by Debra Hauser, Advocates for Youth; Monica Rodriguez, Sexuality Information & Education Council of the US (SIECUS);  Elizabeth Schroeder; and Danene Sorace

We have been around long enough to expect politics as usual in Washington, D.C. The backroom deals and secrecy should not surprise us.  The jettisoning of young people and their sexual health for political expediency is not new.  But, this blatant hypocrisy needs to stop.  This latest example is just too much.

Sometime this month an updated list of “evidence-based” teen pregnancy prevention programs was endorsed by the Department of Health and Human Services (HHS) and posted to the website of the Office of Adolescent Health (OAH). No notice, not even a press release to announce the addition of three programs to the coveted list of 28 deemed effective and carrying the HHS seal of approval.

Until now, this list was the holy grail of the Administration’s commitment to a science-based approach to teen pregnancy prevention and a directive for grantees of the President’s Teen Pregnancy Prevention Initiative (TPPI).

So why the secrecy about the new additions? What does the Administration have to hide?

Perhaps the Administration realized that the inclusion of Heritage Keepers Abstinence Education on this select list would call into question its commitment to young people and their sexual health.  Once again they have succumbed to the political pressure of social conservatives and allowed the ideology of the right to prevail over the health and well-being of the nation’s youth.  The Obama Administration’s endorsement of this abstinence-only-until marriage program runs in direct contradiction to its stated commitment to the health and well-being of young people and, quite possibly, its promise to uphold science and evidence.

The Trampling of Young People’s Sexual Health

The President has talked about his administration’s commitment to LGBT health and rights by recording his own “It Gets Better Video” and announcing support for both the Safe Schools Improvement Act and Student Non-Discrimination Act.  And, the CDC has recognized the disproportionate impact of the HIV epidemic on young men who have sex with men and has committed millions of federal dollars to reducing the burden of disease on this population.

Yet, at best Heritage Keepers Abstinence Education ignores LGBT youth --and at worst it promotes homophobia. The stigmatization of LGBT youth throughout the program reinforces the cultural invisibility and bias these students already face in many schools and communities. The curriculum's focus on marriage as the only appropriate context for sexual behavior further ostracizes LGBT youth and the children of LGBT parents who still cannot legally marry in most states.

The Director of the CDC has called teen pregnancy prevention and HIV prevention two of the country’s six “winnable battles,” and recent analysis of National Survey of Family Growth data trends indicates that significant reductions in teen births have been primarily fueled by increased contraceptive use.[1]

Today roughly 40 percent of high school students have had sex[2] and young people under age 29 continue to account for approximately 30 percent of all new cases of HIV infection.[3]

Yet, Heritage Keepers Abstinence Education does not include information about the health benefits of contraception or condoms.

Igniting Fears and Spreading Misinformation

In fact, Heritage Keepers contains little or no information about puberty, anatomy, sexually transmitted diseases, or sexual behavior. Instead, most of its lessons are devoted to promoting the importance of heterosexual marriage and the value of abstinence before marriage. Students are asked to take virginity pledges and class time is devoted to having students envision and plan their wedding days.  Heritage Keepers also teaches students that:

• “Males and females are aroused at different levels of intimacy. Males are more sight orientated whereas females are more touch orientated.” The implications of this difference are explained further: “This is why girls need to be careful with what they wear, because males are looking! The girl might be thinking fashion, while the boy is thinking sex. For this reason, girls have a responsibility to wear modest clothing that doesn't invite lustful thoughts.” (Heritage Keepers, Student Manual, p. 46)

• “Sex is like fire. Inside the appropriate boundary of marriage, sex is a great thing! Outside of marriage, sex can be dangerous.”  (Heritage Keeper, Student Manual, p. 22)

• “Cohabitation (when two people live together before marriage) is not like marriage!  [Heritage Keepers, p 30] When couples live together outside of marriage, the relationships are ‘weaker, more violent, less [equal], and more likely to lead to divorce”” (Heritage Keepers, Student Manual, p. 26)

