Evidence-based sex ed

The Baltimore Sun

It's a paradox worthy of the federal government: Abstinence-only education inhibits the effective promotion of abstinence.

It is possible to keep teens abstinent, at least temporarily. More than a dozen programs have been shown, in peer-reviewed studies, to delay teen sex. For example, the Becoming a Responsible Teen program helped low-income African-American teenagers in Mississippi both to delay sex and to have safer sex, and its effects were visible one year later: Only 12 percent of sexually inexperienced participants became sexually active, compared with 31 percent in the comparison group. Moreover, 83 percent of sexually active participants used condoms, versus 61 percent in the comparison group. This program is recognized by the Centers for Disease Control and Prevention as a "Best-Evidence Intervention," meaning it is backed by the strongest scientific evidence - but it can't be funded under the federal government's $200 million annual abstinence-only education program.

On the other hand, those programs that are eligible for abstinence-only funding don't result in abstinence, according to the congressionally mandated evaluation of several programs thought to be the most promising.

Abstinence-only education - driven, seemingly, by ideology rather than science - requires that curricula not teach how to use condoms and birth control, even though none of the dozens of studies on the issue finds evidence that teaching birth control accelerates teens' sexual behavior. In fact, programs that teach birth control are the only programs found to cause teens to delay sex.

Worse, the millions spent annually for abstinence-only curricula carry no requirement for scientific accuracy, according to a Government Accountability Office study. The GAO found numerous inaccuracies, including one curriculum that said that condoms don't protect against AIDS because the AIDS virus can pass through condoms.

In fact, abstinence-only education, by its very nature, requires that birth control information be inaccurate; only disadvantages and failures of birth control may be taught.

Unsurprisingly, studies of abstinence-only sex education have found that it gives students negative views of condoms' effectiveness. Negative and inaccurate curricula may make students in such classes less likely to use condoms, even years later. Our study of 934 socially conservative teenagers found that five years after some of them took a virginity pledge, pledgers and nonpledgers had sex at the same rates - but 54 percent of nonpledgers used condoms most of the time, whereas only 42 percent of pledgers did so, even though the two groups had similar views about birth control before the pledge.

The incoming Obama administration is emphasizing consensus as an important part of the policy process. Sex education could be a surprisingly easy issue on which to find consensus. Nearly all parents want their children to delay sex, and 89 percent of parents agree that schools should teach birth control in sex education classes, according to the most recent peer-reviewed survey in the April 2008 Journal of Adolescent Health.

Federal policy can meet parents' goals of delayed and safer sex by redefining abstinence education in terms of outcomes. Teaching birth control is only controversial among ideologues. That $200 million per year could fund only programs rigorously proved to achieve delayed and safer sex.

Even Sarah Palin was quoted in the 2006 Alaska gubernatorial debate as favoring teaching birth control in addition to abstinence. Despite her conservative evangelical roots, Governor Palin acknowledges that most teenagers have sex - even religious teenagers - so of course they should know about birth control.

Yes, there are still right-wing ideologues who fear - without evidence - that teaching birth control encourages sex. Hockey moms and researchers know otherwise.

Janet Rosenbaum is a postdoctoral fellow at the Johns Hopkins Bloomberg School of Public Health. Her e-mail is jerosenb@jhsph.edu.

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