Rebranding of Federal Abstinence-Only Programs
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GUTTMACHER POLICY REVIEW GPR 2018 | Vol. 21 REPRODUCTIVE HEALTH IN CRISIS: A SPECIAL SERIES New Name, Same Harm: Rebranding of Federal Abstinence-Only Programs By Jesseca Boyer HIGHLIGHTS ince 1996, more than $2 billion in federal funding have been spent on programs • Proponents have rebranded abstinence-only programs by for young people that focus on promot- co-opting public health and rights-based language and Sing sexual abstinence outside of marriage calling them “sexual risk avoidance” programs. (“abstinence-only”). Federal funding for these • Under any name, abstinence-only programs not only programs accelerated under the George W. Bush remain ineffective at their goal of promoting abstinence administration, then dropped significantly while until marriage, they also withhold potentially life-saving President Obama was in office. During the Obama information, promote dangerous gender stereotypes, era, proponents of abstinence-only programs stigmatize sex, sexual health and sexuality, and perpetuate found themselves on the defensive: Politically, systems of inequity. they could no longer look to the president for support for their ideologically driven agenda. As • Despite these negative outcomes, the Trump administration and conservatives in Congress are pushing for funding a practical matter, they were faced with a wealth increases for abstinence-only programs in an effort to of evidence that abstinence-only programs do not promote an ideological and coercive agenda. work to deter or delay sex among young people. And public opinion was not on their side, with a majority of the public in favor of sex education that includes information about contraception in One of the most significant changes has been to addition to abstinence.1 Rather than reexamining rebrand abstinence-only programs as “sexual risk their programmatic approach, abstinence-only avoidance” programs, based on the premise that proponents began to adopt a new rhetorical frame young people should be held to a higher standard of in an attempt to appeal to a wider audience and in behavior than merely risk reduction. Risk avoidance preparation for a change in the political landscape. and risk reduction are two common public health prevention strategies that aim to address risk-taking With social conservatives now in control of both behaviors—such as cigarette smoking and illicit drug the White House and Congress, abstinence-only use—and promote differing protective behaviors. programs are poised for a dramatic comeback Interventions can range from those that promote and federal funding for these programs is likely to abstaining from the activity in the first place, return- see significant increases again. But despite some ing to abstinence (cessation) or reducing individual retooling, abstinence-only programs remain as risks if and when engaging in the activity. flawed as ever. For activities that have inherent dangers that out- Rebranding Abstinence-Only Programs weigh any potential benefits, such as cigarette Over the past several years, proponents of smoking or drunk driving, this range of strategies abstinence-only programs have been working to makes sense. But sexual activity is not like many enhance their brand and reframe their approach. other risky behaviors, which can be prevented Guttmacher Policy Review | Vol. 21 | 2018 www.guttmacher.org 11 altogether. By contrast, sexual activity is a natural 2017, Valerie Huber, the former president and and healthy part of being human, and sexuality—far CEO of Ascend, was appointed chief of staff to from being inherently harmful—can offer pleasure the assistant secretary for health within the U.S. and intimacy throughout one’s life, not to mention Department of Health and Human Services (HHS), the potential for having children. with the authority to direct the work of offices charged with promoting sexual and reproductive Another part of the abstinence-only rebranding health information and services.7 effort has been elevating the concept of “suc- cess sequencing for poverty prevention.” Initially Proponents are using their new-found influence to developed by analysts at the Brookings Institution, revitalize and reshape federal abstinence-only pro- this view holds that the formula for escaping grams. There are two such programs at the federal poverty is for young people to finish high school, level. The first of these programs, created in 1996 work full time, and wait to get married and have under Title V of the Social Security Act, provided at children until at least age 21.2 Groups across the its peak $75 million per year to states for programs political spectrum have endorsed and adapted that conformed to a highly restrictive eight-point this