Relatively high rates of teenage pregnancy and sexually transmitted infections (STI) have caused parents, educators, healthcare professionals, and policymakers to question the effectiveness of federally funded abstinence-only sexuality education. Research data do not convincingly show that abstinence-only sexuality education significantly decreases the number of adolescents engaging in sexual intercourse prior to marriage. In order to examine the reasons for these findings, this paper reviewed and analyzed studies evaluating the effectiveness of various abstinence-only programs. It was determined that abstinence-only programs are difficult to comprehensively evaluate due to a number of influencing factors, but based on the presented data, abstinence-only programs appear to be ineffective as they often increase or do not affect sexual activity.
Do adolescents really wait for true love? Many certainly do not, even though most abstinence-only sexuality education programs preach abstinent behavior until marriage (Santelli et al., 2006). Approximately half of roughly 400 unmarried males and 400 unmarried females ages 15-19 reported having sexual intercourse (Mueller, Gavin, & Kulkarni, 2008). Moreover, the Alan Guttmacher Institute (2006) found that more than five out of ten males and six out of ten females have had intercourse by the age of eighteen. Sexual intercourse prior to marriage contributed to over 750,000 teenage pregnancies and approximately nine million cases of sexually transmitted infections (STI) each year among 15-24 year olds in the United States (Mueller, Gavin, & Kulkarni, 2008). These numbers have concerned parents, educators, healthcare professionals, and policymakers.
Among American females ages 15-19, there were 117 pregnancies per 1,000 women in 1990. This number decreased to 75 pregnancies per 1,000 women in 2002 (Alan Guttmacher Institute, 2006). Although teenage pregnancy rates in the U.S. are steadily decreasing, these rates are still nearly twice as high as those in Great Britain, and eight times higher than those in the Netherlands and Japan (Alan Guttmacher Institute, 2006). Additionally, there were approximately nine million STIs in youths under age twenty-five in 2000, a number that has not changed much since then (Santelli et al., 2006; Mueller, Gavin, & Kulkarni, 2008; Alan Guttmacher Institute, 2006). Thus, in a continuing effort to decrease the pregnancy and STI rates and to reduce the number of adolescents participating in sexual intercourse prior to marriage, abstinence-only sexuality education programs have been encouraged in schools across the nation with the help of federal funding. These programs have gained support from the United States Congress and organizations such as the National Abstinence Clearinghouse, Project Reality, the National Coalition for Abstinence Education, and the Department of Health and Human Services (Alan Guttmacher Institute, 2006; Blinn-Pike, 1999; Thomas, 2000). In 2000, the Department of Health and Human Services stated its goals to reduce the percentage of youths participating in sexual intercourse to 15% by age fifteen and 40% by age seventeen, and to increase the proportion of non-virgin, abstinence-practicing youths to 40% (Thomas, 2000). These general goals have also been extended to the year 2010 (Mueller, Gavin, & Kulkarni, 2008). It is difficult to determine whether these goals will be met and how significantly the current steady decrease in teen pregnancy and STI rates will be affected by decreased participation in sexual intercourse.
At this time, seventeen states have rejected federal funding for abstinence-only sexuality education (SIECUS, 2008). Despite the prevalence of abstinence-only education, research data do not convincingly show that abstinence-only education significantly reduces the number of adolescents engaging in sexual intercourse prior to marriage. This article will begin by defining abstinence and abstinence-only sexuality education, describing common characteristics of abstinence-only sexuality education, providing a historical background of abstinence-only education, and presenting the rationale behind abstinence-only sexuality education. Then, this article will examine studies that evaluated the efficacy of abstinence-only education. Finally, a critical analysis of these studies and a discussion of the future of sexuality education in the United States will be provided.
Definition of Abstinence and Abstinence-Only Sexuality Education
Abstinence has been defined differently in behavioral (e.g., postponing intercourse) and moral terms (e.g., making a commitment, making responsible decisions), but for the purposes of this paper abstinence will be defined simply as abstinence from sexual intercourse, regardless of virginity (Santelli et al., 2006). The United States Congress added Section 510 to Title V of the 1996 Social Security Act, allotting $50 million each year from 1998 to 2002 for state programs providing abstinence-only education (Thomas, 2000). The federal definition of abstinence-only education under Section 510 states that abstinence education is an educational motivational program that:
- has as its 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 human 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 increases vulnerability to sexual advances; and
- teaches the importance of attaining self-sufficiency before engaging in sexual activity (Santelli et al., 2006).
