Monday, December 20, 2010

Abstinence-Only Education Doesn’t Work, So Here’s What We Should Do About It – Catherine Hummel


The United States has continued to support and fund abstinence-only education as the appropriate way to address adolescent sexual health and behavior. How to best approach adolescent sexual behavior is one of the most controversial topics among politicians, public health professionals, teachers and parents. Rising rates of pregnancy and sexually transmitted diseases among the teen population are problematic and public health professionals continue to work toward finding interventions that are effective in reducing these rates. The sexual behavior of teens is influenced by a multitude of factors which include environmental, socioeconomic status, family origin, and values; however most interventions have focused on health education (1).

Abstinence only education is defined by eight specific guidelines. Examples of these are: teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children; teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases and other associated health problems; teaches that a mutually-faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity; teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects (1). The guidelines were created as part of the welfare reform act of 1996 (1). If states wish to receive federal funding for abstinence only education they must follow the guidelines for their teachings.

Abstinence-only education seems to follow the principles behind the Health Belief Model. Many public health interventions follow this model, with the assumption that once you educate individuals on the negative consequences of a certain behavior they will not behave that way. Through this model, it is assumed that personal beliefs or perceptions about a disease or consequence play the biggest part in an individuals’ health behavior decision-making. Adolescence is a unique time in which most decisions made are driven by emotional desire and many adolescents behave as if the benefits outweigh the costs. It is during this time that teens begin to experiment with drugs, alcohol and sex as they begin to form their identity. They are also more likely to rebel against authority. Abstinence-only education is ineffective in communicating to adolescents in a way that responds to their developmental changes. Additionally, it has been shown to have no quantifiable effect on teenage sexual behavior and may actually increase the incidence of risky sexual behavior among teens (2). This type of education violates young people’s basic rights by withholding information about condoms and contraception, does not acknowledge the environmental factors that influence behavior and assumes inaccurately that sexual behavior is rational.

Critical Argument 1- Misleading and Withholding Information

Public health professionals and advocates for adolescents believe that teens’ have a right to medically-accurate, comprehensive information that enables them to make informed, healthy decisions around their sexual health. One of the fundamental flaws of abstinence-only education is the rejection of this right. One report found that over 80 percent of abstinence-only curricula contain false, misleading or distorted information about reproductive health (3). It misrepresents factual information about the effectiveness of condoms as a birth control method, risk of abortion, blurs religion and science, and reinforces stereotypes about girls and boys (3).

Abstinence-only education promotes abstinence from all sexual activity until marriage as the only way to reduce risks of pregnancy, disease and other consequences of sex (3). A dramatic consequence of the abstinence-only message is through promotion of rejection of all sexual activity, the adolescent begins to desire to do exactly the opposite. The Theory of Psychological Reactants is used to describe the way in which individuals respond to a perceived threat to freedom. Freedom is measured by choice, and in this case, whether an adolescent can choose to or choose not to have sex. The way in which people resolve the threat to their freedom is by doing the exact opposite behavior. The more abstinence-only stresses denial of sex the more sex the adolescent will desire to do; producing the exact opposite of the intention the message tries to promote. One could say that abstinence-only is actually encouraging sexual behavior among adolescents and provides them with no information on how to protect themselves from pregnancy or sexually transmitted diseases.

Abstinence-only leaves no room for adolescents to meaningfully discuss and share their values and perspectives (4). Without this, adolescents are denied the opportunity to determine for themselves how they want to behave sexually. Abstinence-only fails to provide a significant measure of sexual health information to adolescents, despite the fact that they are capable of both understanding and reflecting upon such information (4). It is crucial that adolescents receive accurate, relevant and comprehensive information in order to strengthen their decision-making skills (4).

Self-efficacy is a very important concept when thinking about health behavior. Abstinence-only demonstrates zero tolerance in terms of sexual behavior, either you can abstain or if you don’t, you are doomed for tremendous negative consequences and essentially that you have failed yourself as an individual. By avoiding educating young people about their options around sexual intercourse and relationships, abstinence only programs fail to teach and promote self-efficacy. The development of self efficacy is vitally important not just in terms of sexual behavior but all health behaviors. In teaching abstinence as the only way to avoid sexually transmitted diseases and pregnancy, students who are not practicing abstinence are left with a feeling of self doubt in their own attempts to avoid the negative outcomes of intercourse. Abstinence only fails to provide accurate, comprehensive information about sexual health, it stigmatizes sexually experienced adolescents and excludes gay, lesbian, bisexual, transgender and questioning youth by emphasizing marriage as the expected standard of when one can experience sex (6).

