Autumn, 1997, Vol. 4, No. 1

ABSTINENCE FUNDING: IS IT WORTH THE PRICE?

New Legislation Denies Adolescents Vital Information

By Rebecca Nolind, SSA second-year administration student

The Federal Abstinence Education . Legislation (P.L. 104-193) is one piece of the 1996 welfare reform act that has received very little attention until recent months. The purpose of this legislation is to provide states with federal funds to develop abstinence-only educational programs. Because of the limited content of abstinence-only education, this legislation has the potential to seriously cripple efforts to prevent teenage pregnancy and the spread of sexually transmitted diseases and HIV in adolescents.

It is an undeniable fact that many teenagers are sexually active. In 1996, the Youth Risk Behavior Surveillance System conducted by the Centers for Disease Control and Prevention reported that 54% of high school students had had sexual intercourse, a rate that has not varied much since the study's inception in 1990 (MMWR, 1996). Another study found that "by the time they reach age 20, 80% of boys and 76% of girls have had sexual intercourse (Alan Guttmacher Institute, 1994)." This finding makes clear the need to provide children and adolescents with ageappropriate comprehensive sexuality education to assist them in making informed healthy decisions.

Sexuality education falls into three general categories. Each type emphasizes the benefits of postponing sexual intercourse, but they differ in relation to the amount of information that is given and its presentation format. Abstinence-Only curricula teach that abstinence is the single acceptable option for unmarried persons. They exclude all mention of contraception and safe sex methods. Abstinence-Based programs provide education on contraception and safer sex, in addition to abstinence messages. The third category is Comprehensive Sexuality Education. This curriculum approaches the subject of sexuality as a normal component of healthy human development. It takes the position that many youth will become sexually active and attempts to provide them with the tools to protect their health. This includes explicit information about contraception and STD prevention. The curriculum also addresses issues of self-esteem and provides assertiveness training as a way for youth to manage social pressures to become sexually active. Additionally, unlike abstinence-only education, comprehensive programs relay information in a format that will be relevant to youth of all sexual orientations.

Through the Federal Abstinence Education Legislation, Congress has allocated $250 million dollars over the next five years for states to develop abstinence only educational programs. To qualify, states must contribute matching funds; $3 dollars for every $4 federal dollars. The matching funds can come in the form of state or local money, private foundation dollars, or in kind support, such as teachers' salaries. Combined with the matching funds, the total amount of the program is approximately $450 million for the years 1998 through 2002. At first glance, this appears to be a generous plan to help states improve their health education efforts. However, further study of the legislation reveals that agencies which receive the funding must adhere to strict guidelines about the education they can provide with this money. It is the restrictions imposed by this legislation that have serious potential to negatively impact youth.

The primary restriction that this legislation places on organizations receiving the funds is that they cannot use it in combination with, or to supplement, educational programs that are abstinence based or comprehensive in nature. States may also require that the receiving agency contribute the matching dollars, rather than having them come out of the state's general revenue funds. In all likelihood, agencies will have to contribute the matching dollars or inkind support, thereby diverting money away from other valuable programs which may include abstinence-based or comprehensive sexuality education.

The language used in the legislation to describe the components of a qualified program is explicit. In part, abstinence-only education is defined as a program which "teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually-transmitted diseases, and other associated health problems; teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity; teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects (P.L. 104-193, 1996)." The legislation itself sends messages that may be psychologically and physically damaging to youth. First, this approach negates the proven effectiveness of safer sex methods.

Second, it implies that once in a married relationship, people are immune from sexually transmitted diseases. The language also has harsh implications for children whose parents or caregivers are involved in relationships that do not fall into the category spelled out by the legislation. Finally, the legislation completely excludes nonheterosexually oriented persons by virtue of their inability to legally marry.

The amount allocated to each state is based on a formula that compares the proportion of low-income children in a state relative to the number of low-income children in all states. The state of Illinois, for example, has decided to accept its federal allocation of $1,956,255. Adding in the matching funds, the total amount for this project is approximately $3,423,446 over the course of the next five years. After accepting the funding, Illinois requested proposals from local entities wanting to apply for a portion of the allocation. Local entities can include schools, health departments, and community-based agencies. Those proposals must be submitted by January 1998, and the awards will be announced the following month.

