A Cochrane review of abstinence-only programs for preventing HIV infection in high-income countries found that they were ineffective [ 7 ]. The most comprehensive review of program efficacy is a meta-analysis by the U. Centers for Disease Control and Prevention which examined 66 comprehensive risk reduction CRR programs and 23 abstinence programs. In contrast, the meta-analysis of risk avoidance AOUM programs found insufficient evidence of a change in adolescent abstinence, other sexual behaviors or other sexual health outcomes [ 8 ].
Additionally, the major program evaluation of U. The goal of education about human sexuality is to raise sexually healthy adults [ 1 ]. Healthy development requires complete information, open and honest conversations, and support for decision-making about sex and relationships. Public opinion polls in the U. Similarly, health professionals have overwhelmingly supported comprehensive sexuality education.
The major associations of physicians and public health workers have endorsed comprehensive approaches to sexuality education; many have specifically taken positions against AOUM programs that limit sexual and reproductive health information for young people [ 1 ] National public health goals, established by the U.
Surveys on health education practice in the U. Marked disparities in access to comprehensive sex education also occur by state and district [ 12 ]. AOUM policies by the U. Human rights groups also found that U. AOUM programs do not meet the needs of and may be harmful to sexual minority youth, as these programs are largely heteronormative and often stigmatize other sexualities as deviant [ 15 ].
Stigma and discrimination can contribute to health problems such as suicide, feelings of isolation and loneliness, risk for HIV infection, substance abuse, and violence among sexual minority youth [ 16 ].
By excluding sexual minorities, AOUM programs may produce feelings of rejection and being disconnected to school. The sexual health needs of LGBTQ students are not the same as the needs of students involved in opposite-sex relationships.
Many AOUM programs reinforce gender stereotypes about female passivity and male aggressiveness. Rigid gender beliefs and gender power imbalance are associated with risky sexual health behaviors including reduced likelihood of condom and contraceptive use [ 17 ]. In contrast, programs that critique gender norms and gender-based power imbalances positively impact sexual and reproductive health knowledge, attitudes, behaviors, and health outcomes [ 17 ].
AOUM programs ignore the realities of adolescents who have experience of sexual abuse or exploitation. These young people cannot easily choose abstinence and may be made to feel guilty for their experiences rather than supported by the education and health care systems. AOUM programs also ignore sexually experienced adolescents. Many sexually experienced adolescents need access to complete and accurate information about contraception, legal rights to health care, and ways to access reproductive health services—none of which are provided in abstinence-only programs.
Federal guidelines for AOUM programs have associated sexual abstinence with virtuosity and therefore implicitly associate sexual activity—whether or not by choice—with negative health outcomes including guilt about sex. Finally, these programs often fail to acknowledge students who are pregnant or parenting.
Thus, AOUM programs systematically ignore or stigmatize many young people. Sexual and reproductive rights are grounded in a constellation of fundamental human rights guarantees, including the right to life, health, access to accurate health information, privacy, information, freedom from discrimination, and freedom from cruel, inhumane, and degrading treatment—among others. Moreover, these rights are addressed in regional human rights treaties and interpretive statements, as well as in political consensus documents.
Thus, access to sexual health information is a basic human right and is essential to realizing the human right to the highest attainable standard of health. Governments have an obligation to provide accurate information to their citizens and eschew the provision of misinformation, which extend to state-supported health education and health care services [ 19 ].
These international treaties and statements clearly define the important responsibility of governments to provide accurate and complete information on sexual health to their citizens. AOUM program is also at odds with commonly accepted notions of medical ethics. Just as adolescents have the right to accurate and complete information from teachers and health educators, health care providers have ethical obligations to provide accurate health information in caring for patients [ 1 ].
Such ethical obligations are part of respect for persons and reflected in clinical counseling and in the practice of informed consent; similar ethical obligations apply to health educators [ 1 ].
AOUM programs exclude accurate information about contraception, misinform by overemphasizing or misstating the risks of contraception, fail to require the use of scientifically accurate information, and promote ideas of questionable value.
They are commonly provided to those adolescents who are already sexually active and to LGBTQ youth, ignoring their pressing needs for accurate information to protect their health.
Ultimately, AOUM programs undermine public health goals and the safe transition of young people into sexually healthy adults. Stephanie A. Laura D. Mary A. Craig J. Amanda J. National Center for Biotechnology Information , U. J Adolesc Health. Author manuscript; available in PMC Jul 9. John Santelli , M. Grilo , M. Lindberg , Ph. Ott , M. Heck , M. Mason-Jones , Ph. Author information Copyright and License information Disclaimer.
Copyright notice. The publisher's final edited version of this article is available at J Adolesc Health. See other articles in PMC that cite the published article. Summary Abstinence from sexual intercourse can be a healthy choice for adolescents, particularly if an adolescent is not ready to engage in sex.
Background The U. Public and Professional Support for Sex Education The goal of education about human sexuality is to raise sexually healthy adults [ 1 ]. Human Rights Concerns and ethical obligations of health professionals Sexual and reproductive rights are grounded in a constellation of fundamental human rights guarantees, including the right to life, health, access to accurate health information, privacy, information, freedom from discrimination, and freedom from cruel, inhumane, and degrading treatment—among others.
Conclusion AOUM programs exclude accurate information about contraception, misinform by overemphasizing or misstating the risks of contraception, fail to require the use of scientifically accurate information, and promote ideas of questionable value. Abstinence and abstinence-only education: a updated review of US policies and programs. Journal of Adolescent Health Health Affairs ; 35 — HR A rating instrument adapted from 2 sets of education guidelines structured the assessment of each curriculum.
Four experienced teachers rated each curriculum. Curricula exhibited considerable variability in overall quality ratings. While on average, materials scored a 3. Eight curricula, however, received a below-average rating. While abstinence materials vary considerably in terms of overall quality, the values and world views underlying this sample of curricula were clear and consistent: those who develop abstinence education curricula value nonsexual antecedents of sexual behavior such as skills goal setting, decision making, and assertiveness , ideals fidelity, friendships , and psychological factors such as self-esteem.
J Sch Health. Typically, curricula accomplish these educational tasks by presenting only certain topics in a certain amount and completely or partially neglecting others.
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