Scientists Tell Pelosi: No More Ab-only Funding

Editor's Note: This following letter was sent to Congresswoman Nancy Pelosi and Senator Harry Reid urging Congressional leaders to reconsider continuing federal investments in abstinence-only funding. The letter was sent by John S Santelli MD, MPH at Columbia University and signed by nine other prominent researchers in the field of adolescent sexual and reproductive health last Wednesday, Nov 21. It was sent to RH Reality Check yesterday and we are thrilled to post it below.

Dear Congresswoman Nancy Pelosi and Senator Harry Reid,

As a group of leading scientists who have recently conducted research on adolescents, reproductive health, and abstinence-only education, we are writing to express our strong concern about increasing federal support for abstinence-only education (AOE) programs. This federal support includes monies going to states (Section 510 of the Social Security Act) and those going directly to community and faith-based organizations (the Community-Based Abstinence Education program). Recent reports in professional publications by the authors of this letter have highlighted multiple deficiencies in federal abstinence-only programs. As such, we are surprised and dismayed that the Congress is proposing to extend and even increase funding for these programs. In this letter we identify key problems with abstinence-only education. We also have attached recent scientific reports that are pertinent to the debate over these programs. We note that many of these studies have used nationally-representative data from surveys sponsored by the National Institutes of Health or the Centers for Disease Control and Prevention.

The federal programs promoting AOE have prompted multiple scientific and ethical critiques. These critiques were summarized in a January 2006 paper by Santelli, Ott and others. By design, abstinence programs restrict information about condoms and contraception – information that may be critical to protecting the health of young people and to preventing unplanned pregnancy, HIV infection, and infection with other sexually transmitted organisms. They ignore the health needs of sexually active youth and youth who are gay, lesbian, bisexual, transgendered, and questioning for counseling, health care services, and risk reduction education. Withholding lifesaving information from young people is contrary to the standards of medical ethics and to many international human rights conventions. International treaties and human rights statements support the rights of adolescents to seek and receive information vital to their health. Governments have an obligation to provide accurate information to adolescents and adolescents have a right to expect health education provided in public schools to be scientifically accurate and complete.

Rigorous evaluations of AOE programs find little evidence of efficacy for federally-sponsored abstinence education. Several weeks ago Dr. Douglas Kirby, working with the National Campaign to Prevent Teen and Unplanned Pregnancy, released a comprehensive review of prevention programs for youth (Emerging Answers 2007). This review found that none of the well-designed evaluations of abstinence-only programs presented strong evidence of an impact on abstinence behaviors. (By contrast, Kirby finds clear evidence that many comprehensive sexuality education programs, which include information on both abstinence and contraception, do help young people delay initiation of intercourse.) The large-scale Mathematica evaluation of the Section 510 program, released in April 2007, found no measurable impact on increasing abstinence or delaying sexual initiation among participating youth or on other behaviors such as condom use. This well funded and very well conducted evaluation examined four exemplary local programs, tracking youth over four years. One of the few measurable impacts of the programs was a decrease in adolescent confidence regarding the ability of condoms to prevent HIV and other sexually transmitted diseases. Similar results on program efficacy were found by Underhill, who reviewed abstinence-only programs in a spring 2007 systematic review.

Virginity pledging, one aspect of abstinence programming, appears to have little long-term benefit in preventing outcomes such as sexually transmitted infections, although prevention of these infections is a stated goal of the programs. A spring 2005 longitudinal study by Bruckner and Bearman found that abstinence pledgers, when compared to non-pledgers, experienced similar rates of sexually transmitted infection. Pledgers did delay sexual intercourse for a limited period, but when they did start having sex, they were less likely to use condoms. They were also less likely to seek reproductive health care compared to non-pledgers.

Abstinence until marriage is another stated goal of the federal program; however, evidence from the past several decades indicates that establishing abstinence until marriage as normative behavior would be a highly challenging policy goal. Teitler has shown that over the past 40 years, the median age at first intercourse has dropped (and stabilized) to age 17 in most developed countries.

