Comparison of Sex Education and Abstinence Only Education

Consequences of protective
sex education and abstinence-only sex education on teenage pregnancy rates in
the United States

Introduction

The United States is perhaps the most powerful country in the known world, yet when compared to other countries, the United States has one of the highest rates of teenaged pregnancies (Assefi, Bennett, 2005). In the United States, 229,715 births as a result of pregnancies sustained by women from the ages fifteen to nineteen were recorded in 2015 (CDC, 2017). While the rate of teenage pregnancies in the United States have decreased from 40 births per 1,000 births in 2007 to approximately 22 births per 1,000 births in 2015 (CDC, 2017), the United States is considerable behind in reducing teenage pregnancy rates within the country given their high status as one of the richest countries in the world.

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Significance of Problem

Teenaged pregnancy can have a multitude of unintended consequences, such as compromising the ability of the mother to complete their educational track, or compromising the family’s socioeconomic wellbeing by placing more of a financial strain on the family to support the baby when they are already facing financial struggles. In Frank Furstenberg’s “Reconsidering teenage pregnancy and parenthood,” he compared the findings in a report about teenaged pregnancy from 2007 and found that teenage mothers who persisted on public welfare for longer periods of times than those who only used welfare for a short period of time fared worse as adults. Furstenberg also found that mothers who were able to return to school and advance their education were more likely than mothers who ended their education as a result of having their first child to enter the middle class, and their resulting children were more likely to succeed in school.

Introduction to PICOT Question

In the United States,
there are state policies that control how schools demonstrate sex education to
their students, particularly to adolescents in middle and high school.
Throughout the United States, there is discourse between how sex education is
taught throughout many states, either: teach sex education in a way that
students understand how to perform safer sex in the event that they are going
to have intercourse, or teach students to abstain from sex until marriage. The
main discourse between these two disciplines is how effective it is in
preventing unwanted pregnancies, especially teenaged pregnancies, and how each
type of education affects adolescents in the long run in terms of their sexual
practices and their perceptions of sex. The research presented in this paper is
to address the clinical question: “is comprehensive sex education more
effective than abstinence-only sex education in reducing teenage pregnancy
rates and providing more sufficient education in the United States?”

Literature Review

The first teachers that
children have are more likely than not their parents. Analyzing the parents’
attitudes about educating their children about protective sex or complete
abstention from sex is important in learning about the attitudes of the generation
of adults who are doing the educating of the adolescents, as generational
thinking is often reflected through attitudes of their children. In
“Parents’ Beliefs Regarding Sex Education for their Children in Southern
Alabama Public Schools, Millner, Mulekar, and Turrens perform a study in order
to obtain survey data from parents about their feelings towards sex education
in the Mobile County Public School System, a particularly conservative town in
Alabama. In their study, they surveyed a stratified sample of 402 randomly
selected parents in Mobile Country with 120 more randomly selected parents in
areas of the county with higher incidences of teenaged pregnancy. When
analyzing the results of the survey, it was found that eighty-one percent (81%)
of the randomly selected parents prioritized abstinence-only sex education
compared to safer-sex education. However, a majority of parents also supported
the teaching of STI prevention (98.3%) and condom usage (92.8%). The study also
identified a positive correlation between the religiosity of a state and the
likeliness of teaching abstinence-only education; Alabama was found in a 2009
study to be the second most religious state in the United States, coinciding
with a position in the top twenty percent of highest incidences of teenage
pregnancy within the United States with Mobile County having the highest
incidence of pregnancy in the three top metropolitan areas of Alabama.

