What Do We Know About Abstinence Education Programs?
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Plainsboro, NJ 08536
Does abstinence work? Well, of course, abstinence works. Teenagers
who are abstinent hardly ever acquire a sexually transmitted disease, they
never get pregnant, they never drop out of school because of pregnancy,
and they will not be a single welfare mom while a teenager.
But the question that I want to address today is not whether abstinence
works, but whether abstinence programs work. And that question is
a lot more difficult to answer. In fact, I argue that we don't have
an answer to that question.
Let's take a closer look at the situation. With age at menarche
currently around 12, most teenagers have a long time before marriage in
which to become sexually active. Some teenagers will stay abstinent
during this time, for a variety of personal reasons, no matter what kind
of program or intervention is aimed at them. Others will become sexually
active, no matter what kind of program or intervention is aimed at them.
But those in the middle of the two extremes--the vast majority of teenagers--are
influenced by many, many different factors. The programs and interventions
they receive can have an influence on them.
Over the past twenty years or more, a variety of programs have been
designed and implemented to influence teenagers' decisions about their
sexual activity. Our focus here is abstinence programs, which promote
a strong message of sexual abstinence before marriage. In the abstinence
category, some programs promote abstinence and provide information on contraception.
(These programs are called Abstinence-plus.) Other programs promote
only abstinence and do not discuss contraception, unless it is to emphasize
high rates of contraceptive failure. These abstinence-only programs
are clearly of the most policy interest today.
Unfortunately, the development of strong and promising abstinence-based
programs have not been matched by good, solid research on program effectiveness.
We don't know whether these programs succeed in reducing teenage sexual
activity. Why don't we know? To answer this, let's first consider
what we need to know to decide whether a program is effective. At
a minimum, I think we need answers to the following two basic questions:
If you provide an abstinence program to a group of teenagers or pre-teens,
how many of them remain abstinent during their teenage years?
These questions sound simple to answer. But consider what happens
in the real world.
How does this number compare with the number who would have been abstinent
without the program?
Teenagers move or leave the program. Some leave because they become
sexually active. It's hard to find the original group year after
year, so often you are left with a very select group of teens who do not
move or leave the program. They may be precisely the group mentioned
earlier--the ones who would be likely to be abstinent anyway. They
don't tell us anything about the teens who left. To find out about
the ones who left, we need to follow them over time and that can be difficult
and very expensive.
Researchers try to compare teenagers volunteering for a program with teenagers
who do not volunteer. Again, the volunteers may be the group of teenagers
who are likely to remain abstinent anyway, and those who do not volunteer
may be the ones who are likely to have sex anyway. Neither group
tells us anything about what kind of influence the abstinence program has
on the vast majority of students who are in between these two extremes.
Teenagers who have had sex, especially those who are in a program that
delivers a strong abstinence message, are reluctant to admit it.
Teenagers hit their peak years of sexual activity starting at ages 15 and
older. Yet, most abstinence programs start at young ages, grades
6th, 7th, or 8th, to influence pre-teens before they become sexually active.
So you have to follow the pre-teens for many years to find out what happens
to their sexual activity and pregnancy rates. This is very expensive.
Most evaluations don't do it and most don't go on long enough to provide
the information needed.
So what do we know about the effectiveness of abstinence programs?
We know that abstinence programs produce a short-term increase in participating
teens' pro-abstinent attitudes and values. Some programs lead to
increases in parent-teen communication about abstinence; others apparently
do not. We know that some abstinence-plus programs appear to reduce
teenage sexual activity, at least when we look at what teens are doing
after short follow-up periods. But we do not know whether abstinence-only
programs lead to reduced sexual activity. And we do not know whether
abstinence programs in general reduce teen pregnancy.
This rather negative summary does not mean that abstinence programs
are failures. It does mean that evaluations of the programs have
been too limited in design and scope to answer the two basic questions
about program effectiveness. In particular, the evaluations of abstinence-only
programs have suffered from follow-up periods that were not long enough,
from sample sizes that were too small, and from difficulties in determining
what would have happened without the program in question.
Despite the lack of conclusive evidence on the effects of abstinence
programs specifically, several reviews have identified the characteristics
of effective programs that attempt to prevent teenage risk-taking behavior.
These reviews suggest that the following traits characterize effective
teenage risk prevention programs. Effective prevention programs:
Focus on a small number of specific behavioral goals.
Are based on a sound theoretical framework.
Include basic information on risks
Reinforce clear and appropriate values
Use small group discussion and role-playing to teach teenagers resistance
Are sufficiently long and intense
Target students at relatively young ages
Nearly all of the abstinence-only programs reviewed in the literature share
many of these characteristics. In particular, abstinence-only programs
focus attention on a small number of behavioral goals--that is, reducing
teenage sexual activity, include basic information on the risks of sexual
activity, and target young, pre-teen students. However, only a few
were sufficiently long and intense, lasting at least three months and requiring
more than one hour of time per week.
However, several abstinence-only programs that meet most of the criteria,
especially those that are sufficiently long and intensive, have currently
not been fully evaluated. (Best Friends meets more of the criteria
for success than any other abstinence-only program). At this point
in time, most evaluations of abstinence-only programs have themselves been
short in duration and they have been of programs that were of relatively
short duration and intensity.
Should we care about whether abstinence programs work? Yes, absolutely.
Abstinence is the current policy emphasis in teenage pregnancy prevention.
A considerable amount of federal dollars are being used to support the
abstinence message. It is imperative that we know whether these programs
reduce sexual activity and teenage pregnancy to levels lower than they
would be without such programs.
Furthermore, abstinence programs are not implemented in a vacuum.
Abstinence programs are likely to replace existing or previous programs
that may provide education about contraceptive use or even provide access
to contraceptives. If such programs reduce unprotected intercourse
among sexually active teenagers, and if these programs are replaced by
abstinence programs, we need to know what happens to teens who do not remain
Finally, a wide variety of abstinence programs are available.
Some are school-based, some community-based. Some target just teenage
girls, while others target both girls and boys. Some start as early
as 5th grade, while others target older teens. Evaluations tell us
not only whether abstinence in general is effective, but also which programs
are most effective in which circumstances. Knowing which programs
work and in what context is therefore important both for our decisions
on whether to continue specific programs and whether to replicate them
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