Health advocates weren’t happy to learn that the sweeping federal health care package extends funding for abstinence-only education in schools, a concession by the Obama administration, which had opposed an abstinence-only approach to sex ed.
The push to revive abstinence funding in the bill had been led by Utah Sen. Orrin Hatch. (Neither Hatch nor any other Republicans voted for the health care bill.)
In a statement on abstinence education, Hatch said, “My first choice would be to not have the federal government involved in any way in these types of education programs and leave these discussions in the proper environment of the home with family members. However, if the federal government is going to spend money on educating people about sexual decisions, the absence of an abstinence only education program has negative health consequences for our nation’s most vulnerable citizens: teenage pregnancy is a leading contributor to poverty, which in turn leads to poor health outcomes for mothers and children; sexually active teens are more likely to experience mental health issues such as depression or attempted suicide; and sexually active teens are more likely to suffer health consequences such as increased rates of infection with sexually transmitted diseases.”
Most studies show poor results for abstinence programs. An eight-year study commissioned by Congress to determine the effectiveness of the programs concluded that abstinence programs were ineffective in reducing the rate of teen sexual activity.However, a recent University of Pennsylvania study found that that an abstinence-only intervention for pre-teens delayed the onset of sexual activity more than a health-promotion control intervention.
According to the university:
A total of 662 African American students in grades 6 and 7 participated in this randomized controlled trial, which was held on Saturdays in classrooms at four public schools participating in the study. The students were randomly assigned to an 8-hour abstinence-only intervention, an 8-hour safer sex-only intervention, an 8- or 12-hour combined abstinence and safer-sex intervention, or an 8-hour health-promotion control group. Participants in the comprehensive intervention had reduced reports of multiple sexual partners compared with the control group (8.8 percent vs. 14.1 percent).
It is not clear whether Obama was influenced by that study or if the abstinence funding was simply a political sacrifice.
According to Education Week:
Although overshadowed by other issues in the health-care debate, a controversial abstinence-only approach to sex education that recently saw its federal support severed is getting a new lease on life—a five-year lease worth $250 million, to be precise—under the final legislative package signed by President Barack Obama.
At the same time, the health-care law also provides $375 million over five years to promote more-comprehensive approaches to sex education that touch on both abstinence and the use of contraceptives to prevent pregnancy and sexually transmitted diseases. The emphasis in the program is on funding efforts that are “evidence-based,” “medically accurate,” and “age-appropriate,” the law says.
That funding stream, called the Personal Responsibility Education program, appears to dovetail with a new teenage-pregnancy-prevention initiative championed by the Obama administration and financed at nearly $115 million in fiscal 2011.
“Advocates for science-based, evidence-based sex education were stunned to learn that some Democrats had kept in the health-care-reform measure a reauthorization of the Title V abstinence-only-until-marriage program,” said James C. Wagoner, the president of Advocates for Youth, a Washington-based nonprofit focused on adolescent sexual health. “Everybody assumed it would be removed.”
The program was added to the health-care legislation through an amendment pushed by Republican Sen. Orrin Hatch of Utah during consideration in the Senate Finance Committee. In the end, no Republicans in Congress supported the health-care legislation.
The abstinence program, which provides grants to states, was first established in 1996 under welfare-reform legislation signed by President Bill Clinton. It is contained in Title V of the Social Security Act.
Valerie J. Huber, the executive director of the Washington-based National Abstinence Education Association, which represents organizations that provide such education, praised its inclusion in the final health-care package.
“Obviously, this is a health issue, so it makes perfect sense for it to be in a health bill,” she said. “We were delighted for the bipartisan support for Title V abstinence education funding.”
She added: “It shows that this continues to be an approach that has merit, and the growing body of research in support of it only strengthens the need for this to continue.” At the same time, Ms. Huber expressed disappointment that the law allocates significantly more money for the Personal Responsibility Education program.
“There is not equitable funding,” she said. “If you look at a public-health model, there is always priority given to the risk-avoidance method.”
The decision to reinstate the federal abstinence-only program comes after the release in February of a high-profile study showing promising results for a particular abstinence-based approach. The study from researchers at the University of Pennsylvania concluded that an abstinence program taught to African-American middle schoolers was more effective than other kinds of interventions in delaying sexual activity. It was described by one co-author as the first randomized, controlled study ever to demonstrate the effectiveness of an abstinence-only intervention.
Some proponents of abstinence-only education had been using the Penn study to argue for reinstating the Title V federal funding. But critics say the program it examined would not even have been eligible for that aid, in part because it did not stress remaining chaste until marriage. The federal abstinence-only program includes eight main points that local programs must adhere to to get funding, such as teaching “abstinence from sexual activity outside marriage as the expected standard for all school-age children” and teaching that “sexual activity outside the context of marriage is likely to have harmful psychological and physical effects.”
“It really is a very rigid, abstinence-until-marriage program,” said Heather D. Boonstra, a senior public-policy associate at the Guttmacher Institute, a New York City-based nonprofit that promotes sexual and reproductive health through research and policy analysis.
Even though the abstinence program will have $50 million to distribute annually over the next five years, some of that money may never be spent. Before the program expired in 2009, 22 states had declined to participate, said Ms. Boonstra. When a state declined the money, she noted, that share simply returned to the U.S. treasury.
Several issues help explain why states declined, she said. Some state officials have openly said they oppose the strict requirements for an abstinence-only approach, according to Ms. Boonstra. There’s also a financial matter. Unlike the Personal Responsibility Education program, the abstinence one requires matching state dollars, equivalent to 75 percent of its grant.
“That’s one question looking ahead: What will states decide to do, having these fiscal budget crises,” she said, “whether they decide, given the lack of evidence, if this is a waste of their taxpayer dollars.”