Abortion is one of the most contentious issues in America. A major strategy employed by the pro-life movement to stop abortions is pushing abstinence-only-until-marriage (AOUM) sex education. However, evidence proves that AOUM sex education fails. These programs withhold medically accurate information, stigmatize and exclude many adolescents and reinforce harmful gender stereotypes. They do not delay sexual initiation or reduce sexual risk behaviors and are, therefore, associated with higher rates of sexually transmitted infections (STIs), teen pregnancy and abortion. The 2012 U.N. Commission on Population and Development’s declaration that adolescents have the right to comprehensive sexuality education (CSE) also makes AOUM sex education a violation of adolescent human rights. Despite this, the U.S. federal government has funneled nearly two billion dollars into AOUM programs since the mid-1990s. With the highest rates of STIs and teen pregnancy in the developed world, the U.S. desperately needs to change direction and fully divest from AOUM sex education. Fortunately, we already know how to improve adolescent sexual health and outcomes and reduce abortions. The answer is CSE and access to contraception.
Abortion is a key component of the increasingly polarized Democratic and Republican parties’ political platforms. Republicans in ten states have passed a rash of anti-abortion “trigger laws.” These laws would ban all or nearly all abortions if the landmark Roe v Wade decision is weakened or overturned, a distinct possibility under the new conservative U.S. Supreme Court. Pro-life advocates claim that banning abortion through these laws is the best way to stop it. However, restrictive laws do not lower abortion rates. Instead, they are linked with higher rates of unsafe abortion which puts women at serious risk for illness and death. Pro-choice advocates have launched a number of lawsuits challenging attacks on abortion access. With such high tensions surrounding the issue, it may come as a surprise that current abortion rates in the U.S. are the lowest since the Roe v Wade decision in 1973. However, STI rates are on the rise, further underscoring the need for CSE.
While a spectrum of sexuality education exists, CSE is the most effective. Its curriculum focuses on the emotional, physical and social aspects of sexuality. The goal of this broad spectrum of information is to equip adolescents with the knowledge, skills and values important to attaining maximum health and well-being. Comprehensive sexuality education also empowers adolescents to develop respectful relationships, consider how their actions affect themselves and others and recognize and protect their rights throughout their lives. Its content is evidence-based and includes sexual and reproductive anatomy and physiology, puberty and menstruation, pregnancy and childbirth, contraception and STIs. It also includes material about healthy relationships, sexual expression and how gender norms can influence people’s health and well-being. Despite accusations that CSE exposes children to graphic and inappropriate material, the curriculum is incremental. It starts at a young age with age- and developmentally-appropriate content that changes as adolescents mature.
The evidence supporting CSE is overwhelming. Comprehensive sexuality education promotes adolescents’ well-being, gender equality and equity, responsible sexual behavior and protection from STIs. Furthermore, it is effective at reducing abortions by targeting the root causes of sexual risk taking and early and/or unwanted pregnancy. A 2016 review commissioned by the United Nations Educational, Scientific, and Cultural Organization (UNESCO) synthesized results from 22 rigorous systematic reviews, 77 randomized controlled trials and 65 non-trial publications and online resources. Contradicting pro-life assertions, research consistently showed that CSE contributes to delayed initiation of sexual intercourse, decreased frequency of sexual intercourse, decreased number of sexual partners, reduced sexual risk-taking and increased use of condoms and other forms of contraception. While it seems that CSE contributes to decreased STI and HIV infection rates, it is difficult to draw strong conclusions due to a lack of high-quality trials, especially those which follow adolescents over longer periods of time. Abstinence-only-until-marriage programs which did not include information about contraceptives were found to be ineffective at delaying sexual initiation, reducing the frequency of sex and reducing the number of sexual partners. Abstinence-only-until-marriage programs were not shown to decrease STI rates, and some studies suggest that adolescents who received AOUM sex education were at an increased risk for STIs. When adolescents are denied the knowledge and tools (i.e. contraception) they need to protect themselves and their partners, they are left vulnerable to disease and unwanted pregnancy.
While CSE programs are shown to improve knowledge, skills and intentions to avoid risky sexual behaviors, other barriers can make adopting safer behaviors difficult. A primary barrier is access to contraception. Increased use of contraceptives drives declines in unintended pregnancy and abortion. State comparisons demonstrate this conclusion. In 1992, California’s teen pregnancy rate was the highest in the nation at 159 per 1,000 teens aged 15-19. In an attempt to lower the teen pregnancy rate, California implemented a three-year AOUM sex education initiative. The program was discontinued after it had no impact on teens’ decisions to start having sex. In 2003, California pivoted to CSE in accordance with the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act. It disallowed classes from promoting religious doctrine and mandated that sex education programs be medically accurate, age-appropriate, non-discriminatory and comprehensive. Just two years later, the teen pregnancy rate declined more than 50 percent, outpacing the national decline of 37 percent. Abortions in California plummeted from 76 per 1,000 teens in 1988 to 26 per 1,000 teens in 2005. In 1992 in Texas, the teen pregnancy rate was 123 per 1,000 teens aged 15-19. In contrast to California, Texas began shifting away from AOUM sex education in 2011 when funding for AOUM sex education dried up. By then, its teen pregnancy rate was the fifth highest in the country. In 2017, with mandated CSE in California and AOUM sex education still dominating in Texas, the teen birth rate in Texas was almost double California’s. Texan teens also reported more sexual partners, earlier sexual debut and lowered use of contraceptives. This trend is seen across the nation, with states that emphasize AOUM sex education having the highest rates of teen pregnancy and birth. The trend remains significant even after accounting for socioeconomic status, teen educational attainment and the ethnic composition of the teen population in each state.
With this strong body of evidence, arguments against CSE on the basis of inefficacy are simply not founded in reality. When delivered as intended, CSE empowers adolescents to make responsible and informed decisions, increases the age of sexual debut, reduces risky sexual behaviors, STIs and unintended pregnancies and leads to fewer abortions. This is why the U.S. government must fully divest from AOUM sex education and invest in CSE. The pro-life movement denies adolescents the information and resources they need to protect themselves, their partners and their futures. Adolescents, suffering the consequences, are then deprived of their rights to medically accurate information and abortion. While abortion is undoubtedly a difficult moral issue for many, the pro-life movement’s fight against CSE in the face of evidence that it prevents abortions is astounding. For a movement characterized by insincerity, contradictions, lies and damaging propaganda, it is, however, unsurprising.