Love in the Time of Abstinence
This year, the Bush administration wants to spend more than $200 million on abstinence-
until- marriage education in an effort to convince teens that the best way to enjoy sex is to avoid it. At APS, and across New Mexico, a portion of these funds are spent
No sane person would deny that adolescence is an awkward time, with the acne, braces, bad breath—the hair!—and especially those hyper hormones. It's well known that these hormones can lead teens to create the beast with two backs when unsupervised. And according to the Center for Disease Control, over 65 percent of our state's high school-aged youth are sexually active—a number about equal with the national trend. Meanwhile, when you compound the laws of puberty with socio-economic realities, New Mexico has one of the highest rates of teenage motherhood in the nation.
The best way to combat this problem, in the eyes of the White House, is to allocate millions of tax dollars to private contractors in an effort to convince teenagers, and presumably anyone else who is single, to avoid sex and sexual activity.
Specifically, the federal program, administered through the U.S. Department of Health and Human Services, is called "Community-Based Abstinence Education," and while the Bush administration has proposed to increase spending nationwide by $112 million this year, critics say the money is not only ill-spent and the program unrealistic, but it is potentially harmful to the health of teenagers.
Beginning with the 1996 federal welfare reform act, abstaining from sex until marriage has become an increasingly popular idea as Washington politics becomes more aligned with Christian conservatism. So much so that this year the Bush administration has proposed an increase from $74 million in 2004 to $186 million in 2005 for the exclusive purpose of promoting an abstinence-
"We have focused money on the most urgent priorities that will make the biggest difference in the health and well-being of Americans," said Leavitt, adding proudly that if Congress approves the president's budget, the Health and Human Services Department will spend $642 billion in "record outlays" this year. Leavitt explained that this increase adds up to $216 billion more than the department spent in 2001, or a 50 percent increase. However, Leavitt did not mention the projected $400 billion deficit the federal government will incur this year; therefore, one was led to believe that "fiscally responsible" in this case was a relative term assuring the increase in spending would produce significant dividends for American society, despite the interest on this borrowed money to be paid later.
"Healthy people depend on healthy families," continued Leavitt. "And healthy families are sustained by fundamental virtues, including abstinence before marriage. ... Funds will help educate adolescents and parents about the health risks of early sexual activity and provide the tools needed to make healthy choices."
In addition to the funds allocated under the federal government's community-based abstinence education program, another $50 million is earmarked under a separate program entitled "Abstinence Education State Grants." Out of this pile, the New Mexico Department of Health receives about $500,000, which is supposed to be dispersed to abstinence-related programs across the state.
Lately, however, the state health department has expressed concerns about the abstinence-only curriculum, particularly information regarding contraception and sexually transmitted diseases, and these funds have not been flowing freely to the private contractors that offer abstinence-only instruction to public and private schools statewide.
"We know that kids are sexually active and they are getting info that condoms don't work, which contradicts the family programs at the DOH," said one state public health official. "Because of that, the health department is trying to figure out how to use those funds and still have good public health practice."
In Albuquerque, one vendor, Best Choice Educational Services, offers a free weeklong abstinence-only program to health classes in grades ranging from seven to 12 in an effort to satisfy the federal law that, among other things, mandates teaching teens "that bearing children outside of the context of marriage is likely to have harmful psychological and physical effects, (and) that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents and society."
During an interview in his small, nondescript conference room inside a two-story office complex near Menaul and Eubank, Best Choice's Executive Director David Magruder explained that the materials used by his instructors strictly adhere to these federal guidelines even if some people disagree with the language. Magruder is a retired APS science teacher who said the abstinence-only curriculum simply sets a "higher standard" for kids when it comes to self-control and making decisions regarding sex. He said his instructors are not required to be virgins if they are unmarried, nor are they required to have an academic background in public health or medicine.
While acknowledging that state public health and APS officials require comprehensive sex education to be taught in public high schools, Magruder said as long as Best Choice qualifies for federal funding and New Mexico remains one of the highest states in the nation for teen birth rates, his organization will provide abstinence-only instruction to any school that wants it. He said he has no problem with more comprehensive sex-ed programs, it's just something Best Choice is not authorized to teach. He added that if the federal guidelines became more flexible and allowed for a more comprehensive discussion of birth control, he would still only be interested in promoting abstinence and would not be willing to acknowledge premarital sex as acceptable behavior.
"Our credibility has got to be the message," said Magruder. "We believe kids can make informed decisions if they have the right information." Because of the restrictions imposed by Best Choice's federal contract, he added, "The subject of contraception cannot be discussed."
More to the point, condoms are discussed, but only to suggest that they are ineffective at protecting teens against pregnancy and sexually transmitted diseases (STDs). Because of this message, the state department of health issued a directive to the public schools requiring a more thorough discussion of contraception. Also, the state health and education departments are currently working on a comprehensive health curriculum to be instituted statewide—one that would ensure contraception and STDs are more thoroughly discussed in the classroom.
