Money is coming for abstinence-only programs . . . but do they work?
Groups urge states to abstain or act responsibly in applying for funds
Do abstinence-only sexuality education programs work? Despite a lack of compelling evidence as to their efficacy, states are considering applications for $50 million in new federal funds for such programs. July 15 is the deadline for the block grant funding, made available through last summer’s sweeping welfare reform legislation.
If states are to follow the current preliminary guidelines, they must be prepared to meet the definition of "abstinence-only education" as set forth in the legislation’s highly prescriptive language. As the legislation now terms it, these "abstinence only" programs have as their exclusive purpose "teaching the social, psychological, and health gains to be realized by abstaining from sexual activity." (See the May 1997 issue of Contraceptive Technology Update, p. 62, for an overview of the abstinence funding requirements.) These programs are different from abstinence-based programs, which "provide young people with a clear message about abstinence in the context of a broader, more comprehensive program," according to a recent report by the Sexuality and Information and Education Council of the United States (SIECUS) in New York City.1 Abstinence-based programs are one facet of a multipronged approach that includes information and access to contraception and sexually transmitted disease programs while abstinence-only programs remain silent on these issues.
To get a piece of the $50 million entitlement, which will be disbursed through the Rockville, MD-based Maternal and Child Heath Bureau, states must be prepared to match every four federal dollars with three dollars of their own.
As of CTU press time, states were awaiting final instructions from the bureau following a March cutoff for comments on the preliminary guidelines. Lisa Kaeser, JD, senior public policy associate with The Alan Guttmacher Institute’s branch in Washington, DC, says she doubts the final guidelines will differ much from the draft.
So how are states approaching this source of funding?
"Our advice to the states is the same as our advice to teen-agers: Abstain, and if you’re not going to abstain, act responsibly," says Debra Haffner, PhD, president and chief executive officer of SIECUS. "We believe it would be better not to take the money for these programs, but if the states are going to take the money, they need to [use it] for programs aimed at preadolescents and early adolescents, and they need to not be fear- and shame-based programs."
Advocates for Youth, a Washington, DC-based group, is urging states not to take the money. It contends that in these times of shrinking budgets, any matching state money will have to be pulled from other youth-based programs.
"That is the biggest fear we have: that dollars will be taken from effective comprehensive programs," says Joyce Walker-Tyson, deputy director of communications and development. "It will be restricted to abstinence-only education, which is a very unrealistic form of sexuality education."
Robert A. Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University in Atlanta and chairman of the CTU Editorial Advisory Board, issues this challenge in light of the new funding: "I know of no evidence that abstinence-only education in the absence of information about contraception, referrals for contraception, or backup of the program in the same institution with contraceptive information works. Here is what I want the abstinence-only people to do: a careful analysis of 1,000 people committed to abstinence alone, who are not told anything about contraceptives, to find out how many pregnancies they have in five years. Until they are willing to carefully evaluate the effectiveness of this approach to birth control, when we know so many teen-agers change their minds, I remain a skeptic about abstinence-only programs."
As of CTU press time, SIECUS had received indications that the following states are likely to accept the abstinence-only funding: Alaska, Iowa, Louisiana, Maine, Massachusetts, Maryland, Minnesota, Missouri, New York, Ohio, Oregon, South Carolina, Vermont, Washington, and Wisconsin.
Many states may be tempted to apply for the "abstinence-only" money to serve a portion of a more comprehensive sexuality education program. Unless the preliminary guidelines are revised, however, comprehensive education advocates say states will be going against the letter of the law if they try to work around the restrictions.
"A lot of people are figuring, We’ll take their four dollars and put it with our three dollars, and the four-dollar portion of the program will be for abstinence-only, and the three-dollar portion of that particular program can continue to be comprehensive sexuality education,’" says Walker-Tyson. "That’s a fallacy. What is required under the law is that once you have accepted any of these restrictive federal funds, all program activity in that case must be restricted to abstinence-only education."
Haffner agrees: "The legislation is so strictly worded in terms that you must have programs that have as their exclusive purpose teaching about abstinence and [meeting] those eight criteria" set in the Maternal and Child Health Bureau Guidelines. "In fact, the guidance was very specific. You cannot say, We’ll use your money to do the abstinence piece, and use our money to do the prevention piece.’ It would be contrary to the law."
No easy answers’ for programs that work
According to a new report issued by the National Campaign to Prevent Teen Pregnancy, programs promoting abstinence alone are unproven. Based in Washington, DC, the campaign was founded in 1996 to reduce the American teen pregnancy rate by one-third by 2005. (For information on how to order a full copy of the report, see resource list, at right.)
The jury is out when it comes to proof of the efficacy of abstinence-only education, says author Douglas Kirby, PhD. Kirby is a senior research scientist with ETR Associates in Santa Clara, CA, a non-profit organization that provides educational resources, research, and training on sexuality and health education issues.
"We still don’t know" whether abstinence-only programs work, he says. "What probably is true is that some of them don’t and some of them do."
To date, only six studies of abstinence-only programs have been published, and the weight of evidence from those studies indicates that abstinence-only programs do not have an impact on adolescent behavior, Kirby notes.2-7 However, the data contained in those six studies are not very strong, with five containing what he terms "significant methodological limitations." The sixth study, which he conducted, was an evaluation of the Postponing Sexual Involvement (PSI) program offered through the Atlanta-based Emory University/Grady Memorial Hospital Teen Services Program. The Atlanta PSI program is one component of Teen Services, which also runs a large clinic providing contraceptives to young teen-agers. Oregon has adapted the PSI curriculum for its STARS (Students Today Aren’t Ready for Sex) program, an abstinence-based effort that is part of a multifaceted approach to preventing teen pregnancy. (For more information , see story, p. 84.)
The national report, which looks at nearly 200 research articles on some 75 programs, concludes that multipronged programs that relay multiple messages and involve whole communities show the most promise in reducing teen pregnancy rates. These kinds of comprehensive programs may suffer if the "abstinence-only" programs begin to drain existing funds, the report states.
"We believe that these abstinence-only programs are harmful and are going to put more young people at risk," Haffner says. "And as I said in the editorial in our SIECUS Report, and I’m always happy to be quoted on this, I support abstinence. But I do not support denying young people information they need to protect their lives." (See Resources, p. 83, for information on how to order the April/May issue of SIECUS Report, which focused on the abstinence-only education controversy.)
References
1. Haffner D. What’s wrong with abstinence-only sexuality education programs? SIECUS Report 1997; 25:9.
2. Christopher FS, Roosa MW. An evaluation of an adolescent pregnancy prevention program: Is "just say no" enough? Family Relations 1990; 39:68-72.
3. Jorgenson SR, Potts V, Camp B. Project Taking Charge: Six-month follow-up of a pregnancy prevention program for early adolescents. Family Relations 1993; 42:401-406.
4. Kirby D, Korpi M, Barth RP, et al. Evaluation of Education Now and Babies Later (ENABL): Final report. Berkeley, CA: University of California, School of Social Welfare, Family Welfare Research Group; 1995.
5. Roosa M, Christopher S. Evaluation of an abstinence-only adolescent pregnancy prevention program: A replication. Family Relations 1990; 39:363-367.
6. St. Pierre TL, Mark MM, Kaltreider DL, et al. A 27-month evaluation of a sexual activity prevention program in Boys & Girls Clubs across the nation. Family Relations 1995; 44:69-77.
7. Young M, Core-Gebhart P, Marx D. Abstinence-oriented sexuality education: Initial field tests of the Living Smart curriculum. Family Life Educator 1992; 10:4-8.
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