Author manuscript; available in PMC Apr Mary A. Ott a and John S. Santelli b. John S. Author information Copyright and License information Disclaimer. Correspondence to: Mary A. Copyright notice.
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Abstract Purpose of review To review recent literature on medical accuracy, program effectiveness, and ethical concerns related to abstinence-only policies for adolescent sexuality education. Summary Federal support of abstinence-only as an approach to adolescent sexuality education is of much concern due to medical inaccuracies, lack of effectiveness, and the withholding and distorting of health information.
Keywords: abstinence, human rights, medical accuracy, policy, sex education. Introduction To review the key issues related to abstinence-only or abstinence-until-marriage education AOE , we use the term AOE to describe those programs and policies that adhere to federal requirements for abstinence education funding see Table 1 [ 1 , 2 ]. Open in a separate window. Sexual behavior, marriage, and pregnancy Adolescence is a time of transition to adulthood.
Adolescent understanding of abstinence Adolescents demonstrate a complex and sometimes nuanced view of abstinence and sex. Public support for abstinence and comprehensive sexuality education Broad public support exists for comprehensive sexuality education, with abstinence as a key component of that education.
Erosion of comprehensive sexuality education Lindberg et al. Ethical concerns The current U. State refusals of federal funding Related to the above concerns about a lack of efficacy, medical inaccuracy and the ethically untenable position of withholding potentially life-saving information, a number of states have refused or are planning to refuse federal Title V, Section abstinence-only funding.
Conclusion Federal support of AOE as an approach to improve adolescent sexual health is deeply troubling because of medical inaccuracies, programs that are not efficacious and may harm adolescents, and the unethical practice of withholding and distorting health information.
Teenagers in the United States: sexual activity, contraceptive use, and childbearing Vital Health Stat. Fields J. Washington, DC: U. Census Bureau; Trends in premarital sex in the United States, — Public Health Rep. Using sophisticated life-table models, this paper demonstrates that sex before and outside of marriage is ubiquitous across the life-span among Americans.
It calls into question whether it is realistic and ethical to hold anyone to a premarital abstinence ideal. Youth risk behavior surveillance—United States, Guttmacher Institute.
Disparities in rates of unintended pregnancy in the United States, and Perspect Sex Reprod Health. Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health. This paper demonstrates the critical role of improved contraceptive use to the declines in adolescent pregnancy between and This paper drives home the importance of providing comprehensive sexuality information to all adolescents, including medically accurate information on contraceptive efficacy and condom use, if we are to experience further declines in adolescent pregnancy.
United Nations Statistics Division. Demographic Yearbook Which comes first in adolescence— sex and drugs or depression? American Journal of Preventive Medicine. Context counts: long-term sequelae of premarital intercourse or abstinence. J Sex Re. A prospective study of psychological distress and sexual risk behavior among black adolescent females. AT Depressive symptoms as a predictor of sexual risk among African American adolescents and young adults. J Adolesc Health. Does early adolescent sex cause depressive symptoms?
J Policy Anal Manage. However, government programs exclusively promoting abstinence-only-until-marriage AOUM are problematic from scientific and ethical viewpoints.
Most young people initiate sexual intercourse as adolescents or young adults, and given a rising age at first marriage around the globe, increasingly fewer adolescents wait until marriage to initiate sex. While theoretically fully protective, abstinence intentions often fail, as abstinence is not maintained. AOUM programs are not effective in delaying initiation of sexual intercourse or changing other behaviors.
Conversely, many comprehensive sexuality education CSE programs successfully delay initiation of sexual intercourse and reduce sexual risk behaviors. AOUM programs inherently provide incomplete information and are often neglectful to sexually active adolescents; lesbian, gay, bisexual, transgender, and questioning LGBTQ adolescents; pregnant and parenting adolescents; and survivors of sexual assault. In many U. The position paper and an accompanying review paper in JAH provided an overview of scientific and human rights concerns with U.
Since , considerable scientific evidence has accumulated and many health and medical professional groups have rejected the focus on AOUM. We have updated our review paper on AOUM programs; the updated review provides additional details and references [ 1 ].
Young people have a right to accurate and complete information to protect their lives and their health. Abstinence can be a healthy choice, but adolescents should decide themselves when they are ready to initiate sex. Young people should be empowered to become full partners in the development and implementation of comprehensive sexuality education programs.
