Abstinence-only sex education
Abstinence-only sex education is a form of sex education that teaches not having sex outside of marriage. It often excludes other types of sexual and reproductive health education, such as birth control and safe sex. Comprehensive sex education, by contrast, covers the use of birth control and sexual abstinence.
Evidence does not support the effectiveness of abstinence-only sex education. It has been found to be ineffective in decreasing HIV risk in the developed world. It does not decrease rates of sexual activity or unplanned pregnancy when compared to comprehensive sex education.
The topic of abstinence-only education is controversial in the United States, with proponents claiming that comprehensive sex education encourages premarital sexual activity, and critics arguing that abstinence-only education is religiously motivated and that the approach has been proven ineffective and even detrimental to its own aims.
Abstinence education teaches children and adolescents to abstain from sexual activity, and that this is the only certain method of avoiding pregnancy and sexually transmitted infections (STIs), and that abstinence until marriage is a standard by which to live. In the U.S., states may apply for federal funding of abstinence-only sex education programs. To be eligible for funding, programs must satisfy requirements given under the Social Security Act, which is reproduced here verbatim:
(2) For purposes of this section, the term "abstinence education" means an educational or motivational program which—
- (A) has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
- (B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
- (C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
- (D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;
- (E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
- (F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
- (G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
- (H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.
Systematic reviews of research evaluating abstinence-only sex education have concluded that it is ineffective at preventing unwanted pregnancy or the spread of STIs, among other shortfalls. A Cochrane systematic review suggests that abstinence-only education neither increases nor decreases HIV risk in high-income countries. In the developing world there is a lack of evidence of effect. In 2008, Douglas Kirby reviewed the evidence for the effectiveness of abstinence-only education programs and found little evidence to justify the use of such programs. A 2011 meta-analysis found that it was ineffective at reducing the risk of HIV infection among adolescents. Abstinence education has also been found to include misleading medical information and exclude potentially life-saving information about sexual risk reduction.
The United States has highest teenage pregnancy rates and sexually transmitted diseases rates among developed countries. The research conducted on 48 states of United States showed that "The level of abstinence education (no provision, covered, promoted, stressed) was positively correlated with both teen pregnancy and teen birth rates.  Also, in John S. Santelli's research, the decline of teenage pregnancy rates during 1995–2002 were largely due to improved contraceptions, and the reduction in pregnancy risk among teenagers at age of 18 or 19 is entirely ascribed to more contraceptions.
According to SIECUS, the Sexuality Information and Education Council of the United States, "[s]cientific evidence simply does not support an abstinence-only-until-marriage approach." A 2010 report by the Guttmacher Institute pointed out that pregnancy rates for teens 15–19 reversed their decline in 2006, near the peak of the Abstinence Only campaign in the United States. Sex education has been linked to a delay in the first time having sex. A 2015 meta-analysis found that abstinence-focused programs had no effect on the likelihood of contracting STDs.
Society and culture
Proponents of abstinence-only sex education argue that this approach is superior to comprehensive sex education because it emphasizes the teaching of morality that limits sex to that within the bounds of marriage, and that sex before marriage and at a young age has heavy physical and emotional costs. They suggest that comprehensive sex education encourages premarital sexual activity among teenagers, which should be discouraged in an era when HIV and other incurable STIs are widespread and when teen pregnancy is an ongoing concern. Many supporters of abstinence-only education do so out of the belief that comprehensive guides to sex or information about contraceptives will ultimately result in teens actively pursuing and engaging in sexual activities, while others oppose the endorsement of contraception for religious reasons. Teenagers are framed as less intelligent and less responsible than adults. They are seen as unable to control themselves due to 'raging hormones'. As a result, a teenager's sexual desire is something that needs to be controlled. Thus, dividing the teens into two separate categories in the minds of adults: "the innocent and the guilty, the vulnerable and the predatory, the pure and the corrupting."
Opponents and critics, which include prominent professional associations in the fields of medicine, public health, adolescent health, and psychology, argue that such programs fail to provide adequate information to protect the health of adolescents. Some critics also argue that such programs verge on religious interference in secular education. Opponents of abstinence-only education dispute the claim that comprehensive sex education encourages teens to have premarital sex. The idea that sexual intercourse should only occur within marriage also has serious implications for people for whom marriage is not valued or desired, or is unavailable as an option, particularly LGBT people living in places where same-sex marriage is not legal or socially acceptable. Abstinence-only education is often criticized for being overly heteronormative, idealizing the institution of heterosexual marriage to the denigration of queer relationships. According to Advocates for Youth, abstinence-only sex education distorts information about contraceptives, including only revealing failure rates associated with their use, and ignoring discussion of their benefits. The language surrounding medicine and health is construed as being both objective and value free. This objectivity is then adopted by conservative politicians and campaigners to assert authority which historically holds its basis in religion.
Another problem for abstinence education is the definition of abstinence. Santelli (2006) states that there is no strict definition of abstinence within the US federal government guidelines for teaching abstinence-only sex education, using a mixture of non-specific phrases, like "postponing sex" or "never had vaginal sex," while also using moralistic terms or phrases like virgin, chaste, and "making a commitment". This has resulted in sexual activities that are not penile-vaginal, including mutual masturbation, oral sex and anal sex, being considered outside of the scope of abstention from sex, which is termed technical virginity.
