Challenging Dogma


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

Saturday, April 21, 2007

Abstinence-Only Programs: Public Health’s Failure To Address Issues Affecting Sexually Active Teens – Tamara Rudich

Abstinence-only programs are designed to teach youth that waiting to have sex until marriage is crucial. However, the reality remains that many youth are having sex in high school and earlier. Instead of acknowledging that teens have sex and talking about the important issues associated with being sexually active, abstinence-only programs fail to educate teens on issues affecting them. “Although abstinence until marriage is the goal of many abstinence policies and program, few Americans wait until marriage to initiate sexual intercourse. Recent data indicate that the median age at first intercourse for women was 17.4 years, whereas the median age at first marriage was 25.3 years. For men, the corresponding median age at first intercourse was 17.7 years, whereas the age at first marriage was 27.1 years”(1).

This paper will examine how framing of abstinence-only programs and creating stigma of sexual activity in these programs fail to fully and open-mindedly educate their audiences: “Framing is the process of selective control over an individual’s perception” (2). In this case, the control is over perception of sexual activity. Teens are sexually active and it is better to educate them comprehensively rather than selectively (1). Abstinence-only programs place a stigma on sexual activity as being deviant. This situation is problematic because it may instill fear in teens rather than appropriately educating them and addressing their concerns. Lastly, this paper will provide a comparative analysis of sexual education programs in Sweden compared to abstinence-only programs in the United States. Sweden provides a comprehensive sexual education for students starting at a young age and the country’s pregnancy and sexually transmitted disease rates are much lower than in the U.S. (3)

Current Federal Policy and Programs for Abstinence-Only Programs
In 1996, the federal government greatly increased the amount of money used toward funding abstinence-only programs, which enforced restriction of information communicated in sexual education. Much of the funding for such programs was through the Social Security Act in 1996, Section 510, which was a part of the welfare reform. In 2000, an additional program called Community Based Abstinence Projects funded by Special Projects of Regional and National Significance (SPRANS) was created and expanded the number of abstinence-only programs which the federal government helps fund. Both Section 510 and SPRANS programs prohibit educators from providing information on contraceptive use, safe-sex education, gender identity, sexual orientation, abortion and many other topics (4).

The current federal policy provides sexual education programs with federal funding as long as these programs are teaching abstinence only. “These programs focus on restricted vision of abstinence promotion and prohibit disseminating information on contraceptive services, sexual orientation and gender identity, and other aspects of human sexuality. Federal funding language promotes a specific moral viewpoint, not a public health approach. These federal programs present questionable and inaccurate opinions as fast, and specifically prohibit information about healthy alternatives to abstinence such as condom and other contraceptive use” (4). In order to get government funding, the programs must be abstinence-only and must abide by the following criteria. “1.Has as its exclusive purpose, teaching the social, psychological and health gains to be realized by abstaining from sexual activity; 2.Teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children; 3. Teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems; 4. Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity; 5. Teaches that sexual activity outside of the 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 and 8.Teaches the importance of attaining self-sufficiency before engaging in sexual activity” (5).

When sexual education programs follow these criteria they are missing many valuable topic areas that should be included in a comprehensive sexual education program. A comprehensive sex education program is one which has the following effects: 1.Makes students more knowledgeable about sexuality 2.reduces sexual guilt, which is often implied by abstinence-only programs 3.helps students become more comfortable with themselves and be open-minded to others’ sexual practices and 4.settles many sexual myths and fallacies (6).
Regardless of the type of sexual education that students are exposed to, they will engage in sexual intercourse, therefore it is important to fully inform students in order to teach them how to best protect themselves. In the study: ‘Sex Education and Its Association with Teenage Sexual Activity, Pregnancy, and Contraceptive Use,’ the authors found the following. “First, the data seems to provide overwhelming support for the claim that the decision to engage in sexual activity is not influenced by whether or not teenagers have had sex education in school. Second, young women who have had sex education appear less likely than those who have not to become pregnant if they are sexually active” (7). These women are less likely to become pregnant and get sexually transmitted diseases because they know how to best protect themselves, as a result of their more comprehensive education.

Abstinence-only programs are not thorough in educating and they utilize scare tactics to attempt to prevent premarital sex. Scare tactics are utilized through a power-coercive approach, which is “using the law to mandate certain behavior”(8). Coercion of abstinence-only is an inappropriate method to influence sexual behavior, because it does not address any of the appropriate issues facing teens. In abstinence-only programs: “coercive strategies emphasize the utilization of moral power, playing upon sentiments of guilt and shame” (9). These programs utilize these scare tactics to instill fear in students.

