Challenging Dogma - Fall 2008

Thursday, December 18, 2008

Abstinence Only’s Alienation of Developmental Psychology, Social Psychology, and Public Health Basics - Joanna Matwiejczuk

Over the last several decades, sexual education has been incorporated into high school classrooms across the country. While policies over comprehensive sexual education versus abstinence only education vary state by state and classroom by classroom, it is also evident that the political climate over this distinction has been in the eye of controversy. The federal government fiscally supports an abstinence only curriculum for adolescents and due to various factors, many schools have accepted the money from the government to teach abstinence only and thus have adopted an abstinence curriculum while forsaking comprehensive sexual education. However, not only is an abstinence only curriculum a close minded approach to sexual health education, but it is also unrealistic for the target audience, as well as irresponsible from a public health perspective. From the 2007 Centers for Disease Control Youth Risk Behavior Surveillance System, it has been found that 48.7% of adolescents have self-reported to being sexually active (1). An abstinence only curriculum therefore is virtually lost on almost half of its target population, statistically speaking. You can’t tell me what to do! What developmental psychology has to say. It comes as no surprise to parents, teachers, the general public and even adolescents themselves that the teenage years have been classified from a behavioral science perspective as a time to rebel, to break rules, to push limits and to act in exactly the opposite way that society would like them to act. This is not to say that all teenagers disobey their parents or the law, but it is inherently natural for them to engage in risky behaviors, especially behaviors that they are told not to engage in. Rebellion is a tool used by adolescents to begin establishing a sense of self and to gain independence. According to Erik Erikson's work in developmental psychology, "adolescence is a period of time in which a young person can take time to explore identity so as to work out conflicts and establish a secure sense of self" (2). Abstinence only teachings rely only on highlighting all the negative aspects of sex, such as the risks of unwanted pregnancy, the risks of contracting sexually transmitted infections, as well as the emotional harm that could result when one begins having sexual contact before they are mentally ready. However, from a developmental perspective, "youth may view abstinence as a developmentally appropriate stage, which precedes the equally appropriate stage of becoming sexually active when they are 'ready'" (3). Abstinence only education does not teach safe sex nor does it point out resources where adolescents can turn to if they do indeed choose to have sex. This absolutist curriculum is unrealistic given what we know about the psychological development of young people. They are essentially being told "do not have sex" which could only further fuel the need to rebel and thus engage in sexual activity. Our country's "just say no" attitude towards adolescent risky behaviors including alcohol consumption, substance use, tobacco use, and sex has not changed the fact that youth across the United States experiment with substances AND with sex on a daily basis.
Adolescence is also a time when young people seek greater freedom and when they hone their abilities to make positive choices. However, oftentimes, young people make many negative choices before they realize what the "right" choice is, but from a developmental perspective, they must be allowed (within reasonable means) to make various choices and recognize the repercussions of their actions. This is what learning and growth is about and this is what teenagers need in order to grow into healthy, balanced adults. "Teenagers’ identification of themselves a people committed to abstinence could keep them from considering situation in which they might someday choose to engage in sexual behavior and from learning how they might then protect themselves against unwanted pregnancy and STDs" (4).
As educators of adolescents, schools as well as the federal government, should create an atmosphere of learning where young people can be presented with many options and receive explanations of the various consequences (positive and negative) of sex before making an educated decision about how they choose to proceed in their own sexual lives. This is similar to various parenting styles in psychology developed by Diana Baumrind, in which there is strong evidence to show that authoritative parenting where children are allowed more freedom and decision making leads to better youth development outcomes, as opposed to authoritarian parenting which demands strong adherence to set rules and stunts psychological development (5). "Strong abstinence intentions may be linked with a view of sexual behavior that minimizes the role of personal choice and agency in making sexual decisions" (6). Restrictive statements and scare tactics about sex education will not foster positive youth development nor will it equip young people with the personal negotiation skills they will need for the more difficult choices in their futures. "Young people...need to be prepared to negotiate and renegotiate...[and] be treated in ways that encourage meaningful decision-making including in relation to sexuality, from a much earlier age" (7).What about your friends? Will they be around? Perspectives from social psychology. A very important aspect that is neglected in abstinence only education is the influence and power of the social environment of adolescents. In general, society is very influenced by community, peers, the media, etc. (8). This influence is heightened for our society's very impressionable teenager. Abstinence only education fails to factor in the everyday environmental exposures into the classroom curriculum. It does not account for what is already out there in the world and merely preaches a single answer (no) to a very complex issue like sex. Many (47.8%) of youth are already engaging in sexual activity and while 52.2% may not be, they are in contact with their peers daily and oftentimes intimately. Abstinence only teachings do not address the power of peers and social groups as a teenager seeks social approval and engages in conformity. Personal and group attitudes towards sex can often be much stronger than messages to simply not have sex. Young people will not only encounter sex as