The disturbing potentially deadly lessons of abstinence-only curriculum
Every weekday at two or three minutes before 3 p.m. the sound of a moaning school bus in front of the house interrupts my work and lets me know my teen-age son has arrived home.
We usually have about an hour together before his younger sister's bus makes the same sound, before guitar lessons, Girl Scouts, homework, dinner and all the other evening rituals and obligations must be tended to.
Quite often these are the best 60 minutes of my day.
I'll be the first to admit that my 14-year-old son can be a huge pain in the ass. But his annoyance factor is significantly diminished in this hour when it's just him and me, and he's both ready and willing to unload about his day.
After complaining about the refrigerator contents, settling on a snack, locating the remote control and getting comfortable on the couch, he opens up about the significant and insignificant trials of junior high.
Recently, our conversations centered on what he was learning in the annual sex-education component of health class. A lot of our talk included his reaction to the material as "stupid," which in 14-year-old boy parlance is synonymous with embarrassing or remotely sexual in nature.
I listened and laughed, but reminded him that the ultimate message of waiting to have sex until adulthood was the right choice.
Throughout the week we joked about sex and puberty, probably to alleviate our respective embarrassment, but also to diminish any taboo. At every opportunity though, I defended what he described as corny videos and conversations while trying to highlight their significance.
But at the end of those five days there was nothing funny about his assessment of sex-ed or his sincere question, "Why would anyone use a condom if they never work anyway?"
I thought I'd prepared myself for the worst case parenting scenarios, but his inquiry about condoms only confirmed my belief that being a parent is improvisation more often than not.
And this time I had some questions of my own. At the top of my list: What in the hell was my son being taught under the guise of sexual education?
Not just what, but by whom
After regaining what little composure I could muster after hearing his question, I went to the phone and called his school. In what would be the first of many surprising lessons, I quickly learned they aren't the ones teaching sex-ed.
Like many other public schools in Indiana, Perry Township hires a private organization to come into the classroom and present the sex-ed curriculum to students - rather than having their own teachers do the job.
It took five phone calls to four different administrators before I could find out any information about the program used in his school.
The principal's secretary knew nothing, so she transferred me to my son's guidance counselor. The guidance counselor knew nothing, so she transferred me to his health teacher. While waiting for a return call from the health teacher, I called the superintendent's office.
No luck there either, just more voice mail.
Finally, I found a name and phone number for the township director of secondary curriculum, Kathleen Carter, on the school district's Web site and reached a secretary who confessed to knowing little about the program herself but did promise to call me back. Within the hour she provided what information she had: a Web site address for Creating Positive Relationships.
Founded by Carmel wife and mother Gayle Bucher in 1987, Creating Positive Relationships (CPR) was first presented to middle school students in 1990 and high school students in 1996. In all, CPR boasts that its abstinence-only program reaches over 60,000 students a year.
Because no one I spoke to at the school had a written copy of any text or curriculum used in the classroom, I bought CPR's self-published The Talk: How to Help Adolescents Choose Sexual Abstinence and Healthy Relationships from Amazon.com.
Relieved that I'd get some answers when the UPS guy delivered later in the week, I put the crisis temporarily behind me and started dinner.
Sex-ed in America
In a stroke of coincidence, the news headlines that same evening were dominated by a report released by U.S. Congressman Henry Waxman evaluating the content of federally funded abstinence-only programs across the nation.
Waxman found that 11 of the 13 most popular programs, used in 25 states by health departments, school districts and hospitals, contain "major errors and distortions of public health information."
Specifically, the report found the overwhelming majority of abstinence-only curricula examined contain false information about the effectiveness of contraceptives, false information about the risks of abortion, blur religion and science, and treat stereotypes about girls and boys as scientific fact.
Currently, 35 states, including Indiana, have laws requiring abstinence-only education as the sole or primary content of sex education in public schools.
Like other abstinence-only programs, CPR maintains, "Parents who proactively discuss birth control methods with their children give the message that they do not believe their children can be sexually abstinent. By initiating a discussion on birth control, well-meaning parents may be inviting their children to experiment with premarital sex."
This is also the position of the Bush Administration, which has allocated $170 million for abstinence-only public school sexual education programs for next year - a $30 million increase, though nearly $100 million less than President Bush originally asked for.
The reason for the unprecedented funding? In the words of White House Press Secretary Scott McClellan, "Abstinence is the only thing that works."
