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Statement of Sexuality Information and Education Council of the United States (SIECUS) on the Public Health and Ethical Concerns regarding Abstinence-Only-Until-Marriage Programs and the Need for Comprehensive Sexuality Education


Committee on Oversight and Government Reform
 Submitted for the Record
April 23, 2008


SIECUS, the Sexuality Information and Education Council of the United States, has served as a strong national voice for sexuality education, sexual health, and sexual rights for over 40 years.

SIECUS affirms that sexuality is a fundamental part of being human, one that is worthy of dignity and respect. We advocate for the right of all people to accurate information, comprehensive education about sexuality, and sexual health services. SIECUS works to create a world that ensures social justice and sexual rights.


As an organization concerned about the health and education of our nation’s young people, we wish to inform you of our public health and ethical concerns regarding abstinence-only-until-marriage programs and urge you to provide the necessary oversight so as to bring an end to federal funding for these ineffective programs.  SIECUS is pleased with the Committee’s decision to hold this critically important hearing.  Abstinence-only-until-marriage programs have been sold as public health and social welfare programs; however, these programs have used billions of federal taxpayer dollars to push a narrow, conservative agenda above all else—above public health, medical opinion, scientific evidence, and basic human rights. This policy has been promoted above what the evidence tells us is the most effective way to help people make healthy life decisions in the long term and ensure that they live full and productive lives.  There is a true need for evidence-based comprehensive sexuality education that meets the needs of all youth and fully informs them about abstinence and contraception, among a variety of other topics.  We are committed to sound science and the health and welfare of our nation’s youth and we wish to express our profound concern with the continuation of any funding for abstinence-only-until-marriage programs. 


Scientific evidence does not support abstinence-only-until-marriage programs.  These programs have been funded by the federal government for over 25 years and yet, no study in a professional peer-reviewed journal has found them to be broadly effective.  Most recently, a federally funded study of abstinence-only-until-marriage programs was conducted by Mathematica Policy Research Inc. on behalf of the U.S. Department of Health and Human Services.  Released in April 2007, the study found no evidence that abstinence-only-until-marriage programs have achieved their goal of increasing rates of sexual abstinence—the entire supposed purpose of the programs. Students in the abstinence-only-until-marriage programs had a similar age of first sex and similar numbers of sexual partners as their peers who were not in the programs.  In addition, the average age of sexual debut was the same for the abstinence-only-until-marriage participants and those in the control groups (14 years, 9 months).[1]


This report followed on the findings from 13 states that have evaluated their own Title V abstinence-only-until-marriage programs with results ranging from finding the programs ineffective to finding them harmful.  For example, the 2004 evaluation completed in President Bush’s home-state of Texas included five self-selected “abstinence education” contractors who participated in a study conducted by researchers at Texas A&M University.  Analysis found that there were “no significant changes” in the percentages of students who “pledg[ed] not to have sex until marriage.”[2]  In addition, the analysis revealed that the percentage of students reporting having ever engaged in sexual intercourse increased for nearly all ages between 13 and 17. One of the study’s investigators said, “we didn’t see any strong indications these programs were having an impact in the direction desired…these programs seem to be much more concerned about politics than kids, and we need to get over that.”[3]


Furthermore, in early November 2007, the National Campaign to Prevent Teen and Unplanned Pregnancy released Emerging Answers 2007, a report authored by Dr. Douglas Kirby, a leading sexual health researcher, discussing what programs work in preventing teen pregnancy and sexually transmitted diseases, including HIV. The report looked at both abstinence-only-until-marriage programs and comprehensive sexuality education and found strong evidence that abstinence-only-until-marriage programs do not have any impact on teen sexual behavior while finding that comprehensive sexuality education programs were effective.[4]


·        The study found that no evidence to support the continued investment of public funds.


“In sum, studies of abstinence programs have not produced sufficient evidence to justify their widespread dissemination…Only when strong evidence demonstrates that particular programs are effective should they be disseminated more widely.”


·        The study also found that, to date, no abstinence-only-until-marriage program that is of the type eligible for funding by the federal government has been found in methodologically rigorous study to positively impact teen sexual behavior.


