Challenging Dogma - Fall 2008

Thursday, December 18, 2008

Abstinence-Only Education: The Failure of a National Forced Belief – Elizabeth Usaj


Abstinence-only education (AOE) programs have been on the rise in the United States since 1996, when the federal government created a program called Title V – section 510 of the Social Security Act (1). Title V is a program that was passed as an attachment to a welfare reform law, and allowed for federal funding for AOE programs. President Bush’s 2009 budget designates $204 million for these AOE programs, which is a steep increase from the original $50 million in 1996 (1). To be eligible to receive these federal funds, a program must follow eight explicit characteristics, which require the programs to teach the physical, social, psychological and emotional consequences of early sexual experimentation and the value of sexual abstinence (2). The programs also must not include a discussion of contraception’s as protection against STDs or pregnancies, because the programs make the assumption that sex in a monogamous, married relationship is the expected standard of behavior (2).

Supporters of AOE programs typically believe that teaching abstinence is the only way to prevent unwanted teenage pregnancies and sexually transmitted diseases (STDs), not discussing safe sex practices and proper contraception use. Current statistics regarding teen pregnancy and STDs show that the issues are still of major significance to teenagers and that AOE programs have had little to no effect in reducing the overall rate of occurrence. The Centers for Disease Control and Prevention (CDC) has estimated that approximately 19 million new STD infections occur each year, and that almost half of them are among teens aged 15 to 24 (3). Teenage pregnancy is estimated at 757,000 a year among women aged 15-19 years of age (4). The U.S. has the highest rate of unwanted teenage pregnancies among developed countries (5), despite the hundreds of millions of dollars a year that are thrown at AOE programs aimed at preventing it. The failure of AOE programs can be attributed to the fact that they do not allow for self-efficacy, do not take into account social and environmental factors, and lack adequate understanding of how teenagers react when being told what to do.

Misleading with False Information and Claims of Morality

AOE programs are inherently coercive and provide misinformation and withhold information needed to make informed decisions (6). Information that is provided in 80% of the AOE curricula regarding reproductive health is false and distorted, claiming that “5-10% of women who have legal abortions become sterile” and that “the popular claim that ‘condoms help prevent the spread of STDs’ is not supported by data” (7). Statements such as these are often discussed as the facts in AOE programs and hinder teen’s ability to decide what is fact and what is fiction. Being provided with the wrong information removes a person’s ability to make an informed decision and infringes upon their self-efficacy. The belief that someone can carry out the desired behavior is affected by knowledge of steps necessary to avoid the risk (8). Teens who have information about reproductive health are more likely to use contraception than those without such information (9).

Albert Bandura, creator of the Social Learning Theory, uses the concept of self-efficacy as a main principle to achieve a desired outcome in his theory. Bandura states that self-efficacy is the conviction that one can successfully execute a specific behavior required to produce the desired outcomes (10). AOE programs fail to incorporate this key aspect of decision making into their structure and curriculum, removing a person’s belief that they have control over their own decisions. It has been shown that behavioral beliefs, self-efficacy, and other skills can reduce STD risk-associated sexual behavior among adolescents (11).

“Federal regulations for state abstinence education funding adopt a moral definition of abstinence, requiring that abstinence education teach that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity” (6). In AOE programs, the word abstinence is often defined in moral terms, using language such as “chaste” or “virgin”, and frames the activity of abstinence as an attitude or a commitment in addition to a behavior (6). Teenagers who have had sex or are contemplating sex may feel ashamed and embarrassed that they are performing immoral or unethical acts, and may try to hide their behaviors. This secrecy can lead them to avoid doctor’s visits that would prevent or treat STDs and pregnancies. The moral definition of abstinence programs is also discriminative against the gay, lesbian, bisexual, transgender and questioning youth because the definition of marriage is limited to heterosexual couples (6). Today, there is currently only one state that recognizes same-sex marriages, which helps to create a stigma around homosexuality as deviant and unnatural behavior (12). These youth may tend to feel isolated, lonely and immoral, increasing their risky behaviors and eliminating their ability to execute healthy behaviors.

Friends and Family Matter

AOE programs are based on the Health Belief Model (HBM) which focuses only on individual level factors and ignores many key aspects of a person’s life that influence decisions. “The HBM explicates the relationship between individual health beliefs associated with a disease or medical condition, and likelihood of engaging in preventive health actions” (13). The model assumes that individual decisions are made in a vacuum and that socioeconomic status, culture, race, social networks, media, and peer pressure do not play into one’s decision. For example, members of racial and ethnic minority groups are more likely to engage in behaviors that lead to early pregnancy, childbearing, and sexually transmitted infections (14). AOE programs are cookie cutter in design and focus on the general population of adolescents, not incorporating the other influential factors into their curriculum.

