Week of Nov 4th-8th: Sexual Development

Do Sex Ed programs reduce teenage pregnancy? (Debate papers due in Brightspace

YES:

Article 1:
Kohler, P. K., Manhart, L. E., & Lafferty, W. E. (2008). Abstinence-Only and Comprehensive Sex
Education and the Initiation of Sexual Activity and Teen Pregnancy. Journal of Adolescent
Health, 42(4), 344–351. https://doi.org/10.1016/j.jadohealth.2007.08.026

Abstract:
Purpose: The role that sex education plays in the initiation of sexual activity and risk of teen
pregnancy and sexually transmitted disease (STD) is controversial in the United States. Despite several
systematic reviews, few epidemiologic evaluations of the effectiveness of these programs on a population
level have been conducted.
Methods: Among never-married heterosexual adolescents, aged 15–19 years, who participated in
Cycle 6 (2002) of the National Survey of Family Growth and reported on formal sex education received
before their first sexual intercourse (n = 1719), we compared the sexual health risks of adolescents who
received abstinence-only and comprehensive sex education to those of adolescents who received no
formal sex education. Weighted multivariate logistic regression generated population-based estimates.
Results: Adolescents who received comprehensive sex education were significantly less likely to
report teen pregnancy (ORadj = .4, 95% CI = .22– .69, p = .001) than those who received no formal sex
education, whereas there was no significant effect of abstinence-only education (ORadj = .7, 95% CI
= .38–1.45, p = .38). Abstinence-only education did not reduce the likelihood of engaging in vaginal
intercourse (ORadj = .8, 95% CI = .51–1.31, p = .40), but comprehensive sex education was marginally
associated with a lower likelihood of reporting having engaged in vaginal intercourse (ORadj = .7, 95%
CI = .49–1.02, p = .06). Neither abstinence-only nor comprehensive sex education significantly reduced
the likelihood of reported STD diagnoses (ORadj = 1.7, 95% CI = .57–34.76, p = .36 and ORadj = 1.8,
95% CI = .67–5.00, p = .24 respectively).
Conclusions: Teaching about contraception was not associated with increased risk of adolescent
sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of
pregnancy than adolescents who received abstinence-only or no sex education.
Article 2:
Bordogna, A. L., Coyle, A. C., Nallamothu, R., Manko, A. L., & Yen, R. W. (2023). Comprehensive
Sexuality Education to Reduce Pregnancy and STIs in Adolescents in the United States: A
Systematic Review and Meta-Analysis. American Journal of Sexuality Education, 18(1), 39–83.
https://doi-org.proxy.library.brocku.ca/10.1080/15546128.2022.2080140

Abstract:
The United States has a higher rate of teen pregnancy than any other developed country with 30%
of American girls becoming pregnant before the age of 20. Laws regarding the inclusion and content of
sexuality education vary across the country, which are associated with differences in pregnancy and
sexually transmitted infection (STI) rates between states. This systematic review aims to determine
whether comprehensive sexuality education (CSE) is more effective than abstinence-only or no sexuality
education at reducing teenage pregnancy. Secondary objectives include analyzing the effect of CSE on
STI incidence, sexual activity, safe-sex behaviors, and social discomfort. We searched multiple databases
for studies published from 1990 to 2021. Twenty-nine studies met our inclusion criteria. Seven included
pregnancy as an outcome, with three fitting our meta-analysis criteria. There was a decrease in pregnancy
rates for participants in the CSE intervention compared to the control (n = 3, risk ratio = 0.89, 95%CI
0.79–1.00, I2 = 0%). We found that CSE is likely to reduce pregnancy rates; however, there was limited
data available on this outcome. CSE increased safe-sex behaviors but did not have a notable impact on
sexual activity or STIs. This review can serve as evidence for the implementation of CSE in the US.

NO:

Article 1:
Stanger-Hall, K. F., & Hall, D.W. (2011) Abstinence-Only Education and Teen Pregnancy Rates: Why We
Need Comprehensive Sex Education in the U.S, PLOS ONE
https://doi.org/10.1371/journal.pone.0024658

Abstract:
The United States ranks first among developed nations in rates of both teenage pregnancy and
sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded
abstinence-only sex education programs for more than a decade. However, a public controversy remains
over whether this investment has been successful and whether these programs should be continued. Using
the most recent national data (2005) from all U.S. states with information on sex education laws or
policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with
teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic
status, teen educational attainment, ethnic composition of the teen population, and availability of
Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only
education as a state policy is ineffective in preventing teenage pregnancy and may actually be
contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based
Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the
National Institutes of Health, we propose the integration of comprehensive sex and STD education into
the biology curriculum in middle and high school science classes and a parallel social studies curriculum
that addresses risk-aversion behaviors and planning for the future.

Article 2:
Carr, J. B., & Packham, A. (2017). The Effects of State‐Mandated Abstinence‐Based Sex Education on
Teen Health Outcomes. Health Economics, 26(4), 403–420. https://doi.org/10.1002/hec.3315

Abstract:
In 2011, the USA had the second highest teen birth rate of any developed nation, according to the
World Bank. In an effort to lower teen pregnancy rates, several states have enacted policies requiring
abstinence-based sex education. In this study, we utilize a difference-in-differences research design to
analyze the causal effects of state-level sex education policies from 2000–2011 on various teen sexual
health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates
or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease
rates in some states.