The difference between these two approaches, and their impact on teen behavior, remains a controversial subject. In the U.S., teenage birth rates had been dropping since 1991, but a 2007 report showed a 3% increase from 2005 to 2006. From 1991 to 2005, the percentage of teens reporting that they had ever had sex or were currently sexually active showed small declines. However, the U.S. still has the highest teen birth rate and one of the highest rates of STIs among teens in the industrialized world. Public opinion polls conducted over the years have found that the vast majority of Americans favor broader sex education programs over those that teach only abstinence, although abstinence educators recently published poll data with the opposite conclusion.
Proponents of comprehensive sex education, which include the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the American Academy of Pediatrics, the American Public Health Association, the Society for Adolescent Medicine and the American College Health Association, argue that sexual behavior after puberty is a given, and it is therefore crucial to provide information about the risks and how they can be minimized; they also claim that denying teens such factual information leads to unwanted pregnancies and STIs.
The impact of the rise in abstinence-only education remains a question. To date, no published studies of abstinence-only programs have found consistent and significant program effects on delaying the onset of intercourse. In 2007, a study ordered by the U.S. Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex (and use contraception) in their teenage years as those who did not. Abstinence-only advocates claimed that the study was flawed because it was too narrow and began when abstinence-only curricula were in their infancy, and that other studies have demonstrated positive effects.
Criticism of abstinence-only sex education in the U.S. Congress
Two major studies by Congress have increased the volume of criticism surrounding abstinence-only education.
In 2004, U.S. Congressman Henry Waxman of California released a report that provides several examples of inaccurate information being included in federally funded abstinence-only sex education programs. This report bolstered the claims of those arguing that abstinence-only programs deprive teenagers of critical information about sexuality.The claimed errors included:
Misrepresenting the failure rates of contraceptives
Misrepresenting the effectiveness of condoms in preventing HIV transmission, including the citation of a discredited 1993 study by Dr. Susan Weller, when the federal government had acknowledged it was inaccurate in 1997 and larger and more recent studies that did not have the problems of Weller's study were available
False claims that abortion increases the risk of infertility, premature birth for subsequent pregnancies, and ectopic pregnancy
Treating stereotypes about gender roles as scientific fact
Other scientific errors, e.g. stating that "twenty-four chromosomes from the mother and twenty-four chromosomes from the father join to create this new individual" (the actual number is 23).
Out of the 13 grant-receiving programs examined in the 2004 study, the only two not containing "major errors and distortions" were Sex Can Wait and Managing Pressures before Marriage, each of which was used by five grantees, making them two of the least widely used programs in the study. With the exception of the FACTS program, also used by 5 grantees, the programs found to contain serious errors were more widely used, ranging in usage level from 7 grantees (the Navigator and Why kNOw programs) to 32 grantees (the Choosing the Best Life program). Three of the top five most widely used programs, including the top two, used versions of the same textbook, Choosing the Best, from either 2003 (Choosing the Best Life) or 2001 (Choosing the Best Path — the second most widely used program with 28 grantees — and Choosing the Best Way, the fifth most widely used program with 11 grantees).
In 2007, a study ordered by Congress found that middle school students who took part in abstinence-only sex education programs were just as likely to have sex in their teenage years as those who did not. From 1999 to 2006, the study tracked more than 2,000 students from age 11 or 12 to age 16; the study included students who had participated in one of four abstinence education programs, as well as a control group who had not participated in such a program. By age 16, about half of each group students in the abstinence-only program as well as students in the control group were still abstinent. Abstinence program participants who became sexually active during the 7-year study period reported having similar numbers of sexual partners as their peers of the same age; moreover, they had sex for the first time at about the same age as other students. The study also found that students who took part in the abstinence-only programs were just as likely to use contraception when they did have sex as those who did not participate. Abstinence-only education advocates claim the study was too narrow, began when abstinence-only curricula were in their infancy, and ignored other studies that have shown positive effects.
