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New data on abstinence What do they mean for teen pregnancy prevention?
U.S. teen pregnancy rate rose 3% in 2006 after decade of decline
Results from new research of a theory-based, abstinence-only intervention appear to be associated with a lower rate of sexual involvement among African American sixth- and seventh-graders.1 How does the inclusion of these new data affect the landscape when it comes to teenage pregnancy prevention?
"State and communities now have a slightly larger and more diverse list of successful interventions to choose from in their attempts to help teens make more responsible decisions about sex and contraception," says Sarah Brown, CEO of The National Campaign to Prevent Teen and Unplanned Pregnancy in Washington, DC. "At a time when the teen pregnancy and birth rates are on the rise for the first time since the early 1990s, at a time when one of the nation's great success stories of the past two decades is in danger of unraveling, we need more proven options rather than fewer."
Publication of the abstinence education study follows the release of an analysis by the Guttmacher Institute that indicates that the nation's teen pregnancy rate rose 3% in 2006, reflecting increases in teen birth and abortion rates of 4% and 1%, respectively.2 The uptick reflects an increase following a decade of decline in such numbers.
"It is too soon to tell whether the increase in the teen pregnancy rate between 2005 and 2006 is a short-term fluctuation, a more lasting stabilization, or the beginning of a significant new trend, any of which would be of great concern," says Lawrence Finer, PhD, Guttmacher's director of domestic research. "Either way, it is clearly time to redouble our efforts to make sure our young people have the information, interpersonal skills, and health services they need to prevent unwanted pregnancies and to become sexually healthy adults."
Look at the data
To conduct the study, researchers enrolled 662 African American students in grades six and seven. The average age was 12.2 years; 53.5% were female. Participants were randomized to the following groups: an eight-hour abstinence-only intervention targeting reduced sexual intercourse; an eight-hour safer sex-only intervention targeting increased condom use; an eight-hour comprehensive intervention focusing on sexual intercourse and condom use; a 12-hour comprehensive intervention aimed at sexual intercourse and condom use; and an eight-hour health promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy. Researchers designed the primary outcome as self-report of ever having sexual intercourse by the 24-month follow-up.
At 24 months, 84.4% of the students still were enrolled in the study. Researchers report that the abstinence-only intervention reduced sexual initiation [risk ratio (RR), 0.67; 95% confidence interval (CI), 0.48-0.96]. The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29%) reported having sexual intercourse in the previous three months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The eight-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.
The abstinence-only program in the current study does not meet the restrictive federal criteria for programs that until 2010, have been eligible for federal abstinence-only-until-marriage funding.3 Its target behavior was "abstaining from vaginal, anal, and oral intercourse until a time later in life when the adolescent is more prepared to handle the consequences of sex," not abstinence until marriage.1
According to a Guttmacher Institute review of the data, the program was not infused with morality, was medically accurate, and did not disparage contraception.3 The intervention did not contain inaccurate information, portray sex in a negative light, or use a moralistic tone.1 Its training and curriculum manual explicitly instructed the facilitators not to disparage the efficacy of condoms or allow the view that condoms are ineffective to go uncorrected.1
While the new abstinence-only research shows promise for one particular program, it does not contradict the body of evidence that abstinence-until-marriage programs are ineffective, the Guttmacher Institute review notes. Findings from a 2007 analysis of four abstinence-only education programs indicate that abstinence-until-marriage programs do not keep teens from having sex.4 In that same year, the National Campaign to Prevent Teen and Unplanned Pregnancy released a comprehensive review of sex education evaluation research that concluded that "there does not exist any strong evidence that any abstinence program delays the initiation of sex, hastens the return to abstinence, or reduces the number of sexual partners."5 Two reviews by the U.S. Government Accountability Office found that many of the curricula used by grant recipients for abstinence-only programs included false claims about condoms, other contraceptive methods, abortion, and sexually transmitted infections.6,7
The new research on abstinence-only education appears just as the current federal administration is eliminating federal financing for abstinence-only programs and starting a pregnancy-prevention initiative that will finance programs that have been shown in scientific studies to be effective.8
The Obama administration has eliminated more than $170 million in annual federal funding targeted at abstinence programs. It has announced plans to launch a $114 million pregnancy prevention initiative that will fund only programs that have been shown scientifically to work, and it has proposed to expand that funding to $183 million.9
"The Obama administration is on the right track in funding only science-based programs with evidence of effectiveness," states a blog from Advocates for Youth, a Washington, DC, youth advocacy group.10 "The administration should also consider how scarce resources are best invested and recognize the rights of all young people to complete, accurate, and honest information about their sexual health."