Sex education in the United States is taught in two main forms: comprehensive and abstinence-only. Comprehensive sex education covers abstinence as a positive choice, but also teaches the benefits of contraception and the avoidance of sexually transmitted diseases between sexually active individuals. Abstinence-only sex education emphasizes abstinence from sex prior to marriage and rejects methods such as contraception. The difference between the two approaches, and their impact on the behavior of adolescents, remains a controversial subject in the United States. Numerous studies have shown conflicting results.
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Almost all students in the U.S. receive some form of sex education at least once between grades 7 and 12; many schools begin addressing some topics as early as grades 4 or 5.[1] However, what students learn varies widely, because curriculum decisions are so decentralized. Many states have laws governing what is taught in sex education classes or allowing parents to opt out. Some state laws leave curriculum decisions to individual school districts.[2]
For example, a 1999 study by the Guttmacher Institute found that most U.S. sex education courses in grades 7 through 12 cover puberty, HIV, STDs, abstinence, implications of teenage pregnancy, and how to resist peer pressure. Other studied topics, such as methods of birth control and infection prevention, sexual orientation, sexual abuse, and factual and ethical information about abortion, varied more widely.[3]
There have been numerous studies on the effectiveness of both approaches, and conflicting data on American public opinion. Public opinion polls conducted over the years have found that the majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.[4][5][6] The poll sponsored by the National Abstinence Education Association and conducted by Zogby International found that:
When parents become aware of what abstinence education vs. comprehensive sex education actually teaches, support for abstinence programs jumps from 40% to 60%, while support for comprehensive programs drops from 50% to 30%. This sharp increase in support of abstinence education is seen across all political and economic groups. The majority of parents reject the so-called "comprehensive" sex education approach, which focuses on promoting and demonstrating contraceptive use. Sixty-six percent of parents think that the importance of the "wait to have sex" message ends up being lost when programs demonstrate and encourage the use of contraception.[7]
Experts at University of California, San Francisco also encourage sex educators to include oral sex and emotional concerns as part of their curriculum. Their findings also support earlier studies that conclude:
...that sexual risk-taking should be considered from a dynamic relationship perspective, rather than solely from a traditional disease-model perspective. Prevention programs rarely discuss adolescents’ social and emotional concerns regarding sex....Discussion about potential negative consequences, such as experiencing guilt or feeling used by one's partner, may lead some adolescents to delay the onset of sexual behavior until they feel more sure of the strength of their relationship with a partner and more comfortable with the idea of becoming sexually active. Identification of common negative social and emotional consequences of having sex may also be useful in screening for adolescents at risk of experiencing more-serious adverse outcomes after having sex.[8]
However, according to a 2004 NPR survey, a majority of the 1001 parent groups polled wanted complete sex education in the schools. Respondents were relatively undivided over the issue. Over 80% of polled parents agreed with the statement "Sex education in school makes it easier for me to talk to my child about sexual issues", and under 17% agreed with the statement that their children were being exposed to "subjects I don't think my child should be discussing". Additionally 90% believed that their children’s sexual education was “not too early”. The study also reports that 49% of the respondents were "somewhat confident" that the values taught in their children's sexual education classes were similar to those taught at home, and 23% were somewhat less confident. [9]
On September 15, 2010, The Centers of Disease Control and Prevention in Atlanta released a government report that found that "almost all U.S. teens have had formal sex education, but only about two-thirds have been taught about birth control methods." Many teenagers are reportedly not absorbing the sex education lessons. The report from CDC is based on face-to-face interviews with nearly 2,800 teenagers in their homes from 2006 through 2008.[10]
In 2010, Congress eliminated two federal programs that had been funding abstinence-only education; the Adolescent Family Life (AFL)[11] Prevention program and the Community-Based Abstinence Education (CBAE) program[12]; $13 million and $99 million a year, respectively for a total of $112 million a year.
That same year, two new evidenced-based sex education programs were initiated; the Personal Responsibility Education Program (PREP)[13], and the Teen Pregnancy Prevention (TPP) initiative[14]; $55 million and $100 million, respectively, for a total of $155 million a year.
