Federally Funded ‘Abstinence-Only’ Education Campaigns Fail to Prevent Pregnancy and Disease Due to Flawed Approach – Sophia Barberich

Federal support for ‘abstinence-only’ and ‘abstinence-only-until-marriage’ sexual health education campaigns grew significantly under former President Bush in the early 2000’s (1). Subsequently, support for programs that educate youth about other choices, such as contraception and prevention of sexually transmitted infections (STI’s), have been without substantial federal support for many years. While teenage pregnancy and birth rates have been declining annually in the United States for almost two decades, the US still has one of the highest teen pregnancy rates in the developed world (2). This fact illustrates just one of many failures of public health programming focused exclusively on abstinence to address the needs of youth in America. In addition to strong evidence from research that evaluates the effectiveness of ‘abstinence-only’ campaigns, the failure of such an approach rests on three key components: the negative effect of psychological reactance, ignoring the context in which decisions about sex are made, and an underlying policy that is laden with values and morals instead of unbiased scientific information that addresses the actual behavior of teen youth in America.

Early in his first term, President Obama attempted to eliminate funding for ‘abstinence-only’ programming and increase funding for more comprehensive sexual health education campaigns. The Obama Administration’s preferred programs included education on preventing pregnancy and STI’s through the use of contraceptives, in addition to promoting abstinence (3). Their effort was, in part, a reaction to research showing that ‘abstinence-only’ campaigns failed to have a significant positive effect on youth’s sexual behavior. A report from Mathematica Policy Research found that participants in four programs had just as many sexual partners as those who did not participate and had sex for the first time at the same median age as non-participants (4). However, despite the President’s best efforts, Congress pushed hard to restore the funding (roughly $250 million over five years) for programs focused exclusively on encouraging youth to practice abstinence (5).

Sexual health education in the US has always been a highly politicized and controversial issue. Supporters of strict ‘abstinence-only’ campaigns argue that educating youths about contraceptives, STI’s, and HIV, encourages them to have sex, and more of it. On the other side of the argument, those in support of more comprehensive sexual health campaigns contend that without educating youth about safe-sex practices, we will inevitably leave them vulnerable to pregnancy and disease. Studies show that many youth in America choose not to abstain from sex until marriage. Knowing this, how can we refuse to educate our youth in a way that best equips them for when and if they choose to become sexually active?

In order to better understand the conflicting positions on ‘abstinence-only’ education, it is important to review the language included in federal Title V, Section 510 Programs. Funded curriculums are required to:

· Have as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;

· Teach abstinence from sexual activity outside marriage as the expected standard for all school-age children;

· Teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;

· Teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity;

· Teach that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects;

· Teach that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents and society;

· Teach young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances;

· Teach the importance of attaining self-sufficiency before engaging in sexual activity (4).

This definition, by which all federally funded ‘abstinence-only’ programs must adhere, proves dangerously narrow with regards to the proven sexual behaviors of youth today. More importantly, however, by imposing upon youth that they adhere to such strict standards as it pertains to sexual behavior, psychological reactance is evoked.

Psychological Reactance

The psychological reactance theory proposes that when one’s freedom or autonomy is threatened, like, for example, when one is told what to do or what not do, the person becomes provoked to reestablish the threatened freedom. The social-science theory is comprised of four parts: perceived freedom, threat to freedom, reactance, and restoration of freedom (6). This theory highlights the underlying flaw in the ‘abstinence-only’ approach: by telling youths not to have sex until marriage, it threatens their freedom. If, instead, the approach provided youth with options with which they were able to make their own informed decision, the campaign might prove much more effective. By not providing choices and by demanding that abstaining from sex is the only way to be certain to avoid pregnancy and disease, youth are compelled to want to rebel against the demand.

As Jack W. Brehm states, “Freedom of behavior is a pervasive and important aspect of human life” (7). With a subject as important as sexual education, we cannot fail to effectively communicate with the youth of today. We must therefore tailor our approach in a way that is more realistic and that better encourages youth to make responsible decisions for themselves. Whether or not youth restore their freedom by choosing to have sex, the current approach creates a “knowledge vacuum” – leaving them under informed and at risk should they engage in sex. It should be noted that ‘abstinence-only’ campaigns have not been proven to negatively increase youth sexual behavior, however, few short-term benefits and no lasting, positive impact has been observed through evaluation of 11 programs in a number of states across the US (8).