The most important
population to be analyzed in this kind of study is the target audience
themselves: adolescents. They are the ones absorbing the information that is
being taught by the state, and therefore applying the information and providing
the data needed to come to conclusions about the best method of sex education.
In Emily Gardner’s study “Abstinence-Only Sex Education: College Students
Evaluation and Responses,” Gardner interviewed fifteen undergraduate
students, who all received abstinence-only sex education from their primary
education, from Emory University and Georgia State University about their
experiences of abstinence-only sex education and their attitudes towards
difference topics such as abstinence, virginity, and marriage, and what they
believe would be good suggestions for improving the state of sex education in
the United States.  In terms of
abstinence, most students accepted abstinence as a valid method of birth
control, but they also had conflicting views on how efficient teaching
abstention is in terms of application to the real world, varying from
abstinence-only education being sufficient to it being “unrealistic”
and “…not necessarily a practical idea.” When evaluating the
positive and negative aspects of abstinence-only sex education, twelve out of
fifteen respondents overwhelmingly commented on the negative aspects of
abstinence-only education, noting the use of “scare tactics” such as
graphic images and videos of childbirth and various STI’s, and the implication
during their education that anything having to do with sex is inherently
negative. In contrast, those who commented on the positive aspects of their sex
education mostly commented on other aspects of the education other than
abstention, such as education about sexually transmitted diseases and how they
were encouraged to focus more on their education and life goals. When asked
about their ideal sex education, options such as teaching sex education in such
a way that assumes young people will be sexually active so that options of
safer sex are explored rather than dismissing any aspect of sexuality as negative
and inherently harmful were addressed. They also wanted full and accurate
information about different sex topics, and for sex education to be taught that
can be applied more realistically rather than in a way that can only be applied
in an ideal situation as abstinence-only does, assuming that every single
person is going to be married and are willing to wait.

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In a study done by
Sylvana Bennett and Nassim Assefi, “School-based teenage pregnancy
prevention programs: a systematic review of randomized controlled trials”
sought to compare school programs that either focused on abstinence-only or
abstinence-plus sex education in terms of teenage pregnancy and rates of sexual
activity among adolescents. Bennett and Assefi compared nineteen randomized controlled
trials of various school-based teenaged pregnancy prevention programs in the
United States, and from the sixteen that had relevant results to their
question, twelve programs evaluated abstinence-plus, while three evaluated
abstinence-only programs and the remaining compared both programs in their
study. One weakness of this study is that most of the studies used did not ask
the subjects directly about pregnancy, though one of the abstinence-plus
programs used found that there were no difference in pregnancy rates before and
after the program was implemented. However, abstinence-plus programs found a
positive correlation between the implementation of abstinence-plus programs and
usage of condoms at a higher instance than when compared to the correlation of
the implementation of abstinence-only programs and condom usage, indicating an
increase of contraceptive use and knowledge when abstinence-plus programs are
implemented, which can be coincided with decreased pregnancy rates.

Authors Marianne
Chevrette and Haim Abenhaim performed a cross-sectional study on state-based
policies on sex education and teenaged abortion rates in the United States in
their article “Do State-Based Policies have an Impact on Teen Birth Rates
and Teen Abortion Rates in the United States?.” In their study, they
performed a retrospective cross study on all teenagers who were aged fifteen to
nineteen who had a delivery in 2008 and compared the teens based on every
state’s policy on how sex education is taught in that particular state. Twenty-eight
out of fifty states are required to teach abstinence-only as either the only or
main method in order to prevent pregnancy and STD-transmission, and in thirty-three
states, education about contraceptive use either is not in policy or is not
covered in the state’s sex education program at all. In their findings, two
independent variables were identified to correlate with teen birth rates:
whichever political party is dominant within the state, and the proportion of
white teenagers populating the state. In states with more Republican dominance
and a lower percentage of white teenagers tend to have a positive correlation
with higher rates of teen births.

