Menstuff® has compiled the following information on abstinance failure. There is potential failure with all forms of prevention, which often comes from not having the knowledge of how to use the protection. That's why it is so important to know as much about "safer sex" before ever experiencing even petting. Without that knowledge, the chances of acquiring an STD or having an unplanned pregnancy, increases dramatically. Nonpartisan researchers have been unable to document measurable benefits of the abstinence-only model. Columbia University researchers found that although teenagers who take "virginity pledges" may wait longer to initiate sexual activity, 88 percent eventually have premarital sex.
The next time someone tells you that abstinence is the only way to be 100% safe from having an unintended pregnantcy or an STD, ask them about self-masturbation. If they tell you that it's unhealthy or wrong, then you've got a pretty good idea that their programs are religious, not scientific based.
Abstinence Failure - It's not 100%
Safe - A Response
Abstinence-only programs aren't certain to curb teen sex
Reality Check: When did you lose your virginity?
Some Abstinence Programs Mislead Teens, Report Says
Virginity Pledge - Does it Work
Abstinence Failure - It's not 100% Safe
National Condom Day - February 14th
Understanding 'Abstinence': Implications for Individuals, Programs and Policies
Were You Told Sex is Holy or Nasty?
Contraceptive Effectiveness Rates for Pregnancy Prevention
Abstinence Education Programs
Abstinence Is Foolproof? Think Again!
Effects of Teenstar, an abstinence only sexual education program, on adolescent sexual behavior.
Abstinence education for rural youth: an evaluation of the Life's Walk Program.
Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the reach for health service learning program.
Effects of abstinence-only education on adolescent attitudes and values concerning premarital sexual intercourse.
The case for comprehensive sex education
States' implementation of the Section 510 abstinence education program, FY 1999
Personal values and sexual decision-making among virginal and sexually experienced urban adolescent girls.
Hooking Up: Harmless Fun or Health Risk?
A Relative RiskBased, Disease-Specific Definition of Sexual Abstinence Failure Rates
When the Underlying Intent is Misread
Chastity is curable, if detected early: A Contraception Guide
Facts of Life
How To Measure Abstinence
Teenagers special: Going all the way
Different approaches to teenage sexuality
Sex and the single artist
More women die of AIDS
Related Issues: Abstinence-only, abstinence not safe, condom use + Editorial
Abstinence Clearing House: www.abstinence.net
Abstinence, The Better Choice: www.abstinencebetterchoice.com
To be a 100% effective against HPV or Herpes, you would have never
had a sexual encounter with anyone, maintain the abstinance after
marriage, and insure that you never share a towel, underware, etc.
with anyone who has every been sexual with anyone. There can't be one
Implications for Individuals, Programs and Policies
For those willing to probe beneath the surface, critical questions abound. What is abstinence in the first place, and what does it mean to use abstinence as a method of pregnancy or disease prevention? What constitutes abstinence "failure," and can abstinence failure rates be measured comparably to failure rates for other contraceptive methods? What specific behaviors are to be abstained from? And what is known about the effectiveness and potential "side effects" of programs that promote abstinence? Answering questions about what abstinence means at the individual and programmatic levels, and clarifying all of this for policymakers, remains a key challenge. Meeting that challenge should be regarded as a prerequisite for the development of sound and effective programs designed to protect Americans from unintended pregnancy and STDs, including HIV.
Abstinence and Individuals
What does it mean to use abstinence? When used conversationally, most people probably understand abstinence to mean refraining from sexual activityor, more specifically, vaginal intercoursefor moral or religious reasons. But when it is promoted as a public health strategy to avoid unintended pregnancy or STDs, it takes on a different connotation. Indeed, President Bush has described abstinence as "the surest way, and the only completely effective way, to prevent unwanted pregnancies and sexually transmitted disease." So from a scientific perspective, what does it mean to abstain from sex, and how should the "use" of abstinence as a method of pregnancy or disease prevention be measured?
Population and public health researchers commonly classify people as contraceptive users if they or their partner are consciously using at least one method to avoid unintended pregnancy or STDs. From a scientific standpoint, a person would be an "abstinence user" if he or she intentionally refrained from sexual activity. Thus, the subgroup of people consciously using abstinence as a method of pregnancy or disease prevention is obviously much smaller than the group of people who are not having sex. The size of the population of abstinence users, however, has never been measured, as it has for other methods of contraception.
When does abstinence fail? The definition of an abstinence user also has implications for determining the effectiveness of abstinence as a method of contraception. The president, in his July 2002 remarks to South Carolina high school students, said "Let me just be perfectly plain. If you're worried about teenage pregnancy, or if you're worried about sexually transmitted disease, abstinence works every single time." In doing so, he suggested that abstinence is 100% effective. But scientifically, is this in fact correct?
Researchers have two different ways of measuring the effectiveness
of contraceptive methods. "Perfect use" measures the effectiveness
when a contraceptive is used exactly according to clinical
guidelines. In contrast, "typical use" measures how effective a
method is for the average person who does not always use the method
correctly or consistently. For example, women who use oral
contraceptives perfectly will experience almost complete protection
against pregnancy. However, in the real world, many women find it
difficult to take a pill every single day, and pregnancies can and do
occur to women who miss one or more pills during a cycle. Thus, while
oral contraceptives have a perfect-use effectiveness rate of over
99%, their typical-use effectiveness is closer to 92%. As a result,
eight in 100 women who use oral contraceptives will become pregnant
in the first year of use.
Reality Check: When did you lose your
40% before 16
Only 33% still a virgin by the time they were old enough to go to college.
Less than 10% were still a virgin at 21
67% of those losing their virginity before 14 were girls
By 16, 37% of boys and 46% of girls lost their virginity.
60% of boys who were virgins at 17 had sex before they finished high school.
20% of girls who were virgins at 17 had sex before they finished high school.
Before their 21st birthday, there were just slightly fewer male
virgins than the female virgins.
Were You Told Sex is Holy or Nasty?
In a similar vein, you might recall Colorado Senator Gary Hart who was running for President in 1988 but was put out of the race when he was discovered having an affair with Donna Rice. He said afterward that one of the reasons he couldn't stop himself from having an affair (and harming his marriage and political career) was that he was raised in a very strict household where sex was considered nasty and secretive (which made it all the more compelling and hard-to-resist for him).
I raise this issue of holiness or nastiness because it seems to make an impact on so many men and women who want to enjoy the beauty and closeness of sensuality but who are filled with thoughts and images that sex is bad or guilt-ridden or sinful. Does that sound true about yourself or someone you care about--were you raised with negative images and harsh ideas that sex is wrong or bad or sinful?
Sometimes you hear people say that these harsh ideas about sex come from the bible. But nine years ago I researched and wrote a book called "The Ten Challenges" (by Leonard Felder) about the deeper meanings and original Hebrew wordings of the Ten Commandments. For instance, even the original Hebrew words for the Ten Commandments don't say the word "commandments." The original biblical words from Exodus 20 say "Ahseret Hadibrot," which mean "the ten things" or "the ten words." You can sense immediately that those translations read more gently and lovingly. In the King James version the Hebrew words that got mistranslated into Greek then got mistranslated into English as harsh "Thou shalt nots" and rigid commandments. But it's quite possible that in the original version they are more like profound and wise principles for living rather than harsh "thou shalt nots" for which you get struck down if you mess up on one.
I spoke with hundreds of experts, scholars, linguists, and clergy from a number of religious and spiritual traditions about how they translate The Ten Commandments, especially the ones about sexuality, such as Do not commit adultery, Do not covet your neighbor's partner, Do not steal (which literally means "lo tignove--do not be sneaky or trick someone with a false impression of who you are"), Do not bear false witness or lie or gossip to create a false advantage.
What I found out is that the original Hebrew word for sexuality is "ya-da" which means to know someone fully. Rabbis and scholars explained that if you keep your sexuality superficial or focused on body sensations or getting your way with another person, you never really get to know someone fully and you never get to be known fully. So what holiness is about with regards to sexuality is to let yourself be fully honest, vulnerable, and trustworthy with another human being--to get to know and accept each other's deeper selves, including their complicated sexual selves.
Several Christian, Muslim and Buddhist scholars and clergy also agreed with this sense of sex as holy in so far as it lets us fully know the richness of God's gifts to us. To appreciate the beauty of the body, the beauty of a deep relationship, and the joy of connecting with someone you love is a holy act. When it becomes sneaky, manipulative, dishonest, or exploitative, that is when it becomes nasty.
In other words, sexuality is one of the greatest opportunities for finding your way into the powerful holy energies of the universe--but it has to be treated carefully and in a deeply honest relationship with someone you truly know and appreciate at all levels, because otherwise it can easily slip back into sneakiness, dishonesty, manipulation, or exploitativeness which go against the awesomeness for which sexuality is intended.
Whatever your religious or spiritual beliefs (or even if you are completely allergic to religion altogether), I urge you to examine whether you are carrying guilt-ridden or shame-filled thoughts into your sex life. If so, you are much less likely to be able to deeply enjoy these holy moments of fully being at peace and in a state of joy and surrender with another human being. If your mind is filled with desires to conquer, manipulate, score, or trick someone, you are very far away from the pleasure of being fully known and fully appreciated for who you are.