Context is everything

The second failure of the ‘abstinence-only’ approach is the lack of consideration for the context in which decisions about sex are made. As Dan Ariely explains in his book, Predictably Irrational, decision-making, especially in moments of sexual arousal, is considerably compromised and is indeed irrational. According to Ariely, sexual arousal is a powerful, irrational force and therefore we cannot expect that all youth are going to remain abstinent until marriage. Researchers agree. He goes on to say, “One this is sure: 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. Whatever lessons we teach them, we need to help them understand that they will react differently when they are calm and cool from when their hormones are raging” (9). This clearly highlights the compromised nature of decision-making as it pertains to sex. An approach to education youth about sex that does not take this into consideration is inevitably going to fail. Therefore, we must instead create programming that addresses the inherently complex world in which decisions about sex are made. There are a series of charged moments that take place before two people actually have sex and it is important that we attempt to address how to navigate these decisions in our communications to youth.

Research confirms that American youth are engaging in sex at younger ages and delaying marriage until later ages, as compared to the 1970’s. The median age at first intercourse for women is 17.4 years and median age at first intercourse for men is 17.7 years. The median age at first marriage for women is 25.3 years and the median age at first marriage for men is 27.1 years (10). This describes the context in which our youth are living. When our approach does not take into consideration the context of our youth’s reality, we risk to have our message continue to go largely unheard and prove ineffective.

An important social-science theory called the Fundamental Attribution Error describes the tendency to overvalue internal personality characteristics to explain someone’s behavior versus taking into consideration the external situational factors. An ‘abstinence-only’ approach makes the mistake of not placing enough emphasis on the situational factors that come into play when an individual decides to have sex. It also risks for youths to feel like they’ve failed when they do not abstain from sex, even when it was their intention to do so. Why then should we not equip our youth with knowledge about how to make the most safe and informed decisions? By failing to include essential information about the context in which decisions about sex are made, we leave them helpless. Instead, we could empower them with information that will help them to make confident decisions about how to behave.

How you say it is just as important as what you’re saying

Abstinence, as used in government policies and local programs, is frequently described in moral terms using words like “chaste” or “virgin” (10). While it is absolutely acceptable for people to view abstinence as a moral or religious issue, it should not be in the interest of the government to frame the issue as such. Rather, it is a public health issue and should be addressed in language that is not morally suggestive. Language should be accurate and unbiased.

Looking closely at the definition for all federally funded ‘abstinence-only’ campaigns, we see just how unscientific the message is. The fact that programs must “teat that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects,” is absurd, not only because it is factually incorrect, but that it is defining sexual behavior in explicitly moral terms (4). The definition also says that all programs must “teach that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents and society” (4). This language is inappropriate to use on behalf of federally funded public health campaigns that are not in a position to promote or imply moral or religious tones. Additionally, these messages are likely to evoke psychological reactance especially among people for whom religious is not a driving force in decision-making in regards to sexual behavior.

Many ‘abstinence-only’ campaigns include a component referred to as a “virginity pledge” (11). A “virginity pledge” is a pledge youth can choose to take, which says they will remain abstinent until marriage. In theory, this technique could be seen as a way of evoking labeling theory, which suggests that the language we use to identify ourselves can have an effect on behavior. However, studies show that youth who break their pledge are one third less likely to use contraception than non-pledgers since they are unaware of contraception methods (11). This illustrates another shortfall of the ‘abstinence-only’ campaign to engage youth in a meaningful way. It is important to use language that is free from moral or religious undertones in the classroom as not to alienate people based on their beliefs. Also, it is in direct opposition to our nation’s founding thesis of separation of church and state.

