Friday, October 30, 2009

The Future of Abstinence

It's been a mainstay of sex ed for more than a decade. Now, as the Obama administration cuts off federal funding, the movement scrambles for money, determined to continue its mission.

By Sarah Kliff Newsweek Web Exclusive

Oct 27, 2009

For as long as anyone can remember, McLennan County has been abstinence country. Nestled in the heart of Bible-Belt Texas, it's the kind of place where the local newspaper prints "In God We Trust" on the front page of every edition. "We're a very conservative community," says Jan Hungate, an assistant superintendent for the West Independent School District. So when the McLennan County Collaborative Abstinence Program (MCCAP) came to her a little more than a decade ago, offering an abstinence-only sex education program, she says, "It was the answer to our prayers. It was exactly the way we wanted to go." For years, each school was responsible for developing their own curriculum. Armed with the federal government's new abstinence-only grants, MCCAP offered to do the heavy lifting for free. They taught kids proper dating behavior, encouraged female students to think about their wedding days and why their virginity would matter then. In 2006 MCCAP had a $1 million budget, all from government grants, which they used to educate 6,000 to 7,000 students.

Today, MCCAP struggles to reach half that number. Its $800,000 Community-Based Abstinence Education grant ran out in 2007 and was not renewed. Then, Obama's 2010 budget did not renew the Title V grant program, the other major source of abstinence-only funding, which MCCAP also used. In three years, their federal funding went from $1 million to zero. "It was a definite shock to go from everything we had ... down to the bare minimums," says MCCAP's executive director, Tracy Cousins. He joined the organization three years ago and had seven staff members serving students in 19 school districts. Now, it's just Cousins and his bookkeeper. With the money remaining from previous grants he hopes "to maybe [serve] 4 or 5 school districts."

Buoyed by $1.9 billion in government funding since 1997 ($1.5 billion of that federal money), abstinence-only education grew from a niche market to a booming industry, with hundreds of curriculums for teachers to choose from. But if the 2000s were abstinence's boom years, the next decade may well be its bust. With Obama's budget for 2010 dropping all abstinence-until-marriage funds from the federal budget, past grantees are left uncertain. Congress could restore funding; the Senate Finance Committee voted to do so, 12–11, last month. But the measure must still pass the full Congress, where chances are slim. So abstinence-only groups are left hoping private donors will step forward to at least partially fill the gap. "The open question is whether these organizations will continue to thrive when federal funding is no longer available," says Alesha Doan, author of The Politics of Virginity: Abstinence in Sex Education (Greenwood Publishing Group, 2008). "What is the underlying support in society for this?"

Abstinence education came of age in the late 1990s and early 2000s. It began with the Welfare Reform Act of 1996, which dedicated an annual $50 million in Title V abstinence-education grants. The money had to be spent on programs that teach "abstinence from sexual activity outside marriage as the expected standard for all school-age children." When George W. Bush took office he created a new program: Community Based Abstinence Education, or CBAE, grants. While only states could take the Title V funds, CBAE grants went directly to community groups, including faith-based organizations. During the Bush administration, funding for abstinence education more than doubled, from $80 million in 2001 to $200 million in 2007, according to figures from the Congressional Budget Office.

In the beginning, the public-health community was open to the programs. The United States did, after all, have the highest teen pregnancy rate in the developed world. "There was open-mindedness then, that it might work" says John Santelli, of Columbia University's Mailman School of Public Health. "Everyone is willing to give new ideas a trial period." By 1999, one study estimated a third of American students were receiving an abstinence-only education. But as funding grew, so did a body of research showing that abstinence didn't change the sexual behaviors of students; pregnancy and STD rates did not go down, the age of initial sexual activity did not go up. "Each evaluation came along ... and each showed it didn't work," says Santelli. The articles appeared in peer-reviewed journals, many in the Journal of Adolescent Health, and in government-commissioned reviews. In 2007, a federally funded study of four abstinence programs found its students no more likely to abstain than those in a comprehensive program. At the same time, comprehensive programs that discuss contraceptives and their use received better, although by no means perfect, marks. Researcher Doug Kirby's 2008 review of 48 studies of comprehensive curriculums found that two-thirds either reduced frequency of sex or number of sexual partners. By time Obama cut Title V abstinence-education funds from his budget, 25 states had already begun rejecting the money, 16 because they didn't agree ideologically or weren't seeing results, the others for administrative reasons.

There's no single reason abstinence-only education proved largely ineffective, researchers say. A major factor, to be sure, was the incomplete information it provided about contraceptives and their use. "The programs that have by far the strongest evidence that they have a positive impact … are those that give the message that not having sex is safest, but if you have sex always use condom and contraception," says Kirby. Message aside, the curriculums themselves were often found to be riddled with inaccuracies. Two major reviews of abstinence curriculums—one in 2004 from the House of Representatives' Committee on Government Reform, another by the Texas Freedom Network Education Fund earlier this year—found unsourced and incorrect information about STDs, contraceptives, and the consequences of sexual activity. The Texas report, which collected data from over 96 percent of the state's school districts, found one curriculum teaching that condoms have "little to no benefit." (The Centers for Disease Control and Prevention describes condoms as "highly effective in preventing the sexual transmission of HIV infection and reduce the risk of other STDs" when used consistently and correctly.) Another incorrect abstinence-only lessonused in the Baird Independent School District: "a young person who becomes sexually active at or before age 14 will contract an STD before graduating from high school. This is no longer the exception, but the rule." Religious influence was another problem for some abstinence-education programs; the American Civil Liberties Union mounted a number of lawsuits (some successful, some not) against abstinence-only curriculums in public schools and state-sponsored events that advanced a specific religious perspective.

