The Attack on Abstinence Education: Fact or Fallacy?

Written by Kate Hendricks, MD, MPH&TM, Patricia Thickstun, PhD, Anjum Khurshid, MBBS, MPAff, Sheetal Malhotra, MBBS, MS, Harold Thiele, PhD

Executive Summary - (Click for full report)

The Journal of Adolescent Health published a review article entitled Abstinence and abstinence-only education^a: A review of US policies and programs¹ and a second article entitled Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine² in the January 2006 issue. Both were written by a team of authors headed by John Santelli, and the position paper simply restates the arguments presented in the review article. The authors of these 2 articles claim that abstinence programs “threaten fundamental human rights to health, information, and life.” They say that “abstinence as a sole option for adolescents is scientifically and ethically problematic. . . [and that] abstinence-only education programs . . . are morally problematic.”

The Medical Institute for Sexual Health (MI) is a nonprofit organization dedicated to evaluating scientific evidence related to sexual health and recommending the healthiest evidence-based options for individuals, families, communities, and societies. We assessed the review article to determine its scientific merit and the credibility of its claims. We obtained copies of the referenced materials and examined them to determine how accurately the authors had interpreted the evidence. Where provocative words and phrases were used (eg, “censorship,” “misinformation”), we searched the documents for these words and phrases. We also evaluated additional authentic references addressing abstinence education that had been omitted from this review article. As necessary, we consulted experts in the field.

We found a significant number of serious omissions, misrepresentations, deviations from accepted practices, and opinions presented as facts. Logic, if employed, was often faulty. However, the authors should not be given full credit for these shortcomings, as even a handful of such errors in an article submitted for publication to most peer-reviewed journals would have caught the attention of at least one reviewer or editor.

The scholarship in this review article is generally lacking in rigor. The authors employ nonstandard research methods. Key points are substantiated by non-peer-reviewed sources. The authors repeatedly state that a source says something, when in fact it does not. Most review articles cite original source documents; these authors cite secondary and tertiary sources. They cite opinion pieces and editorials. They cite on-line news magazines. Although the authors promise to tell their readers when they use non-peer-reviewed references, they do this just twice – both times to diminish the credibility of reports favorable to abstinence education. They fail to mention that dozens of references they use to support their key arguments are not peer reviewed; many declarative statements are not referenced. Finally, when discussing abstinence program evaluations, they equate failure to prove an affirmative with evidence of a negative – a common error in logic – typically committed either through ignorance or by design.

Throughout the first half of the review article, the authors are critical of educational policies influenced by morality, alleging that proponents of abstinence education are primarily concerned with religious or moral beliefs. They deride domestic abstinence policies for adopting “. . . a moral and culturally specific definition of abstinence.” They paint educational policies having moral components as patently unscientific. Although they contend that such policies are in conflict with public health principles, Santelli et al offer no evidence to support this opinion. Then, throughout the last half of this review article, the authors parade about in the finery of ethics and human rights. Because ethics is “the study of standards of conduct and moral judgment,”³ the authors’ initial rejection of “moral beliefs” and their later adoption of “ethics” as a guiding principle for sex education is the height of sophistry.

The authors allege that “[a]bstinence-only programs are inconsistent with commonly accepted notions of human rights.” They claim that such programs have led to misinformation, censorship, coercion, and the stigmatization of homosexuals. Such claims, presented as fact, are simply opinions. The citations, if offered, provide no support for these contentions. The claim that abstinence education programs restrict educators from discussing contraception is not substantiated. The authors’ claim that abstinence education does not meet the health needs of gay, lesbian, bisexual, transgender, and questioning youth is not accurate. All school-aged youth must be given a clear message that abstinence is the healthiest choice and must be informed of the STI and pregnancy risks associated with oral, anal, and vaginal sex with or without condoms and contraceptives.

In their section on human rights, the authors quote an international document recommending that “. . . children and adolescents [should be ensured] adequate access to confidential sexual and reproductive health services, including HIV/AIDS information, counseling, testing and prevention measures such as condoms[.]”⁴ These recommendations are contrary to American cultural norms and legal injunctions regarding the abuse of children. In the United States, children do not “need” reproductive health services, nor do they need condoms to protect them from STIs and pregnancy. Rather, children need adults who will protect them from predators.

The authors of this review article attack abstinence education programs as immoral, unethical, unscientific, ineffective, and contrary to human rights and public health principles. When measured against usual standards of scientific evidence, their arguments, are at best, weak and, at worst, fallacious. Abstinence education programs are based on the basic public health principle of primary prevention. They mirror other widely accepted youth-oriented programs that advocate risk avoidance strategies for drugs, alcohol, and tobacco. Few, if any, public health professionals would argue against abstinence as the healthiest behavior for school-aged children.

Therefore, it should come as no surprise that the only sex education programs to have actually documented decreased teen pregnancy were abstinence-based programs,⁵,⁶ a fact conveniently ignored by the authors. Anyone wishing to reproduce the success of these programs should also note that they were community based. It is therefore fitting that the federal government’s new “Community-Based Abstinence Education” initiative is based on the best available evidence and sound public health principles.

a Although the title purports to be a review of abstinence and abstinence-only education policies and programs, throughout the article, the authors choose to use the poorly descriptive “abstinence only” moniker coined by Kirby in a 1993 SIECUS Report

Authors:

Reprinted with permission