Challenging Dogma

...Using social sciences to improve the practice of public health

Saturday, April 21, 2007

Abstinence-Only, Only Comes Up Short: Public Policy’s Failure to Acknowledge Teen Realities – Gabrielle Ghafari

The United States has one of the highest teen pregnancy rates of all developed nations. (1) In an effort to address this situation, the Adolescent Family Life (AFL) Program was enacted in 1981 to promote family involvement in the delivery of services around adolescent sexuality and pregnancy. (2) Over time, the federal government has allocated more and more money to address the issue of teen pregnancy. While monies are many, how they can be used is extremely limited. Programs accepting this money must promote an abstinence-only message. Abstinence-only education provides education to teens only around the importance of abstaining from sexual intercourse and often does not include accurate information about contraception and sexually transmitted infections. (3) In the 2005 fiscal year, around $170 million was allocated by the federal government for abstinence-only programs. (3) Unfortunately, the theories behind abstinence-only education are not evidence-based and the rate of teen pregnancy remains high. (1) The federal government’s goal of reducing teen pregnancy by exclusively supporting abstinence-only programs, fails to account for the many different motivations in teens’ sexual activity in addition to leaving teens without information that is vital to their safety and their ability to make healthy choices.

Abstinence Only Education – What Does it Entail?
In order to effectively examine and critique abstinence-only education, is it important to know what is included under that heading. The term “abstinence education” is defined in the Social Security Act as a program that includes the following: (2)
1. Has as its exclusive purpose, teaching the social, psychological, and health gains of abstaining from sexual activity
2. Teaches abstinence from sexual activity outside of marriage as the expected standard for all school-age children
3. Teaches that abstinence is the only certain way to avoid out-of-wedlock pregnancy, STDs and associated health problems
4. Teaches that a mutually faithful monogamous relationship within marriage is the expected standard of human sexual activity
5. Teaches that sexual activity outside of marriage is likely to have harmful psychological and physical effects
6. Teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society
7. Teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances
8. Teaches the importance of attaining self-sufficiency before engaging in sex

Abstinence Only – How It Fails
69% of public school districts teach sex education and 35% percent of those schools teach abstinence as the only option/lifestyle and are prohibited to discuss contraception or can only mention its shortcomings. (2) One report found that 80% of abstinence-only programs contain false or misleading information about sexual health. (3) In addition, from 1995-2002, more and more students received abstinence education while less and less received education about contraception. (4) The number of teen pregnancies has not decreased since the wide-spread implementation of abstinence-only programs, nor has the number of sexually active teens. (1)

Why It Fails – Teen Development
Abstinence-only programs primarily take place during an individual’s adolescent years. In order to attempt anything during this fragile and confusing time of life, on must understand what it is to be a teen. Teenage years are especially challenging years. Teens experience mental and physical changes. In addition to the physical changes that occur during teen years, there are changes going on in the brain. There are hormonal changes and structural changes going on in the corpus callosum, the amygdala and other areas. (5) Areas that are involved with problem solving and primal emotions. Teens experiencing these changes act less rationally than adults and may rebel more than adults. Renowned psychologist Erik Erickson’s theory of psychosocial development helps in understanding teen development. According to Erikson’s stages, the adolescent years (~12-19 years) are the years that a person’s identity and coherent self concept are being developed. (6) In order for a teen to develop a sense of self, he or she may rebel in one way or another. By teaching teens only one thing when they know that there are other options available, those providing the information are asking them to rebel against what is being preached. Erikson also states that later adolescence is the time when “clear sexual identity is established.” Being a teen is the time in life that one begins to explore sexuality. Abstinence-only programs are denying teens important information about sexuality at the time when they need it most. If a teen does not agree or assimilate with an abstinence-only philosophy he or she has no information about how to behave responsibly in his or her quest to choose how and when to act.

