Abstinence only programs statistics

In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.

The appropriate type of sex education that should be taught in U. Much of this debate has centered on whether abstinence-only versus comprehensive sex education should be taught in public schools. Some argue that sex education that covers safe sexual practices, such as condom use, sends a mixed message to students and promotes sexual activity. The central message of these programs is to delay sexual activity until marriage, and under the federal funding regulations most of these programs cannot include information about contraception or safer-sex practices [5] , [7].

The federal funding for abstinence-only education expired on June 30, , and no funds were allocated for the FY budget. This constitutes the first large-scale federal investment dedicated to preventing teen pregnancy through research- and evidence-based efforts.

This was authorized by the legislature on March 23, [9]. With two types of federal funding programs available, legislators of individual states now have the opportunity to decide which type of sex education and which funding option to choose for their state, while pursuing the ultimate goal of reducing teen pregnancy rates.

This large-scale analysis aims to provide scientific evidence for this decision by evaluating the most recent data on the effectiveness of different sex education programs with regard to preventing teen pregnancy for the U.

We used the most recent teenage pregnancy, abortion and birth data from all U. Other factors may also influence teenage pregnancy and birth rates, including socio-economic status, education, cultural influences [10] — [12] , and access to contraception through Medicaid waivers [13] — [15] and such effects must be parsed out statistically to examine the relationship between sex education and teen pregnancy and birth rates.

It was the goal of this study to evaluate the current sex-education approach in the U. Based on a national analysis of all available state data, our results clearly show that abstinence-only education does not reduce and likely increases teen pregnancy rates. Data on abstinence education were retrieved from the Education Commission of the States [16]. Of the 50 U. Thirty of the 38 state laws contained abstinence education provisions, 8 states did not.

Following the analysis of the Editorial Projects in Education Research Center [17] , which categorizes the data on abstinence education into four levels from least to most emphasis on abstinence: no provision, abstinence covered, abstinence promoted, abstinence stressed , we assigned ordinal values from 0 through 3 to each of these four categories respectively.

These policies may be published as Health Education standards or Public Education codes [19]. These policies can also provide information on how existing sex education laws may be interpreted by local school boards.

We analyzed the state profiles on sex education laws and policy data for all 50 states [19] following the criteria of the Editorial Projects in Education Research Center [17] to identify the level of abstinence education Table 2. Analyses of the two data sets gave essentially identical results. In this paper we present the analyses of the more extensive 48 states law and policy data set.

Data on teen pregnancy, birth and abortion rates were retrieved for the 48 states from the most recent national reports, which cover data through [11] , [12].

The data are reported as number of teen pregnancies, teen births or teen abortions per one thousand female teens between 15 and 19 years of age. In general, teen pregnancy rates are calculated based on reported teen birth and abortion rates, along with an estimated miscarriage rate [12]. We used these data to determine whether there is a significant correlation between level of prescribed abstinence education and teen pregnancy and birth rates across states.

The expectation is that higher levels of abstinence education will be correlated with higher levels of abstinence behavior and thus lower levels of teen pregnancy. Data on four possibly confounding factors were included in our analyses.

To account for cost-of-living differences across the US, we used the adjusted median household income for for each state from the Council for Community and Economic Research: C2ER [20].

These data are based on median household income from the Current Population Survey for from the U. We determined the proportion of the three major ethnic groups white, black, Hispanic in the teen population 15—19 years old for each state [12] , and assessed whether the teen pregnancy, abortion and birth rates across states were correlated with the ethnic composition of the teen population.

To account for the ethnic diversity among the teen populations in the different states in a multivariate analysis of teen pregnancy and birth rates, we included only the proportion of white and black teens in the state populations as covariates, because the Hispanic teen population numbers were not normally distributed see below.

Medicaid-funded access to contraceptives and family planning services has been shown to decrease the incidence of unplanned pregnancies, especially among low-income women and teens [13]. According to the Guttmacher Institute, the national family planning program prevents 1.

Since the increasing role of Medicaid in funding family planning was mainly due to the efforts of 21 states to expand eligibility for family planning for low-income women who otherwise would not qualify for Medicaid, we analyzed whether these Medicaid waivers for family planning services available in some states but not in others could bias our results.

We determined which states had received permission as of from the Federal Medicaid program to extend Medicaid eligibility for family planning services to large numbers of individuals whose incomes are above the state-set levels for Medicaid enrollment [15]. We assessed whether the waivers access to family planning services had an effect on our analysis of teen pregnancy and birth rates across states, specifically whether they could bias our analysis with respect to the effects of the different levels of abstinence education.

