George Bush's proposed 2005 budget cuts funding for veterans' healthcare and public housing. It freezes funding for after-school programs and Temporary Assistance for Needy Families grants. It provides less than one-sixth of the increase needed to close the budget shortfall in the AIDS Drug Assistance Program, which helps low-income HIV patients access medical care and lifesaving drugs. It cuts state Medicaid funding by $1.5 billion.
Yet when it comes to abstinence education, money seems to be no object. Bush's budget recommends $270 million for programs that try to dissuade teenagers from having sex, double the amount spent last year. Much of that money would be given in grants to Christian organizations such as Youth for Christ and to anti-abortion groups operating so-called crisis pregnancy centers, outfits that masquerade as women's health clinics but deliver a strongly anti-abortion message and often medically inaccurate information. It would pay for school programs that teach kids that premarital sex leads to psychological maladies and that sex with condoms is a kind of viral Russian roulette.
Experts in sex education and AIDS prevention say that in a country where the vast majority of people lose their virginity before their wedding night, these lessons aren't just distorted, they're dangerous. "To promote abstinence-only in the era of AIDS is to promote ignorance. It's inexplicable," says James Wagoner, president of Advocates for Youth, a nonprofit organization devoted to sex education. Some abstinence-only programs, like more comprehensive sex education, have been shown to delay the age at which teenagers first have sex -- which almost everyone agrees is a good thing. Yet studies also show that when teenagers from abstinence-only programs do have sex, they're less likely than others to use protection. Perhaps that's why the teen pregnancy rate in Texas remains one of the highest in the country, despite the abstinence-only policies Bush pushed as governor.
"When you displace decades of public health practice based on what works and substitute a more ideological and political approach to preventing teen pregnancy and HIV, you're really using young people as a political football," says Wagoner. "It's their health and lives that are placed in the balance as a result." And it's not just American lives, either -- Bush is using American leverage to try to force other countries to promote abstinence-only education at the expense of safe sex.
Federally funded abstinence education has been around since 1996, when Clinton's welfare reform bill provided grants to states to teach abstinence. Under Bush, though, it has expanded dramatically, from $97.5 million when he took office to $270 million next year. Bush has also retooled abstinence-only funding so that most of it is given directly to private groups, several of them evangelical religious organizations, and he has put it under the same agency that runs his faith-based initiatives.
For health and social service experts, however, that presents one basic problem: There is no scientific evidence that abstinence-only programs work. Some studies are inconclusive; others find, unambiguously, that the programs don't work. Yet there's one way in which they're clearly effective -- as a massive patronage system for the religious right. Bill Smith, legislative director for the Sexuality Information and Education Council of the United States, or SIECUS, a nonprofit research and lobbying group that advocates comprehensive sex education, calls abstinence-only grants "political pork."
"This president clearly needs to shore up the right wing of his party," Smith says. "It's not a mistake that in his State of the Union address he suggested doubling domestic spending on these programs. It's an election year and he has to give them something to get their votes."
Bush's involvement with the abstinence-only movement stretches back over a decade and is about more than just electoral politics. It's a case study in the right's subversion of science. Their ideas rejected by mainstream scientists, conservatives have built their own scientific infrastructure, which then buttresses once-derided theories in the political arena. This administration recruits its scientists from that right-wing counterintelligentsia, which has been funded by some of the same groups that are now collecting taxpayer money to teach abstinence-only programs instead of traditional sex education.
The Bush administration has lately come under fire for distorting science for political expediency. Last week, the Union of Concerned Scientists released a report on the administration's abuse of science, along with a statement signed by more than 60 scientific luminaries, including 20 Nobel laureates. "When scientific knowledge has been found to be in conflict with its political goals, the administration has often manipulated the process through which science enters into its decisions," the statement says. "This has been done by placing people who are professionally unqualified or who have clear conflicts of interest in official posts and on scientific advisory committees; by disbanding existing advisory committees; by censoring and suppressing reports by the government's own scientists; and by simply not seeking independent scientific advice. Other administrations have, on occasion, engaged in such practices, but not so systematically nor on so wide a front."
As an example of the president's disregard for science, the report lists Bush's appointment of abstinence advocate Dr. Joe McIlhaney to government advisory panels. It describes McIlhaney as a doctor of "questionable credentials" who is "known for his published disdain for the use of condoms to prevent the spread of HIV and other sexually transmitted diseases and his continued advocacy of abstinence-only programs despite negligible evidence that they actually reduce pregnancy rates among young people."
