Abstinence for prevention – policy with a hole

This is a column about sex, so if you keep reading you cannot say you were not warned. I would give it a rating of Reverse PG-13 (parents should be accompanied by a teenager).

The current effort of the Bush administration to promote abstinence-only programs for the prevention of unwanted pregnancies, AIDS and sexually transmitted diseases (STDs) flies in the face of these facts; there is no evidence that such programs work, and there are a lot of people out there having sex regardless of whether we tell them to abstain from sex before marriage or not. Between half and two-thirds of American teens will have had sex by the time they finish high school, which suggests that if an abstinence-until-marriage approach is to work, it would be most successful if we just had all of our teenagers get married in the 10th grade. By the time they marry, more than 90 percent of American men and 80 percent of American women will already have had sex. Given that sex is usually more fun for most people than going bowling, and that Americans on average don’t marry until they are between 24 to 26 years of age, the fact that most of us “didn’t save ourselves for marriage” should be no surprise to anyone whose head is not firmly imbedded in packed sand.

Despite this, the Bush administration, driven by the agenda of its conservative religious supporters, has been encouraging high schools in their sex education programs to advocate abstinence until marriage as the only appropriate way to prevent STDs, AIDS and pregnancy. Funded by $50 million annually in federal tax dollars for such programs, fully one in five American high schools now has an abstinence-only sex education program.

In order to get the money such programs are required to teach that “sexual activity outside of marriage is likely to have harmful psychological and physical effects.” Birth control and condom use are mentioned only in a negative context (the harmful effects of sex before marriage, failure rates of birth control methods, etc.).

Abstinence-only programs, and a puritanical approach to sex, are not unique to the Bush administration. The funding for them was passed by during the Clinton administration by the Republican Congress. More broadly, Americans have always been happy to have sex but reluctant to educate our teens about it. That is why the average age of first intercourse in this country is similar to that of Canada, England, France, etc., but our teen pregnancy rates are twice as high.

The abstinence-only approach, while understandable as a Judeo-Christian religious objective for those adhering strictly to its tenets, is misguided and potentially harmful as social policy. There is no evidence that the abstinence-only approach is effective in preventing unwanted pregnancy, sexual activity among teens, STDs or AIDS. On the other hand, so-called abstinence-plus programs, which teach that abstinence is the best prevention method for teens but fully educate participants about sexuality, STD prevention, AIDS prevention, and birth control, have been shown to be very effective in reducing teen pregnancy and STD rates. In the United States, for example, there is a direct correlation between the comprehensiveness of a state’s program and its rate of teen pregnancy.

Maine, which has one of the best programs in the country, now has one of the lowest teen pregnancy rates in the country. Connecticut ranks about 27th.

Nevada ranks worst – perhaps more evidence that you usually lose when you gamble. Abstinence-only programs cannot replace good, effective alternatives without repercussions for our teenagers.

Comprehensive sex education programs have been endorsed by most major American medical associations. This is not because doctors support sexual activity among teens but because they know what works, and most of their patients talk a lot more about sex than they do about abstinence. As a doctor who practices family medicine and emergency medicine, I cannot swing a cat without hitting some patient who wants to talk to me about sex – good sex, bad sex, Oh-my-God-why-was-I-so-stupid sex, not enough sex, too much sex , I-need-birth-control-before-Friday-night sex, forced sex, adolescent sex, geriatric sex, etc. If you know anything about sexual health care you understand that abstinence-only programs are well-intentioned jokes.

Like most bad jokes, however, abstinence-only programs are going to be around for a long time. Their progressive use is being supported in school districts and legislatures around the country, not just in Washington. Parents hearing about them should think twice about the issue before allowing a school board or a state legislature to implement such programs for their children. They should think about this; more than one half of our teenagers will have sex before they finish high school, no one knows which half, and none of us can know where our teenagers are all of the time.

If teenagers are going to have sex they should do so with all of the facts and a condom. There are approximately 900,000 teen pregnancies, 300,000 teen abortions and 500,000 babies born to teenagers each year in this country. A sex education program that suggests abstinence until marriage as the only legitimate way to prevent STDs, AIDS and the 900,000 pregnancies is as safe and effective as a condom with a large hole in it.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.