St. Louis area groups involved in teen pregnancy issues agree with the findings of a new report showing that middle school children who take part in abstinence-only education programs are more likely than others to delay sex. But the groups caution that it would be misleading to draw broad conclusions about abstinence programs from this study or argue that it vindicates the Bush administration’s abstinence-only program.

The federally funded study, done by John B. Jemmott III, a professor at the University of Pennsylvania, involved 622 sixth and seventh grade African-American students. The study looked at a variety of intervention programs:

• An eight-hour abstinence-only class that did not preach morality;
• Programs that promoted the use of condoms;
• Programs that involved other interventions, such as contraceptives.

Allison Hile (right), executive director of St. Louis’ Teen Pregnancy and Prevention Partnership, says people need to make a distinction between the programs in the University of Pennsylvania study and the abstinence-only programs that were begun by the Bush administration.

Hile stressed that the study found there was no difference in the sexual activity of youths who got abstinence-only education and those who were counseled about condom use and contraceptives. “So people who say if you talk about condoms that will encourage kids to have sex – the study proves them wrong,” Hile said.

She notes that almost one-quarter of the students in the University of Pennsylvania study already were sexually active. Youngsters need information about condoms and contraceptive. Providing that information won’t “lower the age that they first have sex, and it does not increase their sexual activity,” Hile said. Abstinence must be part of any good sex education program, but the program must also include discussion of condoms and contraceptives, she added.

Hile says comprehensive programs are especially important because youngsters are receiving lots of media messages about having sex. She mentioned one song that encourages young people to have sex on their birthdays.

“When kids are faced with that kind of music, we have to talk to them about being able to say no,” and “if they choose to have sex, they need to know how to be safe, ” Hile said.

Critical thinking

Several area groups got funds to run sex education programming under the Bush administration’s abstinence-only program. One was Lutheran Family and Children’s Services. Christine Reams, director of community services for the group’s St. Louis office, says about 1,000 kids have gone through the program. She estimates that no more than 2 percent of the girls became pregnant.

But she says organizations have to do a lot more than preach about morals to discourage youngsters from engaging in sexual activity. She notes that the Bush program forbade groups from discussing condoms and contraceptives. But she said her organization helped youngsters develop “critical thinking skills and apply those strategies for making choices not only in terms of engaging in at-risk behavior but in other areas as well.”

Other studies

Although the University of Pennsylvania study is being billed as the first of its kind to measure the effectiveness of abstinence-only programs, there have been other studies, including those evaluating the Bush administration’s abstinence programs.

As part of the federal welfare reform program, Missouri got millions in Title V abstinence-only funding. One example, a $713,000 grant for a program called Life’s Walk, involving public schools in six rural counties in northwest Missouri. The program aimed to “increase students’ understanding of the realities of teen parenthood, and foster the belief that abstinence is the best way to avoid the negative consequences of early sexual activity,” according to a 2003 report in the Journal of School Health.

A report from Advocates for Youth in Washington says a study found the Missouri program ended with a “statistically significant increase in sexual behavior … with the increase in sexual activity being larger for males than females.” One quote from the evaluation of the study said, “it seems clear that the abstinence-only philosophy … may have popular support, but (there is a) lack (of) evidence of effectiveness.” Another study concluded that the results confirmed “early research that found no evidence that abstinence-only programs change adolescent sexual behavior.”

Debra Hauser (right), vice president of Advocates for Youth, the group that cited the Missouri evaluation, says the difference between what was in place during the Bush years and what the University of Pennsylvania study sought to do was to “evaluate a program that promoted abstinence but was not moralistic.”

While praising the study’s findings as offering a more realistic approach to sex education, Hauser stressed that “it’s only one study and we have to be careful and we have to repeat it in other communities so that we know that it will work. These were very young teens in the study. What would be dangerous for public policy is that we assume this kind of program would work for older teens. There’s no evidence that that would be accurate.”

By the numbers

Paula Gianino, the CEO of Planned Parenthood of St. Louis, says the new study comes quickly on the heels of a new report showing that the U.S. teen pregnancy rate rose in 2006, marking the first increase in a decade. She offers the following statistics from the Guttmacher Institute to counter arguments that the Bush administration’s abstinence-only program was a success: The teen abortion rate rose 1 percent from 2005 to 2006.

• Among black teens, the pregnancy rate declined by 45 percent (from 223.8 per 1,000 in 1990 to 122.7 in 2005), before increasing to 126.3 per 1,000 in 2006.
• Among Hispanic teens, the pregnancy rate decreased by 26 percent (from 169.7 per 1,000 in 1992 to 124.9 in 2005), before rising to 126.6 per 1,000 in 2006.
• Among non-Hispanic white teens, the pregnancy rate declined 50 percent (from 86.6 per 1,000 in 1990 to 43.3 in 2005), before increasing to 44.0 per 1,000 in 2006.

The best answer for combating teen pregnancies, she says, is a comprehensive, factual, and age-appropriate program that increases communication (about sex-related issues) between teens and their parents.

“Our problem with many abstinence-only sex education curriculum that we’ve seen and reviewed is that they are not evidence-based,” she says. “Some, but not all, are not medically factual.”

Gianino (right)says she expects the Obama administration to issue new guidelines that will require all programs be evidence-based. That policy would be in line with programs that Planned Parenthood favors, she says.

Sarah Kuehnel, a graduate of Washington University School of Law, wrote a law journal article published in May 2009 about abstinence programs. She argued that abstinence-only education failed African American kids.

Asked Tuesday if the University of Pennsylvania study had changed her mind, Kuehnel, now a lawyer for Ogletree Deakins, said society should instruct teens to abstain from sex for many reasons.

“However, practically speaking, not everyone is going to abstain from sex until marriage,” she says. As a result, it is important to ensure that teens are educated on safe sex, as well as ensuring that teens have access to condoms and birth control.”

She noted about a third of the youngsters in the study still engaged in sex by the age of 14 and that only 84.4 percent were still enrolled at 24 months.

“It’s plausible that the 15.6 percent dropped out because they did not want to report that they had had sex,” Kuehnel says. She adds that “it is absolutely essential that any sex-education program provide teens with all the information they need to protect themselves. (The programs should) be designed and presented considering the demographics of the audience.”

More than one approach

St. Louisans interviewed stressed that the study doesn’t settle the debate over whether one approach – teaching about safe sex and contraceptives versus teaching abstinence – is better than the other.

In an editorial accompanying the study, published in Archives of Pediatrics & Adolescent Medicine, Dr. Frederick Rivara of the University of Washington and Dr. Alain Joffe of Johns Hopkins, urged that the public not use the findings to support one approach over the other.

Instead, they urged policymakers to view the findings in the context of other kinds of interventions to try to figure out what works best. They also discouraged people from drawing broad generalizations from this or any teen pregnancy study, saying, "No public policy should be based on the results of one study, nor should policy makers selectively use scientific literature to formulate a policy that meets preconceived ideologies."