“At present, there does not exist any strong evidence that any abstinence program delays the initiation of sex, hastens the return to abstinence, or reduces the number of sexual partners. In addition, there is strong evidence from multiple randomized trials demonstrating that some abstinence programs chosen for evaluation because they were believed to be promising actually had no impact on teen sexual behavior.”


·        In contrast, the study found that a substantial majority of the comprehensive sexuality education programs are effective.  The positive effects found include delaying the initiation of sex, reducing the frequency of sex, reducing the number of sexual partners and increasing condom or contraceptive use.


“Two-thirds of the 48 comprehensive programs that supported both abstinence and the use of condoms and contraceptives for sexually active teens had positive behavioral effects.”


·        In addition, comprehensive sexuality education programs were found to be well suited for widespread replication and dissemination.


“When three [comprehensive] programs were replicated with fidelity in different locations throughout the United States, but in the same type of setting, the original positive effects were confirmed. This is very encouraging and suggests that effective programs can remain effective when they are implemented with fidelity by other people in other communities with similar groups of young people.”


The study also found that, contrary to the statements of many advocates for abstinence-only-until-marriage programs, comprehensive sexuality education does not increase sexual activity nor does it provide a confusing or “mixed message” to adolescents.[5]  In addition, Dr. Kirby found that the benefits of sexuality education extend to several areas of decision-making skills for adolescents:[6]


“Virtually all of the comprehensive programs also had a positive impact on one or more factors affecting behavior. In particular, they improved factors such as knowledge about risks and consequences of pregnancy and STD; values and attitudes about having sex and using condoms or contraception; perception of peer norms about sex and contraception; confidence in the ability to say ‘no’ to unwanted sex, to insist on using condoms or contraception, or to actually use condoms or contraception; intention to avoid sex or use contraception; and communication with parents or other adults about these topics. In part by improving these factors, the programs changed behavior in desired directions.”


A report released by the non-partisan Government Accountability Office (GAO) in November 2006 confirms that there are few mechanisms in place to measure the effectiveness of abstinence-only-until-marriage programs and questions the oversight of these programs. The report documents the actions of the U.S. Department of Health and Human Services (HHS) and finds, in part, that:


  • The Administration for Children and Families (ACF), the division of HHS responsible for the vast majority of the programs, including Community-Based Abstinence Education grantees, does not review its grantees’ materials for scientific accuracy and does not require grantees to review their own materials for scientific accuracy.


·        ACF has a total lack of appropriate and customary measurements to determine if funded programs are actually working. ACF took over the administration of these programs in 2001 and promptly gutted evidence-based measures such as determining whether programs reduced teen pregnancy rates. In their place, ACF now only requires grantees to provide non-health based measures, such as how many young people were in the program and the number of hours the program operated.


Furthermore, these programs are not supported by any of the leading public health and medical organization in this country or abroad.  Every major medical and public health organization supports a comprehensive approach to sexuality education. These include the American Academy of Pediatrics, the American Medical Association, the American Nurses Association, the American Public Health Association, the Institute of Medicine, the National Institutes of Health, and the Society for Adolescent Medicine, among others. Several, including the American Public Health Association, the Institute of Medicine, and the Society for Adolescent Medicine, have gone so far as to call for the repeal of current abstinence-only-until-marriage programs and funding.


In addition, on November 21, 2007, ten public-health researchers sent a letter to House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid urging Congress to reduce or eliminate federal support for abstinence-only-until-marriage programs, in part because the programs have “multiple scientific and ethical errors.”  We strongly support the researchers’ conclusion that abstinence-only-until-marriage programs withhold “potentially life-saving information” about birth control and ignore the health needs of lesbian, gay, bisexual, and transgender (LGBT) youth.  The letter focused on the large body of evidence showing that abstinence-only-until-marriage programs are ineffective in getting young people to delay sexual initiation, noting that, “Recent reports in professional publications by the authors of this letter have highlighted multiple deficiencies in federal abstinence-only programs.”  The researchers noted at the time that, “…we are surprised and dismayed that the Congress is proposing to extend and even increase funding for these programs.” They continued by concluding that “We strongly urge the U.S. Congress to reconsider federal support for abstinence-only education programs and policies.”