Funding for Title V, Section 510 abstinence-only education had expired in 2009, but was reinstated by a provision in the 2010 health care reform law by Senator Orrin Hatch. Although this funding stands at $50 million a year, only $33 million seems to have actually been awarded.[15]
A 2002 study conducted by the Kaiser Family Foundation found that 58% of secondary school principals describe their sex education curriculum as comprehensive.[2]
The American Psychological Association,[16] the American Medical Association,[17] the National Association of School Psychologists,[18] the American Academy of Pediatrics,[19] the American Public Health Association,[20] the Society for Adolescent Medicine[21] and the American College Health Association,[21] have all stated official support for comprehensive sex education. Comprehensive sex education curricula are intended to reduce sexually transmitted disease and out-of-wedlock or teenage pregnancies. According to Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases by Douglas Kirby, PhD, “a large body of evaluation research clearly shows that sex and HIV education programs included in this review do not increase sexual activity – they do not hasten the onset of sex, increase the frequency of sex, and do not increase the number of sexual partners."
Proponents of this approach argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized. They hold that abstinence-only sex ed and conservative moralizing will only alienate students and thus weaken the message.
A report issued by the Department of Health and Human Services has found the "most consistent and clear finding is that sex education does not cause adolescents to initiate sex when they would not otherwise have done so."[22] The same report also found that:
Family life or sex education in the public schools, which traditionally has consisted largely of providing factual information at the secondary school level, is the most general or pervasive approach to preventing pregnancy among adolescents....Adolescents who begin having sexual intercourse need to understand the importance of using an effective contraceptive every time they have sex. This requires convincing sexually active teens who have never used contraception to do so. In addition, sexually active teens who sometimes use contraceptives need to use them more consistently (every time they have sex) and use them correctly. [22]
Comprehensive sex education curriculums offer medical data that is presented in an age appropriate manner. A wide spectrum of topics is covered in these programs, which include abstinence, contraception, relationships, sexuality, and the prevention of disease (Siecus). The main focus is to educate youth so that they can make an informed decision about their own sexual activity and health. Studies have shown that the comprehensive programs work for youth population across the spectrum. Inexperienced, experienced, male, female, the majority of ethnic groups, and different communities all benefitted from this type of curriculum. Yet unlike its counterpart, comprehensive sex education programs are ineligible for federal funding due to mandates against educating youth about contraception (Advocates For Youth). The proposed Responsible Education About Life Act (S. 972 and H.R. 1653) would provide federal funding for comprehensive sex education programs which include information on both abstinence and contraception and condoms.
Abstinence-only sex education emphasizes abstinence from sex to the exclusion of all other types of sexual and reproductive health education, particularly regarding birth control and safe sex. Adolescents are encouraged to be sexually abstinent until marriage and are not provided with information about contraception. In the Kaiser study, 34% of high-school principals said their school's main message was abstinence-only. Many religious groups consider premartial sex to be morally objectionable and some, such as Catholic church, object to the use of contraception even by married couple. And some of these groups often objects to teaching of contraception because they feel that teaching of contraception for school children presume premartial sex from the outset and somewhat imply that such things are morally permissible. These organisation advocate abstinence-only sex education because it is the only approach they find acceptable and in accordance with their religious teachings.
Some organizations promote what they consider to be "sexual purity", which encompasses abstaining from not only intercourse before marriage, but also from sexual thoughts, sexual touching, pornography, and actions that are known to lead to sexual arousal. Advocates of abstinence-only sex education object to comprehensive curricula which fail to teach moral behavior; they maintain that curricula should promote conventional (or conservative) morality as healthy and constructive, and that value-free knowledge of the body may lead to immoral, unhealthy and harmful practices.
A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that programs that stress abstinence as the only acceptable behavior for unmarried teens delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners.[23] According to the study author:
"Even though there does not exist strong evidence that any particular abstinence program is effective at delaying sex or reducing sexual behavior, one should not conclude that all abstinence programs are ineffective. After all, programs are diverse, fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs have provided modestly encouraging results. In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination."
Proponents of abstinence-only sex education object to curricula that fail to teach their standard of moral behavior; they maintain that a morality based on sex only within the bounds of marriage is "healthy and constructive" and that value-free knowledge of the body may lead to immoral, unhealthy, and harmful practices.