If you start to view sexuality as a holy and wonderful part of
life that gives you awe about the greatness of God's creation (or the
beauty of nature if the word 'God' is uncomfortable for you), you
will probably find it enhances your sensuality and the strength of
your relationship. Instead of feeling like a "bad person" who is
about to get caught and punished, you will begin to experience
sexuality as a "good person" who is growing closer to your true
essence through your exploration of profound intimacy with another
Contraceptive Effectiveness Rates for Pregnancy Prevention
Female Sterilization **
IUD - Mirena
IUD - Paragard
Shot - Depo Provera
Patch - Ortho Evra
Thus, when the president suggests that abstinence is 100% effective, he is implicitly citing its perfect-use rateand indeed, abstinence is 100% effective if "used" with perfect consistency. But common sense suggests that in the real world, abstinence as a contraceptive method can and does fail. People who intend to remain abstinent may "slip" and have sex unexpectedly. Research is beginning to suggest how difficult abstinence can be to use consistently over time. For example, a recent study presented at the 2003 annual meeting of the American Psychological Society (APS) found that over 60% of college students who had pledged virginity during their middle or high school years had broken their vow to remain abstinent until marriage. What is not known is how many of these broken vows represent people consciously choosing to abandon abstinence and initiate sexual activity, and how many are simply typical-use abstinence failures.
To promote abstinence, its proponents frequently cite the allegedly high failure rates of other contraceptive methods, particularly condoms. By contrasting the perfect use of abstinence with the typical use of other contraceptive methods, however, they are comparing apples to oranges. From a public health perspective, it is important both to subject abstinence to the same scientific standards that apply to other contraceptive methods and to make consistent comparisons across methods. However, researchers have never measured the typical-use effectiveness of abstinence. Therefore, it is not known how frequently abstinence fails in the real world or how effective it is compared with other contraceptive methods. This represents a serious knowledge gap. People deserve to have consistent and accurate information about the effectiveness of all contraceptive methods. For example, if they are told that abstinence is 100% effective, they should also be told that, if used correctly and consistently, condoms are 97% effective in preventing pregnancy. If they are told that condoms fail as much as 14% of the time, they should be given a comparable typical-use failure rate for abstinence.
Abstinence is 100% effective if 'used' with perfect consistency. But common sense suggests that in the real world, it can and does fail.
What behaviors should be abstained from? A recent nationally representative survey conducted by the Kaiser Family Foundation and seventeen magazine found that half of all 15-17-year-olds believed that a person who has oral sex is still a virgin. Even more striking, the APS study found that the majority (55%) of college students pledging virginity who said they had kept their vow reported having had oral sex. While the pledgers generally were somewhat less likely to have had vaginal sex than nonpledgers, they were equally likely to have had oral or anal sex. Because oral sex does not eliminate people's risk of HIV and other STDs, and because anal sex can heighten that risk, being technically abstinent may therefore still leave people vulnerable to disease. While the press is increasingly reporting that noncoital behaviors are on the rise among young people, no research data exists to confirm this.
Abstinence Education Programs
To date, no education program focusing exclusively on abstinence has shown success in delaying sexual activity.
There is no question, however, that increased abstinencemeaning delayed vaginal intercourse among young peoplehas played a role in reducing both teen pregnancy rates in the United States and HIV rates in at least one developing country. Research by The Alan Guttmacher Institute (AGI) indicates that 25% of the decrease in the U.S. teen pregnancy rate between 1988 and 1995 was due to a decline in the proportion of teenagers who had ever had sex (while 75% was due to improved contraceptive use among sexually active teens). A new AGI report also shows that declines in HIV-infection rates in Uganda were due to a combination of fewer Ugandans initiating sex at young ages, people having fewer sexual partners and increased condom use (see related story).
But abstinence proponents frequently cite both U.S. teen pregnancy declines and the Uganda example as "proof" that abstinence-only education programs, which exclude accurate and complete information about contraception, are effective; they argue that these programs should be expanded at home and exported overseas. Yet neither experience, in and of itself, says anything about the effectiveness of programmatic interventions. In fact, significant declines in U.S. teen pregnancy rates occurred prior to the implementation of government-funded programs supporting this particularly restrictive brand of abstinence-only education. Similarly, informed observers of the Ugandan experience indicate that abstinence-only education was not a significant program intervention during the years when Uganda's HIV prevalence rate was dropping. Thus, any assumptions about program effectiveness, and the effectiveness of abstinence-only education programs in particular, are misleading and potentially dangerous, but they are nonetheless shaping U.S. policy both here and abroad (see related story, page 13).
Accordingly, key questions arise about how to measure the success of abstinence-promotion programs. For example, the administration is defining program success for its abstinence-only education grants to community and faith-based organizations in terms of shaping young people's intentions and attitudes with regard to future sexual activity. In contrast, most public health experts stress the importance of achieving desired behavioral outcomes such as delayed sexual activity.
To date, however, no education program in this country focusing exclusively on abstinence has shown success in delaying sexual activity. Perhaps some will in the future. In the meantime, considerable scientific evidence already demonstrates that certain types of programs that include information about both abstinence and contraception help teens delay sexual activity, have fewer sexual partners and increase contraceptive use when they begin having sex. It is not clear what it is about these programs that leads teens to delaya question that researchers need to explore. What is clear, however, is that no program of any kind has ever shown success in convincing young people to postpone sex from age 17, when they typically first have intercourse, until marriage, which typically occurs at age 25 for women and 27 for men. Nor is there any evidence that the "wait until marriage" message has any impact on young people's decisions regarding sexual activity. This suggests that scarce public dollars could be better spent on programs that already have been proven to achieve delays in sexual activity of any duration, rather than on programs that stress abstinence until marriage.
Finally, there is the question of whether delays in sexual activity might come at an unacceptable price. This is raised by research indicating that while some teens promising to abstain from sex until marriage delayed sexual activity by an average of 18 months, they were more likely to have unprotected sex when they broke their pledge than those who never pledged virginity in the first place. Thus, might strategies to promote abstinence inadvertently heighten the risks for people when they eventually become sexually active?
Difficult as it may be, answering these key questions regarding abstinence eventually will be necessary for the development of sound and effective programs and policies. At a minimum, the existing lack of common understanding hampers the ability of the public and policymakers to fully assess whether abstinence and abstinence education are viable and realistic public health and public policy approaches to reducing unintended pregnancies and HIV/STDs.
This is the fourth in a series of articles examining emerging
issues in sex education and related efforts to prevent unintended
pregnancy and sexually transmitted diseases. The series is supported
in part by a grant from the Program on Reproductive Health and Rights
of the Open Society Institute. The conclusions and opinions expressed
in these articles, however, are those of the author and The Alan
Abstinence Is Foolproof? Think Again!
Sixteen-year-old Sabrina grew up believing that shed be abstinent until marriage.
Photo by Martyna Majok
My parents always spoke openly about sex, but it was under the assumption that I wouldnt do it until Im married. Theyve always made it clear that they want me to wait, says Sabrina, who lives in Edison, NJ.
But last spring, Sabrina found her first love.
My boyfriend and I were just so compatible, on so many levels. We got to be so close, so fast, she says.
Eventually, things started moving fast in a physical direction.
After a while, sex became a reality. Its a lot harder to abstain when youre actually in the moment, faced with that decision, she says.
Sabrinas story illustrates one rarely publicized factabstinence can fail. Even though teens are taught that abstinence is a 100-percent effective method of preventing unplanned pregnancy and sexually transmitted infection (STI), abstinence can fail when teens try to practice it every day.
This fact is largely ignored by the powers that dictate the content of abstinence-only sex education, but its just common sense to many teens.
How can abstinence fail? The method can be complicated and difficult to use, and hard to maintain for an extended period of time, explains Clara S. Haignere, Ph.D, an associate professor of public health at Temple University, in Philadelphia. Haignere has published research on teens and abstinence failure in the journal Health Education & Behavior.
As a method of pregnancy and STI prevention, abstinence from oral, vaginal, or anal intercourse can be 100-percent effective, but only if its used correctly and consistently. If a user (for example, a teen) uses a method incorrectly or inconsistentlywhether its condoms or abstinencethen the effectiveness rate goes down.
By studying research on teens who abstained for a period of time, Haignere found that abstinence has a user-failure rate between 26 and 86 percent. This rate is higher than the condom user-failure rate, which is between 12 and 70 percent.
Are teens being given all the accurate information about abstinence if theyre told that its completely safe and easy to use?
Abstinence is complicated to use. It requires negotiation skills. Teens have to talk to their partners about it, and use it all the timeevery time theyre intimate, says Haignere.
Teens at Risk
Katie, 19, of Memphis, TN, understands how difficult it is to be abstinent. She and her boyfriend, who share the same values and religious beliefs, decided to abstain from sex.
But, she says, For the past three years, we really struggled with abstinence. We did pretty much everything except intercourse. Occasionally wed stop and say, No more, but then our hormones put us back into the same routines.
