Accuracy, Efficacy And Ethics Of Abstinence-only Programs Questioned By Public Health Experts

Edited by John S. Santelli, MD, MPH, professor and chair of the Heilbrunn Department of Family and Population Health and Leslie M. Kantor, MPH, assistant professor of clinical Population and Family Health at the Columbia University Mailman School of Public Health, the theme issue examines scientific and ethical implications of federal abstinence-only policies and programs. 

In sum, the articles show that abstinence-only programs contain medical inaccuracies, fail to help young people to change behavior, and conflict with ethical standards. Abstinence-only programs violate young people's right to accurate information—and also teachers' and health educators' rights to answer questions and provide medically accurate information. Many states have now refused to participate in the federal program (25 states as of August 2008) citing concerns about efficacy and accuracy of abstinence-only programs. The federal program provides funding for abstinence-only education and restricts information about contraception and other aspects of human sexuality.

"Abstinence-only programs have a broad variety of problems with accuracy, efficacy, and ethics," Dr. Santelli. "These studies clearly demonstrate that federal promotion of abstinence has failed in its primary goal of helping young people delay initiation of sex, and actually, withholds life-saving information from young people."

"Many states are rejecting abstinence-only funding often over concerns about medical accuracy and program efficacy," says Professor Kantor. "States are now lining up with the vast majority of parents and health professionals who support comprehensive health education."

"U.S. government's policies are out of step with the realities of young peoples' lives." observes Dr. Santelli. "Historical trends toward earlier sex and later marriage in the 20th Century are incongruent with abstinence-until-marriage policies and programs."

Individual Studies

Douglas Kirby assessed the impact of 56 programs on adolescent sexual behavior, comparing abstinence-only and comprehensive sex education programs. He found that most abstinence programs did not delay initiation of sex and only 3 of 9 had any significant positive effects on any sexual behavior. In contrast, about two thirds of comprehensive programs showed strong evidence that they positively affected young people's sexual behavior, including both delaying initiation of sex and increasing condom and contraceptive use among youth.

Alison Lin and John Santelli found that three commonly used, abstinence-only curricula often provide inaccurate medical information to adolescents, including false or misleading statements about the effectiveness and safety of condoms, and inflate the actual failure rate of condoms, suggesting that using condoms is somewhat like playing "Russian roulette" with HIV. Study results are consistent with earlier reviews that found medical inaccuracies throughout a wide sample of abstinence-only program curricula.

Marissa Raymond and colleagues explore the reasons that many states have rejected federal abstinence-only funds. Refusal states generally cite concerns about the efficacy and accuracy of abstinence-only curricula. Those states also tend to have progressive governments and strong advocates for comprehensive sexuality education. As of August 2008, 25 states had opted out of Title V funding including Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Idaho, Iowa, Maine, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington, Wisconsin, and Wyoming.

Ali Miller and Rebecca Schleifer describe investigations by Human Rights Watch both in Texas and Uganda that abstinence-only programs violate key human rights principles. The article illustrates how international human rights principles and human rights tools can be used strategically by policy advocates and health programmers concerned about abstinence-only programs. Human rights violations include withholding accurate information about prevention of HIV and sexually transmitted diseases and using discriminatory language about gay men and lesbians in abstinence-only programs. Abstinence-only education violates young people's rights—to information, to education, and to health.

Leslie Kantor, John Santelli, Julien Teitler and Randall Balmer provide an overview of abstinence-only policies and programs that includes a history of the growth in U.S. support for abstinence-only programs. These programs have their origin in particular religious viewpoints which are often at odds with mainstream public thinking. The article also illustrates key demographic trends, the effects of virginity pledges, and the ways that abstinence-only programs are out of step with key human rights principles.

A related article "Medical Accuracy in Sexuality Education: Ideology and the Scientific Process" has been published by Dr. Santelli in the American Journal of Public Health (October 2008, vol 98, no 10) and examines the criteria for determining scientific accuracy and the ways that abstinence-only programs overlook established medical facts.