Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact

Since 1991, rates of teenage pregnancy and birth have declined significantly in the United States. These are welcome trends. Yet, teens in the United States continue to suffer from the highest birth rate and one of the highest rates of sexually transmitted infections (STIs) in the industrialized world. Debate over the best way to help teens avoid, or reduce, their sexual risk-taking behavior has polarized many youth-serving professionals. On one side are those that support comprehensive sex education—education that promotes abstinence but includes information about contraception and condoms to build young people's knowledge, attitudes and skills for when they do become sexually active. On the other side are those that favor abstinence-only-until-marriage—programs that promote "abstinence from sexual activity outside marriage as the expected standard"[1] of behavior. Proponents of abstinence-only programs believe that providing information about the health benefits of condoms or contraception contradicts their message of abstinence-only and undermines its impact. As such, abstinence-only programs provide no information about contraception beyond failure rates.
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Ten states made some form of evaluation results available for review. For Arizona, Florida, Iowa, Maryland, Minnesota, Oregon, Pennsylvania, and Washington, Advocates was able to locate evaluation results from state Title V programs. For Missouri and Nebraska, Advocates located evaluation findings from at least one program among those funded through the state's Title V initiative. Finally, the evaluation of California's abstinence-only program was published in a peer-reviewed journal and readily available.
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Evaluation of these 11 programs showed few short-term benefits and no lasting, positive impact. A few programs showed mild success at improving attitudes and intentions to abstain. No program was able to demonstrate a positive impact on sexual behavior over time. A description follows of short- and long-term impacts, by indicator.

Discussion
These evaluation results—from the first five-year cycle of funding for abstinence-only-until-marriage under Section 510(b) of Title V of the Social Security Act—reflect the results of other studies. In a 1994 review[5] of sex education programs, Kirby et al assessed all the studies available at the time of school-based, abstinence-only programs that had received peer review and that measured attitudes, intentions, and behavior. Kirby et al found that none of the three abstinence-only programs was effective in producing a statistically significant impact on sexual behaviors in program participants relative to comparisons. In a 1997 report for the National Campaign to Prevent Teen Pregnancy, Doug Kirby reviewed evaluations from six abstinence-only programs[6], again finding no program that produced a statistically significant change in sexual behavior. This was again confirmed in 2000[7], when another review by Kirby found no abstinence-only program that produced statistically significant changes in sexual behaviors among program youth relative to comparisons. This failure of abstinence-only programs to produce behavior change was among the central concerns expressed by some authors of the evaluations included in this document. [For examples of authors' remarks on behavior change, see quotations under Arizona, Florida, Missouri, and Pennsylvania in the state-by-state analyses that follow.] It is important to note that a great deal of research contradicts the belief that changes in knowledge and attitudes alone will necessarily result in behavior change.[8]

A few evaluators also noted the failure of abstinence-only programs to address the needs of sexually active youth. Survey data from many of the programs indicated that sexually experienced teens were enrolled in most of the abstinence-only programs studied. For example:

In Erie County, Pennsylvania, researchers found that 42 percent of the female participants were sexually active by the second year of the program.
In Clinton County, Pennsylvania, data collected from program participants in the seventh, eighth, and ninth grades showed a dramatic increase in the proportion of program females who experienced first sexual intercourse over time (six, nine, and 30 percent, respectively, by grade).
In Minnesota, 12 percent of the eighth grade program participants were sexually active at posttest.
In Arizona, 19 percent of program participants were sexually active at follow-up. Concurrently, Arizona's evaluators found that youth's intent to pursue abstinence declined significantly at follow-up, regardless of whether the student took another abstinence-only class. Eighty percent of teens reported that they were likely to become sexually active by the time they were 20 years old.
Abstinence-only programs provide these youth with no information, other than abstinence, regarding how to protect themselves from pregnancy, HIV, and other STIs.

A third, related concern of evaluators was abstinence-only programs' failure to provide positive information about contraception and condoms. Evaluators noted more than once that programs' emphasis on the failure rates of contraception, including condoms, left youth ambivalent, at best, about using them.

In Clinton County, Pennsylvania, researchers noted that, of those participants that reported experiencing first sexual intercourse during ninth grade, only about half used any form of contraception.
Arizona's evaluation team found that program participants' attitudes about birth control became less favorable from pre- to posttest. They noted that this was probably a result of the "program's focus on the failure rates of contraceptives as opposed to their availability, use and access."
Table I follows on the next page. It includes information about the evaluation design, short-term impacts, and long-term impacts of the 11 programs summarized in this document. After Table I, individual state-by-state summaries follow, ordered alphabetically by state.

Conclusion
Abstinence-only programs show little evidence of sustained (long-term) impact on attitudes and intentions. Worse, they show some negative impacts on youth's willingness to use contraception, including condoms, to prevent negative sexual health outcomes related to sexual intercourse. Importantly, only in one state did any program demonstrate short-term success in delaying the initiation of sex; none of these programs demonstrates evidence of long-term success in delaying sexual initiation among youth exposed to the programs or any evidence of success in reducing other sexual risk-taking behaviors among participants.
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