Abstinence-Only-Until-Marriage Programs Are Ineffective and Harmful to Young People, Expert Review Confirms

Updated Policy Recommendations Emphasize the Importance of Scientific Evidence Guiding Sexuality Education Programs

A new review of U.S. sexuality education policies and programs reaffirms the harms of abstinence-only-until-marriage (AOUM) programs and the importance of investing in comprehensive sexuality education. Thirteen leading experts in adolescent sexuality research and policy, including Guttmacher Institute researcher Laura Lindberg, review the scientific evidence accumulated over several decades and once again conclude that AOUM programs are ineffective, stigmatizing and unethical.

The review, published in the Journal of Adolescent Health, examines the U.S. government’s decades-long history of funding AOUM programs. It also presents evidence on AOUM programs' efficacy and potential harms, as well as the efficacy and benefits of more comprehensive sexuality education programs. Based on this body of research, the Society for Adolescent Health and Medicine has published updated recommendations on sexuality education policies and programs, reaffirming the importance of approaches that are comprehensive and grounded in scientific evidence. 

"While sexual abstinence can be a healthy choice for some adolescents, abstinence-only-until-marriage programs are highly problematic," says Laura Lindberg, review coauthor and Guttmacher principal research scientist. "These programs withhold important sexual health knowledge and provide medically inaccurate information that compromises young people’s healthy sexual development."

In theory, abstinence is 100% effective at preventing pregnancy and STIs. However, many adolescents who intend to practice abstinence fail to actually do so, and they often fail to use condoms or other forms of contraception when they do have intercourse. Considerable scientific evidence accumulated over the past 20 years has found that AOUM programs are not effective at preventing pregnancy or STIs, nor do they have a positive impact on age at first sexual intercourse, number of sexual partners or other behaviors.

Despite this evidence, the U.S. government has spent approximately $2 billion on domestic AOUM programs over the past two decades. Based on the available evidence, experts assert that government support of these programs has undermined sexuality education in the U.S. Dr. Lindberg’s prior research documented a decline in U.S. adolescents’ reports of receiving formal sex education on a range of topics, including birth control, in the last decade.

AOUM programs are not only ineffective, but also potentially harmful to adolescents. These programs often promote gender stereotypes that are associated with negative sexual health behaviors. They fail to provide pertinent sexual health information to sexually active adolescents and those who are already pregnant or parenting, and they stigmatize sexually active young people by implying that those who have sex are less worthy than their abstinent peers. AOUM programs also marginalize and systematically ignore the needs of sexual minority youth, including LGBTQ adolescents.

More comprehensive sexuality education programs, on the other hand, are not only effective at preventing pregnancy and STIs among adolescents, but also helpful in guiding young people as they learn how to navigate relationships, negotiate with partners and become sexually healthy adults.

Adolescent health experts emphasize that access to complete and accurate sexual health information has repeatedly been recognized as a basic human right. Governments, health care providers and educators have an ethical obligation to provide such information to their citizens, patients and students.

"We urge Congress to consider the evidence as they negotiate funding for sexual health programs in the next fiscal year," says Megan Donovan, Guttmacher policy expert. "Young people have a right to complete and accurate information to support their healthy sexual development." 

"Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact," by John Santelli et al., is currently available online, as is "Abstinence-Only-Until-Marriage Policies and Programs: An Updated Position Paper of the Society for Adolescent Health and Medicine." Both pieces will appear in the September 2017 issue of the Journal of Adolescent Health.