Abstinence (If) Only Education

As it happened, the Monday following a weekend during which my interest was piqued by a study making claims about, as the title states, "Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use," Rhode Island Education Commissioner Peter McWalters announced that a particular abstinence-only curriculum had been approved for use in Rhode Island schools. That such a thing should be considered newsworthy illustrates how misleading it is to conduct effectiveness studies as if abstinence-only programs are broadly in effect. The Guttmacher Institute–affiliated authors of the "Recent Declines" study conclude:

Abstinence promotion is a worthwhile goal, particularly among younger teenagers; however, the scientific evidence shows that, in itself, it is insufficient to help adolescents prevent unintended pregnancies. The current emphasis of US domestic and global policies, which stress abstinence-only sex education to the exclusion of accurate information on contraception, is misguided. Similar approaches should not be adopted by other nations.

Given the paucity of broad and sustained abstinence programs, however, one might be justified in concluding that the obvious effectiveness of abstinence wholly accounts — without the benefit of any educational curricula at all — for the 6.4% decrease in teenage girls who'd recently had sex at the time of the Dept. of Health and Human Services' 2002 National Survey of Family Growth (PDF), as compared with the 1995 iteration (PDF), and the 9.5% decrease in teenage girls who'd ever had sex. In light of the overwhelmingly "safe-sex" approach of public school sex-ed programs and the sex-saturation of youth culture, it might be that abstinence's contribution is actually astounding, even were the study correct that, as the news hook alludes, "only 14 per cent of the drop [in teenage pregnancies] amongst 15- to 19-year-olds was linked to reduced sexual activity."

Of course, to evaluate the study's claims, one must understand what, precisely, is being said, and as a point of fact, it doesn't claim that "86 per cent of the decline in teenage pregnancy was due to improved use of contraception." Rather, the author-created "contraceptive risk index" (CRI) contributed 86% of the change in the author-created "pregnancy risk index" (PRI). The emphasis on the manufactured nature of these statistics is key, because closer inspection reveals that the authors aren't, in fact, measuring what they claim to be measuring.

In essence, the CRI reflects the effectiveness of sexually active teen girls' contraception; the PRI multiples that times the percentage of girls having sex. The 14% value is merely the effect of fewer girls' having sex on that last multiplication, which, as is proven when the findings lead to headlines claiming that "success of abstinence in cutting teen pregnancies is a 'myth,'" wildly distorts the reality. Interested readers can refer to the Addendum in the extended entry of this post for my mathematical proof, but the upshot is that the Guttmacher study fails to distill the effects of abstinence from the effects of contraception. In other words, the contraception side of the formula actually compounds improvements in contraception with improvements in abstinence.

More important is the pervasive mindset revealed in the fact that the authors don't approach saying "no" as if it were a form of birth control. The force behind opposition to abstinence-only programs, as habitually exhibited by the ACLU, for one, is a cultural movement that does not really believe that the safest, healthiest sex occurs within marriage; it believes that restricting sex to lifelong monogamous relationships is unrealistic and, therefore, that the act of setting such expectations is, itself, a central source of the harm that can come from sex. It believes that contraceptives and medicine will address diseases, with abortion culling any human lives with the audacity to mistake their creation as the actual purpose for sex. If the stigma attached to deviant and/or promiscuous sexual acts by us scolds can be stamped out, then humankind will be free to experience the sheer joys of our sexual essence.

Since this commentary is on the level of movements, it will not apply to any given individual, of course. Most of those who subscribe to the safe-sex, pro-abortion, anti-religion-in-the-public-square platform do so not out of intellectual conviction, but out of a vague dislike of authority, an affinity for sex, and a disinterest in complicated consideration of consequences more than one step removed from the policies that they end up espousing. For some portion, such as Steven Brown, executive director of the Rhode Island affiliate of the ACLU, when he argues that teaching "abstinence until marriage" can "marginalize" homosexual students, equivalence between homosexual and heterosexual sex allows elision of the connection between sex and procreation, a goal for which the movement has long been striving.

That goal, as the movement has progressed and adapted to a society that is increasingly uneasy with its destination, has found its fruition in the cause of same-sex marriage. If marriage can be defined without reference to procreation, it can become merely another context in which to have intimate relations, only with the variations and trappings of marriage, and as such, it will cease to be the safest, healthiest context for sex. (Perhaps this is an example of progressives' handling the present as if it ought to conform with a future that they envision.)

The dividing line across this broad, rambling series of topics is between those who believe that sex is a behavior and those who believe that it is an activity. For one side, the goal is teaching children how to be responsible sexual beings; for the other, it is teaching them how to have sex safely. Those of a conservative bent will spot instantly the operative phrase — the fatal flaw — of the latter: "teaching them how to have sex." But rather than recoil from such instruction, we ought to absorb the correctly assessed need to openly address the minefield that puberty requires the young to cross.

What proponents of safe-sex education fail to consider — perhaps deliberately — is that abstinence education does not so much entail the provision of information (it's pretty straightforward, really) as the expression of encouragement. It's ridiculous on its face to offer analysis of five-hour programs' effects on the long-term lives of children. Safe-sex education, on the other hand, provides information — to be learned — on how to do particular things. Thus, the short-term curriculum format is more likely to have measurable results with such an approach. Of course, one of those results seems likely to be an interest in the things that the children now know how to do. (I recall the sense of passing opportunities imparted by the unused condom handed to me in a high school classroom, branding its message on the leather of my wallet.)

Too often, in imparting such knowledge, decreases in sexual activity — versus decreases in STDs and pregnancies — are not treated as a continual goal. Rather, they are handled as temperance might be among alcoholics in a land with no non-alcoholic beverages but water — instructing the audience to fail well, rather than to recover. If abstinence were handled, intellectually, as a form of contraception, then there wouldn't appear to be this supposedly unrealistic all-or-nothing religious/moral statement of waiting until marriage.

The reason the unbelievable 14:86 ratio in the Guttmacher study caught my interest is that I firmly believe that safe-sex education encourages sex, and that it therefore carries an inherently greater risk of pregnancy, especially as comfort levels increase. In contrast, it seems to me that truly encouraging abstinence could make those who slip feel more pressure to do so safely. The objective, for those who would formulate an optimal policy for public education, should be frank discussion of the biology — and the options — surrounding sex, but consistently and persistently within a context encouraging abstinence.

Studies suggest the counterintuitive finding that even a single pledge of abstinence can have significant effects on teenagers' behavior. Imagine the results were adults to succeed in overcoming the failure of imagination and personal restraint that prevents them from offering children a mature and maturely sustained vision of their sexuality.

ADDENDUM:
When analyzing which behavior category (abstinence or contraception) contributed more to changes in the PRI, the study's calculations heavily favor the CRI side of the measure, which is why the attributions (14% and 86%) come out so lopsided, despite improvements on both counts.

Because, as the authors are hopefully now learning, percentages have a tendency to distract one from the actual calculations in effect, consider the analysis in fractions, instead. If we designate "n" for the total survey population, then the number of girls who had sex within the three months prior to the study ("sexually active" girls) can be represented as follows:

And the number of sexually active girls using a particular form of birth control can be represented thus:

Therefore, the CRI is calculated thus (with 1/F representing the failure rate for the particular form of birth control):

Finally, the PRI renders thus:

As you can see, a decrease in sexual activity benefits both factors, whereas a decrease in contraceptive risk benefits only the CRI. A decrease in both compounds the benefit to the CRI side.

(As I hope would go without saying, I welcome corrections to my rusty algebra.)