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S government's initiative to combat HIV/AIDS globally. PEPFAR works with the governments of 22 countries worldwide to create sustainable programs to prevent HIV and improve the lives of those suffering. PEPFAR provides funding to other countries to help combat HIV/AIDS. It does so with certain guidelines and restrictions on the recipients. PEPFAR promotes an "ABC" approach – Abstain, Be faithful, and use Condoms. Funding recipients may give information about condoms to youth over 15 years old, but cannot use the funding to provide condoms or promote usage. In countries receiving funds from PEPFAR, teens under the age of 15 are not allowed to receive information about condoms. The rationale behind this is to not encourage sexual activity despite evidence that condom use does not cause promiscuity. PEPFAR was founded in 2003 with the mandate that 33% of its funds provided for prevention be used for abstinence-only education. Since the reauthorization in 2008, this mandate was removed, with a shift toward directives to spend at least 50% on abstinence-only education. The role of parters has been an area of debate surrounding PEPFAR. In 2006, 23% of all the community partners were faith-based and debate exists over whether the U.S. should be allowing grants specifically written for faith-based organizations and prevention. A few countries that have received PEPFAR funding – specifically Mozambique and Rwanda – have expressed distaste for the U.S.' push for faith-based education and abstinence-only funding. Human rights groups have expressed concern that condom availability has decreased since PEPFAR's involvement in the global AIDS crisis.
Religion and sexual education
Religious doctrines take varying stances on contraception and pre-marital sex, some of which are covered by:
- Religion and birth control
- Christian views on contraception
- Protestant views on birth control
- Catholic teachings on sexual morality
- Sexuality and Mormonism
- Premarital sex in Islam
- Age of consent
- Sex education in the United States
- Comprehensive Sex Education
- Religious views on birth control
- Sexual norm
- Virginity pledge
- Abstinence-only sex education in Uganda
- Abstinence, be faithful, use a condom
- Ott, MA; Santelli, JS (Oct 2007). "Abstinence and abstinence-only education". Current opinion in obstetrics & gynecology. 19 (5): 446–52. doi:10.1097/GCO.0b013e3282efdc0b. PMID 17885460.
Abstinence-only curricula have been found to contain scientifically inaccurate information, distorting data on topics such as condom efficacy, and promote gender stereotypes. An independent evaluation of the federal program, several systematic reviews, and cohort data from population-based surveys find little evidence of efficacy and evidence of possible harm.
- Chin, HB; Sipe, TA; Elder, R; Mercer, SL; Chattopadhyay, SK; Jacob, V; Wethington, HR; Kirby, D; Elliston, DB; Griffith, M; Chuke, SO; Briss, SC; Ericksen, I; Galbraith, JS; Herbst, JH; Johnson, RL; Kraft, JM; Noar, SM; Romero, LM; Santelli, J; Community Preventive Services Task, Force (March 2012). "The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.". American journal of preventive medicine. 42 (3): 272–94. doi:10.1016/j.amepre.2011.11.006. PMID 22341164.
- Underhill, K; Operario, D; Montgomery, P (Oct 17, 2007). Operario, Don, ed. "Abstinence-only programs for HIV infection prevention in high-income countries". Cochrane database of systematic reviews (Online) (4): CD005421. doi:10.1002/14651858.CD005421.pub2. PMID 17943855.
- Social Security Act, Section 510
- Kirby, D. (2007). "Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases". National Campaign to Prevent Teen Pregnancy. 
- Fonner, VA; Armstrong, KS; Kennedy, CE; O'Reilly, KR; Sweat, MD (2014). "School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis.". PLOS ONE. 9 (3): e89692. doi:10.1371/journal.pone.0089692. PMID 24594648.
- Kirby, Douglas B. (September 2008). "The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior". Sexuality Research and Social Policy. 5 (3): 18–27. doi:10.1525/srsp.2008.5.3.18.
- Johnson, Blair T.; Scott-Sheldon, Lori A. J.; Huedo-Medina, Tania B.; Carey, Michael P. (1 January 2011). "Interventions to Reduce Sexual Risk for Human Immunodeficiency Virus in Adolescents". Archives of Pediatrics & Adolescent Medicine. 165 (1). doi:10.1001/archpediatrics.2010.251.
- Santelli, John S.; Speizer, Ilene S.; Edelstein, Zoe R. (January 2013). "Abstinence promotion under PEPFAR: The shifting focus of HIV prevention for youth". Global Public Health. 8 (1): 1–12. doi:10.1080/17441692.2012.759609.
- Stanger-Hall, Kathrin (October 14, 2011). "Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.". PLoS ONE. doi:10.1371/journal.pone.0024658.
- Santelli, John; Lindberg, Laura; Finer, Lawrence; Singh, Susheela (2007). "Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use". American Journal of Public Health. 97 (1): 150–156. doi:10.2105/AJPH.2006.089169.
- SIECUS Fact Sheet (includes research citations).
