Sunday, October 21, 2018

Abstinence Only Education: A Social Psychology Failure

Every decision, regardless of whether it is made by an individual or an organization, not only has an immediate, foreseeable, and desirable effect, but also several long-term, unforeseeable and unintended effects. This is especially true, and noticeable, in the production of legislation, regulations, ordinances, executive orders, and court opinions. The actions of governments seem to be the most susceptible to the law of unintended consequences. One of the first scholars to study this concept identified the causes of unintended consequences as ignorance, error in judgment, immediate gratification, rigid adherence to values, and self-defeating prophecies (Nworie & Haughton, 2008). Perhaps the failure of government actions meant to alleviate social ills can best be understood within this context. This is well exemplified in the federal government’s adoption and subsequent funding of abstinence only sexual education during the late nineteen nineties welfare reform. The idea that teaching adolescents to abstain from all sexual activity until marriage, while withholding information on safe sex practices and contraceptives, will reduce their engagement in sexual behavior and its subsequent effects seems intuitive, but social psychology often contradicts what we may consider intuitive or common sense. For instance, the bystander effect, the classic observation that we are less likely to receive help in emergency situations when there are more strangers around us, runs counter-intuitive to our notion of safety in numbers. The same thing could be said of abstinence only sexual education, which has historically either been negligible or had the opposite effect of what it intends. The research on this matter has shown that abstinence only sexual education tends to increase the risk of teen pregnancy, abortion rates, and does not decrease or delay adolescent sexual activity.

Ever since the Trump administration’s Department of Health and Human Services brought an end to the Teen Pregnancy Prevention Program, an evidence based adolescent health program established by congress in 2010, in late June of this year (Charo, 2017), the issue of sex education in public schools has never been more critical. The Teen Pregnancy Prevention program represented an important turning point in federal sex education policy. It encompassed funding for initiatives that not only aimed to delay sexual behavior among adolescents, but also provided information on the responsible use of contraceptives and other safe sex practices (Charo, 2017). Before this Obama era program, the exclusive policy of HHS was abstinence only sex education, which has historically meant chiding teens to wait until marriage, usually by employing scare tactics about the dangers of sex, while withholding information on contraceptives and safe sex practices (Kohler, Manhart, & Lafferty, 2008). Abstinence only education also tends to provide inaccurate or exaggerated information on the risks of pregnancy and STD/HIV transmission to promote a religious view of sexuality. Comprehensive sex education, such as the initiatives funded through the Teen Pregnancy Prevention program, also emphasizes the importance of delaying sexual behavior until one is responsible enough to handle the consequences, but provides accurate information on pregnancy risks, STD/HIV transmission, contraceptives and safe sex practices (Kohler et al., 2008).

Formal sex education was initially implemented in public schools across the country in response to the HIV/AIDS epidemic of the 1980’s (Hall, Sales, Komro, & Santelli, 2016). As a result, adolescents’ sex education vastly improved between 1988 and 1995; however, because of the welfare reform efforts of 1996, the federal government, through the Department of Health and Human Services, adopted abstinence until marriage as its exclusive position on sex education (Hall et al., 2016). In 1996, congress amended Title V of the Social Security Act, adding section 510(b) to include a provision of federal grants to state sexual education initiatives promoting abstinence only until marriage (Kohler et al., 2008). Thus, to receive federal funding under Title V of the Social Security Act, state sex education programs must exclusively teach the social, psychological, and health benefits of abstaining from sexual activity and that marriage is the only acceptable situation for sexual activity (Kohler et al., 2008). Congress also funds abstinence only sex education initiatives through the Adolescent Family Life Act, Community Based Abstinence Education, and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, among other legislation that provides federal grants (Stanger-Hall & Hall, 2011). The Teen Pregnancy Prevention program was introduced as an evidence based and value neutral alternative to abstinence only education during the Obama administration, with original appropriations of 114 million dollars in the 2010-2011 fiscal year (Stanger-Hall & Hall, 2011). Since Trump’s HHS discontinued this program, state legislators only have one federal funding avenue for sex education. At present, thirty-seven states require abstinence information in sex education while only eighteen states require information about contraceptives and safe sex practices (Hall et al., 2016).

