Getting the ‘No’ out of North Carolina

Less than a week after the State of Minnesota released a report stating that its abstinence-only sex education program was not effective in preventing or delaying teenage sexual activity, the Wake County North Carolina school board forged ahead regardless and on January 6, 2004 approved by a 5-3 vote an abstinence-only sex education curriculum for the county’s schools. There are two possibilities: Wake County was either uninformed of the Minnesota report or it deliberately ignored it. “Just Say No” is now the law in Wake County schools.

If Wake County ignored the Minnesota report, they also ignored a number of other reports issued previously saying the same thing. The Minnesota evaluation was just the latest in a series of evaluations that show that abstinence-only programs do not work.

The Alan Guttmacher Institute (AGI) issued a report on sexuality education in December 2003 that stated: “To date, no education program in this country focusing exclusively on abstinence has shown success in delaying sexual activity.”

The Minnesota abstinence-only curriculum, ENABL (Education Now and Babies Later), as the Minnesota Star Tribune reported, “teaches the view embraced by social conservatives — that abstinence is the only sure way to avoid pregnancy and sexually transmitted diseases, and that teaching kids about birth control or safer sex practices simply encourages them to have sex.”

The evaluation report to be found at on the positive side found the ENABL program to be “well implemented”, with good leadership and good visibility in the community. Also on the positive results front, there was a reported increase in parent-child communication on sexual matters, by about 8%, but no comparison on how another more comprehensive type of program might have helped increase parent-child sexual communication. This ends the good news.

On the inconclusive news front, the Minnesota report found that “our analysis found that the percentage of abstinence students was still lower in counties that had no MN ENABL funding (53%) than in counties with MN ENABL funding (49%)”. The report however could not attribute this result to the program.

On the bad news front, the Minnesota report found that the program had little long term impact on youth attitudes, sexual intentions and sexual behaviors. A year later a survey found that the percentage of students who said they would use the refusal skills taught in the program declined significantly, as did those who said they would avoid risky situations like going into a bedroom or drinking. The percentage of students saying that they would decline to have sex also declined, and sexual activity increased during the year after the program as it did for students statewide. For the 3 ENABL counties, one county had a lesser percentage that was sexually active, one a greater percentage and one was the same as the statewide figure (19% for ninth graders statewide and 15%, 19% and 22% for the 3 counties with the ENBLE program).

The Minnesota Star Tribune reported these findings and stated: “The study found that sexual activity among junior high kids at three schools where the program was taught doubled between 2001 and 2002 — a pattern similar to that exhibited by kids statewide — and that the number who said they would probably have sex during high school nearly doubled, as well.”

The Tribune also reported: “ ‘So far all of the programs that have been demonstrated to have a positive impact . . . have been comprehensive sex education that emphasize abstinence and talk about condoms and contraception and encourage their use for young people who are sexually active,’ said Douglas Kirby, a researcher on sex education for the National Campaign to End Teen Pregnancy.”

So what did Wake County, N.C. do in response to this report and all the others? They ignored it.

As the Raleigh News & Observer reported:

“Under Wake’s most recent policy, comprehensive sex education taught as part of new high school health electives will be dropped.

Lessons about diversity and tolerance for homosexuals and other groups also will be eliminated from the sex-education curriculum that Wake uses in grades seven through nine.

The policy will require all school employees to promote abstinence until marriage as the expected standard for all students.”

The News & Observer also reported that “the board on Dec. 16 had voted 5-3 to preliminarily approve a proposal that would prevent any school employee from encouraging or demonstrating the use of contraceptives, a restriction that currently is placed only on health teachers in grades seven through nine.”

One proposed provision was dropped by the school board was a requirement that would have mandated that whenever sex was mentioned, for instance in a novel in English class, teachers would be required to mention abstinence.

This was the only flash of sanity demonstrated by the school board last week. The school board totally ignored the health findings of the county government.

The 2002 Wake County Community Assessment Report stated: “Wake County faces challenges including infant mortality, teen pregnancy, smoking, school dropout rates…”

In Wake County low birth rate babies have increased 27.6% since 1997, as opposed to an increase of 11.9% in North Carolina and a decrease nationwide. Infant deaths have increased 21.3% in Wake County since 1996, and there is a huge disparity between white deaths at 3.7/1000 and African American deaths at 13.0/1000.