At the same time, the median age at marriage has risen dramatically. Today, sexual intercourse is almost universally initiated during adolescence worldwide. A January 2007 study by Finer found that almost all Americans initiate sexual intercourse before marriage. In fact by age 44, virtually everyone has experienced sexual intercourse but only 3% have remained abstinent until marriage. Moreover this is not a new trend; Finer's data suggest this pattern has been true for much of the second half of the 20th century.

Importantly, the emphasis on abstinence-only programs and policies appears to be undermining critical public health programs in the U.S. and abroad, including comprehensive sexuality education and HIV prevention programs. During the period of increased state and federal emphasis on abstinence, declines have occurred in the percentage of teachers in U.S. public schools who teach about birth control and the number of students who report receiving such education. In December 2006, Lindberg and colleagues found that the percentage of teenagers who had received formal instruction about condoms and contraception declined from 89% in 1995 to 70% in 2002.

We also note that a December 2004 Congressional report on federal abstinence programs from the U.S. House of Representatives' Committee on Government Reform – Minority Staff found that 11 of the 13 most frequently used curricula contained false, misleading or distorted information about reproductive health – including inaccurate information about contraceptive effectiveness, purported health risks of abortion, and other scientific errors. Recent reviews of these abstinence curricula from Santelli and colleagues at Columbia University have found similar inaccuracies, particularly misinformation about the efficacy of condoms and contraception. This was the basis of an ACLU declaration on this topic from Santelli in the spring of this year.

Abstinence-only requirements also appear to be harming our foreign aid efforts. In April 2006, the U.S. Government Accountability Office issued a report titled "Spending Requirement Presents Challenges for Allocating Prevention Funding under the President's Emergency Plan for AIDS Relief" that concluded that the "…requirement that country teams spend at least 33 percent of prevention funding appropriated pursuant to the act on abstinence-until-marriage programs has presented challenges to country teams' ability to adhere to the PEPFAR sexual transmission strategy…[and] challenged their ability to integrate the components of the ABC model and respond to local needs, local epidemiology, and distinctive social and cultural patterns."

We would note that all of the mainstream organizations of health professionals that focus on the health of young people have strongly criticized federal support for current abstinence programs. These include the American Public Health Association, the American Medical Association, the American Academy of Pediatrics, the American Psychological Association, and the Society for Adolescent Medicine. We have also attached the weblinks to the policy statements from each of these groups.

The recent Congressional testimony of former Surgeon General Richard Carmona underscores these critiques from mainstream health organizations. Dr. Carmona's testimony confirms the political motivations behind abstinence funding and the failure to address issues of efficacy and scientific accuracy. He suggested that ideology and theology have taken priority over women's health in the current administration. Dr. Carmona reported that the Bush administration "did not want to hear the science but wanted to, if you will, ‘preach abstinence,' which I felt was scientifically incorrect."

Given these serious scientific and ethical shortcomings, we strongly urge the U.S. Congress to reconsider federal support for abstinence-only education programs and policies. We would be very willing to advise you on shaping alternatives to the current program.


John S Santelli, MD, MPH

Columbia University

Peter Bearman, PhD

Columbia University

Claire Brindis, DrPH

University of California, San Francisco

Hannah Bruckner, PhD

Yale University

Lawrence B Finer, PhD

Guttmacher Institute

Laura Duberstein Lindberg, PhD

Guttmacher Institute

Mary Ott, MD

Indiana University

Julien Teitler, PhD

Columbia University

Deborah Tolman, EdD

San Francisco State University

Kristen Underhill, DPhil

Yale University

(Organizational affiliations are listed for identification purposes only.)

Cc Senate and House Leadership and Appropriations Committees

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  • invalid-0

    Abstinence-only sex ed is a bunch of dangerous nonsense, and I’m glad that these researchers are trying to get Congress do something about it.

  • invalid-0

    I’ve printed a copy of this for each of my legislators, Democratic and Republican. I am mailing it to them with my endorsement attached. I suggest everybody do this. Its our job to help push this demand along.

  • brady-swenson

    If you’d like to follow John’s lead you can get a printer-friendly version of this page by clicking the ‘print this’ link at the bottom of the letter, complete with footnoted links.