Critical Argument 2- No Consideration of the Environment

Another failure of abstinence-only is the disregard for the environmental factors that may influence health behavior. It is unrealistic to assume that all teens are not going to have sex. Adolescents today are constantly exposed to sex and multiple forms of sexual content through various media. The socio-ecological model stresses the importance of considering environmental factors when studying patterns of behavior (5). In doing this, one is able to develop effective interventions to change behavior. By virtue of not considering the environmental factors that influence sexual behavior, abstinence only was destined to fail.

Media influence plays a very large part in shaping adolescents sexual attitudes and behaviors. One research study established a positive relationship between exposure to sexual content on television and teen pregnancy (7). Teens that were exposed to high levels of sexual content on television were twice as likely to experience a pregnancy, compared to those with low level exposure (7). Mention of the risks or responsibilities of sex, including pregnancy, sexually transmitted infections and condom or contraceptive use rarely occurs in television programs (7). The media is tremendously influencing teen sexual behavior and neglecting to inform teens how to practice safe sex. Abstinence-only puts them in increased risk by remaining silent on addressing contraception in its programs.

Social expectations theory helps us to understand how people perceive normative behavior and social norms. The normative behavior around us deeply impacts the way we perceive our world and when we observe normative behavior it seems permissible, regardless of consequences. Television increases the risk of teen pregnancy by encouraging lax attitudes toward the need for contraceptive use and normalizing risky sexual behavior. In addition to the media, adolescents are influenced by their peers to varying degrees. Relationships with peers are an essential component of growth. However, research has shown that adolescents’ conformity to negative peer norms may be a major risk factor linked to negative outcomes ranging from delinquency and substance abuse to risky sexual behavior (8). Adolescents are greatly influenced by their peers and social norms and therefore will behave according to expectations. Abstinence-only programs oppose every other message a teen receives outside of school and through the media, failing to equip teens with how to handle peer pressure, relationships, how to communicate effectively with partners and no information on safer sex practices.

Critical Argument 3- Sexual Behavior is not Rational

Most social science theories assume that human health behavior decision-making is rational. This greatly impacts how consequent interventions are developed. Abstinence-only education assumes that if teens are taught the negative consequences of a sexual behavior, using fear tactics, they will not engage in such behavior. As previously discussed in evaluating the impact of environmental factors on a teens decision to engage in sexual activity, teens rarely make decisions regarding their sexual health based on a rational decision evaluating costs and benefits.

Not only are teens irrational in their behavior, the specific region of the brain, the amygdala, which is responsible for instinctual reactions is not yet fully developed. The frontal cortex, the area of the brain that controls reasoning and helps us think before we act, develops later (9). This is important to understand about adolescent behavior, it is almost never rational. They often behave in an impulsive, irrational or dangerous way (9). Author Dan Ariely, evaluated the influence of arousal on sexual decision making. Teens are already making decisions based on instinct, add arousal to the mix and it seems impossible to address safe sex practices. In the heat of passion, most individuals are unable to “just say no” and/or put on a condom (10). Most of the appeal of sex is the fact that it is often not planned and occasionally just happens. Ariely goes on to explain that “there are most likely many situations where teenagers simply won’t be able to cope with their emotions” (10 ). Abstinence-only education not only fails to provide teens with information on how to cope with peer pressure but provides them with no skills on what to do in potentially risky situations.

It also fails to help teens assess and understand a potential risky situation. The human perception of risk is very low. As demonstrated through the Law of Small Numbers, people overestimate the implications of a small sample size. Even though they may see one person that something happens to, maybe one student in school becoming pregnant or one person being upset about engaging in sexual behavior, adolescent’s think that it won’t happen to them. Adolescents also possess a sense of invincibility. This belief leads to the perception that somehow the consequences of high-risk behavior will not happen to them (11). Media exposure further influences and creates the idea that there is little risk to sex without contraceptive use (7).

Resolving to tell teens never to have sex is an unrealistic approach to addressing teen sexual behavior. The silence about sex and sexuality is violating the right of teens to medically-accurate, comprehensive information that enables them to make healthy, informed decisions. Research has failed to demonstrate that abstinence-only programs bring about the desired behavioral outcomes at which they aim-no evidence of delay in sexual activity and/or reductions in unintended pregnancies and sexually transmitted diseases (6). There is a solution.