It is noteworthy that 17 states have declined participation in the federal Title V abstinence-only-until-marriage program.  Acting on principle and in the best interest of their youth, many of these governors have rebuffed a source of much needed revenue because they concluded that these unduly restrictive and ideologically driven programs were, at a minimum, ineffective and, at worst, harmful.  In states such as California, Maine, and New Jersey, it is essentially illegal to teach these programs in publicly funded schools.  Of Arizona’s decision to no longer participate in the program, Governor Janet Napolitano said that the state should not fund “and educational system that doesn’t educate.”  John Auerbach, Massachusetts’s state commissioner of public health, stated, “We don’t believe that the science of public health is pointing in the direction of very specific and narrowly defined behavioral approaches like the one that is mandated by this funding.”  Ned Calonge, Chief Medical Officer of the Colorado Department of Public Health and Environment, asked, “Why would we spend tax dollars on something that doesn’t work? That doesn’t make sense to me. Philosophically, I am opposed to spending government dollars on something that’s ineffective.  That’s just irresponsible.”  And, upon turning back his state’s Title V abstinence-only-until-marriage funding, Virginia’s Governor Tim Kaine noted, “Studies have shown that…comprehensive sex education programs have been successful in delaying initiation of sex and preventing teen pregnancy.”  This chorus from the states is sending the message to policymakers in Washington to end the extremism of abstinence-only-until-marriage programs and help states fund real solutions to helping young people.


We also have several ethical concerns with abstinence-only-until-marriage programs.  Federally funded abstinence-only-until-marriage programs must adhere to a strict eight-point definition[7] and even stricter federal guidelines. Many aspects of the definition and guidelines are in direct opposition to the goals and tenets of a public health framework, which seeks to help young people navigate adolescence and become healthy adults. Though they are often presented to communities and school boards as programs designed to prevent pregnancy or sexually transmitted diseases (STDs), including HIV/AIDS, abstinence-only-until-marriage programs consistently ignore many youth who are most in need of information, education, and skills training and censor information vital to the health of all young people.  


Abstinence-only-until-marriage-programs do a serious disservice to young people as they provide medically inaccurate information and consistently disparage contraception, particularly condoms.  This only serves to leave youth woefully unprepared when they do become sexually active and to set back the public health gains the United States has made thus far.  In December of 2004, now-Chairman of the Oversight and Government Reform Committee, Representative Henry Waxman released a report documenting serious problems with abstinence-only-until-marriage curricula used in Community-Based Abstinence Education-funded programs.  The report reveals an utter disregard for basic public health data that resulted in gross medical inaccuracies being taught to youth.  For example, several curricula repeatedly reference a discredited study on condom effectiveness that said condoms fail approximately 30% of the time. Others told young people that HIV could be transmitted through tears and sweat.


As it has been interpreted by Congress, the federal definition of “abstinence education” prohibits federally funded programs from discussing the effectiveness of condoms and contraception in preventing unintended pregnancy and disease transmission. Because the first element requires that federally funded abstinence-only-until-marriage programs have as their “exclusive purpose” promoting abstinence outside of marriage, programs may not in any way advocate contraceptive use or discuss contraceptive methods except to emphasize their failure rates.  Some programs actually discourage the use of contraception, especially condoms, and many programs give teens medically inaccurate information about and exaggerated failure rates.[8]


For example, Why kNOw, one curriculum widely used in federally funded programs, provides distorted information about condoms and their effectiveness.  One of the lesson plans in the curriculum instructs teachers to construct an eighteen-foot long Speedy the Sperm© out of what essentially amounts to a pillow and a piece of rope. Speedy is designed to be exactly 450 times the size of a penny, because “the HIV virus is 450 times smaller than a human sperm.” (Why kNOw, 8th grade and high school, p. 96) The teacher is told to stretch Speedy© out to his full length, then hold up a penny and ask the students: “If the condom has a failure rate of 14% in preventing Speedy© from getting through to create a new life, what happens if this guy (the penny) gets through? You have a death: your own.” (Why kNOw, 8th grade and high school, p. 96) While the curriculum does not actually state that condoms may have holes large enough for the HIV virus to travel through, this is clearly the implication behind this activity. The suggestion that condoms have large holes is a myth that continues to be used in abstinence-only-until-marriage programs to discourage their use.


WAIT (Why Am I Tempted) Training, another of the most widely used curricula in federally funded programs states:


“[Students] need to know that, when used every time, condoms at best only provide a 50% reduction in the transmission