Except for teen abortion rates and Hispanic teen population data, all variables were normally distributed. The distribution of the Hispanic teen population across states was not normal: most states had relatively small Hispanic teen populations, and a few states had a relatively large population of Hispanic teens. Teen pregnancy and birth rate distributions included outliers, but these outliers did not cause the distributions within abstinence education levels to differ significantly from normal, thus all outliers were included in subsequent analyses.

For all further statistical analyses we used SPSS [24]. We used non-parametric Spearman correlations to assess relationships between variables, and for normally distributed variables we also used parametric Pearson correlations, but these results showed the same trends and significance levels as the non-parametric correlations.

As a result, we only report the results for the non-parametric correlations here. We tested for homogeneity of error variances Levene's Test and for equality of covariance matrices Box test between groups. For pairwise comparison between abstinence levels, we used the Bonferroni adjustment for multiple comparisons. Among the 48 states in this analysis all U.

To the contrary, teens in states that prescribe more abstinence education are actually more likely to become pregnant Figure 2. All outliers were included in the statistical analyses. A multivariate analysis of teen pregnancy and birth rates identified the level of abstinence education as a significant influence on teen pregnancy and birth rates across states.

Socio-economic status, educational attainment, and ethnic differences across states exhibited significant correlations with some variables in our model Table 4.

We examined the influence of each possible confounding factor on our analysis by including them as covariates in several multivariate analyses.

However, after accounting for the effects of these covariates, the effect of abstinence education on teenage pregnancy and birth rates remained significant Figure 3. A The adjusted median household income significantly influenced teen pregnancy and birth rates, but the level of abstinence education still had a significant influence on teen pregnancy and birth rates after accounting for socioeconomic status.

B Education had a significant influence on teen birth, but not on teen pregnancy rates. After accounting for the influence of teen education, the level of abstinence education still had a significant influence on both teen pregnancy and teen birth rates.

C The proportion of white teens but not black teens in the population had a significant influence on teen pregnancy and teen birth rates. After accounting for this influence, the level of abstinence education still had a significant influence on teen pregnancy and birth rates.

For this analysis we focused on the three largest ethnic groups for which data are available: white, black, and Hispanic [12]. Teen pregnancy rates differ across these three ethnic groups. For the 48 states in this analysis, an ethnic breakdown for all three ethnic groups of teen pregnancy and abortion rates was available for 26 states, and of teen birth rates for 43 states. Across this reduced sample of states, teen pregnancy rates averaged Teen birth rates averaged Across all 48 states, abstinence education levels were significantly correlated with the proportions of white and black teens in the state populations Table 4.

When we included the proportion of white and black teens in the state populations as covariates in a multivariate analysis evaluated at proportion white: 0. If Medicaid waivers contribute to the positive correlation between abstinence education and teen pregnancy at the state level, then states with waivers should have different teen pregnancy and birth rates than states without waivers.

This was not the case. A recent study [14] found the same level of non- significance 0. This study used a correlational approach to assess whether abstinence-only education is effective in reducing U. Correlation can be due to causation, but it can also be due to other underlying factors, which need to be examined.

Several factors besides abstinence education are correlated with teen pregnancy rates. In agreement with previous studies, our analysis showed that adjusted median household income and proportion of white teens in the teen population both had a significant influence on teen pregnancy rates.

Richer states tend to have a higher proportion of white teens in their teen populations, tend to emphasize abstinence less, and tend to have lower teen pregnancy and birth rates than poorer states. A recent study [25] found that higher teen birth rates in poorer states were also correlated with a higher degree of religiosity and a lower abortion rate at the state level.

Medicaid waivers have previously been shown to reduce teen pregnancy rates [13] , but our analysis shows that they do not explain our main result, the positive correlation between abstinence education level and teen pregnancy rates.

After accounting for other factors, the national data show that the incidence of teenage pregnancies and births remain positively correlated with the degree of abstinence education across states: The more strongly abstinence is emphasized in state laws and policies, the higher the average teenage pregnancy and birth rate.

Level 0 states present an interesting sample with a wide range of education policies and variable teen pregnancy and birth data [17] — [19]. For example, several of the level 0 states as of did not mandate sex education, but required HIV education only e. CT, WV [19]. This state NV has the highest teen pregnancy and birth rates in that group Figure 1. Nevada is also one of only five states with MD in level 0, CO in level 2, and AZ and UT in level 3 that required parental consent for sex education in public schools instead of an opt-out requirement that is present in all the other states [16] , [19].

The effectiveness of Level 1 comprehensive sex education in our nation-wide analysis is supported by Kirby's meta-analysis of individual sex education programs [8] , Underwood et al. All these studies suggest that comprehensive sex or HIV education that includes the discussion of abstinence as a recommended behavior, and also discusses contraception and protection methods, works best in reducing teen pregnancy and sexually transmitted diseases.

