Abstinence-only sex education

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Laura Bush with an AIDS orphan at a center in Zambia that promotes abstinence and faith for youth Laura Bush talks with African boy.jpg
Laura Bush with an AIDS orphan at a center in Zambia that promotes abstinence and faith for youth

Abstinence-only sex education (also known as sexual risk avoidance education) [1] is a form of sex education that teaches not having sex outside of marriage. It often excludes other types of sexual and reproductive health education, such as birth control and safe sex. In contrast, comprehensive sex education covers the use of birth control and sexual abstinence.

Contents

Evidence does not support the effectiveness of abstinence-only sex education. [2] [3] It has been found to be ineffective in decreasing HIV risk in the developed world. [4] It does not decrease rates of sexual activity or unplanned pregnancy when compared to comprehensive sex education. [2]

The topic of abstinence-only education is controversial in the United States, with proponents claiming that comprehensive sex education encourages premarital sexual activity, and critics arguing that abstinence-only education is religiously motivated and that the approach has been proven ineffective and even detrimental to its own aims.

Description

Abstinence education teaches children and adolescents to abstain from sexual activity, and that this is the only certain method of avoiding pregnancy and sexually transmitted infections (STIs). With a heavy focus on the importance of "family values", programs also teach that abstinence until marriage is a standard by which to live. [5] [6] Since 2019, the federal government has spent $110 million annually on abstinence-only sex education. [7]

In the U.S., states may apply for federal funding of abstinence-only sex education programs from either Title V, the Adolescent Family Life Act (AFLA), and/or Community-Based Abstinence Education (CBAE). To be eligible for funding, programs must satisfy requirements given under the Social Security Act, which is reproduced here verbatim:: [8]

(2) For purposes of this section, the term "abstinence education" means an educational or motivational program which—

(A) has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
(B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
(C) 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;
(D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;
(E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
(F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society;
(G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
(H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.

Funding, which began in the 1980s, has continued to increase since its inception, though support for the programs and legislation surrounding them has become dependent upon the current administration. [9] For example, George W. Bush administration increased federal funding for abstinence-only programs (the only type funded even under the previous Clinton Administration), while the Obama administration reversed the emphasis and provided more federal dollars for comprehensive sex education. [10] President Donald Trump cut grants to comprehensive sex education [11] and proposed increased funding for abstinence-only education. [12] Increased funding continued through the Joe Biden administration. [7]

Effectiveness

Systematic reviews of research evaluating abstinence-only sex education have concluded that it is ineffective at preventing unwanted pregnancy or the spread of STIs, among other shortfalls. [2] [13] [14] The American Academy of Pediatrics has recommended against the use of abstinence-only sex education because it has been found to be ineffective, and because the media frequently conveys information about non-abstinence. [15]

STI transmission

Sign to promote abstinence in Ghana as a way of preventing HIV/AIDS (2005) No Sex Signage in Ghana.jpg
Sign to promote abstinence in Ghana as a way of preventing HIV/AIDS (2005)

A 2015 meta-analysis found that abstinence-focused programs had no effect on the likelihood of contracting STIs. [16]

A Cochrane systematic review suggests that abstinence-only education neither increases nor decreases HIV risk in high-income countries. [4] In the developing world there is a lack of evidence of effect. [17] In 2008, Douglas Kirby reviewed the evidence for the effectiveness of abstinence-only education programs and found little evidence to justify the use of such programs. [18] A 2011 meta-analysis found that it was ineffective at reducing the risk of HIV infection among adolescents. [19] Abstinence education has also been found to include misleading medical information and exclude potentially life-saving information about sexual risk reduction. [20] A 2016 study found "that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states." [21]

Pregnancy

Evidence does not support abstinence-only-until-marriage sex education. [22] Research in the United States has found that abstinence-only education is related to increases in teen pregnancy and teen birth rates. [23] Comprehensive sexual education on the other hand leads to a reduction in teenage birthrates. [24] The decline of teenage pregnancy rates during 1995–2002 were largely due to improved contraception, and the reduction in pregnancy risk among teenagers aged 18 or 19 is due to less unprotected sex. [25]

A 2010 report by the Guttmacher Institute pointed out that pregnancy rates for teens 15–19 reversed their decline in 2006, near the peak of the Abstinence Only campaign in the United States. [26]

