On April 29th, the Daily Show did a segment on the Committee for Government Reform's hearing on Domestic Abstinence-Only Programs. It was - as usual - hilarious. Phrases like a boy's "God-stick' and a girl's 'Shame-cave' were used.

It probably wouldn't have been so funny (or so worrying) to me if it weren't so close to the truth for some students. As Stewart mentions, the government (particularly the Bush administration) has spent a lot of money making sure kids know three things: sex before marriage is wrong, you shouldn't do it, and that's all you need know.

Now for some background on me: I work primarily in emergency preparedness and response. However, because I work in what used to be the health education division, I do a bit of health education on the side. Primarily, I work with middle to high school age girls talking about everything from healthy relationships, self- and body-image, girl power, and - yes - sex education. I've had specific training on comprehensive sex education programs for teens.

Aside from that, even if it wasn't part of my job, I'd still feel that sex education is a vital - VITAL - part of an adolescent's education, and that neglecting it can have serious consequences.

So! I'm doing a let's-educate-ourselves-through-dialogue post.

But, before I continue, I want to make three points clear:

1) This post is based on very informal research (read: rather cursory survey using resources I already had or knew existed). It's not a result of extensive or exhaustive effort. This may affect the validity and/or usefulness of the information you find here.
2) I am hardly what could be considered an expert. I am, however, probably more informed about these issues than the average person, and have done my best to represent the issues (as I see them) as accurately as I can. This doesn't mean I won't get things wrong, so take everything you read not cited to a source as opinion.
3) I welcome debate and corrections. I will not ridicule, chide, berate, or in any other way abuse you for disagreeing or pointing out an inconsistency. This is a safe, wank-free zone.

Jon Stewart Started This, Or: An Overly-Detailed Discussion of Sex Education in this Country.

Alright, then. Before I get to the opinion portion of my post, I want to share with you some statistics about what we like to call youth risk behaviors nation-wide, findings from a report in 2004 on problems with abstinence-only programs, and a report assessing the impact of 10 abstinence-only-until-marraige programs.

The 2005 United State Youth Risk Surveillance Report1

The first batch of statistics I'll be sharing with you is from the 2005 United States Youth Risk Surveillance Report compiled by the CDC. The YRBSS began surveying 9th through 12th grade students about the kind of behaviors in which they engage in 1990, and have continued to conduct this survey every two years since. The reports are conducted at the local, state, and national levels (in fact, I have the Wyoming 2007 YRBS report on my desk right now).

Among the risk behaviors identified are: tobacco use, unhealthy dietary behaviors, inadequate physical activity, alcohol and other drug use, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (including HIV infection), and behaviors that contribute to unintentional injuries and violence. We'll be dealing with sexual behaviors for the purpose of this discussion. (Note: I would use the 2007 national report, but it won't be available until June.)

Okay!

In 2005, here are some of things the report found:

48.6% of high school students have ever had sex (slightly higher among females than males; higher among black and hispanics than whites).
6.2% of students who said they have had sex indicated that they had first sexual intercourse before the age of 13. (Higher among male than female; higher among black and hispanics than whites.)
14.3% of students who said they have had sex indicated that they have had sexual intercourse with four or more partners in their lifetimes. (Higher among male than female; higher amongs blacks and hispanics than whites.)

33.9% of students indicated that they were currently sexually active (had sex with one or more partners during the three months preceding the survey). (Slightly higher among females than males; higher among black and hispanics than whites.)
Of this 33.9%:
62.8% used a condom during their last sexual encounter. (Higher among males than females; higher among blacks and whites than hispanics.)
17.6% indicated that they or their partners used birth control pills to prevent pregnancy during their last sexual encounter. (Higher among females than males; higher among whites than blacks and hispanics.)
23.3% drank alcohol or used drugs before last sexual encounter. (Higher among males than females; higher among hispanics and whites than blacks.)

87.9% of high school students reported that they were taught in school about AIDS or HIV infection. (Slightly higher among females than males; slightly highter among whites than blacks and hispanics.)
11.9% of high school students reported that they had been tested for HIV infection. (Higher among females than males; Higher among blacks than hispanics and whites.)