One night, things went too far, says Katie. We still didnt have intercourse, but later on, I learned there was a possibility I could be pregnant without having intercourse, because his semen came extremely close.
Like Katie, some teens consider themselves abstinent, even when they participate in other sexual behaviors, like oral or anal intercourse. Even though they think theyve used abstinence properlyby avoiding vaginal intercoursetheyre still engaging in high-risk sexual behaviors.
This is another case of abstinence failure, since, in order to be 100-percent protected from pregnancy and/or STIs, you have to abstain from oral, anal, and vaginal intercourseall the time.
Abstinence failure can be dangerous for teens if they dont know how to protect themselves. A recent study of teens who took virginity pledges finds that while pledgers delayed having intercourse, the ones who eventually did have intercourse were less likely to use contraceptionleaving them at risk for unplanned pregnancy and/or STIs.
Need for Knowledge
But most abstinence-only sex educators dont consider that abstinence can fail, so they dont prepare teens to use contraception just in case. They continue to inform teens that abstinence is the only, 100-percent foolproof way to avoid unplanned pregnancy and STIs.
For the past three years of high school, Lauren Maurer, 17, of Boca Raton, FL, received abstinence-only sex ed.
Now that Ive been in a relationship for over a year and were considering becoming sexually active, I realize that my sex ed experiences made me terrified of sex.
My teachers made it seem like everyone had an STI, and that contraceptives are expected to fail. If it werent for my own reading, I wouldnt know what kinds of contraceptives are available, says Maurer.
Haignere thinks that schools should prepare teens for abstinence failure by giving them medically accurate information about contraception. And she thinks the just say no to sex approach isnt realistic, given that nearly half of all 9th #8220;12th graders have already had sexual intercourse, according to the 2001 Youth Risk Behavior survey by the U.S. Centers for Disease Control and Prevention.
Look at the public health information given on skin cancer, says Haignere. The only 100-percent effective method of preventing skin cancer is to stay out of the sun, but no one in the public health community promotes that as the only alternative, since its almost impossible to avoid.
Given the risks of abstinence failure, many teens are speaking up for comprehensive sex education, which teaches the benefits of abstinence plus accurate information about contraception and STIs.
Teach teens how to have safer sex. Using condoms and birth
control will help a majority of young people, says Amber, 15,
of Torrington, CT. If teens are taught that no sex is safe sex,
theyll have sex anyway without knowing the right thing to
do. (This web site is by teens for teens.)
Effects of Teenstar, an abstinence only
sexual education program, on adolescent sexual behavior.
Unidad de Reproduccion y Desarrollo, Departamento de Ciencias Fisiologicas, Facultad de Ciencias Biologicas, Pontificia Universidad Catolica de ChileChile.
Urgent measures are required to stop the increase in the frequency
of pregnancies and sexually transmitted diseases among teenagers. A
means of facing this problem is promoting sexual abstinence among
youngsters. There are studies that confirm the efficacy of this
approach. Aim: To show the results of the application of a holistic
sexuality program (TeenSTAR) among Chilean teenagers. Subjects and
Methods: Students attending basic or high school were divided into a
control or study group. The control group (342 students) received the
usual education on sexuality given by their schools and the study
group (398 students) participated in twelve TeenSTAR sessions lasting
1.5 hours each, given by a trained professor. Assessment of
achievements was made using an anonymous questionnaire answered at
the start and end of the program. Results: The rates of sexual
initiation among control and study groups were 15 and 6.5%,
respectively. Among sexually active students, 20% of those in the
study group and 9% of those in the control group discontinued sexual
activity. Conclusions: A higher proportion of students in the
TeenSTAR program retarded their sexual initiation or discontinued
sexual activity and found more reasons to maintain sexual abstinence
than control students (Rev Med Chile 2005; 133: 1173-82).
Abstinence education for rural youth: an
evaluation of the Life's Walk Program.
Northwest Missouri State University, Maryville, MO 64468, USA. Barnett@mail.nwmissouri.edu
This paper summarizes an evaluation of a school-based sexuality
education program, an abstinence-only program, taught in public
schools to eighth- and 10th-graders. The program uses infant
simulators to provide adolescents with a realistic view of parenting
and to encourage them to delay initiation of sexual behavior until
marriage. Two evaluations are summarized here. The first evaluation
used a pretest-posttest design. Significant increases in
parent-adolescent communication, knowledge about sexuality, and
sexual behavior were found. No changes were found in attitudes toward
teen sexual activity. The second evaluation employed a
quasi-experimental design with a treatment group and a comparison
group, with testing delayed four months after the program. No group
differences were found in attitudes, behavior, or communication.
Program effects were found only for knowledge about sexuality.
Long-term reductions in sexual initiation and
sexual activity among urban middle schoolers in the reach for health
service learning program.
Education Development Center, Inc., Newton, Massachusetts 02428, USA. firstname.lastname@example.org
PURPOSE: To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade. METHODS: During the fall of seventh grade and again in eighth grade, students were randomly assigned by classroom to participate either in community youth service (CYS) or not (controls). Service learning is an educational strategy that couples meaningful service in the community with classroom instruction. Students in both intervention and control conditions received classroom health lessons. Surveys were conducted at seventh grade baseline and at the end of 10th grade, approximately 2 years after intervention. Self-reported sexual behaviors of youths who had participated in CYS were compared with those of controls receiving classroom curriculum alone (n = 195). RESULTS: CYS participants were significantly less likely than controls to report sexual initiation (2 years CYS, odds ratio [OR] = 0.32; 1 year, OR = 0.49) as well as recent sex (2 years CYS, OR = 0.39; 1 year CYS, OR = 0.48). Among those who were virgins at seventh grade, 80% of males in the curriculum-only condition had initiated sex, compared with 61.5% who received 1 year of CYS, and 50% who received 2 years. Among females, the figures were 65.2%, 48.3%, and 39.6%, respectively. CONCLUSION: A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents.
Effects of abstinence-only education on
adolescent attitudes and values concerning premarital sexual
College of Nursing, University of Nebraska Medical Center, Omaha, USA.
This article compares the values and attitudes of two groups of
7th and 8th grade adolescents toward premarital sexual activity. One
group received state-funded, abstinence-only education; the other
group did not receive that education. Abstinence-only education did
not significantly change adolescents' values and attitudes about
premarital sexual activity, nor their intentions to engage in
premarital sexual activity. The majority of both the treatment and
control group subjects expressed disagreement with the statement: "It
is okay for people my age to have sexual intercourse," and they did
not intend to have sexual intercourse while an unmarried
The case for comprehensive sex education.
American Foundation for AIDS Research (amfAR), New York, New York 10005, USA. Naomi.email@example.com
Half of all new human immunodeficiency virus (HIV) infections in
the United States and two thirds of all sexually transmitted diseases
(STD) occur among young people under the age of 25. It is estimated
that by the end of high school, nearly two thirds of American youth
are sexually active, and one in five has had four or more sexual
partners. Despite these alarming statistics, less than half of all
public schools in the United States offer information on how to
obtain contraceptives and most schools increasingly teach
abstinence-only-until-marriage (or "abstinence-only") education.
There is little evidence that abstinence-only programs are successful
in encouraging teenagers from delaying sexuality activity until
marriage, and consequently, avoiding pregnancy, or STD or HIV
infection. Comprehensive sex education, which emphasizes the benefits
of abstinence while also teaching about contraception and
disease-prevention methods, has been proven to reduce rates of teen
pregnancy and STD infection.
States' implementation of the Section 510
abstinence education program, FY 1999
Alan Guttmacher Institute, Washington, DC, USA.
CONTEXT: As part of its reworking of the nation's welfare system
in 1996, Congress enacted a major new abstinence education initiative
(Section 510 of Title V of the Social Security Act), projected to
spend $87.5 million in federal, state and local funds per year for
five years. The new program is designed to emphasize abstinence from
sexual activity outside of marriage, at any age, rather than
premarital abstinence for adolescents, which was typical of earlier
efforts. The actual message and impact of the program, however, will
depend on how it is implemented. METHODS: Program coordinators in all
50 states, the District of Columbia and Puerto Rico were surveyed
concerning implementation of the Section 510 abstinence education
program in FY 1999. The questionnaire asked about expenditures and
activities performed, about policies established for a variety of
specific situations and about how the term "sexual activity" is
defined and what specific components of the federal definition of
"abstinence education" are emphasized. RESULTS: Forty-five
jurisdictions spent a total of $69 million through the Section 510
program in FY 1999. Of this total, $33 million was spent through
public entities, $28 million was spent through private entities and
$7million (in 22 jurisdictions) was spent through faith-based
entities. Almost all jurisdictions reported funding school-related
activities, with 38 reporting in-school instruction and
presentations. Twenty-eight jurisdictions prohibited organizations
from providing information about contraception (aside from failure
rates), even at a client's request, while only six jurisdictions
prohibited information about sexually transmitted diseases. Few
reported having a policy or rendering guidance about providing
services addressing sexual abuse, sexual orientation or existing
pregnancy and parenthood. Only six respondents said they defined
"sexual activity" for purposes of the program, and 16 reported
focusing on specific portions of the federal definition of
"abstinence education." CONCLUSIONS: More than one in 10 Section 510
dollars were spent through faith-based entities. Programs commonly
conducted in-school activities, particularly instruction and
presentations, not only through public entities, but also through
private and faith-based entities. Most jurisdictions prohibited the
provision of information about contraception, about providers of
contraceptive services or about both topics, even in response to a
direct question and when using other sources of funding. Most also
left definitions of "abstinence" and "sexual activity" as local
decisions, thus not clearly articulating what the program is designed
to encourage clients to abstain from.
