Best Way To Teach Teens About Sex?

Last Editorial Review: 1/31/2005

Teach Abstinence Only?

By Richard Trubo
WebMD Feature

Reviewed By Michael Smith

Is virginity the new rock 'n' roll?

That intriguing question was posed not long ago by no less dignified a publication than the British Medical Journal.

While virginity isn't exactly igniting most high school and college campuses with the same excitement as, say, a Saturday afternoon football pep rally, a growing number of adolescents are making the choice to postpone their first sexual experience until marriage, believing that doing otherwise may be risky business. At the same time, however, about two-thirds of all students still report that they've had sex before graduating from high school, according to the National Campaign to Prevent Teen Pregnancy.

Statistics like these have added fuel to the ongoing and sometimes contentious debate over sex-education classes in public schools. Specifically, parents and educators are taking sides on whether schools should concentrate solely on an "abstinence-only" message, or whether they should also be educating teenagers about contraceptive options and how to protect themselves from pregnancy and sexually transmitted diseases (STDs).

The Abstinence Movement

The landscape of sex education is changing in America. In 1988, only 2% of sex education teachers reported that they taught abstinence as the only option for preventing pregnancy and STDs, according to a study by the Alan Guttmacher Institute. But the focus of many these programs changed during the 1990s and into the current decade, and now about 35% of America's school districts have adopted abstinence-only curricula, with another 58% teaching more comprehensive classes -- so-called "abstinence-plus" programs -- that encourage young people to wait to have sex, but if they do become sexually active to use contraception and practice safe sex.

"This is about health," says obstetrician/gynecologist Patricia Sulak, MD, a proponent of abstinence-only education and the creator of the "Worth the Wait" curriculum now being taught in 31 Texas school districts. "When kids have sex early, bad things often happen. No birth control pill is 100% effective."

The Bush Administration has aligned itself with the abstinence-only proponents, seeking increased Congressional funding for sex education that focuses solely on refraining from sex until marriage. At the same time, under President Bush's watch, the CDC has quietly removed from its web site certain information about condom use that described ways that sexually active people could reduce their health and pregnancy risks.

Critics of this CDC decision argue that, without contraceptive information, young people are being put in jeopardy. Marcela Howell, public affairs director of Advocates for Youth, points to research showing that when adolescents have taken "virginity pledges" as part of sex-education programs -- but then eventually break those pledges and become sexually active -- they are more likely to engage in high-risk behaviors. "These young people are at more risk of having unprotected sex because they don't have information about contraception, or they have been told that condoms don't work so they feel they shouldn't use them."

What Works? What Doesn't?

As the volume levels of the debate over abstinence-only programs increase, both camps are encouraged by research showing that a growing number of young people are waiting to have sex. "Over the last 10 years, the number of high-school kids having vaginal intercourse has gone down," says Sulak, professor at Texas A&M School of Medicine.

In fact, CDC data released in 2002 showed that adolescents who said they had sexual intercourse fell from 54% in 1991 to 46% last year. And both sides are claiming that their own message is largely responsible for this trend.

"This decline started long before the abstinence-only programs were being funded by the government and were really being pushed," says Howell, whose Advocates for Youth organization promotes policies and programs that it says help young people make informed choices about their sexual well-being.

"This decline has come from comprehensive sex education. Young people are getting more information and using contraception better." At the same time, she adds, concerns about AIDS and other STDs have prompted some adolescents to delay their first sexual experience or to have fewer sexual partners.

David Landry, senior research associate at the Alan Guttmacher Institute, agrees, pointing to a strong trend toward rising condom use. "Young people, beginning with their first sexual experience, are much more likely to use contraception today, and most of that increase has been in condom use," he says. "So youth are getting the message to use contraception the first time they have sex, and to continue using it."

A report issued in October by the National Campaign to Prevent Teen Pregnancy concluded that the jury is still out on whether the abstinence-only programs really do change the sexual behavior of teenagers. "There is simply too little evidence to know whether abstinence-only programs delay the initiation of sex," according to the study. On the other hand, the same report noted that the "abstinence-plus" programs "can delay sexual intercourse, reduce its frequency, increase condom use, and/or increase contraceptive use."

Not everyone agrees with those conclusions, however. Leslee Unruh, president and founder of the National Abstinence Clearinghouse, says that comprehensive programs encouraging abstinence but also incorporating contraceptive education have contributed to teen pregnancy rates by their emphasis on the use of condoms and contraceptives.

"You cannot promote a mixed message that you call sex education, because it just confuses young people," argues Unruh. "They ask, 'What are you telling me to do -- abstain or not?' The analogy is: What if you were running a drug education program, and were saying, 'Use clean needles.' What's the message? The message can't be mixed."

Just the Facts...

Critics of abstinence only insist that such programs ignore the real world of adolescent behavior, where four out of 10 girls in the U.S. get pregnant at least once before the age of 20. But Sulak counters that sex education programs aren't the proper venue for presenting information about contraceptive options. "We tell students, 'If you're going to have sex, you need to go see a healthcare professional,'" she says. "It's not the job of the school system to treat people who are engaging in risky behaviors."

Unruh believes that adolescents who are sexually active have plenty of other venues for learning about birth control. "Just go into any public bathroom," she says. "I was in Atlanta, and went into five restrooms in the mall, and every one of them had condoms there. Every gas station that I've gone into in the last year has had condoms there. Every time I turn on the TV, I see information about condoms. We've been throwing latex at these kids everywhere. They are getting this information."

Meanwhile, opponents of abstinence only say they're concerned about what they call the changing language of these programs. "About three years ago, many abstinence-only advocates changed their approach to present information from a medical perspective rather than a religious or moral perspective, which they had been doing in the early to mid-1990s," says Landry. "But unfortunately, they've taken medical findings and distorted them."

According to Howell, many abstinence-only programs "exaggerate the failure rates of contraception, but don't talk about how condoms can protect against HIV and certain STDs, and protect against unintended pregnancy. Their premise is that if they use the fear approach, young people will abstain. But that's not what happens. Young people are having sex."

To complicate the sex-education picture, some adolescents who are refraining from sexual intercourse are engaging in oral sex instead. Oral sex, according to some teenagers, is "not really sex," and is a way of protecting their "technical virginity."

But abstinence-only advocates say that they make it clear to adolescents who sign "virginity pledges" that they should refrain from all forms of sexual behavior. Sulak says that in her "Worth the Wait" program, students are cautioned to avoid all types of sex -- from vaginal to oral to anal sex. "You can get HIV from oral sex," she says. "You can get herpes from oral sex. It's all sex."

Meanwhile, surveys suggest that the majority of parents favor broader sex education that includes educating young people about contraception. In a national study by the Kaiser Family Foundation in 2000, more than eight of 10 parents of adolescents said that schools should teach students about the use of condoms and other forms of contraception.

Published Nov. 11, 2002.

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