Most abstinence-only programs of the type that have received $1.5 billion in federal funding do not help teens delay initiation of sex, and there is no scientific evidence to warrant their widespread use, according to a new review of sexuality education program evaluations by Douglas B. Kirby. In contrast, many comprehensive sex education programs, which emphasize both abstinence and the use of protection for those who do have sex, were found to have a positive impact and should be replicated more widely. The study concludes that a comprehensive approach to sex education is effective and does not send a confusing message to young people.

The new review is part of a series of articles that identify major flaws in abstinence-only education, including problems with accuracy, effectiveness and ethics, all published in a special edition of the journal Sexuality Research and Social Policy, guest edited by John S. Santelli and Leslie M. Kantor, both with Columbia University’s Mailman School of Public Health.

"These articles present the serious ethical and scientific reservations many experts have about policies mandating abstinence as the sole choice for adolescents and about the withholding of potentially life-saving information from teenagers that occurs in such programs," says John S. Santelli, a Guttmacher Institute senior fellow. "The articles make clear that abstinence-only programs are based on ideology and politics—and go against the consensus of public health science."

Also in the special issue of Sexuality Research and Social Policy:

• Key critiques of abstinence-only programs
  Promotion of abstinence until marriage is directly at odds with long-term demographic trends, including earlier age at first sex and later age at first marriage, according to "Abstinence-Only Policies and Programs: An Overview," by Kantor and colleagues. Abstinence-only programs also coincided with increasing restrictions on teachers’ ability to teach and with fewer young people receiving comprehensive sexuality education.
• Abstinence-only programs violate key human rights principles
  Abstinence-only programs’ silence or misinformation on condom effectiveness violates young people’s right to information and to the means with which to protect their health, according to "Abstinence-Only-Until-Marriage Programs and Their Impact on Adolescent Human Rights," by Alice M. Miller and Rebecca A. Schleifer. The authors examine both Texas and Uganda in their demonstration of the ways that human rights approaches can help to illustrate limitations on programs that restrict access to information.
• What motivated states to reject abstinence-only funding?
  States that refused to accept federal funding under the rigid Title V abstinence-only program often had concerns about its efficacy and accuracy, as well as progressive governments and strong advocates for comprehensive sexuality education, according to "State Refusal of Federal Funding for Abstinence-Only Programs," by Marissa Raymond and colleagues. The authors suggest that policy change can be achieved by building coalitions supporting comprehensive sexuality education and challenging the medical accuracy and efficacy of abstinence-only education.
• Condom misinformation in abstinence-only curricula
  Commonly used abstinence-only curricula do not provide complete, current or accurate medical knowledge about the effectiveness of condoms. These curricula explicitly and implicitly convey the message that condoms do not provide protection against HIV, according to "The Accuracy of Condom Information in Three Selected Abstinence-Only Education Curricula," by Alison Jeanne Lin and John S. Santelli.

Dedicated to the memory of Cynthia Dailard

The editors have dedicated this special issue to the memory of Cynthia Dailard, who tirelessly championed adolescent health and reproductive rights, and was a leading voice in the policy community against abstinence-only programs as a senior public policy associate at the Guttmacher Institute from 1998 until her death in 2006.

Related commentary: Medical accuracy in abstinence-only education

In response to the increasing injection of ideology into sexuality education, many states have recently implemented requirements for scientific and medical accuracy in sexuality education and HIV prevention programs. Medical accuracy is based on a scientific consensus process, which considers the weight of scientific evidence, incorporates scientific theory, is built upon peer review and is recognized by mainstream scientific and health organizations as objective and complete, according to "Medical Accuracy in Sexuality Education: Ideology and the Scientific Process," by John Santelli, published in the American Journal of Public Health.