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'Risk Avoidance' Sex Education Is the New Abstinence-Only

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In a speech on the House floor Monday, U.S. Rep. Randy Hultgren (R-Ill.) declared that sex education in the United States isn't sufficient, citing a new report from the Centers for Disease Control that says young people ages 15 to 24 are responsible for half of all new cases of sexually transmitted infections. According to The Hill newspaper, Hultgren says abstinence-only education needs to be increased.

To that end, Hultgren submitted a bill, co-sponsored by Rep. Dan Lipinski (D-Ill.), that spends $110 million annually for the next five years on grants to abstinence programs. He would spend the money out of the Prevention and Public Health Fund established in Section 4002 of the Affordable Care Act (née Obamacare). The ACA appropriated $1.25 billion for the fund in the current fiscal year, though that number rises to $2 billion beginning in fiscal year 2015.

What's interesting, though, is that in place of "abstinence-only education," Hultgren, along with abstinence-education groups, are using the term "risk-avoidance education." It's like how global warming is now "climate change"; this has the feel of a slow-growing rebranding effort.

Whether risk is avoided depends on whether you look at the philosophy behind the policy or the practical results that come from it. Many institutions have studied the effectiveness of comprehensive sex education as compared to abstinence-only education, and found that comprehensive policies lead to reduced numbers of sexually transmitted infections. According to the Guttmacher Institute, comprehensive sex education is superior to abstinence-only education at lowering pregnancy rates. And a meta-analysis by the Community Preventive Services Task Force found abstinence-only programs showed a (arguable) decrease in average sexual activity, but had no significant effect on the average number of sexual partners, use of protection, or engagement in unprotected sex, and actually increased pregnancy.

If you like things in graph form, here you go:

Rules-TeenagePregnancyRates.jpg

(Click graph to enlarge)

This graph shows the pregnancy rate for all states that have some kind of policy in place. States that don't appear on this chart neither mandate sex education nor mandate the content of sex education should it be taught anyway. The trend isn't perfect, but in general, where states have comprehensive sex education, pregnancy rates are lower than other states. New Hampshire, Vermont, Maine, and Minnesota, at the lowest end, have required comprehensive programs. Some states use "abstinence plus," a kind of policy that stresses abstinence but includes information on contraceptives.

The graph is rudimentary; it doesn't take into account benefits from separate state programs that teach about STIs. And some states, while they mandate abstinence-only policies, nevertheless have local opt-out options. To be sure, not all programs of either variety are guaranteed to be accurate or helpful, but the statistical trend ties lower pregnancy rates to comprehensive sex education.

In addition, the CDC report offers only a national snapshot, rather than a state-by-state breakdown, according to a CDC spokeswoman. That means that states with comprehensive sex education programs could be doing very well at minimizing STIs. In answer to your next question, here's another chart, taken from CDC data:

Rules-STIrate.jpg

In general, states with comprehensive sex education programs also have lower STI rates than states that don't.

Hultgren's bill likely won't go far; the Obama administration has deliberately focused on comprehensive sex education, and Hultgren is right that funding streams have been altered to meet that preference. At the same time, though, an April 2010 CDC analysis found schools cutting back on instruction in disease prevention.

Alternatively, since human papilloma virus is the leading cause of STI increases, I'd bet the makers of HPV vaccines have some ideas about what to do with ACA money, too.

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