|Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact|
By Debra Hauser, MPH, Vice President, Advocates for Youth
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" 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.
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.
During the first five years of abstinence-only-until-marriage Title V programming, the 10 states received about $45.5 million in federal funds. To further support the initiatives and to cover their required funding match, these states appropriated about $34 million in additional funds over the five years. In addition, California spent $15 million in state funds between 1991 and 1994 to support its abstinence-only initiative. In sum, the program efforts discussed in this paper cost an estimated $94.5 million in federal and state dollars.
For the most part, Title V funds were administered through states' departments of health and then sub-granted to abstinence-only contractors within each state. Program components varied from state to state and from contractor to contractor within each state. However, all programs discussed in this document included an abstinence-only curriculum, delivered to young people in schools or through community-based agencies. Popular curricula included: Education Now Babies Later (ENABL), Why Am I Tempted? (WAIT), Family Accountability Communicating Teen Sexuality (FACTS), Choosing the Best Life, Managing Pressures before Marriage, and AC Green's Game Plan, among others. Some programs included peer education, health fairs, parent outreach, and/or Baby Think it Over simulators. Some states supplemented their educational programs with media campaigns, also funded through Title V.
The 11 evaluations summarized in this document represent those Advocates for Youth could uncover through extensive research. The quality of the evaluation designs varied greatly. Most evaluations employed a simple pretest/posttest survey design. Slightly fewer than half (five) assessed the significance of changes from pre- to posttest, using a comparison group. Additionally, seven evaluations included some form of follow-up to assess the program's impact over time, although results are not yet available for two. Three of these seven also included a comparison group. For those programs that included follow-up, surveys were administered at three to 17 months after students completed their abstinence-only-until-marriage program.
Summary of Results
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.
Short-Term Impacts of State Abstinence-Only Programs
In 10 programs, evaluation measured the short-term impact of the program on at least one indicator, including attitudes favoring abstinence, intentions to abstain, and/or sexual behavior. Overall, programs were most successful at improving participants' attitudes towards abstinence and were least likely to positively affect participants' sexual behaviors.
Intentions to Abstain—Nine evaluations measured short-term changes in intentions.
Sexual Behaviors—Six evaluations measured short-term changes in sexual behavior.
Long-Term Impacts of State Abstinence-Only Programs
Seven evaluations included some form of follow-up survey to assess the impact of the abstinence-only programs over time. Results from two of these are not yet available (Nebraska and Oregon). Of the remaining five, three were of statewide initiatives (Arizona, California, and Minnesota). Two were evaluations of programs within statewide initiatives (Missouri's Life Walk Program and Pennsylvania's LaSalle Program). All five evaluations included questions to assess changes in participants' attitudes and behaviors between pretest/posttest and follow-up. Four also measured changes in intentions to abstain. Three evaluations included a comparison group.
Comparisons of Abstinence-Only-Until-Marriage versus Comprehensive Sex Education
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 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, again finding no program that produced a statistically significant change in sexual behavior. This was again confirmed in 2000, 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.
Abstinence-only programs provide these youth with no information, other than abstinence, regarding how to protect themselves from pregnancy, HIV, and other STIs.
Table I (pdf) includes information about the evaluation design, short-term impacts, and long-term impacts of the 11 programs summarized in this document. Individual state-by-state summaries follow, ordered alphabetically by state.
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.