Wednesday, February 10, 2010

Sex Education: Beyond NO Agreement!

What is a parent to do? On the same week, two reports dealing with teen pregnancy rates and the effectiveness of sex education programs came to exactly the opposite conclusion: abstinence only teaching programs work; abstinence only teaching programs do not work!

After a decade-long decline, teen pregnancy rates rose in 2006. When the teen pregnancy rate dropped in the 1990's, it was largely attributed to increased contraception use. With the Bush administration in power, though, Congress directed a whole lot of money towards abstinence-only education — telling kids just to keep it in their pants until marriage. The result? A 4 percent rise in teen births, and a 1 percent increase in abortion.

The U.S. also has the highest rate of teen pregnancy, birth and abortion of any industrialized, Western nation. Seven percent of all teenage girls here get pregnant.

While abstinence programs were a favorite of the Bush administration, Pres. Barack Obama’s administration has eliminated over $170 million in federal funding for abstinence programs after previous studies showed that they did not work.

Shockingly, those statistics were challenged by a new study concluding that teaching abstinence in sex education classes works better than showing them safe methods of contraception. According to the study, published last week in the Archives of Pediatrics and Adolescent Medicine, 67 percent of the teens who received some form of abstinence-only education delayed having sex for two years, compared with 48 percent of teens who received no sex education.

These findings have caught the attention of those from across the political spectrum and even across the globe because it is the FIRST study showing that abstinence education might be affective.

Just Say No – that’s the fundamental message of controversial abstinence campaigns such as the U.S.-based Silver Ring Thing, aimed at encouraging teenagers to save sex for the marriage bed. But this is not just an American phenomenon. Similar “abstinence-centred” approaches are taking an increasingly defining role in the sex education of young people across Europe. Thus, this new U.S. report is getting a lot of attention because it actually contradicts the findings of many other international studies.

This dramatic new evidence ought to be good news for Texas, right? After all, state law there requires an emphasis on abstinence, and most school districts stop there.

But education experts caution that the program tested is very different from the curriculum offered in many Texas schools. And while elements can be found in some North Texas classrooms, not even the researchers can say for certain which parts of their specially designed program made it work.

Advocates of abstinence-only classes praised the study. Even many experts who are generally critical of abstinence-only are impressed with the new research.

"That sends a message to people that you can do abstinence-only, but you need to be smart about it," said David Wiley, president of the American School Health Association. Wiley, a Texas State University professor who co-authored a study last year that was highly critical of most sex education programs in Texas, said there were valuable lessons in the new research.

"It proves that when you do it the right way, using medically accurate information, you get better results," he said.

The new study involved 662 black sixth- and seventh-graders in four Philadelphia-area public schools. The researchers tested five education programs: abstinence-only, two kinds of "comprehensive" classes that included discussion of contraception, a "safer sex" class, and a health class that did not discuss sex education.

The researchers identified at least two important results, first that abstinence-only classes worked. By the end of two years, about half of the students in the health-only class probably had sex at least once, compared with about a third of the students who took the abstinence-only course.

Secondly, even those students in the abstinence-only group who had sex were no less likely to use a condom – a concern raised by critics of the abstinence-only approach.

But John Jemmott, the University of Pennsylvania professor who led the study, warned that these results don't necessarily apply to other abstinence-only programs, including those in Texas.

Compared with many public school programs for children in those grades, his class was significantly longer – eight hours, plus follow-up sessions.

Gloria Canham, director of health services for the Richardson school district, said there's no time for the level of detail and student-engaging education strategies employed in Jemmott's class design. Richardson school nurses spend about an hour each year with students, starting in fifth grade.

"We feel lucky to get the time we have, away from instruction" she said.

Jemmott's approach did not take a moral stand on sex. It did not tell students to wait until they were married. It engaged the students to come up with their own lists of positive goals and dreams that could be affected by the consequences of sex. And instructors were not allowed to unfairly disparage the use or effectiveness of condoms.

How does that stack up with what's offered in most Texas schools? The most intense sex education classes here are aimed at higher grades. Many take a clear moral stand against sex. There's usually an emphasis on waiting until marriage. And state law requires that instructors use "reality rates" to describe the effectiveness of contraception – a rule that critics say pushes some instructors into avoiding questions or into answers that confuse students.

Which of those differences may matter? Jemmott has his theories but admits that his research doesn't offer clear directions.

"I don't know whether the intervention would have worked any differently if we'd said 'until marriage,' " he said.

But some of the elements of his classes can be found in North Texas. Kids in the lower grades get at least an introduction to sex education at most schools.

