By Felipe E. Vizcarrondo, MD, MA
UNESCO (United Nations Educational, Scientific, and Cultural Organization) in the document International Technical Guidance on Sexuality Education 1 of December 2009 declared that “sexuality is a fundamental aspect of human life: it has physical, psychological, spiritual, social, economic, political, and cultural dimensions.” Sexuality education is important because “of the impact of cultural values and religious beliefs on all individuals, especially young people, in managing relationships with their parents, teachers, other adults and their communities.” The Guidance was developed as a set of international guidelines for all countries to use after making them culture appropriate. The Guidance was developed after consultation with members from UNAIDS, UNESCO, UNFPA, UNICEF, and WHO. The role of schools was deemed essential; most children spend the greater part of their day in school. The schools have the infrastructure and trusted adults in teachers and administrators. Schools can become the trusted community centers that provide links for services for sexual and reproductive health.2 The Guidance calls for the parents to be included on consultations on the content of the sex education; however, the report insists that teachers and the state are most responsible for the child’s education and well being.
“Sexuality education is defined as an age-appropriate, culturally relevant approach to teaching about sex and relationships by providing scientifically accurate, realistic, non-judgmental information.” The Guidance claims current comprehensive reproductive health education programs in the United States, in other developed and in underdeveloped countries, are designed to reduce unintended pregnancies and STIs including HIV; they are not designed to provide information in sexual and reproductive health. The Guidance authors also claim abstinence programs in the United States show minimal effect in delaying sexual initiation.3 The Guidance proposes to improve on the current situation by introducing effective school based teaching in sexual and reproductive health starting at age 5.
There is extensive and very specific description of the recommended content of the teaching for the specific age group students. The key concepts are (1) relationships, (2) values, attitudes and skills, (3) culture, society and human rights, (4) human development, (5) sexual behavior, and (6) sexual and reproductive health.4 Among the learning objectives are (1) redefinition of family with different kinds of families for age 5-8,5 (2) values regarding gender, relationships, intimacy, sexuality and reproduction for age 9-12,6 (4) the correct and consistent use of condoms and contraception for age 9- 12,7,9 (5) masturbation for age 9-12.8
The federal government is in line with the United Nations. The Community Guide research staff of the Center for Disease Control (CDC), United States Department of Health and Human Services, conducted an analysis of current group-based interventions to prevent adolescent pregnancy, HIV, and other STIs. Conclusions published in November 2009 were: (a) “The Task Force on Community Preventive Services concludes there is insufficient evidence of group based abstinence education (AE) to prevent pregnancy, HIV, and other STIs. Evidence was considered insufficient due to inconsistent results across studies.”10 (b) “The Task Force on Community Preventive Services recommends group based comprehensive risk reduction [comprehensive sexual and reproductive health education] delivered to adolescents to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other STIs.”11 The claim is made that “these results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to adolescent health and prevention of pregnancy, HIV, and other STIs.”
The Center for Reproductive Rights (CRR) of New York, whose mission is to use the law to advance reproductive freedom as a fundamental human right that all governments are legally obligated to protect, respect, and fulfill, claims in their statement, An International Human Right: Sexuality Education for Adolescents in Schools,12 of September 2008, that international human rights standards require that governments guarantee the right of children to health, life, education and non-discrimination by providing them comprehensive sexual and reproductive health education in primary and secondary schools. The CRR states the rights to life, health, and education cannot be fully realized if children lack sexuality education. “A comprehensive understanding of sexual and reproductive health is imperative to an individual’s ability to protect his or her health and make informed decisions about sexuality and reproduction.” The CRR further states that existing programs provide medically inaccurate information and are ideologically driven. “They teach biased information on contraception, abortion, HIV/AIDS, and sexual orientation; are abstinence based, discourage condom use, and “rely on stereotypes about sex, sexuality and gender identity.” According to the CRR, abstinence based programs are ineffective in delaying sexual activity. The CRR based this statement on the Mathematica Policy Research, Inc., study of abstinence education programs of 2007.13 In the conclusion of their statement, the CRR affirms that under international human rights law, states are obligated to provide comprehensive sexuality education in schools.