The founder of a Texas-based pro-abstinence think tank called the Medical Institute for Sexual Health, McIlhaney is an old Bush friend who many say has shaped the president's policies on abstinence. Demonstrating his faith in the doctor, Bush placed him on the Presidential Advisory Council on HIV/AIDS and on the advisory committee to the director of the Centers for Disease Control and Prevention. That's an enormous leap in legitimacy for McIlhaney, a former OB-GYN and conservative Christian who just nine years ago was reprimanded by the Texas Department of Health for spreading false information about sexually transmitted diseases and condoms' ineffectiveness.
In 1995, the Texas Department of Health wrote a letter to McIlhaney's institute criticizing a slide presentation he'd been showing throughout the state. It included a detailed slide-by-slide critique, prepared by two doctors, a registered nurse and the director of the state's HIV/STD Epidemiology Division, that pointed out a number of distorted, downright false and "ridiculous" statements in McIlhaney's lesson. "Some of the data presented suffers from investigator bias," the letter said. "Dr. McIlhaney's presentation tended to report the outlier data as 'proof' that condoms don't work rather than present those reports in the context of the entire data set. The only data that was reported in the presentation are those which supported his bias on the topics he addressed. Intellectual honesty demands that he present all the data."
Yet even as the Texas Department of Health was criticizing McIlhaney's program, the state's governor, George W. Bush, was embracing it.
"When he was governor of Texas, he promoted and lobbied for and pushed abstinence-only education," says Fred Peterson, a professor of health education at the University of Texas at Austin, who trains instructors to teach comprehensive sexual education classes. McIlhaney was and is a "major player" in Bush's abstinence agenda, says Peterson. He's also a beneficiary -- his Medical Institute for Sexual Health has received $1.5 million in federal contracts related to abstinence education and STD research.
"He's very close politically and probably personally to George W. Bush," Peterson says. "I remember that Dr. McIlhaney did a statewide conference on abstinence-only education, and Governor Bush was the first speaker. Now, Bush has appointed McIlhaney to a major policymaking position."
Peterson, who's met McIlhaney on several occasions, describes him as a nice man and a gentleman, but one who never presents his findings in venues where they might be debated. "Dr. McIlhaney never presented papers at scientific conferences in front of his own peers where he would be challenged and questioned," he says. "His viewpoint was always presented at churches and public forums that did not include scientists, academicians and physicians."
McIlhaney couldn't be reached for comment, but Joe Webb, CEO of the Medical Institute for Sexual Health, defends the organization's scientific integrity. "We're not a religious organization, we're a medical educational organization," says Webb. "Every scientist brings presuppositions to his or her work. We try to be aware of our presumptions in terms of the research and science we're doing. We do have values commitments, just like any person would, but first and foremost, we have to be accurate."
Often, though, the doctors associated with the Medical Institute seem to put their "values commitments" ahead of hard evidence. One member of the institute's advisory board is W. David Hager, the author of a book called "As Jesus Cared for Women: Restoring Women Then and Now." Hager has suggested prayer as a cure for premenstrual syndrome and, in private practice, refused to prescribe contraception to unmarried women. In 2002, Bush appointed Hager, whom Time Magazine called "scantily credentialed," to head an FDA panel on women's health policy, but after a public outcry, he was merely made a member of the panel.
As the Union of Concerned Scientists report points out, there's no evidence at all that the policies pushed by the institute reduced pregnancy rates in Texas. "Unfortunately, despite spending more than $10 million on abstinence-only programs in Texas alone, this strategy has not been shown to be effective at curbing teen pregnancies or halting the spread of HIV and other sexually transmitted diseases," it says. "During President Bush's tenure as governor of Texas from 1995 to 2000, for instance, with abstinence-only programs in place, the state ranked last in the nation in the decline of teen birth rates among 15- to 17-year-old females. Overall, the teen pregnancy rate in Texas was exceeded by only four other states."
The evidence on abstinence-only programs from elsewhere hasn't been much more promising. Last year, the Minnesota Department of Health evaluated the state's five-year, $5 million abstinence-only program and found that it hadn't reduced sexual activity among teenagers at all. Instead, over a year, the rates of sexual activity among students taking the abstinence course doubled, from 5.8 percent to 12.4 percent, which corresponded to the rate of sexual activity among teens statewide. The evaluators found a "lack of fit between the program and kids who face complex problems in their lives and are most at risk for sexual activity."
