10/9/2017 The Looming Threat to Sex Education: A Resurgence of Federal Funding for Abstinence-Only Programs?

| Guttmacher Institute

GuttmacherInstitute

FirstPublishedOnline:March30,2017

HIGHLIGHTS

Overthelastdecade,federalfundingforadolescentsexualhealthprogramminghasshifted
awayfromabstinenceonlyuntilmarriageprogramsandtowardmorecomprehensive
programmingintendedtopreventpregnancy,HIVandotherSTIsamongadolescents.
TheseprogramsmaybeonthechoppingblockassocialconservativesinCongressseekto
redirectfederaldollarsbackintoharmfulprogramsfocusedexclusivelyonpromoting
abstinence.

Overthepasttwodecades,theUnitedStateshasspentapproximately$2billiononineffectiveand
stigmatizingprogrammingforadolescentsfocusedonpromotingabstinencefromsexoutsideofmarriage.
FundingfortheseprogramswasreducedsignificantlywhilePresidentObamawasinoffice,shiftingin
largeparttosupportmorecomprehensive,medicallyaccurateandageappropriateprograms.Now,with
socialconservativesinCongressemboldenedbythe2016electionsandanewfederaladministrationthat
includesproponentsofabstinenceonlyuntilmarriageprograms,weareagainatacrossroadswhenit
comestofederalsupportforsexeducation.Althoughfederalspendinginthisarearepresentsjusta

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fractionofthetotalamountinvestedannuallybystateandlocalgovernments,ithasasignificantimpacton
thedevelopmentandimplementationofsexeducationstandardsandcurriculaatalllevelsandsendsan
importantmessageaboutourprioritiesasanation.

Abstinenceonlyprogramsviolateadolescentsrights,ignoretheirneedsanddonotwork.
Adolescentshaveabasichumanrighttocompleteandaccurateinformationabouttheirsexualand
reproductivehealth.1,2Theabstinenceonlyuntilmarriageapproachwithholdscomprehensiveinformation
oneffectivewaystoreducetherisksofunintendedpregnancy,HIVandotherSTIs,whichviolates
adolescentsrighttoinformationandalsorequireseducatorstodisregardbasicethicalstandardsby
providingincompleteandpotentiallyharmfulinformationtostudents.3

Programsthatseektostopadolescentsfromhavingsexbeforemarriagearealsooutoftouchwiththe
livesandneedsofyoungpeople.NinetyfivepercentofAmericanshavesexbeforemarriageand,on
average,adolescentsintheUnitedStateshavesexforthefirsttimeataboutage17butdonotmarryor
beginhavingchildrenuntiltheirmidtolate20s.4,5Duringthislonginterimperiod,theymaybeat
heightenedriskforunintendedpregnancyandSTIs.Yetabstinenceonlyprogramsdenigratesexual
activitybeforemarriageasshamefulandignoretheneedsofsexuallyactiveadolescents.Suchprograms
havealsobeenfoundtoreinforcegenderstereotypesandexcludeorstigmatizeindividualsonthebasisof
sexualorientationorgenderidentity.69

Giventhisreality,itisespeciallyalarmingthatthefederalgovernmentcontinuestospendmoneyon
programsthatsimplydonotwork.Althoughasmallnumberofabstinenceonlyprogramshaveshown
limitedeffectiveness,theweightofscientificresearchindicatesthatstrategiesthatsolelypromote
abstinenceoutsideofmarriagewhilewithholdinginformationaboutcontraceptivesdonotstoporeven
delaysex.10,11Tothecontrary,abstinenceonlyprogramscanactuallyplaceyoungpeopleatincreased
riskofpregnancyandSTIsoncetheydobecomesexuallyactive.12