Why It Fails – Information Processing
Another idea not considered in teaching abstinence only is how people process information. The information processing model that states that in order for a person to eventually change his or her behavior he or she needs to successfully complete all of the steps prior to the behavior change. By expecting teens to remain abstinent by only teaching abstinence, we assume that first, they pay attention to the message, second they understand the message, third, they believe what you are telling them, and fourth, that they remember it. If teens pay attention and understand the message, they are likely to be distrusting, especially with all of the conflicting messages they get outside of the abstinence program. Therefore, it seems unlikely that many teens will get to the issue of behaving in accordance with the message sent. As previously mentioned, teens brains are undergoing substantial change, second only to just after birth. (5) These changes will undoubtedly interfere with teens’ ability to process information. Assuming teens pay attention to the message, abstinence-only programs presume that they believe what they are being told. Teens are inherently distrusting of adults, especially ones who preach a message so different than the messages they get in popular culture. If teens do not believe the message, they will not complete processing of the abstinence message, and therefore not behave accordingly. In addition to not believing the message, the abstinenc- only education that is being taught to many contains incorrect information which means teens will not understand the message. Teens may be told not to engage in sex because it is inappropriate and potentially damaging to their health. However, if the information is vague teens may go onto conclude that sexual intercourse is the issue and not oral sex or other risky sexual behaviors. If this is how a teen interprets the abstinence message, then he or she could go onto engage in risky behavior and not realize the potentially harmful consequences.

Why It Fails – Teen Behavior
Children may often get the message, ‘do as I say, not as I do.’ This is clearly not how to teach behavior, as is suggested by social learning theory. Observing behaviors, attitudes and emotional reactions affect behavior much more than words. (7) Even if a message of abstinence is presented, teens leave the room and go out into the world. There they are constantly bombarded with sex –music, television, advertisements, and celebrities to name a few sources of information. If teens are told to be abstinent but observe the power and intrigue of sex, the behavior they see is more likely to be modeled. In addition to seeing sex in the ‘outside world,’ they may also see their peers engaging in sexual activity. Peer pressure is also of particular importance during teen years. If a teen’s peers are engaging in sexual affection or portray that they are, then there is more pressure for an individual to engage in sexual behavior to feel accepted.

Despite the federal government’s effort to reduce teen pregnancy by funding abstinence-only education in public schools, the teen pregnancy rate in the United States remains one of the highest in the developed world. No evidence-based-research has shown abstinence only education to be effective, yet it continues to receive more and more funding each year. The lack of an evidence-base is not the only reason this program has failed. Abstinence-only education fails to account for teens’ motivations and the physiological changes that happen during teen years. Teen years are a time of rebellion, mistrust, and exploration. In addition, peer acceptance is paramount during teen years as teens generally pay more attention to the opinions of their peers over teachers. All of these factors contribute to the failure of abstinence-only education in the United States. In addition to the failure of abstinence-only education in reducing the teen pregnancy rate, it may even be harmful. Teens who have had an abstinence-only message and who chose to engage in any form of sexual activity, may do so unsafely as they lack the information they need to keep them safe – from pregnancy and sexually transmitted infections. Many other developed countries, have comprehensive sexual education and have substantially lower teen-pregnancy rates (8), in addition to a more educated teen population. Based on the failure of the current abstinence-only curricula, the federal government should seriously consider revamping sexual education in the United States and use successful programs in other nations as models.

(1) Hoffman S. Report for the National Campaign to Prevent Teen Pregnancy. By the Numbers: the Public Cost of Teen Childbearing. Washington, DC, 2006.
(2) Solomon-Fears C. CRS Report for Congress. Reducing Teen Pregnancy: Adolescent Family Life and Abstinence Education Programs. Domestic Social Policy Division, 2004.
(3) Waxman HA. United States House of Representatives Committee on Government Reform – Minority Staff, Special Investigations Division. The Content of Federally Funded Abstinence-Only Education Programs. Washington DC, 2004.
(4) Lindberg LD, Santelli JS, Singh S. Changes in formal sex education: 1995-2002. Perspectives on Sexual and Reproductive Health. 2006;38:182-189.
(5) Kraft B. What Makes Teens Tick. Time Magazine. 2004:127-133.
(6) Seifert KL, Hoffnung RJ. Child and Adolescent Development, 5th edition. Boston, MA: Houghton Millflin Company, 2000.
(7) Psychology Tips. Social Learning Theory – A. Bandura.
(8) Shorto R. Contra-Contraception (pp1-9). New York Times Magazine. New York, New York: May 7, 2006.

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  • At April 26, 2007 at 8:08 AM , Blogger christine peloquin said...

    really good explanation and description of what is happening in one's teenage years, including the need to rebel, the physical changes happening in the brain, and the influence of peer pressure.

    i think that if we empowered teen-agers with all the necessary information and stressed that we trust them to make the right choice for them, the results would be better. if we stressed that it is a choice THEY are going to make ON THEIR OWN, maybe the teenagers would treat it as an important issue, rather than something to rebel against.

    thought the section on information processing theory was informative and interesting.


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