Challenging Dogma

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

Tuesday, April 24, 2007

Teen Pregnancy and HIV Transmission: Abstinence-Only Education in Public Schools Assumes too Much and Fails to Reach Our Youth – Cheri Raffo

The Issue

The United States has the highest rate of teen pregnancy in the developed world and American adolescents are contracting HIV faster than almost any other demographic group (1). In 1981, Congress passed the Adolescent Family Life Act (AFLA), which funded millions of dollars for abstinence-only educational programs promoting such ideas as “self-discipline” and “chastity education”(2). Abstinence-only proponents argue that these educational tools are the only means to reduce teenage pregnancy and the transmission of HIV. However, this public health intervention is immersed with such religious and moral underpinnings that it fails to propose a diversified and effective method to curb these health outcomes. Abstinence-only programs taught to adolescents, aged 13 to 18, in public schools are headed towards failure because these campaigns deny a right to accurate information, they ignore any cultural or sexual diversity that continues to be a growing part of our adolescent population today, and fail to account for the societal and environmental pressures concerning sex, which surround adolescents in present day.

Congress’ Legislation

The Adolescent Family Life Act, providing abstinence-only program grants, helped to fund the church and religious conservatives throughout the country. Rebekah Saul, a public policy associate with the Alan Guttmacher Institute, says that the AFLA is basically identical to the five-year, $250 million “abstinence-only” education program created by the 1996 welfare reform law (2). Many groups tried to challenge these acts, saying that it was dimming the division of church and state, but were too late. However, these federally funded grant recipients such as Sex Respect had already flourished into booming for-profit businesses that were lead by Christian fundamentalists (2). Many years later, when the Supreme Court ordered to keep the division between church and state by reining in some of the grants, these programs were too powerful to be impacted by the ruling. Now these powerful organizations are in charge of our youth’s sex education and are providing a very ineffective policy.

The Problem

School-based sex education programs taught to 13 - 18 year olds are aimed at the problems of teenage pregnancy and HIV/AIDS transmission. Although, the teen pregnancy rates have begun to decline recently, the United States still has the highest teenage pregnancy rate among the developed countries in the world, including Australia, Canada, England, France, Germany, Italy, Japan, Netherlands, Norway, Spain, and Sweden (2,3). According to the National Vital Statistic Reports, 34% of young women become pregnant at least once before they reach 20 years of age, which equates to about 820,000 women per year (4). Also, eight in ten of these pregnancies are unintended and 79% are to unmarried teens (4).

Another risk that adolescents face is the HIV/AIDS epidemic. An estimated 4,883 adolescents received a diagnosis of HIV infection or AIDS, representing about 13% of the people given a diagnosis during 2004 (5). Not only HIV/AIDS but each year about 9.1 million 15-24 year olds are infected with sexually transmitted diseases (STDs), which account for almost one-half of the total new STDs occurring annually in the United States (6). Alarmingly, the CDC estimates that one-half of all new HIV infections occur among people under the age of 25, with the majority contracted through sexual intercourse (7). These numbers are shocking, considering the youth population that we are observing. Adolescents who are facing teen pregnancy, HIV/AIDS and STD transmission should be more educated on safe sex practices, not just abstinence-only, to help these rates decline.

With these public health issues at the forefront of people’s minds, abstinence-only education programs taught in schools are limiting in every sense of the word. Amy Bryant, a Planned Parenthood associate, says that abstinence-only programs teach that abstinence before marriage “guarantees a happier life, complete with greater wealth, healthy children, longevity, freedom from psychological problems, and better educational opportunities” (8). These organizations are promising lies of happiness and wealth to our youth that will not come true unless we start providing comprehensive sexual education teachings in our public schools.

Knowledge is Power

Abstinence-only programs are powered by a curriculum that has misguiding and inaccurate information. In 2004, the Democratic Representative from California, Henry Waxman, released a report stating that two-thirds of government funded abstinence-only programs had ‘misleading or inaccurate’ information about abortion, contraception, genetics, and sexually transmitted diseases (9). One of the many examples of these inaccuracies found by Waxman include a source, WAIT Training states that HIV can be transmitted through tears and sweat (9). However, according to Planned Parenthood (a more reputable source) HIV can only be transmitted through blood, semen, or vaginal secretions (8,9).

Adolescents are being denied access to accurate and complete health information. Currently, there has been no conclusive evidence found proving that abstinence-only sex education reduces the rate of teenage pregnancy or sexually transmitted diseases (7). Furthermore, evidence shows that comprehensive sexuality education programs that provide information about abstinence and contraception has shown to delay the start of sexual activity in teens and also increases the use of condoms in teens who are already sexually active (7).

Comprehensive sex education gives teens the information needed to help make safer decisions concerning sex. Giving credit to our youth in their ability to make better decisions about their health will be a huge step in reducing teen pregnancy rates and HIV/AIDS transmissions. If we could provide accurate information and empower today’s youth to strive for safer sex practices, we could have a more realistic approach to an effective health intervention concerning teen’s sexual behavior.

Denial of Cultural Aspects of Sex and GLBTQ Youth

Abstinence-only programs deny the cultural, racial, and sexual diversity that is such an integral part of our country. These single-minded programs assume that every adolescent shares the same background, culture, and ideology - but this assumption threatens our youth’s health. Teaching that abstaining until you are married, goes against an abundance of religious and cultural ideologies that may not accept this as an important notion in their culture. An effective intervention should aim to reach as many people in the target population. However, teaching abstinence until marriage is a notion that many teens cannot relate to and, as such, they will have problems identifying with the intervention. This is an important exclusion factor in taking one single religious point of view and trying to distribute their ideas to today’s diverse youth. Youth that are ‘left out’ or cast aside from these teachings may be left with a feeling of unimportance. Any emotional or psychosocial effect that could occur from this marginalization could potentially be detrimental to the choices they make concerning their sexual behavior. These choices could lead to teen pregnancy, HIV transmission, or other health issues.

