Sex education: Why an abstinence-only approach is problematic

 
Young couple holding hands
(Pixabay)
By

May 22, 2019

Sex education has been a controversial subject for decades as public school officials and parents have debated the best ways to help teenagers avoid unplanned pregnancies and sexually transmitted diseases. Not all states require schools to teach sex ed. But many states require sex education instructors to discuss or stress abstinence from sexual activity, with some schools offering abstinence-only programming, which urges kids to wait until marriage and often excludes information about contraceptives.

Over the years, as academic studies have raised questions about the effectiveness of the abstinence-only approach, schools in some parts of the country have adopted so-called “comprehensive” sex education programs. These programs teach students about abstinence in addition to a range of topics, including contraception, sexual health and how to handle unwanted sexual advances.

In 2019, sex education continues to make headlines even as teen pregnancy rates continue to fall. Policymakers in Colorado, California and Alabama have pushed for big changes in the way sex education is taught there. In Colorado, a bill that would ban abstinence-only education in public schools awaits the governor’s signature. The legislation, which also requires that sex education be inclusive for students who are lesbian, gay, bisexual, transgender and questioning (LGBTQ), was “one of the most contentious battles of the 2019 legislative session,” according to the Colorado Times Recorder.

Earlier this month, the California Board of Education approved new guidelines for sex education that have sparked statewide protests, partly because they now suggest educators discuss homosexuality and gender fluidity in elementary, middle and high school.

Meanwhile, a Republican senator in Alabama introduced legislation in March that would drastically change the state’s sex education law, which currently requires teachers to emphasize that “homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under the laws of the state.” The proposed legislation would remove that requirement.

Sex education policies vary from state to state and, in some states, from school district to school district. Forty-four states as well as the District of Columbia have at least one law that addresses whether or how local schools should teach sexual health, STD prevention or HIV prevention, according to the U.S. Centers for Disease Control and Prevention (CDC).

The CDC offers a state-by-state analysis of sex education programs. It shows, for example, that as of 2016, abstinence was a required topic of instruction in states such as Arkansas, South Dakota and Texas and that 29 states, including Florida, Montana and Pennsylvania, did not require their sex education curricula to be based on medically accurate information. In some schools, teachers have been accused of inflating condom failure rates to discourage use.

For journalists covering this topic, it’s important to understand what the most recent research says about it. Below, we have gathered and summarized 11 peer-reviewed studies, some of which examine the effects of abstinence-only programs and abstinence pledges. We also have included research that looks at students’ views and experiences with sex education.

 

———————

 

Comparing programs

 

Funding for Abstinence-Only Education and Adolescent Pregnancy Prevention: Does State Ideology Affect Outcomes?
Fox, Ashley M.; et al. American Journal of Public Health, 2019.

Four researchers teamed up to look at the relationship between teen birth rates and federal funding for two types of sex education program — one that teaches abstinence until marriage and one that takes a more comprehensive approach. The main takeaway: Federal funding for neither program impacted teen birth rates overall. However, in politically conservative states, funding for abstinence-only education resulted in higher teen birth rates.

For the study, researchers built a database that included information about federal funding for both types of sex education program as well as teen birth rates nationwide between 1998 and 2016.

The authors estimate that between those years, conservative states received a total of $692 million in federal abstinence-only sex education funding. In 2008 alone, those states received more than $71 million in federal abstinence education funding, which the researchers estimate resulted in an additional 1,080 births to adolescents that year.

The researchers note that after conservative states received more than $13 million to offer a more comprehensive sex education program in 2014, the adolescent birth rate fell. “This small amount [of funding] resulted in a reduction in the birthrate of 1.87 births per 1000, potentially averting 1870 births,” the authors write.

The results, according to the authors, “suggest that efforts to encourage abstinence in the absence of providing more comprehensive information can be detrimental, particularly in conservative states, where birthrates have historically been the highest. By contrast, comprehensive adolescent pregnancy-prevention programming appears to reduce births in those states, although it has not had an impact overall, perhaps because of its lower funding levels relative to abstinence funding.”

 

Abstinence-only education

 

The Effects of State‐Mandated Abstinence‐Based Sex Education on Teen Health Outcomes
Carr, Jillian B.; Packham, Analisa. Health Economics, 2017.

Do abstinence-based sex education programs cause teen birth rates and abortion rates to rise or fall? What about the rate of acquiring a sexually transmitted disease?

In the five states the researchers studied, they found that abstinence-based sex education programs have no impact on teen and abortion rates. But the results indicate these programs might increase STD rates in states with relatively small populations.

Researchers examined Colorado, Maine, Michigan, Washington and Wisconsin, where school districts, between 2000 and 2011, were required to emphasize abstinence until marriage as the most effective way to avoid unplanned pregnancies and STDs.

