Challenging Dogma - Spring 2011

Sunday, May 8, 2011

The Failure of Abstinence Only Education and the Need For Comprehensive Sexual Education- Kara Kimball


Abstinence only education has failed to properly prepare or deter adolescents and teenagers from sexual activity. The three primary areas wherein this model of sexual education fails are: it strips the individual teenagers of their ability or freedom to choose whether or not to engage in sexual activity, it ignores relationship dynamics, and it assumes that abstinence is a normative behavior. Policymakers, health workers, and social groups have long fought over how to best address teenage sexual behaviors and the inherit health risks. While teenage pregnancy rates have declined over the past few decades American rates have remained relatively high compared to other developed nations (11). The Guttamacher Institutive estimates that there are 750,000 teenage pregnancies each year—82% of which are unplanned (4). Teenagers get information about sexual behaviors from a variety of sources including family, friends, school, and social media. Different types of information sources encourage different types of behaviors. The Abstinence Only Until Marriage framework and subsequent programs have been proven failures in the real of sexual health information.

For nearly three decades, beginning in 1981, the federal government has fiscally supported a handful of programs the promote abstinence only education. Beginning in 1981, the Adolescent Family Life Act (as part of Title XX) was a federal act that promoted the ideas of “chastity” and “self discipline” (6,11). This program was a proven failure, and federal funding was not renewed under the Obama administration (6,11). Under Title V, however, government programs have established more abstinence only education programs, and these programs were recently renewed until 2014. These programs teach adolescents such ideas as “a mutually faithful monogamous relationship in the context of marriage is the expected standard of sexual activity” and “teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects”(11). The claims of Title V have not been proven correct or backed by study. Instead, students are left with misinformation about sexual health and poor health outcomes.

Despite the recent slight decline in federal promotion of abstinence only education, the effects of former and current policies and programs still resonate. According to the Guttamacher Institute, approximately “one in four adolescents received information about abstinence only without information on contraception”, and “teens aged 18–19, 41% report that they know little or nothing about condoms and 75% say they know little or nothing about the contraceptive pill” (4). To deny information to students about their own sexual health has consequences that have come to fruition in the teenage pregnancy and STI rates amongst teenagers. Certain social science theories help explain why abstinence only education is not an appropriate way to go about sexual and reproductive health for teenagers. Psychological reactance theory, attitude alignment, and diffusion of innovation each provide insight on different aspects of the failures of abstinence only education. These theories, and others, also help to explain why a more comprehensive approach to health education is appropriate.

Abstinence Only Education Strips Adolescents of Freedom

There are a number of factors as to why abstinence only education has been a statistical and practical failure; removal of freedom of choice is a major player. Psychological reactance theory illustrates how abstinence only education is both ineffective and counterproductive in sexual and reproductive health education. Abstinence only education is based on the premise that adolescents should not, cannot, and will not have any form of sexual behaviors before marriage. (It is important to note that due to the nature of marriage in this country this implies heterosexual relationships as the only legitimate form of sexual relationship.) In effect, abstinence only education strips adolescents of their sexual freedom. Psychological reactance theory has shown that when individuals are threatened with loss of freedom, they will react by engaging in the prohibited behavior. In studies of patients and noncompliance, health researchers found that when health practitioners told patients not to do something, this advice had the reverse effect (3,7,9). In essence, telling adolescents that they cannot have sex, for some individuals, may evoke a need to do the opposite. The freedom of sex is taken away and the desire to reclaim this need heightens.

Psychological reactance theory further explains the extent by which abstinence only education not only fails to discourage sexual behavior but also increases the desire for sexual risk behavior. Reactance theory has shown that when administration removes the freedom to do a behavior, the behavior becomes increasingly desirable—beyond its original worth (3). This is particularly problematic with sexual health. School policies that enforce only abstinence thereby encourage the desire to engage in sexual behavior. The number of partners may increase with the increase of desire. Furthermore, because of the nature of abstinence only education, students who act on this desire are uneducated as to how to protect themselves from unintended pregnancies and sexually transmitted infections. Students in abstinence only programs are not taught about condom use, contraception, or other methods of protection. As a result, adolescents will engage in this forbidden desire without taken the necessary precautions—perhaps with more partners than initially expected.

