What is the difference in the content of abstinence-based and comprehensive programmes of sex education?

Another way in which the debate gets framed is in relation to differences in beliefs about what the 'real facts' are that young people should be presented with in the context of sex education. Many supporters of abstinence-based sex education say that comprehensive programmes are too positive about the protective potential of contraceptives and understate their failure rate and the risks of contracting HIV or another STI 37. In addition, they criticise programmes of comprehensive sex education for placing too little emphasis on abstinence and sending young people a mixed message by referring both to abstaining from or delaying when they first have sexual intercourse, and the benefits of using contraception.

Some reviews of abstinence -based programmes suggest factual inaccuracies.

For their part critics of abstinence-based programmes have said that they are too negative about the effectiveness of contraception and sometimes include inaccurate information about failure rates. Proponents of abstinence-based approaches have been accused of overstating condom failure rates, exaggerating the risks of infection with HIV and other STIs, reinforcing gender and sexuality stereotypes, and presenting sex and sexuality in an overly negative way.

The criticisms levelled against comprehensive programmes of sex education are difficult to sustain because research suggests that in practice many sex educators are very concerned not to present sex in too positive a light and tend to avoid coverage of sensitive and potentially embarrassing subjects like homosexuality and abortion. Young people consistently report that the underlying message is that they should not have sex. Moreover, much of the evidence for the ineffectiveness of condoms and other contraceptives cited by critics of comprehensive programmes is highly suspect, being based on poor quality research or the outcome of a partial reading of its results.

In contrast, those criticisms levelled at abstinence-based approaches do seem to have a firmer foundation. Some reviews of programme materials suggest factual inaccuracies - such as massively overestimating the prevalence of HIV and STIs and the failure rates of condoms when properly used - are common. These reviews have also shown that these programmes tend to project stereotypes about gender, repress information about positive aspects of sexual relationships, and overstate the emotional risks and dangers associated with sex.
Is it realistic to encourage abstinence until marriage?

The premise on which abstinence education is founded - that it is reasonable to wait until marriage before having sex for the first time and then be faithful to that one partner for life - may well be unrealistic for many young people because it fails to reflect the nature of modern, industrial societies in which people marry later in life, if at all. And with the high frequency of breakdown in marriage, people are very likely to have several sexual partners over their lifetime. Across the US, the UK and the rest of Europe data on sexual lifestyles consistently show that the age at which people first marry has risen to around 30 years old and that about a fifth of marriages end in divorce or separation within five years 50 51. Yet while the age at which people marry has risen, the age at which they first have sexual intercourse has been falling to around 16 years old, and a diminishing minority of people report that their first sexual partner was also their marriage partner.

But which method is best in sex education?

One of the ways in which the debate between supporters of abstinence and comprehensive approaches to sex education has been framed is in terms of which is the most effective.

Although at first glance the evidence can seem confusing, with claims coming from both groups about the proven effectiveness of programmes embodying their values, when only the most reliable studies are taken into account the position is clear 20. There is good evidence, from studies of programmes implemented in the US, UK and other European countries and countries in Africa and Asia 21 22 23 24 25 26 27 28, that comprehensive sex education can reduce behaviours that put young people at risk of HIV, STIs and unintended pregnancy. Studies have repeatedly shown too that this kind of sex education does not lead to the earlier onset of sexual activity among young people and, in some cases, will even lead to it happening later.

In contrast there is no such robust evidence for the effectiveness of abstinence education. Almost all the studies that have claimed to show any positive outcomes are not well-enough designed to sustain these claims 29 30 31 so it is not possible to infer whether they work or not from the research reports.
So, what does the research evidence show about the effects of abstinence-based approaches?

The research that is available currently shows at best mixed outcomes for abstinence-based approaches to sex education, benefiting some young people in the short term but placing them at greater risks later. For example, two studies suggest that for some young people making pledges to abstain from sexual intercourse until marriage does lead to delay in the timing of their first sexual intercourse. But these young people tend to hold strong religious beliefs and enjoy being an exclusive group among peers who do not take abstinence pledges. As the researchers note this means that pledging abstinence is not appropriate for young people who do not hold strong religious views and, moreover, if lots of young people are involved in making pledges (as using abstinence education as a method of sex education requires) the sense of being special will be dissipated 32. In addition, while an abstinence pledge may work for some groups of young people as a way of delaying when they have sexual intercourse, the majority still have sex before they are married and when they do they report using condoms less often than 'non-pledgers' and are more likely to substitute anal or oral sex for vaginal sexual intercourse 33 34.

In April 2007 a company called Mathematica Policy Research published the results of a Congressionally mandated evaluation of federally funded abstinence-based programmes in American schools 35. The investigation, which looked at four programmes offering a range of settings and strategies, found that rates of abstinence and unprotected sex in students who took part in the programmes were virtually identical to rates among students who had been randomly assigned to not take part. The ages at first sexual intercourse were also nearly identical, as were the numbers of sexual partners. It appears that the programmes had no impact on how the students behaved.

With regards to HIV prevention, a systematic review of all relevant studies 36, published in October 2007, concluded, "Evidence does not indicate that abstinence-only interventions effectively decrease or exacerbate HIV risk among participants in high-income countries; trials suggest that the programs are ineffective." Nevertheless the authors stressed the paucity of robust data and the need for more rigorous trials. They noted that most studies have been conducted among American youth, which may limit the generalisability of their findings.