Criticism of abstinence-only sex education by the scientific and medical communities
Abstinence-only education has been criticized in official statements by the American Psychological Association, the American Medical Association, the National Association of School Psychologists, the Society for Adolescent Medicine, the American College Health Association, the American Academy of Pediatrics, and the American Public Health Association, which all maintain that sex education needs to be comprehensive to be effective.
The AMA "urges schools to implement comprehensive... sexuality education programs that... include an integrated strategy for making condoms available to students and for providing both factual information and skill-building related to reproductive biology, sexual abstinence, sexual responsibility, contraceptives including condoms, alternatives in birth control, and other issues aimed at prevention of pregnancy and sexual transmission of diseases... and opposes the sole use of abstinence-only education..."
The American Academy of Pediatrics states that "Abstinence-only programs have not demonstrated successful outcomes with regard to delayed initiation of sexual activity or use of safer sex practices... Programs that encourage abstinence as the best option for adolescents, but offer a discussion of HIV prevention and contraception as the best approach for adolescents who are sexually active, have been shown to delay the initiation of sexual activity and increase the proportion of sexually active adolescents who reported using birth control."
On August 4, 2007, the British Medical Journal published an editorial concluding that there is "no evidence" that abstinence-only sex education programs "reduce risky sexual behaviours, incidence of sexually transmitted infections, or pregnancy" in "high income countries".
A comprehensive review of 115 program evaluations published in November 2007 by the National Campaign to Prevent Teen and Unplanned Pregnancy found that two-thirds of sex education programs focusing on both abstinence and contraception had a positive effect on teen sexual behavior. The same study found no strong evidence that abstinence-only programs delayed the initiation of sex, hastened the return to abstinence, or reduced the number of sexual partners. According to the study author:
"Even though there does not exist strong evidence that any particular abstinence program is effective at delaying sex or reducing sexual behavior, one should not conclude that all abstinence programs are ineffective. After all, programs are diverse, fewer than 10 rigorous studies of these programs have been carried out, and studies of two programs have provided modestly encouraging results. In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination."
Joycelyn Elders, former Surgeon General of the United States, is a notable critic of abstinence-only sex education. She was among the interviewees Penn & Teller included in their Bullshit! episode on the subject.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, argues that abstinence-only sex education leads to the opposite of the intended results by spreading ignorance regarding sexually transmitted diseases and the proper use of contraceptives to prevent both infections and pregnancy.
In July 2009, researchers from the U.S. Centers for Disease Control and Prevention released their analysis of national data collected between 2002 and 2007. Their findings included:
Birth rates among U.S. teens had increased in 2006 and 2007, following large declines from 1991 to 2005.
About one-third of adolescents had not received instructions on methods of birth control before age 18.
In 2004, there were about 745,000 pregnancies among females younger than 20, including an estimated 16,000 pregnancies among girls between 10 and 14.
In 2006, about one million young people aged 10 to 24 were reported to have chlamydia, gonorrhea, or syphilis. Nearly one-quarter of females aged 15 to 19, and 45% of females aged 20 to 24, had a human papillomavirus infection during 2003 and 2004.
In 2006, the majority of new diagnoses of HIV infection among young people occurred among males and those aged 20 to 24.
From 2004 to 2006, about 100,000 females aged 10 to 24 visited a hospital emergency department for nonfatal sexual assault, including 30,000 females aged 10 to 14.
Hispanic teens aged 15 to 19 are much more likely to become pregnant (132.8 births per 1,000 females) than non-Hispanic blacks (128 per 1,000) and non-Hispanic whites (45.2 per 1,000)
Non-Hispanic black youth in all age groups have the highest rates of new HIV and AIDS diagnoses.
“ This report identifies a number of concerns regarding the sexual and reproductive health of our nation's young people... It is disheartening that after years of improvement with respect to teen pregnancy and sexually transmitted diseases, we now see signs that progress is stalling and many of these trends are going in the wrong direction ”— Janet Collins, director of the CDC's National Center for Chronic Disease Prevention and Health Promotion, CDC Morbidity and Mortality Weekly Report, July 17