An example of a scare tactic is telling students that if they have sex they will get a STD. The programs do not provide information on other topics such as using condoms to prevent STDs, pregnancy prevention, and abortion. The truth remains that individuals have sex before marriage; many kids have sex in high school and even earlier. In order to protect these students’ educators must be willing to have open conversations. If they want to have sex they will, so public health educators should be able to provide them with all the necessary tools to protect themselves.

Abstinence Only-Programs Place Stigma on Sexual Activity
The term stigma is applied when “elements of labeling, stereotyping, separation, status loss and discrimination co-occur” (10). A stigma places a label and stereotype of those who are sexually active as having undesirable traits because they have not remained abstinent. Abstinence-only programs fail to address the concerns of teens and place a stigma on sexual activity as being deviant. This stigma is problematic because it makes teens uncomfortable with talking about sexual identity, intercourse, and other important issues. By not talking about these issues, teens feel that being sexually active is sinful. An individual’s sexuality and sexual experience should not be something that they should feel bad about. It is better to be open about concerns and questions regarding sexual activity, in order to help teens embrace themselves and understand their wants and needs in terms of deciding to be sexually active or not. The best way to prepare and protect teens is to make sure they are comfortable with talking about these issues and educating them as fully as possible.

Stigma is defined in the social sciences as: “an attribute that is deeply discrediting and that reduces bearer from a whole and usual person to a tainted and discounted one” (10). A deviant stigma is placed on individuals who engage in premarital sexual activity through abstinence-only programs. Stigma occurs in a several step process, beginning with differences being labeled and identified. In this case those in charge of abstinence-only programs enforce the labeling process. Next, the culture attaches negatives connotations to differences that have been created, for example being deviant or promiscuous. Thirdly, individuals who are stigmatized are placed in outcast categories, separating them from mainstream society. Next, those who are stigmatized feel a sense of loss of power and inequality to others. Lastly, this stigmatism creates a world in which those who are stigmatized are discriminated and unaccepted by others (10).
Placing a stigma on sexual activity inhibits students’ ability to explore their sexuality in a healthy and educated manner. These students may be afraid to ask questions, and as a result their understanding of issues important to them remains minimal.

Framing the Issue
“Framing is the process of selective control over an individual’s perception” (2). In this case, the control is over perception of sexual activity. By controlling how individuals perceive a particular idea, the educators are not allowing students to think freely and feel able to communicate their concerns and ideas. Framing also implies that there is only one way to understand a concept, and any other assessment of this concept is incorrect or invalid (2). In assessing the framing of abstinence-only programs, it is important to examine the title of the program. Titling the program abstinence-only makes it appear as though abstinence is the only option. Framing is a process by which ideas are communicated, if we are communicating that abstinence is the sole option and fail to provide a comprehensive sexual education, many students will lack an understanding of sexual activities they engage in.

Abstinence-only programs fail to reduce teen pregnancy and sexually transmitted diseases in part because sexual activity is being framed in a way that is irrelevant to the reality of the students’ sexual experience (2). The framing of abstinence-only programs has resulted in inappropriate education for teens and has provided limited information to students who are consequentially misinformed. “Surveys on health educational practice in the United States provide further evidence of an erosion of comprehensive sexual education. Data from the School Health Policies and Programs Study in 2000 found that 92% of middle and junior high schools and 96% of high schools taught abstinence as the best way to avoid pregnancy, HIV and STDs. Only 21% of junior high and 55% of high school teachers taught the correct use of condoms. Between 1988 and 1999, sharp declines occurred in the percentage of teachers who supported teaching about birth control, abortion, sexual education and in the percentages who actually taught these subjects” (4). Regardless of their lack of knowledge from abstinence-only courses, many teens are sexually active. As was mentioned earlier, the mean age of first experience having intercourse was 17.7 for women and 17.4 for men. Without the appropriate education to protect them these teens may end up in bad situations. For example, many abstinence-only programs fail to discuss contraceptive options; without a knowledge of these options, many teens may have sex without using any protection resulting in the possibility of pregnancy and getting an STD.
By limiting sexual education, abstinence only programs are framed to cut off students from the facts of sexual activity. Abstinence-only programs are guided by the myth that once students understand sexual activity and have a more comprehensive education in this area, they will engage in this more risky behavior. Since abstinence-only programs fear that knowing the truth about sexual education will lead to increased sexual activity they have framed the programs to teach abstinence as the only option. These programs are guided by a myth that comprehensive education leads to increased sexual activity, when the reality is that this education guides teens to make better choices and to better understand themselves (11).