While sex education has been linked to a delay in the first time having sex, [27] abstinence-only programs specifically have not shown this link, and do not seem to influence if or when young people begin having sex. [28]

Society and culture

Support

Proponents of abstinence-only sex education argue that this approach is superior to comprehensive sex education because it emphasizes the teaching of morality that limits sex to that within the bounds of marriage, and that sex before marriage and at a young age has heavy physical and emotional costs. [29] In addition, abstinence programs often teach young people that pleasure in sex is most likely to be found within marriage, and therefore, that they should wait to engage in sexual activity until they are married. [30] Abstinence generally places a great emphasis on the importance of the institution of marriage, which some proponents believe allows young people to grow and develop as individuals. [31]

Proponents suggest that comprehensive sex education encourages premarital sexual activity among teenagers, which should be discouraged in an era when HIV and other incurable STIs are widespread and when teen pregnancy is an ongoing concern. According to the Guttmacher Institute, [32] the AFLA, or Adolescent Family Life Act, was a five year-program with costs estimated around $250 million. Many supporters of abstinence-only education do so out of the belief that comprehensive guides to sex or information about contraceptives will ultimately result in teens actively pursuing and engaging in sexual activities, [23] while others oppose the endorsement of contraception for religious reasons. [33] Adults may view teenagers as less intelligent and less responsible, and unable to control themselves due to their hormones. As a result, a teenager's sexual desire is something that needs to be controlled, [34] dividing the teens into two separate categories in the minds of adults: "the innocent and the guilty, the vulnerable and the predatory, the pure and the corrupting." [35]

Opposition

Opponents and critics, which include prominent professional associations in the fields of medicine, public health, adolescent health, and psychology, argue that such programs fail to provide adequate information to protect the health of adolescents. Not only is information inadequate, but opponents believe that young people have the right to receive comprehensive information about how to protect themselves and their sexual health. [36] Accurate information is especially important since, although some supporters may claim that abstinence is an effective method, it has been found that a small percentage of people actually practice it. [36]

Some critics also argue that such programs verge on religious interference in secular education. Opponents of abstinence-only education dispute the claim that comprehensive sex education encourages teens to have premarital sex. [37] The idea that sexual intercourse should only occur within marriage also has serious implications for people for whom marriage is not valued or desired, or is unavailable as an option, particularly LGBT people living in places where same-sex marriage is not legal or socially acceptable. [38] [39] [40] [41] [42] Abstinence-only education is often criticized for being overly heteronormative, idealizing the institution of heterosexual marriage to the denigration of queer relationships. [43] In addition, the heteronormativity of abstinence-only education, as well as the focus on marriage, means that members of the LGBT community will never receive formal information about how to practice safe sex, which is problematic, since they are already at an increased risk for STIs. [44]

According to Advocates for Youth, abstinence-only sex education distorts information about contraceptives, including only revealing failure rates associated with their use, and ignoring discussion of their benefits. [45] The language surrounding medicine and health is construed as being both objective and value free. [43] This objectivity is then adopted by conservative politicians and campaigners to assert authority which historically holds its basis in religion. [46]

Abstinence-only education is not supported by the majority of public school teachers, parents, and students. The majority in each of these groups is opposed to abstinence-only curriculum and wants a more comprehensive curriculum. "Although more than nine in 10 teachers believe that students should be taught about contraception... one in four are instructed not to teach the subject." Even when there are no rules limiting sex education to abstinence-only, teachers may continue to teach abstinence-only curriculum because they fear retaliation from the local community. Parents also want their children to be taught about contraception. "Most parents (65%) believe that sex education should encourage young people to delay sexual activity but also prepare them to use birth control and practice safe sex once they do become sexually active." 86% of parents want schools to teach their children how to get STD testing, 77% want their children to learn how to talk to a partner about STDs and birth control, 71% want them to learn how to use condoms, and 68% want them to learn about using other forms of birth control. Students are also opposed to abstinence-only education. "Approximately half of students in grades 7-12 report needing more information about what to do in the event of rape or sexual assault, how to get tested for HIV and other STDs, and how to talk with a partner about birth control and STDs." Clearly, there is a disparity between the type of sex education curriculum teachers, parents, and students want and what government policy determines they receive. [47]