What do these statistics mean?

It's important to put all of this in context. The best way I know how to do that is by showing you how the statistics have changed2 since the survey began.

In summary, from 1991 to 2005:

The percentage of students who said they had had sexual intercourse decreased.
The percentage of students who reported having had four or more partners in their lifetime decreased.
The percentage of students who reported as being sexually active decreased.
The percentage of students who reported using a condom during their last sexual encounter increased.
The percentage of students who reported using birth control pills before their last sexual encounter decreased by 3.2% (this is, however, very close to being within the margin of error of 2.6%+/-, so it's considered as no change).
The percentage of students who reported using alcohol or drugs increased by 1.7% (this is well within the margin of error, so considered as no change).
The percentage of students who reported being taught in school about AIDS or HIV infection increased.

What this means is that - on a whole - sex education appears to be working; not radically or quickly, but as far as reasonably correcting certain risk behaviors among high school students, progress is being made. (Although, admittedly, this is really an assumption; aside from the AIDS/HIV question, the survey doesn't indicate whether these findings as a whole are a result of formal sex education programs in schools.)

Unfortunately, because the survey doesn't include information on formal sex education programs, it also can't provide statistics on the type of sex education high school students are receiving (comprehensive vs. abstinence-only sex education), so it's impossible to say based on these statistics which method is best.

What I would have liked to do is compare the YRBS statistics between the 17 states known to have refused government funds3 for abstinence-only-until-marriage sex education to the states that have accepted government funds to see how both groups hold up. I couldn't do that because 1) resources vital to this study aren't available yet, and 2) it would require a lot more effort and expertise that I am willing give and have today.

Instead, I'll give you a summary of what the US House of Representatives found to be serious problems with abstinence-only-until-marriage programs.

The United State's House of Representatives Committee on Government Reform's Report: The Content of Federally Funded Abstinence-Only Education Programs4

The Content of Federally Funded Abstinence-Only Education Programs Report was requested by Representative Henry Waxman (why, yes, it is the same guy you see in the footage of the hearings from a few days ago) in 2004 in response to fact that the Bush administration would be spending approximately $170 million on abstinence-only programs in 2005. The Special Investigations Division of the Committee conducted a comprehensive review of the most popular abstinence-only programs used by the 100 organizations that received assistance in 2003. They made an overall assessment of the scientific accuracy of 13 curricula used by the funded organizations.

It found that most of the programs have major errors and distortions in how they presented sexual and public health information.

Of the 13 programs funded by SPRANS (one of the three major government funding programs for abstinence-only education), 11 were found to have misleading or completely false information regarding the effectiveness and risks of contraception and abortion.

Under the SPRANS requirements, abstinence-only education programs are not allowed to teach their participants any methods to reduce the risk of pregnancy other than abstaining until marriage. They are allowed to mention contraceptives only to describe their failure rates. Although the curricula purport to provide scientifically accurate information about contraceptive failure rates, many exaggerate these failure rates, providing affirmatively false or misleading information that misstates the effectiveness of various contraceptive methods in preventing disease transmission or pregnancy.

And:

A high number of the programs receiving SPRANS funding are formally opposed to abortion access. Multiple SPRANS recipients are explicitly pro- life organizations such as "crisis pregnancy centers." Several of the curricula used by these and other recipients give misleading information about the physical and psychological effects of legal abortions.

Many of these abstinence-only programs "treat stereotypes about girls and boys as scientific fact," such as stereotypes that undermine girls' achievement, stereotypes that girls are weak and need protection, and stereotypes that reinforce male sexual aggressiveness. This is a infuriating mind-boggling interesting section, and I highly recommend you read the details of how these stereotypes are used in some abstinence-only programs.

Most of these programs discourage sexual activity by presenting exaggerated or - again - downright false information about the risks of sex.