Personal values and sexual decision-making
among virginal and sexually experienced urban adolescent girls.
Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA. firstname.lastname@example.org
PURPOSE: To guide the development of an intervention to reduce the
incidence of sexually transmitted diseases (STDs) in urban,
adolescent girls, we investigated such girls' reasons for deciding to
have or not to have sexual intercourse. METHODS: Consecutive girls
>or=14 years of age attending an urban adolescent clinic were
invited to complete an anonymous survey about sexual decision-making.
In this pilot study, girls were asked: (a) whether they agreed with a
statement that they had or had not had sexual intercourse "because of
my values and beliefs"; and (b) to select from a list one or more
specific reasons why they had or had not had intercourse. The girls
were categorized by self-report as either "virgins," "currently
inactive" (no intercourse in the preceding 3 months), or "currently
active" (had intercourse during the preceding 3 months). RESULTS:
Usable surveys were obtained from 197 adolescents whose age (18.2 +/-
2.6 years) and race (69% black) were comparable to those of clinic
attendees in general. Forty girls (20%; age 16.1 +/- 2.1 years) were
virgins, 25 girls (13%; age 17.8 +/- 2.3 years) were inactive, and
132 girls (67%; age 18.9 +/- 2.5 years) were currently active.
"Values and beliefs" were cited as the reason for decisions about
sexual behavior by 53% of the virgins, but only by 24% of the
sexually inactive and 24% of the sexually active girls (p = .002).
Virgins were more likely than inactive girls to cite three specific
reasons for not having sex: "not the right thing for me now" (82% vs.
50%, p = .007), "waiting until I am older" (69% vs. 8%, p = .001),
and "waiting until I am married" (67% vs. 38%, p = .02). The reason
"against my religious beliefs" was cited by 23% of virgins and 13% of
inactive girls (p = not significant). Personal values were implicit
in the two specific reasons for having sex that active girls chose
most frequently, namely, "I like/love the person" (86%) and "I like
having sex" (37%), although only 24% of these girls had explicitly
cited "values and beliefs" as their reason for having sex.
CONCLUSIONS: Our data indicate that urban girls, both those who have
had sexual intercourse and those who have not, view their sexual
behavior as being based on personal (although infrequently religious)
values. Many of the virginal urban, adolescent girls we surveyed hold
abstinence as a personal value. The sexually active adolescents
perceive the decision to have sexual intercourse as being based
affirmatively on their personal values rather than on the chance
occurrence of opportunities to have intercourse. These data may be
useful in the development of new strategies for reducing urban
adolescent girls' risk of acquiring sexually transmitted
Hooking Up: Harmless Fun or Health
At this point in my life, Id rather be having fun than tied down. The act of hooking up is exciting. It makes me feel mainly thrilled, happy, and satisfied, he says.
In recent years, hooking uphaving casual sexual relationships without commitmenthas become a more common, openly discussed pastime for many teens. And two-thirds of 15- to 17-year-olds report that some of their friends participate in hook-ups, according to a recent SexSmarts national survey, by the Kaiser Family Foundation and seventeen magazine.
Like Drew, many teens arent ashamed to talk about their experiences. Why? Theres now less stigma attached to hooking up, says Lynn Ponton, M.D., author of The Sex Lives of Teenagers: Revealing the Secret World of Adolescent Boys and Girls.
According to Dr. Ponton, a hook-up can include different sexual behaviors. In high school, it usually means doing everything but vaginal or anal intercourse with a partner, once or a few times. At the college level, the sexual behaviors can grow to include all types of intercourse (oral, vaginal, and anal).
So, whats the appeal of a short-term or one-time only hook-up?
Brooke, 15, of Washington, NJ, whos hooked up about five times, says she prefers it to long-term relationships because of the freedom it brings.
I dont feel restricted, and Im free to experience many people and relationships at the same time, says Brooke, who claims that hormones and sexual attraction (not emotional connection) motivate her to hook up.
Hooking up has helped me mature a lot. Ive really looked at who I am and what I value as a person because of my experiences, and now I realize that Im in control. Im a lot more comfortable being myself around new people, and Im definitely more confident with guys, she says.
When used as a stepping-stone to self-discovery and more mature sexual relationships, hooking up can be beneficial, according to Marsha Levy-Warren, Ph.D., author of The Adolescent Journey: Development, Identity Formation, and Psychotherapy. She says that hooking up gives teens an alternate way to explore their sexuality.
Some teens learn about their bodies through masturbation, but many are very uncomfortable with it. They sometimes turn to hooking up as a way of getting to know how their bodies work, says Levy-Warren.
But Levy-Warren stresses that its the way in whichand how oftenteens hook up that ultimately determines whether it has positive or negative effects. For instance, hooking up isnt healthy if its a teens only type of intimate relationship, for years at a time.
Teens can easily feel that no one really wants them, that theyre just wanted for their bodies or sexual expertise, and not for the whole of who they are, explains Levy-Warren.
There also can be real differences between how guys and girls feel after hooking up, adds Levy-Warren.
Guys can feel more confident socially, more mature, when theyve had a lot of sexual encounters. Girls can start out feeling that way, but if by the end of high school they havent had a more prolonged dating relationship, they begin to feel somethings wrong with them, she says.
Brooke agrees that there are emotional risks to hooking up, including ending up feeling used and rejected.
Aside from emotional effects, hooking upif done without protectioncan lead to unintended pregnancy and sexually transmitted infections (STIs), including HIV/AIDS. Without the benefit of learning about and knowing their partners, teens that hook up often make quick decisions about contraception and their partners sexual health status.
Brooke waits until she feels comfortable and familiar with a guy before she hooks up with him. Drew says he assesses the risks by surveying the girls looks and getting to know her a little before we hook up. But, he adds, You cant really find out a persons sexual history on the spot. You kind of have to go with your best judgment.
Levy-Warren says that theres no question many teens put themselves at risk when they hook up, especially when theyre not using contraception to prevent unintended pregnancy and STIs. In fact, according to the SexSmarts survey, teens are more likely to talk about their sexual history and STI testing, and use birth control pills with a partner, the longer theyre in a relationship.
Aside from cautioning teens about the physical risks, Levy-Warren encourages them to evaluate their reasons for hooking up. She says that many teens hook up because of fear and insecurity.
They want to feel that theyre in some way keeping up
socially. They want to be on the scene, be seen and involved with
people, so they keep hooking up. But inside they may feel, How
come no one really wants me?
Source: Megan Esteves, sxetc.org/index.php?topic=Stories&sub_topic=Love+and+Relationships&content_id=1754
A Relative RiskBased,
Disease-Specific Definition of Sexual Abstinence Failure Rates
When the Underlying Intent is Misread
...but the psychological tricking us into using the wrong mental model to solve problems is not always so obvious. We are constantly bombarded with advertisements, religious warnings, and political pronouncements that sound like good logical presentations and lead us to a conclusion that might not be in our best interests.
I read part of a presentation by an abstinence-only anti-sexual activity speech... Another fallacy he used in the same presentation was to say that abstinence in the only 100% effective way to avoid unplanned births. Sounds good, you don't do it, and you don't get pregnant. Except that when a method of birth control is proposed, it must be tested, not as an ideal logical thing, but as ground truth in the field, and when that is done, abstinence is probably the least effective of the common methods of birth control. Its failure rate as a method is greater than the failure rate of other techniques. This is totally independent of an moral or health issues.
This example generated a series of comments that can be summarized by one from Alan:
That's ridiculous. Human shortcomings may drive people to change their minds about BEING abstinent, but abstinence itself by definition is automatically 100% effective.
After thinking about the various ways to revisit this issue, I decided the most direct way is to simply share my response to Alan. Here it is.
Thanks for the letter. It made me think, and that is always good.
You have been misled by falling into the linguist trap that promotes so much misunderstanding. "Abstinence" is commonly used in two ways with two separate meanings. As a moral objective, abstinence is a goal that appears in various manifestations promulgated by religionists of several, but not all, varieties.
The rub comes when abstinence is promoted not only as a moral value (about which I have no comment here or in the column) but also as a birth control method. When that change takes place, then abstinence enters to realm of measurement and its effects must be assessed just like any pill, condom, etc. In that sense, it is a failure.
You go a step further and assign the lack of effectiveness to a specific item: human failure. That is an interesting, and probably correct, analysis, but not relevant to the statistics of things as they are. It might be relevant to improving the method, but that is another story entirely.