The United Nations Convention on the Rights of the Child (1989)14 includes a right to education (articles 28 and 29). This document written by an international organization and purportedly overruling individual nation state’s laws is considered by some to be legally binding to all the state signatories. The United States signed the document in 1995 but has not ratified it. Comprehensive sexuality education as an international human right is based on article 29 of the Convention. There is no specific mention of sexuality education in the document. In 1994, the International Conference on Population and Development (ICPD) of the United Nations had 179 countries sign a program of action whereby these countries agreed to deliver improved sexual and reproductive health.15
On March 2010, the International Planned Parenthood Federation (IPPF), an organization self described as a global service provider and leading advocate of sexual and reproductive health and rights, delivered a petition to the United Nations asking governments around the world to prioritize young people’s sexual and reproductive health and rights, including comprehensive sexuality education and information and youth friendly health services.16 The IPPF is the world’s largest provider of contraceptives, abortifacients and surgical abortions.
Science and Research
Abstinence based programs are dismissed by UNESCO, the CDC, and CRR as not resulting in any appreciable benefit to the children, being ineffective in delaying sexual activity and having no effect on condom use. The Mathematica Policy Research, Inc., study of abstinence programs of 2007 was used to support the dismissal of abstinence programs. Supporters of comprehensive or condom based sex education claim this is definitive proof that abstinence programs do not work. Implicit was the opinion that comprehensive sex education does work.
The Mathematica study selected 4 abstinence programs in the U.S. for long term follow up. The students were of elementary and middle school age and received a single intervention at the onset of the study. The Mathematica study found that teens who participated in these abstinence programs did not abstain from sexual activity more than non-participants when measured 2 ½ to 5 ½ years after the program ended. Dr. Stan Weed and his group at the Institute for Research and Evaluation in Salt Lake City, Utah, reviewed 17 the Mathematica study with the purpose of documenting the study’s conclusions with the research findings. The Utah Institute group found serious limitations in the Mathematica study, such like, the use of high risk populations not representative of the U.S. teen population, and inappropriate timing of intervention, i.e., intervention at a very young age and no reinforcement during the key years of adolescence. Careful evaluation of the evidence presented by Mathematica fails to support the conclusion that abstinence sex education does not work. Dr. Weed’s group adds they have conducted more than 100 evaluations of abstinence education interventions in the past 15 years and have found significant long term reductions in teen sexual activity. Abstinence program participants showed a reduction of one-third to one-half as likely to initiate sexual activity as the matched comparison group at 1 and 2 years of follow up. In addition, abstinence education offers benefits that condom based education does not, such as, 100% protection from STDs, pregnancy, and abortion, as well as the negative psychological and social consequences related to teen sex.17
Dr. Weed adds that the Mathematica study did not examine comprehensive sex education programs. However, many studies have examined condom based intervention. Of 50 rigorous studies, only one of them reported an improvement in consistent condom use (CCU) after a period of one year. CCU is the best comparison with abstinent behavior. The interpretation that some have made to the Mathematica study results of – “abstinence programs do not work, therefore, a ‘safe sex’ program must be provided to reduce the risks of sexual activity” is unfounded. 17
