NEW YORK, Jan. 6-Abstinence-only education programs are not turning out to be a panacea for the problems inherent in adolescent and premarital sex.
Indeed, they may deprive adolescents and young adults of critical sexual health information that could protect them from potentially life-threatening sexually transmitted diseases, researchers here reported in a literature review in the January issue of Journal of Adolescent Health.
The review suggested that while abstinence-only programs may offer some benefit, young people remain misinformed about contracting sexually transmitted diseases (STDs) through sexual activities other than intercourse, like oral sex or manual stimulation.
Another problem is that many teens simply fail to remain abstinent, added John Santelli, M.D., MPH, professor and chair of the department of clinical population and family health at Columbia University here.
The review he and his colleagues published showed that for women, the median age of first intercourse was 17.4 years while the median age at first marriage was 25.3 years. For men, those figures were 17.7 years and 27.1 years, respectively.
The evidence they found showed that more than 800,000 adolescents become pregnant every year, with 80% of these pregnancies being unintended.
Data in 2000 showed than there were 18.9 million sexually transmitted infections, and almost half of these occurred among individuals under age 25. Their review also showed that 50% of new HIV infections occur among people under age 25, with 25% of these infections occurring among young people ages 22 and under.
In many communities, abstinence-only programs are "replacing comprehensive sexuality education," the authors wrote. Abstinence should be encouraged, they said, but not to the exclusion of important sexual health information.
"Abstinence is a very healthy choice for teenagers," Dr. Santelli said, "but sex education for teenagers needs to give teenagers all the facts, all the medically accurate information they need to protect themselves."
Dr. Santelli and colleagues went on to say that it was unethical for misinformation to be distributed or withheld from adolescents.
"An oncologist who presented only the benefits of chemotherapy and only the risks from radiation therapy would be denounced as failing in his or her obligations to the patient," they wrote. The same holds true for health care professionals who do not provide all the necessary information available for young people to protect themselves from HIV, other STDs, and pregnancy, they said.
Abstinence-only sex education programs have been increasing in popularity, and federal funding for these programs has jumped significantly over the past decade, from $60 million in 1998 to $168 in 2005.
Yet the review by Dr. Santelli and colleagues showed that 90% of parents of middle- and high school-aged children supported sex education in school, compared with only 7% who thought sex education did not belong in schools. Only 15% of the parents said they wanted an abstinence -- only form of sex education, the authors reported.
Dr. Santelli and his team conducted their literature review by searching Medline and Google Scholar for reports about abstinence-only education. They also tracked newspaper reports and internet list serves that covered the issue between January 2004 and July 2005 to read about the latest studies or reports.
Included in their evaluation were looks at current policies, adolescent pregnancy rates, and the impact of abstinence-only programs on sexually active youth, including homosexual adolescents.
Polls have shown that 99% of parents of middle- and high school-aged children support providing information on STDs and 95% supported teaching young people that sexual intercourse should be postponed into adulthood. Eighty-six percent of the parents supported having their children learn about how and where to obtain contraception.
Dr. Santelli also noted that in these polls, parents and adolescents "do not see education that stresses abstinence while also providing information about contraception as a mixed message."
While parents appear supportive of teaching their children both abstinence and ways to protect against STDs and pregnancy, current government policies appear to suggest that there is no room for sexual health information in abstinence-only education. They also noted that many faith-based organizations are receiving increased funding to promote an abstinence-only message.
Their review indicated, for example, that contraceptive methods should not be discussed and that contraceptive failure rates should be emphasized in abstinence-only programs. "Three states, including, most recently, Maine, have refused federal abstinence-only education funding given federal restrictions on providing information about contraception," Dr. Santelli and colleagues wrote.
Further analysis showed that data from the 2000 School Health Policies and Programs Study showed that only 21% of junior high school teachers and 55% of high school teachers taught the correct use of condoms.
When looking at gay, lesbian, bisexual, transgender, and questioning youth (those who are unsure of their sexual orientation), the authors asserted that abstinence-only education was "unlikely to meet the health needs" of this population because abstinence-only programs focus heavily on no sex until marriage and ignore homosexuality. This could lead to increased risk of infection among these youngsters, the investigators said.
The research team also looked at last year's virginity pledge debate. A Yale study based on the National Longitudinal Study of Adolescent Health and published in the April 2005 issue of this same journal suggested that virginity pledges, which are heavily promoted in abstinence-only programs, failed to protect young people from STDs.
A few months later, the Heritage Foundation criticized the conclusions of that study citing serious flaws in the Yale researchers' analysis.
"Schools and health care providers should encourage abstinence as an important option for adolescents," the researchers concluded. "However, 'abstinence-only' as a basis for health policy and programs should be abandoned."