Abstinence Education
American College of Pediatricians - October 2010
The American College of Pediatricians strongly endorses
abstinence-until-marriage sex education and recommends adoption by all school
systems in lieu of “comprehensive sex education". This position is based
on “the public health principle of primary prevention – risk avoidance in lieu
of risk reduction,” upholding the “human right to the highest attainable
standard of health.”1
By every measure, adolescent sexual activity is detrimental
to the well-being of all involved, especially young women, and society at
large. Children and adolescents from 10 to 19 years of age are more at risk for
contracting a sexually transmitted infection (STI) than adults.2 This is due to
the general practice of having multiple and higher risk sexual partners, and to
the immaturity of the cervical tissue of girls and young women. The CDC
recently stated that of the 19 million new cases of STIs annually reported in
the United States, 50 percent occur in teens and young adults under 25 years of
age.3 Twenty-five percent of newly diagnosed cases of HIV occur in those under
22 years of age.4 This translates into one in four sexually active female
adolescents being infected with at least one STI.5
Bacterial STIs may cause life-threatening cases of pelvic
inflammatory disease (PID) and infertility. Viral STIs which include herpes,
the Human Papilloma Virus (HPV) and HIV are generally incurable. Herpes
afflicts its victims with life-long painful recurrences, may be passed on to
sexual partners even when asymptomatic, and may be life threatening to infants
if passed on at birth during vaginal delivery. HPV is found among 90 percent of
sexually active young adults and teens.6 While often self-limited, HPV has
high-risk strains that may persist for life and cause cancer of the cervix. HIV
not only causes premature demise, but also significant suffering with life-long
dependence on multiple toxic and costly medications. The CDC estimates that
STIs cost the U.S. health care system as much as $15.3 billion dollars
annually.7
Adolescent pregnancy is similarly associated with adverse
socioeconomics that have an impact on the family, community, and society at
large. One in thirteen high school girls becomes pregnant each year.8
Adolescent pregnancy results in decreased educational and vocational
opportunities for the mothers, an increased likelihood of the family living in
poverty, and significant risk for negative long-term outcomes for the children.
For example, children of adolescent mothers are more likely to be born
prematurely and at a low birth weight; suffer from poor health; perform poorly
in school; run away from home; be abused or neglected; and grow up without a father.9
Even if sexually active teens escape acquiring sexually
transmitted infections (STIs) and becoming pregnant, few remain emotionally
unscathed. Overall, one in eight teens suffers from depression,10 and suicide
has risen to become the third leading cause of death for adolescents,
paralleling the rise in STIs within this population.11 Infection with an STI
has long been recognized as a cause for depression among teens. More recently,
however, adolescent sexual activity alone has been acknowledged as an
independent risk factor for developing low self-esteem, major depression, and
attempting suicide.12 In studies that controlled for confounding factors,
sexually active girls were found to be three times as likely to report being
depressed and three times as likely to have attempted suicide when compared to
sexually abstinent girls.13 Sexually active boys were more than twice as likely
to suffer from depression and seven times as likely to have attempted suicide
when compared to sexually abstinent boys.14 This is not mere coincidence.
Scientists now know that sexual activity releases chemicals in the brain that
create emotional bonds between partners. Breaking these bonds can cause
depression, and make it harder to bond with someone else in the future.15
Sexual activity is defined as genital contact. This includes
mutual masturbation, as well as oral, vaginal, and anal intercourse. While only
vaginal intercourse may result in pregnancy, all of these practices may spread
STIs, and lead to emotional trauma. Abstaining from all sexual activity is the
only 100 percent safe and effective way to avoid teen pregnancies, STIs, and
the emotional fallout of adolescent sexual activity. Almost 40 years of
emphasis on “safer sex” with “values-neutral sex education,” condoms and
contraception has clearly failed our young people. Abstinence education does
not occur in a vacuum, making it especially difficult to separate its influence
from the opposing influence of the media and cultural milieu. Nevertheless,
effectiveness of abstinence sex education in delaying the onset of sexual debut
has been demonstrated in rigorous scientific studies. For example, five out of
seven programs recently reviewed showed a significant reduction in sexual
initiation rates (two programs showed rates decreased by half).16 Evaluation of
community-based abstinence programs in peer-reviewed journals showed that they
are effective in significantly reducing pregnancy. According to an April 2008
report by the Heritage Foundation “fifteen studies examined abstinence programs
and eleven reported positive findings of delayed sexual initiation.”17 Reviews
by The Institute for Research and Evaluation state that “several well designed
evaluations of abstinence programs have found significant long- term reductions
in adolescent sexual activity.”18 These do not begin to thoroughly evaluate the
hundreds of ongoing programs.
In its endorsement of abstinence-based sex education, the
College calls attention to the scientific controversies surrounding alternative
educational platforms. Most sex education curricula fall into two categories,
abstinence-until-marriage or comprehensive sex education programs (occasionally
also referred to as “abstinence plus” programs). Recently, abstinence education
has been criticized for not providing critical health information about condom
use. Abstinence education curricula, however, do not discourage the use of
condoms; rather they note that chastity obviates the need for condoms.