Althoughfederalabstinenceonlyuntilmarriagefundinghasdroppedsinceitspeakat$177millioninfiscal
year(FY)2008,recentappropriationsindicateitisontheriseonceagain(seechart).ForFY2016,
Congressraisedannualfundingforabstinenceonlyprogramsfrom$55millionto$85million.Thebulkof
thismoney$75millionisallocatedfortheTitleVabstinenceeducationprogram,agrantprogramfor
statesthatcontainsaneightpointstatutorydefinitionofaneligibleabstinenceeducationprogram.
Amongitspointsareteachingthatsexualactivityoutsideofthecontextofmarriageislikelytohave
harmfulpsychologicalandphysicaleffectsandthatamutuallyfaithfulmonogamousrelationshipinthe
contextofmarriageistheexpectedstandardofhumansexualactivity.13Theremaining$10millionis
directedtoagrantprogramforcommunitybasedorganizationsrecentlyrepackagedassexualrisk
avoidanceeducation,whichseekstoteachadolescentshowtovoluntarilyrefrainfromnonmaritalsexual
activityandavoidyouthriskbehaviorswithoutnormalizingteensexualactivity.14

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Federalpolicyshouldfocusoncomprehensive,medicallyaccurateandageappropriateprograms.
Strongevidencesuggeststhatcomprehensiveapproachestosexeducationhelpyoungpeopletodelay
sexandalsotohavehealthy,responsibleandmutuallyprotectiverelationshipswhentheydobecome
sexuallyactive.Manyexamplesofcomprehensiveprogramshaveresultedindelayedsexualdebut,
reducedfrequencyofsex,fewersexualpartners,increasedcondomorcontraceptiveuse,orreduced
sexualrisktaking.15Moregenerally,populationbasedstudieshavefoundthatreproductivehealth
outcomesimprovewhenadolescentsreceiveformalsexeducationthatincludesinformationabout
contraceptionandabstinence.16,17Accordingly,leadingpublichealthandmedicalprofessional
organizationssupportacomprehensiveapproachtosexeducationstressingtheneedformedically
accurate,ageappropriatecurriculathatincludeinformationaboutbothabstinenceandcontraception.18

Althoughthereisnofederalfundingstreamdedicatedtopromotingtrulycomprehensivesexeducation,
federalfundingforteenpregnancypreventionhaslargelyshiftedawayfromafocusonabstinenceonly
programstoamorecomprehensiveapproachthateducatesadolescentsaboutcontraceptioninadditionto
abstinence.Ofthe$176millionprovidedformorecomprehensiveprogramsinFY2016,$75millionwent
tothePersonalResponsibilityEducationProgram(PREP),agrantprogramthatmainlyprovidesfundsto
statesforprogramsthateducateadolescentsaboutbothabstinenceandtheuseofcontraceptionforthe
preventionofpregnancyandSTIs.Theother$101millionfundedtheTeenPregnancyPrevention
Program,acompetitivegrantprogramgearedtowardcommunitybasedgroupstosupportevidencebased
andinnovativeteenpregnancypreventionapproaches.Recentevaluationsofprogramsfundedunderthis
initiativeshowedthatroughlyoneinthreehadsuccessfullydemonstratedapositiveimpactalarger
proportionthantypicallyfoundinevaluationeffortsofthisnatureandthusanimpressiveresult.19,20

Thesefederalinitiativesarefarfromperfect.Theirfocusonreducingteenpregnancywithoutdistinguishing
betweenintendedandunintendedpregnanciesreflectsanassumptionthatyoungpeopleshouldnot
becomeparents.Moreover,theprimarygoalofthesepoliciesisnottosupportadolescentstohavehealthy
relationshipsandleadhealthylivesinstead,theyweredesignedtoachievespecificoutcomes:reducing
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theincidenceofpregnancy,HIVandotherSTIsamongyoungpeople.Nonetheless,thesetwofunding
streamsplaceemphasisonscientificevidence,medicalaccuracyandinformationtailoredtoadolescents
specificageandneeds,andtheprogramstheyfundcanimplementelementsofcomprehensivesex
education.