Characteristics of Abstinence-Only Sexuality Education
Abstinence-only programs are mainly first taught in middle school or high school, sometime within the 12-15 year range (Thomas, 2000). The programs tend to vary in length from 3-6 weeks with sessions lasting 45-60 minutes, although the lengths of some programs are measured in units or lessons (Thomas, 2000). These programs mainly stress the advantages of waiting to have sex; omit important information on topics such as reproduction, body image, and sexual identity; and emphasize the problematic consequences of intercourse (Thomas, 2000; Kempner, 2001). For instance, the curricula often present failure rates of contraception instead of success rates, include biased and inaccurate information about STIs and pregnancy options, and portray sexual activity as shameful and harmful in an effort to scare adolescents into refraining from sexual activity (Kempner, 2001).
History of Abstinence-Only Sexuality Education
Due to social and economic problems relevant to adolescent sexuality, the Adolescent Family Life Act (AFLA) of 1981 (Title XX) was passed, which financially supports abstinence- only programs that do not teach about contraception and abortion (Perrin & DeJoy, 2003; Thomas, 2000). To this day, AFLA still continues to fund abstinence-only programs. However, it was determined in an out-of-court settlement in 1993 that these AFLA-funded programs must:
- not include religious references,
- be medically accurate,
- respect the principle of self-determination regarding contraceptive referral for teenagers, and
- not allow grantees to use church sanctuaries for their programs or to give presentations at parochial schools during school hours (Perrin & DeJoy, 2003).
Federal financial support has influenced the face of abstinence-only education by dictating what these programs can and cannot teach.
In 1996, concerns grew regarding the increasing birth rate for unmarried women, leading to the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), a component of the nation’s attempt to reform the welfare system (Perrin & DeJoy, 2003). Due to the House and Senate’s conflicting versions of the bill containing PRWORA, $50 million for abstinence-only sexuality education was added to the bill as a last-minute compromise (Perrin & DeJoy, 2003). The bill was thus signed into law without any public debate (Perrin & DeJoy, 2003). This large sum of money was officially set to be distributed to abstinence-only programs based on a hasty, unchallenged decision within the House and Senate. The $50 million was to be administered by the federal Maternal and Child Health Bureau at the Department of Human Services under the aforementioned Title V, Section 510 of the Social Security Act (Perrin & DeJoy, 2003; Santelli et al., 2006). For every four federal dollars given to state abstinence-only programs, states would have to match this amount with three state dollars (Perrin & DeJoy, 2003). By providing monetary support to abstinence-only curricula, federal funds continue to feed the prevalence of abstinence-only education today.
Rationale Behind Abstinence-Only Sexuality Education
Abstinence-only programs are mainly supported by the rationale that only abstinence can fully guarantee prevention of teenage pregnancy and STIs (Thomas, 2000; Moore & Sugland, 1997). If adolescents are abstinent from sexual intercourse 100% of the time, then clearly there is no possibility of pregnancy or sexual disease transmission. Scientific studies show that the brains of children and adolescents are not fully developed to the stage where they are capable of processing information properly to foresee possible consequences of their actions (Thomas, 2000). Thus, children and adolescents are educated about the ill consequences which can result from deciding to have sexual intercourse and are taught to make one choice only to avoid the ill consequences: to not have intercourse at all. Failure rates of condoms and contraception are cited as another reason not to have intercourse. If this decision is made 100% of the time, there is no need for children and adolescents to learn about contraception methods and what constitutes safe sex. It is implied in Section 510 that engagement in sexual activity prior to marriage could produce harmful psychological, physical, and emotional harm, further justifying the “protection” of children and adolescents from sexual activity prior to marriage (Thomas, 2000). Abstinence-only education supporters cite these as the main reasons why abstinence-only programs work.
This review focuses only on the results of research studies pertaining to changes in intentions to have intercourse and/or the number of participants actually having intercourse even though the studies may have also evaluated other behaviors and attitudes regarding sexuality in general. This decision was based on the definition of abstinence – no intercourse until marriage – and the objective of abstinence-only education – to encourage adolescents to avoid intercourse and its consequences of teen pregnancy and STIs.