Abstinence education programs do not claim that condoms have no place in
preventing STIs. Comprehensive programs, on the other hand, are misleading in
the emphasis they place on condom use. These programs give teens the impression
that condoms make sexual activity safe. In reality, there has been much conflicting
medical literature on the effectiveness of condoms in preventing STIs since the
2000 NIH report on the subject and much of the controversy remains
unresolved.19 Teens must be informed that condoms do not offer complete
protection from either pregnancy or STIs.
The College position supporting abstinence-until-marriage
education, unlike alternative education platforms, also recognizes the unique
neurobiology of adolescent brains. The frontal cortex of the adolescent brain
is still in development and unable to make the consistently wise executive
decisions necessary to control action based on emotional input. Researcher Jay
Giedd and others have found that young people do not have the physical brain
capacity to make fully mature decisions until their mid-twenties.20
Consequently, when it comes to sex education, adolescents
need to be given clear direction repeatedly, as is done with programs that
address smoking, drugs, and alcohol use. Emphasis on contraceptive methods
undermines the authority of parents and the strength of the abstinence message.
This approach reinforces the ubiquitous (yet erroneous) message presented by
the media that engaging in sexual activity is not only expected of teens, but
also the norm. Adolescent brains are not equipped to handle these mixed
messages. Parents and teachers need to “function as a surrogate set of frontal
lobes, an auxiliary problem solver” for their teens, setting firm and immutable
expectations.21 Adolescents need repetitive, clear, and consistent guidance.
As families address this issue of sex education, the
American College of Pediatricians recommends that parents be fully aware of the
content of the curriculum to which their children are being exposed. The
national “Guidelines for Comprehensive Sex Education” that were drafted by the
Sexuality Information and Education Council of the United States (SIECUS) place
strong emphasis on “values neutral” sex education beginning in kindergarten.
According to these guidelines, children between the ages of 5 to 8 should be
taught not only the anatomically correct names of all body parts, but also the
definitions of sexual intercourse, and masturbation.22
Overall, these comprehensive programs only emphasize “safer
sex.” Many comprehensive programs also provide sexually erotic material to
teens with explicit condom demonstrations. Other programs suggest alternative
types of sexually stimulating contact (referred to as “outercourse”) that would
not result in pregnancy but still could result in STIs. Some of these
activities, depending on the ages of those involved and the state in which they
occur, could actually be illegal. These education programs can break down the
natural barriers of those not yet involved in sexual activity and encourage
experimentation. Additionally, many programs emphasize that teens do not need
parental consent to obtain birth control and that teens therefore need not even
discuss the issue with them.23
Discouraging parental involvement eliminates one of the most
powerful deterrents to sexual activity, namely, communication of parental
expectations.24 Firm statements from parents that sex should be reserved for
marriage have been found to be very effective in delaying sexual debut.
Parental example and “religiosity” have also been found to be similarly protective.
Adolescents reared by parents who live according to their professed faith25 and
are actively involved in their worship community,26 are more likely to abstain
from sexual activity as teens. Successful sex education programs involve
parents and promote open discussion between parents and their children.
The American College of Pediatricians also believes parents
should be aware of the current state of funding, and government involvement in
sex education choices. Comprehensive programs receive seven to twelve times the
funding of abstinence programs.27 However, according to a recent study by the
Department of Health and Human Services, comprehensive programs do not give
equal time to abstinence.
In 2004 Congressman Henry Waxman of California presented a
report before Congress critical of the medical accuracy of abstinence education
curricula.29 The Mathematica Study was similarly critical of the medical
accuracy of abstinence education programs.30 However, in 2007 the U.S
.Department of Health and Human Services conducted an extensive review of nine
comprehensive sex education curricula using the same methods employed by
Congressman Waxman and the Mathematica Study. These comprehensive programs were
found to have no better record for medical accuracy. The HHS review also found
that the comprehensive programs were hardly comprehensive. The amount of
discussion dedicated to “safer sex” exceeded that spent on abstinence by a
factor of up to seven. Some of the programs failed to mention abstinence
altogether. None of the programs carefully distinguished between reducing and
eliminating the risks of sexual activity, and nearly every program failed to
mention the emotional consequences of early sexual activity. Although some of
the comprehensive programs showed a small effect in reducing “unprotected” sex
(7 of 9 programs) and to a lesser extent in delaying sexual debut (2 of 8
programs), the impact did not extend beyond six months.31
According to a 2004 Zogby Poll, 90% of adults and teens
agree with The American College of Pediatricians position that teens should be
given a strong abstinence message.32 Programs that teach sexual abstinence
until marriage are about much more than simply delaying sexual activity. They
assist adolescents in establishing positive character traits, formulating
long-term goals, and developing emotionally healthy relationships. These
programs increase the likelihood of strong marriages and families - the single
most essential resource for the strength and survival of our nation.
March 13, 2009
Edited October 26, 2010
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