Abstinence-only failure

At what point do we admit that something is a failure, and stop supporting it with our time and money?

Because that time has come for abstinence-only sex education.  Actually, that time came and went a few years ago, when the Sexuality Information and Education Council of the United States (SIECUS) published a fact sheet with the damning information that not only does it not decrease rates of teen pregnancy and STD transmission, that the states that pushed abstinence-only sex education had increased rates of both.  Additionally, SIECUS stated that:

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 found strong evidence that abstinence-only-until-marriage programs do not have any impact on teen sexual behavior. 

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 to be 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.”

$1.5 billion later, that's pretty unequivocal.  Our determination to stick with this obvious failure has to do with two things, I think; the desperation of some people to demonize sexual behavior and therefore legislate sexual morality, and the sunk-cost fallacy -- if we've already put a lot of money into something, we have to keep forging ahead out of some crazy sense that doing so will justify the amount of money we've already spent.

In other words, continue to blow money on a losing proposition because to admit defeat and reverse course would make it obvious that we've been wrong from the outset.

[image courtesy of photographer Bruce Blaus and the Wikimedia Commons]

In any case, the word is finally getting out that the only way to reduce the incidence of teen pregnancy is to have candid, fact-based sex education, and cheap, available birth control.  So what's an arbiter of morality to do?

Export the same failed plan to other countries, of course.

Starting in 2004, Congress has allocated $1.4 billion to fund abstinence-only sex education in sub-Saharan Africa, ostensibly to slow down the transmission of HIV, but driven by the same sex-equals-bad morality that generated similar programs here in the United States.  And to no one's particular surprise, methodologies that didn't work in one place don't work anywhere else.  According to a paper  by Christine Gorman published this week in Scientific American:

A rigorous comparison of national data from countries that received abstinence funding under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) with those that got none of the funding showed no difference in the age of first sexual experience or in the number of sexual partners or teenage pregnancies—all aspects of behaviors that have been linked to a higher risk of becoming infected with HIV.

Who could have predicted that?

What the study also showed was that the single factor that correlated best with low HIV transmission rates and decreased risk of pregnancy outside of marriage was educational opportunities for women.  Give women opportunities for education and career, and they are less likely to engage in behaviors that might jeopardize their goals for a better life.

It seems like common sense to me.  Education, especially for young women.  Teach children about sexuality and responsibility and how their own bodies work.  Given that most teenagers think about sex pretty much 24/7, make sure they understand the importance of birth control and know how to use it, and make contraceptives widely available and cheap.

And fer cryin' in the sink, stop pretending that abstinence-only sex education works.  We've wasted enough money, and worse -- stood by while thousands of young women got pregnant when those pregnancies might have been prevented through sex education that is actually effective.

Puritans in charge

H. L. Mencken once quipped that "Puritanism [is] the haunting fear that someone, somewhere, may be happy."  We always associate Puritanism with the 17th century, with funny hats with buckles and dark clothing and women in modest dresses -- and the torture and execution of witches.  In other words, as a thing of the past.

[image courtesy of the Wikimedia Commons]

However, there is a deep streak of Puritanism in our culture still.  The simultaneous obsession with and revulsion over sex in the United States is peculiar, to say the least.  You can't go to a mall without being accosted by images of nearly naked models of both genders in places like Victoria's Secret and Abercrombie & Fitch.  Movies and television are full of references to sex, both oblique and overt.  And yet a lot of the time, we alternately act as if sex is shameful or depraved, or as if it simply doesn't exist.

And in no realm does our split attitude show as clearly as in how we educate children about their own bodies.  Any time someone proposes frank, realistic sex education in schools, parents have a meltdown about the erosion of morality in the United States.  As if their children won't become sexually active unless they find out about it in class.  As if there weren't an inverse correlation between teen birth rates and the degree to which birth control, HIV prevention, and general sex education is addressed in the schools.  As if abstinence-only education programs haven't been shown over and over to be completely ineffective at reducing teen pregnancy and the incidence of STDs.

Ignore it and it won't happen, seems to be the usual approach.

Of course, when simply ignoring sex doesn't work, the modern-day Puritans choose instead to go on the offense.  Witness the recent push by lawmakers in Kansas to prosecute teachers who "expose students to material of a sexual nature."

We're not talking about pornography here.  The whole thing got started by Representative Mary Pilcher-Cook, who flipped her frilly white bonnet when she found out that there was a poster displayed in Shawnee Mission High School that had the question, "How do people express their sexual feelings?" and listed "oral sex" as one possibility.  Pilcher-Cook said, in a quote that I am not making up, "Children could have been irreparably harmed by viewing this poster... because it affects their brains."

"State laws should protect parents’ rights to safeguard our children against harmful materials, especially in schools," Pilcher-Cook went on to say.  "The fact that the poster was posted without fear is a problem in and of itself."

Phillip Cosby, head of the American Family Association of Kansas and Missouri, was quick to jump to her defense.  With respect to children finding out about sex, he said, "It’s a tsunami.  And maybe we’re the Dutch boy who’s just putting their finger in the dam."  He went on to say that he can't even watch a Kansas City Royals game with his grandchildren without their seeing a commercial for erectile dysfunction.

So how is that a problem, Mr. Cosby?  When my sons were young, I can see the conversation going this way:

Television commercial:  "See your doctor if you think this medication might help your erectile dysfunction." 

My kid:  "Dad, what's 'erectile dysfunction?'" 

Me:  It's a problem some older guys get, where the penis doesn't work as it should.  There's a medication that can help." 

My kid:  "Oh.  Okay.  When's the baseball game going to be back on?"

Yup.  They'd clearly have been scarred for life.

It isn't that I'm not cognizant of the importance of a child's age with regards to what sort of material they're exposed to.  With sexuality, as with most things, there is a point where children become capable of understanding, and it's not a good idea to push ideas on kids for which they're not emotionally ready.  But we seem to have no particular problem with trusting educators to make those judgments in other realms, do we?

No one is assigning Macbeth to nine-year-olds, for example.

But there's something different about sex, apparently, that makes it taboo at any age.  Instead of being honest with our children about their own bodies, we're teaching them that their feelings and desires are inherently shameful.

I still remember a couple of years ago in my neuroscience class, when we were talking about neurotransmitters.  I brought up endorphin, which is a neurotransmitter associated with pleasurable feelings of all sorts, and I mentioned that endorphin is released in the brain during orgasm.

One student looked a little taken aback.  I asked him what was up.  He said, blushing scarlet, "I've never heard a teacher use that word before."

This kid, by the way, was in 11th grade.

Why shouldn't we be honest with kids about their bodies as a source of pleasure and as a way to connect with their partners, and not just as a tool for reproduction?  When we take a step past the focus on men and women as baby-making machines, it's usually only to warn students about the risks.  Only rarely do we make any effort to give teenagers a well-rounded view of sexuality.  How do we expect young people to approach sex in a respectful and responsible fashion when we won't even bring up the topic?  And considering the fact that teenagers are usually hyper-focused on sex anyhow, isn't it better to discuss it openly rather than pretend that if we ignore it, it'll go away?

But the undercurrent of Puritanism that still exists in the United States makes it unlikely that such an approach will be realized any time soon.  If we're still at the point when a state legislator wants to have criminal charges levied against a teacher for mentioning oral sex, we have a very long way to go.