Abstinence-only sex education became more prominent in the U.S. over the last decade, largely as a result of over $1 billion in federal government funding initiatives. Through direct funding and matching grant incentives, the U.S. government steered more than a billion dollars to abstinence-only education programs between 1996 and 2006.[24] However, few long-term, rigorous studies have been done on these programs, and their effectiveness remains a matter of question. While abstinence-only sex education is a controversial subject, the fact that complete abstinence itself (even within marriage) is the most effective preventative measure against both pregnancy and sexually transmitted diseases has never been in dispute. What is in dispute is whether abstinence-only sex education actually succeeds in increasing abstinence.[25]
In 1996, the federal government attached a provision to a welfare reform law establishing a program of special grants to states for abstinence-only-until-marriage programs. The program, Title V, § 510(b) of the Social Security Act (now codified as 42 U.S.C. § 710b), is commonly known as Title V. It created very specific requirements for grant recipients. Under this law, the term “abstinence education” means an educational or motivational program which:
Title V-funded programs were not permitted to advocate or discuss contraceptive methods except to emphasize their failure rates.[24]
The program dedicated $50 million annually to be distributed among states choosing to participate. States accepting the funds were required to match every four federal dollars with three state-raised dollars. For the first five years of the initiative, every state but California participated in the program.[26]
After its first five years, many states evaluated the effectiveness of their programs. A comprehensive review of 11 state evaluations conducted by Advocates for Youth showed some short-term benefits, but did not find any programs with lasting positive impact.[26]
Research conducted by the Kaiser Family Foundation in 2002 indicated that, by that time, about a third of U.S. secondary schools were using an abstinence-only approach.[2] However, after their five-year evaluations, more states began declining the funding.[27][28][29][30][31] By 2009, only 25 of the 50 states continued to receive and pursue Title V funding.[32]
In 2000, the federal government began another large program to fund abstinence education, Community-Based Abstinence Education (CBAE). CBAE became the largest federal abstinence-only funding source, with $115 million granted for fiscal year 2006. The CBAE awards bypass state governments, offering federal grants directly to state and local organizations that provide abstinence-only education programs. Many of these grantees are faith-based or small non-profit organizations, including crisis pregnancy centers, which use their grants to provide abstinence-only programs and services in local public and private schools and to community groups.[30] Within the last decade, the federal government has encouraged abstinence-only education by steering over a billion dollars to such programs.[33] Some 25 states now decline the funding so that they can continue to teach comprehensive sex education.[28][34][35][36] Funding for one of the federal government's two main abstinency-only funding programs, Title V, was extended only until December 31, 2007; Congress is debating whether to continue it past that date.[37]
Congress extended funding of Title V several times, through fiscal year 2006. In October 2007, Congress again extended funding, only until December 31, 2007.[37] In 2010, the Obama administration and Congress eliminated two federal abstinence-only programs - the Community-Based Abstinence Education (CBAE) grant program and the Adolescent Family Life Act (AFLA) Prevention program.[38] This leaves the Title V program as the only remaining federal abstinence education program.
The prevalence of religion in the United States contributes to the widespread implementation of abstinence-only sex education. Historically, contraception was generally condemned by all the major branches of Christianity, the most common religion in America (though today there exists a wider variety of positions towards contraception within the religion). Some Christians consider birth control a sin, and sex education is based on the belief that sexual intercourse must be "free, total, faithful, and fruitful," and that this is impossible outside the context of marriage. The “Silver Ring Thing” is a nationwide abstinence-only-until-marriage program, and was heavily backed by the Christian church, which claimed, “This mission can only be achieved by offering a personal relationship with Jesus Christ as the best way to live a sexually pure life.”
The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed a 3% increase from 2005 to 2006.[39] From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines.[40] However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world.[41] Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.[4][6][42]
Proponents of comprehensive sex education, which include the American Psychological Association,[16] the American Medical Association,[17] the National Association of School Psychologists,[18] the American Academy of Pediatrics,[19] the American Public Health Association,[20] the Society for Adolescent Medicine[21] and the American College Health Association,[21] argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.
The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse.[41] In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not.[43] Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.[44]
Two major studies by Congress have increased the volume of criticism surrounding abstinence-only education.
In 2004, U.S. Congressman Henry Waxman of California released a report that provides several examples of inaccurate information being included in federally funded abstinence-only sex education programs. This report bolstered the claims of those arguing that abstinence-only programs deprive teenagers of critical information about sexuality.[45] The claimed errors included:
Out of the 13 grant-receiving programs examined in the 2004 study, the only two not containing "major errors and distortions" were Sex Can Wait and Managing Pressures before Marriage, each of which was used by five grantees, making them two of the least widely used programs in the study. With the exception of the FACTS program, also used by 5 grantees, the programs found to contain serious errors were more widely used, ranging in usage level from 7 grantees (the Navigator and Why kNOw programs) to 32 grantees (the Choosing the Best Life program). Three of the top five most widely used programs, including the top two, used versions of the same textbook, Choosing the Best, from either 2003 (Choosing the Best Life) or 2001 (Choosing the Best Path — the second most widely used program with 28 grantees — and Choosing the Best Way, the fifth most widely used program with 11 grantees).
