Lawmakers, Health Groups Question Value of Federal Abstinence-Only Program
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April 23, 2008 — Health and medical groups on Wednesday called for federal "abstinence-only" sex education funding to be scrapped, saying the programs have not helped lower teens' rates of pregnancy or sexually transmitted diseases.
The calls come as Democrats in Congress consider trying to suspend funding for the programs, which have become an ideological flash point between Republicans and Democrats over the last decade.
The federal government does not tell school districts what kind of sex education to administer. But the Bush administration strongly backs a program that sends millions of dollars to state and local public school authorities if those dollars are spent on programs urging teens to abstain from sex until they're married.
Seventeen states, including California, have opted out of the programs, choosing to forgo federal funds and instead teach about abstinence along with contraception, including condom use.
Experts from several health groups told lawmakers Wednesday that abstinence-only programs have failed to show evidence of delaying kids' foray into sex or in staving off teen pregnancies for those who do have sex.
"To limit them to abstinence-only does not comport with the evidence. It does not, at least in my judgment, seem wise," Harvey Feinberg, MD, president of the Institute of Medicine, told lawmakers on the House Oversight and Government Reform Committee.
Feinberg pointed to a study of sexual education programs conducted by the Cochrane Collaboration. Out of 13 studies testing abstinence-only programs, none showed "an enduring effect" on teens' sexual behavior, he said.
But 23 of 39 studies of programs combining abstinence advice with education about condoms and other contraception found "at least some" effect on adolescents' behavior.
"That doesn't mean they worked very, very well," Feinberg said.
Teen Pregnancy Down
Teen pregnancy rates have fallen from 117 births per 1,000 females in 1990 to 76 per 1,000 in 2002, a 35% drop, according to the National Survey of Family Growth, conducted by the National Center for Health Statistics.
But most of that drop occurred before 1998, when two separate federal abstinence-only programs were started, said John Santelli, a professor of population studies at Columbia University.
Margaret Blythe, MD, chairwoman of the committee on adolescents at the American Academy of Pediatrics, said programs encouraging abstinence "should obviously be encouraged."
"But abstinence should not be the only strategy discussed," she said.
Abstinence is the only foolproof way to avoid pregnancy and sexually transmitted diseases.
Conservatives maintain that abstinence-only education provides an unambiguous message in the face of media and social pressures to have sex.
Stanley Weed, PhD, director of the Institute for Research and Evaluation, pointed to evidence that he said shows abstinence education can be effective. In one Virginia program, called "Reasons of the Heart," 9.2% of students had sex for the first time within a year of participating in the program. That's compared to 16.4% in a comparison group of teens who did not participate, Weed said.
"Even though the figures will show that it does not work all the time, it doesn't mean we should not be doing it," said Rep. Darrell Issa, a California Republican.
Democrats on the committee suggested that the $1.3 billion Washington has spent on abstinence-only programs over the last decade has been money wasted.
But Feinberg warned that studies looking at sex education programs of any kind are riddled with uncertainty and ambiguity, including cultural surroundings, how long students participate, and where students go when their education is done.
"There's no dominant, clearly victorious magical strategy that will solve all these problems," he said.
SOURCES: Harvey Feinberg, MD, president, Institute of Medicine. John Santelli, professor of population studies, Columbia University. Margaret Blythe, MD, American Academy of Pediatrics. Rep. Darrell Issa, (R.-Calif). Stanley Weed, PhD, director, Institute for Research Evaluation. Weed, S. American Journal of Health Behavior, January/February 2008; vol 32(1); pp 60-73. National Survey of Family Growth, 2006, Division of Vital Statistics, National Center for Health Statistics.
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