Definition

Another problem for abstinence education is the definition of abstinence. Santelli (2006) states that there is no strict definition of abstinence within the US federal government guidelines for teaching abstinence-only sex education, using a mixture of non-specific phrases, like "postponing sex" or "never had vaginal sex", while also using moralistic terms or phrases like virgin , chaste, and "making a commitment". [36] This has resulted in sexual activities that are not penile-vaginal, including manual sex, oral sex and anal sex, being considered outside of the scope of abstention from sex, which is termed technical virginity. [48]

Global impact

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. government's initiative to combat HIV/AIDS globally. [49] PEPFAR works with the governments of 22 countries worldwide to create sustainable programs to prevent HIV and improve the lives of those suffering. [50] PEPFAR provides funding to other countries to help combat HIV/AIDS. It does so with certain guidelines and restrictions on the recipients. PEPFAR promotes an "ABC" approach – Abstain, Be faithful, and use Condoms. Funding recipients may give information about condoms to youth over 15 years old but cannot use the funding to provide condoms or promote usage. In countries receiving funds from PEPFAR, teens under the age of 15 are not allowed to receive information about condoms. [51] The rationale behind this is to not encourage sexual activity despite evidence that condom use does not cause promiscuity. [52] PEPFAR was founded in 2003 with the mandate that 33% of its funds provided for prevention be used for abstinence-only education. Since the reauthorization in 2008, this mandate was removed, with a shift toward directives to spend at least 50% on abstinence-only education. [53] The role of partners has been an area of debate surrounding PEPFAR. In 2006, 23% of all the community partners were faith-based and debate exists over whether the U.S. should be allowing grants specifically written for faith-based organizations and prevention. [54] A few countries that have received PEPFAR funding – specifically Mozambique and Rwanda – have expressed distaste for the U.S.' push for faith-based education and abstinence-only funding. [54] Human rights groups have expressed concern that condom availability has decreased since PEPFAR's involvement in the global AIDS crisis. [55]

The $1.3 billion that the U.S. government spent on programs to promote abstinence in sub-Saharan Africa had no meaningful impact. [56] [57] [58]

Politics

The Christian Right, who initially stood against having school-based sex education programs, began supporting abstinence-only programs due to the focus on marriage. [59] As a driving force behind the abstinence movement, they have focused on getting more funding for these programs and have also been successful in creating more awareness surrounding abstinence through their use of activism. [60] To the New Right, the abstinence-only sex education movement was an opportunity and an avenue to change the current view and status of sexuality in America, aligning it more with their own values, and as a result, creating individuals who remained abstinent until marriage, and thus, citizens who embodied values of self-discipline and morality. [61] In addition, abstinence-only programs utilize ideas of individualism and personal responsibility when educating young people about sex, seeking to create individuals who take responsibility for sexuality and morality. [62] These ideas underlie the basis of conservative ideology, a focus on the individual having a strong place in the beliefs of this group. [63] Thus, it makes sense that support for abstinence-only programs as an effective form of sex education has been linked to conservative individuals. [64]

Religion

Religious doctrines take varying stances on contraception and premarital sex; see:

The philosophical sex-positive movement cuts across many religions and rejects the idea that consensual premarital sex or contraception are immoral.

See also

Related Research Articles

<span class="mw-page-title-main">Safe sex</span> Ways to reduce the risk of acquiring STIs

Safe sex is sexual activity using methods or contraceptive devices to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.

<span class="mw-page-title-main">Sexual abstinence</span> Act of refraining from sexual activity

Sexual abstinence or sexual restraint is the practice of refraining from sexual activity for reasons medical, psychological, legal, social, philosophical, moral, religious or other. It is a part of chastity. Celibacy is sexual abstinence generally motivated by factors such as an individual's personal or religious beliefs. Sexual abstinence before marriage is required by social norms in some societies, or by law in some countries. It is distinct from asexuality, which is a sexual orientation where people feel small or no sexual attraction.

<span class="mw-page-title-main">Sex education</span> Instruction on human sexuality issues

Sex education, also known as sexual education, sexualityeducation or sex ed, is the instruction of issues relating to human sexuality, including human sexual anatomy, sexual activity, sexual reproduction, safe sex, and birth control, sexual health, reproductive health, emotional relations and responsibilities, age of consent, and reproductive rights. Sex education that includes all of these issues is known as comprehensive sexuality education. In contrast, abstinence-only sex education, which focuses solely on promoting sexual abstinence, is often favored in more socially conservative regions, including some parts of the United States. Sex education may be provided as part of school programs, public health campaigns, or by parents or caregivers. In some countries it is known as "Relationships and Sexual Health Education".