Fullysupportingadolescentsrequiresmakingthesefederalinitiativesbetter.9Onevehicleforimprovement
istheRealEducationforHealthyYouthAct(REHYA),sponsoredinthe114thCongressbyRep.Barbara
Lee(DCA)andSen.CoryBooker(DNJ),whichsetsoutaholisticvisionforcomprehensivesexuality
educationnationally.REHYAwouldensurefederalfundingforprogramsthatprovideadolescentsand
youngadultswiththeinformationandskills[they]needtomakeinformed,responsible,andhealthy
decisionsinordertobecomesexuallyhealthyadultsandhavehealthyrelationships.21Theseprograms
wouldaddressarangeoftopics,fromanatomyandphysiologytohealthyrelationships,datingviolence,
andgenderrolesandidentity.Theywouldalsoprovideinformationabouttheimportanceofabstinence
andcontraceptiveuseforthepreventionofunintendedpregnancy,HIVandotherSTIs.

Programsthatbenefitadolescentsareatrisk.MembersofCongressmustsoonturntheirattentionto
thetaskoffundingfederalagenciesandprogramsfortheremainderofFY2017andallofFY2018.Given
currentconservativepressurestodrasticallycutdomesticspendingandtaxesacrosstheboard,andwitha
likemindedadministrationnowintheWhiteHouse,socialconservativeswilllikelypressforwardwith
effortstosignificantlyreduceoreliminatefundingforthemorecomprehensiveprogramsthatcurrently
serveadolescents:theTeenPregnancyPreventionProgramandPREP.Inparticular,Congressmust
reauthorizePREPfortheprogramtosurvivebeyondFY2017.Atthesametime,Congresswillhavethe
opportunitytoreauthorizetheTitleVabstinenceonlyprogramandtosetnewfundinglevelsforitaswell
asthesmallergrantprogramforsexualriskavoidanceeducation.Despitethecurrentemphasison
reducingspendinglevels,proponentsofabstinenceonlyeducationmayseektorampupfundinginthis
areawithoutaffectingoverallspendingbydivertingmoneyfromthemorecomprehensiveprograms.

CongressandtheDrumpfadministrationarefacingasignificantchoice:whethertopromoteideologyover
thehealthandrightsofyoungpeople,ordirectfederalinvestmenttowardmorecomprehensiveprograms
insupportoftheirsexualandreproductivehealthandwellbeing.Federallyfundedprogramsplayakey
roleinguidingthestandardsandcurriculadevelopedandfundedatthestateandlocallevels
fundamentallyshapingthedefinitionandscopeofsexeducationnationwide.Atthiscriticaljuncture,how
ourcountrychoosestospendfederaldollarswillspeakvolumesaboutourprioritiesasanation.

1.CenterforReproductiveRights(CRR),AnInternationalHumanRight:SexualityEducationfor
AdolescentsinSchools,NewYork:CRR,2008,https://www.reproductiverights.org/document/an
internationalhumanright....

2.UnitedNationsPopulationFund(UNFPA)andCRR,TheRightstoContraceptiveInformationand
ServicesforWomenandAdolescents,NewYork:UNFPAandCRR,2010,
http://www.unfpa.org/resources/rightscontraceptiveinformationandserv....

3.SantelliJetal.,Abstinenceonlyeducationpoliciesandprograms:apositionpaperoftheSocietyfor
AdolescentMedicine,JournalofAdolescentHealth,2006,38(1):8387,
http://www.jahonline.org/article/S1054139X(05)002764/abstract.

4.FinerLB,TrendsinpremaritalsexintheUnitedStates,19542003,PublicHealthReports,2007,
122(1):7378,https://www.ncbi.nlm.nih.gov/pubmed/17236611.
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5.FinerLBandPhilbinJM,TrendsinagesatkeyreproductivetransitionsintheUnitedStates,1951
2010,WomensHealthIssues,2014,24(3):e271e279,https://www.guttmacher.org/article/2014/04/trends
ageskeyreproductive....