an issue among their peer groups, but will also be confronted with it on a much more personal level in their intimate relationships. A curriculum that incorporates the possibility of such situations and provides tools to navigate such situations would be much more appropriate given the national statistics concerning sex and adolescents and the social climate that youth live in. "They live in a largely peer-defined world easily accessible through communication technologies" (7). Another extremely powerful influence on young people is the media. Sex is not only on television, but in movies, on the radio and in music, in magazines, billboards, advertisements, news, commercials, etc. countless times each day. "The mass media are an increasingly accessible way for people to learn about and see sexual behavior. The media may be especially important for young people as they are developing their own sexual beliefs and patterns of behavior, and as parents and schools remain reluctant to discuss sexual topics" (9, 10). Adolescents are heavily exposed to the media and while they view others (adults and their celebrity peers) engaging and negotiating sexual situations in their "on screen lives," it is unrealistic to expect them not to be considering it in their own lives. Abstinence only education fails to acknowledge all of the publicity sex is gaining in our society's media and instead chooses to voice the same message of simply saying no to sex before marriage. Instead of addressing and perhaps utilizing examples of sex in the media as an avenue for a lesson plan about safe sex, abstinence only delivers the same messages today as it did decades ago. Just as Trojan condom commercials can highlight the positive consequences from engaging in safe sex, sexual health education should be able to do the same. I didn’t do it because I thought you were…Well I didn’t because you were supposed to…A stance on public health and education responsibility As educators and public health professionals, we need to consider the repercussions of an abstinence only curriculum. While it may seem "best" to encourage young people to wait until marriage or a long term relationship to have sex, in reality many youth are not taking this course of action. However, even those who do choose to wait will eventually need information, resources, and support to inform their decisions and judgment about sex. Unfortunately, an abstinence only curriculum does not equip these youth for their "next step." Abstinence only education alienates the sexually active as well as the homosexual youth population. Since these groups have either started having sex, or may not see sex in a heterosexual framework (i.e. at risk for pregnancy or for intercourse), these young people are not included and given no resources to protect their own sexual health (11).
As a center of learning, schools should take responsibility for teaching their students about sex, about the risks and benefits, about safe and protected sex, and guide young people to resources that can be utilized to help make decisions, to facilitate safe sex, or resources to turn to in a time of need following sex. "Ironically, the very methods aimed at protecting children often contribute to their abuse...[by] underminding their potential of being aware, knowledgeable, and competnet individuals" (12). Indeed we are doing a disservice to young people by not sharing the facts with them and allowing them to develop and make healthy decisions based on their individual needs. It is disturbing to think that sex education has been forced to exist only outside the classroom for so many young people. As educators, there is an opportunity to shed light, accurately inform, and spread a message but, instead abstinence only educators are just saying no. "This approach captures only negative consequences of sexual activity, ignoring potentially positive aspects, such as developing a sense of intimacy, achieving social skills and goals, and experiencing sexual pleasure" (3). For the public health world, where disease prevention and health promotion are key goals, sex in and of itself is not the public health problem. Unsafe and unprotected sex is what causes of the spread of STDs and unwanted pregnancies. Of course abstinence would solve the issues, but since that is not realistic in the long term, the focus needs to remain on the promotion of safe sex to all those at risk, including and especially, adolescents. "Sex education is intended to serve a very practical public health purpose...[but] the growing prominence of the abstinence only approach will likely have serious unintended consequences by denying young people access to the information they need to protect themselves" (11). Ignoring the issue, as abstinence only education does in a way, will not eradicate the problems associated with unsafe sexual activity.
It is also dangerous to assume that those adolescents engaged in sex and those thinking about initiating sex are armed with the facts they need in order to do it safely. Their information may not come from parents or other educational sources, but rather the internet, media, and peers which can be much less reliable and send unclear, mixed, inaccurate messages. What abstinence only education has taught us
In conclusion, abstinence only education fails to deliver what adolescents need at this developmental stage in their lives and ill equips them for skills needed to engage in positive decision making. Adolescents will eventually, if they aren't already, become a part of the sexually active population and when they reach that point, they must have some information about safe sex, as well as options and resources to turn to. "Society must recognize that a majority of adolescents will become involved in sexual relationships during their teenage years" (13). Abstinence only education has failed to account for the dynamic influence of social environment, especially media and peer groups. Instead, it has focused on a static, close minded approach to address a complex and ever changing issue that faces our teens. Above all else, abstinence only education has failed the public health community by bypassing the real issue at the heart of sex which is the prevention of disease. By not taking the curriculum to the next level, the ignorance of safe sex can lead to very negative and unfortunate outcomes for our young people. Abstinence only supporters are failing our young people by not providing them with the information they need to protect their health and well being. So it's our responsibility, but what can we do?
