This is a paper that I wrote for my Health Care Policy Class last semester. I thought the topic was important and could lead to some good discussions. I think parents, healthcare workers, policy makers and concerned citizens need to be more aware of these issues and how they are handled. In light of the recent Hobby Lobby ruling, I think it is even more imperative that the public is given accurate medical information about sex.
Adolescent Sex Education Policy and Effects
“One of the great mistakes is to judge policies and programs by their intentions rather than their results.” —Milton Friedman, American economist, statistician, writer and Nobel Prize winner
In the past twenty years, adolescent pregnancy rates in the United States have been declining; however the United States still has the highest rates of teen pregnancy, births and abortions when compared with other industrialized nations. (Trends in Teen Pregnancy, 2014;Kohler et. al. 2008) Teen pregnancy does not only effect teenagers and their families, it effects society as a whole. Teen pregnancy contributes to many social and health problems such as poverty, child abuse and neglect, low birth weights, crime, school failure and poor preparation for the work force. Some of these effects on society are difficult to adequately measure; however, what can be measured is that teen pregnancies cost US tax payers approximately $9.4 billion dollars annually (Thenationalcampaign.org, 2014).
In addition to high rates of pregnancy among adolescents in the United States there are alarming rates of sexually transmitted diseases (STDs) among teens. Of the 19 million new incidence of STDs in the US, half of those occur among youth aged 15-19, meaning 25% of sexually active teens have an STD (CDC.gov, 2014). US abstinence-only approaches have also influenced family planning and HIV prevention programs internationally by reducing availability of condoms and access to accurate information about HIV/AIDS in some countries. (Ott and Santelli, 2007). If we are to adequately address these problems, it must be done through effective sex education. (Santelli, Orr, Lindberg and Diaz, 2009) There is much debate and controversy about which form of sex education is best, and to determine what the most effective method is, we have to look at the results of studies analyzing sex education. There are two basic sex-education plans: abstinence only education (AOE) or comprehensive sex education, also known as abstinence-plus education. In examining the current policy in regards to sex education, it is also helpful to look at how policy regarding sex education has developed in the United States.
History of Sex Education Policy in the United States
“Study the past if you would define the future.” — Confucius
In 1892, the National Education Association suggested sexuality education as a necessary part of a national education curriculum. Sexuality education in United States public schools began en force, in 1913 with the founding of the American Social Hygiene Association, whose objective was “wholesome living” and eradication of “social diseases.” These early policy shapers were mostly women’s rights proponents, physicians, lawyers, and educators, and created a broad campaign targeted against sexually transmitted infections and prostitution through “character building.” They were some of the first to suggest that sexuality education should take place in public schools with a focus on containing sex to marriage. (Elia and Eliason, 2010) This premise continued into the 1960’s when societal changes demanded comprehensive sexuality education to be considered. In 1964, Dr. Mary Calderone established the Sex Information and Education Council of the United States (SIECUS), which suggested that sex education should go beyond discussion of hygiene and that sex was an integral part of the human experience. Around the time that SIECUS was founded, conservative groups like The John Birch Society, Parents Opposed to Sex and Sensitivity Education and the Christian Crusade became involved in the debate about sex education. In addition to supporting traditional values, they often used fear tactics to argue their stance. For example, they claimed that educating adolescents about sex would lead to a communist take-over of America. (Horowitz, 2004). In response, in 1966 organizations like the National Congress of Parents and Teachers, and the American Nurses Association published declarations defending youth’s “right to know” about birth control (Advocatesforyouth.org, 2014).
Through the 1960’s and early 1970’s there was significant support for comprehensive education. Former President Eisenhower announced his support of Planned Parenthood. Congress enacted Title X of the Public Health Services Act, providing funding for family planning services, educational programs, and research. However, by 1975 twenty states had voted to abolish or restrict sex education in public schools. More and more parents were hesitant about their children being taught about sex in schools. In 1976, Congress expanded Title X to include community-based sexuality education and other preventive services for teenagers, with increased focus on helping parents teach their children about sex. (Advocatesforyouth.org, 2014)
In 1981 the Adolescent Family Life Act was passed, funding programs to promote sexual abstinence before marriage. In 1996, Congress authorized $250 million of initial funding for community based abstinence education (CBAE) as part of the welfare reform act. These AOE programs had to have “as their exclusive purpose the promotion of abstinence outside of marriage and may not in any way advocate contraceptive use or discuss contraceptive methods or condoms except to emphasize their failure rates”. State and local programs following these guidelines received this additional funding. There was no comparable funding for comprehensive sexuality education. Comprehensive sex education declined from 1995 to 2002, as did condom and contraceptive use among adolescents (Ott, 2007). In 2004, the Government Accountability Office (an investigative arm of the US Congress) found that AOE curricula contained “false, misleading, distorted” and medically inaccurate information with multiple scientific errors. The programs receiving funding were not reviewed for accuracy, just for their emphasis on abstinence. The report stated that “longitudinal studies show that abstinence-only programs are ineffective and may cause harm”. (Ott, 2007) By 2008, twenty-five states had rejected federal funding for abstinence-only education. In 2009, President Obama eliminated funding for AOE programs. In 2010, Congress funded the Personal Responsibility Education Program (PREP) as part of the Afforadable Care Act, which provides $75 million annually for evidence-based, medically accurate, age-appropriate programs to educate adolescents about both abstinence and contraception in order to prevent unintended teen pregnancy and STDs, including HIV/AIDS. That same year, Teen Pregancy Prevention (TPP) initiative was launched and is funded by the CDC. Since 2010, sex education has been left up to the discretion of individual states. In the past decade as homosexuality and same-sex marriage has had increased acceptance and public support, questions of AOE and its relevance to LGBT adolescents have entered the national conversation.
