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Put another way, abstinence advocates hope that saying "abstinence is the only method which is 100% effective in preventing pregnancy and STIs" will be misinterpreted by the public and politicians to mean the same thing as "abstinence-only education is the only method which is 100% effective in preventing pregnancy and STIs." This is akin to pretending that the fact that never using silverware is the only method which is 100% effective in preventing one from stabbing oneself with a fork is a reasonable justification for never using silverware, as if there were no way to still use a fork such that the risk of stabbing oneself is almost negligible. Ultimately, as Santelli et al. (2006, p. 76) note, this kind of argumentation "is misleading and potentially harmful because it con-ates theoretical effectiveness with the actual practice of abstinence," leaving those in abstinence-only programs woefully unprepared to deal with the reality of sexual experience.
The subsequent arguments in favor of abstinence education stem either from this central conceit or are more blatantly moralizing. Arguing that condoms can sometimes break or fail is just another version of the absurd 100% success-rate standard, and encouraging early sexual activity among young people (something which has not actually been shown to result from contraceptive and comprehensive sex education) is only a negative if one assumes from the outset that teenage or premarital sex is automatically something that should be discouraged.
Thus, the most common arguments in favor of abstinence have been shown to be fallacious or otherwise disingenuous even before considering the actual data regarding abstinence programs. However, just because the arguments in favor of abstinence are not valid, this does not necessarily mean that abstinence programs do not work; perhaps abstinence advocates, though ill-equipped to construct reasonable arguments nonetheless have managed to create programs that reduce sexual activity, unwanted pregnancies, and the transmission of STDs despite their otherwise glaring failures of reason and logical thought. Of course, this is not the case, and abstinence programs have not only been shown to be far less effective than contraceptive and comprehensive sexual education, but have also been seen to actually increase the likelihood of pregnancy or STDs. Before considering this abundance of evidence in more detail, however, it was useful to discuss one of the programs most commonly cited as a success by abstinence advocates, namely, Uganda's efforts to forestall the spread of HIV / AIDS during the 1980s and 1990s.
It is necessary to discuss the particular case of Uganda, not only because it is a popular example for abstinence advocates in general, but because it has actually been cited by members of Congress as justification for abstinence-only education in America. In 2003, during a debate regarding the so-called Pitts amendment to House Resolution 1298, which would have required at least 33% of a $15 billion-a-year effort to combat AIDS be spent on abstinence-only efforts, then-Majority Leader Tom Delay argued that "abstinence-based prevention programs work," and that "after years of trial and error and research, the facts, and the striking success of Uganda's abstinence program, are very clear. No other method has produced the success rates or saved as many lives as Uganda's ABC approach" (Delay 2003). Delay's comments were characteristic of the Pitts amendment's supporters, and as his role as Majority Leader demonstrates, he was advocating what was essentially the majority view of Congress at the time. However, ABC refers to "Abstain, Be faithful, use Condoms," a reasonably comprehensive approach that has been subsequently mischaracterized by abstinence advocates to mean something far more restrictive. Examining the success of Uganda's program in more detail will reveal far more nuanced and comprehensive reasons for the country's success.
Even though "between the late 1980s and mid-1990s, at a time when HIV / AIDS was well on its way toward ravaging Sub-Saharan Africa, Uganda achieved an extraordinary feat: It stopped the spread of HIV / AIDS in its tracks and saw the nation's rate of infection plummet," the idea that this success can be tied solely to abstinence is ludicrous (Cohen, 2003). The success of Uganda's program encouraged "U.S.-based social conservatives in and out of government" in their belief in the efficacy of abstinence so that "for them, ABC has become little more than an excuse and justification to promote their long-standing agenda regarding people's sexual behavior and the kind of sex education they should receive: A for unmarried people, bolstered by advocacy of B, but for most people, 'anything but C'" (Cohen, 2003). However, the reality of Uganda's program does anything but justify abstinence-only programs, and in fact, demonstrates the need to comprehensively educate people about healthy sexual practices. In fact, one study which found increased sexual abstinence in Uganda discovered that the increased abstinence was not the result of abstinence-only instruction, but rather from the following "key interventions:"
(1)Improved access to information and other resources for healthy sexual behaviour decision making.
(2) Improved adolescent to adolescent interaction regarding information and decision making relating to AIDS, sexuality and health.
(3) Improved quality of the existing district educational system in the implementation of the school health curriculum and in counselling / advice giving to students. (Shuey et al., 1999, p. 412).
Far from "information about sex, contraception and HIV" encouraging young people to engage in sex earlier and more frequently, the near-comprehensive nature of Uganda's program gave individuals the knowledge necessary to make better decisions regarding their sexual health. Cohen sums up the behavioral changes in each of the three categories of ABC and demonstrates how Uganda's success arose precisely from the combination of all three, rather than abstinence alone:
Between 1988 and 1995, the time period during which HIV prevalence was declining, key changes in behavior occurred.
• Fewer Ugandans were having sex at young ages. The proportion of young men who had ever had sex decreased substantially and the median age at which young women began having sex rose from 15.9 in 1988 to 16.3 in 1995. Importantly, however, among those people who were having sex, overall levels of sexual activity did not decline.
• Levels of monogamy increased. Sexually active men and women of all ages, particularly the unmarried, were less likely to have more than one sexual partner in a 12-month period in 1995 than in 1989. Other research has found that the proportion of men reporting three or more sexual partners also fell during the period.
• Condom use rose steeply among unmarried sexually active men and women. Among unmarried women who had had sex in the last four weeks, the proportion who used condoms at last intercourse rose from 1% in 1989 to 14% in 1995; among unmarried men, condom use rose from 2% to 22%. (Cohen, 2003).
Thus, "contrary to the assertions of social conservatives [like Tom Delay] that the case of Uganda proves that an undiluted 'abstinence-only' message is what makes the difference, there is no evidence that abstinence-only educational programs were even a significant factor in Uganda between 1988 and 1995" (Cohen, 2003). This fact is necessary to reiterate almost to the point of annoyance because Uganda represented a key example for abstinence-only advocates, and without it, their argument falls apart. Social conservatives like Delay latched onto the example of Uganda precisely because evidence for the success of abstinence-only education could not be found elsewhere, even though the United States had begun a push towards abstinence-only education well before Uganda began its ABC approach to sexual education.
As the reader will recall, the United States began its decline towards abstinence-only education with the passage of the Adolescent Family Life Act (AFLA) in 1981, offering perhaps the best place with which to begin this study's direct comparison of the relative effectiveness of abstinence and contraception. Roosa and Christopher's (1990) study "Evaluation of an abstinence-only adolescent pregnancy prevention program" considered programs created out of the AFLA in order to determine their effectiveness nearly ten years later, finding that these programs had far smaller successes than those which "used supplementary funding from other sources to include contraceptive education and/or contraceptive referral in their programs" (Roosa & Christopher, 1990, p. 363). However, perhaps even more important than their comparison of abstinence-only and contraceptive programs (as there is ample evidence regarding the inefficacy of abstinence elsewhere) is what Roosa and Christopher uncovered about the evaluation of abstinence-only programs in the first place, a discovery which helps explain the continued acceptance of abstinence as a 'legitimate' form of sexual education even in the face of overwhelming evidence suggesting otherwise.
Roosa and Christopher found that "after almost a decade of sponsoring abstinence-only pregnancy prevention programs, very little has been heard about the impact of the [AFLA] sponsored programs," because "the basic research designs for the majority of the funded programs have been too poor to provide meaningful data" due to "the lack of adequate control groups, little relationship between measures and program goals, poor…[continue]
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