Talk is Cheap, Teen Pregnancy is Expensive

Which of the following arguments do you find persuasive?

A. Sex ed for teenagers should only teach abstinence, because teaching about other aspects of sexuality and sexual health implies that schools expect teenagers to have sex. Thus it stands to reason that more teenagers will have sex, leading to more unintended pregnancies and more STIs.

B. Sex ed for teenagers should be comprehensive, including the full range of options for contraception, because teenagers will have sex no matter what is happening in their classrooms. Thus it stands to reason that teenagers who are only taught about abstinence will be less likely to use protection when they do have sex, leading to more unintended pregnancies and more STIs.

C. Neither of the above.

I choose option C.

Sex ed is back in the headlines here in Wisconsin. We lost over 12,000 jobs this past month, but the Governor’s special legislative jobs session has so far been focused, as the Capital Times editorial succinctly put it, on Deer, Fertilizer, and Sex Ed, (oh and a few other things), but not so much on jobs.

I testified in support of the Healthy Youth Act, which is now on the chopping block, in 2009 when the State Senate held public hearings, and my testimony may be found below. It is not my best work, but the premise is sound, and it is this: empirical evidence is available of the comparative effectiveness of abstinence-only and comprehensive sex ed curricula. That means that we don’t need to debate and debate in a seemingly endless effort to reason out a priori which type of curriculum must work best. We can look at the research which tells us which type of curriculum DOES work best.

At the time the Healthy Youth Act was passed, the balance of research favored comprehensive sex ed, both for reducing unintended pregnancies and STIs and for increasing abstinence. I freely admit that I have not tried to stay on top of new studies in the field since that time, but my point is not so much the state of the evidence, it is how we use the evidence–or more often fail to use it.

Is all research correct in its conclusions? Obviously not. But if you think that the studies supporting comprehensive sex ed have methodologic flaws that call their results into question, that is a reason to demand bigger, better studies. It is not a reason to trash the entire principle of basing policy decisions on what works. Limited evidence makes a better guide than pure conjecture, which is what option A and option B above both are.

We can have a meaningful debate around sex ed on the issues of the value of abstinence, the value of education, the meaning of childhood, the right of a society to dictate sexual practices, and so on. These are moral issues, and important ones. But most people understand that most other people have firmly held beliefs on these issues which are not going to change because of a well-reasoned argument from someone of the opposite view. Instead we debate effectiveness, because that makes our argument sound objective and rational. The problem is that effectiveness can’t actually be proven or disproven by debate.

My 2009 testimony appears below the jump:

Testimony

 

To:                  Members of the Senate Education Committee

From:              Medical Students for Choice, University of Wisconsin Chapter

Date:               October 29, 2009

Re:                  SB 324 – The Healthy Youth Act

Position:         Support

Thank you for the opportunity to speak in support of SB 324, the Healthy Youth Act.  My name is Anna G. Mirer and I am speaking today on behalf of Medical Students for Choice.  I am a medical student in the MD/PhD program at the University of Wisconsin School of Medicine and Public Health.  I hold a Master of Public Health degree in Epidemiology/Biostatistics at the University of California, Berkeley, and am also a former educator, having taught in the Head Start program in Southeastern New Mexico.

Medical Students for Choice urges each member of the Education Committee to vote for and support the Healthy Youth Act.  As future doctors, we recognize the importance of sex education to public health.  As medical students, we are learning how complex the study of reproduction and sexuality can be. It is not easy for anyone, adult or teenager or child, to understand how to make healthy choices without the guidance of research and excellent education.

The word doctor comes from the Greek word for teacher.  We are being trained to educate our patients about their bodies and how their bodies interact with their world.  Like teachers, we are trusted to be a resource for students and their families who need to make informed decisions about their sexual health.  Unlike Wisconsin teachers, however, we currently enjoy the freedom to tell the truth.  Passing the Healthy Youth Act will ensure that school is a place where students get medically accurate information about their health, and that parents are kept involved in the process of educating their children.

The public health consequences of inaccurate sex education are most grave.  In 2004, a peer-reviewed study by Weinstock et. al. found that in the United States, 48% of patients with new sexually transmitted infections were between the ages of 15 and 24—9.1 million new diagnoses in a single year—even though this age group makes up only 25% of the sexually active population[1].  We feel this definitively shows that comprehensive sex education is developmentally appropriate for high school age students.  Against this backdrop, a randomized trial of abstinence-only programs by Trenholm et. al., published in 2008, found that they had no impact on the rate of teen abstinence, or on the risk of pregnancy or sexually transmitted infection.[2]  An epidemiologic analysis by Kohler et. al. found that risk of teen pregnancy was 50% lower among teenagers who reported receiving comprehensive sex education than those reporting abstinence-only education.[3]  These are just a few examples of results from decades of scholarship that have led professional medical organizations to support comprehensive sex education, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Psychological Association, and the American Medical Association.

Evidence-based medicine is the hallmark of our training, and the future of our practice.  The field of medicine is always changing, and old practices are discarded or revised as new evidence emerges.  It is vital that sex education be guided in the same way—by the most solid research available. Nothing less is required to serve the population of Wisconsin, and keep its children healthy.


[1] Weinstock H et al., Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000, Perspectives on Sexual and Reproductive Health, 2004, 36(1):6–10.

[2] Trenholm C et. al., Impacts of Abstinence Education on Teen Sexual Activity, Risk of Pregnancy, and Risk of Sexually Transmitted Diseases, Journal of Policy Analysis and Management, 2008, 27(2):255-276

[3] Kohler PK et al., Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy, Journal of Adolescent Health, 2008, 42 (2008) 344–351

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