Two scientific review papers released today show that abstinence-only-until-marriage programs and policies in the United States are ineffective as they do not delay sexual initiation or reduce sexual risk behaviors. They also violate adolescent human rights, withhold medically accurate information, stigmatize or exclude many youth, reinforce harmful gender stereotypes, and undermine public health programs. Abstinence-only-until-marriage programs have been widely rejected by health professionals who care for young people, including the Society for Adolescent Health and Medicine. The findings are published online today in the Journal of Adolescent Health.
Considerable scientific evidence has accumulated on the lack of efficacy of abstinence-only-until-marriage programs since the authors published a 2006 review in the Journal of Adolescent Health. In contrast, comprehensive programs have favorable effects on multiple adolescent behaviors, 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 programs 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 John Santelli, MD, MPH, professor of Population and Family Health at the Mailman School of Public Health. "These programs simply do not prepare young people to avoid unwanted pregnancies or sexually transmitted diseases."
To study current U.S. policies on abstinence-only-until-marriage programs, the investigators turned to multiple sources - including scientific research and other review articles focusing on the efficacy of abstinence-only-until-marriage programs - as well as information from human rights organizations.
Given a rapidly rising age at first marriage around the globe, a rapidly declining percentage of young people remain abstinent until marriage. In the U.S. 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 programs 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 percent to 48 percent and requirements for HIV prevention declined from 64 percent to 41 percent. In 1995, 81 percent of adolescent males and 87 percent of adolescent females reported receiving formal instruction about birth control methods; by 2011-2013, this had fallen to 55 percent of young men and 60 percent 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 Leslie Kantor, PhD, MPH, 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 programs 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 $2 billion on domestic abstinence-only programs between 1982 and 2017; current funding is $85 million per year. The U.S. has also spent $1.4 billion on abstinence-only-until-marriage in foreign aid for HIV prevention. Under current guidelines, U.S. states cannot use funds to educate adolescents about contraceptive use or discuss contraceptive methods, except to emphasize 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 programs should be abandoned."
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Co-authors are from the following institutions: Planned Parenthood Federation of America; Gillings School of Global Public Health, University of North Carolina; Guttmacher Institute; University of Massachusetts Amherst; Children's National Medical Center, George Washington University Medical Center; University of York, North Yorkshire, England; Altarum Institute, Rockville, Maryland; and Indiana University.
The authors report no conflicts of interest.
Columbia University's Mailman School of Public Health
Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.
Journal
Journal of Adolescent Health