In 2007, a study ordered by Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex in their teenage years as those who did not.[46] From 1999 to 2006, the study tracked more than 2,000 students from age 11 or 12 to age 16; the study included students who had participated in one of four abstinence education programs, as well as a control group who had not participated in such a program. By age 16, about half of each group students in the abstinence-only program as well as students in the control group were still abstinent. Abstinence program participants who became sexually active during the 7-year study period reported having similar numbers of sexual partners as their peers of the same age; moreover, they had sex for the first time at about the same age as other students. The study also found that students who took part in the abstinence-only programs were just as likely to use contraception when they did have sex as those who did not participate. Abstinence-only education advocates claim the study was too narrow, began when abstinence-only curricula were in their infancy, and ignored other studies that have shown positive effects.[47]
Abstinence-only education has been criticized in official statements by the American Psychological Association,[16] the American Medical Association,[48] the National Association of School Psychologists,[18] the Society for Adolescent Medicine,[21] the American College Health Association,[21] the American Academy of Pediatrics,[19] and the American Public Health Association,[20] which all maintain that sex education needs to be comprehensive to be effective.
The AMA "urges schools to implement comprehensive... sexuality education programs that... include an integrated strategy for making condoms available to students and for providing both factual information and skill-building related to reproductive biology, sexual abstinence, sexual responsibility, contraceptives including condoms, alternatives in birth control, and other issues aimed at prevention of pregnancy and sexual transmission of diseases... [and] opposes the sole use of abstinence-only education..."[48]
The American Academy of Pediatrics states that "Abstinence-only programs have not demonstrated successful outcomes with regard to delayed initiation of sexual activity or use of safer sex practices... Programs that encourage abstinence as the best option for adolescents, but offer a discussion of HIV prevention and contraception as the best approach for adolescents who are sexually active, have been shown to delay the initiation of sexual activity and increase the proportion of sexually active adolescents who reported using birth control."[19]
On August 4, 2007, the British Medical Journal published an editorial concluding that there is "no evidence" that abstinence-only sex education programs "reduce risky sexual behaviours, incidence of sexually transmitted infections, or pregnancy" in "high income countries".[49]
A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that abstinence-only programs delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners.[50][51] According to the study author:
"Even though there does not exist strong evidence that any particular abstinence program is effective at delaying sex or reducing sexual behavior, one should not conclude that all abstinence programs are ineffective. After all, programs are diverse, fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs have provided modestly encouraging results. In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination."
Joycelyn Elders, former Surgeon General of the United States, is a notable critic of abstinence-only sex education. She was among the interviewees Penn & Teller included in their Bullshit! episode on the subject.[52]
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, argues that abstinence-only sex education leads to the opposite of the intended results by spreading ignorance regarding sexually transmitted diseases and the proper use of contraceptives to prevent both infections and pregnancy.[53]
In July 2009, researchers from the U.S. Centers for Disease Control and Prevention released their analysis of national data collected between 2002 and 2007. Their findings included:[54]
| “ | This report identifies a number of concerns regarding the sexual and reproductive health of our nation's young people... It is disheartening that after years of improvement with respect to teen pregnancy and sexually transmitted diseases, we now see signs that progress is stalling and many of these trends are going in the wrong direction | ” |
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— Janet Collins, director of the CDC's National Center for Chronic Disease Prevention and Health Promotion, CDC Morbidity and Mortality Weekly Report, July 17
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In 2004, President George W. Bush announced his Five-Year Global HIV/AIDS Strategy. Also known as the President's Emergency Plan for AIDS Relief (PEPFAR),[55] the plan committed the U.S. to provide $15 billion over five years toward AIDS relief in 15 countries in Africa and the Caribbean, and in Vietnam.[56] About 20% of the funding, or $3 billion over five years, was allocated for prevention. The program required that, starting in fiscal year 2006, one-third of prevention funding be earmarked specifically for abstinence-only-until-marriage programs. The earmark had numerous critics, including global AIDS prevention advocates, the U.S. Government Accountability Office, and a Congressionally authorized three-year evaluation of PEPFAR by the non-partisan Institute of Medicine.[57][58][59]
During its 2008 reauthorization of PEPFAR, Congress dropped the earmark, resorting instead to more flexible spending directives encouraging countries to spend at least 50% of prevention funds on abstinence and fidelity programs.[60]