Healthcare Reform

Community groups in Nebraska, for instance, are using abstinence money for canoe trips, picnics and — a real trick for a landlocked state — an abstinence beach party. Held during a snowy week in February, the party involved motivational speakers, calypso music and a “beach” simulated by decorating a gym with sand, fake tropical birds and patio furniture.

In Ohio, a group that discourages women from having abortions has used its funding to train public school teachers about abstinence. One of the suggested lesson plans has students signing a pledge to remain celibate until marriage.

In Illinois, Kathleen Sullivan, a mother of 12 who runs that state’s abstinence-only programs, put some of the state’s funds toward a secondary virginity rally at which “educators” led kids in the chant: “Sex-free is the way to be!” And Arizona is using some abstinence money to target adults. The state has allocated $67,000 to the Arizona State University Community Health Services Clinic for the Healthy Relationships program, which encourages recovering alcoholics and drug addicts — some of whom used to be prostitutes — to remain free of romantic attachments during their recovery processes.

Back in New York, Figueroa, who works for a local nonprofit called the Bronx Perinatal Consortium, asks students to think about their goals — and about how having premarital sex might interfere with them. She also has kids work on their own feelings of self-worth by passing around a mirror and asking each one to say two good things about themselves. “I like my hair and my ears,” says a 16-year-old girl, wearing a miniskirt and platform sandals. The next girl likes “my hair and my teeth, even though my braces have pizza in them.”

And what, asks Figueroa, might these feelings about themselves have to do with the decision to have sex? Seventeen-year-old Elizabeth has a ready answer: “You notice that the girls that have sex, or the people that have it, they’re usually the ones with lower self-esteem, the ones that care about how they look on the outside,” she says, pausing to flick her hair over her shoulder. “When in reality, what they’re looking for is the feeling of acceptance.”

Whether such game playing and pat positive-image talk will actually affect how these students think about sex, or when and how safely they have it, is an open question. Elizabeth, for instance, says that even before the workshop she had planned to remain abstinent, since having premarital sex may interfere with her plans to hold public office. “I could get pregnant, even if I use protection,” she says. “Or I could get a disease, so I might not be around.” Yet, after the workshop, even she — who describes herself as coming from “a strict Latin family” — says she would consider having sex with the right guy.

Indeed, no one knows what the effect of this giant experiment in sex education will be. Scientifically speaking, there is little reason to believe the almost 700 grants awarded for abstinence-only education so far will make even a dent in the teen-pregnancy or STD rates. A 1997 study from the University of Nebraska-Lincoln that analyzed the evaluation of more than two dozen non-government-funded abstinence-only education programs from 1985 to 1995 found that the vast majority had no effect on the timing or amount of sexual activity. And the largest study to date of an abstinence-only program found that the Education Now, Babies Later program, which involved 187,000 teens in California, had no impact on the age at which teenagers began to have sex.

According to the author of the California study, Douglas Kirby, the results don’t mean that all abstinence programs are necessarily ineffective. “We just don’t know whether any do work,” he says. “The jury is still out.”

Despite its dubious value, abstinence-only-until-marriage education has become the law of the land. Back in 1996, during the final days of hashing out the Welfare Reform Act, conservative Republican Sens. Lauch Faircloth and John Ashcroft added a provision calling for $250 million a year in federal money — the only federal money allotted for sex education — as well as almost as much in matching state funds to exclusively teach about the benefits of abstaining from sex. Under the benign heading Section 510, Title V, the language went directly into the final version of the bill, usually reserved for corrections and technical revisions, without public comment.

Had voters — or even other senators — been afforded the chance to debate it, the abstinence provision probably would never have made it beyond the Senate chambers. More than 80 percent of Americans think that young people should be given information about contraception and how to protect themselves from sexually transmitted diseases, according to a recent nationwide poll conducted by SIECUS, the Sexuality Information and Education Council of the United States. (The questionnaire asked about opinions on sexuality education after mentioning that 70 percent of 18-year-olds and nearly 90 percent of 20-year-olds have had intercourse at least once.)

Yet Title V of the Welfare Reform Act forbids its recipients to teach about contraception beyond providing various methods’ failure rates when asked. The provision also requires grantees to promote the message that “a mutually faithful monogamous relationship in the context of marriage is the expected standard of human activity” and “that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects.”

Abstinence programs have supplanted more comprehensive school-based sex education programs in only two states, according to a report by SIECUS, which tracks — and critiques — the abstinence-only process. In most cases, already existing sex education programs have remained intact. (Schools can conduct both abstinence-only programs and sex-education classes that teach about birth control, as long as their budgets, instructors and sites are kept separate.) But the plentiful Title V money has brought many religiously based sexual abstinence programs into public schools, even as they remain true to their ideological roots.

Consider Teen Aid, for instance, a group that runs an anti-abortion crisis pregnancy center in addition to publishing an abstinence-only education curriculum taught in both public and private schools. The curriculum, “Me, My World, My Future,” states that “the unborn child is alive and human at all stages of intrauterine growth.” A 1994 case brought by the local Planned Parenthood affiliate in Duval County, Fla., where Teen Aid was taught in local public schools, charged that, because of the program’s religious bias and medical misinformation, it violated the state’s requirement for comprehensive sexuality education. The local school board has since voted to implement a curriculum that also includes teaching about contraception.

