Abstinence education is a theoretical dream that does not work

30 August 2017

A review of abstinence-only education policies and programmes in the United States (USA) found they violated human rights, stigmatised or excluded youth, reinforced gender stereotypes, and set back HIV and other STI prevention efforts.

Students in a seminar

Despite the US government pumping $US 2 billion into domestic abstinence-only-until-marriage (AOUM) programmes, they are largely ineffective and have had a detrimental effect on health outcomes for young people.

According to a review of AOUM programmes and policies promoted by the government in the US, it was revealed that while theoretically effective, these programmes have had no real-life impact on delaying sexual debut or reducing sexual risk taking behaviours.                    

The USA takes a seemingly moralistic approach in their definition of abstinence education, teaching that “a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity.”

This stance is widely rejected by healthcare professionals and public health officials, who instead advocate for a comprehensive approach inclusive of information and education on how to have safer sex.

"The weight of scientific evidence shows these programs do not help young people delay initiation of sexual intercourse. While abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail," said study co-author John Santelli, MD, MPH, from Columbia University’s Mailman School of Public Health. "These programs simply do not prepare young people to avoid unwanted pregnancies or sexually transmitted diseases."

For the government, the main goal of abstinence education is to delay sex until marriage. But trends have changed markedly in recent times, with people choosing to marry later in life.

For women living in the USA, the median age for first-time sex is 17.8 years, and 26.5 years for getting married – an 8.7 year gap. For men, the gap is even larger, with median age for first-time sex 18.1 years, and first marriage at 29.8 years – resulting in a 11.7 year gap.

Furthermore, the federal definition for abstinence education states that young people should be taught that sex out of wedlock has harmful psychological and physical effects, and that giving birth out of wedlock will also have negative consequences for the child. Programmes are also not allowed to advocate for contraceptive use, or discuss any of these methods except to highlight their failure rates.

Yet no evidence was found suggesting that consensual sex between adolescents is psychologically harmful, despite their explicit teaching. Rather, harmful psychologically outcomes are the result of sexual abuse and coercion, or harmful gender roles. In fact, the risk associated with adolescent sexual activities are greatly influenced by the policy environment – and whether they have access to sexual health information and contraception.

AOUM approaches have been found to set back sex education, family planning programmes and HIV prevention efforts – domestically and globally.

Between 2002 and 2014, the percentage of schools requiring students to learn about human sexuality fell from 67% to 48% and requirements for HIV prevention declined from 64% to 41%. In 1995, 81% of adolescent males and 87% of adolescent females reported receiving formal instruction about birth control methods; by 2011-2013, this had fallen to 55% of young men and 60% of young woman.

Moreover, AOUM programmes exclude young people who are already sexually active, potentially stigmatising them among their peer group.

"Young people have a right to sex education that gives them the information and skills they need to stay safe and healthy," said Leslie Kantor, PhD, MPH, assistant professor of Population and Family Health at the Mailman School of Public Health and vice president of Education at Planned Parenthood Federation of America.

"Withholding critical health information from young people is a violation of their rights. Abstinence-only-until-marriage programs leave all young people unprepared and are particularly harmful to young people who are sexually active, who are LGBTQ, or have experienced sexual abuse."

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Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health