<span class="mw-page-title-main">Teenage pregnancy</span> Childbirth in human females under the age of 20

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20.

<span class="mw-page-title-main">Premarital sex</span> Sexual activity before marriage

Premarital sex is sex before marriage. Premarital sex is sex between two people who are not married to each other. Premarital sex is considered a sin by a number of religions and also considered a moral issue which is taboo in many cultures. Since the Sexual Revolution of the 1960s, it has become accepted by certain liberal movements, especially in Western countries. A 2014 Pew study on global morality found that premarital sex was considered particularly unacceptable in "Muslim Majority Countries", such as Malaysia, Jordan and Pakistan, each having over 90% disapproval, while people in Western European countries were the most accepting, with Spain, Germany, and France expressing less than 10% disapproval.

Comprehensive sex education (CSE) is an instructional approach aimed at providing individuals, particularly young people, with accurate, holistic information about sexuality, relationships, and reproductive health. Unlike abstinence-only education, CSE includes a broad curriculum that covers topics such as safe sex practices, contraception, sexually transmitted infections (STIs), sexual orientation, gender identity, and relationship skills. This approach seeks to empower individuals to make informed, responsible decisions regarding their sexual health and to promote respect and equality in sexual relationships.

Abstinence, be faithful, use a condom, also known as the ABC strategy, abstinence-plus sex education or abstinence-based sex education, is a sex education policy based on a combination of "risk avoidance" and harm reduction which modifies the approach of abstinence-only sex education by including education about the value of partner reduction, safe sex, and birth control methods. Abstinence-only sex education is strictly to promote the sexual abstinence until marriage, and does not teach about safe sex or contraceptives. The abstinence-based sex education program is meant to stress abstinence and include information on safe sex practices. In general terms, this strategy of sex education is a compromise between abstinence-only education and comprehensive sex education. The ABC approach was developed in response to the growing epidemic of HIV/AIDS in Africa, and to prevent the spread of other sexually transmitted infections. This approach has been credited by some with the falling numbers of those infected with AIDS in Uganda, Kenya and Zimbabwe, among others. From 1990 to 2001 the percentage of Ugandans living with AIDS fell from 15% to between 5 and 6%. This fall is believed to result from the employment of the ABC approach, especially reduction in the number of sex partners, called "zero grazing" in Uganda.

Adolescent sexuality is a stage of human development in which adolescents experience and explore sexual feelings. Interest in sexuality intensifies during the onset of puberty, and sexuality is often a vital aspect of teenagers' lives. Sexual interest may be expressed in a number of ways, such as flirting, kissing, masturbation, or having sex with a partner. Sexual interest among adolescents, as among adults, can vary greatly, and is influenced by cultural norms and mores, sex education, as well as comprehensive sexuality education provided, sexual orientation, and social controls such as age-of-consent laws.

The sexuality of US adolescents includes their feelings, behaviors and development, and the place adolescent sexuality has in American society, including the response of the government, educators, parents, and other interested groups.

<span class="mw-page-title-main">Prevalence of teenage pregnancy</span> Overview of the prevalence of teenage pregnancy around the world

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The very high rate of human immunodeficiency virus infection experienced in Uganda during the 1980s and early 1990s created an urgent need for people to know their HIV status. The only option available to them was offered by the National Blood Transfusion Service, which carries out routine HIV tests on all the blood that is donated for transfusion purposes. The great need for testing and counseling resulted in a group of local non-governmental organizations such as The AIDS Support Organisation, Uganda Red Cross, Nsambya Home Care, the National Blood Bank, the Uganda Virus Research Institute together with the Ministry of Health establishing the AIDS Information Centre in 1990. This organization worked to provide HIV testing and counseling services with the knowledge and consent of the client involved.

Advocates for Youth is a nonprofit organization and advocacy group based in Washington, D.C., United States, dedicated to sexuality education, the prevention of HIV and of sexually transmitted disease, teenage pregnancy prevention, youth access to condoms and contraception, equality for LGBT youth, and youth participation. In addition, Advocates for Youth sponsors media campaigns and other forms of outreach which attempt to change societal norms to be more understanding of, accepting, of, and responsible about youth sexuality and to drive youth sexual health equity.

<span class="mw-page-title-main">Birth control</span> Method of preventing human pregnancy

Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable or wrong.