Many of the curricula distort information about the risks of sexual activity. In the case of cervical cancer, the risk of disease is stressed, but simple prevention measures often go unmentioned. HIV exposure risks are discussed in confusing terms, and risks of substances and activities are exaggerated. Several curricula also present misleading information about the relationship between sexual activity and mental health, inaccurately suggesting that abstinence can solve all psychological problems.

Possibly the saddest finding in this report is the fact that many of the programs contain inaccurate or incorrect information about basic scientific facts about subjects like basic human genetics, infectious diseases, puberty, and HIV.

I want to share one more study with you before I sum up (and shut up).

Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact5

Advocates for Youth's Vice President Debra Hauser wrote a report in 2004 assessing the impact of a number of government-funded abstinence-only-until-marriage programs. She used 11 state-funded evaluation results of programs (in Florida, Iowa, Maryland, Minnesota, Oregon, Pennsylvania, Washington, Missouri, Nebraska, and California) as a basis for her assessment.

[Note: Many of the programs used and evaluated in these states are the same programs found to have considerable problems in the Committee on Government Reforms Report.]

Hauser got very detailed about the short- and long-term benefits of abstinence-only education in the above states (the report itself is worth the long read), but also eloquently summarized the results of the programs:

Evaluation of these 11 programs showed few short-term benefits and no lasting, positive impact. A few programs showed mild success at improving attitudes and intentions to abstain. No program was able to demonstrate a postive impact on sexual behavior over time.

Now, all of these statistics and findings tell me the following things:

1) Schools are often teaching abstinence-only to students who are already sexually active. There is no proof to show that abstinence-only education will spur a sexually-active student to stop having sex or change risky sexual behavior.

2) In addition, many of these programs discourage the use of safe sex through 1) failing to teach safe sex practices at all, or 2) teaching incorrect or negatively-exaggerated "facts" about condom use, pregnancy prevention, and disease prevention. This is true for students who may become sexually active and for students who are already sexually active.

3) Many abstinence-only programs promote unhealthy ideas about male-female relationships (in promoting gender stereotypes, more below), and the inaccurate and (in my opinion) irresponsible idea that sex before marriage leads to psychological problems (which are often present among adolescents regardless of sexual activity, some of which may lead to risky behavior).

4) Most neglect to cover same-sex relationships at all, consequently casting same-sex relationships as negative or "unnatural." This leads to a closed, unhealthy environment for gay and lesbian students.

5) Abstinence-only programs rarely result in the student having a concept of self-advocacy, either in their sexual rights or in their sexual health rights. This appears to be particularly true for females students (for instance, facts about birth control methods and abortions are often inaccurate or the side affects negatively-exaggerated).

6) Female students are taught a curious dichotomy; many curricula teach that females are - to quote an oft-used metaphor - delicate flowers who should protects their 'petals'. However, they are also taught that they are emotional beings who are primarily responsibly for building a happy, loving relationship with males, who are just naturally unemotional, sexual beings.

This is hardly an comprehensive list of conclusions to be made, but they are my major ones. The bottom line? Abstinence-only-before-marriage sex education programs may seek to prevent teen pregnancy and the spread of STIs/STDs, but in fact they indirectly cause these problems.

All right. Most of you know that I do my best work in a discussion, so:

What do you think?

1Department of Health and Human Services. National Center for Chronic Disease Prevention and Health Promotion. Youth Risk Behavior Surveillance System-United States 2005. Morbidity & Mortality Weekly Report 2006;55(SS-5):1-108.
2Department of Health and Human Services. National Center for Chronic Disease Prevention and Health Promotion. Trends in the Prevalence of Sexual Behaviors. National Youth Risk Behavior Survey 1991-2005.
3American Association of University Women. AAUW Discussion-Information-Advocacy Log. List of States Rejecting Abstinence-Only Funding Grows. March 12, 2008.
4United States House of Representatives. Committee on Government Reform-Minority Staff. Special Investigation Division. The Content of Federally Funded Abstinence-Only Education Programs. December 2004.
5Hauser, Debra. Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact. Washington, DC: Advocates for Youth, 2004.