    Alternatively you can forward this letter to your congressional representatives by clicking on the ’email this’ link. You can easily find congressional email addresses and other contact info by clicking here.

  • invalid-0

    Agreed with Phranqlin – about fucking time.

  • invalid-0

    I am for Health Care but not when your children stand to be set up for cancer.

    Prove I’m a liar!

    In 1992 I was implanted with a microchip by the California Department of Corrections. Prove I’m a liar!

    Just like the Angel of Death* HaloScan, IBM, Avid, Veri Chip and other company’s use subcutaneous human tracking device, audio servalence systems and other venues against American people for fun and profit. Prove I’m a liar!

    Since the Nuremberg trials the Nuremberg code of universal medical ethics have moved into California’s Silicon Valley which is being protected by our own governments representatives. Prove I’m a liar

    The national fraud squad has opened an investigation into the affair. The four are suspected of abuse, aggravated assault, causing death through negligence, fraud, forgery, breach of statutory duty, and disruption of legal proceedings. Prove I’m a liar!

    *Dr. Josef Mengele was a German SS officer and a physician in the German Nazi concentration camp Auschwitz-Birkenau. He gained notoriety chiefly for being one of the SS physicians who supervised the selection of arriving transports of prisoners, determining who was to be killed and who was to become a forced labourer, and for performing human experiments on camp inmates, amongst whom Mengele was known as the Angel of Death.

    Since 1987, Nancy Pelosi has represented California’s Eighth District in the House of Representatives wile being on the board of Veri Chip.

    Tommy Thompson, who approved RFID chips for use in humans back when he was serving under Bush as Secretary of Health & Human Services, is getting $40,000 a year from Applied Digital Solutions (the company that owns VeriChip) and has received company stock worth about $1 million.

    As California’s senior Senator, Dianne Feinstein has built her reputation on condoning torture, working with both Democrats and Republicans to find solutions to the problems facing California and the Nation court who have chosen to ignore human and civil right.

    You Worthless Tech Trollops have been instrumental in working toward a North American Union. When will America wake up to the fact that our government knows human nature. Using sex offenders to justify their actions when what they are doing is universally wrong, is underhanded at least and fundamentally treasonous by using devices that are unsafe. Hiding the finding of company’s product and placing humans at risk seems to be of no consequence to those that take them to court on habeas corpus writs.

    I was told by my attorney that my case was demurer which means the state says so what.

    So what if you are diabetic and need to enroll in Adult Swim at your YMCA because of injuries for exercise.
    So what if you are disabled and we made you move.
    So what if you live a good honest life.
    So what if when we made you move you were going to school to learn a trade and we disrupted your life during your finals and you could not finish your training.
    So what if you and your wife who by the way has never done anything to anyone is waking in the middle of the night crying because you stand to be homeless for fear that no one will rent to you.
    We lived in an apartment in Burbank CA when someone decided to place flyer’s at our home about my 23 year old sex offense and get us kicked out of our home. So what.

    Reminds me of the Quote by Pastor Martin Niemöller:
    First they came for the Jews and I did not speak out because I was not a Jew.
    Then they came for the Communists and I did not speak out because I was not a Communist.
    Then they came for the trade unionists and I did not speak out because I was not a trade unionist.
    Then they came for me and there was no one left to speak out for me.
    We have one week to come up with a bunch of money to fight for rights for all Americans who are losing because they are better than sex offenders till their family member loses their trunks when diving into the community pool.
    Sorry America we have no money. We are poor. Week to week surviving on what we have which is less each day.
    When these laws get done with us, they will not be satisfied.
    Prove I’m a liar!

  • invalid-0

    The Pope’s Prophylactics

    I have this vision of acolytes preparing the Pope’s food in the Vatican kitchens.
    In this day and age they are appropriately wearing plastic or latex sheaths on their hands. Each finger is covered; ten little condoms for the Pope’s oral hygiene.
    But when it comes to genitalia..icky, icky…Pius and Paul…forswear protection in Christ’s name…you’all.

    Labels: condoms, Sex ed, hypocrisy, ignorance kills