TO EDUCATE OR NOT: COMPREHENSIVE OR ABSTINENCE-ONLY SEXUAL EDUCATION PROGRAMS: WHICH IS MOST EFFECTIVE?

As a proponent of comprehensive sexual education as a method of preventing preganancy in adolescents, I want to share with others what I have learned from an examintion of the literature regarding abstinence only and comprehensive sex education programs in schools. I will also discuss the risks and consequences associated with adolescent pregnancy and parenthood as well as the federal funding programs for both programs. In conclusion, I will also make suggestions for change.


HEALTH RISKS AND ECONOMIC CONSEQUENCES ASSOCIATED WITH ADOLESCENT PREGNANCY AND PARENTHOOD

The Centers for Disease Control and Prevention, CDPC, reports that between eight hundred and nine hundred thousand women, younger than age twenty, become pregnant each year in America (CDPC, 2000). The CDPC also reports that several adverse health and social risks are associated with adolescent pregnancy and parenthood (CDPC, 2000). Babies born to adolescent mothers are twice as likely to face such health risks as low birth weight, premature birth, and infantile mortality (King, 2003). Furthermore, these children are more likely to have cognitive and behavioral difficulties than are children born to adult women (Anderson, et. al 2003).

Social risk factors for children born to adolescent parents include abuse and/or neglect by cognitively immature mothers (King 2003). Elders and Albert (1998) report that 66 percent of pregnant adolescents have a history of sexual abuse, and therefore the risk of abuse and neglect for infants born to sexually abused teen mothers is much higher than for babies born to teens who have not been sexually abused.

Several economic consequences are associated with adolescent pregnancy and parenthood that result in increased public spending. In 1994, the Center for Population Options reported that $34 billion in public welfare funds were spent to support adolescent mothers and their children (Solomon & Liefeld, 1998). According to Yampolskaya (2002), adolescent mothers are also more likely to drop out of high school and are less likely to pursue a higher education, creating a burden for the society that must support them.


COMPREHENSIVE VS. ABSTINENCE-ONLY SEXUAL HEALTH EDUCATION

Advocates of Comprehensive Sexual Health Education programs promote abstinence. However, supporters of such programs also believe that all adolescents have the right to accurate sexual health information and the right to choose their level of sexual activity. In this manner, supporters of comprehensive sexual health education programs assert that youth will be fully informed and therefore better able to protect themselves against unwanted pregnancy and sexually transmittable disease (McCave, 2007).

Proponents of Abstinence-Only programs believe that abstinence is the only choice and that married heterosexual couples alone should engage in sexual activity. By asserting their morality regarding sexual behavior, supporters believe that they can positively influence the sexual behavior of adolescents (McCave, 2007). Proponents of Abstinence- Only programs believe that Comprehensive programs promote promiscuity (McCave, 2007). Increasingly, public funds are being allocated to programs that support Abstinence-Only education (McCave, 2007).


COMPREHENSIVE SEXUAL HEALTH EDUCATION PROGRAMS

Recent studies show the effectiveness of comprehensive sexual health education programs. According to the CDPC (1999), 1.3 million adolescent pregnancies were prevented due to the use of comprehensive reproductive health care services. According to the Alan Guttmacher Institute, contraception was responsible for a 75 percent decline in teen-aged pregnancy between 1988 and 1995 (McCave, 2007). Studies also show that students who are exposed to comprehensive programs are more likely to abstain from sexual activity for two to three years longer than those exposed to abstinence-only programs (Huberman, Berne 1995). Furthermore, adolescents with access to school-based family planning clinics sought assistance within two months of becoming sexually active as compared to their peers with no such access whom sought family planning services fifteen to twenty-two months after becoming sexually active (Bar-Cohen, et al., 1990).

In order to be effective, comprehensive programs must adhere to a specific curriculum. In 1996, the Sexuality Information and Educational Council of the United States stated that comprehensive sexuality education should include a discussion of the following subject matter: reproductive development and health, communication skills, affection and intimacy, healthy body image, and gender role identification (McCave, 2007). Comprehensive programs also include activities that address social pressures. Student participants are encouraged to practice such communication skills as negotiation and refusal. Materials for such programs are age appropriate and culturally sensitive. Classes are of a sufficient length of time and are taught by instructors who are specifically trained in the topic and are supportive of comprehensive programs (Kirby, 2001).


ABSTINENCE-ONLY SEXUAL HEALTH EDUCATION PROGRAMS

Studies show that Abstinence-Only programs reduce the occurrence of adolescent pregnancy by twenty-five percent (Daliard, 2002). Federally funded abstinence-only programs must adhere to the following principles of thought: (1) all unmarried individuals must practice abstinence; (2) children born to unmarried individuals are a burden for the individual, family, and community; (3) alcohol and drugs impair judgment; (4) all individuals must be self sufficient before becoming sexually active. Such programs must also include instruction in methods to avoid unwanted sexual advances (McCave, 2007). An examination of the curriculum for abstinence only programs found that eight of twenty-one programs omitted information and provided inaccurate information, and/or presented a negative view of certain populations, particularly homosexual, bisexual, and transgender individuals, as well as adolescent parents (Wilson, et al. 2005). Many abstinence only programs are federally funded under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (McCave, 2007).


