In his 2010 budget, President Barack Obama eliminated funding for most abstinence-only sex-education programs. It was a significant shift after a decade in which the federal government spent more than $1.3 billion promoting the “no sex until marriage” message. From now on, the administration announced, sex-education funding would flow to programs backed by scientific evidence of their effectiveness—a mark abstinence-only programs had consistently failed to meet.
One month into the year, that policy shakeup was followed by a scientific one. John B. Jemmott III, the Kenneth B. Clark Professor of Communication at the Annenberg School, reported an abstinence-only intervention that had proven its merit in a randomized controlled trial targeting African-American 6th and 7th graders—the very demographic group whose high rates of teenage pregnancy and sexually transmitted infections, including HIV, concern experts most. The finding was published in the February issue of Archives of Pediatric & Adolescent Medicine.
Jemmott and his colleagues—including Loretta Sweet Jemmott GNu’82 Gr’87, the van Ameringen Professor in Psychiatric Mental Health Nursing and director of the Center for Health Disparities Research—tested three sexual-education programs. There was an eight-hour abstinence-only intervention targeting reduced sexual intercourse; an eight-hour safer-sex-only intervention emphasizing increased condom use; and a pair of eight- and 12-hour comprehensive interventions targeting both goals. A control group received an eight-hour intervention focusing on health issues unrelated to sexual behavior. Each one was conducted over the course of several weekend days for adolescents who were paid $20 to attend each session.
Alone among the approaches, the abstinence-only program reduced the rate of sexual initiation over the subsequent two years. Only about a third of the students enrolled reported having had sex at the 24-month follow-up, versus about half in the control group. Furthermore, students assigned to the abstinence-only intervention were no more likely to report having had unprotected sex than any of the other groups.
Why did Jemmott’s abstinence-only program succeed where others have failed? A critical difference, he believes, is that his program did not comply with federal criteria for abstinence-only sex education.
An influential 2004 report by U.S. Representative Henry Waxman criticized federally approved abstinence-only programs “as being moralistic and providing inaccurate information, describing women in stereotypic terms, and disparaging the efficacy of condoms,” Jemmott notes. “Others have criticized them as not realistic, in terms of the goal of abstinence until marriage, and excluding people who don’t plan on getting married, or can’t get married because they engage in same-gender sexual behavior. So we knew about all those criticisms, and we wanted to avoid them.”
They designed a program that featured videos, games, experiential exercises, and group discussions. Among the primary aims were increasing knowledge about HIV and other sexually transmitted infections, and strengthening beliefs that abstinence can prevent pregnancy and infection while fostering attainment of future goals. The no-sex-until-marriage paradigm was discarded in favor of an approach that stressed “abstaining from vaginal, oral, and anal intercourse until a time later in life when the adolescent is more prepared to handle the consequences of sex.” Likewise, the intervention did not employ a moralistic tone, or portray sex in a negative light.
This intervention’s success matters, the authors noted, because “abstinence is the only approach that is acceptable in some communities and settings in both the United States and other countries.”
Jemmott casts abstinence in pragmatic rather than ideological terms. “If you can delay the onset of sexual involvement for two years, that’s two years where the person is not exposed to the risk of pregnancy or sexually transmitted disease, or even HIV. So that is a benefit in and of itself,” he says. “We also know that if people begin having sex for the first time at an older age, they’re more likely to be what some would call responsible, and protect themselves against pregnancy and sexually transmitted disease.”
That said, delayed sexual initiation is not the only measure of a sex-education program’s effectiveness. Another crucial factor is the number of sexual partners adolescents have when they bid their virginity goodbye. On that count, Jemmott’s abstinence-only intervention underperformed the comprehensive one that combined abstinence and safer-sex programming.
“Multiple partners is an extremely important variable,” Jemmott says. “Some people might even say it’s more important than abstinence. There’s a lot of work coming out now about concurrent partnerships being very important in the spread of sexually transmitted diseases in sub-Saharan Africa, and even in the United States.”
Looking ahead, the next question is whether Jemmott’s results can be replicated in other contexts and among other populations. “Is it limited to the way we did it, which was on weekends with kids who volunteered to come to the study?” he asks. “Would it also work during regular classroom time with a broader population, and taught by teachers [instead of trained researchers], which is the way most sex education in U.S. public schools is delivered? And along the same lines, would it work with other populations of young people in school—whether it’s Latino adolescents, white adolescents, or middle-class adolescents?”
Further research will be required to answer those questions, but if Jemmott’s initial success can be replicated more broadly, federal policy might shift again. The Obama administration left the door open for funding evidence-backed abstinence programs. By departing from the moral fervor that colored that last decade of efforts, this one appears to have promise.
—T.P.