For the lower grades in Richardson, the nurses show films, present slides and answer questions. As with the Jemmott method, morality isn't an issue, Canham said. Richardson's policy says that students are to be taught that abstinence is the "only effective prevention" of sexually transmitted diseases and pregnancy. Questions about the effectiveness of condom use are generally deflected, with a suggestion that the students talk to their parents, she said.

In Dallas, at least two elementary schools offer a voluntary program called SMART (Students Making Abstinence Real Today). Standard coursework starts in sixth grade with basic human biology, plus training in how to resist peer pressure, maintenance of self-esteem and an explanation of sexual harassment.

As for when to have sex, "our teachers are told to frame it in terms of a marital relationship," Dallas schools spokesman Jon Dahlander said.

Should Texas schools beef up their efforts to reach younger students with a more intensive sex education program? Both Dahlander and Canham were cautious about drawing specific lessons from the new study. And even Jemmott said others should not pull too many conclusions from one piece of research.

Jemmott, long a critic of other abstinence-only programs, now finds himself an unlikely champion. He said he still believes that there is more evidence that a comprehensive approach works. But he said he recognizes that many communities want an effective abstinence-only approach.

"I would be very happy if other researchers who have developed effective comprehensive interventions in the past would turn their skills and experience to the creation of abstinence-only interventions," he said.

Good grief, now my head hurts! I have read through what feels like millions of columns related to these reports, but for me, one of the best is by well-respected sex therapist Dr. Laura Berman. Here is the column in full, or you can read it at the Chicago Sun-Times website:

By Dr. Laura Berman

“The debate over sex education was heightened last week as a result of a new study that found that abstinence-only sex education might be effective in preventing teenage sexual activity.

Among parents and policy makers, there are three main schools of thought when it comes to sex education. These are:

• Abstinence-only education (like the one followed in the study) takes a "just say no" approach to sex. Students are given tips on how to resist peer pressure along with the sobering statistics on STDs.

• Comprehensive sex education teaches about the importance of abstinence while including facts about birth control methods, tips for how to negotiate condom use, and normalizing sexuality and sexual urges.

• Safer sex education teaches teens how to protect against STDs and unplanned pregnancy, including symptoms of common STDs and treatments.

The most recent study, which was published in the Archives of Pediatric & Adolescent Medicine, followed African-American middle schoolers for 24 months. The researchers found that students who attended the abstinence-only program were less likely to engage in sexual activity than those who attended general health classes (such as safer sex education programs).

However, as any middle schooler attending social studies can tell you, one study can't have all the answers. All studies have potential flaws and biases and, in particular, this one paid students $20 for each abstinence-only class they attended. This might have caused students to feel obligated to misrepresent their sexual activity.

Even if the research was without flaw, its findings do not mean that we should throw out all other sex education classes; especially when there are numerous studies supporting their success. The fact that the 2006 teenage pregnancy rate increased for the first time in years is proof enough that the Bush administration's support of abstinence-only curriculum was ineffective.

Add to that the statistic that shows that one in four teenage girls has an STD and we can all agree that our sex education programs need work.

Sex education shouldn't just be about teaching kids to say no, or even just about teaching kids about STDs and pregnancy. It also should include information on how to negotiate for condom use, how the only "safe sex" is no sex at all, and how sexual feelings are normal and healthy. The physical risks of sex can be discussed, along with the emotional risks, such as heartbreak, embarrassment and disappointment.

But, we also can teach that sex is healthy and special in the right circumstances; and then help them to identify what those circumstances are.

Abstinence always can be offered as the first and safest option, but it should not be offered as the only option.

If we teach our teenagers about the importance of waiting and about the importance of condoms and other contraceptives, sex doesn't have to be the biggest mistake of their lives. By giving them information, we are not giving them permission. We are merely giving them the tools they need to make the right decision when the issue of sex arises (and trust me, it will).

When it comes to our children's health and safety, we absolutely cannot let personal politics or religious taboos get in the way. Let's stop arguing amongst ourselves and think about the millions of teens who need our help. Save the drama for the next election season.”

I couldn’t agree more with Dr. Berman. Children need to be instructed about sex and safe sex, accurately and completely, but should also be encouraged to wait by parents/guardians who can explain why it is important for them to hold off until they are older. I believe if parents/guardians have this conversation lovingly while they listen and not lecture to their kids, they will be able to explain that the decision to wait is relevant to their young lives.

— The Curator


  1. how did the abstinence only class compare to the safer sex and comprehensive classes?

  2. Apparently, better. It was a confusing study, to me, so I and a friend took another more in depth look and made a co-post with what we found. I just think there's no way to generalize, since this was just ONE study, and has not been repeated. Thank you for your question.