Given all this information, we should start to consider what a more ideal approach to achieving safe sex amongst adolescents should actually look like. We have learned that abstaining from the abstinence only educational approach may prove to be beneficial if executed properly. A comprehensive sex education program needs to be developed in order to address the multifaceted issues that adolescent sexuality raises. And, not only developed but implemented and mandated by government as the most responsible approach to sexual health education. Although "comprehensive sex education" curricula are in place in schools across the country, we must examine what that really means. I do believe that a comprehensive approach is necessary, but there are crucial, key elements missing from many of the current comprehensive programs. We must specifically address what is known about adolescent psychological development and factor that into every feature of the program. We must also carefully consider adolescent psychology from a social perspective and be aware of the social climate of our society. Lastly, in order to address the issues outlined prior, we must always keep in mind that it is the duty of educators and public health professionals to design programs that effectively incorporate information and strategies specific to adolescents when considering the features of a comprehensive sex education curriculum.
Comprehensive sex education, unlike abstinence only education, acknowledges that adolescents may already be engaging in sexual activity, or may be considering beginning engagement in sexual activity. It incorporates abstinence into the curriculum, but does not solely focus on abstinence as the only option for preventing unwanted pregnancy or the transmission of STIs. It also points out and encourages safe sex practices, such as using birth control and condoms as well as teaches communication skills to assist adolescents in negotiating sexual activity. This education should ideally be happening in the classroom, either at the middle school or high school level when a large percentage of adolescents are starting to initiate sexual activity or thinking about it. I strongly believe that a classroom setting is the most effective way to reach many young people because school is mandatory. They have to attend. School is also where youth learn everything from math to science, and sexual health should be another course that they need to complete. As an epicenter of learning in their communities, schools must take on this responsibility and intentionally address sexual health in order to fully serve the students, as well as their parents, the community members, and society as a whole. It is a public health responsibility to teach complete (comprehensive) sex education that addresses all topics and considers all members of a population. This responsibility can be achieved very effectively in a classroom setting. It is harmful to employ an abstinence only education as it falls short of information dissemination. Information that is essential to making safe, healthy decisions.But, won't they just do what they want anyway?
In order to address the complexity of adolescent psychological development it is important to acknowledge that adolescent rebellion exists and that there may not be an effective way to combat it, nor should we try to. Comprehensive sex education would be charged with needing to work around this issue and find a way to successfully incorporate strategies that can work in such an atmosphere. The message of "no sex" as abstinence only education sets forth is very absolutist and casts a rule out for adolescents to follow. Not only would this be ineffective knowing what we know about adolescent rebellion, but it also would not allow for adolescents to naturally develop cognitively. Adolescents will be faced with difficult situations throughout their lives, and "no" will not always be the answer. From a youth development standpoint, comprehensive sex education needs to allow for healthy decision-making, both encouraging the navigation of options available and also equipping adolescents with skills to be able to critically think through a decision in order to make a positive one. I propose incorporating into the comprehensive sexual education curriculum a unit on healthy relationships and decision-making strategies. This may involve interactive lesson plans that allow youth to practice skills and also must include posing situations to them about sexual scenarios that they may need to navigate. Healthy relationships will need to cover everything from friendships, "hooking up," and dating, to long-term relationships, homosexual relationships and unhealthy (abusive, etc.) relationships. Some of these topics may be sensitive and it may be difficult for teachers to talk about, but creating an open environment where frank discussion is not only allowed but encouraged may make all the difference.
Comprehensive sex education needs to exist on a continuum. In other words, information dissemination is only the first step, other supports and reinforcements need to be in place in order for the information to be fully processed and utilized. I propose supplying "sex goody bags" during sex education which include resources and samples of many commonly used contraceptives. Items can include male and female condoms, spermicide, a condom carrying case, and tangible "dummy" examples of prescription contraceptives such as the vaginal ring, the patch, etc. as well as information accompanying each piece in the bag. The bag can also include a resource list of health centers, or a business card with important information that can be kept with them at all times. This way, adolescents have a chance to experiment with the various options they have and may more effectively find one that suits them. This approach factors in adolescent development because it allows for experimentation in a controlled environment and also acknowledges that not all young people may be comfortable approaching an adult with questions about sex. This way, youth have the chance to explore various methods to prevent unwanted pregnancy and STIs, and truly get a feel for their options.They won't listen...there's too much competition...
