In 2001
Kirby1 found
that, of 28 sex education programmes in the US
and Canada
aimed at reducing teen pregnancy and STIs, including HIV, none of the three
abstinence-only programmes that met inclusion criteria for review were
effective in delaying sexual debut. Furthermore, these three programmes did not
reduce the frequency of sex or the number of partners among those students who
had ever had sex.
However,
this same review found that nine abstinence-plus programmes (meaning abstinence
education as part of comprehensive sex education) showed efficacy in delaying
sexual debut, as well as reducing the frequency of intercourse and increasing
condom use once sex began.
In 2007,
a second review by the same researchers of 56 programmes2 found
encouraging signs as a result of sex education progammes in the US and Canada
in general. They found that “the percentage of sex and STD/HIV education
programs with positive effects on behavior continues to increase and the
strength of their evidence has also increased”. However, they had no reason to
change their conclusions on abstinence-specific programmes. They said:
“Several abstinence programs, including
abstinence-until-marriage programs, have been rigorously [emphasis in original]
evaluated in experimental studies with large samples and found to have no
overall impact on delay of initiation of sex, age of initiation of sex, return
to abstinence, number of sexual partners, or use of condoms or other contraceptives.”
The same
year, the Oxford University-based Centre for Evidence-Based Intervention
published a meta-review3 of 13 US
trials of abstinence-only programmes, enrolling about 15,940 young people in
total (they had searched for trials of abstinence-only programmes in other high
income countries, but had not found any).
They
found that, compared with various
controls, no programme affected the incidence of unprotected vaginal sex,
number of partners, condom use, or sexual initiation. Only five of the
13 programmes measured the biological outcome of pregnancy rates and only four
measured STI rates. Of these, one found a statistically significant fourfold
increase in STIs amongst people who participated in abstinence-only programmes
(p= 0.03), and one a twofold increase in the risk of pregnancy (p = 0.02). On
the other hand, just one abstinence-only programme produced a significant 47%
decrease in the rate of recent sex (protected or otherwise) in participants,
and that only in the last month (p= 0.04).
In April
2007 the Princeton-based body Mathematica Policy Research produced a report4
evaluating four specific abstinence-only-until-marriage programmes. These
programmes were intensive and started with children before the age they became
sexually active.
They
conducted a randomised controlled study of these four programmes, enrolling a
total of 2057 children in the study and randomising 1209 to the programmes and
848 to receive nothing other than biological information about sex. Then they
waited for four to six years after the young people started participating in
the programmes. At this point, when the youngest participant would be 12 years
old and the oldest 20, they examined the impact the programmes had made on
sexual abstinence, unprotected sex, number of sexual partners, and knowledge
about STIs, pregnancy and condoms.
Strikingly,
the programmes made absolutely no difference whatsoever to the eventual sex
lives of the participants. There was hardly a percentage point difference
between the intervention and control groups on any measure of effectiveness. To
give two examples: 49% of young people who had participated in the programmes
had remained sexually abstinent – as had 49% who had not. Twenty-one per cent
who had participated in the programmes had had unprotected sex in the previous
twelve months – as had 21% who had not.
Programme
participants were 2% better at identifying particular STIs than controls – and
because of the sample size, this was statistically significant. Apart from
this, the only significant difference between programme participants and
control students was that more programme participants were likely to believe
something untrue. For instance, 21% of programme participants agreed with the
statement that “condoms never prevent HIV” compared with 17% of controls.
Twenty per cent believed they did not stop gonorrhoea or chlamydia either,
compared with 14% of controls.