In the week since sex educators and activists called out the Obama administration for getting in bed with Heritage Keepers Abstinence Education, the Department of Health and Human Services has stayed silent on why the program had been added to a list of approved, “evidence based” programs for teen pregnancy and STI prevention – until now. In an interview with Salon, HHS spokesman Mark Weber said Heritage Keepers had met the criteria, “gone through a transparent, rigorous review process” and had “demonstrated outcomes” – in this case, delaying sexual activity, and that alone.
The controversy arose when, sometime in April, Heritage Keepers Abstinence Education was quietly added to an Office of Adolescent Health list of approved groups eligible for government funds -- “the holy grail of the Administration’s commitment to a science-based approach to teen pregnancy prevention and a directive for grantees of the President’s Teen Pregnancy Prevention Initiative,” wrote four prominent sexual health experts in RH Reality Check. They accused HHS of “succumb[ing] to the political pressure of social conservatives and allowed the ideology of the right to prevail over the health and well-being of the nation’s youth.”
On April 30, over a dozen major organizations, including the ACLU and Human Rights Campaign, asked Secretary of Health and Human Services Kathleen Sebelius to explain Heritage Keepers’ inclusion. They said the program “ostracizes lesbian, gay, bisexual, and transgender (LGBT) youth; promotes heterosexual marriage as the only acceptable family structure; withholds life-saving information from sexually active youth; and uses fear-based messages to shame youth who have been sexually active and youth living in ‘nontraditional’ households.”
Like most abstinence-only programs, contraception and condoms aren’t on the agenda, nor is detailed information about sexually transmitted diseases or safe sexual behavior. Sample language from the student manual: “girls have a responsibility to wear modest clothing that doesn't invite lustful thoughts.” Both aspects are awkward at a moment in which the president’s reelection campaign is struggling to have it both ways on gay marriage, as well as to paint itself as a champion of reproductive health.
The RH Reality Check piece also says that there is “limited evidence of effectiveness” of the Heritage Keepers program. But Christopher Trenholm, associate director of research at Mathematica Policy Research, which conducted the independent research evaluation for HHS, and whose previous work is cited as proof that the Heritage Keepers program doesn’t work, told Salon there are actually two different programs in question. The one in the 2007 Mathematica study that was found to have little impact on sexual abstinence, a complementary after-school program called Life Skills Education Component, differs from the health class curriculum that ended up on the HHS list.
This time around, Trenholm’s task was to grade the outside research that purported to back up the organization’s claims. HHS decided that every organization that got a moderate or high rating on doing what it said it did would end up on the approved list. Mathematica took a look at a 2011 study of Heritage Keepers Abstinence Education as taught to 2,215 7th- through 9th-grade students, which found that a year after participating in the program, “sexual experience” increased from 29 to 33 percent of students, compared to 43 percent of students in the control group. The study quality was deemed “moderate,” allowing Heritage Keepers to tout its HHS seal of approval on its website.
In other words, Heritage Keepers simply followed the rules of the “evidence based” system – and prevailed. The problem for supporters of inclusive and comprehensive sex education is that the HHS criteria say that studies “must measure program impact on at least one measure of sexual risk behavior or its health consequences.” That measure can be contraceptive use or fewer sexually transmitted infections, or it can be simply delaying sexual activity, as Heritage Keepers was found to do – but it doesn’t have to do both or all. And as written, it certainly does not mean that the program can’t marginalize LGBT students or shame students about their sexual behavior.
I asked Weber, the HHS spokesman, what would have to change for such groups to be left out of the program. Would the criteria simply have to be revised? “What we're committed to is an open and transparent scientific process,” he repeated. That process appears to have been followed here – but it shows the limits of a narrowly technocratic approach.
Update. Critics respond to the HHS rationale: “HHS is being frighteningly shortsighted," said Dr. Elizabeth Schroeder, executive director for Answer, a national sexuality education organization based at Rutgers University. "Heritage Keepers relies on fear, shame, distorted information and biases. Why are we supporting any program that discriminates against groups of students and endangers their health? How can the HHS justify putting its seal of approval on a sexist, homophobic curriculum?"