Abstinence-only proponents and programs have co-opted several other concepts as well. They have adopted terms such as “evidence-based” and “medically accurate and complete,” and embraced language on “healthy relationships” and “youth empowerment,” all of which are typically associated with programs that respect young people’s decision making. For example, even though abstinence-only programs may claim to promote “healthy relationships” and provide “youth empowerment,” the terms are used in the context of federal program requirements that “ensure that the unambiguous and primary emphasis and context...is a message to youth that normalizes the optimal health behavior of avoiding nonmarital sexual activity.”3 In 2012, the primary advocacy organization for abstinence-only programs, the National Abstinence Education Association (NAEA), dropped “abstinence” from its name altogether and rebranded itself as “Ascend.” Nevertheless, most of the “sexual risk avoidance” curricula endorsed by Ascend are the same as the “abstinence education” curricula promoted by NAEA prior to 2012 and have the same goals.4–6
With social conservatives now in the White House, abstinence-only proponents are in positions of power within the administration. In June 2017, Valerie Huber, the former president and CEO of Ascend, was appointed chief of staff to the assistant secretary for health within the U.S. Department of Health and Human Services (HHS), with the authority to direct the work of offices charged with promoting sexual and reproductive health information and services.7
Proponents are using their new-found influence to revitalize and reshape federal abstinence-only programs. There are two such programs at the federal level. The first of these programs, created in 1996 under Title V of the Social Security Act, provided at its peak $75 million per year to states for programs that conformed to a highly restrictive eight-point definition of “abstinence education.” Some of the more controversial components of this definition included teaching that “abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems” and that “a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity.”8
The second federal abstinence-only program was a competitive grant program created by Congress in 2000 to bypass the states entirely and provide funding directly to community-based organizations. Under the George W. Bush administration, annual funding for the program—then called “community-based abstinence education” and explicitly tied to the same restrictive eight-point definition—ballooned from $20 million initially to $113 million at its peak. The program ended briefly after Obama came into office, but was revived in federal fiscal year (FY) 2012 at $5 million.
Both of these programs have been revised and renamed in recent years, but the goal remains the same: to implement programs exclusively focused on voluntarily refraining from sexual activity outside of marriage. First, in FY 2016, Congress renamed the competitive grant program as “sexual risk avoidance” and decoupled it from the eight-point definition of “abstinence education.” To qualify for funding, programs must, among other things, “teach the benefits associated with self-regulation, success sequencing for poverty prevention,” and “resisting sexual coercion…without normalizing teen sexual activity.”9 Funding for the program has again started to increase, rising to $15 million in FY 2017 and likely to go as high as $25 million under House and Senate spending proposals for FY 2018.
In February 2018, the Title V abstinence-only program (which expired briefly in September 2017) was renewed for two more years at $75 million annually under the new name of “sexual risk avoidance education.”10 Congress eliminated the “abstinence education” definition, replacing it with similarly motivated topics that the program must address, including “the advantage of refraining from nonmarital sexual activity in order to improve the future prospects and physical and emotional health of youth”; “the increased likelihood of avoiding poverty when youth attain self-sufficiency and emotional maturity before engaging in sexual activity”; and in the context of preventing sexual coercion and dating violence, “recognizing that even with consent teen sex remains a youth risk behavior.” Additionally, the program specifies information that must be withheld from students, requiring that “the education does not include demonstrations, simulations, or distribution of contraceptive devices.”10
Despite efforts to rebrand abstinence-only programs, these approaches remain just as harmful as in the past. Abstinence-only programs are ineffective at reaching their primary goal of keeping young people from engaging in sexual activity as well as at meeting the needs of all adolescents. They also create barriers for young people in making informed decisions about their health, require unethical behavior from educators, perpetuate inequities and discrimination and promote stigma against marginalized individuals and toward sex more generally in society.
Ineffective at their primary goal. Even judging the abstinence-only approach on its own limited terms—where the only thing that matters is stopping or even delaying sex outside of marriage—this approach is ineffective. The first federally funded evaluation of Title V abstinence-only programs, conducted in 2007 by Mathematica Policy Research on behalf of HHS, found no evidence that these programs increased rates of sexual abstinence.11 In fact, according to scientific evidence amassed over the past 20 years, abstinence-only programs do not have a significant impact on the age of first sexual intercourse, number of sexual partners or other sexual behaviors.12 Further, abstinence-only programs may place young people at increased likelihood of pregnancy and STIs once they do become sexually active.11,13,14
Fail to meet the needs of young people. By withholding potentially life-saving sexual health information and skills, abstinence-only programs do nothing to prepare young people for when they will become sexually active and systematically ignore the needs of those who are already sexually active.12 Specifically, abstinence-only programs typically overlook or downplay the benefits of contraception and often overemphasize its relative risk. These programs may be doing long-term damage by deterring condom and other contraceptive use among sexually active adolescents, increasing their risk of unintended pregnancy and STIs. In addition, abstinence-only programs typically fail to provide education and skill building on the complete scope of critical sexual health and sexuality topics, such as healthy relationships, communication and consent.
In the United States, two-thirds of 18-year-olds have had sexual intercourse, and nine in 10 people have by their mid-20s (see figure).15 Despite this reality, only 57% of sexually active young women and 43% of sexually active young men have received formal instruction about birth control methods before having sex for the first time,16 and even fewer have presumably received complete and accurate information. These figures demonstrate the need to increase access to sexual and reproductive health information, rather than withholding or distorting it through the lens of an abstinence-only approach.
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