Peer pressure can play a large role in one’s decision to begin sexual activity. Teenagers with sexually active friends are more likely to engage in sexual activity themselves – they see sex as a “cool” thing to do (15). Even kids who believe, but don’t know for sure, that their peers are having sex, are more likely to engage in sex and feel that it will increase others’ respect for them (16). The same goes for condom usage and contraception methods. Teens who believe their friends do not use condoms are less likely to use them (17).

The relationship with one’s family influences one’s sexual behavior just as much as peer pressure can. Teens born from teenage mothers are more likely to start having sex at an early age and become teen parents themselves (9). Conversely, teens that come from families with two parents that are more educated and have higher incomes are “more likely to engage in positive reproductive behaviors than their peers who lack such backgrounds” (18). The expansion of a visible sexual culture including the increasingly sexually oriented media can also factor into a teens decision as to whether and when to engage in sexual behavior (19). The historical context and current environment of the teen can predict, to some degree, the likelihood that they will engage in risky sexual behaviors. The current AOE programs being designed around the HBM model fail to account for such factors, limiting the impact of the program.

Rational decision-making is another major flaw with the HBM. The model assumes that behaviors are always planned and rational. AOE programs follow this model and ignore the fact that behaviors can be impaired by other risky behaviors such as substance abuse. Teens that are already involved in other risky behaviors such as using alcohol and drugs are more likely to engage in risky sexual behaviors (20). Alcohol and drugs are known substances that blur one’s sense of judgment between right and wrong. Teenagers experimenting with alcohol and drug use could end up having unplanned sexual activity, where there is less of a chance of using protection. AOE programs, by not teaching or discussing information on contraception, do nothing to decrease the chance that these teens, while under the influence of alcohol and drugs, will use protection. 81% of teens want young people to receive more information about both abstinence and contraception (21). Including information regarding contraception options in AOE programs could possibly increase the chance of using them during unplanned and irrational sexual activity.

Don’t Means Do – Rebellious Teens

When a parent asks a teenager to do something, teens usually say no. It is not that they don’t want to help out; it is the mere fact that teens don’t like being told what to do (22). Teens want to figure things out for themselves and have the personal satisfaction of achieving it on their own. This ideology can be applied to AOE programs. Teens want the facts and then to be left to make their own educated decision (22). Smoking, risky sexual behavior and alcohol are all behaviors about which teens want to make their own decisions, and for which the government has set restrictions – in essence telling teens what not to do. Generally the methods used the Florida’s “Truth” campaign can be applied to the AOE programs, as teens generally feel the same way about sex as they do smoking. Research found that for the campaign to be successful the tone of “truth” could not preach and that “truth” needed a message other than “don’t” (22). Research also showed that teens were already well aquatinted with the negative effects of tobacco and despite this knowledge and awareness, teens still saw smoking as rebellious and self-identifying (23). “Using tobacco was a tool of rebellion for the teens, and was all about sending a signal to the world that the user made decisions for themselves” (22). Understanding this attitude, the “truth” campaign turned the focus from telling teens to stop smoking; to telling them it was actually the tobacco companies that were telling them what to do. This idea made the teens want to rebel out against the tobacco companies and the rates of smoking decreased.

The US has created an environment for teenagers to rebel out against the government’s forced beliefs and attitudes regarding sex. Comparing the US teenage pregnancy rates against other developed countries, the US tops the list (5). The situation is the UK, for example, is rather different in that “abstinence education has no support in public policy and receives no funding from government, although there is an expectation that sex educators in schools will emphasize the potential benefits of delaying or abstaining from sexual activity alongside providing information about contraception, sexual health services, sexuality and gender issues” (24). The U.K. government believes that encouraging a delay in the start of sexual activity has its place, but that fundamentally they must recognize the reality that people are able to make their own decisions about their sex lives (25).

Western and Northern European countries are beginning to accept the idea that teens will begin to have sex in their teenage years, certainly before marriage. Rather than trying to force abstinence beliefs upon their citizens, these countries “emphasize through their social institutions the provision of sex education and health care services aimed at equipping young people to avoid the negative consequences of sex” (26). These countries are going against the AOE programs by encouraging and expecting the teens to use contraceptives. This method has been proven effective by studies showing that rates of teenage pregnancy, childbirth and STDs are low in these countries (26).


AOE programs are fundamentally flawed in theory, design and message. Failure to allow for self-efficacy in the programs eliminates teen’s ability to feel that they are capable of postponing sex until they are married. The program curriculum provides false and misleading information. The curriculum also discriminates against the gay, lesbian, transgender and bisexual population by only considering marriage for heterosexuals. The program language also creates a sense that abstinence is the only moral decision for preventing pregnancies and STDs, forcing teens to feel embarrassed or ashamed of their sexual activity.

