Consequences of protective sex education and abstinence-only sex education on teenage pregnancy rates in the United States
The United States is perhaps the most powerful country in the known world, yet when compared to other countries, the United States has one of the highest rates of teenaged pregnancies (Assefi, Bennett, 2005). In the United States, 229,715 births as a result of pregnancies sustained by women from the ages fifteen to nineteen were recorded in 2015 (CDC, 2017). While the rate of teenage pregnancies in the United States have decreased from 40 births per 1,000 births in 2007 to approximately 22 births per 1,000 births in 2015 (CDC, 2017), the United States is considerable behind in reducing teenage pregnancy rates within the country given their high status as one of the richest countries in the world.
Significance of Problem
Teenaged pregnancy can have a multitude of unintended consequences, such as compromising the ability of the mother to complete their educational track, or compromising the family’s socioeconomic wellbeing by placing more of a financial strain on the family to support the baby when they are already facing financial struggles. In Frank Furstenberg’s “Reconsidering teenage pregnancy and parenthood,” he compared the findings in a report about teenaged pregnancy from 2007 and found that teenage mothers who persisted on public welfare for longer periods of times than those who only used welfare for a short period of time fared worse as adults. Furstenberg also found that mothers who were able to return to school and advance their education were more likely than mothers who ended their education as a result of having their first child to enter the middle class, and their resulting children were more likely to succeed in school.
Introduction to PICOT Question
In the United States, there are state policies that control how schools demonstrate sex education to their students, particularly to adolescents in middle and high school. Throughout the United States, there is discourse between how sex education is taught throughout many states, either: teach sex education in a way that students understand how to perform safer sex in the event that they are going to have intercourse, or teach students to abstain from sex until marriage. The main discourse between these two disciplines is how effective it is in preventing unwanted pregnancies, especially teenaged pregnancies, and how each type of education affects adolescents in the long run in terms of their sexual practices and their perceptions of sex. The research presented in this paper is to address the clinical question: “is comprehensive sex education more effective than abstinence-only sex education in reducing teenage pregnancy rates and providing more sufficient education in the United States?”
The first teachers that children have are more likely than not their parents. Analyzing the parents’ attitudes about educating their children about protective sex or complete abstention from sex is important in learning about the attitudes of the generation of adults who are doing the educating of the adolescents, as generational thinking is often reflected through attitudes of their children. In “Parents’ Beliefs Regarding Sex Education for their Children in Southern Alabama Public Schools, Millner, Mulekar, and Turrens perform a study in order to obtain survey data from parents about their feelings towards sex education in the Mobile County Public School System, a particularly conservative town in Alabama. In their study, they surveyed a stratified sample of 402 randomly selected parents in Mobile Country with 120 more randomly selected parents in areas of the county with higher incidences of teenaged pregnancy. When analyzing the results of the survey, it was found that eighty-one percent (81%) of the randomly selected parents prioritized abstinence-only sex education compared to safer-sex education. However, a majority of parents also supported the teaching of STI prevention (98.3%) and condom usage (92.8%). The study also identified a positive correlation between the religiosity of a state and the likeliness of teaching abstinence-only education; Alabama was found in a 2009 study to be the second most religious state in the United States, coinciding with a position in the top twenty percent of highest incidences of teenage pregnancy within the United States with Mobile County having the highest incidence of pregnancy in the three top metropolitan areas of Alabama.
The most important population to be analyzed in this kind of study is the target audience themselves: adolescents. They are the ones absorbing the information that is being taught by the state, and therefore applying the information and providing the data needed to come to conclusions about the best method of sex education. In Emily Gardner’s study “Abstinence-Only Sex Education: College Students Evaluation and Responses,” Gardner interviewed fifteen undergraduate students, who all received abstinence-only sex education from their primary education, from Emory University and Georgia State University about their experiences of abstinence-only sex education and their attitudes towards difference topics such as abstinence, virginity, and marriage, and what they believe would be good suggestions for improving the state of sex education in the United States. In terms of abstinence, most students accepted abstinence as a valid method of birth control, but they also had conflicting views on how efficient teaching abstention is in terms of application to the real world, varying from abstinence-only education being sufficient to it being “unrealistic” and “…not necessarily a practical idea.” When evaluating the positive and negative aspects of abstinence-only sex education, twelve out of fifteen respondents overwhelmingly commented on the negative aspects of abstinence-only education, noting the use of “scare tactics” such as graphic images and videos of childbirth and various STI’s, and the implication during their education that anything having to do with sex is inherently negative. In contrast, those who commented on the positive aspects of their sex education mostly commented on other aspects of the education other than abstention, such as education about sexually transmitted diseases and how they were encouraged to focus more on their education and life goals. When asked about their ideal sex education, options such as teaching sex education in such a way that assumes young people will be sexually active so that options of safer sex are explored rather than dismissing any aspect of sexuality as negative and inherently harmful were addressed. They also wanted full and accurate information about different sex topics, and for sex education to be taught that can be applied more realistically rather than in a way that can only be applied in an ideal situation as abstinence-only does, assuming that every single person is going to be married and are willing to wait.