Tips to avoid masturbation
According to Gayle Bucher, founder of CPR: Creating Positive Relationships, "If masturbation becomes excessive, there may be an indication of an emotional problem. Feelings of guilt connected with masturbation can cause mental anguish." To avoid the problems and guilt, CPR recommends the following:
1. Write down reasons why you don't want to do it and why you don't have to do it.
2. When tempted to masturbate, read the list and realize you don't want to do it and you are capable of not doing it.
3. Try to anticipate when you may be tempted, and decide ahead of time you will not do it.
4. Be accountable to a friend who supports your decision to stop.
In Indiana, abstinence-only programs are funded and administered by the Indiana State Department of Health. The department's abstinence program, Indiana RESPECT, awards more than $770,000 a year in federal funding and nearly $600,000 a year in state funds to a variety of organizations who agree to teach abstinence as the foundation of sexual education (see sidebar, pg. 17).
With so many cash-strapped states and schools depending on federal dollars, the current funding restrictions assure that only those states and schools that can afford to turn down hundreds of thousands of dollars will teach students about contraception and safer-sex practices.
But my son's question about condoms and Rep. Waxman's report raised serious questions and concerns about the content of abstinence-only programs.
False and misleading information about condoms
Given my son's assessment of sex-ed and the benefits of condoms, I wasn't surprised to learn 80 percent of the abstinence-only curricula Waxman reviewed contain false and misleading information about the effectiveness of contraceptives.
While the Center for Disease Control (CDC) reports, "Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS," it seems our kids are frequently being taught the opposite.
Many of the curricula cite a 1993 study of condom effectiveness by Dr. Susan Weller, who concluded that condoms reduce HIV transmission by only 69 percent. What the abstinence-only programs don't mention, however, is that the Department of Health and Human Services dismissed the study, calling her work "flawed" and containing "serious error."
They go on to emphasize, "More recent and larger [studies] than the ones Weller reviewed, and conducted over several years ... have demonstrated that consistent condom use is highly effective in preventing HIV infection."
In only one such example, a New England Journal of Medicine study found that despite a total of 15,000 acts of intercourse between partners where one individual was HIV positive and the other was HIV negative, not one case of HIV transmission occurred.
CPR, however, maintains that "an evaluation of all available studies through 1990 ... found that the risk of acquiring HIV was reduced by about 69 percent when condoms were used," citing the disproved Weller study.
While none of the curricula Waxman reviewed provides information on how to select a birth control method and use it effectively, many abstinence-only programs, including CPR, exaggerate condom failure rates in preventing pregnancy.
Source: Department of Health and Human Services Centers for Disease Control and Prevention
According to both the CDC and the World Health Organization, when used consistently and correctly, condoms have a failure rate of 2 to 3 percent in pregnancy prevention. When human error is factored into the equation, condoms have a "typical usage" failure rate of 15 percent.
While the curricula all cite the failure rate, none point out that the failure rate is calculated over the course of a year for sexually active couples, not in each instance of usage, and none cite human error as the predominant reason for the failure. Students of CPR are simply told, "Condoms can fail at least 15.7 percent of the time in preventing pregnancy."
Other erroneous claims by CPR are less serious, but are no less distorted.
One example is the inclusion of scabies as one of "The 10 Most Common STDs," stressing the parasite is transmitted via "sexual contact" and can spread by " kissing, hugging and from dirty toilets."
According to the Center for Disease Control, scabies is a parasite that "spreads rapidly under crowded conditions where there is frequent skin-to-skin contact between people, such as in hospitals, institutions, child care facilities and nursing homes."
The American Social Health Association reports that scabies spreads between those who share the same bed linens much more frequently than through sexual intercourse. Additionally, "It is unlikely that scabies would be transmitted during casual contact (e.g. shaking hands or hugging) or contact with inanimate objects, such as a toilet seat," directly contradicting the CPR text.
Technically, scabies can be transmitted during sex, but then again so could lice, and to my knowledge no one has added that to the list of STDs. Warning teen-agers that condoms won't protect them against the spread of scabies is tantamount to warning they won't prevent the spread of chicken pox.
Thankfully, neither lice nor chicken pox are included in CPR's top 10. But it was already clear why my son had learned the lesson that condoms are effectively a waste of time.
Unfortunately, the misinformation about contraception and STD transmission was only the tip of the proverbial iceberg. Like Rep. Waxman, my review of abstinence-only curriculum would lead to a series of disconcerting discoveries.
Misinformation about the risks of abortion
It should come as no surprise that many who promote abstinence-only education adamantly oppose abortion. What is alarming, however, is the manipulation and outright falsehoods many curricula contain in regards to the effects of abortion.
The Waxman report found claims such as, "Studies show that 5 to 10 percent of women will never again be pregnant after having a legal abortion," and, "Premature birth, a major cause of mental retardation, is increased following the abortion of the first pregnancy." Neither claim is true.
According to CPR, "For some people [abortion] causes grief and guilt that can last for years or a lifetime. Numerous studies reveal that women who have had an abortion experience a high incidence of depression, stress, low self-esteem, suicidal feelings and substance abuse."