If you dismiss abstinence's poor performance as a birth control method because you know why it fails, then you must logically dismiss condoms' failures because you know latex has certain properties. You must also dismiss the pill's occasional failures in large part for exactly the same reason you dismiss abstinence's failure: human shortcomings. To do otherwise would be intellectually dishonest and biased toward one physical method - this paragraph has nothing to do with morals!
My point is not to attack or belittle anyone's beliefs or morals, but to try to defuse arguments by insisting that we all know what we are discussing before calling the other guy a fool or tool of the dark forces. If you and I argue over the effects of abstinence on birth control, then we impede meaningful discussion on the really interesting subject: abstinence as a moral value. My goal is to promote understanding and mutual respect.
By sticking to artificial logical and gaming examples, I can avoid more than academic conflict. But what is the use of that? Issues such as birth control, abortion, violence, personal morality, corporate greed, etc. cause much unnecessary heat and argumentation. My goal is to help everyone of every persuasion use the tools of logical analysis and decision theory to simplify issues by removing false assumptions and faulty thoughts. I will not argue pro or con whether we possess an immortal soul as long as the purported soul has no measurable interaction with the physical world. You are free to believe whatever you wish. I have no problem with anything. However, if you believe in a soul that does interact with the physical world, then we can obviously measure that interaction and put limits on it. People have even gone so far as weighing people as they died to see if something with mass leaves their body upon death (no reproducible positive results attributable to a soul or significant differences between people and animals). That is a reasonable thing to do. Propose a hypothesis, make predictions based on it, and test them.
Similarly, if you want to propose abstinence as a birth control method, the statistics are there for all to see. This has nothing to do with validating or disproving any particular belief system.
For those who wish to delve further into decision theory without
wading through a lot of equations, I have posted a tutorial on
elementary decision theory. It shows examples of faulty physicians'
diagnoses (important for those considering surgery) and how to
evaluate anti-terrorist activities (important for everyone). That
tutorial can be found here.
Chastity is curable, if detected
early: A Contraception Guide
Please note that the failure rates of the contraception types listed below is given in a percentage, both for ideal (perfect usage) and typical (actual statistical usage) situations. This is your chance of becoming pregnant if you have regular intercourse over the course of one year's time. For example, if you have regular intercourse with someone every week for an entire year using condoms as your contraception, with ideal use your chance of pregnancy is 2.0% and with typical use it is 10.0%. Calculating failure rates for certain combinations of contraception such as using both the pill and condoms can be a little tricky, so we've not included those. However, combining certain forms of contraception to maximize effectiveness is always a good idea.
No Protection - Failure rate: 80-90%.
No protection simply means having sexual intercourse or contact without any form of contraception. Obviously, choosing this option will result in your greatest chance of becoming pregnant. Only couples who are actively trying to get pregnant should have unprotected intercourse. There's simply no excuse otherwise. Guys, if you really think using a condom takes THAT much away from the feeling and insist on having raw sex, then go home and jack off. It's a lot cheaper and takes a lot less time than raising a child. Let's compare: Cost of raising child: Estimated $200,000 for 18 years. Cost of jacking off: Free. Time required to jack off: Anywhere from 30 seconds to an hour. Time required to raise a child: 18 years. Ladies, don't let any guy convince you to do something you are not planning to do or are not comfortable with. No man is worth compromising your values for. And vice versa.
Abstinence - Failure rate: 0%.
Abstinence is complete restraint from sexual intercourse. It is the only 100% effective form of contraception and STD prevention. Note, however, that, in order to be 100% effective, one must obstain from petting, oral and anal sex in addition to vaginal intercourse. While sex can be a lot of fun between two people who love each other, abstinence is the wisest choice and often the right one for couples who do not want to risk pregnancy.
Withdrawal - Failure rate: 20-30%.
Withdrawal, also known as coitus interruptus, is when a male withdraws his penis from the female's vagina before he ejaculates. This is the most common form of birth control used by younger people who are ignorant about how the human body works. One reason why this form of contraception is not very effective is because several thousands of sperm are often present in precum, the thin clear liquid which oozes out of a penis during high arousal and especially during the friction of intercourse. Another reason is because often the man won't pull out before some ejaculate is left in the vagina. Pulling out before ejaculation is not only ineffective in preventing pregnancy, but it can be very frustrating for both partners, especially the male. Ladies, never let a guy convince you to have unprotected intercourse because he says he will "pull out." First of all, it's not very effective, and second, he may not pull out in time or not at all anyway.
Rhythm Method - Ideal failure rate: 10%. Typical failure rate: 15-25%.
Also known as the safe period method, this is another less than effective contraception method. The idea is for the couple to have sex at a time during the woman's menstrual cycle when she is not ovulating and not likely to get pregnant. There are several ways to discover this "safe time" however they usually must be taught by a family planning professional and there are a lot of variables that must be considered and understood. Younger people and those less conscientious about contraception may use other forms of this method such as having sex right before or during the female's period. This is because most woman tend to ovulate in the middle of their cycles. This isn't always very reliable, however.
The Pill (female) - Ideal failure rate: 0.5%. Typical failure rate: 2%.
The pill is a prescribed hormonal medicine that prevents pregnancy in most cases by preventing ovulation. It contains progestogen and estrogen. While this method is extremely effective, a decrease in this effectiveness can come from several things. For one, the woman might take the doses irregularly, forget doses, etc. Another problem might be taking other drugs that decrease the pill's effectiveness. Side effects that cause vomiting or diarrhea can also decrease effectiveness. For more information about taking contraceptive pills, please see your doctor.
Emergency Contraception (female) - Ideal failure rate: 1%. Typical failure rate: 3-5%.
This form of contraception is known commonly as the "morning after pill" and can be obtained by prescription up to 72 hours after unprotected intercourse. This pill is hormonal medication that prevents a fertilized egg from implanting in the uterus. Four pills are taken, two immediately and two more 12 hours later. This pill is basically the same as normal contraceptive medication, however the dosage is much higher so some adverse side effects like nausea and vomiting can occur. Like all medical forms of contraception, this pill does nothing to stop STDs. If you are interested in this option please see your doctor.
Gels and Foams - Ideal failure rate: 5%. Typical failure rate: 15%.
Gels, foams, jellies, and creams that contain spermicides work as contraceptives by killing sperm. They shouldn't be relied on to prevent pregnancy alone but should be used along with other methods such as condoms or diaphragms. They can also be used with the sponge method, although contraceptive sponges are not terribly effective and have been discontinued from widespread production. Most spermicides contain nonoxynol-9, which can offer limited protection against STDs as well. some people can have allergic reactions to nonoxynol-9 and thus should use other contraception methods or find spermicides with other active ingredients.
Condom (male) - Ideal failure rate: 2%. Typical failure rate: 10%.
The condom is perhaps the most common form of contraception. It can also be fairly effective against both STDs and pregnancy, if used properly. Most condoms are made of thin latex rubber, but polyurethane condoms are also available for those who have allergic reactions to latex. It is unrolled on the man's erect penis to contain ejaculate during intercourse. Using one carefully and properly is extremely effective to maintain their effectiveness. The man should hold the condom at the base and withdraw immediately after ejaculation in order to keep semen from spilling into the vagina. Condoms should never be reused. Only water-based lubricants should be used with latex condoms because oil based lubricants break down the composition of latex.
For more detailed information about condoms please see our Condom Guide.
Female Condom - Ideal failure rate: 3%. Typical failure rate: 10-15%.
First introduced in 1992 as "Reality." This is a loose polyurethane condom designed for the female to insert into her vagina before intercourse. It has a wide open ring at the bottom and a smaller, closed ring at the top that is designed to fit over the cervix. It is effective against pregnancy and STDs but because some women may not learn how to insert them correctly before they have intercourse with them, they can fail.
For more detailed information about condoms please see our Condom Guide.
Cervical Caps and Diaphragms (female) - Ideal failure rate: 2%. Typical failure rate: 10-15%.
Unlike condoms, cervical caps and diaphragms (pronounced "diafram") allow semen to enter the vagina, but they prevent it from entering the cervix, traveling up the uterus, and fertilizing an egg in the fallopian tube. They are made of small round pieces of latex rubber that fit securely over the cervix. Caps merely fit over the cervix, while diaphragms cover the cervix and are held in place by bracing against the pubic bone. They come in a few different varieties. They must be fitted by a doctor or nurse and take some knowledge and practice in order to be used effectively. They are also usually used with spermicides to increase effectiveness. The caps and diaphragms must be inserted prior to sexual activity or intercourse and must remain in place for at least 6 hours afterwards. They're relatively durable can last years if properly cared for. While they have some drawbacks, this is a suitable contraceptive option for women who are unable to use pills for whatever reason. Once again these need to be purchased and fitted by a doctor, so if you are interested in this method please see yours.
IUD (Intrauterine Device) - Ideal failure rate: 1-2%. Typical failure rate: 4%.
IUD's are small, t-shaped, plastic devices that are inserted into the uterus by a doctor. There are 2 types, those containing a thin coil wrap of copper, and those containing progestogen. They generally prevent pregnancy by creating a hostile environment in the uterus for fertilized eggs and in the case of the copper variety, sperm as well. While they are regarded as highly effective, they have some possible side effects such as infection, spotting, cramps, acne, and tenderness. They can last up to 5 years. See your doctor if you are interested in this method of contraception.