In 2013, Elizabeth Smart, a famous rape survivor and abuse activist, stirred national debate when she publicly spoke out against another problem with AOE. As a young girl, the shame rhetoric regarding sex education she was given in public school was psychologically damaging to her as she was held captive by her rapist. What she was taught in school gave her the message that because she had been raped she was “dirty, filthy and had no value” (Dominguez, 2013).
Studies Evaluating Sex Education
“Well, we came out with the conviction that you must get the best evidence you could, rather than you must believe what somebody has told you. And it sent them into the literature.” —Virginia Henderson, Nursing Theorist
One literature review by Toups and Holmes, in favor of abstinence-only education claimed that it was effective in curtailing teenage sexual activity. They showed that ‘family connectedness’ was a primary protective factor against risky teenage sexual behavior. The review listed a few studies where abstinence education and a social support among high-risk youth led to decreased pregnancy rates. The study also made questionable claims such as “Medical evidence shows that abstinence is the only reliable way to prevent pregnancy”, without sources to back up this statement (Toups & Holms, 2007). A more rigorous review, which inspected 56 studies of AOE programs found that only 3 had a small positive effect and there was not scientific basis for the wide proliferation of AOE programs (Kirby, 2008).
There are multiple studies that support comprehensive education (Corngold, 2011; Elia, 2010; Kantor, 2008; Kirby, 2008; Kohler, P., Manhart, L. and Lafferty, W. 2008; Ott, 2007; Santelli et.al. 2006; Santelli et.al. 2007; Santelli et. al. 2009). Comprehensive education for adolescents with accurate information about abstinence, contraception, human sexuality and STDs is supported by the American College of Obstetricians and Gynecologists (ACOG), the Society of Adolescent Medicine (SAM), the American Academy of Pediatrics (AAP), the American Medical Association (AMA) and the American Public Health Association (APHA) (Ott, 2007). Abstinence is a healthy choice for teenagers. Remaining abstinent through high school is supported by many parents and adolescents, and is very effective in preventing pregnancy and disease. However, it fails in practice because abstinence is often not maintained and AOE leaves youth uninformed about how to care for their own health (Santelli, 2006). Studies have shown that not only do comprehensive sex education programs result in fewer pregnancies and STDs, they also result in more adolescents delaying initiation of sexual activity. (Ott, 2007)
In addition to pregnancy and disease, there is another problem with abstinence-only education. It assumes that every adolescent will eventually be married to someone of the opposite gender. This is insensitive to LGBT youth, who in most states currently do not have the legal option of marrying the person that are attracted to (Santelli, 2006). AOE often promotes stereotypical gender roles and homophobia by sending a message of exclusion and intolerance (Santelli, 2006; Elia, 2010). In homophobic climates, heterosexual teens are encouraged to hate LGBT teens, and the LGBT teens are encouraged to hate themselves. This can lead to harassment, violence, significantly decreased grade point averages, higher use of drugs and alcohol, increased depression and suicide attempts and increased risky sexual behaviors (Elia,2010).
“Education is the most powerful weapon which you can use to change the world.” ― Nelson Mandela
In the absence of a federal initiative of the comparable strength of the CBAE, many states continue to teach the same sex-education programs that they have been teaching. As AOE received additional funding, it eliminated comprehensive sex education programs. Education is left to the discretion of the local level. Sometimes this can be alarming. In Utah in 2012, a bill was proposed that would eliminate any sex education that was not AOE, making Utah the only state to make comprehensive sex education illegal. At the last minute, and to great backlash, the bill was vetoed (Gehrke and Schenker, 2012). Many other states continue to embrace AOE (Kirby, 2008).