When an option (freedom) is taken away, psychological reactance theory illustrates that individuals who didn’t intend on doing the behavior will wish to (3,7,9). For example, a young female may have held no desire to have sexual intercourse. However, under the abstinence only model, this choice is taken away. As a result, the young woman may react by wishing to begin sexual activity. Sex may not have even been something the young woman thought about before she was told it was something she could not have. The forbidden nature and removal of choice leads to increase desirability and action. Also, because this young woman (or man) had not previously thought about engaging in sexual activity, she or he is likely unaware of what safe sex practices are. The failures of abstinence education in this instance are numerous. Abstinence only education fails to stop the initiation of sexual behavior (one of its fundamental claims) and fails to keep the adolescent healthy and safe.

Abstinence only education is a hierarchal structure whereby students swear to authoritative figures that they will not engage in sexual activity before marriage. This power structure, according to further psychological reactance theory study, is an additional fault of abstinence only education. According to research, the more power the group removing the freedom has, the greater the response (3,7,9). The stripped freedom has a greater weight through the evidence power indifference. Adults with age, social, and political power in the abstinence only model tell younger students of the limitations of their sexual freedom. Adolescents and teenagers are also at a particularly developmental stage. As part of this development, adolescents often act to dismiss authority. This dynamic compounds with the other problematic tendencies illustrated in the psychological reactance model to create poor sexual health outcomes.

The Importance of Relationship Dynamics in Sexual Health

Abstinence only education is limited and further flawed as it ignores the impacts of relationship dynamics. Abstinence only education presumes that the individual is capable of making decisions about when to begin sexual activity. However the individual is not in isolation; decisions about sex do not happen in a vacuum. Researchers have recently developed a new theory to explain just how these relationship dynamics unfold. Coined attitude alignment theory, this theory combines aspects of balance theory and interdependence theory (1). Balance theory claims that relationships are more successful and positive when the partners are better able to agree on issues. For example, two teenagers may be able to better handle remaining abstinence if it is what they both believe. This, however, is not always the case. According to research on teenage sexual practice, seventy percent of teenagers will have had sexual intercourse by age nineteen. Clearly, the majority of partners are not sticking the abstinence until marriage framework. Interdependence theory also speaks of the desire of both partners to do a particular activity (1). Attitude alignment theory helps explain why even when one partner may not wish to engage in sexual activity he or she may decide to. According to attitude alignment theory, partners in a relationship will shift their ideals and decision making to be more congruent (1). This shift in attitude, or alignment, makes for a stronger relationship and helps solidify a partner mentality.

In attitude alignment theory, both pressure by partner and the desire to gain acceptance of a partner are reasons why an individual would shift ideas. In abstinence only education, teenagers are not equipped with the social and or practical skills to deal in this type of situation. A young female or male may be in a relationship with a partner who does not share the same abstinence only beliefs. However, after a certain time, the individual with abstinence only education may feel pressure to accommodate or align to his or her partner’s willingness to engage in sexual activity. The result is likely unsafe sexual behavior or a regretful experience because of the inability to properly address the situation. Without comprehensive sexual education, the individual is left with only the often-misleading information given in abstinence only education.

Abstinence only education fails to differentiate between different types of sexual activity; attitude alignment theory explicates how truly problematic this is. Certain behavior shifts can happen either consciously or unconsciously under this theory (1). An individual may be unaware of the risks of oral sex (without comprehensive education) and equally unaware of the shift in behavior methods. The partner in a certain situation may imply that oral sex is normative and not actually “sex”. Here again abstinence only education will fail to guard the formerly abstinent individual from harm.

Abstinence Only Education Ignores Normative Sexual Behavior

As illustrated in the numbers of teenagers who do indeed engage in sex, abstinence is not the norm. It is particularly difficult to encourage teenagers and adolescents to abstain from sexual activity when social and media images illustrate that sexual activity is happening in their age bracket (13, 14). These media images combined what is common colloquial discussion creates a difficult dynamic of decision-making for teenagers to undergo about sexual activity. Diffusion of innovation theory explains why the rates of premarital sex of teenagers make the expectations of abstinence only education unfeasible. Diffusion of innovation theory explains that in a population a behavior is adapted over a long period of time (8, 10). Eventually, this behavior becomes what is socially normative, and most to all members of the population adopts this behavior change. There are a number of steps in diffusion of innovation theory that the population undergoes before fully adhering to the behavior. In particular, innovation, maintenance, and sustainability are three steps where abstinence only education fails (10).