As ethicist Arthur Caplan summarizes, “In short, the idea that teens will remain celibate until they marry – and that they don’t need information about sex – says much more about the values and fantasies of the people who are promoting these policies than it does about teens” (12). If we are to expect that our teens will behave as young adults, then we must treat them as such. We must also frame the issue in neutral terms. Empowering teen youth through accurate and unbiased knowledge allows them to assess the risks and behave accordingly. It is important to emphasize that abstinence is a worthy pursuit. It is, however, not sufficient in and of itself.

Comprehensive sexual education

A comprehensive sexual health education campaign promotes abstinence as one way to avoid unwanted pregnancy and disease, in addition to informing youth about contraceptives and how to practice safe sex. In other words, an approach that focuses on prevention instead of denial. Research shows that a comprehensive approach is more effective than an ‘abstinence-only’ approach and should therefore be better supported through federal funding. American families concur. A 2004 poll conducted by NPR, the Harvard Kennedy School and the Kaiser Family Foundation shows that the plurality (46%) of Americans polled believe that the most appropriate approach to sexual health education is one that teaches that while abstinence is best, some youth do not abstain, so schools should also teach about condoms and contraception (13).

An intervention for a campaign along these lines would draw, in part, upon the Social Norms Theory for support. The Social Norms Theory (SNT) makes the assumption that individuals often incorrectly perceive or exaggerate the beliefs or behaviors of their peers to be different from their own (14). In order to address these misperceptions, SNT proposes to promote existing positive behaviors in a community that help to strengthen healthy attitudes and behaviors. The SNT is a valuable theory to use to form the basis of a comprehensive approach because it sends positive messages about how people are actually behaving within a community. Reinforcing positive messages provides the opportunity to better inform a community about themselves while not telling people explicitly what to do.

Perkins and Berkowitz, two notable social psychology researchers, have conducted considerable research among college students and their behaviors around drinking alcohol. Research has lead them to believe that social norms are inextricably linked to human behavior (15). They argue that social norms of a given community are often misperceived and therefore people are acting in accordance to misperceived norms. For example, if teen youth believe that the majority of their peers are having sex at a young age (while in fact the majority are waiting until they are older), youth will generally be more likely to engage in sexual behavior at an earlier age.

The first critical component of the SNT requires that the actual and misperceived social norms of a given community or population be evaluated. Researchers are able to determine the baseline for where and how an intervention can be implemented based on an initial assessment of social norms. For a comprehensive approach to sexual health education, an evaluation of the actual and misperceived social norms around sexual behavior must first be established. Survey questionnaires and one-on-one interviews are appropriate methods that can be used to elicit the beliefs and behaviors of teen youth sexual behavior. Once data has been collected, researchers look to determine whether there are any misperceived social norms within the population. If there are not any existing misperceptions, the SNT would not be an effective theory upon which to base an intervention. The SNT is most useful when there is a distinct disconnect between perceived social norms and actual social norms. Given a scenario where there are misperceptions among the surveyed youth, it is critical to understand what they are, whether the majority of the population holds them, and what is their effect on the community.

Next, the intervention would look to determine what healthy behaviors exist among the youth surveyed that could be strengthened through an intensive education campaign. Assuming that the majority of youth are practicing safe sex, do not have STI’s, and have a low teen pregnancy rate, this data could be used as support to bolster a sexual health curriculum. Such a campaign would be addressing the “pluralistic ignorance” of youth by recalibrating their attitudes and beliefs about the sexual behaviors of their peers – ultimately strengthening existing healthy sexual practices. In this example, the SNT would be an important component used to help inform the community about how people are actually behaving. It would inadvertently encourage them to do the same, because we know that people are influenced by social norms. Instead of coming from a place of judgment, the SNT can be a gentle nudge to practice healthy behaviors. In addition to supporting communications with social norms, the campaign would focus on encouraging safe sex through abstinence-promotion, factual information about currently available methods of contraception, STI’s, and HIV.

