Here we are in 2019 with $10 million available for abstinence-only education. The Title 5 competitive Sexual Risk Avoidance Education (SRAE) requests for proposal are out. I hear echoes—let’s teach abstinence. I guarantee you will cringe as you read what the curricula must contain:

• Voluntarily refrain from non-marital sexual activity.

• Agree to use medically accurate information referenced to peer-reviewed publications

• Implement an evidence-based approach integrating research findings with practical implementation that aligns with the needs and desired outcomes for the intended audience;

• Teach the benefits associated with self-regulation,

• Success sequencing for poverty prevention, healthy relationships, goal setting, and resisting sexual coercion, dating violence,and other youth risk behaviors such as underage drinking or illicit drug use without normalizing teen sexual activity.

• Additionally, there is a requirement that messages to youth normalize the optimal health behavior of avoiding non-marital sexual activity.

Okay, almost thirty years later and over $1.5 Billion in Federal Funds spent on abstinence-only education and research says definitively it doesn’t work. See this 2017 summary in the Journal of Adolescent Health.  But maybe this time around?

I want to pull out my hair. I started my career in reproductive health. My first job after residency was the medical director at a Twin Cities community clinic that focused on women’s health, serving a late teens and a twenty-something population. Those were the days of the New Our Bodies Ourselves (1984), the women’s health bible having been first published in 1970. Those were the early days of AIDS, promoting condom use, and identifying human papilloma virus(HPV). We were the first clinic in the area to offer sliding fee scale colposcopy, the evaluation for abnormal Pap smears which tried to identify evidence of HPV, then being linked to cervical cancer. The HPV vaccine hadn’t yet been developed. Raised Catholic with my own dose of abstinence education, I was empowered to teach women about their bodies.

In retrospect, I realize I have ridden a wave. A little history may be of interest. In 1981 (the Regan years) Congress passed the Adolescent Family Life Act (AFLA), Title XX money. Also known as the chastity law, it was designed to encourage adolescents to postpone sexual activity until marriage,emphasizing “chastity” and “self-discipline,” as well as providing support for pregnant or parenting teens and their families. The ACLU brought a lawsuit, Bowen v. Kendrick, which reached the Supreme Court. The Court ruled that the statute did not violate the separation of church and state principles.

Then during the Clinton years, the Welfare Reform Act, or the Temporary Assistance for Needy Families (TANF), also referred to as Title 5 included a new system of grants for states providing abstinence-only-until-marriage education that used a specific 8-point criteria, known as the “A-H definition.” These are kind of interesting so I’ve listed them below:

• The exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;

• Teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;

• 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;

• Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of sexual activity;

• Teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;

• Teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society;

• Teaches young people how to reject sexual advances and how alcohol and drug use increase vulnerability to sexual advances

• Teaches the importance of attaining self-sufficiency before engaging in sexual activity.

Funding required states to match every $5 of Federal money with $4 of state funds. Only California immediately rejected theprogram. And it’s kind of ironic that President Bill Clinton rejected monogamy as well, given his dalliances.

Now on to the Bush years when Congress created Community-Based Abstinence Education (CBAE) programs which made grants available to community-based organizations, including faith-based organizations.

Thankfully, the office of Rep Henry Waxman(CA), the former chair of the House Committee on Oversight and Government Reform, released a report in 2004 showing that two-thirds of the abstinence-only education curricula contradicted the scientific findings of the CDC, and contained incorrect scientific information regarding condom failure,sexually transmitted diseases, the health consequences of abortions, and mental health. Furthermore, the report noted that these curricula relied on stereotypes of gender roles and sexuality, and religious notions of conception.At the same time, a poll conducted by NPR, the Kaiser Family Foundation, and Harvard’s Kennedy School for Government found that only 7% of the parents surveyed for the study supported abstinence-only education. 

That was no deterrence however, by 2006 the 3mechanisms for abstinence only education (AFLA, CBAE, and Title 5) provided$176 million in abstinence only education—the highest in a year to date. But by2007, almost half of the states refused to use apply not wanting to use theirown funds.

There were global ramification to what was happening in the US. Bush’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003, focused on 15 countries in sub-Saharan Africa, the Caribbean, and Asia that had been severely affected by AIDS. At that time, PEPFAR required grantees to devote at least 33% of prevention spending (and two thirds of funds for sexual transmission) to abstinence-until-marriage programs. The programming for abstinence within PEPFAR often undermined country-level national efforts tocreate integrated messages and programs for HIV prevention. In addition, the US emphasis on abstinence likely reduced condom availability and access to accurate information on HIV/AIDS in some countries. Then came Obama, and after2008, the abstinence focus was dropped.

In 2010 his budget eliminated most federal funding for abstinence-only sex-education programs in the US as well, replacing it with funding for programs that have been proven effective through"rigorous evaluation," to delay sexual activity, increase contraceptive use (without increasing sexual activity) or to reduce teen pregnancy.

So here we are again. I agree with a bumper sticker I’ve seen on occasion: I Miss Obama.

Thanks Dr. Andrew Saal for bringing my attention to this.

Reference: https://ncac.org/resource/timeline-of-abstinence-only-education-in-u-s-classrooms