CPR's only source for these claims is Dr. Vincent Rue, founder of the Institute for Pregnancy Loss, a "crisis pregnancy center" that is publicly and actively a part of the anti-abortion movement. Rue is listed with the "Pro-Life Physician Directory."
The book in which his claims appear and is cited as the CPR source is Post-Abortion Aftermath, Writings Generated by Various Experts at a Post-Abortion Summit Conference, edited by the Rev. Michael Mannion and published by Sheed and Ward, a publishing house with the mission "to publish, promote and distribute books of contemporary impact and enduring merit primarily within the Catholic tradition."
Not only does CPR quote a decidedly biased and religious-based source, the facts as presented by Rue are false at worst and disputable at best.
According to the American Psychiatric Association, "For the vast majority of women, an abortion will be followed by a mixture of emotions, with a predominance of positive feelings," and another study found that "although women may experience some distress immediately after having an abortion, the experience has no independent effect on their psychological well-being over time."
Further, an August 2000 study published by the Archives of General Psychiatry found a diagnosable depression rate of 1.4 percent in women who'd had an abortion in the previous two years. The study, however, did not consider how many of the women surveyed experienced depression or suicidal thoughts prior to having an abortion. This supports the findings of an additional study published in 1997 that found "no long-term effects on emotional well-being" for women who have had abortions.
Blurring the line between science and religion
Abstinence-only curricula often teach moral judgments alongside scientific facts. In some of the curricula, however, the moral judgments are explicitly religious. The Waxman report found repeated incidences where the line between science and religion disappears and sexual education becomes religious indoctrination.
In addition to the claims of pro-life physician Dr. Rue, the CPR book also provides a "Fetal Development" section described as "recognized medical information, documented by scientific research." Among other claims, this chart states that the "new life" is formed on "Day 1" at the moment of conception.
The source for this data is the Rev. James Dobson's Focus on the Family, and can be found on the Christian organization's Web site under their "Pregnancy Resource Ministry" link.
CPR also cites the Medical Institute of Sexual Health repeatedly as its primary source for statistics and risks associated with sex outside of marriage. The Medical Institute for Sexual Health is a "nonprofit and nonpartisan" educational organization founded by obstetrician/gynecologist Joe Mcllhaney "to confront the global epidemics of non-marital pregnancy and sexually transmitted diseases."
A magazine interview from 2003 provides a bit more background: "In 1996, after 28 years of being in private practice, Joe and [his wife] Marion put their retirement plans on hold and followed God into a second career at The Medical Institute: advocating for a new sexual revolution."
In addition to running the institute, Mcllhaney has held positions under George Bush both as governor and now as president. Currently, Mcllhaney is an appointed member of the Presidential Advisory Council on HIV/AIDS.
While there is nothing wrong with citing Focus on the Family, The Medical Institute or Mcllhaney, CPR does not disclose the political and religious basis of the source, nor does it present opposing or contradictory views, of which there are many.
Gender stereotypes treated as scientific fact
Waxman's research found abstinence-only curricula include a detailed discussion of differences between boys and girls. Some of the differences presented are simply biological. Some, however, present stereotypes as scientific fact.
Claims such as, "Women gauge their happiness and judge their success by their relationships. Men's happiness and success hinge on their accomplishments," and, "Just as a woman needs to feel a man's devotion to her, a man has a primary need to feel a woman's admiration" pepper the curricula.
In a throwback to the Middle Ages, one text in the Waxman report presents a fairy tale about a knight who saves a princess from a dragon. The next time the dragon arrives the princess suggests the knight use a noose to kill the dragon. The final time she suggests using poison.
On both occasions, the knight takes her advice but doing so leaves him feeling "ashamed." Eventually, the knight dumps the princess in favor of a village maiden, but only after making sure she knows nothing about nooses or poison.
The moral of the story? "Occasional suggestions and assistance may be alright, but too much of it will lessen a man's confidence or even turn him away from his princess."
Thankfully, the CPR text does not contain any such lessons. That's not to say, however, it's free of outdated and stereotypical characterizations of the two sexes.
For example, according to CPR, "Girls ... are looking for a guy who listens to them, talks with them and enjoys their companionship," while, "Boys are attracted to what they see."
In characterizing traits of puberty, CPR mentions that girls are likely to "experience more mood swings, crying spells and feelings of agitation that are related to the fluctuation of hormones," while boys "experience spontaneous erections frequently."
Perhaps one of the more convoluted sections of the CPR curriculum comes from the discussion of the "underwear zone," the forbidden line that should not be crossed.