A teenager does not make a decision to have sex by only thinking about their individual susceptibility and severity. Teens tend to engage in risky sexual activity as a result of peer pressure, family circumstances, media attention, or even under the influence of alcohol and drugs. Their decisions are not always planned and are not always rational. AOE programs fail to account for these factors since the programs are designed off of the HBM. AOE programs also fail to account for the mentality of teenagers when it comes to being told what to do. Teens hate being told what to do and rebel out against this idea by any means that show they are in control. With the amount of money put into sexual education programs, it is only reasonable that they be expected to produce meaningful results. AOE programs have been proven ineffective, so now additional measures must be taken, including teaching safe sex practices and contraception use. These realistic programs, which do not insult the intelligence of their target audience, have been proven far more effective abroad, so it is time we started expanding them in the United States.

A Counter-Proposal to Abstinence Only Education Programs: Re-Framing Sex Education

With the United States ranking highest among industrialized countries in teenage pregnancy and the rates of STDs skyrocketing (3,5), the time for change is now. The current method of sexual education aimed at teens, abstinence only education (AOE), has not accomplished the goal of reducing teenage pregnancies and STDs. AOE education programs are based on the premise that teens should not engage in sexual intercourse until they are married (2), despite the fact that “few Americans remain abstinent until marriage, many do not or cannot marry, and most initiate sexual intercourse and other sexual behaviors as adolescents” (6). In order to create an environment where sexual education can make an impact on the rates of unwanted pregnancies and STDs, the United States needs to re-frame the way we think about sex. This new way to think about sex must address the key limitations of the AOE programs. AOE programs do not allow for self-efficacy, do not take into account social and environmental factors, and lack adequate understanding of how teenagers react when being told what to do.

Proposed Intervention

An intervention that would reduce the number of teenage pregnancies and STD infections would have to take a two-fold approach. The first step would be to re-frame the way the United States thinks about sex in an effort to create a social change. The second step would be to eliminate AOE programs because of their misguided framing of sex, and re-vamp the sexual education curriculum to include information on urging protection, based on social norms and the environment. To begin to re-frame the way the US thinks about sex is a difficult undertaking that may take a considerable investment of time to accomplish. “Frames are fundamentally about the relationship to the world and how people view it,” (27) they are unconscious, develop naturally, come into the public's mind through common use (28), and can be hard to change. The current frame used regarding sex is that sex before marriage is immoral and wrong, and that abstinence is the only way to protect oneself from unwanted pregnancy and STDs. Framing is a powerful tool to use to change peoples behavior. “The essence of social change is changing perceptions, which itself is the territory of framing” (27). People can often be expected to change their behavior solely based on the way something is framed or worded.

The proposed intervention would frame abstinence as being unrealistic and focus on the notion of “be real, be safe.” The frame would acknowledge that teens do engage in sexual activity, but that society doesn’t have to think it’s wrong and immoral. The message would no longer be “don’t have sex before marriage,” but “if a teen chooses to engage in sex, be safe and use protection.” The unconscious frame would no longer be “sex is wrong before marriage,” but “if you I’m going to have sex, I should be safe about it.” This key message would disseminate throughout all aspects of sexual education including the elimination of AOE programs. The basis for sex education for teens would now incorporate curriculum including contraception options, and the method of teaching would be based on the Social Learning Theory, including information on social factors and the environment.

The Social Learning Theory, created by Albert Bandura says that changing a behavior is based on three factors: “A person’s sense of self-efficacy about the behavior, the social/physical environment surrounding individuals, and the interactive process of reciprocal determinism, where a person acts based on individual factors and social/environmental cues, receives a response from that environment, adjusts behavior, and acts again” (29). The proposed programs are designed to incorporate the key message of how social factors and environmental factors can also affect a teen’s relationship with sex and contraception use, factors that AOE programs were lacking.

Knowing The Full Truth

The new intervention method of teaching teens about contraception provides them with the full range of options to prevent pregnancies and STDs. Teens will no longer be provided with false and misleading information regarding contraception, as was occurring under AOE programs (6). Teens will have access the full truth about prevention and will be able to make informed decisions for themselves. It has been shown that teens who do have information about prevention of STDs and pregnancy are more likely to use those contraception methods than those without such information (9). Self-efficacy, the ability to make informed decisions and the belief that one can successfully carry out the desired behavior to prevent STDs and pregnancy (10), will no longer be minimized in the new method of sexual discussions. Studies have also shown that self-efficacy can reduce STD risk-associated sexual behavior among teens (11).