Rebecca Maynard, a professor of education and social policy at the University of Pennsylvania, is the project director and principal investigator for a study of abstinence-only programs commissioned by the U.S. Department of Health and Human Services. The results won't be out until 2006, but when asked if there's any evidence that abstinence-only programs work, Maynard says, "There's not much evidence that they do or that they don't." Still, Maynard says that she hasn't come across any scientifically inaccurate information in the curricula she's evaluated (though she notes that she's not a medical scientist).
Yet the government virtually mandates that abstinence-only education exaggerate the risks of sex by requiring federally funded programs to teach that "sexual activity outside the context of marriage is likely to have harmful psychological and physical effects." (By this logic the sexual behavior of most Americans has caused them psychological and physical harm, since the overwhelming majority of Americans have sex before they get married.) As a review of popular abstinence-only curricula conducted by the Sexuality Information and Education Council shows, many programs do this by telling students that premarital sex is likely to ruin their relationships and perhaps their lives.
"Unmarried couples who become sexually active tend to stop communicating on all levels," teens are warned in the student workbook for the Reasonable Reasons to Wait program. A workbook for Choosing the Best Path includes this question: "Circle the item(s) that can be totally eliminated through the use of a condom? Infertility, isolation, jealousy, poverty, heartbreak, substance abuse, AIDS, pregnancy, cervical cancer, genital herpes, unstable long-term commitments, depression, embarrassment, meaningless wedding, sexual violence, personal disappointment, suicide, feelings of being used, loss of honesty, loneliness, loss of personal goals, distrust of others, pelvic inflammatory disease, loss of reputation, fear of pregnancy, disappointed parents, loss of self-esteem, leaving high school before graduation."
The answer, according to the teachers guide, is "None."
Then students are instructed to "cross out the item(s) that can be eliminated by being abstinent until marriage.
According to the teachers guide, the correct answer is "All."
This kind of education hasn't been shown to stop kids from having sex, though it has delayed them. That in itself is a good thing -- most experts believe it's healthier for teenagers to lose their virginity later rather than sooner. The problem is that when they do have sex, these teenagers may be less likely to use condoms. According to a 2001 study published in the American Journal of Sociology, students who'd signed public "virginity pledges," a key component of many abstinence-only programs, had sex an average of a year and a half later than their peers. Yet when they did have sex, they were a third less likely to use contraceptives.
In the end, advocates of both comprehensive sex education and abstinence-only want to discourage teenagers from having sex. "The problem with abstinence-only until marriage is not the 'abstinence,' it's the 'only until marriage' part," says Wagoner. "Public health should be guided by what works. The last thing we need is politicians grandstanding as moralists, because it ends up delivering bad health for young people. These programs are prohibited from providing information about condoms or contraception for the prevention of pregnancy or disease."
That's true even if a teenager in the program tells the instructor that he or she is already having unprotected sex. Clearly, such teenagers endanger themselves if they remain ignorant about safe sex, but abstinence educators say that giving advice about condoms would cloud their absolute condemnation of premarital sex. Besides, it's prohibited under the terms of government grants.
"We don't tell them, 'If you're going to have sex, go ahead and use this,'" says Charles Eaddy, project coordinator for Metro Atlanta Youth for Christ's abstinence program. "We're specifically restricted from doing that by law, and it would not be consistent with the spirit of the program. We really encourage you not to do this thing."
Last year, Metro Atlanta Youth for Christ received a federal grant of $363,936 a year for three years, doubling its budget. The group has used the money to hire three "abstinence educators." These educators aren't required to have any specific credentials in public health. They do, however, have to be Christian, because Metro Atlanta Youth for Christ won't employ people who aren't.
Other federal grantees include Bethany Christian Services -- listed on the Department of Health and Human Services Web site as Bethany Crisis Pregnancy Services -- which bills itself as a "not-for-profit, pro-life, Christian adoption and family services agency," and A Woman's Concern, a crisis pregnancy center in Boston. None of the 2003 grants went to Jewish or Muslim groups. Not that many Jewish groups are applying -- the Central Conference of American Rabbis, which represents the Rabbis of Reform Judaism, the country's largest denomination, passed a resolution in 2001 calling for comprehensive sex education and rejecting government funds for abstinence-only programs.
While Christian abstinence-only groups are enjoying federal largesse, many medical organizations with expertise in protecting children from AIDS are ineligible. Chicago's Children's Memorial Hospital Section for Pediatric, Adolescent and Maternal HIV Infection, which does outreach and education in colleges and high schools in at-risk areas of the city, relies on private donations to finance its teaching. According to Tom Foster, the section's academic manager, teaching abstinence isn't an option. "What I've heard from the very beginning is that abstinence doesn't work, especially for our target market, high-risk adolescents," he says.