• “One reason may be that when people bond closely through sexual activity, then break up and bond with someone else, and then someone else, it may become increasingly difficult to maintain a lasting bond.” (Heritage Keepers, Teacher Manual, p. 56)

• Sexual activity outside of marriage can lead to:“Sexually Transmitted Viruses, Sexually Transmitted Bacteria, Cervical Cancer, AIDS, Legal and financial responsibility for a child until he or she is at least 18, Raising a child alone, Emotional hurt and regret, Increased chance of abuse from a partner.”  (Heritage Keepers, Student Manual, p. 35)

When planning their weddings during class:

• Young men are asked to envision their wedding day: “The doors swing open and there stands your bride in her white dress…This is the woman you have waited for (remained abstinent for) who has waited for you…This woman loves you and trusts you with all that she is and all that she has. You want to be strong, respectful and courageous for her. With all your heart, you want to protect her, and by waiting (sexually) you have.” (Heritage Keepers, Student Manual, p. 59)

• Young women are asked to envision their wedding day: “Everything is just as you have seen it in a million daydreams…” When the bride takes her father's arm: “Your true love stands at the front. This is the man who you have waited for (remained abstinent for) and who has waited for you…This man wants to be strong and courageous for you, to cherish and protect you… You are ready to trust him with all that you have and all that you are, because you have waited (sexually) you have it all to give.” (Heritage Keepers, Student Manual, p. 49)

Limited Evidence of Effectiveness

Not only does the Heritage Keepers program ostracize LGBT youth, withhold life-saving information from sexually active and HIV-positive youth, and  use fear-based messages to shame sexually active youth, youth who have experienced sexual assault, and youth living in “nontraditional” households, there are also questions about the effectiveness of this program to delay sexual initiation or favorably impact sexual behavior among youth. The original evaluation by Stan Weed, et al of the Heritage Keepers program in 2005 was criticized by other researchers for having a flawed design[4] and was never published, much less published in a peer-reviewed journal.  Next, the program was reviewed in a congressionally mandated study of Title V abstinence-only-until marriage programs conducted by Mathematica Policy Research, Inc. and published in 2007. Mathematica found no evidence to support the effectiveness of the program. Specifically, their interim report stated:

…the [Heritage Keepers] Life Skills Education Component did not have significant impacts on 11 of the 12 intermediate outcomes related to sexual abstinence. The one exception is a significant impact among middle school youth on their friends’ support for abstinence. [5] 

Mathematica’s final report concluded:

Findings indicate that the [Heritage Keepers Abstinence Program’s] Life Skills Education Component had little or no impact on sexual abstinence or activity. [6]

But, we are expected to believe that the third time must be a charm?  This winter Mathematica was contracted by HHS to review evaluations for their rigor and this time they recommended Heritage Keepers for inclusion on the list of HHS-approved programs. To date there is still no published peer-reviewed manuscript to help assess what, if anything changed for the program to make the list.  Was a new study conducted?  Did the authors submit new data or simply rework the old?

A Call for Evidence and Rights

Whether the data exists to support the program’s effectiveness is still in question, but the egregious content of the program is crystal clear. The Administration’s hypocrisy must end.  It is time to embrace both an evidence- and a rights-based approach to youth sexual health promotion. Evidence of effectiveness is important but it should not be sufficient. It is not enough to help some students delay sexual initiation while leaving others ill-equipped to protect themselves when they do have sex.  It is unacceptable to promote teen pregnancy prevention at the cost of ostracizing LGBT youth, survivors of sexual assault, or youth who are sexually active.  Thirty years of public health science clearly demonstrates that providing young people with information about the health benefits of both abstinence and contraception and condoms, does not cause young people to initiate sex earlier or have sex more often.^{4,[7], [8]} Abstinence-only-until marriage programs leave young people unprepared.  They are unethical.

Young people have the right to honest, age-appropriate, comprehensive sexual health information to help them protect their health and lives.  The Administration should immediately remove Heritage Keepers Abstinence Education from the HHS-endorsed list of evidence-based programs currently posted on the Office of Adolescent Health’s (OAH) website. America’s youth deserve better.