“Sex Respect,” another popular abstinence-only curriculum that has been put to use in many a Title V-funded program, describes abortion as “killing the baby.” The curriculum, written by Colleen Mast — who also authored “Love and Life: A Christian Sexual Morality Guide for Teens” — teaches kids that premarital sexual behavior can lead to anything from selfishness to death. “Even the practice of petting before marriage can develop negative habits that carry over into marriage,” according to the curriculum, which also refers to AIDS as nature’s way of “making some kind of a comment on sexual behavior.” Sex Respect — which has been the subject of two lawsuits that charged it provided medical misinformation and religious teaching — also refers to homosexuality only in the context of AIDS.

Abstinence supporters are up front about their crusade being morality-based — and unpopular. Congressional staffers involved in drafting the legislation wrote, “That both the practices and standards in many communities across the country clash with the standard required by the law is precisely the point.” Which explains why much pro-abstinence literature aims to convince the reader of the social need for abstinence. Log on to the pro-abstinence Web site of the National Abstinence Clearinghouse, and you can read (under the heading of “research”) articles that show that the “majority of Americans disapprove of sex before marriage,” that “most think saving sex for marriage is a good idea,” and that “saving sex for marriage reduces the risk of divorce.”

Abstinence proponents also tend to focus on the failure of condoms, which they use to illustrate the futility of teaching about contraception. According to the pro-abstinence National Coalition on Abstinence Education, the “condom crowd,” (as NCAE likes to refer to educators who promote contraception) expose kids to danger, since every birth-control method has some risk of failure. NCAE also believes that providing contraception necessarily promotes sexuality itself. “Supplying teenagers with condoms inevitably produces a marked increase in their sexual activity,” the group explains in one of its many tracts on abstinence. To suggest that there is an alternative to abstinence, it argues, ignores basic human nature: “Given the option between two alternatives, some people will choose the worst alternative.”

Ironically, across the ideological divide, the “condom crowd” bases its own approach on a similar assumption: that some kids are going to have sex. Both sides also agree that the American teen pregnancy rate — higher than that of virtually any other industrialized country — represents a national crisis. But, while abstinence-only supporters would try to talk kids out of sex, those supporting broader sex education programs think that the kids who are likely to have sex need to know how to do it without catching diseases or making babies.

“I don’t think a lack of information ever improves any situation,” says Dan Daly, director of public policy for SIECUS. Daly worries that the abundance of funding for abstinence programs cuts into support for education about both contraception and abstinence. “The large sums for abstinence may tempt policy makers because the money’s available and it seems politically less divisive,” says Daly. “The money tail will wag the dog.”

And while some groups are using Title V money to pay for mental-health services and career planning that make only the vaguest references to sexual activity, the conservative forces behind the law have also tried to make sure that those programs that do receive money toe the abstinence line. One of the provision’s authors, Rep. Thomas Bliley, R-Va., wrote to the Department of Health and Human Services in late 1997, requesting that the office evaluate grant applications to make sure they are “consistent with the letter and spirit of the legislation.” And NCAE has issued “compliance report cards” on states’ abstinence performance, giving failing grades to states that manipulate congressional intent “to remove the spirit of the abstinence-until-marriage message.”

State by state, the fight over what Title V programs should say — and what local kids will hear about sex — hasn’t been pretty. In Louisiana, Gov. Mike Foster took the state’s abstinence-only program away from the jurisdiction of the state’s Office of Public Health, after the office had already issued its own request for funding based on grant applications, and placed the process under the control of a Christian Coalition activist in his office, a move described by Julie Redman, president of Planned Parenthood of Louisiana, as a “real tragedy.” “The Office of Public Health had a very good plan; it was based on good research and credible public health practice. And then it was taken away,” says Redman. “Public-health folks feel this was political. The Christian Coalition wanted that money — and they got it.”

In Alaska, a similar takeover ensued after the department of health used their abstinence funds to create a book about generally getting ahead in life. “Helping Kids Succeed — Alaskan Style” was extremely well received, according to the state’s adolescent-health coordinator, Becky Judd. But, because it only obliquely referred to sexual abstinence (the section on the importance of not being sexually active, for instance, suggests helping “people explore the sacred writings for guidance in the area of restraint” and helping “your children learn their Native language [so] they can talk with Elders”), more literal interpreters of Title V put an end to the project on the grounds that it didn’t comply with the law. Judd was heartbroken.

In the midst of this tug of war, Republican favorite, George W. Bush, has made his enthusiasm for abstinence education clear. This past June, while visiting an abstinence program in South Carolina that he called “cool,” Bush promised to up the current $50 million per year in federal funding toward just-say-no education to $135 million if elected. He also made much of his emphasis on abstinence as governor of Texas, where, with his approval, the state Legislature passed a law requiring all state school districts to have “abstinence-based” human sexuality curricula. During his term, Texas also used more state funds for abstinence than required by the law.

Bush’s official Web site even has an entire section devoted to abstinence, where he decrees: “We must stress that abstinence isn’t just about saying no to sex; it’s about saying yes to a happier, healthier future.” Interestingly, while stumping for his own happier future, the presidential hopeful has attempted to gloss over his past. He’s repeatedly bragged of being faithful to his wife, Laura. But Bush has been about as clear about his sexual history pre-Laura as he’s been on his cocaine use. Presumably, his vague, that-was-then explanation — that “what the baby boomers have got to say is not ‘did we make mistakes,’ but if we learned from our mistakes and are willing to share the wisdom” — can be taken to apply to his premarital love life as well.

Not that anyone really wants to hear the details. It’s enough to know he had the tools he needed to stay alive and make it into office. As for Elizabeth, who’s now beginning her senior year, the path to public life is less clear. “You can never know for sure what’s going to happen,” she said recently. “I’m just going to try to keep to my goals.”