Given their need for assistance in funding education, it is not surprising that states have overwhelmingly sought to accept this funding. However, there remains no empirical evidence which shows abstinence-only education is effective at postponing sexual activity, reducing out-of-wedlock births or slowing the spread of STDs and HIV. One study, published by the Alan Guttmacher Institute in New York, looked at California's Postponing Sexual Involvement initiative. The study focused on seventh and eighth graders participating m the Education Now and Babies Later Program and found that the program had no measurable impact on sexual or contraceptive behaviors (Cagampang, Barth, Korpi, and Kirby, 1997). The World Health Organization (WHO) has also expended efforts to look at the effects of sexuality education. After a review of 35 studies, the WHO concluded that comprehensive programs addressing abstinence, contraception, and STD prevention were the most effective in changing youth's behavior (Grunseit & Kippax, 1993). The most assertive statement made thus far on the issue comes from the National Institutes of Health. Their Consensus Panel on AIDS issued the statement that the abstinence-only approach to sexuality education "places policy in direct conflict with science and ignores overwhelming evidence that other programs [are] effective (NIH, 1997)."

Public opinion is not united behind the use of abstinence-only education and many groups have organized to oppose the legislation. In Chicago, the Youth Need to Know Network has formed in response to this issue. The Network is made up of individuals and organizations, such as the Illinois Caucus for Adolescent Health and the AIDS Foundation of Chicago, who are concerned about the legislation's potentially damaging effects. The Network's initial efforts included trying to dissuade Illinois from accepting the money. They also organized a set of focus groups with students from Chicago high schools to gather their impressions on the use of abstinence-only education. The results of the focus groups were that the teenagers did not believe abstinence-only education would provide youth with enough information to make informed choices regarding sexual activity. In light of the state's decision to accept the money, however, the Network has expanded its agenda. " Although we hope to create an educated public which will convince the state from making further annual applications, we also plan to be a resource for communities on this issue," explains Jenny Knauss, a member of the Network. They intend to provide agencies with ideas about how to use the funding in a way that will satisfy the requirements of the guidelines, but won't detract from already existing comprehensive programs. Other states are hoping to do the same by using the money for media campaigns and public service announcements expressing the positive benefits of abstinence, rather than developing specific classroom curriculums.

The Federal Abstinence Education Legislation has serious implications for the ability to reduce pregnancy, STDs, and HIV in adolescents. By the passage of this act, government has decided to promote abstinence-only education that denies youth vital information and sends them negative, biased messages. Further, their is no conclusive evidence regarding the effectiveness of abstinence-only education. In a time where adolescents are faced with difficult choices regarding their sexuality and health, every effort should be made to increase their level of knowledge about reducing high-risk behavior. They should learn more, not less, about how to protect themselves if they choose to become sexually active.

It is inevitable that there will be programs in Illinois funded by this legislation. This doesn't mean however, that the abstinence-only theme must dominate sexuality education with adolescents. Agencies that receive awards need to be creative in the way they use the funding to stay within the guidelines, but so as not to damage existing comprehensive programs. In the meantime, organizations that serve adolescents should brace themselves for the negative consequences that will appear once the legislation goes into effect.

REFERENCES

Cagampang, Barth, Korpi, & Kirby, "Education Now and Babies Later (ENABL): Life History of a Campaign to Postpone Sexual Involvement," Family Planning Perspectives, 29, no. 3 (1997), pp. 109-114.

Grunseit, & Kippax, "Effects of Sex Education on Young People's Sexual Behavior," Geneva: World Health Organization, 1993, pp. 5-6.

Illinois Department of Human Services, Division of Community Health and Prevention, Request for Grant Applications for the Abstinence Education Project' November 1997.

National Institutes of Health' Consensus Development Conference Statement, February 11-13, 1997.

P.L. 104-193, Title V of Social Security Act, Section 510, 1996.

Rebecca Nolind is a second-year administration student at SSA. Her field placement is at the American Medical Association, Department of Adolescent Health.

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