Review ArticlesAbstinence-based programs for prevention of adolescent pregnancies: A review
Section snippets
Federal government’s abstinence promotion activities
In 1996, Congress added Section 510 to Title V of the Social Security Act. This allocated $50 million per year from 1998 through 2002 to fund state programs providing abstinence education. These funds can be used by the states for instructional programs and programs in mentoring, counseling, or providing adult supervision to those groups most likely to bear children out of wedlock. Abstinence education is defined as teaching the benefits of abstinence in terms of social, psychological, and
Evolution of pregnancy-prevention programs
The first generation of adolescent pregnancy prevention programs began in the 1970s with a focus upon increasing knowledge about sex and the risks and consequences of teen pregnancy. The second generation of programs included similar information but placed greater emphasis upon values-clarification and skills in decision-making and communication. The evaluations of these programs were unable to demonstrate a lessening of sexual risk-taking behaviors in their target audience 6, 7, 8. In reaction
Rationale for abstinence-based programs
The principal rationale for abstinence is that it provides the only absolute protection against teen pregnancy and sexually transmitted diseases. In addition, programs that emphasize only abstinence as a means of birth control may be seen as sending a more consistent message to adolescents involved in sexual decision-making (7). It is also believed that abstinence provides buffering from the psychosocial and emotional harm resulting from premature sexual relationships 10, 11. Several
Evaluated programs
In this review, abstinence-based programs will be divided into programs that discuss abstinence-only as their approach to preventing pregnancy and sexually transmitted diseases in adolescents (“Abstinence Only”) and (“Abstinence Plus”) programs that include other prevention methods such as contraception, in addition to a strong emphasis on abstinence. Details of each program and the corresponding evaluations are listed in Table 1.
Successful programs and promising program components
The programs that showed a measurable desired behavioral change included PSI, Reducing the Risk, and Project Taking Charge. Programs that showed a desired attitudinal change, but were not evaluated in terms of behavior, included Sex Respect, and the curriculae of Teen-Aid, Inc. Values and Choices as well as Facts and Feelings showed desired attitudinal changes that were not sustained.
Program elements found in this review to hold promise of program success are listed in Table 2. A strong
Current efforts to promote abstinence
Several programs are currently being implemented that promote teenage abstinence outside the realm of public health education institutions. These programs range from those within religious groups to efforts by popular media and sports celebrities. Although none of these have undergone rigorous evaluation, some may become valuable parts of the efforts against the problems associated with adolescent sexual behavior.
Campaign for Our Children was incorporated in November 1987 as a not-for-profit
Discussion
A sizable minority of adolescents are abstinent. According to the 1995 report of the Youth Risk Behavior Surveillance System, 46.9% of students in Grades 9–12 have never experienced intercourse (34). This percentage remained stable during the early 1990s (45.8% in the 1990 report and 47.0% in the 1993 report) (35). Among those with previous sexual experience, 28.5% had not experienced intercourse within the preceding 3 months. An even larger proportion of young teenagers was reported never to
Conclusions
Teen pregnancy and sexually transmitted diseases including HIV carry tragic consequences for adolescents. The message that abstinence is the only absolute protection against these dangers is gaining acceptance and has shown some positive effect upon adolescents’ attitudes and sexual behavior. Evaluations of abstinence-only programs using behavioral indicators and long-term follow-up are needed to truly assess their impact.
Program designers should be encouraged to explore new approaches while
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