The Effectiveness of Abstinence-Only Education

The Administration has changed sex education performance measures to produce the appearance that scientific evidence supports abstinence-only programs. Latest News on Abstinence Only-Education

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”).