Another important aspect of a comprehensive approach to sexual health education is to address the role of relationships. Little attention is currently given to this topic, while it is at the crux of human sexuality. Humans are inherently social creatures. Humans seek intimacy and this desire can be part of expressing sexuality. Whether or not a youth chooses to have sex, he or she may choose to have a romantic relationship. Providing some understanding of how to develop and maintain a healthy and safe relationship is of paramount importance, especially at a young age. An existing campaign called ‘Stay Teen’ emphasizes the role of relationships and discusses some important elements such as communication, trust and respect.

Stay Teen does an excellent job of making information about all topics related to sexuality readily available on its website. It relies, in part on the SNT, as it uses factual information about teens to encourage healthy behavior. For example, it states, “Sometimes it seems like everyone is doing it…especially if you’re not. But less than half of teens in high school (only 42% of girls and 43% of boys) have had sex. That means that more than half of all high school students are virgins” (16). It also provides examples of reasons why some teens are choosing not to have sex such as, waiting for the right guy or girl, got better things to do with my time, don’t want to catch an STI, and just don’t feel like I’m ready (16). Providing realistic, practical information like this in a friendly, youthful, and esthetically pleasing format makes Stay Teen an attractive destination for youth to come to gather information about sex.

In order for us as Americans to be able to enjoy fewer unwanted teen pregnancies and lower rates of STI’s, our approach to sexual health education must be starkly different from how it has been in the past. Former approaches focused solely on abstinence have been proven to fall short of our mission: to keep our teens safe. They have relied on weak theories for support and have not been attuned enough to the needs of our youth. A comprehensive approach promises to be more successful, but a successful one must draw from multiple social and psychology theories in order to form a web of support. This kind of approach will more effectively communicate with our children, nieces, nephews, and neighbors in a way that treats them with respect, maturity and consideration.

REFERENCES

1. United States House of Representative Committee on Government Reform – Minority Staff Special Investigations Division. (2005). The Content of Federally Funded Abstinence-Only Education Programs. Washington, D.C.: United States House of Representative Committee on Government Reform – Minority Staff Special Investigations Division, Prepared for Rep. Henry A. Waxman.

2. Kirby, Douglas. (2002). Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing. Journal of Sex Research.

3. Meckler, Laura. (2009, May). Budget Widens Teen-Pregnancy-Prevention Efforts. The Wall Street Journal. Accessed at: http://online.wsj.com/article/SB124171750523696797.html

4. Mathematica Policy Research Inc. (2007). Impacts of Four Title V, Section 510 Abstinence Education Programs. Princeton, N.J.: Mathematica Policy Research Inc.

5. Stein, Rob. (2010, March). Health bill restores $250 million in abstinence-education funds. The Washington Post. Accessed at: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/26/AR2010032602457.html

6. Brehm, S. S., & Brehm, J. W. (1981). Psychological Reactance: A Theory of Freedom and Control. Academic Press.

7. Brehm, J. A theory of psychological reactance. New York: Academic Press, 1966.

8. Hauser, Debra. (2004). Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact. Washington, D.C.: Advocates for Youth.

9. Ariely, Dan. Predictably Irrational. New York: HarperCollins Publishers, 2009.

10. Santelli, John et al. Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health 2006; 72-81.

11. Healthy Teen Network. (2006). Abstinence-Only-Until Marriage Programs. Washington, D.C.: Healthy Teen Network.

12. Somit, Albert. From Human Nature to Public Policy: A Case Study in Sex Education. Philadelphia, Pennsylvania, 2009.

13. Kaiser Family Foundation, National Public Radio, Harvard University. Sex Education in America. Menlo Park, CA: Kaiser, 2004.

14. Berkowitz, AD. Applications of Social Norms Theory to Other Healtha dn Social Justice Issues. Chapter 16 in HW Perkins (Ed). The Social Norms Approach to Preventing School and College Age Substance Abuse. San Francisco, CA: Jossey-Bass, 2003.

15. H. Wesley Perkins. Department of Anthropology and Sociology, Hobart and Williams Smith Colleges. A Brief Summary of Social Norms Theory and the Approach to Promoting Health. 2006.

16. The National Campaign to Prevent Teen and Unplanned Pregnancy. StayTeen. Washington, D.C.: The National Campaign to Prevent Teen and Unplanned Pregnancy. www.stayteen.org