The innovation concept within diffusion of innovation theory explains that the idea presented to the public needs to be something new. Abstinence only education is not a new idea, and teenagers within this program are already aware that their peers are engaging in sexual activity. As a result, this behavior of abstaining is difficult to adapt from the onset. A later aspect of diffusion of innovation theory is maintenance; this behavior should be easy to continue over a long period of time. Data on sexual initial rates suggest that teenagers begin sexual activity at higher rates as they age. As the number of peers who are no longer abstinent increase celibacy becomes increasingly difficult. The sustainability concept of diffusion of innovation theory has similar issues for abstinence only education. There is no further innovation or change over time with abstinence only education; the message remains the same. Adolescents will then grow tiresome of this message and not adhere to the ideas of abstinence.

Diffusion of innovation theory culminates into what has been termed the “tipping point” (8,10). This is the point where enough of the population has adapted the behavior that it is easy and expected. However, teenagers have shown that they will continue to have sex regardless of education and messages sent. Therefore, abstinence will never reach this tipping point—it will never be what is “normal.” As a result, it is impractical to expect teenager to continuously do a behavior (that is, not engage in sexual activity) when it is not what peers consider normal.

Newer studies and ideas on diffusion of innovation theory further explain why abstinence only education is difficult to adhere to. Researchers found in clinical studies of program adaptation five areas of diffusion of innovation that either supported or were detrimental to patient practice. Particular to abstinence only education, compatibility is a particularly difficult concept for sexual behavior. Compatibility, according to researchers, “is a measure of the degree to which and innovation is perceived as being compatible with existing values, past experience, and the needs of potential adopters (8,10).” The problem with abstinence only education is that ignores what the values of the individual may be. The ideals of abstinence only education may not be compatible with the values of the adolescent, his or her family, or community.

The Intervention: Comprehensive Sexual Education and the Long Live Love Model

The purpose of sexual education is to educate youth on what sexual activity is, what the risks involved are, and how to best protect and prepare for future sexual behaviors. Abstinence only education instead denies useful information for young individuals on this topic. Adolescents are often encouraged to engage in sexual behavior because of abstinence only education and the freedoms it denies. Without proper education, these teenagers are at risk for the health outcomes other education programs work to prevent. Social science theories help explain why comprehensive sexual education methods in coordination with media influences are the best method to tackle sexual risk behaviors amongst adolescents and teenagers.

Comprehensive sexual education provides adolescents with extensive health information about the foundations of sexual activity, the necessary precautions to take when engaging in sexual activity, and the possible health risks involved with sexual activity. Within most comprehensive sexual education programs, abstinence is supported as a useful method to prevent sexually transmitted infections and unplanned pregnancies. However, unlike abstinence only education, comprehensive sexual education takes into account the high number of adolescents that are either currently having sex or planning to do so in the future. The majority of adolescents have had sex before the time they graduate high school (4,13). It is the responsibility of sexual education programs to ensure the safety and wellbeing of these adolescents as they engage in sexual activity.

Certain regions of the United States have implemented successful comprehensive sexual education programs. Compared to abstinence only programs, these comprehensive sexual education programs have resulted in lower sexually transmitted infection rates, lower teenage pregnancy rates, and later onset of first sexual intercourse (2,5,6). Furthermore, students who wish to abstain from sex are encouraged to with the inclusion of abstinence ideals. While these American programs have had their own successes, the Dutch program of Long Live Love presents the opportunity for profound success in sexual education. Long Live Love, in coordination with the current comprehensive sexual education programs in the United States, deconstructs the issues presented in the abstinence only model. The theories of psychological reactance, attitude alignment, and diffusion of innovation work positively within this framework towards superb sexual health.