Education for adolescents regarding abstinence is best provided within health education programs that provide adolescents with complete and accurate information about sexual and reproductive health.
Sexuality education should be comprehensive, medically accurate, and culturally competent; promote healthy sexuality; and prepare young people to make healthy sexual decisions.
Instruction in sexuality education should include essential concepts and issues such as sexual orientation, sexual health, gender identity and power dynamics, intimate partner violence and sexual exploitation, healthy relationships, social and structural determinants, personal responsibility, risks for HIV and other STIs and unwanted pregnancy, access to sexual and reproductive health care, and the benefits and risks of condoms and other contraceptive methods.
Health educators and health care providers should provide comprehensive information to young people. Governments and schools should eliminate censorship of information related to human sexuality, including sexual orientation and gender identity.
Sexuality education curricula and programs should be based on scientific principles and evidence from research. Government policy regarding sexual and reproductive health education should be science-based.
The focus on evidence-based interventions EBIs in current U. The USG and other governments should increase support for development and evaluation of programs to promote adolescent sexual and reproductive health, including school-based interventions, media efforts, and clinic-based interventions. United States government programs promoting abstinence-only-until-marriage are ethically flawed, are not evidence-based, and interfere with fundamental human rights to complete and accurate health information.
Current funding for abstinence-only-until-marriage programs should be replaced with funding for programs that offer comprehensive, medically accurate sexuality education.
The U. Funding was greatly expanded after and focused on exclusionary programs i. Programs cannot in any way advocate contraceptive or condom use or discuss contraceptive methods except to emphasize their failure rates. Given concerns about program efficacy and restrictive federal program requirements, U. California has never accepted AOUM funding. By , nearly half of the states had chosen not to take federal support. After , the emphasis of federal funding shifted to evidence-based interventions to prevent adolescent pregnancy.
In FY , U. While the goal of AOUM programs is to delay initiation of sexual intercourse until marriage, this goal ignores global demographic trends in age at marriage. See Coronavirus Updates for information on returning to campus, and more.
Two scientific review papers find abstinence-only-until-marriage programs and policies in the United States are ineffective because they do not delay sexual initiation or reduce sexual risk behaviors.
According to the researchers, these programs also violate adolescent human rights, withhold medically accurate information, stigmatize or exclude many youth, reinforce harmful gender stereotypes, and undermine public health programs. Both papers are published online in the Journal of Adolescent Health. In , a nine-year congressionally mandated study that followed four of the programs during the implementation of the Title V AOUM program found that abstinence-only education had no effect on the sexual behavior of youth.
Among those who did have sex, there was no difference in the mean age at first sexual encounter or the number of sexual partners between the two groups. The study also found that youth that participated in the programs were no more likely to engage in unprotected sex than youth who did not participate.
While teens who participated in these programs could identify types of STIs at slightly higher rates than those who did not, program youth were less likely to correctly report that condoms are effective at preventing STIs. A more recent review also suggests that these programs are ineffective in delaying sexual initiation and influencing other sexual activity.
A study that found an abstinence-only intervention to be effective in delaying sexual activity within a two-year period received significant attention as the first major study to do so. Instead, the evaluated programs differed from traditional abstinence-only programs in three major ways: they did not discuss the morality of a decision to have sex; they encouraged youth to wait until they were ready to have sex, rather than until marriage; and they did not criticize the use of condoms.
There is, however, considerable evidence that comprehensive sex education programs can be effective in delaying sexual initiation among teens, and increasing use of contraceptives, including condoms. The Trump administration continues to shift the focus towards abstinence-only education, revamping the Teen Pregnancy Prevention Program and increasing federal funding for sexual risk avoidance programs.
Despite the large body of evidence suggesting that abstinence-only programs are ineffective at delaying sexual activity and reducing the number of sexual partners of teens, many states continue to seek funding for abstinence-only-until-marriage programs and mandate an emphasis on abstinence when sex education is taught in school. There will likely be continued debate about the effectiveness of these programs and ongoing attention to the level of federal investment in sex education programs that prioritize abstinence-only approaches over those that are more comprehensive and based on medical information.
The Consolidated Appropriation Act, November 3, Heritage Foundation Mathematica Policy Research Santelli JS, et al. Guttmacher Institute. Policies and Programs and Their Impact. Journal of Adolescent Health, 61 e Abstinence-Only-Until-Marriage Programs fact sheet.
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