It is not enough for the federal government to stop endorsing harmful education programs. There needs to be a big push to give adolescents accurate health information. Policy makers, healthcare workers, parents and educators need to be informed of the benefits and realities of giving youth accurate sexual health information. Adolescence is a vulnerable time, if uninformed, youth are at greater risk of making choices that can be harmful to their health and limit their choices as adults. Healthcare providers are not allowed to withhold information from a patient in order to influence their healthcare choices. Likewise, it is unethical to withhold information from teens about sexual health or give distorted information, including ways that they can protect themselves from disease and pregnancy (Ott, 2007). It is important that they are given facts about their bodies without shame and fear rhetoric. There needs to be increased funding directed towards comprehensive education. Preparing adolescents to make informed adult decisions is the crucial piece in decreasing teenage pregnancy and sexually transmitted diseases.
In addition to this, it is important that youth are taught to be respectful and sensitive. We live in a democratic country that is full of diversity; this includes individuals who are homosexual. It is important that the average teen is not taught to fear someone based on their sexual-orientation. It is important that LGBT teens are taught to accept themselves, and learn about sex that is safe, as well as relevant to them. One controlled study showed that when gay-sensitive sex education was given LGB youth reported fewer sexual partners, less frequent sex and less substance abuse and better grades (Blake et al. 2001). These healthier behaviors benefit not only the youth, but the community as a whole.
Sex education needs to be changed to not only to give youth accurate information about preventing pregnancy and disease, but to give them a more comprehensive understanding of sexuality.
Advocatesforyouth.org, (2014). History of Sex Ed. [online] Available at: http://www.advocatesforyouth.org/serced/1859-history-of-sex-ed.
Blake, S. M., Ledsky, R., Lehman, T., Goodenow, C., Sawyer, R. and Hack, T. 2001. Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: The benefits of gay-sensitive HIV instruction in schools. American Journal of Public Health, 91(6): 940–946.
CDC.gov, (2014). CDC – Sexual Behaviors – Adolescent and School Health. [online] Available at: http://www.cdc.gov/healthyyouth/Sexualbehaviors/index.html.
Corngold, J. (2011). Misplaced priorities: Gutmann’s democratic theory, children’s autonomy,and sex education policy. Studies in Philosophy and Education, 30(1), pp.67–84.
Dominguez, A. (2013). Elizabeth Smart speaks about abstinence education. The Salt Lake Tribune. [online] Available at: http://www.sltrib.com/sltrib/news/56248622-78/abstinence-smart-elizabeth-trafficking.html.csp.
Elia, J. and Eliason, M. (2010). Dangerous omissions: Abstinence-only-until-marriage school-based sexuality education and the betrayal of LGBTQ youth. American Journal of Sexuality Education, 5(1), pp.17–35.
Ertelt, S. (2009). Barack Obama’s Federal Budget Eliminates Funding for Abstinence-Only Education. LifeNews.com. [online] Available at: http://www.issues4life.org/pdfs/news_20090508b.pdf [Accessed 23 Apr. 2014].
Gehrke, R. and Schenker, L. (2012). Herbert vetoes sex-ed bill, says it constricts parental choice. The Salt Lake Tribune. [online] Available at: http://www.sltrib.com/sltrib/news/53736564-78/bill-veto-governor-herbert.html.csp.
Horowitz, H. (2004). Talk about Sex: The Battles over Sex Education in the United States. By Janice M. Irvine. (Berkeley: University of California Press, 2002. xii, 271 pp. isbn 0-520-23503-7.). The Journal of American History, 90(4), pp.1550–1550.
Jones, T., 2011. Saving rhetorical children: Sexuality education discourses from conservative to post-modern. Sex Education, 11(4), pp.369—387.
Kantor, L. (2008). Abstinence-only Education Violating Students’ Rights to Health Information. Human Rights. 35, p.12.
Kirby, D. (2008). The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sexuality Research & Social Policy, 5(3), pp.18–27.
Kohler, P., Manhart, L. and Lafferty, W. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), pp.344–351.
Ott, M. and Santelli, J. (2007). Abstinence and abstinence-only education. Current Opinion in Obstetrics and Gynecology, 19(5), pp.446–452.
Santelli, J., Lindberg, L., Finer, L. and Singh, S. (2007). Explaining recent declines in adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. American Journal of Public Health, 97(1), p.150.
Santelli, J., Orr, M., Lindberg, L. and Diaz, D. (2009). Changing behavioral risk for pregnancy among high school students in the United States, 1991–2007. Journal of Adolescent Health,45(1), pp.25–32.
Santelli, J., Ott, M., Lyon, M., Rogers, J., Summers, D. and Schleifer, R. (2006). Abstinence and abstinence-only education: a review of US policies and programs. Journal of Adolescent Health, 38(1), pp.72–81.
Thenationalcampaign.org, (2014). Making the Case: For Wanted and Welcomed Pregnancy. [online] Available at: http://thenationalcampaign.org/why-it-matters.
Toups, M. and Holmes, W. (2002). Effectiveness of Abstinence-Based Sex Education Curricula: A Review. Counseling and Values, 46(3), pp.237–240.
Trends in Teen Pregnancy, (2014). The Office of Adolescent Health, U.S. Department of Health and Human Services. [online] Available at: http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/trends.html#_ftn2 .