The Sponge (female) - Ideal failure rate: 5%. Typical failure rate: 15-20%.
The sponge is a small spongy ball with a string attached that is meant to be inserted deep in the vagina before intercourse and prevent semen from reaching the cervix and uterus. It is often soaked in spermicides to increase effectiveness. While widespread production of contraceptive sponges has been discontinued, it is still available in some areas and some women still swear by its use. It is not highly effective but does provide much more protection against pregnancy than using no protection at all.
Vasectomy (male) - Failure rate: 0.15%.
A vasectomy involves a simple outpatient surgical procedure in which the male's vas deferens are clipped. The vas deferens are the small tubes that carry sperm up from the testicles to the prostate. After this procedure, the man can still ejaculate and orgasm, however no sperm is present in his semen. The only possibility for failure exists if the man has unprotected intercourse within a few weeks after having the procedure, as some sperm can remain in his semen until then before it is all "flushed out." There is some discomfort shortly following the procedure, however this is by far the simplest and most effective form of permanent contraception available for the male.
Tubal Litigation (female) - Failure rate: 0.04%.
This involves a surgical procedure in which the fallopian tubes of the female are cut and cauterized. This prevents sperm from reaching an ovum, and prevents an ovum from traveling into the uterus. The woman will still continue to menstruate, and after healing has occurred little decrease in sexual enjoyment is felt. Conception can still occur if an ovum has passed the point of litigation before surgery and intercourse takes place, so women who have had this operation are advised to use other protection if they have intercourse before their next menstrual cycle after the operation.
Of course there are other forms of birth control available,
however we have presented only the most well-known and most popular
methods in this guide. New additions may show up later, and if they
do we will be sure to keep you updated. If you have any other
questions or comments about any of the methods described, please
contact us by writing. E-Mail
Facts of Life
Abstinence-based sex education programs for school children are multiplying across the nation, due in no small part to a 1996 change in the federal welfare law outlining a specific abstinence curriculum that the programs must follow to receive federal funding.1 According to the law, acceptable programs should teach abstinence from sex outside of marriage as the expected standard and that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects. Since 1996, programs meeting these and other criteria have received more than $50 million in federal funds. 2
Despite their increasing popularity and government support, there are few randomized controlled trials the gold standard in health research or systematic reviews of how abstinence-based programs affect outcomes such as postponement of sex until marriage, rates of sexually transmitted diseases among young adults or teen pregnancy rates. Program curricula vary from state to state and school district to school district, making comparison and evaluation difficult.
Abstinence After Sex
According to 2003 data from the Centers for Disease Control and Preventions Youth Risk Behavior Surveillance System, more than 45 percent of high school students have had sex at least once.3 Some abstinence programs have tailored their messages to reach sexually experienced youth, but few studies examine the effects of abstinence messages in this group of teens.4
A 2001 policy statement from the American Academy of Pediatrics, reaffirmed in 2005, encourages pediatricians to make information on contraception available at local schools where the sex education curriculum does not discuss contraception. 7
In a 2004 survey of 1,000 Americans conducted by the Kaiser Family Foundation, only 15 percent said schools should teach a strict abstinence-only curriculum without any mention of condoms or other contraceptives. 5
Public school districts in the South were almost five times more likely than districts in the Northeast to offer abstinence-only sex education curricula, according to a 1999 survey of 825 districts nationwide. 6
A review of 21 abstinence-only education programs in Texas found that masturbation, sexual identity and orientation and the common occurrence of sexual fantasies were among the topics least likely to be discussed. 8
A report on federally funded abstinence-only programs found that the programs increased students favorable attitudes about abstinence but did not significantly affect their attitudes about marriage or change their perceptions about peer pressure to have sex. 9
AIDS education programs do not affect abstinence rates among adolescents, but they do boost the likelihood that the teens will have condom-protected versus unprotected sexual intercourse, according to a 2005 study. 10
Teens who made a virginity pledge but later had sexual intercourse before marriage were less likely to use contraception during their first sexual encounter than those who did not pledge, according to a 2001 study. 11
Rates of sexually transmitted diseases do not differ between those who have taken a virginity pledge and those who have not taken the pledge, according to a 2005 study. 12
A 2000 review found black adolescent boys are less likely than white and Hispanic peers to receive sex education before their first sexual intercourse. 13
A 1998 randomized trial comparing abstinence and safe sex programs for black adolescents concluded that teens in the abstinence groups were less likely than those in the safe sex group to have sex in the three months after the trial, but this difference disappeared 6 months and 12 months later. 14
Sexually active middle school students had fewer sexual partners
after participating in an abstinence-only education program compared
to their peers who did not go through the program, according to a
2005 Ohio study. 4
Source: Issue Briefings for Health Reporters, Vol. 10, No. 10, October 2005
How To Measure Abstinence
Defining the Terms: It seems easy to define but a 2003 15 review of Texas abstinence-only programs by Texas A&M University professor Patricia Goodson concluded that students, program instructors and program directors all emphasized different ideas when asked to describe abstinence. Program directors defined abstinence as refraining from sexual intercourse, oral and anal sex, while instructors were more likely to include any type of petting. The researchers were also surprised by how many students thought of abstinence in positive terms, emphasizing self-control, greater choice and future opportunities in their definitions.
Asking the Right Questions: Researchers try to measure the effects of abstinence programs by comparing teen pregnancy rates, the onset of sexual activity or STD rates between teens who participate in the programs and those who do not. It can be tricky to gather the essential data for those questions because of the controversy surrounding asking teens about sex, pregnancy and abortion, says Sylvana Bennett, M.D., of the University of California, San Diego Medical Center. Bennett conducted one of the few systematic reviews of school teen pregnancy programs in the United States, published in 2005.16 Because of pressure from parents who did not want their children interviewed about such sensitive topics, Several of the studies I reviewed stated that they were required to drop some of their questions, Bennett says.
Making Useful Comparisons: Abstinence curricula are often tailored for a specific states school districts requirements, making it difficult to compare outcomes across programs. One pregnancy prevention program that worked great in inner city Chicago may not have worked in a suburban school in Utah and vice versa, says Bennett.
In school districts where most of the students come from the same background, abstinence strategies that have proven successful elsewhere can be thwarted. A recent study of an abstinence program for Ohio middle schoolers, for instance, seems to be unique in that the program did appear to have an effect on sexual behavior of the sexually experienced, according to study author Elaine Borawski of Case Western Reserve University.4
Waiting for Data: Its easy enough to give a multiple-choice test after an abstinence program to find out if students have changed their attitudes toward premarital sex and the risks of pregnancy and STDs. But most studies are not long enough to find out whether the new information and attitudes translate into new behaviors. 2, 12, 17, 18 I do think that part of the problem is asking teens about behavior before they have had time to change it, Bennett says.
Sylvana Bennett, M.D., University of California, San Diego Medical Center or 619.543.6922 or E-Mail
Patricia Goodson, Ph.D., Texas A&M University or 979.845.1756 or E-Mail
Douglas Kirby, Ph.D., ETR Associates or 831.438.4060 x 144 or E-Mail
Marilyn Maxwell, M.D., Saint Louis University School of Medicine
or 314.577.6143 or E-Mail
1.U.S. Social Security Act 510 (b)(1) Last accessed 9-22-05 at http://www.socialsecurity.gov/OP_Home/ssact/title05/0510.htm.
2. M.H. Thomas (2000) Abstinence-based programs for prevention of adolescent pregnancies. Journal of Adolescent Health, 26, 5-17.
3. Centers for Disease Control and Prevention (2004). Surveillance Summaries. Morbidity and Mortality Weekly Report, 53 (No.SS-2).
4. E.A. Borawski et al. (2005) Effectiveness of abstinence-only intervention in middle school teens. American Journal of Health Behavior, 29, 423-434.
5. National Public Radio/Kaiser Family Foundation/ John F. Kennedy School of Government Poll. Sex Education in America. Poll results last accessed 9-8-05 at http://www.kff.org/newsmedia/upload/Sex-Education-in-America-Summary.pdf.
6. D.J. Landry et al. (1999) Abstinence promotion and the provision of information about contraception in public school district sexuality education policies. Family Planning Perspectives, 31, 280-286.
7. Committee on Psychosocial Aspects of Child and Family Health and Committee on Adolescence (2001) American Academy of Pediatrics: Sexuality education for children and adolescents. Pediatrics, 108, 498-502.
8 .K.L. Wilson et al. (2005) A review of 21 curricula for abstinence-only-until-marriage programs. Journal of School Health, 75, 90-98.
9. R.A. Maynard et al. (2005) First-Year Impacts of Four Title V, Section 510 Abstinence Education Programs. Evaluation contracted by U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Last accessed 9-8-05 at http://aspe.hhs.gov/hsp/05/abstinence/execsum.pdf.
10. C.H. Tremblay and D.C. Ling (2005) AIDS education, condom demand, and the sexual activity of American youth. Health Economics, 14, 851-867.
