On April 23, the House Oversight and Government Reform Committee held a hearing, “Domestic Abstinence-Only Programs: Assessing the Evidence.” The hearing examined Title V federal abstinence-until-marriage education funding, first established in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) and most recently reauthorized in 2006 (P.L. 109-432). Title V authorizes $50 million annually for grants to states to create or augment existing abstinence-until-marriage education programs for unmarried teenagers and adults.
Chair Henry Waxman (D-CA) said, “We’re here today to discuss evidence on the effectiveness of abstinence-only programs. There is a broad consensus that the benefits of abstinence should be taught as part of any sex education effort. But abstinence-only programs teach only abstinence. In federally funded abstinence-only programs, teenagers cannot receive information on other methods of disease prevention and contraception, other than failure rates. To date these programs have gotten over $1.3 billion of federal taxpayer money, along with hundreds of millions of dollars in state funds…Meanwhile, we have no dedicated source of federal funding specifically for comprehensive classroom sex education.”
He continued, “In 2007, the Bush Administration released the results of a longitudinal, randomized, controlled study of four federally funded programs. The investigators found that, compared to the control group, the abstinence-only programs had no impact on whether or not participants abstained from sex. They had no impact on the age when teens started having sex. They had no impact on the number of partners. And they had no impact on rates of pregnancy or sexually transmitted disease.”
Ranking Member Tom Davis (R-VA) said, “In fact, the federal government funds the full spectrum of sex education. As it must be under our constitutional system, decisions about the nature and content of sex education in schools are made at the state and school district levels, with strong input from parents…So we permit states, school districts, and community organizations to seek federal funds for the types of sex education they judge best to meet the needs of their students. We should not deny them the option of abstinence education programs because some perform better than others.”
He continued, “Data on the impact of abstinence education programs may be difficult to capture or slow to be recognized. But problems with how abstinence is taught cannot be allowed to undermine its indispensability as a core element of what is taught. It is inaccurate and unfair to claim all abstinence education programs are the same; or that all such programs fail, therefore none should be funded…Identifying what works, and what doesn’t, can help focus federal funding on the best practices and the most efficient programs.”
The committee heard testimony from Rep. Lois Capps (D-CA) and Sen. Sam Brownback (R-KS). Rep. Capps said, “Mr. Chairman, according to a 2005 CDC study, 46.8 percent of all high school students reported having had sexual intercourse. For high school seniors, this figure reaches 63.1 percent. The bottom line is, as much as parents and teachers alike stress abstinence among teens, sexual activity is a reality for many young people.”
She continued, “Some say that abstinence-only education is the answer. But claiming that the only proper information to share with teens, even teens who are already parents, is abstinence-only and nothing else, means withholding scientifically-based medical information. This is completely unrealistic. Of course, abstinence should be at the core of any comprehensive sexual education curriculum. Practicing 100 percent complete abstinence is 100 percent effective in preventing pregnancy…[B]ut it is not realistic to expect such behavior from all teens. So the best thing we can do to protect young people from the negative consequences of unsafe sex is to give them the information they need. We know this works. A National Campaign to Prevent Teen Pregnancy study revealed that over 40 percent of comprehensive education programs that were evaluated delayed the initiation of sex and more than 60 percent reduced unprotected sex.”
Sen. Brownback said the “bulk of money” from all government sources goes to comprehensive programs, noting that states and localities spend more on such programs than the federal government does on the Title V program. “Studies have shown that abstinence education is effective in decreasing the number of teen [pregnancies] and rates of sexually transmitted diseases [STD] among youth,” he said. “Clearly our current approach to sex education is not working; STD rates among teens are rising, and it is irresponsible of us to silence the abstinence message. We need more funding for abstinence programs, not less. Cutting funding to such valuable programs will only have negative results as we see teens, and even pre-teens, engage in risky sexual behavior…Parents want the best for their children, and have high expectations and goals for their futures. It is ironic that most of my colleagues agree that abstinence education is preferred, but are not willing to fund such programs at the same level as ‘comprehensive’ sex education, the funding of which is weaved throughout our federal budget.”
Rep. Christopher Shays (R-CT) asked how schools could teach only abstinence when students have “seen it all” on TV and heard about such topics from their peers. Sen. Brownback responded that it was schools’ duty to “set high expectations” for students, even if not all students could live up to the goal of abstinence. Rep. Mark Souder (R-IN) said that there were ten federal sources for “comprehensive sex education,” but only one source for abstinence-until-marriage programs, and said that 25 percent of schools offered abstinence-until-marriage education programs while 68 percent offered comprehensive programs. Sen. Brownback responded that, because of continuing high rates of STD infections, especially among certain minority communities, the current emphasis on comprehensive education “is not working.”