Kathrin Stanger-Hall and
David Hall analyze the relationship between sex education and teen pregnancy
rates and abortion in their article “Abstinence-Only Education and Teen
Pregnancy Rates: Why we Need Comprehensive Sex Education in the U.S.” In
their study, they pulled data about sex education from the Education Commission
of the States and collected data on teen pregnancy, birth, and abortion rates
from recent national reports to determine if there was a correlation between
abstinence education and teen pregnancy and birth rates. Data on other factors
related to teenage pregnancy were also collected. In their results, out of the
forty-eight states that data was collected from, twenty-one states stressed
abstinence-only sex education, and those states that stressed abstinence more
were correlated in having higher teen pregnancy rates than the states that
stressed comprehensive sex education. The study also found that other factors
such as socioeconomic status and ethnic composition had significant
correlations in teenage pregnancy rates.

The research done on how
sex education method affects teenage pregnancy is not entire conclusive; while there
were multiple studies that found that comprehensive sex education contributed
to increased knowledge of contraceptive use, there were no studies that made
definitive conclusions that demonstrated a direct correlation between what type
of sex education is stressed and the rate of teenage births within the United
States. On the contrary, while there were some minute positive differences in
teen birth rates between states that stressed abstinence-only and states that
stressed comprehensive sex education, the studies also addressed the fact that
factors that affect teen pregnancy rates did not just include sex education
itself, but also factors such as socioeconomic status, ethnic composition, and
educational level. In terms of socioeconomic status, Stanger-Hall and Hall
found a significant negative correlation in socioeconomic status and rates of
teen pregnancy across the states, also finding that rates of teen pregnancy
were significantly higher in lower-income states. While there was no
significant correlation between education level and teen pregnancy rates, they
did find that education level did have a significant correlation with teen
birth rates, as teens with a higher level of education were more likely to
receive an abortion than those who did not have a high education level
(Stanger-Hall, Hall, 2011). Some strengths of the research done is that the data
is not extremely difficult to collect when looking at past data to form
inferences about trends about teen pregnancies and such. With the data readily
available from national reports and government databases, the data from these
studies are reliable to be used to form conclusions. Some weaknesses, for
example, is that in Stanger-Hall and Hall’s article, they found a correlation
between the type of sex education taught and rates of teenage pregnancies,
other studies used in this research were not able to conclusively identify a
correlation. Also, the purpose of their paper were biased towards comprehensive
sex education, which would contribute to skewing the interpretation of data
found in order to support their views on the clinical problem. Another weakness
found is that while there was a study done that followed teens in teenage
pregnancy prevention programs, most studies that were used did not ask directly
about pregnancy rates or followed up with the subjects into adulthood (Bennett,
Assefi, 2005).

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Proposed Research Design

The purpose of this proposed research design is to determine whether comprehensive sex education or abstinence-only sex education is more effective in educating the target sample population in protecting themselves from teen pregnancy in the long-term, with the hypothesis of: participants who were introduced to sex education through comprehensive sex education is less likely to experience higher rates of teenage pregnancy than those were introduced to abstinence-only sex education.  The participants of this study will be a sample of at least 100 adolescent students who are aged ten through 11, whose responses will be collected each year until they turn the age of twenty-one where they would then be considered legal adults. The participants would be selected randomly from different schools throughout the state. After the participants are chosen, the participants will be separated into two groups: one group will be educated about sex through the method of teaching comprehensive sex education, while the other group will be educated on abstinence-only sex education. The type of study this would be is a longitudinal cross study, where the researcher would be able to follow the subjects of the study through the long term. By this being a longitudinal study, the research would be able to collect surveyed data from each subject on various subjects such as their age of when they first started having sex, how often they use contraceptives and what type, and if they are or are expecting to become teenage parents. The researcher can then compare answers throughout the study until the subjects are twenty-one years of age and then compare their answers based on whether they were sorted into learning about comprehensive sex education or abstinence-only sex education. Protections will be provided to the participants by having the participants’ parents sign a form of consent for their children to participate in the study each grade year until they reach the age of eighteen, since when the study begins the participants are minors. Also, the participants will be debriefed on what they are going to be taught but not debriefed on what the purpose of their study will be as it may give bias to each side depending on the participants’ personal beliefs about sex education. Strengths of this research design is that the longitudinal set-up will allow for the researcher to be in contact with the participants for the long-term until they are twenty-one, giving them the chance to collect data of their sexual and reproductive activities throughout their adolescent years in order to form inferences on how students understand and absorb the sex education given to them. However, a weakness of this study is that parents of the participants may withdraw their children out of the study based on which group the child got sorted into and how the parents personally believe in children being taught sex education, which can hinder the sample size.

