Violate ethical principles. Teachers, health educators and health care providers have ethical obligations to provide accurate information to their students or patients and to not withhold information as a way of influencing their choices.17,18 According to the Society for Adolescent Health and Medicine’s 2017 position statement on abstinence-only programs, “the withholding of information on contraception or barrier protection to induce the adolescent to become abstinent is inherently coercive.”19 Abstinence-only interventions restrict professionals from fulfilling their ethical responsibilities to provide complete and accurate information by requiring them to emphasize condom and contraceptive failure rates and prohibiting instruction on how to access or use contraceptives effectively.17,18 An approach that inherently excludes the full range of information on contraception or other sexual health topics—or provides it in a misleading manner—is ethically problematic.
Perpetuate harmful gender stereotypes and discrimination. Research has long established that gender inequities—and the ideologies that uphold them—have an impact on sexual and reproductive health outcomes, including HIV and other STIs, unintended pregnancies and sexual violence.20,21 Through the actual curricula materials or their implementation, many abstinence-only programs teach gender stereotypes as facts.22 These programs commonly reinforce stereotypes about feminine passivity and sexual restraint, while linking masculinity with an intense sex drive, lack of emotional involvement and aggressiveness.23–25 This perpetuation of stereotypical gender roles has been shown to impede women’s sexual autonomy while also having negative health consequences for men.22 Moreover, abstinence-only programs persist in relying on unequal and outdated perceptions of gender roles at a time when there is movement in some segments of society to examine and improve gender dynamics in the workplace and beyond.
In addition to promoting gender stereotypes, abstinence-only programs fail LGBTQ youth. Although nationally representative data on these young people remain limited, 2015 data indicate that at least 8% of high school students identify as lesbian, gay or bisexual.26 While some abstinence-only programs no longer explicitly condemn same-sex relationships, they still emphasize heterosexual relationships as the expected societal norm and not only ignore, but often undermine, the sexual health and overall well-being of LGBTQ youth.12,27 In addition to being excluded within an abstinence-only program, LGBTQ youth may face outright discrimination, which “can contribute to health problems such as suicide, feelings of isolation and loneliness, HIV infection, substance abuse, and violence.”12
Stigmatize sex, sexual health and sexuality. Sexual development and sexuality are fundamental parts of being human, yet abstinence-only programs deliberately promote judgment, fear, guilt and shame around sex. These programs frame premarital sexual activity and pregnancy as wrong or risky choices with negative health outcomes and seek to shame sexually active young people and young parents.28
Although abstinence-only proponents may not intend it, by stigmatizing sex outside of marriage, they also stigmatize survivors of sexual assault and coercion. In 2015, 11% of high school students experienced physical or sexual dating violence, with disparities by sex, race and ethnicity.29 Abstinence-only programs can fail to equip young people with education for all genders essential to not just preventing abuse and harassment but also promoting healthy relationships, and often blame young people who have experienced circumstances beyond their control.
Ignore systemic inequities in defining “success.” Abstinence-only programs seek to prescribe a single life path for young people, the “success sequence for poverty prevention,” while ignoring systemic inequities—such as racism, inequality, discrimination and trauma—that contribute to poverty and also influence adolescent sexual and reproductive health.22,30 In fact, several Brookings Institution researchers have critiqued the success sequence as too simplistic and resulting in “more success for whites than blacks.”31 According to those researchers, “the hurdles are clearly higher for some groups—especially black Americans—than others. And the pay-offs from following the success sequence clearly differ by race.”31
Abstinence-only proponents argue that the message of abstinence outside of marriage is one that resonates with all young people and therefore addresses the needs of marginalized populations. But in fact, by focusing on a single life path for success, abstinence-only programs stigmatize young people for whom this specific set of prescribed goals may not be desired or obtainable. Ultimately, abstinence-only programs fail to take into account the structural barriers, cultural differences and individual choices and experiences that shape people’s lives.
In spite of these fundamental flaws, the Trump administration and social conservatives in Congress continue to call for dramatic increases in funding for abstinence-only programs (see “The Looming Threat to Sex Education: A Resurgence of Federal Funding for Abstinence-Only Programs?” 2017). This is in line with other ideologically motivated attacks on evidence-based teen pregnancy prevention programs and on sexual and reproductive health and rights more broadly in an effort to promote a coercive agenda (see “Coercion Is at the Heart of Social Conservatives’ Reproductive Health Agenda,” 2018).
This effort to reinvigorate federal abstinence-only programs is dangerous and counterproductive. For decades, abstinence-only programs have failed to meet the needs and uphold the rights of young people. A name change and claims of raising the standard of behavior for all young people do nothing to correct these flaws. Young people deserve more than the same programs under a new name; it is past time to end federal funding for abstinence-only programs.
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