The Long Live Love program in The Netherlands has four basic learning objectives: knowledge, attitudes, social norms, and skills (2). This program promotes positive ideas about both having sex and not having sex. Furthermore, the program incorporates issues from both genders, and it provides information and skills on how to best tackle these issues. The purpose of this program intervention is to educate students on safe sex and how to incorporate safe sex into healthy relationships. Students, for example, are taught what is safe and unsafe sex, how to use different methods of contraception, how to discuss sex with their partner, what the responsibilities involved with sex are, and how to respect the decisions of their peers (2,5,6). The results of the program are astounding. Compared to the United States, more Dutch teenagers are using both a condom and a contraceptive pill at the time of first intercourse. These behaviors come into fruition in measurable health outcomes. The United States teen birth rate (for young women between the ages of 15-19) is 41.2 per 1,000; the Dutch teen birth rate is 4.6 per 1,000 (2). The success of the Dutch program is relative to its ability to work with teenage desire to have sex, incorporate both genders and partners into the equation of sexual initiation and practice, and appreciate social influences.

Comprehensive Sexual Education Gives Choice to Youth

Comprehensive sexual education and the Long Live Love program place the power of decision making in the hands of the adolescent. Abstinence only education has continuously failed because it strips the power of choice from adolescents; this choice is given back in comprehensive sex education. One premise of abstinence only education believes that giving adolescents information about sex will encourage sexual activity. This idea is the antithesis to proven accurate psychological reactance theory. Psychological reactance theory shows that giving adolescents information on contraception will encourage safer sexual activity because the option of sex still remains. No freedom has been taken away. Furthermore, sixty-seven percent of Americans reject the idea that giving information about contraception will encourage adolescents to have sex (). Students are given information and choice without pressure to begin or deny sexual activity.

Psychological reactance theory further supports one aspect in particular of the Long Live Love model. Under the skills objective, students can discuss their opinions on both positive and negative aspects of sex. Here again sexual activity and the types of sexual activity are choices. Students present their own opinions; this ownership is empowering.

Understanding the Power Dynamics

The Long Live Love model and comprehensive sex education programs incorporate the impacts of partner dynamics in a relationship. In abstinence only programs, the decision about sex is seemingly left to the individual. However, the Long Live Love model gives both young women and men the power to engage or choose not to engage in sexual behavior with their partner. The attitude alignment theory on relationships supports this appreciation of partnership. Some of the particulars of the Long Live Love program relative to attitude alignment theory are in the teachings of:

-Students recognize that purchasing and having condoms is the responsibility of both boys and girls

- Girls and boys can describe and discuss what they think is nice (or will be nice) about sex

-Students know how to use the pill and condom correctly

-Girls can ask and convince boys to use a condom(2)

Attitude alignment theory explains that relationships work best when the partners are on common ground. The Long Live Love model understands this dynamic. The model teaches young men and women to appreciate the other partner; this appreciation may help to avoid conflict. As illustrated in the discussion of abstinence only education, when one partner wishes to engage in sexual behavior and the other doesn’t, one partner often wins out. It is in these scenarios that adolescents who are unfamiliar or uncomfortable with sex often face potential health risks. However, here in the Long Live Love program, both the men and women know how to better express their feelings on sex and work on condom negotiation.

Comprehensive Sexual Education Respects the Norm

The Long Live Love model, and other comprehensive sexual education programs are successful because they recognize that adolescents and adults are engaging in sexual activity outside of the institution of marriage. Ideas and concepts, under diffusion of innovation theory, work best when they are compatible with contemporary beliefs. Both adults and adolescents agree that providing information to students about how best to protect them is far greater than restricting access to information. Therefore, future programs in the style of Long Live Love have their foundation in the beliefs of the majority.

Intervention strategies, like education classes, also work best when the “relative advantage” of the new innovation is greater than the former. For example, schools who formerly had abstinence only educations must assure the community that the comprehensive education program is better. When this “relative advantage” is expressed, diffusion of innovation theory comes into effect. For parents and community members, the data is clear. These programs have been proven effective; these statistics will prove the advantage. Furthermore, students will be more adept to listen to a comprehensive style education wherein discussions are based on reality and not unrealistic expectations of chastity.

Without question, abstinence only education is a proven failure. It denies students not only the freedom to make choices about their sexuality, but it also restricts useful information as to how to best approach situations of sexual activity. Communities and schools are better suited with programs like the Dutch Long Live Love model. The programs encourage sexual health behaviors, delay onset of sexual intercourse, and have proven better health outcomes. The psychological reactance theory, attitude alignment theory, and diffusion of innovation theory are helpful in illustrating why this dynamic exists.


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