In the Advocates for Youth Report, Hauser (2004) summarized evaluations of federally funded abstinence-only sexuality education programs. Regarding sexual behavior in the short term, three out of six programs had no impact, two out of six programs reported increases, and the last program showed mixed results. In the long term, there was no significant impact three to seventeen months after the termination of the program; overall few programs were successful in increasing intentions to abstain. In the National Campaign to Prevent Teen Pregnancy in 1997, only six studies evaluating abstinence-only education were found by Kirby (1997). One of the studies showed a decrease in recent intercourse, another had inconsistent results, and the remainder found the evaluated programs to have no effect. Studies suggest that abstinence-only education either does not change or increases the intention or initiation of sexual intercourse among adolescents. These results have not changed much in the past eighteen years.
Many studies evaluated program effectiveness through pretest and posttest evaluations of both a control group and a group that received abstinence education. Christopher and Roosa (1990) evaluated an abstinence-only program known as Just Say No, which targeted middle school age individuals. The program taught self-esteem, communication skills, peer pressure, and waiting until marriage to have sex. It was administered to 191 participants and 129 controls over a period of six weeks. Variables such as self-esteem, communication, premarital sexual behaviors, and premarital sexual and marital attitudes were measured. After participation in the Just Say No program, there was an increase in sexual intercourse.
St. Pierre, Mark, Kaltreider, and Aikin (1995) conducted a twenty-seven month evaluation of Stay SMART among fourteen Boys & Girls Clubs across the United States. Stay SMART addresses sexual activity, focusing on abstinence-only, as well as drug and alcohol use. All clubs began with a pretest. Five clubs received the Stay SMART program for the first three months and no intervention afterward for the next two years. Five other clubs received the Stay SMART program for the first three months and then booster programs known as SMART Leaders I the following year and SMART Leaders II the year after that. The SMART Leaders I and II booster programs were designed to allow past Stay SMART program participants to become leaders and role models who would encourage their peers to abstain from sex, smoking, drinking, and drugs. These clubs were compared to four control clubs, which had no exposure to the program at all. The researchers discovered a decrease in the frequency of sexual intercourse among those receiving Stay SMART only, but not among those receiving Stay SMART and the subsequent SMART Leaders I and II programs in the following years. Similar results appeared in a follow-up study conducted by Jemmott, Jemmott and Fong (1998), who studied 659 low-income African American adolescents who participated in an eight-hour abstinence-only program. Decreased intercourse was found at three months but not at six or twelve months for program participants compared to a control group.
Lieberman, Gray, Wier, Fiorentino, and Maloney (2000) evaluated a 3-4 month long small group intervention known as Project IMPPACT on 125 participants (with 187 control participants) in New York City middle schools. Project IMPPACT differs from health educator programs in that it is led by trained social workers in a small group setting conducive to discussion rather than in a typical lecture-style classroom. Lieberman et al. (2000) found few differences in the initiation of intercourse at pretest compared to a relatively immediate posttest. No difference was found a year later between the female intervention and control groups in the initiation of intercourse, but a higher (not statistically significant) increase in the initiation of intercourse was found among males (Lieberman et al., 2000). Sather and Zinn (2002) also examined two groups of seventh and eighth graders’ attitudes toward premarital sexual activity before and after programs such as the Family Accountability Communicating Teen Sexuality (FACTS) and the Why Am I Tempted? (WAIT) programs in Nebraska. Student commitment to abstinence at pretest and posttest did not differ from that of a control group.
On the other hand, some studies show abstinence-only education programs occasionally can be effective. Denny, Young, Rausch, and Spear (2002) claimed that the five-week program known as Sex Can Wait, offered at the upper elementary, middle/junior high, and high school levels, had a positive effect on sexual behavior. Sex Can Wait focuses on self-esteem, communication skills, decision making, goal setting, and life planning in a role-play, cooperative learning group environment. Statistical analysis showed that the group participating in the program had a lower percentage of non-virgins and a lower number of students engaging in sexual intercourse in the last thirty days at posttest compared to the control group. Overall, however, an increase in the percentage of individuals who had ever had sexual intercourse in the last thirty days was found for all school levels among both the control group and the Sex Can Wait group.