In a study done by Sylvana Bennett and Nassim Assefi, “School-based teenage pregnancy prevention programs: a systematic review of randomized controlled trials” sought to compare school programs that either focused on abstinence-only or abstinence-plus sex education in terms of teenage pregnancy and rates of sexual activity among adolescents. Bennett and Assefi compared nineteen randomized controlled trials of various school-based teenaged pregnancy prevention programs in the United States, and from the sixteen that had relevant results to their question, twelve programs evaluated abstinence-plus, while three evaluated abstinence-only programs and the remaining compared both programs in their study. One weakness of this study is that most of the studies used did not ask the subjects directly about pregnancy, though one of the abstinence-plus programs used found that there were no difference in pregnancy rates before and after the program was implemented. However, abstinence-plus programs found a positive correlation between the implementation of abstinence-plus programs and usage of condoms at a higher instance than when compared to the correlation of the implementation of abstinence-only programs and condom usage, indicating an increase of contraceptive use and knowledge when abstinence-plus programs are implemented, which can be coincided with decreased pregnancy rates.
Authors Marianne Chevrette and Haim Abenhaim performed a cross-sectional study on state-based policies on sex education and teenaged abortion rates in the United States in their article “Do State-Based Policies have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States?.” In their study, they performed a retrospective cross study on all teenagers who were aged fifteen to nineteen who had a delivery in 2008 and compared the teens based on every state’s policy on how sex education is taught in that particular state. Twenty-eight out of fifty states are required to teach abstinence-only as either the only or main method in order to prevent pregnancy and STD-transmission, and in thirty-three states, education about contraceptive use either is not in policy or is not covered in the state’s sex education program at all. In their findings, two independent variables were identified to correlate with teen birth rates: whichever political party is dominant within the state, and the proportion of white teenagers populating the state. In states with more Republican dominance and a lower percentage of white teenagers tend to have a positive correlation with higher rates of teen births.
Kathrin Stanger-Hall and David Hall analyze the relationship between sex education and teen pregnancy rates and abortion in their article “Abstinence-Only Education and Teen Pregnancy Rates: Why we Need Comprehensive Sex Education in the U.S.” In their study, they pulled data about sex education from the Education Commission of the States and collected data on teen pregnancy, birth, and abortion rates from recent national reports to determine if there was a correlation between abstinence education and teen pregnancy and birth rates. Data on other factors related to teenage pregnancy were also collected. In their results, out of the forty-eight states that data was collected from, twenty-one states stressed abstinence-only sex education, and those states that stressed abstinence more were correlated in having higher teen pregnancy rates than the states that stressed comprehensive sex education. The study also found that other factors such as socioeconomic status and ethnic composition had significant correlations in teenage pregnancy rates.
The research done on how sex education method affects teenage pregnancy is not entire conclusive; while there were multiple studies that found that comprehensive sex education contributed to increased knowledge of contraceptive use, there were no studies that made definitive conclusions that demonstrated a direct correlation between what type of sex education is stressed and the rate of teenage births within the United States. On the contrary, while there were some minute positive differences in teen birth rates between states that stressed abstinence-only and states that stressed comprehensive sex education, the studies also addressed the fact that factors that affect teen pregnancy rates did not just include sex education itself, but also factors such as socioeconomic status, ethnic composition, and educational level. In terms of socioeconomic status, Stanger-Hall and Hall found a significant negative correlation in socioeconomic status and rates of teen pregnancy across the states, also finding that rates of teen pregnancy were significantly higher in lower-income states. While there was no significant correlation between education level and teen pregnancy rates, they did find that education level did have a significant correlation with teen birth rates, as teens with a higher level of education were more likely to receive an abortion than those who did not have a high education level (Stanger-Hall, Hall, 2011). Some strengths of the research done is that the data is not extremely difficult to collect when looking at past data to form inferences about trends about teen pregnancies and such. With the data readily available from national reports and government databases, the data from these studies are reliable to be used to form conclusions. Some weaknesses, for example, is that in Stanger-Hall and Hall’s article, they found a correlation between the type of sex education taught and rates of teenage pregnancies, other studies used in this research were not able to conclusively identify a correlation. Also, the purpose of their paper were biased towards comprehensive sex education, which would contribute to skewing the interpretation of data found in order to support their views on the clinical problem. Another weakness found is that while there was a study done that followed teens in teenage pregnancy prevention programs, most studies that were used did not ask directly about pregnancy rates or followed up with the subjects into adulthood (Bennett, Assefi, 2005).
