The
Effectiveness of Abstinence-Only
Education
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The
Administration has changed sex education performance
measures to produce the appearance that scientific
evidence supports abstinence-only programs. |
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President
Bush has consistently supported the view that sex education
should teach “abstinence only” and not include
information on other ways to avoid sexually transmitted diseases
and pregnancy.[1] White House Spokesperson
Ari Fleischer has asserted that “abstinence is more
than sound science, it’s a sound practice . . . . [A]bstinence
has a proven track record of working.”[2]
In
pushing an “abstinence only” agenda, however, the
Bush Administration has consistently distorted the scientific
evidence about what works in sex education. Administration officials
have never acknowledged that abstinence-only programs have not
been proven to reduce sexual activity, teen pregnancy or sexually
transmitted disease.[3] Instead,
HHS has changed performance measures for abstinence-only education
to make the programs appear successful, censored information
on effective sex education programs, and appointed to a key panel
an abstinence-only proponent with dubious credentials.
Performance
Measures
Over the
past three years, Congress has appropriated over $100 million
in grants to organizations that sponsor abstinence-only education.
In November 2000, under the Clinton Administration, HHS developed
meaningful, scientifically sound outcome measures to assess
whether these programs achieved their intended purposes, including
the “proportion of program participants who have engaged
in sexual intercourse” and the birth rate of female
program participants.[4]
In late
2001, however, the Bush Administration dropped these measures
and replaced them with a set of standards that does not include
any real outcomes. Rather than tracking pregnancy or sexual
activity, these measures assess attendance and the attitudes
of teens at the end of the education program, including the
“proportion of participants who indicate understanding
of the social, psychological, and health gains to be realized
by abstaining from premarital sexual activity.”[5]
Such standards
are not scientifically valid. A 2001 review of scientific
evidence concluded that “adolescents’ sexual beliefs,
attitudes, and even intentions are . . . weak proxies for
actual behaviors.”[6]
That
is, even if teens pledge to remain abstinent, they may not
actually do so. According to a major HHS-funded report, two
“hallmarks of good evaluation” in programs designed
to reduce teen pregnancy rates are evaluations that “[m]easure
behaviors, not just attitudes and beliefs” and “[c]onduct
long-term follow-up (of at least one year).”[7]
However,
the Bush Administration’s standards for measuring the
success of abstinence-only programs contain no reports or
assessments of actual behavior or health outcomes and do not
require any minimum followup period.
The result is that
the performance measures appear constructed to produce the
appearance that scientific evidence supports abstinence-only
programs when, in fact, the best evidence does not.
“Programs
That Work”
Until
recently, a CDC initiative called “Programs That Work”
identified sex education programs that have been found to
be effective in scientific studies and provided this information
through its web site to interested communities.[8]
In 2002,
all five “Programs That Work” provided comprehensive
sex education to teenagers, and none were “abstinence-only.”
In the
last year, and without scientific justification, CDC has ended
this initiative and erased information about these proven
sex education programs from its web site.[9]
Appointment
to CDC Committee
The
Bush Administration appointed a prominent advocate of abstinence-only
programs, Dr. Joe McIlhaney, to the Advisory Committee to
the CDC’s Director. This committee is charged with providing
advice on “policy issues and broad strategies for promoting
health and quality of life by preventing and controlling disease,
injury and disability.”[10]
Dr. McIlhaney was appointed to this prestigious position
despite the fact that in 1995 the Texas Commissioner of Health
under then–Governor George W. Bush questioned his professional
credibility, writing:
[M]any
of the items in [Dr. McIlhaney’s] presentation [on sexually
transmitted diseases] are misleading and are quoted incompletely
. . . . The only data which was reported in the presentation
are those which supported his bias on the topics he addressed.
Intellectual honesty demands that he present all the data.[11]
As recently
as April 2002, Dr. McIlhaney asserted in congressional testimony
that “there is precious little evidence” that
comprehensive sexual education programs are “successful
at all.”[12]
This
assertion, however, is inaccurate. A 2001 review found that
comprehensive sex education programs that both encourage abstinence
and provide information on contraception have been shown in
scientific studies to delay the onset of sexual activity and
can result in greater use of potentially life-saving condoms
and other contraceptives.[13]
[1]
See, e.g., White House, President Discusses Welfare Reform
and Job Training (Feb. 27, 2002) (online at http://www.whitehouse.gov/news/releases/2002/02/
print/20020227-5.html).
[2]
White House, Press Briefing by Ari Fleischer (Jan. 27,
2003) (online at http://www.whitehouse.gov/news/releases/2003/
01/20030127-2.html).
[3]
D. Kirby, National Campaign to Prevent Teen Pregnancy, Emerging
Answers: Research Findings on Programs to Reduce Teen Pregnancy,
at 88 (May 2001) (“[T]here do not currently exist any abstinence-only
programs with reasonably strong evidence that they actually delay
the initiation of sex or reduce its frequency”).
[4]
65 Federal Register 69562–65 (Nov. 17, 2000).
[5]
These new measures are:
· Proportion
of program participants who successfully complete or remain enrolled
in an abstinence-only education program.
· Proportion
of adolescents who understand that abstinence from sexual activity
is the only certain way to avoid out-of-wedlock pregnancy and sexually
transmitted disease.
· Proportion
of adolescents who indicate understanding of the social, psychological,
and health gains to be realized by abstaining from premarital sexual
activity.
· Proportion
of participants who report they have refusal or assertiveness skills
necessary to resist sexual urges and advances.
· Proportion
of youth who commit to abstain from sexual activity until marriage.
· Proportion
of participants who intend to avoid situations and risk, such as
drug use and alcohol consumption, which make them more vulnerable
to sexual advances and urges.
U.S.
Department of Health and Human Services, SPRANS Community-Based
Abstinence Education Program, Pre-Application Workshop (Dec.
2002) (online at http://www.mchb.hrsa.gov/programs/adolescents/
abedguidetext.htm).
[6]
D. Kirby, supra note 3, at 78.
[7]
National Campaign to Prevent Teen Pregnancy, Get Organized:
A Guide to Preventing Teen Pregnancy, 136 (Sept. 1999) (online
at http://www.teenpregnancy.org/resources/reading/getorgan.asp).
[8]
CDC, Programs That Work (archived version online at http://web.archive.org/web/20010606142729/
www.cdc.gov/nccdphp/dash/rtc/index.htm).
[9]
CDC, Programs That Work (online at http://www.cdc.gov/nccdphp/dash/rtc/)
(“Thank you for your interest in Programs that Work (PTW).
The CDC has discontinued PTW and is considering a new process that
is more responsive to changing needs and concerns of state and
local education and health agencies and community organizations”).
[10]
CDC, Secretary Thompson Appoints Nine to CDC Advisory Committee (Feb.
20, 2003) (online at http://www.cdc.gov/od/oc/media/pressrel/r030220d.htm).
[11]
Letter from Dr. David R. Smith, Commissioner of Health, to Mr.
Tom E. Smith, Executive Director, Medical Institute for Sexual
Health (Jan. 23, 1995).
[12]
Testimony of Dr. Joe S. McIlhaney, Jr., Subcommittee on Health,
Committee on Energy and Commerce, Welfare Reform: A Review
of Abstinence Education and Transitional Medical Assistance,
107th Cong., 51 (Apr. 23, 2002).
[13]
D. Kirby, supra note 3, at 171 (“[A] number of programs
that discussed condoms or other forms of contraception and encouraged
their use among sexually active youth also delayed or reduced the
frequency of sexual intercourse”). |