The authors discovered an increase in STD rates in the smallest of the five states — Maine and Colorado.  “The effects for these two states are quite stark as we find a significant positive effect on STDs of 10% overall and between 10% and 14% for the year of enactment [of the sex education program] and the following 2 years,” the authors write.

 

Worth the Wait? The Consequences of Abstinence-Only Sex Education for Marginalized Students
Hoefer, Sharon E.; Hoefer, Richard. American Journal of Sexuality Education, 2017.

For this study, researchers sought to better understand how abstinence-only sex education affects marginalized students — young women, racial and ethnic minorities, LGBTQ students and other gender-nonconforming students. Between December 2014 and April 2015, the researchers conducted in-depth interviews with 16 students at a large university in the southwestern U.S., all of whom had received some form of sex education in a public school in that state at some point between the first and 12th grade. All participants received abstinence-based sex education, with the overwhelming majority receiving abstinence-only education.

Six themes emerged during the interviews:

  1. Participants “expressed frustration at the lack of practical information and resources provided in school sex education, as well as perceived condescension from educators. … More than half of the participants recalled finding answers in other, often less reliable sources, such as friends and the Internet.”
  2. The information provided to participants when they were in grade school relied on stereotypes about gender and sexual orientation. “Nearly all participants reported that classmates often expressed insulting or dangerous stereotypes about LGBTQ students, which educators frequently reinforced. Three participants described blatantly homophobic statements made by their instructors.”
  3. “Black and Hispanic students reported facing assumptions that they were sexually active and knowledgeable, despite this often not being the case. Students of color expressed that they felt educators made assumptions about their previous sexual experiences based on their race, and that this resulted in sex education that was not relevant to their lives.”
  4. “Many participants, especially those who identified as LGBTQ, reported experiencing a lack of emotional safety in both their sex education classrooms and high schools at large. This often resulted in a need to hide their orientations or gender identities, and in a refusal to ask questions in class, which might suggest that they were not straight and cisgender.”
  5. “Participants almost universally reported that their sex education curricula relied primarily on instilling fear of sexual activity by discussing only STIs and pregnancy, as well as shaming sexual activity and curiosity by refusing to answer student questions and referring to sexually active students as inferior to abstinent students.”
  6. “Although many participants reported learning from teachers who engaged in shaming and fear mongering, a quarter of the participants described a teacher who had gone out of his or her way to provide a safe and informative sex education environment. Each of these participants expressed gratitude for the teacher’s efforts to provide accurate, practical information and create a safe and welcoming classroom environment, even when doing so entailed working around school regulations.”

 

Broken Promises: Abstinence Pledging and Sexual and Reproductive Health
Paik, Anthony; Sanchagrin, Kenneth J.; Heimer, Karen. Journal of Marriage and Family, 2016.

This study examines abstinence pledges, also known as virginity pledges, which generally involve an adolescent volunteering to publicly declare verbally or in writing that he or she will remain abstinent until marriage. This study aims to determine whether girls and young women who take these pledges are less likely to become pregnant outside of marriage or acquire an STD. The researchers find that those who took pledges were more likely to become pregnant outside of marriage when compared with girls and young women who did not take abstinence pledges. Once girls and young women became sexually active, both groups were equally likely to have the human papillomavirus (HPV), a common STD.

The researchers analyzed data collected through Add Health, a nationally representative, longitudinal study of adolescents. They looked at data collected during the first wave of the study in 1994 and 1995, when 20,745 students in grades 7 to 12 were asked about such topics as their health, romantic relationships and whether they had taken abstinence pledges. The scholars also looked at data collected in 2001 and 2002, when 15,197 of those students were re-interviewed as young adults. For the purposes of this study, the researchers focused on data on girls and young women. A subsample of 3,254 young women were tested for HPV.

The researchers find that about 27% of young women from both groups tested positive for HPV — those who broke their pledges and became sexually active and sexually active young women who never took a pledge. However, sexually active pledgers who had six or more sexual partners were more likely to be infected with HPV than non-pledgers who had six or more sexual partners. Also, about 30% of pledgers and 18% of non-pledgers became pregnant within six years after they began to have sex outside of marriage.

“We have demonstrated that pledging can be associated with negative health effects for young adults once they engage in sexual activity,” the authors write. They explain that girls and young women who take these pledges may be less prepared to handle the risks of sexual activity because they “are more likely to receive cultural messages downplaying the effectiveness of condoms and contraceptives as well as to be exposed to the framing of premarital sexual activity as a form of failure.”

 

Using contraceptives

 

Associations Between Sex Education and Contraceptive Use Among Heterosexually Active, Adolescent Males in the United States
Jaramillo, Nicole; et al. Journal of Adolescent Health, 2017.