Even without money or science to back them up, abstinence advocates are not quitting. "If the president's [budget] proposal is enacted similar to what he recommended, it will have a chilling effect on abstinence education across the country," says Leslee Unruh, director of the Abstinence Clearinghouse, a national association of abstinence-only organizations. In the past, the organization's monthly Webinars on fundraising seldom attracted more than 80 participants; now, they hold weekly sessions that draw hundreds. "We're in a race against time to keep these people in business," Unruh says. Some abstinence educators report initial success in private fundraising, like K.E.E.P. (Kids Eagerly Endorsing Purity), the biggest abstinence-education provider in Tulsa, Oklahoma. K.E.E.P. regularly received upwards of $100,000 in federal funds each year; so far, they've raised $40,000 privately towards next year's budget. "We're just going to have to work smarter, pace ourselves, be more aggressive," says executive director Mike Jestis. The vote by the Senate Finance Committee has also given some a reason to remain optimistic.

Even if Congress does restore Title V funding, experts on both sides of the issue expect the abstinence industry to shrink significantly. "If you're seeing increases in teen pregnancy rates, or sexually transmitted infections, you'll start evaluating what you've been using," says Doan, the Politics of Virginity author. That's what happened in Springfield School District 186 in 2007, where a funding shortage triggered a reassessment. For years, the district had received free abstinence curriculum from an Illinois-based abstinence-only group called Project Reality. But when the State Legislature cut funding for abstinence education, Project Reality could no longer distribute complimentary materials. Faced with the prospect of paying for a sex-ed curriculum, school board members decided to reevaluate their program. "That's how it initially came up and we felt like we didn't want to fund [abstinence], since it wasn't giving all the information," says Kathy Sanders, the district's director of research, testing and evaluation. In the end, they switched their middle schools to different health text book with a more comprehensive program. "We felt strongly that we need to let kids know what their options are," says Sanders. They're currently reviewing their abstinence-only high-school curriculum and will likely switch to comprehensive in the near future.

Some in the abstinence-only community are open to a compromise approach as the way to move forward, a sort of hybrid of abstinence and comprehensive sex education that would include the basics of contraception. "The bottom line for me is, if kids have sex, bad things can and often do happen," says Patricia Sulak director of Scott & White's Worth the Wait, an "abstinence-centered" program in Texas. "It's better if you delay the onset of sexual activity. But if you're not going to wait, you must do things to decrease your risk." This summer, the North Carolina Legislature approved a hybrid model, where students are taught that abstinence until marriage is the only surefire way to prevent pregnancy and STDs, but are also given information on contraceptives; parents can choose to opt out of either segment. Reverend Mark Creech, executive director of the state's Christian Action League, says it's a good compromise. "When it became apparent that we weren't going to be able to succeed [in providing just abstinence-only education], we shifted to try to preserve as much of the abstinence message as possible," he says. Planned Parenthood also supports the new program because of its increased scope.

But many of the abstinence advocates NEWSWEEK talked to thought such compromises were untenable, that they could not teach students to remain abstinent until marriage while demonstrating how to use condoms. "If the funding is for a different worldview, one that says you should give condoms to kids, that's not my belief system," says Unruh. "I think it's very harmful." She and others say it's a question of morals and values, which is not an area for compromise. "Our program indicates that sex is more than physical. It's emotional. There's a lot of different aspects," says Scott Phelps, who directs A&M Partnership, an Illinois-based provider of abstinence-only curriculums. The group has a federal grant that expires in 2013. "If I'm teaching all of that, and then I'm teaching contraception, what is contraception going to do for all those consequences? It would be sort of nonsensical."

Back in Texas, Cousins at MCCAP pondered the same the question: should he stick with the abstinence-only message and forgo federal dollars, or tweak the message a bit to get funding? In the end, he and his board of directors decided to remain abstinence only. "We're not at the point where we want to compromise our message," he says. "It's not only the belief of the organization, it's all of our personal beliefs. We believe the best approach [for students] is they should not engage in sexual activity." Cousins and his board are currently working on a fundraising plan, targeting local schools and private donors, something they've never done before. Hungate, the school administrator, would love to have MCCAP continue at her schools, but doesn't have the money. If federal dollars mandate instruction on contraceptives and their benefits, she's open to that. "It would be a conservative comprehensive program," she says, noting that her teachers won't "talk about bisexuality or hand out condoms." If it comes to that, Hangett knows she'll face resistance from some parents. "I'd have some people who will drill me, but I'd rather see my daughter practicing safe sex than die from AIDS."

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