<span class="mw-page-title-main">Douglas Kirby</span> Research scientist

Douglas Bernard Kirby was senior research scientist for ETR Associates in Scotts Valley, California, and one of the world’s leading experts on the effectiveness of school and community programs in the reduction of adolescent sexual risk-taking behaviors. In recent years he had also undertaken research and analysis on the impact of HIV/AIDS prevention programs in Uganda under the auspices of the World Health Organization, USAID, and other organizations.

In the United States, sex education is taught in two main forms: comprehensive sex education and abstinence-only as part of the Adolescent Family Life Act, or AFLA. Comprehensive sex education is also called abstinence-based, abstinence-plus, abstinence-plus-risk-reduction, and sexual risk reduction sex education. This approach covers abstinence as a choice option, but also informs adolescents about age of consent and the availability of contraception and techniques to avoid contraction of sexually transmitted infections. Every state within the U.S. has a mandated AIDS Education Program.

Adolescent sexuality in Canada is not as well documented as adolescent sexuality in the United States; despite the proximity of the two nations, Canada has its own unique culture and generalizations about Canadian adolescent sexuality based on American research can be misleading. Because of this, several surveys and studies have been conducted which acquired information on Canadian adolescent sexuality. Surveys which provide this information include the Canadian Community Health Survey (CCHS), the National Population Health Survey (NPHS) and the National Longitudinal Survey of Children and Youth (NLSCY). According to information drawn from the Canadian Community Health Survey and the National Population Health Survey, in 2005 43% of teens aged 15 to 19 reported that they had had sexual intercourse at least once.

<span class="mw-page-title-main">Teenage pregnancy in the United States</span>

Teenage pregnancy in the United States occurs mostly unintentionally and out of wedlock but has been declining almost continuously since the 1990s. In 2022, the teenage birth rate fell to 13.5 per 1,000 girls aged 15 to 19, the lowest on record. According to the Centers for Disease Control and Prevention (CDC), this decline is due to abstinence and the use of contraception.

Uganda is one of the few Sub-Saharan African countries that has adopted abstinence-only sex education as an approach of sexual education that emphasizes abstinence from sexual intercourse until marriage as the only option. Abstinence-only sex education does not include joint curriculum covering other options including safe sex practices, family planning, and is espoused as the only sure way to avoid pregnancy and sexually transmitted infections. Uganda is commonly recognized as an exemplary case of lowering the rate of HIV prevalence. Prevalence figures may have also been distorted by the lack of treatment, meaning that the percentage of infected is decreased by disproportionately early deaths. Abstinence-only sex education has been implemented and supported for this cause to a large degree in Uganda, to some controversy. Critics have questioned its effectiveness in lowering HIV/AIDS transmission. They have also highlighted discrimination, gender inequality and social stigma as the outcomes of the program in Uganda.

Sex education is a controversial subject in India, sometimes viewed as a taboo topic; across the country and within the community, opinions on how or whether to deliver it are divided. The states of Gujarat, Maharashtra, Madhya Pradesh and Chhattisgarh have banned or refused to implement sex education in schools. The BJP government in Madhya Pradesh said sex education had "no place in Indian culture" and plans to introduce yoga in schools instead. On the global level, India has notably fallen behind numerous countries, including underdeveloped and significantly smaller countries such as Sudan and the Congo Republic, where sex education is first taught at the primary level.

Sexuality in the United States varies by region and time period.