It is critical to realize that there are many societal influences upon young people. Comprehensive sex education may have to compete for attention. Or, there may be a way to utilize and incorporate social influences (peer and media especially) into sex education. Not only are communication skills necessary for adolescents, but a reliable medium of communication is necessary. As previously discussed, young people may not be comfortable enough to raise questions about their own sexual health. I propose the creation of a text message network ("Sext me!") that can provide resources, answers to questions and support for teens thinking about sex, experiencing the emotional aftermath of sex, or needing to know where to go for help. This two-way, anonymous form of communication could be a relatively easy, non-judgmental, non-confrontational way to get questions answered and resources supplied. It goes beyond just supplying information and text messaging is a medium that adolescents communicate through a lot. Such a network and program can be established through community resources, not necessarily exclusively schools. To address staffing issues, resources can pooled through the community, or city, county, state, etc. in order to create an extended network. Also, incorporating youth into the development of the "sext network" as well as employing young people in the infrastructure can add to the legitimacy as well as the approachability that other young people will experience when they consider sending a text message to obtain sex information.
It may seem nearly impossible to counteract with media influence in the lives of young people. And although it would be extremely difficult to monitor or change what is shown in the media about sex, there is a way to counteract the messages that are conveyed about sex. I propose that classroom curricula devote time to digesting and discussing the week's, for example, media activity. Whether it be the latest episode of a popular teen sitcom, or the release of a controversial song, teachers should intentionally designate classroom time to view, discuss, demystify, and engage young people in talking about any questions that could arise. It is also important to address details that may be missing from the staged situation, or address what follow up to a scene may look like in reality. Incorporating humor and open-mindedness into the classroom discussion is essential in order for this approach to be effective. Although this does not eliminate inaccurate, unrealistic information from reaching a very impressionable audience like teenagers, it does provide a solution so as to not ignore that this indeed does exist as a very real and powerful influence in their lives. This approach also grants an opportunity for educators to remain at the forefront of current youth sex culture and remain informed. This information and experience can also help mold their classroom curriculum to be more relevant, current and timely for teenagers.In conclusion, abstinence only education barely scratches the surface of what is a complex, involved, and multifaceted issue like adolescent sexual health. Comprehensive sexual education is a primary step in the right directions. There are obviously many other interventions that can be incorporated at an after school level, or within the community, or in a young person's home. However, I believe that sex education needs to heavily involve educators who spend day after day with the same young people and who are expected to teach. And they must teach. All the options and uncover all the resources that are available. Comprehensive sex education as laid out in this discussion must incorporate creative and current strategies in order to be effective. As times change, curricula must as well. However, three facts that will not change is that adolescent sex education is the responsibility of the public health and education community. Also, interwoven into all aspects of a comprehensive sex education curriculum, must be principles seeped in what is known about adolescent psychological development and what positive, healthy youth development looks like. And finally, educators must never ignore the strong effects of peer groups and the media on our society's young people. Education need not combat these effects, but rather find meaningful ways to use social psychology principles to create a strong, all encompassing curriculum that will reach adolescents and ultimately shape their decision-making skills and capacities.

1. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, 2007.
2. Erikson, E. Identity: Youth and Crisis. London: W.W. Norton & Company, Inc., 1968.
3. Ott, MA, Pfeiffer, EJ, and Fortenberry, J. Perceptions of sexual abstinence among high-risk early and middle adolescents. Journal of Adolescent Health 2006; 39(2):192-198.
4. Masters, N, Beadnell, B, Morrison D, Hoppe, M, and Rogers Gilmore, M. The opposite of sex? Adolescents' thoughts about abstinence and sex, and their sexual behavior. Perspective on Sexual and Reproductive Health 2008; 40(2):87-93.
5. Baumrind, D. Parental disciplinary patterns and social competence in children. Youth and Society 1978; 9:238-276.
6. Fine, M. Sexuality, schooling, and adolescent females: the missing discourse of desire. Harvard Educational Review 1988; 58(1):29-53.
7. Lehr, V. Developing sexual agency: rethinking late nineteenth and early twentieth century theories for the twenty-first century. Sexuality & Culture 2008; 12:204-220.
8. Kirby, D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001. 9. Brown, JD. Mass media influences on sexuality. Journal of Sex Research 2002; 39: 42-45.
10. Brown, JD, Steele, JR, and Walsh-Childers, K (eds.). Sexual Teens, Sexual Media: Investigating Media's Influence on Adolescent Sexuality. Mahwah, NJ: Lawrence Erlbaum Associates, 2002. 11. Collins, C, Alagiri, P, and Summers, T. Abstinence Only vs. Comprehensive Sex Education: What are the arguments? What is the evidence? Policy Monograph Series, 2002.
12. Robinson, KH. Childhood and sexuality: adult constructions and silenced children (pp. 66-78). In: J.Mason, J.Mason, & T. Fattore (eds.). Children taken seriously: Theory, practice, and policy. London: Jessica Kingsley Publishers, 2005. 13. Sexuality Information and Education Council of the United States. Adolescent Sexuality Fact Sheets. New York, NY: Sexuality Information and Education Council of the United States.

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