Study: Abstinence education is undersold

Health and Human Services says schools curricula biased toward condom use

WASHINGTON -- Liberal critics periodically complain that federally funded "abstinence only" sex-education materials are full of false or misleading statements about the effectiveness of condoms and other issues. Now the Bush administration is firing back, charging that programs that endorse condom use also are marred by imbalance and inaccuracies.

The latest round in the sex-ed culture war comes in a 40-page report by the Department of Health and Human Services that critiqued "comprehensive sex-education curricula" -- materials that teach about both abstinence and the use of condoms and other protective methods.

The analysis -- requested two years ago by Sen. Tom Coburn, Okla., and former Sen. Rick Santorum, Pa., both conservative Republicans -- concluded that nine widely used curricula contained misleading statements about condom failure, focused too little on abstinence and were only marginally successful in persuading young people to use condoms or, better yet, to delay having sex.

"This study shows that very little of the message is around abstinence," said Harry Wilson, an associate commissioner in HHS's Administration on Children, Youth and Families. "When it comes to what they actually do in their curricula, this shows that it is kind of given the short end of the stick."

One curriculum, Safer Choices Level 1, mentioned condoms 383 times and abstinence only five, the report said. But Douglas Kirby, a senior research scientist at ETR Associates, the California-based nonprofit organization that developed the curriculum, said the materials make the same point with different language, using phrases such as "choosing not to have sex" or "saying no to sex."

"It's all about abstinence; it's just different words," Kirby said. "There's twice as much material in this curriculum on abstinence than on condoms and contraception."

HHS spends about $176 million a year on abstinence education, said Wilson, who did not know the comparable figure for comprehensive sex education.

The new study, which cost $77,000, was done by the nonprofit Sagamore Institute for Policy Research in Indianapolis and the Medical Institute for Sexual Health, an Austin-based nonprofit group that advocates that adolescents and adults remain abstinent "until committing to a life-long mutually monogamous relationship such as marriage."

Misinformation culture

The rhetorical exchange has been raging for years. In 2004, Rep. Henry A. Waxman, D-Calif., issued an analysis that found that 11 of 13 abstinence-only curricula contained medically inaccurate or misleading information, including assertions that touching a person's genitals can result in pregnancy and that condoms fail to prevent HIV transmission as often as 31 percent of the time in heterosexual intercourse.

The HHS report said that of the nine curricula it reviewed, six had medically inaccurate statements, most commonly that the spermicide nonoxynol-9 reduced the risk of contracting HIV and other sexually transmitted diseases. The Centers for Disease Control and Prevention has said that it does not protect against such infections.

The HHS report said that eight of the curricula contained no inaccuracies about statistics related to condom effectiveness, but that the numbers sometimes lacked context. For example, programs that say latex condoms prevent pregnancy 97 percent of the time when used correctly (the figure actually is 98 percent, experts said) should also note that studies show that the probability of pregnancy during the first year of "typical" use is 15 percent. Not everyone uses condoms properly every time.

The report also objected to statements such as, "Condoms made of latex provide good protection from HIV when used correctly and consistently during vaginal, anal or oral sex." It said such statements lacked "explicit details" about condom failure rates.

James Trussell, a demographer at Princeton University whose research on condom failures was cited frequently in the HHS report, said the authors got the data right but overstated the importance of the errors.

"These examples of medical inaccuracies pale in comparison to those in abstinence-only curricula," he said in an e-mail message. "Many errors cited in the Waxman report are egregious, whereas many errors cited in the [HHS] report are not."