STATS ARTICLES 2006

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Contraception v Abstinence Education
Rebecca Goldin Ph.D, December 12, 2006
If you look at the statistics, perhaps the twain should meet.

A new study has shown that contraception, not abstinence, is behind declines in teen pregnancy. Researchers from Columbia University and the Guttmacher Institute took a nation-wide look at why it is that teen pregnancy rates are down. In 1995, there were just under 100 pregnancies for every 1,000 teenage women age 15-19, according to the Guttmacher Institute (the figures vary slightly among the three major sources for teen pregnancy rates – the Guttmacher Institute, the National Center for Health Statistics, and the National Center for Chronic Disease Prevention and Health Promotion).

By 2002, this had gone down to just over 75 per 1,000. According to the new study, 86 percent of the decline is attributable to the use of contraception, while only 14 percent is attributable to abstinence.

Abstinence has only contributed to a small percentage of the overall decline, and none for teens aged 18-19. For those ages 15-17, abstinence was responsible for about 23 percent of the decline, according to the study published in the American Journal of Public Health.

Yet news organizations jumped to making conclusions about sexual education. CNN led with a (correct) statement on the new study finding contraceptives more responsible than abstinence for reducing teen pregnancy. But the second paragraph, citing an opinion about the scientific finding, reached an unwarranted conclusion:

“‘The current emphasis of U.S. domestic and global policies, which stress abstinence-only sex education to the exclusion of accurate information on contraception, is misguided,’ warn doctors in a report just released online by the American Journal of Public Health.”

This reasoning doesn’t work for the following reason: In theory, abstinence-only education could be a major contributor to pregnancy prevention, all the while having a poorer showing on the percentages than contraceptive use. Why is this? Suppose that abstinence education was extraordinarily effective, and contraception education only modestly so. If abstinence were only taught on a very limited scale, but contraception taught everywhere, then the fact that abstinence is responsible for 14 percent of the decline is actually pretty impressive.

On the other hand, it may be that abstinence education is not at all responsible for increased abstinence among teens. All sex education includes the basic principle that, barring divine intervention, a sure-fire way not to get pregnant is not to have sex. So the increase in abstinence, mild as it was, could actually be due to contraceptive-based educational efforts.

Alternatively, the trend of decreasing pregnancy rates might well be independent of education. Perhaps cultural shifts are prompting teens to be more responsible in exercising birth control – from contraceptives to abstinence, and that this occurred independent of the type of sex-ed messages these young adults were getting from school.

So how do we know whether abstinence education is as effective as education about contraceptive use in keeping teen pregnancy down, or reducing it further? It can’t be measured by looking at the data for the reasons behind the decline in teen pregnancy rates.

One way of trying to measure the impact of abstinence education versus contraception education is to compare regions within the US that use abstinence as their major source of sex ed, with regions that primarily teach about contraceptive use. It’s important that these comparisons are made among regions with similar demographics: pointing out that Texas has had major funding for abstinence education and maintains one of the worst teen pregnancy rates is unfair, since there may be other reasons for a high pregnancy rate than the type of sex ed Texan teens are getting.

But here’s some more pertinent evidence that abstinence education may not be working. While Texas championed abstinence education, and teen pregnancy rates were going down, the Texan teen pregnancy rate went down less than in other states.

Another source of comparison comes from Minnesota, which invested five-million dollars in an abstinence education plan over five years (1998-2002) for certain counties, but not for others. The efficacy of the program was then evaluated. The result? There was no measurable increase in abstinence among young teens (9th graders), but there was a significant decline in sexual activity among 12th graders, which could not be explained by the program since those teens had been too old to participate in it.

After adjusting for a variety of demographic differences (such as poverty) among different counties, it was found that those counties with no abstinence education funding had slightly lower rates of abstinence than those with the abstinence education (49 versus 53 percent), but the difference was not significant enough to warrant attribution to the education itself. Any difference in pregnancy rates was not reported. Even Connie Schmitz, the lead author on the study, commented that the program “seems like a really weak intervention,” according to the Minneapolis Star Tribune.

Reports of the success and failures of abstinence-only education have yielded mixed results; some of them suggest that abstinence education does delay when teens first have sex, but that when the students do have sex, they are less likely to use protection. The Postponing Sexual Involvement (PSI) curriculum (that does not include contraceptive education) showed no positive effects California.

In 2002, when the Heritage Foundation found ten programs that supported the view that “abstinence education was working”, Douglas Kirby of the National Campaign to Prevent Teen Pregnancy did an analysis of these programs, finding that only one of these ten programs actually showed weak support that abstinence education works (the others did not satisfy criteria ensuring that the results were scientifically valid).

Furthermore, it seems that these ten studies were drawn from a pool of many studies on abstinence education – and that the ten studies were selected to have encouraging results. According to Kirby, “So far all of the programs that have been demonstrated to have a positive impact ... have been comprehensive sex education that emphasize abstinence and talk about condoms and contraception and encourage their use for young people who are sexually active," He concedes that abstinence-only programs have not been deemed ineffective, either; there may be some programs that demonstrate progress against teen pregnancy in the future.

What about contraceptive education? Does it fare better than abstinence education? This is something of a loaded question, since comprehensive sex education includes both information about contraceptives and basic facts about the birds and the bees. It is a simple fact of nature that abstinence is the only 100 percent guaranteed method of birth control. Advocates for Youth found 19 programs it deemed scientifically worthy and which proved their effectiveness in preventing pregnancy, reducing HIV and sexually transmitted diseases, or producing a behavioral benefit such as increased contraceptive use or delaying the onset of sexual activity. Of those that actually decreased pregnancy rates, all included contraceptive education.