Although teen pregnancy has declined by 8.5% since 1996 in Wake County, the teen pregnancy rate has declined far less in North Carolina than in the rest of the nation. According to the Community Assessment report, “Unintended pregnancy is a major concern in Wake County.”

It is axiomatic that contraception prevents pregnancy. Having sex without contraception means that about 85% of women will become pregnant within a year. Whatever the failure rate might be of any contraceptive method, it is less than 85%. There is no indication that teaching young people about contraception leads to more sexual activity. Any arguable increase in sexual activity with contraception will result in far fewer pregnancies than the amount resulting from unprotected sex.

The good news is that teens have been having less unprotected sex since 1990, and since 1990 the nationwide teen birth rate has been declining. The New York Times reported on December 23, 2003:

“Last week, the Centers for Disease Control and Prevention, in its annual tally of birth statistics, announced that the teenage birthrate had declined 30 percent over 10 years to a historic low of 43 births per 1,000. African-American teenagers showed the sharpest declines, down more than 40 percent since 1991.

For young black teenagers, from 15 to 17, the rate was half, to 40 births per 1,000 in 2002 from 83.6 per 1,000 in 1991.These declines, combined with a decrease in abortions among teenagers, points to a promising trend: fewer teenagers are becoming pregnant. According to the Alan Guttmacher Institute, in women 15 to 19, the pregnancy rate dropped from 11.5 per 1,000 in 1991 to 8.5 in 1999, the latest year with available statistics.

“When you see the abortion rate decline in tandem with birthrate, this essentially means that teenagers are being more successful in avoiding pregnancy, both that end in abortion and end in birth,” said David Landry, senior research associate at the institute. It estimates that in women 15 to 19, the abortion rate declined, from 40 per 1,000 in 1990 to 24 in 1999.”

The Alan Guttmacher Institute has reported that “25% of the decrease in U.S. teen pregnancy rate between 1988 and 1995 was due to the decline in the proportion of teens who ever had sex (while 75% was due to improved contraceptive use among sexually active teens).”

The New York Times report stated that statistics

“show that teenagers are having less sex and using contraception more effectively when they do. According to the C.D.C. Youth Risk Behavior Survey, the percentage of high school students who have ever had sexual intercourse dropped. Among girls, it fell to 43 percent in 2001 from 51 percent in 1991. For boys, it fell to 48 percent from 57 percent in the same period.

The survey found that use of condoms among high school students rose to 57 percent from 46 percent in those 10 years.”

The evidence is clear, according to AGI, that certain programs that combine messages about abstinence and provide contraceptive information “can help teens delay sexual activity, have fewer sexual partners and increase contraceptive use when they begin having sex.”

Comprehensive sexuality education has its limits. No program is effective in delaying intercourse past age 17 until marriage, which now averages when men and women are 27 and 25 respectively.

The danger of abstinence only sexuality education is that it is no sexuality education at all. There is some evidence that teens were more likely to have unprotected sex when they broke their virginity pledge. Other anecdotal evidence indicates that teens who keep a virginity pledge are as good as some adults in redefining “virginity” and “sex” and end up preserving their “virginity” by engaging in unprotected oral and anal intercourse, thereby putting themselves at increased risk of sexually transmitted diseases.

Given that the Wake County Community Assessment Report accurately reflects the health challenges facing the young people of Wake County, perhaps the school board should think about what they can do to help, rather than get in the way and hinder the community from finding solutions to the problems.

The reality that school boards must face is the same reality that parents face every day: their kids are growing up really fast. Mother Nature is playing a trick on us. Given a variety of factors including changes in diet, lifestyle and environment, girls now reach menarche at about age 11 and marry at about age 25 on average. This is a 14 year period where young girls, and boys, are vulnerable to pregnancy and diseases from unprotected sex. They deserve more than “Just Say No”. They need to know what to do when they say “yes” or when “yes” happens.

Abstinence-only sex ed doesn’t work. The lead author of the Minnesota report concluded: “Given how much money is being spent, (the abstinence-only program) seems like a really weak intervention.”

The 2002 Wake County Community Assessment Report on its cover says “On the Right Track”. I suggest that the county adopt a New Year’s Resolution to make that less of a political statement and more of a commitment to the health of the 105,000 school children in the county.

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