Case Study Example of Sexual Education in Sweden
In Sweden sexual education is approached as an issue about which educators should be very open with students. The Swedish provide students, starting at a young age, with a comprehensive education in sexual education. Areas that are often covered in their programs emphasize biology, physiology “as well as teaching sexuality in the context of relationship and their psychological, ethical and social dimension” (3). These programs also explore moral and cultural values with their students. The programs cover controversial issues such as: contraceptive use, STDs, cohabitation, abortion, and premarital sex while not to forcing students to take any position on these matters. The following explains why the Swedes have taken on a comprehensive sexual education approach and start programs at an early age: “Many very early sexual relationships are started before the young people concerned can handle the situation emotionally or can cope with the responsibility, and this can have unfortunate consequences. Teaching about sexual and personal relationships should try to help reduce the number of very early relationships and to mitigate their negative consequences. However, many teenage relationships are handled in a responsible and considerate manner, and the school should not cut itself off from the opportunity to provide assistance and advice to young people involved in relationships…The school, in other words, should not take sides on this moral question but should keep the channels of communication open for an unprejudiced consideration of such theoretical and practical aspects as may help students to see more clearly and to find their own way” (3).

The Swedish educators view sexual education as an opportunity to help students understand themselves and explore their thoughts in a safe environment. The Swedes have formed a setting in which students feel comfortable asking questions, which may not be allowed to be discussed in the U.S. abstinence-only programs, such as contraceptive use. By being open and providing a comprehensive education, the Swedish are more successful in educating and addressing important issues. Interestingly, when comparing teen pregnancies in Sweden and the U.S., Sweden has much lower rates. Many researches have found that the openness of the sexual education system in Sweden clearly contributes to lower pregnancy rates (3). More policy makers in the U.S should take a closer look at the abstinence-only programs, and understand that these programs are providing limited education, having students confused and uneducated about important issues, contributing to higher teen pregnancy rates and growing number of teens with STDs.

The Future for Sexual Education in the United States
As has been already discussed, abstinence-only programs fail to address many valuable topics that ought to be included in a comprehensive sexual education program. A comprehensive program does the following: 1.Makes students more knowledgeable about sexuality 2.reduces sexual guilt, which is often implied by abstinence-only programs 3.helps students become more comfortable with themselves and be open-minded to others’ sexual practices and 4.settles many sexual myths and fallacies (5). The Swedish sexual education programs are comprehensive in these areas and clearly teens have benefited as is evident by the lower teen pregnancy rates and STDs.

The government needs to closely examine abstinence-only programs in order to confront their failure. It would be beneficial to have a comparative study of abstinence-only programs and other more comprehensive sexual education programs. Also a study of abstinence-only programs compared to other countries such as Sweden with lower teen pregnancy and sexually transmitted disease rates would be essential. The high rates of teen pregnancy and sexually transmitted diseases should be a warning sign that the current sexual education programs are not working and improvements are critical.

References
1.Lyon M., Ott M., Rogers J., Santelli J., Schleifer R. ‘Abstinence and abstinence- only education: A review of U.S. policies and programs.’ Journal of Adolescent Health 2006; 39: 150-151.
2.Wikepedia. Framing (Social Sciences).
www.en.wikipedia.org/wiki/Framing_(communication_theory)
3.Brown P. ‘The Swedish Approach to Sex Education and Adolescent Pregnancy: Some Impressions.’ Family Planning Perspectives 1983; 15:90-95.
4.Lyon M., Rogers J., Summer D., Santelli J., and Ott M. ‘Abstinence –Only Education Policies and Programs: A position paper of the Society for Adolescent Medicine’. Journal of Adolescent Health 2006; 38: 83-87.
5.Waxman T. ‘The Content of Federally Funded Abstinence-Only Education Programs.’ U.S. House of Representatives, December 2004.
6.Gunderson, M.P., McCary, J.L. ‘ Effects of Sex Education on Sex Information and Sexual Guilt, Attitudes, and Behaviors.’ Family Relations 1980; 29: 375-379.
7.Zelnik M., Kim, Y.J. ‘Sex Education and Its Association with Teenage Sexual Activity, Pregnancy, and Contraceptive Use.’ Family Planning Perspectives 1982; 14: 117-126.
8.Siegel M. ‘In My View: Education and Persuasion versus Coercion as Public Health Approaches.”
http://www.tobacooanalysis.blogspot.com/2006/05/in-my-view-education
9.Bennis W.G., Benne K.D., Chin R., Corey K.E. The Planning of Change 1961. New York; 31: 399-424. 10.Link B.G. On Stigma and Its Public Health Implications. Columbia University and New York State Psychiatric Institute.

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