To prevent teen pregnancy, should students be taught only the merits of abstaining from sex? Or should they also learn about contraception, just in case? Believers on both sides are facing off again, after a government announcement in early December that teen birthrates rose 3 percent last year following a 14-year decline. Some public-health experts blame increasingly popular sex-ed programs that preach abstinence only and keep kids in the dark about other pregnancy-prevention methods: A study published recently in the American Journal of Public Health attributed most of the 14-year birthrate drop to wider contraceptive use. "Abstinence-only programs are ideology driven," says Marilyn Keefe, director of reproductive health and rights at the nonprofit National Partnership for Women and Families, "and not a good use of our public-health dollars."
Abstinence advocates, meanwhile, are crying foul, saying the uptick in pregnancies is a sign that a stronger pitch for delaying sex is needed. "Any kind of assertion of blame is a disingenuous attempt to turn these statistics into a political agenda," insists Valerie Huber, executive director of the National Abstinence Education Association. Even with more schools teaching the benefits of abstinence, she says, most still emphasize contraceptive techniques over waiting. Huber believes the purist approach is bound to lead to less sex among teens.
Benefits? The latest research suggests otherwise, however. A study released in April by Mathematica Policy Research looked at four "promising" sex-ed programs that advocate postponing all sexual activity until marriage and emphasize the social, emotional, and health benefits that can be gained from abstinence. What it found is that the teens in these programs were no more likely to delay their first sexual experience, have fewer partners, or use condoms than their peers who didn't have a sex-ed class.
What's worse, experts fear, is that an anti-birth-control message could turn kids off to ever using contraception—even as adults. Federal law mandates that to receive funding, programs must teach that abstinence is the "only certain way" to avoid sexually transmitted diseases and pregnancy. Some educators have taken this to mean that they should focus exclusively on the limitations of birth control—that condoms fail 15 percent of the time, for example. These concerns, plus a 2004 congressional report showing that over two thirds of the programs provide inaccurate information about contraception and abortion risks, have prompted 15 states to decline federal funds for abstinence education.
More encouraging are the data on comprehensive education programs, which show that some do delay first encounters and improve contraceptive use, according to a recent analysis by the nonpartisan National Campaign to Prevent Teen and Unplanned Pregnancy. In order to be effective, though, a program must convince teens that avoiding sex or using condoms is the right thing to do, as opposed to just laying out the risks and benefits. And that's not easy. "There are probably thousands of efforts underway to prevent teen pregnancy, but we identified only 15 that seemed to help," says Sarah Brown, chief executive officer of the organization, whose analysis included 116 programs previously studied in published journal articles. "Most haven't even been evaluated in research studies."
Having no standard curricula for sex-education programs means huge variations in how they're taught and what impact they have. The really good ones, says Brown, engage teens by discussing issues relevant in their school culture, like gang membership or sex parties. For girls, particularly effective programs combine sex education with general health issues, schoolwork assistance, and a push for participation in sports or the performing arts, with the goal of getting students to plan for their future.
Researchers caution that for now, any link between the teen birthrate increase and abstinence-only efforts remains tenuous at best. "It's too soon; we don't even know if it signals a trend," says Stephanie Ventura, chief of the reproductive statistics branch of the National Center for Health Statistics, which conducted the government's analysis. She points out that higher birthrates also occurred in unmarried women ages 18 to 44. While more single women nowadays intentionally have babies, some experts speculate that poor uninsured women may be feeling the lack of federal funding for contraceptive services, which hasn't been raised to match inflation. (Congress and President Bush have just decided to raise the budget for these services.) As for sex ed's role, Brown says it's important not to overlook other forces: "We're naive to think we can counteract inattentive parents and sexually active friends with three weeks of classroom lectures."