Despite large differences between individual research studies that evaluate specific sex education programs e. Only 13 states require that the information provided in a sex education class be medically accurate and contain verifiable facts. Only 2 programs that teach abstinence-only were found to be medically and factually correct.

Although supporters will point toward the fact that teen pregnancy rates are at some of the lowest rates of all time, those who support contraceptive use and safe sex practices can point to effective uses of birth control, condoms, and other items that help to prevent the spread of disease or prevent pregnancy.

Modern teen pregnancy rates are at their lowest levels since the CDC began tracking them in and it seems to be because teens are having less sex and using the above pregnancy prevention efforts when they do. Is this because of abstinence only educational programs? Or is it because there is a comprehensive effort to provide a well-rounded education on human sexuality? With hundreds of millions spent already on abstinence only sex education with arguably no results, it seems like the time has come to make some changes.

Congress has already started taking some action to improve sex education across the country. With PREP, both abstinence and contraception are supposed to be emphasized. Does early adolescent sex cause depressive symptoms? J Policy Anal Manage. Longitudinal analysis of Add Health data suggesting that early teen sex is not a cause of depressive symptoms, but rather an early indicator of these symptoms. The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse.

Perceptions of sexual abstinence among high-risk early and middle adolescents. This qualitative study shows that high risk adolescents hold a nuanced and developmental perspective on abstinence and the transition to sexual activity.

Defining abstinence: views of directors, instructors, and participants in abstinence-only-until-marriage programs in Texas. J Sch Health. Public opinion on sex education in US schools. Arch Pediatr Adolesc Med. This survey documents overwhelming support for comprehensive sexuality information that includes information on both abstinence and contraceptives among a nationally representative adult population. Parent opinion of sexuality education in a state with mandated abstinence education: does policy match parental preference?

This survey by the National Campaign documents showing parent and adolescent support for comprehensive sexuality information that includes information on both abstinence and contraceptives. Dailard C. Guttmacher Policy Review. Changes in formal sex education: — This paper documents the erosion of comprehensive sexuality education during a time of escalating spending on abstinence-only education.

It demonstrates that massive federal funding can markedly change the health education landscape across a short time period. Changing emphases in sexuality education in U. Fam Plann Perspect. Report No. Human Rights Watch. The Philippines: Unprotected sex, condoms, and the human right to health. Government Accountability Office. One of a trio of GAO reports raising issues of medical accuracy. Abstinence-only education policies and programs: a position paper of the Society for Adolescent Medicine.

The Society for Adolescent Medicine strongly rejects presenting abstinence as the sole option for STI and pregnancy prevention to adolescents. This position paper and its companion review paper lay out how these policies do not reflect the realities of sexuality among Americans, lack effectiveness, potentially cause harm, and violate principles of medical ethics and human rights.

American Public Health Association. Abstinence and U. Sexuality education for children and adolescents. American Social Health Association. American Medical Association. Kittredge D. Abstinence and abstinence-only education. Elster A, Fleming M. Abstinence and abstinence-only education: a review of U. This review article is a companion to the Society for Adolescent Medicine position paper.

It lays out methodology for the review, and provides clear arguments against programs presenting abstinence as the sole option for pregnancy and STI prevention for adolescents. Data support conclusion that AOE is troubling from practical, program effectiveness, ethical, and human rights perspectives.

Commissioned by the U. Congress and conducted by an independent policy research firm, this prospective, randomized, controlled trial evaluated four large abstinence-only education programs, and included nearly adolescents.

The final report demonstrated no effect on behavior at 4 year follow-up, and raised the possibility of future harm, in that abstinence-only program participants were more likely to believe that condoms never work to prevent STIs.

If abstinence only approaches cannot be shown to be effective in model programs with careful implementation and meticulous follow-up, they are unlikely to be effective elsewhere.

Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world. The most recent in a series of systematic reviews of both comprehensive and abstinence-only sex education programs examining the effectiveness of the curricula in changing specific health behaviors such as delaying the onset of sex and condom use.

The authors use clear scientific criteria for inclusion, including experimental or quasi-experimental design, peer review, and behavioral outcomes. Results showed that, compared to controls, many comprehensive programs were effective, but no abstinence-only programs showed differences in behavior.

Bruckner H, Bearman P. After the promise: the STD consequences of adolescent virginity pledges. Kirby D. Bearman PS, Brueckner H. American Journal of Sociology. Santelli JS. New England Journal of Medicine. Henry A. Government Accountability Office; Oct, Kaiser Family Foundation. Daily Reports Declaration of John S. Santelli, M. Freedman LP. Censorship and manipulation of reproductive health information. In: Coliver S, editor. Coliver S. The right to information necessary for reproductive health and choice under international law.