In addition to "a risk of contracting an STD with this intimate level of foreplay," crossing the underwear zone without completing the sex act "leaves one feeling frustrated, dissatisfied and sometimes depressed. In addition, women particularly may have difficulty reaching a sexual climax later in marriage when their minds have programmed their bodies to shut down before intercourse."
In another context, I might be tempted to make a joke here. But as a mother now convinced my son is being brainwashed, I've pretty much lost my sense of humor with this book and Creating Positive Relationships in general.
After comparing the problems of abstinence-only curricula discussed in the Waxman report with the content of CPR's text, I was decidedly a woman on the verge of a nervous breakdown.
How in the hell can such flawed and biased information be presented as fact in a public school system? Why would the school allow the program to be taught to students and pay for it?
Some answers were reassuring.
Esther Meier, executive director of Creating Positive Relationships, is a cheerful and patient woman who deserves a great deal of credit for both the thoroughness of her answers and her commitment to the organization she represents.
I felt a tremendous sense of relief in the first few minutes of our 45 minute conversation when she reassured me that the information I had reviewed had been published in 1999 and has been updated to reflect more accurate and current statistics.
And while not entirely convinced, I also felt relieved to know an innocuous PBS video, not Focus on the Family, is the source of fetal development instruction. Meier also promised to find out who had been the instructor in my son's classroom and to make sure no one is telling kids "condoms don't work."
Under federal law, sexual education funding is available only to programs that meet the following criteria:
* Stress sexual abstinence until marriage
* May not provide instruction regarding family planning, contraception or disease risk-reduction methods
* May not provide medical services/medical supplies
* May not promote religion or provide religious instruction
Additionally, state and local funds are only given to a sexual education program that:
a) has as its exclusive purpose teaching the social, psychological and health gains to be realized by abstaining from sexual activity;
b) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
c) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases and other associated health problems;
d) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;
e) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
f) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents and society;
g) teaches young people to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
h) teaches the importance of attaining self-sufficiency before engaging in sexual activity.
Source: Indiana Code 20-10.1-4-11 and Federal Personal Responsibility and Work Opportunity Reconciliation Act Section 510b
"We try to be very accurate. We use statistics from the CDC. But we don't teach kids that condoms are safe, because they aren't. Safe means free from harm, and condoms do not eliminate the risk. They might reduce it, but kids need to know that they are still at risk," Meier maintained.
She went on to reassure me that CPR "wants the parents to be involved, we respect your concerns because you are the primary educators. We just want to come alongside you and present an abstinence message."
In the final moments of our conversation, Meier summed up my options and CPR's intentions, as disparate as they might be: "If you want to supplement the abstinence message with information about birth control and condoms, we respect that decision but it is not part of our program."
Unintentionally, Meier also provided my next step. Her assertion that "we've been doing this for 14 years, and if we were using false information or promoting religion, schools wouldn't keep bringing us back into the classroom" fell on unconvinced ears.
Given my previous contact with my son's school and everyone's lack of knowledge about what the kids were being taught, I wanted reassurance that someone in the Perry Township school district would review the CPR program and reevaluate whether or not it is the best option available for educating teen-agers about sex.
Finally, I have that reassurance.
Perry Township Director of Secondary Curriculum Kathleen Carter has promised to take on the difficult task of reviewing how and what students are taught as part of their sexual education.
While I'm not convinced the change will occur, I do feel a whole lot better knowing someone will be monitoring the abstinence-only curriculum a lot more closely.
The bottom line
The debate over sex education in America should be over. A recent survey conducted by the Kaiser Family Foundation and Harvard's Kennedy School of Government found only 7 percent of parents did not want sex education taught in public schools. Of the overwhelming majority who do want a sex-ed, 86 percent want their children to know how to use contraception.
At its heart, abstinence-only education contains a simple truth: The only sure way to avoid pregnancy and sexually transmitted diseases is to abstain from sex. And, in a perfect world, teen-agers would be satisfied with that truth.
But given that there is a 50-50 chance they won't be virgins when they walk down the aisle to collect their diplomas, the abstinence-only approach leaves half of the targeted population uninformed and ill-equipped.
Looking at the boy on the verge of becoming a man lying on the couch, eating Cheetos and laughing at Vh1's I Love the '80s, I know the odds are the same as a coin toss he'll have sex before graduating from high school. Having lived through the '80s, I also know being naïve about sex can kill you.
I don't know of any era in which parents summarily condoned their teen-age children having sex, and I remain steadfast in my hope that my own kids will wait until they are adults, in healthy and committed relationships, and mature enough to make responsible choices and decisions.
All I'm after is the reassurance that the education my children receive is comprehensive, accurate and realistic. Condoms save lives. I want my son to know that and keep it in mind when, not if, he has sex.