Synthesis and Recommendation

Looking at all of the evidence provided on the correlation between method of sex education and the rate of teenage pregnancies in the United States, while the evidence does answer the question incompletely, the evidence results in opening up more exposure to factors that contribute to this phenomenon. However, the evidence does help educate the health professional in knowledge about what affects teenage pregnancy and how sex education affects people’s knowledge on how to protect themselves from not just teenage pregnancy while they are adolescents but also from transmitting sexually-transmitted diseases to themselves and other potential partners that can harm their wellbeing in the long run. The evidence does not provide direct recommendations to change practice, but it does help open up discussion on important factors that contribute to increasing rates such as socioeconomic status, that while not related to the health field, can still addressed to improve the situation. There is not a support for recommendations because this clinical question also has to consider multiple variables that may or may not be able to be changed in the health education field. Some recommendations that can be made to help facilitate change in the clinical question would be to participate in more longitudinal studies on adolescents based on what type of sex education they receive, because this initial contact of sex education will affect how their attitudes towards sex and can possibly affect their future sexual habits. Another recommendation that can be made is to gather more data on how teenage pregnancy affects those affected and gather more data on how the subjects feel about the education they are receiving, as their input can help lead to changes that will further benefit the initiative to help decrease the pregnancy rate in the United States.

Conclusion

There is no definite answer on how to combat teenage pregnancy rates, unfortunately. However, there are ways to help educate adolescents on how to protect themselves from learning incorrect information about sex and reproductive health that is often handed down by educators as a method of fear mongering to convince students to abstain from sex. The best way to help teach adolescents how to have safe sex is to be informed about how sex works. There are factors that are unavoidable, such as the ethnicity of someone or their socioeconomic status that they were born into, and that also has to be addressed in order to tackle teenage pregnancy. Teenage pregnancy is not caused by just one definitive thing, but changing one of the contributing factors can help lead to positive change. Sex education is just as an important subject for adolescents to learn as the Pythagorean theorem and the function of the mitochondria, as sex and reproduction is something that will follow someone for the rest of their lives no matter what path they take in life, and it is their right to know how to protect themselves and those they care about.

References

Bennett, S. E., & Assefi, N. P. (2005). Review
articles: School-Based Teenage Pregnancy Prevention Programs: A Systematic
Review of Randomized Controlled Trials. Journal Of Adolescent
Health, 3672-81.

Centers
for Disease Control and Prevention. (2017). Reproductive Health: Teenage
Pregnancy. Retrieved from https://www.cdc.gov/teenpregnancy/about/index.htm

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Chevrette,
M., & Abenhaim, H. A. (2015). Do State-Based Policies Have an Impact on
Teen Birth Rates and Teen Abortion Rates in the United States?. Journal Of Pediatric And Adolescent Gynecology, (5),
354.

Frank, F.
(2016). Reconsidering Teenage Pregnancy and Parenthood. Societies, Vol 6 Iss 4 P 33 (2016), (4), 33.

Gardner, E. A. (2015). Abstinence-Only Sex Education:
College Students’ Evaluations and Responses. American Journal of Sexuality Education, 10(2), 125-139

Millner, V., Mulekar, M., & Turrens, J. (2015).
Parents’ Beliefs Regarding Sex Education for Their Children in Southern Alabama
Public Schools. Sexuality Research & Social Policy: Journal Of
NSRC, 12(2), 101-109.

Stanger-Hall, K.F., &Hall, D.W. (2011). Abstinence-Only
Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in
the U.S. Plos ONE, 6(10), 1-11.

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