As the mother of three (two of them teenagers) and a health educator who enjoys and is enlightened by middle- and high-school students, and who furthermore possesses a pathologically encyclopedic knowledge of sexually-transmitted infections, I consistently counsel teenagers to postpone sexual activity. I teach them about unintended physical consequences of sexual activity, and I encourage them to consider emotional consequences, as well. The comments of the adolescents I talk to are thoughtful and insightful. Their questions tell me how eager they are to discuss love, relationships and sexuality candidly, confidentially and comprehensively.
I have done this work for many years—often precariously perched on the political see-saw that is sexuality education for adolescents—but I have never been as troubled as I am now by federal and State policy and funding allocation. Last year, the U.S. Department of Health and Human Services Administration for Children and Families awarded $37 million to agencies providing “abstinence only until marriage” sexuality education programs serving adolescents. The Charlottesville Pregnancy Center benefited from this federal largesse, receiving $645,642 to implement a three-year abstinence-only education program locally. This program, called “Worth Your Wait,” aspires to reach 30,000 middle- and high-school students. If these programs reduced high-risk sexual activity, this financial outlay might be justified, but evaluations have not shown such efficacy. In a study of teens and “chastity pledges” conducted by researchers at Columbia and Yale universities, those who took the public pledge and those who did not had virtually the same rate of sexually-transmitted infections. What’s more, pledgers were less likely to be tested and treated for their infections. Perhaps pledgers were ashamed they had been sexually active; perhaps they did not know how and where to get help. Both the Society of Adolescent Medicine (SAM) and the American Academy of Pediatrics have recently released reports opposing this federal policy. In the SAM position paper, Dr. John Santelli, of Columbia University, and Dr. Mary Ott, from the Indiana University School of Medicine, state that, while abstinence is a healthy choice for adolescents, “Providing ‘abstinence only’ or ‘abstinence until marriage’ messages as a sole option for teenagers is flawed from scientific and medical ethics viewpoints.” Teenagers are as heterogeneous as adults, so a single ideological approach makes no sense. Those who care for, and about, adolescents should support those who postpone being sexually active, and provide education about (and access to) pregnancy and infection prevention to those who are sexually active.
The Centers for Disease Control (CDC) Youth Risk Behavior survey tells us that almost 70 percent of high school students have had intercourse by the time they graduate. Survey results from the CDC’s National Center for Health Statistics released last fall provided information about teens and oral sex. Of teens ages 15 to 19, over 50 percent reported having had oral sex. Of those who had had intercourse, over 80 percent reported having had oral sex. This research highlights the need for explicit and accurate information about specific sexual activities (vaginal, oral and anal intercourse) and associated health risks.
Over the past 10 years, the national and state teen pregnancy rates have declined, while rates of sexually transmitted infections increase steadily. The CDC calls STIs a series of epidemics, pointing to high rates of chlamydia, gonorrhea, genital herpes and HPV (a virus that can cause genital warts, and one that is also connected to cervical cancer). Of infections reported to local and state health districts, gonorrhea rates are highest in the 15- to 19-year-old cohort. The CDC estimates that almost 4 million teens are newly infected annually; most, who are not tested or treated, infect others, and may experience future infertility. Most likely this combination of decreasing teen pregnancy rates with increasing teen STD rates has less to do with sexual abstinence, and more to do with extremely effective birth control methods (such as Depo-Provera and birth control patches) that leave little room for user error, but provide no protection against infections. And yet our enlightened community of Charlottesville has actually seen a steady increase in teen pregnancies since 2001, the year in which the feds began pushing abstinence-only sexuality education. Charlottesville’s teen pregnancy rate—which, at last measure, was 70.8 per 1,000 females ages 10 to 19—now exceeds that of Virginia, and Virginia has the 19th-highest pregnancy rate in the United States.
Is this any way to teach our children?
Mary A. Sullivan, M.Ed., is a Charlottesville/ Albemarle Teen Pregnancy and STD Preven-tion Coordinator.
