Tuesday, May 4, 2010

Abstinence-only Sex Ed, part 2

Okay. Now that we all know what I think about abstinence-only sex ed, it's time to backtrack and talk about the history of the sex-ed movement, and some of the things that have happened there. This post seems to have gotten bewilderingly long somehow, so I think I'll keep this limited to a brief overview/explanation of history. Part 3 will deal with the evaluation and effectiveness of teen pregnancy prevention programs and part 4 will be centered on my personal response (or, alternatively, part 4 will describe what I believe to be the more typical evangelical response, and part 5 will elaborate on my own views). I reserve the right to change the outline of proposed posts as content gets overwhelming.

Health educators became concerned about teen pregnancy in the 1970s (Kirby,Barth, Leland,Fetro 1991). Additionally, the HIV epidemic of the 1980s heightened awareness of the importance of using sex education as a tool for reducing risky sexual behavior (Kirby,et al., 1991). In 1991, Kirby and colleagues grouped pregnancy prevention programs into four generations. (Note that while I am extremely interested in sexual health, I am a generalist as far as public health goes, and have only been dabbling in this for the past semester or two- A LOT of people know a lot more than I do! For those outside the field, Doug Kirby is considered pretty much THE leading expert on teen pregnancy, and I will cite his work heavily)

First Generation:
Focused on teen's knowledge about risks and consequences of teen pregnancy (Kirby, et al., 1991). These programs basically took the position that if teens knew about sex, pregnancy, and contraception they would avoid risky sexual behavior. Well....the first thing that gets drilled into your head as a public health student now is "Knowledge alone is not enough to change behavior," so, you can guess how well these worked...

Second Generation:
Added an emphasis on values-clarification, decision-making and communication skills (Kirby, et al., 1991). Evaluation of 2nd generation programs showed mixed results (Kirby, et al., 1991).

Third Generation:
It's important to understand that the third generation of teen pregnancy prevention programs did not stem from lessons in the first two generations of programs, but rather, in opposition to those programs (Kirby, et al.1991). Out of concern that teens were being given a "values free" education, a different group of people, with religious rather than health concerns launched a set of programs that were focused on teaching teens not to have sex before marriage (Kirby, et al., 1991). These programs typically presented no information on contraception in order to avoid being seen as self-contradicting (Kirby, et al., 1991). Not many of these programs have been thoroughly evaluated (Kirby, et al. 1991, Santelli,et al., 2006, www.advocatesforyouth.org). I personally would like to think that this is because for the most part, these sorts of programs are led by well-meaning religious folks instead of public health practioners and they don't know how important evaluation is, or what the parts of a good evaluation are. On the other hand, I know a number of professionals who have spent decades in the field of sex education and believe that the reason abstinence-only programs are only half-heartedly evaluated is that if you only measure certain things, you can do a bit of handwaving and make it seem that an ineffective program actually did some good. This will be discussed further in part 3 of this series of blog posts.

Fourth Generation:
The fourth generation of teen pregnancy prevention programs attempt to build on the first three (Kirby, et al., 1991). These programs attempt to be neither values-free nor moralistic and focus on increasing teens' knowledge about risky sexual behavior and its consequences, teaching teens skills for delaying intercourse, and changing social norms around early sexual activity (Kirby, et al., 1991).

Abstinence-Only Sex Ed and Federal Funding
(fact sheet:http://www.acf.hhs.gov/programs/fysb/content/abstinence/factsheet.htm)

Federal funding for abstinence only sex education was created by Section 510 of the Federal Social Security Action, first created in 1996 (Clinton Administration), established under Section 912 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193).

In 2004, the Bush administration moved the program out of division of the Department of Health and Human Services (DHHS) to the Administration for Children and Families(ACF) and tightened funding regulations. In order to receive section 510 funds, programs had to adhere to all eight points of the federal definition of abstinence-only education:
According to federal law, an eligible abstinence education program is one that:
A) has as its exclusive purpose, teaching the social, physiological, and health gains to be realized by abstaining from sexual activity;
B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;
E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society;
G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.
(U.S. Social Security Act, Sec 510 (b), cited in Santelli et al. 2006).

Federally funded abstinence only programs use behavioral terms such as "postponing sex," and "never had vaginal sex." These programs often do not include information about touching, kissing, anal sex or oral sex (Aside- one of my professors observed that this can be seen as a reflection of Bill Clinton's stance that "Oral sex is not sex." Unfortunately, much of my generation, and those younger share that view).

Especially in the 2000s, federally funded abstinence-only programs discuss sex in moral terminology, using words like "chaste" "virgin" "making a commitment."

President Obama attempted to end section 510 funding, however, it was included in the health care reform bill in an effort to secure support from Republicans (http://www.tellthemsc.org/headlines.aspx?article=358)

Works Cited:
Kirby, D., Barth, R., Leland, N. Fetro, J.V., (1991). Reducing the risk: impact of a new curriculum on sexual risk-taking. Family Planning Perspectives 23: 253-63.

Santelli, J., Ott, M.A. , Lyon, M., Rogers, J., Summers, D., Schleifer, R. Abstinence and abstinence only education: A review of U.S. policies and programs.(2006). Journal of Adolescent Health 38: 72-81.


wistfulwanderer said...

Interesting. Again, I appreciate your clarity.

So, (correct me if I'm wrong) the purpose of formal sex-ed. programs is to reduce teen pregnancy and the spread of STDs? Thus a program's effectiveness is measured by how well it accomplishes these goals? And abstinence-only sex ed. programs do not include info about contraception. Got it.

(Forgive my ignorance of the subject. I was homeschooled :) My sex-ed. has come from my mother, friends, reading, and experience.)

I imagine, though, that people who run formal sex-ed. programs do so for a variety of reasons. (Religious groups, particularly, probably have purposes beyond preventing teen pregnancy and the spread of STDs; also, I know that when I informally educate others about sex, my purpose is definitely much broader than the above).

So, is the stated purpose of the federal government's funding of sex-ed. programs to prevent teen pregnancy and the spread of STDs?

Thanks for this series, btw. It is very informative. I'm also enjoying learning more about something you're passionate about :)

charis said...

Thanks Em! I run in so many different circles with so many different backgrounds these days it's really difficult to know whether I'm communicating clearly.

As side note, the STD acronym has been replaced by STI. Because many infections can be asymptomatic, (especially in women) it's more accurate to refer to them as infections rather than diseases.
As another side note- we're starting to see antibiotic resistant strains of gonorrhea. Scary, scary stuff.