Proposed Intervention- Comprehensive Sex Education

The purpose of school-based sexuality education is to help young people transition as safely as possible into adulthood and enable them to grow into sexually healthy adults. The International Planned Parenthood Federation has created seven essential components of comprehensive sex education: gender, sexual and reproductive health and HIV, sexual rights and sexual citizenship, pleasure, violence, diversity and relationships (12). Comprehensive sex education has demonstrated effectiveness in helping young people delay the onset of sexual activity, reducing the frequently of sexual activity, reducing the number of sexual partners and increasing condom and contraceptive use (13). These are the results of providing medically-accurate, comprehensive information, consideration of environmental factors that influence sexual behavior, and acceptance of the irrationality of teen sexual behavior.

Component 1- Presentation of Medically-Accurate, Comprehensive Information

Comprehensive sex education provides age-appropriate, medically-accurate, comprehensive information on sex, sexuality, relationships and contraceptive methods. It does still present information about abstinence; however it does not present this as the only appropriate behavior. Sexually mature and maturing adolescents are entitled to accurate and honest information that respects their sexual needs and rights (13). It presents accurate information regarding effectiveness of condom use, how to use a condom, the various forms of birth control methods and their effectiveness, discussions about healthy relationships and teen dating violence and it also addresses and respects the needs of gay, lesbian, transgender, bisexual and questioning teens.

By including information about sex, sexuality and contraception it eliminates the prospect of creating psychological reactants. Teens are given the opportunity to decide for themselves how they wish to behave and they are not criticized for choosing to or choosing not to engage in sexual activity. They are actually granted freedom of choice through this form of education. Again regarding the Illusion of Control Theory, adolescents regain a sense of control in thinking they have a choice in determining their sexual health behavior. Furthermore, it actually promotes self-efficacy, empowering teens to act responsibly. Self efficacy can be defined as the belief in your own ability to do whatever it is you set out to do. Comprehensive sex education empowers teens to believe that they can protect themselves from pregnancy and sexually transmitted infections and enables them to wish to do so.

It also empowers them to respect themselves, their own values and creates a space in which they can discuss their feelings. Comprehensive sex education supports a teens need to balance their own values with those of their family, society and culture. It also addresses cultural competency and acknowledges that teen pregnancy rates differ among minority populations. Comprehensive sex education provides a safe space for adolescents to grow and transition into adulthood. It is necessary to address the needs of teens, giving them a space to ask questions about their sexual health and increase the likelihood that they will become a sexually healthy adult.

Component 2- Considering Environmental Factors that influence Adolescent Sex

Comprehensive sex education is more effective than abstinence through acknowledging the environmental factors that influence sexual behaviors among teens. Socioeconomic status, family values and morals are some of the factors that influence health behavior. An effective comprehensive sex education program would also address the influence of drug and alcohol abuse on risky sex behaviors.

During the period of adolescence, a majority of teens are beginning to experiment with sex, drugs and alcohol. It is essential to understand the extent to which alcohol and drugs influences sexual behavior. Research has confirmed a positive association between alcohol abuse and sexual behaviors among teens (14). According to the 2007 Youth Risk Behavior Survey, 22.5% of currently sexually active high school students had drunk alcohol or used drugs before their last sexual intercourse (15). Adolescents already possess a sense of invincibility and with the aid of alcohol and drugs can develop invulnerability to the nervousness and hesitation that may arise as a teen attempts sexual intercourse. This suggests that sexual behavior among adolescents is not occurring in a vacuum. Parents and teachers must be aware of the impact of prom and house parties and other important/monumental events of high school that give rise to opportunities to use alcohol and drugs and thus engage in sexual behavior.

These programs create a safe space for adolescents to discuss their needs and wants and concerns. The program is implemented in a way in which the teens are equals, the teacher or instructor does not come from a place of authority and refrains from ever promoting one or another sexual behavior. Simply providing the information and allowing the teen to determine for themselves appropriate behavior would hopefully encourage teens to be more aware about their alcohol and drug use.

Since the media, as well as abstinence-only education fails to address contraceptive use, it is critical that comprehensive sex education provides information about safer sex practices. It is difficult to compete with the sex industry and mass media as public health professionals. However, comprehensive sex education attempts to provide all of the necessary information to enable teens to protect themselves from pregnancy and sexually transmitted diseases.

