March 29, 2012 — Summary of "Consequences of Sex Education on Teen and Young Adult Sexual Behaviors and Outcomes," Duberstein Lindberg/Maddow-Zimet, Journal of Adolescent Health, March 7, 2012.
Between 1997 and 2008, the federal government allocated more than $1.5 billion for sex education programs that focused solely on abstinence only until marriage and excluded discussions about contraception, except to emphasize its failure rates, according to Laura Duberstein Lindberg and Issac Maddow-Zimet of the Guttmacher Institute.
During this time, there was a significant increase in the proportion of teens receiving abstinence-only instruction, accompanied by a significant decrease in the proportion learning about both abstinence and contraception. However, there was no scientific evidence to support the efficacy of abstinence-only instruction. To date, most studies on the subject have concluded that abstinence-only programs are ineffective in delaying sexual debut or reducing sexually risky behaviors, whereas studies on "comprehensive sex education programs find greater efficacy," Lindberg and Maddow-Zimet wrote. A few studies have examined the impact of sex education at the population level in a limited context.
Lindberg and Maddow-Zimet devised a study to determine the association between receiving formal sex education by type and certain sexual and reproductive health behaviors.
The researchers analyzed National Survey of Family Growth data on 2,505 female and 2,186 male teens and young adults ages 15 through 24. Their sample did not include subjects who reported receiving formal sex education that mentioned contraception without discussing abstinence. Between June 2006 and December 2008, NWFG respondents completed an in-person interview about their formal sex education and a computer-assisted, self-administered interview about sensitive topics, such as pregnancy and sexually transmitted infections.
Lindberg and Maddow-Zimet found that 66% of sexually experienced female respondents and 55% of sexually experienced male responded received sex education that included abstinence and birth control (Ab+BC) prior to first vaginal sex. About 20% of respondents said they received abstinence-only education before first sex, while 16% of sexually experienced female respondents and 24% of sexually experienced male respondents said they did not receive instruction on either abstinence or birth control before first sex.
Respondents who were black or Hispanic, living in lower-income households, whose mothers had lower education levels, female respondents who were not living with both parents at age 14, and female respondents who attended religious services less frequently were more likely to not have received sex education on either topic.
Among both genders, healthier behaviors and outcomes were linked with receiving either type of sex education, while riskier behaviors were more common among respondents who did not receive instruction of either type.
Respondents who did not receive any sex education had a significantly earlier sexual debut. About 86% of female and 88% of male respondents with no sex education had vaginal sex before age 20, compared with 77% to 78% of respondents receiving abstinence-only or Ab+BC education. When researchers adjusted for other socio-demographic variables, receiving either type of sex education significantly delayed first vaginal sex, but the association was stronger for male than female respondents. Among both genders, there was no significant difference in the timing of sexual debut between those receiving either type of sex education.
Female respondents receiving Ab+BC were more likely to have used contraception, including condoms, at first sex, compared with those who received no sex education. Among male respondents, both abstinence-only and Ab+BC were associated with an increased likelihood of using contraception/condoms at first sex. However, when researchers controlled for age at first sex, only Ab+BC was associated with contraceptive/condom use for both genders.
Respondents who received Ab+BC had a reduced likelihood of having a partner who was three years older or younger, compared with those receiving either abstinence-only or no sex education. Ab+BC also was associated with a more than 50% reduction in the likelihood that first sex was unwanted among female respondents, while there was no statistically significant association among male respondents.
Ab+BC was associated with a lower likelihood of having six or more sexual partners for respondents of both genders, although the association was not statistically significant once the researchers controlled for age at first sex. For male respondents, Ab+BC also was negatively associated with ever getting a partner pregnant and recent STI treatment, and positively associated with condom use at last sex, but the association lost statistical significance after researchers controlled for age at first sex. Among female respondents, there were no significant associations between sex education and pregnancy, STI treatment, and contraceptive/condom use at last sex.
The study showed that "receipt of formal sex education before first sex, particularly that including instruction about both delaying sex and birth control methods, was associated with a range of healthier outcomes among adolescents and young adults as compared with not receiving instruction in either topic," Lindberg and Maddow-Zimet wrote.
They noted that receiving Ab+BC was associated with multiple positive outcomes related to first sex, while associations with longer-term outcomes were more indirect. There were few clear associations between receiving abstinence-only instruction and sexual and reproductive health behaviors and outcomes.
Lindberg and Maddow-Zimet noted that "[c]ontrary to some critics of formal sex education, [they] found no evidence that receipt of either type of sex education was associated with earlier onset of sex, greater risk taking or poorer [sexual and reproductive health] outcomes." Further, "the direction of association was consistently towards less healthy [sexual and reproductive health] behaviors and outcomes among those who did not receive instructions in either abstinence or birth control before first sex."
The researchers wrote, "The protective influence of sex education is not limited to the questions of if or when to have sex, but extend to issues of partner selection, contraceptive use and reproductive health outcomes." They added that expanding "access to medically accurate comprehensive sex education, and reducing socio-demographic disparities in its receipt, should remain a primary goal for improving the well-being of teens and young adults."