The Centers for Disease Control used to agree. "Until recently, a CDC initiative called 'Programs That Work' identified sex-education programs that have been found to be effective in scientific studies and provided this information through its web site to interested communities," says a report on the Web site of U.S. Rep. Henry Waxman, D-Calif. "In 2002, all five 'Programs That Work' provided comprehensive sex education to teenagers, and none were 'abstinence-only.' In the last year, and without scientific justification, CDC has ended this initiative and erased information about these proven sex education programs from its web site."
Waxman has been so outraged by Bush's manipulation of science that he's set up a Web site called Politics & Science to chronicle it. As Politics & Science shows, "Programs That Work" isn't the only government health document that's been scrubbed. "In October 2002, CDC replaced a comprehensive online fact sheet about condoms with one lacking crucial information on condom use and efficacy," says Waxman's site. "Like the CDC, the State Department's Agency for International Development (USAID) has censored its Web site to remove information on the effectiveness of condoms."
Conservatives hope that by challenging the idea of safe sex, they can encourage Americans to change their louche ways. In the meantime, though, whether the right likes it or not, Americans aren't waiting until marriage to have sex. Thus abstinence-only programs and the censorship of information about condoms ignore the needs of the majority of the population. By age 18, Wagoner says, 70 percent of young people in the United States have had sexual intercourse. "What relevance do these programs have to young people when they stress abstinence until marriage? Less than 10 percent of Americans are virgins on their wedding night," he says. Of course, that's exactly what many proponents of abstinence-only education want to change. They argue that by accepting and accommodating this unwholesome state of affairs, sex educators only encourage it. Traditional sex educators "make a fundamental assumption that the vast majority [of kids] are going to have sex and that therefore the job of sex education is to prepare them for that event," says Webb.
Instead, Webb says, educators should focus on preventing the "event" from happening before students are legally wed. That might seem unrealistic, but Webb believes that abstinence education can change the mores of an entire society. As evidence, he points to Uganda, which he calls "probably the best example of a long-term abstinence and character-based approach."
"You have a situation there where HIV/AIDS rates were as high as 30 percent," he says. "Those rates have been brought down to around 5 percent. It's the only country in the world that has significantly reduced the prevalence rate of HIV infection."
The idea that Uganda is an abstinence success story is popular on the right these days. The Heritage Foundation recently published a background paper that concluded that Uganda's experience shows that "[a]bstinence and marital fidelity appear to be the most important factors in preventing the spread of HIV/AIDS" and "[c]ondoms do not play the primary role in reducing HIV/AIDS transmission."
As the Heritage Foundation acknowledges, though, Uganda used a so-called ABC approach. "A" stands for abstinence, "B" for "be faithful," and "C" for condoms -- a formula very similar to that espoused by most comprehensive sex educators in this country. A report from the Alan Guttmacher Institute, one of the country's leading sexuality research organizations, says that Uganda benefited from "a range of complementary messages and services delivered by the government and a wide diversity of nongovernmental organizations. To be sure, those messages included the importance of both young people delaying sexual initiation and 'zero grazing' (monogamy). But contrary to the assertions of social conservatives that the case of Uganda proves that an undiluted 'abstinence-only' message is what makes the difference, there is no evidence that abstinence-only educational programs were even a significant factor in Uganda between 1988 and 1995."
That hasn't stopped conservatives from trying to export the abstinence-only messages to countries that receive American aid. A recent law mandates that one-third of U.S. assistance to fight AIDS globally be used for abstinence education. "In effect, this makes 'abstinence-until-marriage' advocacy the single most important HIV/AIDS prevention intervention of the U.S. government," says the Guttmacher report.
Meanwhile, the U.S. is trying to force its anti-condom agenda on the rest of the world. As Politics & Science reported, in December 2002, "the U.S. delegation at the Asian and Pacific Population Conference sponsored by the United Nations attempted to delete endorsement of 'consistent condom use' as a means of preventing HIV infection. U.S. delegates took this position on the grounds that recommending condom use would promote underage sex."
As Waxman's site points out, there's no scientific basis for this. "Contrary to these U.S. claims, scientific studies have shown that comprehensive sex education delays the onset of sexual activity," it says. It's not surprising, though, that the administration would assert otherwise. "In pushing an 'abstinence only' agenda," Politics & Science says, "the Bush Administration has consistently distorted the scientific evidence about what works in sex education."
Some in the administration may secretly agree. In a 2002 story, Newsweek quoted a top Bush adviser who dismissed the data showing that the only effective sex education programs are those that teach both abstinence and contraception.
"Values trumps data," the adviser said.