Component 3- Accepting the Irrationality of Adolescent Sexual Behavior

Comprehensive sex education acknowledges not only the irrationality of adolescence, but the irrationality of sex. Components of comprehensive sex education programs are designed to help teens prepare for placement in these situations.

One important component of developing self efficacy is by providing teens the tools to combat media and peer influence through role-playing. Comprehensive sex education helps students practice what they would say if presented with a situation in which they would be pressured to have sex or to use alcohol and drugs. During these sessions, students are able to understand how to form rational decisions and consider consequences, relationship dynamics, and risk (16). This is also helpful when thinking about the influence of arousal on decision-making. Abstinence-only does not prepare teens for understanding the magnitude of their emotions. Role playing enables teens to practice conversations about safe sex and helps them to understand that they may react differently when they are calm and cool from when their hormones are raging (10). As author Dan Airely states, “If we don’t teach our young people how to deal with sex when they are half out of their minds, we are not only fooling them; we’re fooling ourselves as well” (10).

Furthermore, comprehensive sex education discusses all forms of sexual behavior. Masturbation, oral sex, vaginal sex and anal sex are discussed and the risks each act poses is examined. Students are presented with factual information with the hope of eliminating any confusion with the perception of risk. Other ways in which comprehensive sex education aims to combat the distorted perception of risk is by bringing in teen mom speakers or HIV/AIDS infected persons to share their story in class. What seems to be more effective is to present one compelling story that teens could potentially identify with, in order to alter perceived susceptibility.


Abstinence-only is not only ineffective but shows no impact on adolescent sexual behavior. It is having harmful effects on the sexual health of United States teens by failing to provide them with information to make healthy, informed decisions about their sexual health and safer sex practices. By neglecting to give them information, failing to acknowledge environmental factors and assuming that sexual behavior is rational we are failing to enable teens to have a healthy transition into adulthood. Comprehensive sex education provides a means to which we can effectively address teen sexual behavior. It provides them with the skills and tools they need to make informed choices about their behavior and to feel confident and competent about acting on these choices.


(1) Perrin KK and DeJoy SB. Abstinence-Only Education: How We Got Here and Where We’re Going. Journal of Public Health Policy: 2003;24(445-459).
(2) Mathematica Policy Research Inc. Impacts of Four Title V, Section 510 Abstinence Education Programs. Princeton, NJ: April 2007.
(3) Waxman, HA. The Content of Federally Funded Abstinence-Only Education Programs. United States House of Representatives. December 2004.
(4) Kornman AJ. A Critique of the Abstinence-only Approach: A Consideration of Adolescent Decisional Development and Democratic Sexual Citizenship. University of Pittsburgh 2008:1-99.
(5) McMurray A. Community Health and Wellness: A socio-ecological approach. Marrickville, New South Wales: Elsevier Australia, 2007.
(6) Alford, S. Abstinence-Only-Until-Marriage Programs: Ineffective, Unethical and Poor Public Health. Advocates for Youth. 2007.
(7) Chandra A, Martino SC, Collins RL, Elliott MN, Berry DE, Does Watching Sex on Television Predict Teen Pregnancy? Findings From a National Longitudinal Survey of Youth. Pediatrics 2008;122:1047-1054.
(8)Allen JP, Porter MR and McFarland C. Leaders and followers in adolescent close friendships: Susceptibility to peer influence as a predictor of risky behavior, friendship, instability and depression. Development and Psychopathology 2006;18:155-172.
(9) The Teen Brain: Behavior, Problem Solving and Decision Making. American Academy of Child and Adolescent Psychiatry. 2010.
(10) Ariely, D. Predictably Irrational. New York, NY: HarperCollins, 2008.
(11) Wickman ME, Anderson NLR, Greenberg CS. The Adolescent Perception of Invincibility and Its Influence on Teen Acceptance of Health Promotion Strategies. Journal of Pediatric Nursing 2008;23(6):460-468.
(12) IPPF Framework for Comprehensive Sexuality Education. International Planned Parenthood Federation. January 2010.
(13)Comprehensive Sex Education: Research and Results. Advocates for Youth. Sept 2009. <>
(14) Rashad I and Kaestner R. Teenage sex, drugs and alcohol use: problems identifying the cause of risky behaviors. Journal of Health Economics 2004;23:493-503.
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance-2007. Atlanta, GA, 2007.
(16) A Lesson Plan From Life Planning Education: A Youth Development Program. Advocates for Youth. 2008 <>

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