Abstinence and Abstinence-Only Education: A Review of U.S. Policies and Programs

While few Americans remain abstinent until marriage and most initiate sexual intercourse as adolescents, abstinence from sexual intercourse is an important behavioral strategy for preventing human immunodeficiency virus, other sexually transmitted infections, and unintended pregnancy among adolescents, according to the report, Abstinence and Abstinence-Only Education: A Review of U.S. Policies and Programs.

The paper also notes that while there is broad support for abstinence as a necessary and appropriate part of sex education, controversy arises when abstinence is the sole choice for teenagers. John Santelli, MD, MPH, professor and chair, Heilbrunn Department of Clinical Population and Family Health, Mailman School of Public Health, and professor of Clinical Pediatrics, Columbia University is the lead author of the report, published in the January issue of the Journal of Adolescent Health.

The paper supports abstinence from sexual intercourse as "a healthy choice for teenagers" but critiques government policies and programs that promote abstinence-only or abstinence until marriage as the only prevention message for teenagers. According to the report, abstinence as the sole option for adolescents is scientifically and ethically problematic and should be abandoned as a basis for health policy and programs.

"Abstinence is a very healthy choice for teenagers - but sex education for teenagers needs to give teenagers all the facts – all the medically accurate information they need to protect themselves, " said Dr. Santelli. "While abstinence from sexual intercourse is theoretically fully protective from pregnancy and sexually transmitted infections, in actual practice, abstinence often is not maintained which leaves teenagers vulnerable to pregnancy and STIs." Recent data indicate the median age at first intercourse for women is 17.4 years, while the median age at first marriage is 25.3 years.

The report recommends that efforts to promote abstinence should be based on sound science. Drawing a distinction between abstinence as a behavior and abstinence-only programs, the paper concludes there is no evidence base for providing "abstinence only" or "abstinence until marriage" messages as a sole option for teenagers. In reviewing scientific literature, the report finds abstinence-only programs demonstrate little evidence of efficacy in delaying initiation of sexual intercourse. Conversely, efforts to promote abstinence as part of comprehensive reproductive health promotion programs, which provide information about contraceptive options and protection from STIs, have successfully delayed initiation of sexual intercourse.

The review of U.S. policies and programs also finds ethical problems with abstinence-only programs, because they provide misinformation to teenagers and withhold information needed to make informed choices. "Typically, abstinence-only education programs provide incomplete and/or misleading information about contraceptives, or no contraceptive information at all. In many communities, abstinence-only education has replaced comprehensive sexuality education," observes Dr. Santelli. According to the paper, federally funded abstinence until marriage programs neglect and stigmatize gay and lesbian youth. These programs also neglect real health needs for contraception and STI testing among sexually experienced youth, putting these youth at increased risk for unintended pregnancy and STIs, including HIV.