TITLE X: FEDERAL FUNDING FOR COMPREHENSIVE PROGRAMS

In 1969, President Nixon signed Title X of the Public Health Service Act into law. Title X is a federally funded comprehensive family planning service program designed to assist individuals and families whose income is at or below the federal poverty limit and to reduce dependency on welfare and to improve the health and well being of women and children (Gold, 2001). The Title X Family Planning Act “makes provisions for educational, comprehensive medical, and social services necessary to aid individuals to determine freely the number and spacing of their children” (Gold, 2001). Most comprehensive sexuality education programs are funded under Title X. “Title X services received by single women ages fifteen through nineteen prevent an estimated 385,800 unplanned pregnancies, 154,700 births, and 183,300 pregnancy terminations” (Friedman, 2005; p. 21). “For every dollar that the federal and state government spend on family planning services, three dollars are saved in Medicaid costs for pregnancy related and newborn care” (Gold, 2001; p. 23).

In recent decades, conservative political administrations have opposed Title X. For example, during his presidency, George Bush, Jr. has opposed comprehensive education and has been quite explicit in his supportive of abstinence-only programs (Friedman, 2005). I suggest that former President Bush and others of similar mindset examine the statistics before making a decision that has so strongly impacts the sexual health education of our nation’s children.


CONCLUSION: SUGGESTIONS FOR CHANGE

Empirically sound studies show that abstinence-only sexual health education programs are ineffective at preventing adolescent pregnancy and that comprehensive sexual health education programs are highly effective in preventing adolescent pregnancy. Studies also show that adolescent pregnancy and parenthood presents physical, social, and economic challenges for the child, adolescent parents, and the society of which they are a part. To help alleviate some of these challenges, I suggest the following recommendations for change. First, according to the California Department of Education (2008), the state of California mandates that all schools offering sexuality education classes must offer a comprehensive curriculum, but does not require all schools to offer sexual education. I suggest that all schools be required to offer comprehensive sexuality education programs at the Federal, State, and local levels. Second, I suggest that the funds allocated under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 be reallocated to Title X of the Public Health Services Act. Third, I suggest that Comprehensive Sexual Education programs be expanded beyond the school setting to community educational organization. Planned Parenthood is an excellent example of such an organization.

The Abstinence-Only approach to sexual health education is ludicrous. As any experienced parent can attest, children are naturally inquisitive and are especially interested in exploring matters from which they are prohibited. Abstinence-Only programs are prohibitive. Rather than tell our children “No, not until you are married”. I suggest that children be given options.

Comprehensive Sexual Health Education programs can provide those options for children. The Comprehensive sexual health education of children is the best approach to reducing the rates of adolescent pregnancy and parenthood, as well as prevention of life threatening sexually transmittable diseases. Only through education can adults hope to better prepare children to take responsibility for themselves and their future.



REFERENCES

Anderson, P. Doyle, L.W. & the Victorian Infant Collaborative Study Group. (2003). Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990’s. Journal of American Medical Association, 289(24), 3624-3672.

Bar-Cohen, A., Lia-Hoaberg, B., & Edwards, L. (1990). First family planning visit in school-based clinics. Journal of School Health, 60(4), 418-422.

California Department of Education. Comprehensive Sexual Health Education. (n.d.). Retrieved March 17, 2008 from website:http//www.cde.ca.gov/ls/he/se/sexeducation.

Centers for Disease Control and Prevention. (2000). National and state specific pregnancy rates among adolescents: United States, 1995-1997. Morbidity and Mortality Weekly Report, 49(27), 605-631.

Centers for Disease Control and Prevention. (1999). Achievements in public health, 1990-1999: Family Planning. Morbidity and Mortality Weekly Report, 48(47), 1073-1080.

Daliard, C. (2002). Abstinence promotion and teen family planning: The misguided drive for equal funding. Guttmacher Report on Public Policy, 5(1), 1-3.

Elders, M.J., & Albert, A.E. (1998). Adolescent pregnancy and sexual abuse. Journal of the American Medical Association, 280(7), 648-649.

Friedman, D. (2005, July). America’s family planning program: Title X. Fact Sheet. Washington, D.C.: Planned Parenthood Federation of America.

Gold, R.B. (2001). Title X: Three decades of accomplishment. Guttmacher Report on Public Policy, 4(1), 5-10.

Huberman, B.K., & Berne, L.A. (1995). Sexuality education: Sorting fact from fiction. Phi Delta Kappan, 77, 229-232.

King, J.C. (2003). The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. Journal of Nutrition, 133, 1732S-1736S.

Kirby, D. (2001). Emerging answers: Research finding on programs to reduce teen pregnancy. Summary. Washington DC: National Campaign to Prevent Teen Pregnancy.

McCave, E. L. (2007). Comprehensive Sexuality Education vs. Abstinence-Only Sexuality Education: The Need for Evidence-Based Research and Practice. School Social Work Journal, 32(1), 14 – 28.

Solomon, R., & Liefeld, C.P. (1998). Effectiveness of a family support center approach to adolescent mothers: Repeat pregnancy and school drop-out rates. Family Relations, 47, 139-144.

Wilson, K.L., Goodson, P., Pruitt, B.E., Buhl, E., & Davis-gunnels, E. (2005). A review of 21 abstinence-only-until-marriage programs. Journal of School Health, 75(3), 90-98.

Yampolskaya, S., Brown, E.C., & Greenbaum, P.E. (2002). Early pregnancy among adolescent females with serious emotional disturbances: Risk factors and outcomes. Journal of Emotional and Behavioral Disorders, 10(2), 108-115.