Additionally, Zanis (2005) evaluated the effectiveness of the ten-week Sexual Safety Awareness Curriculum (SSAC) for thirty-one students from aged 12 to 16 years. Findings revealed a decrease in the percentage of abstinent students who intended to have sexual intercourse in the next year. Moreover, the results displayed a decrease in the percentage who would say “yes” if someone tried to have sex with them, and, vice versa, an increase in the percentage who would say “no” if someone tried to have sex with them among both currently sexually active and abstinent students. Yet, 100% of sexually active students reported having sexual intercourse in the past month at both pretest and posttest compared to a 13% increase from 0% among abstinent students.
Analysis and Discussion
Abstinence-only programs mainly emphasize delaying sexual intercourse until marriage. Yet, research studies on these programs tend to conduct posttest follow-ups within a relatively short time span after termination of the program, even when purporting to demonstrate long term effects. The follow-up time span ranged from one month to twenty-seven months and focused mainly on middle and high school students who are unlikely to be married by the time of posttest. Therefore, these evaluations cannot necessarily predict the effectiveness of abstinence-only in delaying coitus until marriage. Moreover, studies conducted by St. Pierre, Mark, Kaltreider, and Aikin (1995) and Jemmott, Jemmott, and Fong (1998) showed no change or no continued decreases in sexual activity after long-term periods, indicating the possibility of little success in abstaining until marriage. The way the program is conducted also seems to have no real impact on how effective it will be. Levels of sexual intent or intercourse tend to be similar among students who participated in small groups with role-playing compared to those who participated in the lecture-like programs.
Each of the previously discussed abstinence-only programs was tested on one specific demographic or socioeconomic group, such as New York City middle school students or members of Boys & Girls Clubs. This makes it difficult to generalize about the effectiveness of abstinence-only programs. Even though the programs did not exert the intended effects on sexual attitudes and behaviors in one area of the nation or among one demographic, they could exert these effects in other areas and among other types of students.
Sample size among these studies was low, especially for Zanis’s SSAC curriculum involving thirty-one students. The resultant data could hardly be considered representative of this program’s general success in the U.S. The Project IMPPACT evaluation involved over 300 participants, which is considerably better than Zanis’s sample size. Nevertheless, with over 750,000 teen pregnancies each year and 9 million STIs, it is questionable whether the data from 300 participants shows that abstinence-only programs explain a U.S.-wide decrease in teen pregnancy and STIs.
Even though Denny et al. (2002) and Zanis (2005) claimed that their abstinence-only programs were effective, a closer look at their findings suggests otherwise. In both studies, the intervention group alone displayed increases in participation in sexual intercourse at posttest, but this increase was lower than the increase observed in the control group. The intervention group results should have stayed the same or decreased at post-test compared to the control group. The effectiveness of these abstinence-only programs is questionable if increases in sexual intercourse were observed at posttest in the intervention groups.
Abstinence-only sexuality education is not the only factor contributing to high pregnancy and STI rates. There are numerous other influences such as religion, culture, parental and peer attitudes, environment, television and movies, location, demographics, and socioeconomic status. With so many contributors, it is difficult to control for them and isolate the effectiveness of abstinence-only education because it is only one factor that affects the formation of attitudes toward sex and sexual risk-taking behavior.
Comprehensive studies of abstinence-only sexuality education are lacking for many reasons. It is difficult to obtain a large sample sizes since the researcher(s) would need to implement the programs across the U.S. Following a large sample group throughout adolescence until marriage is also difficult. Data from 2002 show that women and men first have intercourse at 17.4 and 17.7 years of age, respectively, and have their first marriage at 25.3 and 27.1 years of age, respectively (Santelli et al., 2006). Researchers would have to follow their sample groups for up to ten years.
Further comprehensive studies of abstinence-only sexuality education programs should be conducted. An abstinence-only program study should be conducted amongst various groups of adolescents in various locations across the U.S. Pretest and posttest questionnaires should be continued for both a control group and intervention group, but the sample sizes must be large to improve statistical significance. The programs could be administered to large adolescent church groups, to middle and high school students in largely populated areas, and to low-income and affluent students. Follow-ups should be carried out ten years after completion of the program. If the program was administered between the ages of 12-15, participants would be in their early to mid-twenties, or close to the median age for first marriages, at the time of follow-up. There may be a possible loss of participants with follow-ups occurring so many years later, but participants could be asked to indicate what schools they intend on attending, family could be contacted if the participant cannot be found later, and past attended schools could be contacted for assistance. More conclusive and convincing studies on the ineffectiveness of abstinence-only sexuality education programs may be able to convince policymakers to reconsider annual federal funding of these programs.