- Table 1.0,"U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity." http://www.guttmacher.org/media/nr/2010/01/26/index.html, downloaded 20100127.
- Wind, Rebecca (March 8, 2012). "Sex Education Linked to Delay in First Sex". Guttmacher Institute Media Center.
- Lindberg, Laura; Maddow-Zimet, Isaac (October 2012). "Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes" (PDF). The Guttmacher Institute. 51 (4): 332–338. doi:10.1016/j.jadohealth.2011.12.028.
- Petrova, D; Garcia-Retamero, R (2015). "Effective Evidence-Based Programs For Preventing Sexually-Transmitted Infections: A Meta-Analysis.". Current HIV Research. 13 (5): 432–8. PMID 26149164.
- PBS, February 4, 2005 Religion & Ethics Newsweekly, Episode 823 Retrieved on 2007-14-03
- Shorto, Russel (May 7, 2006). "Contra-Contraception". New York Times Magazine.
- Fields, J (2012). "Sexuality Education in the United States: Shared Cultural Ideas across a Political Divide". Sociology Compass: 1–14
- Fields, p. 6
- Douglas Kirby, Ph. D.: Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. National Campaign to Prevent Teen Pregnancy, 2001. Homepage of the study.
- K Van Wormer, R McKinney: What Schools Can Do to Help Gay/lesbian/bisexual Youth: A Harm Reduction Approach. http://www.questia.com/PM.qst?a=o&se=gglsc&d=5002082003
- Journal of Adolescent Health: Volume 38, Issue 1, Pages 83–87 (January 2006): Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine: John Santelli, M.D., M.P.H.a, Mary A. Ott, M.D.b, Maureen Lyon, Ph.D.c, Jennifer Rogers, M.P.H.d, Daniel Summers, M.D.e http://www.jahonline.org/article/PIIS1054139X05002764/fulltext - "abstinence-until-marriage programs discriminate against gay, lesbian, bisexual, transgender and questioning youth, as federal law limits the definition of marriage to heterosexual couples."
- United States Ignorance Only Hiv/aids, Human Rights and Federally Funded Abstinence-only Programs in the United States Texas: a Case Study; Human Rights Watch, September 2002, Vol. 14, No. 5(G)., Page 39.
- Nancy D. Polikoff, Beyond straight and gay marriage: valuing all families under the law; Politics, Culture and Society Series, Beacon Press, 2008 ISBN 0-8070-4432-6, ISBN 978-0-8070-4432-2
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- Wilkerson, A. (2013). I Want to Hold Your Hand: Abstinence Curricula,Bioethics, and the Silencing of Desire. Journal of Medical Humanities, 34, 101-108.
- Effective Sex Education, Brigid McKeon, 2006; http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=450&Itemid=336
- Santelli, John; Ott, Mary A; Lyon, Maureen; et al. (January 2006). "Abstinence and abstinence-only education: A review of U.S. policies and programs". Journal of Adolescent Health. 38 (1): 72–81. doi:10.1016/j.jadohealth.2005.10.006.
- Bryan Strong; Christine DeVault; Theodore F. Cohen (2010). The Marriage and Family Experience: Intimate Relationship in a Changing Society. Cengage Learning. p. 186. ISBN 0-534-62425-1. Retrieved October 8, 2011.
Most people agree that we maintain virginity as long as we refrain from sexual (vaginal) intercourse. But occasionally we hear people speak of 'technical virginity' [...] Data indicate that 'a very significant proportion of teens ha[ve] had experience with oral sex, even if they haven't had sexual intercourse, and may think of themselves as virgins' [...] Other research, especially research looking into virginity loss, reports that 35% of virgins, defined as people who have never engaged in vaginal intercourse, have nonetheless engaged in one or more other forms of heterosexual sexual activity (e.g., oral sex, anal sex, or mutual masturbation).
- "About PEPFAR". PEPFAR.
- "Partnership Frameworks". PEPFAR.
- Boonstra, H.D. (2007). "Young People Need Help in Preventing Pregnancy and HIV; How Will the World Respond?". Guttmacher Policy Review. 10 (3).
- "Abstinence & Fidelity". PEPFARWatch.
- Dietrich, John (2007). "The Politics of PEPFAR: The President's Emergency Plan for AIDS Relief". Ethics & International Affairs.
- "Access to Condoms and HIV/AIDS Information: A Global Health and Human Rights Concern". Human Rights Watch: 1–28. 2004.
- U.S. Push for Abstinence in Africa Is Seen as Failure Against H.I.V. By DONALD G. McNEIL Jr. New York Times. FEB. 26, 2015
- 19th Conference on Retroviruses and Opportunistic Infections in Seattle. US PEPFAR abstinence and faithfulness funding had no impact on sexual behaviour in Africa. Keith Alcorn. CROI News. 26 February 2015
- The impact of PEPFAR faithfulness and abstinence funding on HIV risk behaviours in sub-Saharan Africa. Conference on Retroviruses and Opportunistic Infections, Lo N, Lowe A, Bendavid E. Seattle, abstract 160, 2015.
- Williams, Mary E. (Ed.). (2006). Sex: opposing viewpoints. Detroit: Greenhaven.