A research team looked at whether heterosexual, adolescent males’ contraceptive use is influenced by the type of sex education they received. The team finds that the more topics young men covered in sex education class, the more likely that two types of birth control were used during their last sexual encounter.

This study relies on data collected between 2011 and 2013 via the CDC’s National Survey of Family Growth, which asks people aged 15 to 24 years questions about the type of sex education they received prior to age 18. The survey asked whether respondents had received formal instruction about the following seven topics: how to say no to sex; waiting until marriage to have sex; sexually transmitted diseases; preventing HIV/AIDS; methods of birth control; how to use a condom; and where to get birth control. Respondents also were asked about the form of birth control they used the last time they had sex. Almost 44% said they had used only condoms while 39.2% reported using dual methods and 8.6% said they had relied on a “female effective” method only.

The researchers learned that the more sex education topics the males were taught, the more likely they were to use contraception, especially dual methods.

“We found that on average with each additional sex education topic received, males had a 47% greater odds of reporting dual method contraception compared to no method,” the authors write.

Also, they found that instruction on two specific subjects — how to say no to sex and where to get birth control — “were associated with a three-fold greater odds of reporting dual method use compared to no contraception.”

 

The Incidental Fertility Effects of School Condom Distribution Programs
Buckles, Kasey S.; Hungerman, Daniel M. Journal of Policy Analysis and Management, 2018.

While most research has shown that giving teenagers access to contraception reduces the likelihood of teen pregnancy, scholars have primarily focused on three birth control methods: oral contraception, long-acting, reversible contraception and emergency contraception. In this study, researchers look specifically at how access to condoms affects teen fertility. The main takeaway: Access to condoms in schools increased teen births by an estimated 12%.

For the study, researchers built a national data set of schools that introduced condom access programs in the late 1980s and early 1990s. The data set comprises 484 schools in 22 districts in 11 states and the District of Columbia. The researchers matched that information to national data on birth rates for women of different ages in counties that had a population of at least 100,000 people. They studied birth data from 1982 to 2000 — before and after the adoption of condom access programs.

The analysis finds that “access to condoms for the entire high-school-aged population in a county would lead to about five extra births per 1,000 teenage women, or about a 12% increase relative to the mean,” the authors write. “Since the average program covered about one-third of the teenage women in the county, the typical program led to an additional two births per 1,000 teenage women.”

The authors offer several possible explanations for why giving students condoms resulted in higher birth rates. One possibility: Young women may have been using a more reliable form of birth control and switched to condoms when schools began giving them out.

 

LGBTQ youth

 

Associations of Lesbian, Gay, Bisexual, Transgender, and Questioning-Inclusive Sex Education With Mental Health Outcomes and School-Based Victimization in U.S. High School Students
Proulx, Chelsea N; et al. Journal of Adolescent Health, 2019.

Researchers investigated how sex education programs that include information for and about LGBTQ students affect the mental health of LGBTQ students and the probability that they are bullied in high school. The key finding: In the 11 states that were studied, LGBTQ-inclusive sex education was associated with fewer reports of bullying of gay and lesbian students and more positive mental health outcomes for all students on campus.

The authors analyzed data from the 2015 Youth Risk Behavior Survey, a national survey the U.S. Centers for Disease Control and Prevention uses to collect data on health risk behaviors among students in grades 9 through 12 at public high schools. The survey also collects information about high schools’ health policies and practices. The authors also analyzed data from the CDC’s 2014 School Health Profiles, a national survey of principals and lead health education teachers in middle schools and high schools.

Eleven states were included in the study because they met all criteria, including agreeing to make some survey data public. Those states are Arizona, Delaware, Florida, Kentucky, Maine, Michigan, New York, North Carolina, South Dakota, West Virginia, and Wyoming.

The final sample was 47,730 high school students, 2.6% of whom identified as gay or lesbian, 6.3% of whom identified as bisexual and 3.7% of whom reported being unsure of their sexual identity. The percentage of schools in each state with an LGBTQ-inclusive sex education program ranged from 6.2% to 57.1%.

The researchers found that in the states studied, an inclusive school climate benefitted heterosexual and sexual minority youth. LGBTQ-inclusive sex education was associated with fewer reports of adverse mental health among all students.

“There was a 20% reduction in reported suicide plans for every 10% increase in schools teaching LGBTQ-inclusive sex education in a state,” the authors write. “A 10% increase in the proportion of schools teaching LGBTQ-inclusive sex education in a state was associated with significantly lower odds of gay/lesbian youth experiencing bullying on school property compared with heterosexual youth.”

 

Does Sex Education Help Everyone?: Sex Education Exposure and Timing as Predictors of Sexual Health Among Lesbian, Bisexual, and Heterosexual Young Women
Bodnar, Kaitlin; Tornello, Samantha L. Journal of Educational and Psychological Consultation, 2018.