11. P.S. Bearman and H. Brückner (2001). Promising the future: Virginity pledges and the transition to first intercourse. American Journal of Sociology, 106, 859-912.
12. H. Brückner and P. Bearman (2005) After the promise: the STD consequences of adolescent virginity pledges. Journal of Adolescent Health, 36, 271-278.
13. L.D. Lindberg et al. (2000) Adolescents' reports of reproductive health education, 1988 and 1995. Family Planning Perspectives, 32, 220-226.
14. J. Jemmott et al. (1998). "Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents, a randomized trial." Journal of the American Medical Association, 279, 1529-1536.
15. P. Goodson et al. (2003) Defining abstinence: views of directors, instructors and participants in abstinence-only-until-marriage programs in Texas. Journal of School Health, 73, 91-96.
16. S.E. Bennett and N.P. Assefi (2005) School-based teenage pregnancy prevention programs: a systematic review of randomized controlled trials. Journal of Adolescent Health, 36, 72-81.
17. S.D. Pinkerton (2001) A relative risk-based, disease-specific definition of sexual abstinence failure rates. Health Education and Behavior, 28, 10-20.
18. T.E. Smith et al. (2003) Measurement in abstinence education: critique and recommendations. Evaluation and the Health Professions, 26, 180-205.
The Center for the Advancement of Health is an independent nonprofit organization that promotes greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness. The Center advocates the highest quality research and communicates it to the medical community and the public. The fundamental aim of the Center is to translate into policy and practice the growing body of evidence that can lead to the improvement and maintenance of the health of individuals and the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, which continue to provide core funding. Funding for this series was provided by the Robert Wood Johnson Foundation.
For Information Contact:
Lisa Esposito, Editor, Health Behavior News Service, Center for
the Advancement of Health, 2000 Florida Ave., NW, Suite 210,
Washington, DC 20009 or 202.387.2829 or fax 202.387.2857 or www.cfah.org
Teenagers special: Going all the way
Teenage mothersLYNSEY TULLIN was 15 when she became pregnant. The only contraception she and her boyfriend had used was wishful thinking: "I didn't think it would happen to me," she says. Tullin, who lives in Oldham in northern England, decided to keep the baby, now aged 3, although as a consequence her father has disowned her.
Tullin is not alone. In the UK nearly 3 per cent of females aged 15 to 19 became mothers in 2002, many of them unintentionally. And unplanned pregnancies are not the only consequence of teenage sex - rates of sexually transmitted diseases (STDs) are also rocketing in British adolescents, both male and female.
The numerous and complex societal trends behind these statistics have been endlessly debated without any easy solutions emerging. Policy makers tend to focus on the direct approach, targeting young adolescents in the classroom. In many western schools teenagers get sex education classes giving explicit information about sex and contraception. But recently there has been a resurgence of some old-fashioned advice: just say no. The so-called abstinence movement urges teens to take virginity pledges and cites condoms only to stress their failure rate. It is sweeping the US, and is now being exported to countries such as the UK and Australia.
Confusingly, both sides claim their strategy is the one that leads to fewest pregnancies and STD cases. But a close look at the research evidence should give both sides pause for thought. It is a morally charged debate in which each camp holds entrenched views, and opinions seem to be based less on facts than on ideology. "It's a field fraught with subjective views," says Douglas Kirby, a sex education researcher for the public-health consultancy ETR Associates in Scotts Valley, California.
For most of history, pregnancy in adolescence has been regarded not as a problem but as something that is normal, so long as it happens within marriage. Today some may still feel there is nothing unnatural about older adolescents in particular becoming parents. But in industrialised countries where extended education and careers for women are becoming the norm, parenthood can be a distinct disadvantage. Teenage mums are more likely to drop out of education, to be unemployed and to have depression. Their children run a bigger risk of being neglected or abused, growing up without a father, failing at school and abusing drugs.
The US has by far the highest number of teenage pregnancies and births in the west; 4.3 per cent of females aged between 15 and 19 gave birth there in 2002. This is significantly higher than the rate in the UK (2.8 per cent), which itself has the highest rate in western Europe (see Chart).
Another alarming statistic is the number of teenagers catching STDs. In the UK the incidences of chlamydia, syphilis and gonorrhoea in under-20s have all more than doubled since 1995. The biggest rise has been in chlamydia infections in females under 20; cases have more than tripled, up to 18,674 in 2003. Chlamydia often causes no symptoms for many years but it can lead to infertility in women and painful inflammation of the testicles in men.
No surprise, then, that teenage sex and pregnancy has become a political issue. The UK government has set a target to halve the country's teen pregnancy rate by 2010, and the US government has set similar goals. But achieving these targets will not be easy. In an age when adolescence has never been so sexualised, in most western countries people often begin to have sex in their mid to late teens; by the age of 17, between 50 and 60 per cent are no longer virgins.
Since the 1960s, UK schools have increasingly accepted that many teenagers will end up having sex and have focused efforts on trying to minimise any ensuing harm. Sex education typically involves describing the mechanics of sex and explaining how various contraceptives work, with particular emphasis on condoms because of the protection they provide from many STDs.
The sex education strategy gained further support in the early 1990s when policy makers looked to the Netherlands. There, teenage birth rates have plummeted since the 1970s and are now among the lowest in Europe, with about 0.8 per cent of females aged between 15 and 19 giving birth in 2002. No one knows why for sure, as Dutch culture differs from that of the UK and America in several ways. But it is generally attributed to frank sex education in schools and open attitudes to sex. Dutch teenagers, says Roger Ingham, director of the Centre for Sexual Health Research at the University of Southampton,"have less casual sex and are older when they first have sex compared with the UK".
Why do virginity pledgers catch STDs? It's difficult to imagine intending not to have sex while also being contraceptively preparedBut a new sexual revolution is under way. Spearheaded by the religious right, the so-called abstinence movement is based on the premise that sex outside marriage is morally wrong. "We're trying to say there's another approach to your sexuality," says Jimmy Hester, co-founder of one of the oldest pro-abstinence campaigns, True Love Waits, based in Nashville, Tennessee.
Abstinence-based education got US government backing in 1981, when Congress passed a law to fund sex education that promoted self-restraint. More money was allocated through welfare laws passed in 1996, which provided $50 million a year.
A key plank of the abstinence approach is to avoid giving advice on contraception. The logic is that such information would give the message that it's OK to have sex. "The moment we do that, we water down the commitment," says Hester.
If contraception is mentioned at all, it is to highlight its failings - often using inaccurate or distorted data. A report for the US House of Representatives published last December found that 11 out of the 13 federally funded abstinence programmes studied contained false or misleading information. Examples of inaccurate statements included: "Pregnancy occurs one out of every seven times that couples use condoms," and: "Condoms fail to prevent HIV 31 per cent of the time." They also use some questionable logic regarding the success rate of abstinence (see "Heads I win, tails you lose").
While some states advocate "abstinence-plus" programmes, providing a level of advice on contraception alongside heavy promotion of chastity, the hard-line "abstinence only" approach is in the ascendant in the US. Around a third of US secondary schools have abstinence-only programmes, and nearly 3 million young people have publicly pledged to remain virgins until they marry.
And it is spreading. Last June an American group came to the UK to promote the Silver Ring Thing, a Christian movement that encourages teens to publicly pledge to remain virgins until marriage and to keep their promise with the aid of a $12 ring. And True Love Waits has held virginity rallies in Australia.
This trend comes amid claims that the UK's more liberal approach not only does not work, but has the opposite effect. "Free pills and condoms boost promiscuity" screamed the headline on the front page of UK newspaper The Times last year (5 April 2004). It was prompted by research by David Paton, an economist at the University of Nottingham, UK, which found that in some areas that had increased access to family planning services, teen pregnancy rates had remained the same and STD rates had actually risen.
Despite many people's assumption that sex education is the best way to reduce pregnancies, there is little evidence backing this viewThere are now increasing calls from conservative and religious groups for schools in the UK to consider the abstinence option. A programme called Love for Life is now operating in 60 per cent of schools in Northern Ireland. It could be described as abstinence-plus that is heavy on the abstinence. Its founder, Richard Barr, a GP from Craigavon, County Armagh, says that focusing on contraception ignores the bigger picture of human sexuality. "There's a massive need for a more holistic approach, not just a damage-limitation approach."
And the UK mainland is home to a small but growing number of groups, most of them with Christian roots, promoting abstinence-centred education. The word abstinence is less in vogue than across the Atlantic, however, and such groups are more likely to talk in terms of delaying sex until young people are in a committed relationship.
But does the abstinence approach work? Do teenagers - a group not renowned for their propensity to do what they are told - take any notice when adults tell them not to have sex?
Proponents of abstinence claim research supports their strategy. But the vast majority of studies that have been done in this area have been small, short-term evaluations without control groups. "There have only been three well-designed trials where an 'intervention' group is compared with a control group and participants are tracked over time," says Kirby.
One of these, published in 1997, looked at a five-session abstinence-only initiative in California. The trial tracked 10,600 teenagers for 17 months (Family Planning Perspectives, vol 29, p 100). The researchers found it had no impact on the sexual behaviour or pregnancy rates of teenagers. The other two studies had similar results. "None of them show that any abstinence-only programmes had any impact on behaviour," says Kirby.
