condoms are ineffective,” and encouraged students to wait until they were “more prepared to handle the consequences of sex,” rather than marriage. These findings support the importance teaching contraception as part of comprehensive education.
A recent study by Stanger-Hall et al. was able to associate actual teen pregnancy rates with levels of the abstinence-comprehensive spectrum. The study rated state policies and law according to their emphasis on abstinence, and found that the more that abstinence was stressed, the higher the teen pregnancy rate. This remained true even after accounting for socioeconomics, education, ethnic composition, and family planning coverage, suggesting that the emphasis of abstinence is contributing to teen pregnancy.
Data such as these motivated the federal government to create the PREP grant, funding comprehensive education, and make clear that HB 363 would have put severe limitations on health education. However, the wording of current Utah law leaves little room for effectively communicating medically accurate methods of disease and pregnancy prevention to youth. Utah school health instruction must stress abstinence, but advocating for, or demonstrating the use of contraception is prohibited. Since there is a fine line between “teaching about” and “advocating for” contraception, educators are often uncomfortable mentioning contraception, especially since the law specifies that educators are even prohibited from answering spontaneous student questions in a way that may cross that line.
We do know that the curricula implemented by PREP fall under the effective forms of health education, and they are not allowed in Utah schools. I congratulate Utah for blocking a move towards potentially debilitating education policy, but there is still work to be done as we pursue an even healthier future for our youth. If you want to help; start locally, by supporting PREP Moab. Then, consider fighting for better Utah legislation.
Valerie Cotton is the former coordinator of the Personal Responsibility Education Program in Moab. She now works with the AmeriCorps National Civilian Conservation Corps in California.