Proposed Research Design
The purpose of this proposed research design is to determine whether comprehensive sex education or abstinence-only sex education is more effective in educating the target sample population in protecting themselves from teen pregnancy in the long-term, with the hypothesis of: participants who were introduced to sex education through comprehensive sex education is less likely to experience higher rates of teenage pregnancy than those were introduced to abstinence-only sex education. The participants of this study will be a sample of at least 100 adolescent students who are aged ten through 11, whose responses will be collected each year until they turn the age of twenty-one where they would then be considered legal adults. The participants would be selected randomly from different schools throughout the state. After the participants are chosen, the participants will be separated into two groups: one group will be educated about sex through the method of teaching comprehensive sex education, while the other group will be educated on abstinence-only sex education. The type of study this would be is a longitudinal cross study, where the researcher would be able to follow the subjects of the study through the long term. By this being a longitudinal study, the research would be able to collect surveyed data from each subject on various subjects such as their age of when they first started having sex, how often they use contraceptives and what type, and if they are or are expecting to become teenage parents. The researcher can then compare answers throughout the study until the subjects are twenty-one years of age and then compare their answers based on whether they were sorted into learning about comprehensive sex education or abstinence-only sex education. Protections will be provided to the participants by having the participants’ parents sign a form of consent for their children to participate in the study each grade year until they reach the age of eighteen, since when the study begins the participants are minors. Also, the participants will be debriefed on what they are going to be taught but not debriefed on what the purpose of their study will be as it may give bias to each side depending on the participants’ personal beliefs about sex education. Strengths of this research design is that the longitudinal set-up will allow for the researcher to be in contact with the participants for the long-term until they are twenty-one, giving them the chance to collect data of their sexual and reproductive activities throughout their adolescent years in order to form inferences on how students understand and absorb the sex education given to them. However, a weakness of this study is that parents of the participants may withdraw their children out of the study based on which group the child got sorted into and how the parents personally believe in children being taught sex education, which can hinder the sample size.
Synthesis and Recommendation
Looking at all of the evidence provided on the correlation between method of sex education and the rate of teenage pregnancies in the United States, while the evidence does answer the question incompletely, the evidence results in opening up more exposure to factors that contribute to this phenomenon. However, the evidence does help educate the health professional in knowledge about what affects teenage pregnancy and how sex education affects people’s knowledge on how to protect themselves from not just teenage pregnancy while they are adolescents but also from transmitting sexually-transmitted diseases to themselves and other potential partners that can harm their wellbeing in the long run. The evidence does not provide direct recommendations to change practice, but it does help open up discussion on important factors that contribute to increasing rates such as socioeconomic status, that while not related to the health field, can still addressed to improve the situation. There is not a support for recommendations because this clinical question also has to consider multiple variables that may or may not be able to be changed in the health education field. Some recommendations that can be made to help facilitate change in the clinical question would be to participate in more longitudinal studies on adolescents based on what type of sex education they receive, because this initial contact of sex education will affect how their attitudes towards sex and can possibly affect their future sexual habits. Another recommendation that can be made is to gather more data on how teenage pregnancy affects those affected and gather more data on how the subjects feel about the education they are receiving, as their input can help lead to changes that will further benefit the initiative to help decrease the pregnancy rate in the United States.
There is no definite answer on how to combat teenage pregnancy rates, unfortunately. However, there are ways to help educate adolescents on how to protect themselves from learning incorrect information about sex and reproductive health that is often handed down by educators as a method of fear mongering to convince students to abstain from sex. The best way to help teach adolescents how to have safe sex is to be informed about how sex works. There are factors that are unavoidable, such as the ethnicity of someone or their socioeconomic status that they were born into, and that also has to be addressed in order to tackle teenage pregnancy. Teenage pregnancy is not caused by just one definitive thing, but changing one of the contributing factors can help lead to positive change. Sex education is just as an important subject for adolescents to learn as the Pythagorean theorem and the function of the mitochondria, as sex and reproduction is something that will follow someone for the rest of their lives no matter what path they take in life, and it is their right to know how to protect themselves and those they care about.
Bennett, S. E., & Assefi, N. P. (2005). Review articles: School-Based Teenage Pregnancy Prevention Programs: A Systematic Review of Randomized Controlled Trials. Journal Of Adolescent Health, 3672-81.
Centers for Disease Control and Prevention. (2017). Reproductive Health: Teenage Pregnancy. Retrieved from https://www.cdc.gov/teenpregnancy/about/index.htm
Chevrette, M., & Abenhaim, H. A. (2015). Do State-Based Policies Have an Impact on Teen Birth Rates and Teen Abortion Rates in the United States?. Journal Of Pediatric And Adolescent Gynecology, (5), 354.
Frank, F. (2016). Reconsidering Teenage Pregnancy and Parenthood. Societies, Vol 6 Iss 4 P 33 (2016), (4), 33.
Gardner, E. A. (2015). Abstinence-Only Sex Education: College Students’ Evaluations and Responses. American Journal of Sexuality Education, 10(2), 125-139
Millner, V., Mulekar, M., & Turrens, J. (2015). Parents’ Beliefs Regarding Sex Education for Their Children in Southern Alabama Public Schools. Sexuality Research & Social Policy: Journal Of NSRC, 12(2), 101-109.
Stanger-Hall, K.F., &Hall, D.W. (2011). Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S. Plos ONE, 6(10), 1-11.
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