The common sense rationale behind abstinence only sexual education seems practical. Discouraging teens from engaging in sexual activity until they are married should have the intended effect of reducing sexual behavior among teens, which would inevitably reduce the negative outcomes associated with said behavior (i.e. teen pregnancy, abortions and STD transmission); however, it seems their hormones get the best of them. Compared to other developed countries, the United States has the highest STD, teen pregnancy, teen birth, and teen abortion rates (Kohler et al., 2008). The teens in these countries are not more prudent than teens in the US.; the difference is sex education. For instance, European countries provide greater access to sexual health information and services for adolescents than the United States and they include information about contraceptives and safe sex practices in their sexual education (Stanger-Hall & Hall, 2011). Most systematic reviews of the effects of abstinence only education on adolescent sexual behavior have shown that it has a minimal impact on reducing it and providing information about safe sex practices does not encourage adolescents to engage in sexual behavior earlier compared to not being given that information (Kohler et al., 2008). Based on an assessment of two types of sex education programs (abstinence only and comprehensive) using National Survey of Family Growth data, Kohler et al.,(2008) found that abstinence only programs have no significant effect in delaying teens’ initial sexual activity or in reducing the risk of teen pregnancy and STD transmission (Kohler et al., 2008). One study of abstinence only virginity pledges found that most adolescents who make virginity pledges end up breaking their pledge and engaging in pre-marital sex (Kohler et al., 2008). Even worse, some studies have found that abstinence only education has the opposite effect of what it intends. Stanger-Hall and Hall (2011) found a significant positive correlation between abstinence only education and teen pregnancy and birth rates (Stanger-Hall & Hall, 2011). States that have abstinence only education and exclude information about safe sex practices have significantly higher average teen pregnancy and birth rates than states with comprehensive sex education (Stanger-Hall & Hall, 2011). Other studies have shown that abstinence only education likely increases teen pregnancy rates compared to both comprehensive sex education and no sex education (Stanger-Hall, 2011). The most plausible explanation is that teens who receive abstinence only education engage in higher risk sexual activity (e.g. do not use contraceptives) compared to teens who receive comprehensive sex education and even teens who receive no sex education (Kohler et al., 2008).

A lack of adequate sex education is a critical issue that American society must tackle. Congress implemented abstinence only sex education in the late nineties as part of their welfare reform effort, but over time it has been proven ineffectual. Study after study has shown that abstinence only education is both ineffective at delaying adolescent sexual behavior and has the opposite effect on teen pregnancy and birth rates. Given the recurrent negative outcomes of abstinence only education and the tactics used to teach it, it must be considered an unethical policy.

References
Charo, R. A. (2017). The trump administration and the abandonment of teen pregnancy prevention programs. JAMA Internal Medicine, 177(11), 1557. doi:10.1001/jamainternmed.2017.4873

Hall, K. S., Ph.D., Sales, J. M., Ph.D., Komro, K. A., Ph.D., & Santelli, J., M.D. (2016). The state of sex education in the united states. Journal of Adolescent Health, 58(6), 595-597. doi:10.1016/j.jadohealth.2016.03.032.

Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344-351. doi:10.1016/j.jadohealth.2007.08.026

Nworie, J., & Haughton, N. (2008). Good intentions and unanticipated effects: The unintended consequences of the application technology in teaching and learning environments. TechTrends: Linking Research & Practice to Improve Learning, 52(5), 52-58. doi:10.1007/s11528-008-0197

Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: Why we need comprehensive sex education in the U.S. PLoS ONE, 6(10), 1-11. doi:10.1371/journal.pone.0024658