concept, some by concluding that waiting definition of “abstinence education.” Some of the until marriage to have sex enables young people more controversial components of this definition to follow this model for success. Abstinence-only included teaching that “abstinence from sexual proponents have taken advantage of the currency activity is the only certain way to avoid out-of- of success sequencing to promote their programs wedlock pregnancy, sexually transmitted diseases, as poverty prevention measures. and other associated health problems” and that “a mutually faithful monogamous relationship in Abstinence-only proponents and programs have context of marriage is the expected standard of co-opted several other concepts as well. They human sexual activity.”8 have adopted terms such as “evidence-based” and “medically accurate and complete,” and embraced The second federal abstinence-only program language on “healthy relationships” and “youth was a competitive grant program created by empowerment,” all of which are typically associ- Congress in 2000 to bypass the states entirely ated with programs that respect young people’s and provide funding directly to community- decision making. For example, even though based organizations. Under the George W. Bush abstinence-only programs may claim to pro- administration, annual funding for the program— mote “healthy relationships” and provide “youth then called “community-based abstinence empowerment,” the terms are used in the context education” and explicitly tied to the same of federal program requirements that “ensure restrictive eight-point definition—ballooned from that the unambiguous and primary emphasis and $20 million initially to $113 million at its peak. The context...is a message to youth that normalizes program ended briefly after Obama came into the optimal health behavior of avoiding nonmari- office, but was revived in federal fiscal year (FY) tal sexual activity.”3 In 2012, the primary advo- 2012 at $5 million. cacy organization for abstinence-only programs, the National Abstinence Education Association Both of these programs have been revised and (NAEA), dropped “abstinence” from its name renamed in recent years, but the goal remains the altogether and rebranded itself as “Ascend.” same: to implement programs exclusively focused Nevertheless, most of the “sexual risk avoidance” on voluntarily refraining from sexual activity curricula endorsed by Ascend are the same as the outside of marriage. First, in FY 2016, Congress “abstinence education” curricula promoted by renamed the competitive grant program as NAEA prior to 2012 and have the same goals.4–6 “sexual risk avoidance” and decoupled it from the eight-point definition of “abstinence education.” With social conservatives now in the White To qualify for funding, programs must, among House, abstinence-only proponents are in posi- other things, “teach the benefits associated with tions of power within the administration. In June self-regulation, success sequencing for poverty Guttmacher Policy Review | Vol. 21 | 2018 www.guttmacher.org 12 Sex is a natural part of being human, and 65% of 18-year-olds Same Inherent Flaws and 93% of 25-year-olds have had sexual intercourse Despite efforts to rebrand abstinence-only programs, % of individuals who have had sexual intercourse, by age these approaches remain just as harmful as in the 100% 97% 98% 99% 93% past. Abstinence-only pro- age 25 grams are ineffective at 80 79% reaching their primary goal of keeping young people 60 65% age 18 from engaging in sexual activity as well as at meet- 40 ing the needs of all ado- lescents. They also create 20 22% barriers for young people in making informed deci- 0 1% sions about their health, require unethical behavior 10 15 20 25 30 35 40 45from educators, perpetuate inequities and discrimina- Source: National Survey of Family Growth. Note: Data are from 2013. tion, and promote stigma against marginalized indi- prevention,” and “resisting sexual coercion…with- viduals and toward sex more generally in society. out normalizing teen sexual activity.”9 Funding for the program has again started to increase, rising Ineffective at their primary goal. Even judging to $15 million in FY 2017 and likely to go as high the abstinence-only approach on its own limited as $25 million under House and Senate spending terms—where the only thing that matters proposals for FY 2018. is stopping or even delaying sex outside of marriage—this approach is ineffective. The first In February 2018, the Title V abstinence-only pro- federally funded evaluation of Title V abstinence- gram (which expired briefly in September 2017) only programs, conducted in 2007 by Mathematica was renewed for two more years at $75 million Policy Research on behalf of HHS, found no annually under the new name of “sexual risk