References

  1. ↑ Deanna Pan (July 8, 2023). "As conservative activism targets sex ed, new Mass. guidelines are on the horizon". The Boston Globe .
  2. 1 2 3 Ott, Mary A; Santelli, John S (2007). "Abstinence and abstinence-only education". Current Opinion in Obstetrics and Gynecology. 19 (5): 446–52. doi:10.1097/GCO.0b013e3282efdc0b. PMC   5913747 . PMID   17885460.
  3. ↑ Chin, Helen B; Sipe, Theresa Ann; Elder, Randy; Mercer, Shawna L; Chattopadhyay, Sajal K; Jacob, Verughese; Wethington, Holly R; Kirby, Doug; Elliston, Donna B; Griffith, Matt; Chuke, Stella O; Briss, Susan C; Ericksen, Irene; Galbraith, Jennifer S; Herbst, Jeffrey H; Johnson, Robert L; Kraft, Joan M; Noar, Seth M; Romero, Lisa M; Santelli, John (2012). "The Effectiveness of Group-Based Comprehensive Risk-Reduction and Abstinence Education Interventions to Prevent or Reduce the Risk of Adolescent Pregnancy, Human Immunodeficiency Virus, and Sexually Transmitted Infections". American Journal of Preventive Medicine. 42 (3): 272–94. doi:10.1016/j.amepre.2011.11.006. PMID   22341164.
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  7. 1 2 "Federally Funded Abstinence-Only Programs: Harmful and Ineffective | Guttmacher Institute". www.guttmacher.org. 2021-04-28. Retrieved 2024-01-23.
  8. ↑ Social Security Act, Section 510 Archived 2011-10-26 at the Wayback Machine
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  10. ↑ Trump Ignores Scientific Evidence Proving Abstinence Only Education Doesn't Work
  11. ↑ Trump administration cuts short teen pregnancy prevention program funding
  12. ↑ Trump's Proposed Budget Would Invest $277 Million in Abstinence-Only Education
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  20. ↑ Santelli, John S; Speizer, Ilene S; Edelstein, Zoe R (2013). "Abstinence promotion under PEPFAR: The shifting focus of HIV prevention for youth". Global Public Health. 8 (1): 1–12. doi:10.1080/17441692.2012.759609. PMC   3984004 . PMID   23327516.
  21. ↑ Carr, Jillian B; Packham, Analisa (2017). "The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes". Health Economics. 26 (4): 403–420. doi:10.1002/hec.3315. PMID   26918400. S2CID   13790413.
  22. ↑ SIECUS Fact Sheet Archived 2010-06-16 at the Wayback Machine (includes research citations).
  23. 1 2 Stanger-Hall, Kathrin F; Hall, David W (2011). "Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S". PLOS ONE. 6 (10): e24658. Bibcode:2011PLoSO...624658S. doi: 10.1371/journal.pone.0024658 . PMC   3194801 . PMID   22022362.
  24. ↑ Fox, Ashley M.; Himmelstein, Georgia; Khalid, Hina; Howell, Elizabeth A. (2019). "Funding for Abstinence-Only Education and Adolescent Pregnancy Prevention: Does State Ideology Affect Outcomes?". American Journal of Public Health. 109 (3): 497–504. doi:10.2105/ajph.2018.304896. PMC   6366514 . PMID   30676806.
  25. ↑ Santelli, John S; Lindberg, Laura Duberstein; Finer, Lawrence B; Singh, Susheela (2007). "Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use". American Journal of Public Health. 97 (1): 150–6. doi:10.2105/AJPH.2006.089169. PMC   1716232 . PMID   17138906.
  26. ↑ Table 1.0,"U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity." "Following Decade-Long Decline, U.S. Teen Pregnancy Rate Increases as Both Births and Abortions Rise". 2010-01-26. Archived from the original on 2010-01-29. Retrieved 2010-01-27., downloaded 20100127.
  27. ↑ Lindberg, Laura Duberstein; Maddow-Zimet, Isaac (2012). "Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes". Journal of Adolescent Health. 51 (4): 332–8. doi: 10.1016/j.jadohealth.2011.12.028 . PMID   22999833. S2CID   45947283.
  28. ↑ Kohler, Pamela K; Manhart, Lisa E; Lafferty, William E (2008). "Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy". Journal of Adolescent Health. 42 (4): 344–51. doi:10.1016/j.jadohealth.2007.08.026. PMID   18346659.
  29. ↑ PBS, February 4, 2005 Religion & Ethics Newsweekly, Episode 823 Archived 2012-03-10 at the Wayback Machine Retrieved on 2007-14-03
  30. ↑ Lamb, Sharon; Lustig, Kara; Graling, Kelly (2013). "The use and misuse of pleasure in sex education curricula". Sex Education. 13 (3): 305–18. doi:10.1080/14681811.2012.738604. S2CID   145512187.
  31. ↑ Luker, Kristin (2007). When Sex Goes To School: Warring Views On Sex - And Sex Education - Since The Sixties. New York, NY: W. W. Norton & Company. pp.  102–105. ISBN   978-0-393-06089-8.