This study finds that sex education programs, which tend to focus on heterosexual students and relationships, don’t meet the needs of sexual minority women. Girls and young women who are sexual minorities and received formal sex education during adolescence were more likely to become pregnant than their heterosexual peers, according to the study. They also were more likely to have a greater number of male partners.

Researchers examined data collected between 2002 and 2013 via the National Survey of Family Growth, which the CDC conducts to learn more about Americans’ experiences related to such things as sexual activity, contraception, pregnancy and whether they received formal sex education before adulthood. Researchers focused on responses given by 5,141 girls and young women aged 15 to 20 years who fit into one of three sexual orientation categories: straight, bisexual, or homosexual.

Women who answered yes to the following question were counted as having participated in a sex education program: “(Before you were 18, did/have) you ever (have/had) any formal instruction at school, church, a community center or some other place about how to say no to sex?”

The researchers find that bisexual and lesbian women were more likely to have received sex education after they had already started having sex with male partners. Bisexual and lesbian women started having sex with male partners at a younger age than straight women did.

There were other differences. “Sexual minority young women were more likely to experience a pregnancy if they had exposure to sex education, while this education predicted fewer reports of pregnancy in heterosexual participants,” the authors write. “Likewise, sex education was not associated with the number of partners among heterosexual young women, although for sexual minority women, exposure to sex education predicted an increase in the number of male sexual partners.”

 

Students with intellectual disabilities

 

Identifying Effective Methods for Teaching Sex Education to Individuals with Intellectual Disabilities: A Systematic Review
Schaafsma, Dilana; et al. Journal of Sex Research, 2015.

Researchers analyzed 20 academic studies published between 1981 and 2012 to determine which methods are most effective at teaching sex education to individuals with intellectual disabilities. The authors point out that it’s hard to know what is being taught and how it is being taught because the academic literature does not go into enough detail. Overall, it appears that modeling — demonstrating a behavior — as well as role-play and rehearsal can help individuals with intellectual disabilities build knowledge and skills related to sexual health and healthy relationships, the study finds.

“For future program development, it is essential that methods are clearly defined and linked to specific determinants and specific goals and that the conditions under which the method is effective are taken into account when methods are translated into practical applications,” the authors write.

 

Student views

 

What Do Young People Think About Their School-Based Sex and Relationship Education? A Qualitative Synthesis of Young People’s Views and Experiences
Pound, Pandora; Langford, Rebecca; Campbell, Roma. BMJ Open, 2016.

Researchers reviewed 48 studies that examine young people’s views of the sex and relationship education (SRE) they got at school. The studies span from 1990 to 2015 and originated in the U.S., United Kingdom, Ireland, Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden. The majority of people who participated in these studies were between the ages of 12 to 18.

The researchers found that many young people “disliked the emphasis on abstinence, finding it unrealistic and contrary to their reality” and that, across the globe, “young people’s accounts suggest that sex was commonly presented negatively whether their SRE was explicitly abstinence-based or not.” Youth also express frustration that instruction tends to be heteronormative.

Students criticized sex education as “being overly biological and for presenting sex as a scientific activity, deeming this approach basic, repetitive, narrowly focused, technical and above all, irrelevant. This approach was also observed to de-eroticize and disembody sex.” Students also reported being embarrassed and uncomfortable in mixed-sex sex education classes and when teachers they knew taught their sex education class. “Some students described their embarrassment at discussing sexual and personal matters with teachers they knew and found it awkward seeing teachers around school afterwards,” the authors write.

 

High-Risk Adolescents’ Sexuality Education Preferences Based on Sexual Orientation
Wilson, Kelly L; et al. Journal of Adolescent Health, 2018.

For this study, researchers surveyed 76 adolescents in Texas who were considered to be “high risk” for becoming pregnant, getting someone pregnant or acquiring an STD. The goal of the survey was to find out how LGBTQ youth differ from heterosexual youth in terms of which topics they think sex education classes should cover and who they think should present this information to students. Among both LGBTQ and straight youth, the most common topic of interest was healthy relationships. Adolescents who were not straight were more likely to say they wanted to learn about “identity in sexual health.”

Of those who participated in the online survey, 63% were female, 58% were Hispanic and 80% identified as straight. Nearly all participants were “sexually experienced” and 66% said they had either been pregnant or gotten someone pregnant.

Across the two groups, participants said they preferred to learn about sexual health from a doctor or nurse. But heterosexual adolescents were more likely to prefer to get this instruction from teachers. Both groups said they preferred to learn sexual health information through small group discussions.

 

We’ve gathered research on other topics related to teens and sexual behavior. Check out our write-ups focusing on lesbian, gay and bisexual high school students’ attitudes toward risk and why many sexual assault survivors, including adolescents, may not come forward.

 

We welcome feedback. Please contact us here.