Abstinence

Supporters of abstinence education believe that by encouraging young people to say no to sex until marriage young people will abstain from sex and as a result teenage pregnancy rates will drop and sexual health will improve.

Abstinence education is widely taught in the United States where it attracts large scale federal funding.   Since 1996 more than $700m of state and federal funding has been spent on abstinence education and it is set to increase.   Some 35% of the school districts in the USA that mandate sexuality education require that abstinence is presented as the only appropriate option outside of marriage. 

The 1996 Welfare Reform Act outlined the official constituents of abstinence education:

• it has as its exclusive purpose teaching the social, psychological and health gains to be realised by abstaining from sexual activity; 
• it teaches that abstinence outside of marriage is the expected norm;
• it teaches that abstinence is the only certain way to avoid out of wedlock pregnancy, STIs and other associated health problems; 
• it teaches that sexual activity outside of marriage is likely to have harmful psychological and physical effects; 
• it teaches that bearing children outside of marriage is likely to have harmful consequences for the child, its parents and society.

Abstinence programmes may include information about failure rates of condoms and other forms of contraception but they may not provide any information about contraceptive methods that could be construed as promoting contraceptive use or they lose federal funding.

There are more than 80 independent organisations, mainly religious-based, that sponsor public virginity pledges and rallies and it is estimated that 2.5m adolescents have taken pledges to remain virgins till they marry. 

Does the evidence from the United States suggest that abstinence-only education is effective?   So far no systematic evaluation of abstinence education has been published but there are pointers from research papers and large-scale studies of young people who have taken virginity pledges.

Teenage pregnancy rates in the US have been falling since 1991, though they are still much higher than in the UK.   Abstinence education is claimed to be responsible for this fall by its proponents.   Research by the Alan Guttmacher Institute suggests in fact that while 25% of the decline was due to more teenagers remaining abstinent 75% was due to improved contraceptive use amongst sexually active teenagers.

There is evidence to suggest that teenagers who pledge to remain abstinent until marriage delay having sex about one-third longer than comparable non-pledgers.   Unfortunately, they are less likely to use contraception when they do have sex.   

Young people who make virginity pledges are more likely than others to be religious suggesting that they may already be committed to delaying sexual activity.   They are also likely to be less advanced in pubertal development, also a factor associated with later initiation of sexual activity.

  
Religious adherence is much stronger in the US than in the United Kingdom.   53% of Americans say that religion is very important in their lives compared to 16% of Britons  suggesting that abstinence pledging is unlikely to be well received by most young people in Britain.

Abstinence supporters claim it is the only certain way to prevent pregnancy and sexually transmitted diseases.   Researchers usually measure the effectiveness of contraception in two ways.   ‘Perfect use’ measures effectiveness when used exactly according to instructions while ‘typical use’ measures how effective a method is for the average person who may not always use it consistently.   Using these measures the contraceptive pill is almost 100% effective with perfect use and 92% effective with typical use.  When abstinence campaigners talk about its effectiveness they are talking about perfect use not typical use.   Not only is there a lack of clarity about what exactly abstinence refers to but evidence suggests that it is not maintained over time.

There appears to be confusion amongst young people about what constitutes abstinence.    Half of all 15-17 year olds in one survey believed that a person who had oral sex was still a virgin.    Even more significantly 55% of college students who had pledged virginity and said they had kept the vow reported having had oral sex.   Pledgers were as likely as non-pledgers to have had oral or anal sex.

The majority of pledgers do not remain abstinent until marriage.   One study found that 60% of college students who had pledged virginity till marriage at high school had subsequently broken their vow.    Another study of 18-24 year olds found that 88% had sex before marriage and the remaining 12% were married.   The average age of marriage in the US is 26 for women and almost 27 for men.  In the UK it is 35 for men and 33 for women  and married couples make up just over 50% of the adult population.

A large scale study of young people recently found that graduates of abstinence programmes had rates of sexually transmitted infection very similar to other young people. This was found to be because they were significantly less likely to use condoms and were less aware of sexually transmitted infections.  They were also less likely to get tested for STIs and less likely to seek help if they were worried about an STI which meant they could be more likely to spread infection to others.   Other, as yet unpublished, findings from the same survey suggest that abstinence programmes do not prevent early pregnancy.

In contrast, a review of all the available evidence on sex education by the NHS Centre for Reviews and Dissemination concluded that good, comprehensive sex and relationships education which starts before the onset of sexual activity does not make young people more likely to have sex.   

In fact it helps them to delay starting sex and makes them more likely to use contraception when they do. This was reaffirmed by the Health Development Agency’s review of the evidence of interventions to prevent teenage pregnancy. A similar review of the evidence of what interventions reduced sexual risk taking concluded that school-based sex education can be effective in reducing risk taking behaviour.

Brook believes that sex and relationships education is an educational entitlement for all young people.   It should focus not just on  information provision but on skills development and the clarification of attitudes and values in order to help young people to make informed decisions, delay intercourse and practice safer sex when they do decide to become sexually active. 

 

Footnotes 

1. J E Darroch & S Singh, Why is teenage pregnancy declining?  The roles of abstinence, sexual activity and contraceptive use.   Occasional Report, AGI, 1999, No. 1

2. Virginity pledge helps teens delay sexual activity.   National Institute of Health press release 4 January 2001 (reporting analysis by Peter Bearman and Hannah Bruckner of information from the Longitudinal Study of Adolescent Health)

3. Ibid

4. University of Michigan World Values Survey, 1997

5. From a nationally representative survey conducted by the Kaiser Family Foundation and seventeen magazine cited by Cynthia Dallard, Understanding ‘abstinence’:  implications for individuals, programs and policies.   Guttmacher Report on Public Policy, December 2003
 

6. From a study presented at the 2003 meeting of the American Psychological Society cited by Cynthia Dallard, Understanding ‘abstinence’:  implications for individuals, programs and policies.   Guttmacher Report on Public Policy, December 2003

7.Dallard, ibid
 

8. The relationship between virginity pledges in adolescence and std acquisition in young adulthood.   After the promise:  the long term consequences of virginity pledges.   Peter Bearman and Hannah Bruckner.   Paper presented at the National STD Conference, March 9 2004, Philadelphia.

9.Marriages in 2002:  England and Wales.   National Statistics News Release, 12 February 2004.

10.Census 2001.   People and places.   Census results on ethnicity, marriage and families.   National Statistics 2003.

11.  Bearman and Bruckner, op cit
 

12. NHS Centre for Reviews and Dissemination (CRD).   Effective Healthcare Bulletin 3 (1) Preventing and reducing the adverse effects of unintended teenage pregnancies, University of York, 1997
 

13. C Swann, K Bowe, G McCormick & M Kosmin.   Teenage pregnancy and parenthood: a review of reviews.   Health Development Agency 2003
 

14. S Ellis & A Grey.   Prevention of sexually transmitted infections (STIs):  a review of reviews into the effectiveness of non-clinical interventions.   Health Development Agency 2004

Brook provides free and confidential sexual health services and advice for young people under 25. Brook is a registered charity number 239966.