The high social cost of abstinence-only sex education in America

Social Cost of Abstinence-Only Sex Education

Comprehensive Sex Education

The High Social Cost of Abstinence-Only Sex Education in the United States

The American Abstinence-Only Movement

In the United States there has been a social and legislative movement favoring abstinence-only sex education over the past 30 years (reviewed by Starkman and Rajani, 2002). Abstinence-only sex education programs do not include information on the purpose and use of contraceptives and by default promote chastity as the only method for avoiding pregnancy and sexually transmitted diseases (STDs). Only 18 states and the District of Columbia require schools to include information on contraception in their sex education courses (Guttmacher Institute, 2011), despite a 1999 nationwide poll revealing that the majority (93%) of respondents supported instruction on such methods in school sex education programs (Starkman and Rajani, p. 616).

Part of the blame for this discrepancy can be attributed to the passage of the Adolescent Family Life Act in 1981 that provided federal funds for schools promoting abstinence-only instruction (Starkman and Rajani, p. 515). Challenges to this law have invoked the legal principle of separation of church and state, which implies that conservative religious agendas are behind the abstinence-only movement. This would explain the prevalence of fear among teachers regarding a community backlash should they attempt to teach a comprehensive sex education syllabus, which as a group overwhelmingly (90%) support including instruction on contraceptive use.

Independent Support for Comprehensive Sex Education

Any studies investigating the efficacy of a comprehensive school sex education program in the United States would be compromised to some extent by the dominant influence of religion on family, teachers, and the community as a whole. In China, religion is not a significant factor in their public school system. The recent sexual awakening that has accompanied economic westernization in China has resulted in a dramatic increase in teen and young adult premarital sexual activity within a single generation, which unfortunately provides an opportunity to test the efficacy of comprehensive sex education on teen pregnancy rates in the absence of a strong religious influence (reviewed by Wang et al., 2005).

Traditionally, teachers in the Chinese public school system have shied away from teaching about contraceptive use for fear of appearing to encourage sexual activity (Wang et al., 2005, p. 64). This fear seems misplaced though, because a large body of scientific evidence has shown overall patterns of teen sexual activity is resistant to prevention programs. This attitude likely contributed to teen pregnancy and premarital abortion becoming the number one public health concern in China.

Towards the goal of testing the efficacy of a comprehensive sex education program, a group of American and Chinese researchers collaborated on a study that created a sex education intervention program for unmarried teens and young adults in suburban Shanghai. The intervention program included instruction on contraceptive use. Of the five contraceptive methods studied, condoms (p < 0.001), emergency contraceptive pills (p < 0.001), and spermicide (p < 0.05) use was increased significantly when compared to the control population (Wang et al., 2005, p. 67). The use of the pill, or abstinence/withdrawal, was unchanged. More importantly, the incidence of reported sexual coercion (p < 0.01), rape (p < 0.05), and pregnancy (p < 0.001) was reduced dramatically by the intervention program, and the incidence of sexual negotiation before intercourse increased significantly (p < 0.001). The overall conclusion from this study is that a comprehensive sex education program was effective in reducing teen pregnancy and modifying teen sexual habits in China.

Summary

Although the overall conclusions from studies investigating the effectiveness of sex education programs in western countries remains controversial (Wang et al., 2005, p. 64), the implementation of a comprehensive sex education program in China revealed the importance of contraceptive use, and sex education in general, in reducing the prevalence of teen pregnancy. Additional support for the importance of comprehensive sex education comes from the reduction in U.S. teen pregnancy rates that occurred between 1990 and 2005, a decrease resulting primarily from an increase in contraceptive use (Guttmacher Institute, 2011). Even if the overall patterns of teen sexual activity are resistant to sex education programs (Wang et al., 2005, p. 64), the way teens engage in this behavior appears to be modifiable by such interventions, resulting in reduced unwanted pregnancies and STD transmissions.