Similarly, federally funded abstinence-until-marriage programs also discriminate against sexual gay, lesbian, bisexual, transgender and questioning (GLBTQ) youth. As many as one in ten adolescents struggle with issues that involve their sexual orientation, and an estimated 2.5% of high school youth self-identify as gay, lesbian or bisexual, and more may be questioning or uncertain (10). In the eye of the law, marriage can only be between heterosexual couples, which exclude all GLBTQ youth. The needs of these youth struggling with their identity are not met with abstinence-only programs which only deal with abstaining heterosexual youth. This discrimination could not only hurt these adolescents emotionally but also put their health at risk by not providing them accurate sex education.

Another group that abstinence-only programs fail to account for is sexually experienced adolescents. According to the National Survey of Adolescents and Young Adults, almost two-thirds of all high school seniors in the United States have had sexual intercourse (11). This group needs access to accurate health information concerning contraception, sexually transmitted diseases, and access to reproductive health clinics. Without the proper information, sexually active youths are at an increased risk of pregnancy and STD transmission and are not accounted for in abstinence-only health policies.

With the inability to reach the rest of today’s youth, abstinence-only intervention limits itself at the cost of our youth’s health. Ultimately having a negative effect of either feeling left out, shame about who they are, or atypical of the perceived norm. At such a critical time in one’s life, our health policies need to try and aim to accommodate all adolescents, to reach even the most diverse groups to try and provide them with the health information needed to live a full and healthy life.

Onslaught of Societal and Environmental Pressures

Sex and promiscuity are plastered throughout the American media. One in four television shows have a scene devoting primary emphasis to sexual behavior and one in eight have a scene in which sex is depicted (12). Today’s culture filled with MTV, VH1, HBO and other hit networks target today’s youth and feed their desire for sexual expression. Shows such as MTV’s The Real World place seven diverse strangers in a house to live together for six months as the producers film the group doing anything and everything. With only a cloth to divide the cameraman and the sexual promiscuity that occurs on the other side, little room is left to question what may be occurring. The fact that MTV’s The Real World is finishing up its eighteenth season goes to show that a majority of America embraces this type of sexual expression on television. With adolescents needing to express their sexuality, they can easily turn to television to see other young adults feeding their same desires.

Music also lends to a culture that screams “sex” to our adolescents. With the lyrics and music videos by some artists, today’s youth is bombarded with sex and sexual promiscuity. The music videos have scenes that show men and women, women and women, all attesting to the slogan “sex” sells.

Media portrayals contribute to sexual socialization and watching shows with high sexual content has been correlated with earlier experimentation with adolescent sexual intercourse (12). These unavoidable pressures ensuing our youth are not accounted for in abstinence-only education programs. Aiming these teachings at youth that will abstain until they are married fails to account for those youth who have been innocently persuaded by environmental pressures to experiment sexually. These environmental pressures can sometimes translate to the norm and social or peer pressure may result. This propagates the cycle of contradicting messages that can further confuse today’s youth. This clashing effect of the “real” world with the sex education taught in schools does not help the abstinence-only technique as a public health intervention. Abstinence is not filling our youth’s mind through the media – actually quite opposite – yet this is our primary intervention. We need to re-evaluate the existing environmental and the peer pressures that can effect our youth in order to find an intervention that can accommodate for these pressures.

Today’s Youth Speaks Out

We need age appropriate, medically accurate sex education in public schools. According to Planned Parenthood, nearly half of high school students report they need basic information concerning birth control and HIV/AIDS (3). Forty percent of students would like more information on where to get contraception; 30% would like more information on how to use condoms; and 51% want to know where to go to get tested for HIV and STDs (3). These alarming statistics come straight from today’s youth as they speak out for their own health. We must to listen to their requests for information in order to help make our country’s youth knowledgeable, and in return foster a healthier and happier adolescent nation.


1. Singh, S. & Darroch, J.E. Adolescent pregnancy childbearing: levels and trends in developed countries. Family Planning 2000; 1:914.

2. Saul, Rebekah. Whatever Happened to the Adolescent Family Lift Act? Alan Guttmacher Institute.

3. Alan Guttmacher Institute. Facts in Brief: Teenagers’ Sexual and Reproductive Health: Developed Countries. AGI.

4. Ventura, S.J., Hamilton, BE, & Sutton, P.D. National Vital Statistics Reports – Revised Birth and Fertality Rates for the United States, 2003.

5. US Department of Health and Human Services. HIV/AIDS Surveillance Report. Atlanta, GA: Center for Disease Control, 2005.

6. American Civil Liberties Union. Abstinence-Only-Until-Marriage programs censor vital health care information, jeopardizing teens’ health. New York, NY: ACLU.

7. Center for Disease Control and Prevention. HIV and its Transmission. CDC.

8. Bryant, A. Abstinence-Only Only Gets Worse. Planned Parenthood Federation of America.

9. Planned Parenthood. Abstinence-Only Programs. Planned Parenthood Federation of America.

10. Sturdevant, M & Temafedi, G. Special health care needs of homosexual youth. Adolescent Medicine 1992; 3:359-371.

11. Henry J. Kaiser Family Foundation, et al. National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitudes and Experiences. Henry J. Kaiser Family Foundation, 2003.

12. Kunkel et al. Sexual messages on television: comparing findings from three studies. The Journal of Sex Research 1999; 36;230-236.

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