Two scientific review papers show that abstinence-only-until-marriage programmes and policies in the US are ineffective as they do not delay sexual initiation or reduce sexual risk behaviours, reports Medical Xpress. They also violate adolescent human rights, withhold medically accurate information, stigmatise or exclude many youth, reinforce harmful gender stereotypes, and undermine public health programmes. Abstinence-only-until-marriage programmes have been widely rejected by health professionals who care for young people, including the Society for Adolescent Health and Medicine.
Considerable scientific evidence has accumulated on the lack of efficacy of abstinence-only-until-marriage programmes since the authors published a 2006 review. In contrast, comprehensive programmes have favourable effects on multiple adolescent behaviours, including sexual initiation, number of sex partners, frequency of sexual activity, use of condoms and contraception, frequency of unprotected sexual activity, STIs and pregnancy. Comprehensive sex education helps young people remain abstinent, while abstinence-only education does not.
“The weight of scientific evidence shows these programmes do not help young people delay initiation of sexual intercourse. While abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail,” said co-author Dr John Santelli, professor of population and family health at the Mailman School of Public Health. “These programmes simply do not prepare young people to avoid unwanted pregnancies or sexually transmitted diseases.”
To study current US policies on abstinence-only-until-marriage programmes, the investigators turned to multiple sources – including scientific research and other review articles focusing on the efficacy of abstinence-only-until-marriage programmes – as well as information from human rights organisations.
Given a rapidly rising age at first marriage around the globe, a rapidly declining percentage of young people remain abstinent until marriage. In the US today the gap between the age at first sex and first marriage is 8.7 years for young women and 11.7 years for young men.
Abstinence-only-until-marriage approaches have also set back sex education, family planning programmes and HIV prevention efforts, domestically and globally. Between 2002 and 2014, the percentage of schools that require students to learn about human sexuality fell from 67% to 48% and requirements for HIV prevention declined from 64% to 41%. In 1995, 81% of adolescent males and 87% of adolescent females reported receiving formal instruction about birth control methods; by 2011-2013, this had fallen to 55% of young men and 60% of young women.
“Young people have a right to sex education that gives them the information and skills they need to stay safe and healthy,” said Dr Leslie Kantor, assistant professor of population and family health at the Mailman School of Public Health and vice president of education at Planned Parenthood Federation of America. “Withholding critical health information from young people is a violation of their rights. Abstinence-only-until-marriage programmes leave all young people unprepared and are particularly harmful to young people who are sexually active, who are LGBTQ, or have experienced sexual abuse.”
Congress has spent over $2bn on domestic abstinence-only programmes between 1982 and 2017; current funding is $85m per year. The US has also spent $1.4bn on abstinence-only-until-marriage in foreign aid for HIV prevention. Under current guidelines, US states cannot use funds to educate adolescents about contraceptive use or discuss contraceptive methods, except to emphasise failure rates.
“Adolescent sexual and reproductive health promotion should be based on scientific evidence and understanding, public health principles, and human rights,” says Santelli. “Abstinence-only-until marriage as a basis for health policy and programmes should be abandoned.”
Adolescence is marked by the emergence of human sexuality, sexual identity, and the initiation of intimate relations; within this context, abstinence from sexual intercourse can be a healthy choice. However, programs that promote abstinence-only-until-marriage (AOUM) or sexual risk avoidance are scientifically and ethically problematic and—as such—have been widely rejected by medical and public health professionals. Although abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail. Given a rising age at first marriage around the world, a rapidly declining percentage of young people remain abstinent until marriage. Promotion of AOUM policies by the U.S. government has undermined sexuality education in the United States and in U.S. foreign aid programs; funding for AOUM continues in the United States. The weight of scientific evidence finds that AOUM programs are not effective in delaying initiation of sexual intercourse or changing other sexual risk behaviors. AOUM programs, as defined by U.S. federal funding requirements, inherently withhold information about human sexuality and may provide medically inaccurate and stigmatizing information. Thus, AOUM programs threaten fundamental human rights to health, information, and life. Young people need access to accurate and comprehensive sexual health information to protect their health and lives.
John S Santelli, Leslie M Kantor, Stephanie A Grilo, Ilene S Speizer, Laura D Lindberg, Jennifer Heitel, Amy T Schalet, Maureen E Lyon, Amanda J Mason-Jones, Terry McGovern, Craig J Heck, Jennifer Rogers, Mary A Ott