At APS, individual schools form a health education curriculum committee—with input from administrators, counselors, school medical staff, teachers, parents and students—that determines what subjects are taught and who, if anyone, will be invited as an outside speaker. Schools are free to invite speakers under APS "controversial issues" program, although the committee must consider all choices when reviewing instructional materials as well as determine what constitutes accurate and up-to-date information. "There has to be awareness of choice," said Jennifer Macdonald, APS coordinator for secondary education and curriculum, "and it has to be consistent with public health information from the state. It has to be factual and unbiased. It needs to be age and gender appropriate."
As a result of concerns at the state department of health, APS Superintendent Beth Everitt advised schools to elaborate on contraception beyond discussing the failure rates.
"We told them to spend equal time with at least two outside speakers and give a balanced, complete viewpoint," said Everitt. "I hear (the statewide health curriculum) is going to be released soon, but we don't have a date yet. Students need to have as much accurate information as possible."
Best Choice operates on a $536,000 federal grant from the federal community based abstinence program and another $75,000 awarded from the New Mexico Department of Health, through the state grant funding. To receive this funding, organizations must adhere to a list of eight federal guidelines (see sidebar). As a result, groups such as Planned Parenthood of New Mexico, Teen Pregnancy Coalition and New Mexico AIDS Service—that include abstinence in their sexual health curriculum, but also talk candidly about sexually transmitted diseases and contraception—are ineligible for this funding.
Nonetheless, Superintendent Everitt said federal funding for a particular program will not be the deciding factor in what kids are taught at APS. "Funding won't drive quality instruction," said Everitt. "We are committed to a comprehensive curriculum."
Best Choice, while enjoying the fruits of the federal governments strict funding guidelines, employs just two staff members in addition to Magruder, one to train high school kids as spokespeople for the program and another to coordinate the part-time instructors that give presentations in schools in Bernalillo, Torrence, Valencia and Sandoval counties. In Albuquerque, more than half of the federal money Best Choice receives goes to purchasing educational materials and advertising, such as billboards strategically located near high schools, said Magruder, adding that Best Choice sub-contracts with an out-of-state marketing expert to run its media campaign.
Project Reality is an Illinois-based company that publishes A.C. Green's Game Plan, the abstinence-only workbook that Best Choice purchased for $5 apiece and distributed to over 9,800 students, mainly at Albuquerque Public Schools, last year. In comparison, Planned Parenthood of New Mexico, which teaches a program called "abstinence-plus" spoke to an estimated 1,500 students in Bernalillo County last year, according to Johhny Wilson, the organization's educational director.
Project Reality's website suggests it is a nonprofit organization (they accept tax-deductible donations), but it does not identify a board of directors, advisors or mention where its financial support comes from. A.C. Green is an ex-Los Angeles Laker, known best as the fourth scoring option during the Magic-Kareem-Worthy showtime years and was once referred to by an NBA teammate as "my bible-thumpin brother."
In chapter one, students learn "Abstinence means: Sex is good. Save it, protect it, and preserve it so that you can enjoy it in a marriage relationship."
Chapter one then tells the "true story" of Steve and Tina. After graduating from high school and preparing for college, Tina begins pressuring Steve for sex as a test of their true love. Steve abstains and discovers two months later Tina was already pregnant the night she was lobbying him for intercourse. While Tina became a single mom at 18, Steve went to college and remained abstinent with his college sweetheart Karen until they both graduated six years later and married. Today, Steve and Karen have celebrated 17 years of marriage and have four children. Steve is a schoolteacher, while Karen "enjoys caring for the children." Game over; the taxpayers' brand of social engineering—Steve's story—wins and Tina implicitly loses, although there is no update on her life 17 years later, nor are the circumstances of her pregnancy revealed.
According to a health department official, in New Mexico 52 percent of children are born out of wedlock. APS school board member Miguel Acosta, a vocal advocate of comprehensive "scientifically and medically accurate" sexual health education and a critic of Best Choice's teaching methods, said Game Plan creates and reinforces stereotypes, making the curriculum appear more motivated by politics than public health. "It sends a negative message by implication if your mom's a single mom, or if your mom was never married, or if you are gay, it makes it sound like you are more than wrong—it's too shaming and guilt-based. You have the teacher saying what is right in society is kids born in wedlock, but kids don't have control of what family structure they belong to."
Other chapters discuss media influence and sexual imagery, the importance of abiding by rules, avoiding peer pressure and the negative emotions teens feel when they engage in sexual activity, which Game Plan posits can lead to using drugs and alcohol. Lastly, the booklet discusses the physical and mental health benefits derived from marriage and monogamy.
Of the eight chapters in Game Plan, chapter four, "Avoiding the Penalties: Understanding Sexually Transmitted Disease" has drawn the ire of public health officials, who say the information is inaccurate and misleading. One section of chapter four clearly intends to inform readers that condoms should not be trusted as a form of protection against pregnancy or STDs. Birth control pills, emergency contraception and abortion are not mentioned at all.
