Abstinence-only education policies and programs: A position paper of the Society for Adolescent Medicine
Abstinence from sexual intercourse represents a healthychoice for teenagers, as teenagers face considerable risk totheir reproductive health from unintended pregnancy andsexually transmitted infections (STIs) including infectionwith the human immunodeﬁciency virus (HIV). Remainingabstinent, at least through high school, is strongly supportedby parents and even by adolescents themselves. However,few Americans remain abstinent until marriage, many donot or cannot marry, and most initiate sexual intercourse andother sexual behaviors as adolescents. Abstinence as a be-havioral goal is not the same as abstinence-only educationprograms. Abstinence from sexual intercourse, while theo-retically fully protective, often fails to protect against preg-nancy and disease in actual practice because abstinence isnot maintained.Providing “abstinence only” or “abstinence until mar-riage” messages as a sole option for teenagers is ﬂawedfrom scientiﬁc and medical ethics viewpoints. Efforts topromote abstinence should be based on sound science. Al-though federal support of abstinence-only programs hasgrown rapidly since 1996, the evaluations of such programsﬁnd little evidence of efﬁcacy in delaying initiation of sexual intercourse. Conversely, efforts to promote absti-nence, when offered as part of comprehensive reproductivehealth promotion programs that provide information aboutcontraceptive options and protection from STIs have suc-cessfully delayed initiation of sexual intercourse. Moreover,abstinence-only programs are ethically problematic, beinginherently coercive and often providing misinformation andwithholding information needed to make informed choices.In many communities, abstinence-only education (AOE)has been replacing comprehensive sexuality education. Insome communities, AOE has become the basis for suppres-sion of free speech in schools. Abstinence-only educationprograms provide incomplete and/or misleading informa-tion about contraceptives, or none at all, and are ofteninsensitive to sexually active teenagers. Federally fundedabstinence-until-marriage programs discriminate againstgay, lesbian, bisexual, transgender and questioning youth,as federal law limits the deﬁnition of marriage to hetero-sexual couples.Schools and health care providers should encourage ab-stinence as an important option for teenagers. “Abstinence-only” as a basis for health policy and programs should beabandoned.
Abstinence from sexual intercourse is an important be-havioral strategy for preventing STIs and unwanted preg-nancy among adolescents and adults. Sexually active teen-agers face considerable risk to their reproductive healthfrom unintended pregnancy and STIs including infectionwith HIV. Although health professionals often are primarilyconcerned with the potentially serious consequences of ad-olescent sexual behavior, we also recognize that sexuality isintegral to human nature and has many positive mentalhealth consequences.Abstinence, as the term is used by program planners andpolicymakers, is often not clearly deﬁned in behavioralterms, nor is the term used consistently. Abstinence may bedeﬁned in behavioral terms, such as “postponing sex” or“never had vaginal sex,” or refraining from further sexualintercourse if sexually experienced. Programmatically, ab-stinence is also frequently deﬁned in moral terms, usinglanguage such as “chaste” or “virgin,” and framing absti-nence as an attitude or a commitment in addition to abehavior . Federal regulations for state abstinence edu-cation funding adopt a moral deﬁnition of abstinence, re-quiring that abstinence education “teaches that a mutuallyfaithful monogamous relationship in the context of marriageis the expected standard of human sexual activity” .Although abstinence until marriage is the goal of manyabstinence policies and programs, few Americans wait untilmarriage to initiate sexual intercourse. Recent data indicatethat the median age at ﬁrst intercourse for women was 17.4years, whereas the median age at ﬁrst marriage was 25.3years [3,4]. For men, the corresponding median age at ﬁrstintercourse was 17.7 years, whereas the age at ﬁrst marriagewas 27.1 years [3,4].
Journal of Adolescent Health 38 (2006) 83–871054-139X/06/$ – see front matter © 2006 Society for Adolescent Medicine. All rights reserved.doi:10.1016/j.jadohealth.2005.06.002