  32. ↑ "Whatever Happened to the Adolescent Family Life Act?". Guttmacher Institute. 2004-09-22. Retrieved 2021-12-08.
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  36. 1 2 3 Santelli, John; Ott, Mary A; Lyon, Maureen; Rogers, Jennifer; Summers, Daniel; Schleifer, Rebecca (2006). "Abstinence and abstinence-only education: A review of U.S. Policies and programs". Journal of Adolescent Health. 38 (1): 72–81. doi:10.1016/j.jadohealth.2005.10.006. PMID   16387256.
  37. ↑ Douglas Kirby, Ph. D.: Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. National Campaign to Prevent Teen Pregnancy, 2001. Homepage of the study. Archived May 17, 2007, at the Wayback Machine
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  40. ↑ "Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States: Texas: A Case Study" (PDF). Human Rights Watch. September 2002.
  41. ↑ Nancy D. Polikoff, Beyond straight and gay marriage: valuing all families under the law; Politics, Culture and Society Series, Beacon Press, 2008 ISBN   0-8070-4432-6, ISBN   978-0-8070-4432-2 [ page needed ]
  42. ↑ Debran Rowland, The boundaries of her body: the troubling history of women's rights in America, SphinxLegal, 2004, ISBN   1-57248-368-7, ISBN   978-1-57248-368-2
  43. 1 2 Wilkerson, Abby (2013). "I Want to Hold Your Hand: Abstinence Curricula, Bioethics, and the Silencing of Desire". Journal of Medical Humanities. 34 (2): 101–8. doi:10.1007/s10912-013-9213-0. PMID   23468394. S2CID   35152974.
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  47. ↑ Dailard, Cynthia. "Sex Education: Politicians, Parents, Teachers, and Teens." The Reproductive Rights Reader. Nancy Ehrenreich, Ed. New York City, 2008.
  48. ↑ Bryan Strong; Christine DeVault; Theodore F. Cohen (2010). The Marriage and Family Experience: Intimate Relationship in a Changing Society. Cengage Learning. p. 186. ISBN   978-0-534-62425-5 . Retrieved October 8, 2011. Most people agree that we maintain virginity as long as we refrain from sexual (vaginal) intercourse. But occasionally we hear people speak of 'technical virginity' [...] Data indicate that 'a very significant proportion of teens ha[ve] had experience with oral sex, even if they haven't had sexual intercourse, and may think of themselves as virgins' [...] Other research, especially research looking into virginity loss, reports that 35% of virgins, defined as people who have never engaged in vaginal intercourse, have nonetheless engaged in one or more other forms of heterosexual sexual activity (e.g., oral sex, anal sex, or mutual masturbation).
  49. ↑ "About PEPFAR". PEPFAR. Archived from the original on 2014-10-28. Retrieved 2014-11-04.
  50. ↑ "Partnership Frameworks". PEPFAR. Archived from the original on 2014-10-28. Retrieved 2014-11-04.
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  52. ↑ "Abstinence & Fidelity". PEPFARWatch. Archived from the original on 2014-10-24.
  53. 1 2 Dietrich, John (2007). "The Politics of PEPFAR: The President's Emergency Plan for AIDS Relief". Ethics & International Affairs. 21 (3): 277–292. doi:10.1111/j.1747-7093.2007.00100.x. S2CID   71217445.
  54. ↑ "Access to Condoms and HIV/AIDS Information: A Global Health and Human Rights Concern". Human Rights Watch: 1–28. 2004.
  55. ↑ U.S. Push for Abstinence in Africa Is Seen as Failure Against H.I.V. By DONALD G. McNEIL Jr. New York Times. FEB. 26, 2015 Archived 2017-08-24 at the Wayback Machine
  56. ↑ 19th Conference on Retroviruses and Opportunistic Infections in Seattle. Archived 2015-02-27 at the Wayback Machine US PEPFAR abstinence and faithfulness funding had no impact on sexual behaviour in Africa. Keith Alcorn. CROI News. 26 February 2015
  57. ↑ The impact of PEPFAR faithfulness and abstinence funding on HIV risk behaviours in sub-Saharan Africa. Conference on Retroviruses and Opportunistic Infections Archived 2015-02-27 at the Wayback Machine , Lo N, Lowe A, Bendavid E. Seattle, abstract 160, 2015.
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  60. ↑ Kelly, Casey Ryan (2016). "Chastity for democracy: Surplus repression and the rhetoric of sex education". Quarterly Journal of Speech. 102 (4): 353–75. doi:10.1080/00335630.2016.1209548. S2CID   147882317.
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