Charles Keckler, acting deputy assistant secretary for policy at the Administration for Children and Families of the Department of Health and Human Services, testified, “At the current time, there is no reason to believe that programs involving abstinence education cannot be designed to be more effective with the available curricular alternatives in encouraging delays or reductions in adolescent sexual activity, and such programs do not appear to cause any decrease in the use of contraception by participants who choose not to abstain. The administration believes that the abstinence education program sends the healthiest message as it is the only certain way to avoid out-of-wedlock pregnancy, and sexually transmitted diseases. The great majority of American parents agree: a 2007 poll conducted by the National Campaign to Prevent Teen Pregnancy found that 90 percent of teens aged 12-19 and 93 percent of adults agree that it is important for teens to be given a strong message that they should not have sex until they are at least out of high school… [M]any current grantee organizations would likely no longer apply to participate in providing health education programs if they were required to give instruction in contraceptive techniques… Consequently, the abstinence education service option expands the range of possible providers, as well as the populations they can serve.”
Dr. John Santelli, chairman of the Department of Population and Family Health of Columbia University’s Mailman School of Public Health, testified, “Throughout the 1990s, teen sexual activity in the U.S. decreased and contraceptive use improved. Much of the improvement in contraceptive use was related to increasing condom use: between 1991 and 2001 condom use at last intercourse by young women rose from 38 percent to 51 percent. Increases in teen condom use in the 1980s were even more dramatic. My own research suggests that 86 percent of the decline in teen pregnancy rates among 15- to 19-year-olds between 1995 and 2002 was the result of improved contraceptive use…While an increase in abstinence (i.e., fewer teens having sexual intercourse) explains some of the decline in teen pregnancy rates in the 1990s, more recently there appears to be little impact of abstinence on teen birth or pregnancy rates.”
Dr. Stan E. Weed, director of the Institute for Research and Evaluation, testified in support of what he called the “abstinence-centered approach to prevention.” He noted that some reports that called “abstinence education” ineffective used programs “with no interim support or reinforcement of the message,” and thus were poor examples of what such programs could achieve. He said four aspects of good programs are “adequate dosage” of classes; “mediating factors” that “address the key predictors of adolescent sexual risk behavior”; a “messenger” that is effective; and “evaluation” of the programs.
Dr. Weed said that three recent studies “provide new and more rigorous evidence that abstinence education programs can be effective. Two more studies that are in the publication pipeline show similar patterns of effectiveness. Taken together, a pattern of scientific evidence is emerging that indicates abstinence-centered sex education programs, if properly designed and implemented, can cut rates of teen sexual activity by as much as half for significant periods of time, without reducing condom use by the sexually active.” He said “abstinence-plus” sex education programs would provide a “diluted message” and that “proponents of this approach often are not committed to abstinence and give it only passing coverage in the curriculum.”
During questions, Rep. Waxman asked Dr. Weed if comprehensive programs “encourage sexual activity;” Dr. Weed said he had seen no evidence they do, but that programs were being evaluated now.
Dr. Harvey Fineberg, president of the Institute of Medicine of the National Academies, testified about the results of a Cochrane Collaboration review of studies evaluating the effectiveness of sex education programs. “In the Cochrane review of abstinence-only programs, no program showed an effect on incidence of unprotected vaginal sex, number of sex partners, condom use or sexual initiation compared to controls,” he said. “One trial favored an abstinence-only program over usual care for incidence of vaginal sex, but this was limited to two-month follow-up and was offset by measurement error and six other studies with non-significant effects. One evaluation found several significant adverse program effects: abstinence-only participants in this program were more likely than [the control group] to report sexually transmitted infections, pregnancy, and increased frequency of vaginal sex. Overall, the authors concluded that abstinence-only programs neither reduced nor exacerbated HIV risk among participants in the U.S.”
Also testifying were Shelby Knox, a youth speaker; Max Siegel, policy associate with AIDS Alliance for Children, Youth, and Families; Dr. Georges Benjamin, executive director of the American Public Health Association; Dr. Margaret Blythe, chair of the Committee on Adolescence of the American Academy of Pediatrics; and Dr. Marcia Crosse, director of health care at the U.S. Government Accountability Office.