Concluding Thoughts and the Future of Sexuality Education
The studies presented here suggest that abstinence-only sexuality education programs do not appear to be effective; often they result in increases in sexual activity or no change at all from pretest to posttest. However, this does not necessarily mean that abstinence-only programs have detrimental effects, as abstinence does have positive influences on those who choose to abide by it 100%. Ideally, abstinence-only programs are a good idea. Practically, in everyday life, abstinence-only programs are not, as reflected by low effectiveness rates. Times are already changing and more and more states are refusing federal funding from the government for abstinence-only programs.
Comprehensive sexuality education programs may be viable alternatives that are gaining popularity but they are not as prevalent because they are not currently federally funded (Santelli et al., 2006). These programs emphasize abstinence but educate youth about STIs, homosexuality, intercourse, masturbation, oral sex, birth control pills, condom use, and responsible and informed decision-making. Comprehensive sexuality education may begin to slowly encourage society to accept that sexuality is human nature and marshal parent, educator, healthcare professional, and policymaker support in providing adolescents with factual sexual health information.
Alan Guttmacher Institute. (2006). Facts on sex education in the United States. New York/Washington, D.C.
Blinn-Pike, L. (1999). Why abstinent adolescents report they have not had sex: Understanding sexually resilient youth. Family Relations, 48(3), 295-301.
Christopher, F., & Roosa, M. (1990). An evaluation of an adolescent pregnancy prevention program: Is 'Just Say No' enough?. Family Relations, 39(1), 68-72.
Denny, G., Young, M., Rausch, S., & Spear, C. (2002). An evaluation of an abstinence education curriculum series: Sex can wait. American Journal of Health Behavior, 26(5), 366-377.
Hauser, D. (2004). Five years of abstinence-only-until-marriage education: Assessing the Impact. Retrieved March 20, 2008, from http://www.advocatesforyouth.org/publications/stateevaluations.pdf.
Jemmott, J.B. III, Jemmott, L. S., & Fong, G. T. (1998). Abstinence and safer sex HIV risk reduction interventions for African American adolescents: A randomized controlled trial. JA MA, 79, 1529-1536.
Kempner, M. (2001). Toward a sexually healthy America, abstinence-only-until-marriage programs that try to keep our youth “Sacred Chaste.” Retrieved March 20, 2008, from http://www.siecus.org/pubs/tsha_sacredchaste.pdf.
Kirby, D. (1997). No easy answers: Research findings on programs to reduce teen pregnancy. Retrieved March 18, 2008, from http://www.teenpregnancy.org/resources/data/report_summaries/no_easy_answers/default.asp
Lieberman, L. D., Gray, H., Wier, M., Fiorentino, R., Maloney, P. (2000). Long-term outcomes of an abstinence-based, small-group pregnancy prevention program in New York City schools. Family Planning Perspectives, 32(5), 237-245.
Moore, K., & Sugland, B. (1997). Using behavioral theories to design abstinence programs. Children and Youth Services Review, 19(5), 485-500.
Mueller, T. E., Gavin, L. E., & Kulkarni, A., M.B.B.S., M.P.H. (2008). The association between sex education and youth's engagement in sexual intercourse, age at first intercourse, and birth control use at first sex. Journal of Adolescent Health, 42, 89-96.
Perrin, K. & DeJoy, S. B. (2003). Abstinence-only education: How we got here and where we’re going. Journal of Public Health Policy, 24(3/4), 445-459.
Sather, L., & Zinn, K. (2002). Effects of abstinence-only education on adolescent attitudes and values concerning premarital sexual intercourse. Family & Community Health, 25(2), 1-15.
Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health, 38, 72-81.
SIECUS. (2008). Iowa becomes 17th state to reject Title V abstinence-only-until-marriage funding. Washington, DC.
St. Pierre, T. L., Mark, M. M., Kaltreider, D. L., & Aikin, K. J. (1995). A 27-month evaluation of a sexual activity prevention program in boys & girls clubs across the nation. Family Relations , 44(1), 69-77.
Thomas, M. H., (2000). Abstinence-based programs for prevention of adolescent pregnancies. Journal of Adolescent Health, 26(1), 5-17.
Zanis, D. (2005). Use of a sexual abstinence only curriculum with sexually active youths. Children & Schools, 27(1), 59-63.