The new frame for sex will no longer consider sex before marriage to be wrong or immoral. Teens that are engaging in sexual activity before marriage will no longer be compelled to hide their behavior or feel ashamed. The frame will encourage teens who choose to engage in sex to use protection. The gay, lesbian, bisexual, transgender and questioning youth will not be discriminated against under the new frame. AOE programs framed the moral standard of sex to be in a monogamous faithful marriage between a man and women (6). With the lack of states that recognize same-sex marriages, the stigma around homosexuality is that it is unnatural and immoral (12). Because the new frame will not place an emphasis on what constitutes a marriage, and will acknowledge that sex happens before marriage, the message will be pure – just be safe. The gay and lesbian population of teens will no longer need to feel isolated or immoral. They can have the confidence that their relationship or sexual activity is deemed normal and the frame of “be real, be safe” applies to them.

Accounting for “The Other” Factors

The new frame and updated sexual education materials will now account for external factors that play a part in teens decision-making process. The cookie cutter design of AOE programs can now be tailored to the specifics of the population in each classroom. Socioeconomic status, culture, race, social networks, media and peer pressure all play into the decision-making process, and information regarding these factors can be incorporated into the curriculum. Education around contraception usage among teens can be discussed and can be turned into the social norm. The knowledge of contraception can also increase use among teens; even when sexual behavior is unplanned or irrational. If teens believe their friends are using condoms, they are more likely to use condoms themselves (17). The old frame allowed teens to see sex as the “cool” thing to do if their friends were doing it (15). With the new frame, the “cool” thing is to use protection if having sex, and the teens will be armed with the appropriate information regarding contraception.

Once sex education classes are modeled around the Social Learning Theory and with the re-framing, factors such as a teen’s family, their history, and even the media will be included in discussions as to why it is good to use protection when having sex. The current media has dramatically expanded the visibility of a sexual culture, which plays into a teen’s decision to become sexually active (19). With the re-framing, acknowledging this fact can be used to the intervention’s advantage. The program could ensure that protection ads are run often, and through popular teen shows, demonstrate that it is “cool” to use protection.

Teen’s family and past history can also influence teen’s behaviors. Teens born from teenage mothers are more likely to start having sex at an early age and become teen parents themselves (9). These teens could have thought that since their mom was a teenage mom, that was normal. Since this lifestyle was all they had known, their environment was supporting that conclusion. Further, existing AOE programs were supporting the conclusion that teenage motherhood is acceptable so long as it is accompanied by a teenage marriage, and it is not too much of a stretch for a pregnant teen to accept the former without the latter. With re-framing the way society views sex, those teens may change their feeling about teenage pregnancy by seeing that the norm is not to be a teenage mom, but to use protection when having sex. Following the Social Learning Theory based curriculum, the media and family history are all part of a teen’s environment and will play into the teens decision making process about when to use protection.

A New View

Under the new proposal, society will no longer be telling teens not to have sex. The framing instead would be, society understands that teens will have sex, just be safe and smart about it - use protection. Teens hate being told what to do - they want to know the facts and then left alone to make their own educated decisions (22). A re-framing message has been proven effective in Florida’s anti-tobacco “Truth” campaign. Research conducted for the campaign found that for the campaign to be successful, the tone of “truth” could not be preachy and that “truth” needed a message other than “don’t” (26). To avoid the “don’t” message, the campaign re-framed the idea that society was telling teens not to smoke, to a frame that the tobacco companies were taking independence away from teens and that it was the tobacco companies that are now trying to tell teens what to do. The methods used in the anti-smoking campaign are applied to sexual behavior in the proposed intervention, as teens generally feel the same way about sex as they do smoking: they want to make up their own minds.

Re-framing sex and providing information regarding contraception is the method that most Western and Northern European countries are using to reduce pregnancies and STDs (24). These countries acknowledge that teens are going to have sex, so they put the emphasis on protection and contraception use. This method has been proven effective in reducing the rates of teenage pregnancy, childbirth, and STDs in these countries (26). The proposed intervention has taken into account what other countries are doing to reduce their rates, further proving that re-framing the idea of sex and providing information on contraception, family history, media and social norms can and will help reduce the rates of the US teen pregnancy and STDs.


AOE programs lack key elements that reduce their chances of achieving their desired goal of lowering the rates of teenage pregnancies and STDs. The proposed intervention accounts for these elements in two key ways: 1) by re-framing the way society views sex among teenagers 2) by basing the sexual education programs around the Social Learning Theory, incorporating teens’ social environments into programs promoting contraception use. Pregnancy and STD exposure are serious risks facing almost all teens. Ignoring the reality that teenagers will, despite all efforts, continue to be sexually active is not doing them any favors. Confronting these mature issues with tactics aimed at juveniles belittles both the issues and the audience. The proposed intervention seeks not only to reframe the way teenagers and Americans in general conceive of teen sexuality, but to empower teenagers with the knowledge to make informed choices and thereby the confidence to make the right decisions.


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