In response to the CDC task force stated conclusions, two members of the panel of consultants (for the CDC analysis) submitted a Minority Report in November 2009, Fundamental Concerns about the CDC Meta-analysis of Group-based Interventions to Prevent Adolescent Pregnancy HIV, and other STIs. In this report, the researchers point out serious limitations to the analysis that cause them to take exception to the recommendations by the Task Force. These limitations led them to conclude that “the statement about the effectiveness of the comprehensive risk reduction is not warranted by the data, and the conclusion that comprehensive sex education is superior to AE is not supported by the evidence.” In fact, the researchers found that the AE programs in the study resulted in a significant reduction in teen sexual activity. In addition, the Task Force Recommendation Statements have been published without also making available to the public the full set of study findings upon which the recommendations are made. The peer review of the evidence is most important since the CDC recommendations will influence policymakers and public health professionals.18
Finally, a leading US medical journal reports on a randomized controlled trial with adolescents in grades 6 and 7 to evaluate the efficacy of an abstinence only intervention in preventing sexual involvement in the February 2010 issue. The results of the trial show the abstinence only intervention students reduced sexual initiation. By the 24 month follow up period, two thirds of abstinence only students showed no sexual activity as compared to one-half of the control group. The authors conclude that abstinence only based interventions have an important role in preventing adolescent sexual involvement. 19
The United Nations (UNESCO) is attempting to establish comprehensive sexual and reproductive health education and information of available resources internationally, a program available to all students staring at age 5 and conducted in the classroom. The argument is made that abstinence education does not work. Therefore, a safe sex program must be implemented. The research evidence used to defend this unprecedented step does not support this recommendation. The evidence from rigorous research protocols, peer reviewed, consistently shows that abstinence education remains the most effective to reduce teen sexual activity and avoid related problems. On the contrary, comprehensive, safe sex, education programs have almost uniformly failed to show a delay in sexual activity or improved consistent condom use in those sexually active.
- International Technical Guidance on Sexuality Education, vol. 1, The rationale for sexuality education, United Nations Educational, Scientific and Cultural Organization (UNESCO), http://hivaidsclearinghouse.unesco.org
- ibid, pg. 2-6, 12
- ibid, pg. 14-15
- International Technical Guidance on Sexuality Education, vol. 2, Topics and learning objectives, United Nations Educational, Scientific and Cultural Organization (UNESCO), http://hivaidsclearinghouse.unesco.org
- ibid, pg. 8
- ibid, pg. 12
- ibid, pg. 22
- ibid, pg. 26
- ibid, pg. 29
- Prevention of HIV/AIDS, other STIs and Pregnancy: Group-based Abstinence Education Interventions for Adolescents, The Community Guide, CDC, United States HHS, http://thecommunityguide.org/hiv/abstinence_ed.html
- Prevention of HIV/AIDS, other STIs and Pregnancy: Group-based Comprehensive Risk Reduction Interventions for Adolescents, The Community Guide, CDC, HHS, http://thecommunityguide.org/hiv/riskreduction.html
- An International Human Right: Sexuality Education for Adolescents in Schools, Center for Reproductive Rights, http://reproductiverights.org/sites/crr.civicactions
- Mathematica Policy Research, Inc., Impacts of Four Title V Abstinence Education Programs: Final Report 59 (2007), http://mathematica-mpr.com/publications/PDFs/impactabstinence.pdf
- Convention on the Rights of the Child, (1989), www. unesco.org/education/pdf/CHILD_E.PDF
- UNICEF – Convention on the Rights of the Child, www.unicef.prg/crc/index.html
- Zaks, L., IPPF Delivers Petition at UN: Young people ask world leaders to fulfill ICPD promises, http://www.ippfwhr.org/en/print/1348
- Weed, S. E., et al, Abstinence or Comprehensive Sex Education?, The Institute for Research and Evaluation, Salt Lake City, UT, 8 June2007.
- Ericksen, I., Ruedt, D., Members of the CDC Community Guide Adolescent Sex Behavior Coordination Team External Partners consultant panel, A Minority Report: Fundamental Concerns about the Meta-analysis of Group-based Interventions to Prevent Adolescent Pregnancy, HIV, and other STIs.
- Jemmott III, J.B., Jemmott, L.S., Fong, G.T., Efficacy of a Theory–Based Abstinence-Only Intervention Over 24 Months, A Randomized Controlled Trial With Young Adolescents, Archives of Pediatric and Adolescent Medicine, vol. 164, No.2, February 2010.