Although not a controlled trial, one of the largest studies of the effect of abstinence pledges tracked the sex lives of 12,000 US teenagers aged between 12 and 18 (American Journal of Sociology, vol 106, p 859). A group led by Peter Bearman, a sociologist at Columbia University in New York, investigated whether taking a virginity pledge affected the age when people first had sex. It did, with an average delay of 18 months. The pledgers also got married earlier and had fewer partners overall.
But when Bearman went back six years later and looked at the STD rates in the same people, now aged between 18 and 24, he was in for a surprise. In research presented at the National STD conference in Philadelphia last year, he found that though pledgers had had fewer sexual partners than non-pledgers, they were just as likely to have had an STD. And the reason? "Pledgers use condoms less," says Bearman. "It's difficult to simultaneously imagine not intending to have sex and being contraceptively prepared."
Here lies the problem that many have with the idea of abstinence-only education. While it may work for those kids who live up to the ideal, those who don't are left without the knowledge to protect themselves when they do have sex. "It's not rocket science," says Bearman.
But here's where proponents of the liberal approach can stop feeling smug. Because despite many people's unquestioning assumption that comprehensive sex education is the best way to reduce teenage pregnancy, there is actually little good-quality evidence backing this view.
One of the problems in carrying out randomised controlled trials in this area is the question of who should be used as the control group. Most schools now have some form of sex education in place, however rudimentary, and it would be unethical to take this away from some children to create the control group. Instead researchers have tended to compare standard sex education with new initiatives specially designed to reduce pregnancy rates. But the results have been unimpressive. A systematic review in 2002 of 26 such studies showed that not one of them improved the use of birth control or reduced the teenage pregnancy rate (British Medical Journal, vol 324, p 1426).
But in the past few years, a handful of randomised controlled trials have been published showing that some carefully designed sex education programmes do appear to work. One of the most effective is the Carrera Adolescent Pregnancy Prevention Program, aimed at 13 to 15-year-olds in a poor area of New York (Perspectives on Sexual and Reproductive Health, vol 34, p 244). Abstinence is mentioned during the programme, but most of the emphasis is on contraception. A three-year study showed that the pregnancy rate of teenage girls who took the programme was less than half the rate of those who didn't. Analysis showed this was due to both greater condom use and delayed onset of sex.
Why should these programmes be any different? As well as lasting longer, they were, says Kirby, "interactive and personalised, not just abstract facts". The Carrera programme, for example, not only covered sexual behaviour, it tackled the social disadvantages that lead to teenage pregnancy. Along with information on and free access to contraceptives, it involved intensive youth work such as sports, job clubs and homework help.
Most UK sex education programmes seem half-hearted in comparison, providing the bare biological facts, perhaps alongside a demonstration of how to put a condom on a cucumber. "It's something I feel quite angry about," says Michael Adler, a former STD physician at University College London Hospital. In his job he saw many casualties of unsafe sex. "We're failing young people right at the beginning," he says.
Unfortunately policy makers have recently lost a good source of information about what works and what doesn't. The US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, commissioned a panel of external experts to carry out a rigorous review of various sex education programmes. The panel identified five strategies that were successful in reducing the rate of teenage pregnancy, all based on comprehensive sex education, and the details were posted on the organisation's website. But in 2002 that information disappeared and the CDC will no longer release it.
According to the CDC press office, the review programme is being "re-evaluated". But sceptics fear it has been dumped because its conclusions don't fit with the Bush's administration's views. "They were inconsistent with the ideology to which this administration adheres," says Bill Smith of the Sexuality Information and Education Council of the United States, a liberal sex education advocacy group based in New York.
Sceptics fear the information on successful sex education programmes has been dumped because it doesn't fit with the Bush administration's viewsWhat of the study that made the newspaper headlines in the UK last year, showing that contraception provision is linked with higher STD rates? Perhaps it should not really be taken as a damning indictment of the liberal approach. The study looked at National Health Service family planning clinics, not school-based comprehensive sex education. Simply doling out condoms without tackling the wider issues is unlikely to have much impact. Anyway, should the correlation between sex clinics and STD levels really be so surprising? "Has it occurred to [David Paton] that they put more services in areas with high rates?" asks Roger Ingham.
In fact, amid all the scare stories, the average age when a person first has sex now appears to be levelling out at around 17 in the US and 16 in the UK. And although rates of STDs are on the increase in the UK, teenage pregnancy and birth rates are on a downward trend, as they have been in most developed countries for several years. A report from the Alan Guttmacher Institute, a reproductive health research group in New York, concludes this is due to factors such as the rise of careers for women, and the increasing importance of education and training (Family Planning Perspectives, vol 32, p 14). Perhaps it is unsurprising, then, that it is among society's lowest income groups that teen pregnancy rates are highest.
In the face of such complex societal forces, those who try to influence teenagers' behaviour on a day-to-day basis undoubtedly have a tough job on their hands. There may be no single solution. More research is needed to produce detailed information on which kind of sex education programmes work best, and in which contexts.
One approach is to involve older teenagers, on the premise that 14-year-olds may be more likely to listen to 18-year-olds than people of their parents' generation. Since having her son, Lynsey Tullin has started working for Brook, a young people's sexual health charity, to ensure that today's teenagers are more savvy about sex. "We talk the same language," she says.
A tactic that she finds hits home is to describe new parenthood in
all its gory details - the nappies, the lack of sleep, a social life
in tatters. "We run workshops about being parents, telling them what
we went through," she says. "It's a shock."
Source: From issue 2489 of New Scientist magazine, 05 March 2005, page 44
Different approaches to teenage
Provides explicit information about contraception, sexuality and sexual health
Teaches that the only place for sex is within marriage, and the only certain way to avoid pregnancy and STDs is abstinence. Does not teach about contraception
Promotes abstinence as the best choice, but provides varying degrees of information on contraception in case teens do become sexually active
Heads I win, tails you lose
LOOK at any abstinence-only literature, and you'll read that this is the only certain way to prevent pregnancy and avoid catching a sexually transmitted disease (STD). "Abstinence. Failure rate 0 per cent," is the claim on one pro-abstinence website.
But does this make sense? The most important measure of any method of preventing pregnancy and STDs is not its ideal effectiveness, but its "use effectiveness" - how successful it is in the real, sometimes messy, world of sex. Condoms, for instance, have a 97 per cent success rate at preventing pregnancy if used correctly, but have an estimated use-effectiveness of 86 per cent, due to problems such as tearing or slipping. If people who intend to use condoms but never get as far as opening the pack are included, some studies suggest the use-effectiveness of condoms could be as low as 30 per cent - the sort of figure abstinence fans shout from the rooftops.
What about applying the same real-world rules to abstinence? Unfortunately there are no studies detailing the use-effectiveness of abstinence in preventing pregnancy, but it is highly unlikely to be 100 per cent, as commonly claimed by its proponents. Their reasoning goes like this: individuals who set out to remain abstinent but succumb to temptation and have sex are no longer seen as abstinence "users". And those who become pregnant may even be marked up as a failure for the contraception strategy if, say, they attempted to use a condom but bungled it.
Abstinence campaigners are very vocal about the failings of
contraception. But is it perhaps time to own up about the failure
rate of abstinence?
Source: Alison George, www.newscientist.com/channel/being-human/teenagers/mg18524891.300
Sex and the single artist
They asked 425 British people, including artists and poets, on many sexual partners they'd had (Proceedings of the Royal Society B, DOI: 10.1098/rspb.2005.3349) Professional artists and poets averaged 4 to 10 sexual partners, other people averaged only 3. "What we seem to have established is that artists and poets are, amongst other things, horny old toads," Nettle says.
Volunteers were also assessed for character traits associated with schizophrenia which has previously been linked to creativity. Some professional artists and poets scored as highly on these measures as people with schizophrenia did.
Combined with a high sex drive this may explain the persistence of schizophrenia in the population, says Nettle.
New Scientist asked Tracey Emin to comment on the results and she denied that she has more sex than the general population. In fact, I do everything to avoid it, she says. Thats because I dont want to have sex with most people. I want angels, giants, tigers, and I would love to love myself.
Source: From issue 2529 of New Scientist magazine,
10 December 2005, page 23, www.newscientist.com/channel/sex/mg18825295.700.html
More women die of AIDS
Godfrey, Rhett with Neale S. Godfrey. The Teen Code. How to talk to us about sex, drugs, and everything else - Teenagers Reveal What Works Best. Believe it or not, there are ways to talk to teenagers so theyll listen. But first you have to crack the code of how teenagers think and talk. To find out how, 18-year-old Redtt Godfrey asked the experts themselves: teenagers from across the country. Now he takes parents inside the very secretive world of todays teenager. The frank and surprising conversations Rhett shares give parents a clear path about what kids say works best-and what can backfire- when talking to them about sex, drugs, privacy, alcohol, cigarettes, school problems , family problems and self expression. Rodale Inc, 2004, ISBN 1-57954-852-0
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