Abstinence guidelines: What should you expect?
By Lisa Kaeser, JD
Senior Public Policy Associate
The Alan Guttmacher Institute
Washington, DC
Far-reaching welfare reform, signed into law last year by President Clinton, includes a number of provisions that although they have not received the same publicity as "workfare" or food stamps may nonetheless affect many young people and women.
Among them is an amendment to the Maternal and Child Health Block Grant, which traditionally has provided states with the means and flexibility to offer prenatal care, family planning, and other services to women in need. The provision creates a separate entitlement of $50 million per year for five years for states to fund abstinence-only education programs. To receive their share of funds, states must match every four dollars in federal funds with three dollars in state funds, bringing the total annual price tag for the effort to $87.5 million.
Draft guidance defines objectives
On Feb. 27, the Rockville, MD-based Maternal and Child Health Bureau, under the auspices of the Department of Health and Human Services in Washington, DC, released for public comment a draft "guidance" that purports to clarify how state health departments can apply for the funds and administer the new abstinence program. Deadline for comments on the guidance was March 19, after which the bureau will issue a final guidance.
In most respects, the draft guidance closely tracks the welfare reform legislation itself, largely because the new law is far more detailed and prescriptive than is usual in federal legislation. The purpose of the new abstinence education program is "to enable the state to provide abstinence education and at the option of the state, where appropriate mentoring, counseling, and adult supervision to promote abstinence from sexual activity, with a focus on those groups which are most likely to bear children out-of-wedlock."
However, the legislation goes on to define abstinence education as a program that teaches:
• social, psychological, and health gains to be realized by abstaining from sexual activity;
• abstinence from sexual activity outside marriage as the expected standard for all school age children;
• abstinence from sexual activity as the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
• a mutually faithful monogamous relationship within the context of marriage as the expected standard of human sexual activity;
• sexual activity outside the context of marriage as likely to have harmful psychological and physical effects;
• bearing children out-of-wedlock as likely to have harmful consequences for the child, the child’s parents, and society;
• young people to reject sexual advances and information on how alcohol and drug use increases vulnerability to sexual advances;
• the importance of attaining self-sufficiency before engaging in sexual activity.
The draft guidance makes clear that all of these criteria must be met by any program to be funded by a state under the new legislation, although it also states that "it is not necessary to place equal emphasis on each element of the definition," thus providing a modicum of flexibility in carrying out the mandate. At the same time, however, the guidance states that such an abstinence education program cannot merely be part of a more comprehensive effort; it must be a separate program.
To date, most of the abstinence information and education efforts conducted under the auspices of the Maternal and Child Health Block Grant have been part of more comprehensive services that have also included contraceptive information and prenatal care. While the draft guidance does not specifically indicate that states may target their abstinence education efforts to a specific population or age group, it seems to give states that ability by instructing them to include in their applications a description of the way they propose their effort to be targeted.
Indeed, some populations who currently receive care with block grant funds are not the most appropriate targets for abstinence education. (Of the nearly 13 million women and children who received care in 1991, 1.5 million women were pregnant and 1.5 million were infants under the age of 1.1)
Although the guidance also would require that states maintain their current efforts under the block grant, each state could choose not to maintain some of the specific activities in which they are now engaged. Moreover, even with this major infusion of money into state-run abstinence education, there may be no way to determine whether the new programs are effective; no funds were set aside by the legislation for evaluation purposes. The final deadline for state applications is July 15, with the funds to be made available for fiscal year 1998, which begins Oct. 1.
Largely due to concerns about state matching requirements, it has been rumored that at least two states will not apply for the funds. Nonetheless, federally mandated abstinence education programs will be in full swing by next year.
Reference
1. Health Resources and Services Administration. Maternal and Child Health Bureau. Report to Congress: Fiscal years 1992-1993. Washington, DC; 47.
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