6.SpecialInvestigationsDivision,CommitteeonGovernmentReformMinorityStaff,U.S.Houseof
Representatives,TheContentofFederallyFundedAbstinenceOnlyEducationPrograms,2004,
http://spot.colorado.edu/~tooley/HenryWaxman.pdf.

7.BeecheySNandMoonLC,Genderintheadoptionandimplementationofsexeducationpolicy,Open
JournalofSocialSciences,2015,3:224233,http://dx.doi.org/10.4236/jss.2015.37035.

8.EliaJPandEliasonMJ,Dangerousomissions:abstinenceonlyuntilmarriageschoolbasedsexuality
educationandthebetrayalofLGBTQyouth,AmericanJournalofSexualityEducation,2010,5(1):1735.

9.SchaletATetal.,Invitedcommentary:broadeningtheevidenceforadolescentsexualandreproductive
healthandeducationintheUnitedStates,JournalofYouthandAdolescence,2014,43(10):15951610,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162986/.

10.DenfordSetal.,Acomprehensivereviewofreviewsofschoolbasedinterventionstoimprovesexual
health,HealthPsychologyReview,2016,11(1):3352,
https://www.ncbi.nlm.nih.gov/labs/articles/27677440/.

11.ChinHBetal.,Theeffectivenessofgroupbasedcomprehensiveriskreductionandabstinence
educationinterventionstopreventorreducetheriskofadolescentpregnancy,humanimmunodeficiency
virus,andsexuallytransmittedinfections:twosystematicreviewsfortheGuidetoCommunityPreventive
Services,AmericanJournalofPreventiveMedicine,2012,42(3):272294,
https://www.ncbi.nlm.nih.gov/pubmed/22341164.

12.PaikA,SanchagrinKJandHeimerK,Brokenpromises:abstinencepledgingandsexualand
reproductivehealth,JournalofMarriageandFamily,2016,78(2):546561,
http://onlinelibrary.wiley.com/wol1/doi/10.1111/jomf.12279/full.

13.FamilyandYouthServicesBureau(FYSB),NationalClearinghouseonFamiliesandYouth,U.S.
DepartmentofHealthandHumanServices(HHS),Stateabstinenceeducationgrantprogramfactsheet,
NorthBethesda,MD:HHS,2016,https://www.acf.hhs.gov/fysb/resource/aegpfactsheet.

14.FYSB,NationalClearinghouseonFamiliesandYouth,HHS,Sexualriskavoidanceeducationprogram
factsheet,NorthBethesda,MD:HHS,2017,https://www.acf.hhs.gov/fysb/resource/sraefacts.

15.UNFPA,EmergingEvidence,LessonsandPracticeinComprehensiveSexualityEducation:AGlobal
Review,Paris:UnitedNationsEducational,ScientificandCulturalOrganization,2015,
http://www.unfpa.org/publications/emergingevidencelessonsandpractice....

16.LindbergLDandMaddowZimetI,Consequencesofsexeducationonteenandyoungadultsexual
behaviorsandoutcomes,JournalofAdolescentHealth,2012,51(4):332338,
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17.KohlerPK,ManhartLEandLaffertyWE,Abstinenceonlyandcomprehensivesexeducationandthe
initiationofsexualactivityandteenpregnancy,JournalofAdolescentHealth,2008,42(4):344351,
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18.SexualityInformationandEducationCounciloftheUnitedStates(SIECUS),Ingoodcompany:Who
supportscomprehensivesexualityeducation?,Washington,DC:SIECUS,2010,
http://www.siecus.org/index.cfm?fuseaction=Page.ViewPage&PageID=1198.

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19.FeldmanFarbAandMargolisAL,TheTeenPregnancyPreventionProgram(20102015):synthesisof
impactfindings,AmericanJournalofPublicHealth,2016,106(S1):S9S15,
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20.EhrlichG,Pittingabstinencevs.contraceptionwonthelpavoidteenpregnancies,TheHill,Mar.21,
2017,http://thehill.com/blogs/punditsblog/healthcare/325054pittingabstinen....

21.H.R.1706,114thCongress,2015.

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