By Dr. Stephen B. Sondike
Much recent attention has been made of a mandatory assembly at George Washington and Riverside high school, where a faith-based group, Believe in West Virginia, brought in a speaker to talk about the importance of sexual abstinence, and the dangers of sexual activity outside of marriage.
During the talk, the speaker apparently discouraged any sort of birth control, implying that the use of contraception in any form is unsafe and ineffective. Supporters of the speaker have stated that this kind of information is the kind of tough love our kids need as they negotiate a difficult world full of difficult choices, social pressures and temptation. Critics said the talk was biased, shrill, insulting, and laden with misinformation. One student, after asking that the presentation not be mandatory and being rebuffed, expressed her discouragement to the media. So, when evaluating whether such a presentation is appropriate in a public school venue, we should ask ourselves three questions: Is it effective? Is it accurate? Is it appropriate?
The first question is relatively easy to answer, because there is evidence on the effectiveness of abstinence-only education. A 2007 study, authorized by Congress, reviewed four federally funded abstinence programs, involving more than 2,000 students, found that there was no difference in age of sexual initiation or amount of sexual partners in those participating in the programs as those who didn't. A 2008 study published in the Journal of Adolescent Health found that abstinence only education did not decrease sexual activity, but increased pregnancy rates among teenagers when compared to comprehensive sex education. A 2009 article published in Pediatrics looked at almost 300 virginity pledgers five years later. Of those, 82 percent denied having ever taken the pledge; the age at sexual initiation and number of sexual partners did not differ between pledgers and non-pledgers. In fact, the only difference between the two groups in this study was that the pledgers were more likely to engage in unprotected sex. The study authors concluded that "Clinicians should provide birth control information to all adolescents, especially virginity pledgers." This is why the Society for Adolescent Health and Medicine (SAHM) recommends "abstinence plus" education, which promotes abstinence as a healthy choice for adolescents in combination with complete and accurate information about sexual health, which includes risks and benefits of condoms and other contraceptive methods.
So that moves us to the second question: Is it accurate? This may be a little difficult because some of the claims attributed to the speaker are so outlandish that they are almost impossible to fact check. For example, we can't even begin to respond to a statement like "If you use birth control, your mother hates you." However, some of the claims of abstinence only proponents like the speaker invite closer scrutiny. For example, the myth that birth control is ineffective compared to abstinence can be rebuked by looking a little closer at the data.
Contraceptive literature usually describes two types of effectiveness; perfect use and typical use. Perfect use is what is described in the clinical trials leading up to approval of the method; if you miss a dose you can go home. Typical use data is usually retrospective, where they ask people what they used and how it has worked, regardless of adherence or correct use. Daily maintenance methods such as oral contraceptives, typically report perfect use effectiveness above 99 percent , and typical use around 97 percent. Newer methods such as the shot, ring, implant, and IUD, have typical use closer to perfect use. So is abstinence 100 percent effective? In perfect use, yes. But in typical use? No, see the above reference to virginity pledgers. Likely it is much lower than 100 percent.
Other statements attributed to the speaker are provably false. Infertility increasing 500 percent and due to untreated STDs? A 2010 study showed infertility hasn't increased over the last 20 years, and most infertility is not due to tube scarring from STDs, but from genetic, hormonal, male, or unknown factors. Many of the speaker's other alleged statements are equally provably false.
To the third question, is it appropriate? We know from experience that fear-based, judgmental approaches to adolescent risk factors don't work. In fact, often lead to cementing of the behaviors as a defense.
The adolescents who tend to participate in the highest risk sexual behaviors are the ones who suffer from the lowest self-esteem. Often they suffer from depression or other mood disorders. Do they need to be told that they are impure? That they are doing horrible things to themselves? This potentially leads to lower self-esteem and an increase in risk behavior, rather than the opposite.
There were reports of young people leaving the assembly in tears. In a culture where we are trying to pay more attention to the effects of bullying, these youth were being bullied. And the question of whether this was a religious message in the public school is one that needs to be debated. Although she didn't mention God or Christianity during the presentation, it was certainly in the subtext, and religion is a major focus of the group who supported the presentation.
So back to our three questions: Effective? No. Accurate? No. Appropriate, No. Now I submit a fourth question for you to mull over on your own: Acceptable?
Sondike, is an associate professor of pediatrics at WVU and medical director of the Disordered Eating Center of Charleston.