"One basic difference between abstinence-only agenda and people working in public health is that the abstinence curriculum believes in absolute solutions—a 100 percent solution and that's the only one that works to avoid pregnancy," said Thomas Scharmen, an epidemiologist, with the New Mexico Department of Health Public. "From a public health perspective we are dealing with a total population and we have to provide different solutions for people at different risk levels."
The public health benefits of teaching sexual abstinence to teenagers are, at best, unclear. A study released in January, commissioned by the Texas health service department and conducted by researchers from Texas A&M University revealed that teens actually had more sex after taking the class. However, the study, conducted at 29 high schools across Texas, did not suggest teens were spurred on by the course—they just got older and discovered sexuality. In an interview with the Reuters news agency, Dr. Buzz Pruitt, the study's director said, "We didn't see any strong indications that these programs were having an impact in the direction desired," adding: "These programs seem to be much more concerned about politics than kids, and we need to get over that."
Dr. Peter Bearman, chairman of the department of sociology at Columbia University and director of the Institute for Social and Economic Research, said the results of the Texas A&M research follow a familiar pattern. "These kinds of programs have never been shown to be effective," he said. "This is consistent with almost every other study that has ever been done."
David Magruder and Best Choice's Board Director Chris Amenson had not seen the recently released Texas study at the time of our interview; however, other studies and data posted on the Internet by the Medical Institute and Abstinence Clearinghouse suggest that abstinence-only curricula works. And these are the sources listed by Best Choice when providing what Magruder calls "thoroughly researched and documented" data to refute studies such as those conducted by Bearman and Pruitt. The Medical Institute, a Web-based (www.medinstitute.org), pro-abstinence organization founded by a Texas gynecologist that lists other doctors and medical professionals as advisors but does not list its funding source, is one of Best Choice's leading providers of research-based information. Their website refers to "nonmarital pregnancy" as a "global epidemic." The Abstinence Clearinghouse website (www.abstinence.net), which operates on "private, nongovernmental funds," promotes "factual and medically-accurate materials" and proclaims, "If you want the best chance at a healthy and happy life, abstaining from sex until marriage is the only choice."
Amenson insisted that Best Choice was simply providing a service sponsored by the federal government and the information on teenage sexuality used in related abstinence-only research comes from credible sources like the Center for Disease Control and National Institute of Health. "If it's biased, it's biased by the federal government, not by us," said Amenson.
Carol Cassell is a senior scientist at UNM school of medicine's prevention research center. Prior to returning home recently to be near grandchildren, she directed research on teen pregnancy prevention at the Center for Disease Control in Atlanta. Thirty years ago, as a UNM graduate student, Cassell recalls working for Bernalillo County Planned Parenthood, along with a medical student, teaching reproductive health and contraception to APS students. "Back then, we never had a single complaint," she said.
Today teenage health education is becoming more influenced by politics than scientific research, said Cassell, adding that the Medical Institute is not highly regarded in the medical research field, but is well-known when it comes to the politics of premarital sex. Cassell called the institute a "nonscientific organization," whose founder and director Dr. Joe S. McIlhaney ran a relentless campaign to have the Center for Disease Control remove information about condoms from the center's website. The Bush administration, she said, complied. "People can't believe it, but we pulled (that section of) the website."
"I think the problem with the CDC is they receive money from Congress and because of this restrictive environment they are trying to stay off the radar," said Cassell. "I don't think their research has been used accurately. I'd like to see a little more common sense and evidence of facts used in the debate. Abstinence-only is not effective at all among boys—I have not seen a study that says its effective."
Because the increase in federal spending restricts comprehensive sex-ed, Dr. Eve Espy, a gynecologist and faculty member at UNM, recently organized Women's Health Interest Group at University Hospital to offer comprehensive sexual health programs to Albuquerque teens. The group, still in its nascent stage, involves medical student volunteers and faculty from family medicine, ob-gyn and pediatrics, along with Planned Parenthood and state health department volunteers, who receive training and then offer "abstinence-plus" education in the public schools. She said her interest in teen health education arose from an article in the local newspaper about Best Choice.
"I was struck that Planned Parenthood doesn't have comprehensive staff to do a sweep of schools the same way," said Espy. "We don't want a political battle with anybody and we don't have an ideological perspective. These are medical students who can role model to Albuquerque high school students to pursue a career in healthcare."
Although this new organization is ineligible for federal funding, Espy said the volunteer list has been growing. "Our feeling is in New Mexico, with the fourth highest rate of teen births in the country, and that at least 60 percent have had sex before graduating high school, it's not realistic to ignore their need for info about contraception and STD prevention."
Chris Amenson of Best Choice agrees that teenage motherhood is a crisis in New Mexico and insists that abstinence-only instruction is simply the best method, of several, to promote good health.
"The federal government has already funded it and we qualify for those funds," said Amenson. "If New Mexico doesn't want to participate then that just means the other states will get more federal money. In my view the older generation owes the younger generation its best advice, and my advice to teens is wait."
As for which form of health education works best to curb teen births and the spread of sexual disease, Best Choice's Magruder seems to sum up the consensus opinion of all parties engaged in the debate. "You can locate whatever research is out there to support what you are trying to profess."