The Expensive Failure of Abstinence Education

Last month's resignation of Wade Horn, former assistant secretary at the U.S. Department of Health and Human Services and point man for conservative social policy, came just as support was crumbling and mistrust mounting for a costly and, many would argue, unsuccessful initiative -- abstinence education.

"At this point we've spent more than a billion dollars on this program that was never proven in the first place," said Heather Boonstra, public policy analyst at the Guttmacher Institute, a research and policy organization specializing in reproductive health issues.

Horn left government in early April for a private-sector position at Deloitte Consulting LLP after heading the Administration for Children andFamilies (ACF), a division of HHS. There, Horn shepherded a host of contentious initiatives, for example: marriage promotion for poor women as an anti-poverty strategy, reduced access to higher education for welfare recipients, standardized testing of low-income preschoolers, programs to strengthen fatherhood by pushing matrimony and relationship skills, and chastity for 19- to 29-year-olds.
Many of these policies had come under fire over the years from members of Congress, feminists and advocates of low-income families -- increasingly so in Horn's final months at HHS. But it was Horn's approach to sex education, with its prime emphasis on virtue, that drew the most opposition and suffered the most discrediting setbacks in the form of political defection and unfavorable research findings.

"Abstinence-only"

Under Horn's leadership, abstinence education became "abstinence until marriage" or "ab-only" education, meaning that the curricula went beyond discouraging teen sex and instead targeted all sex outside marriage without explaining the preventive role of contraception. ("Abstinence-plus" education also discourages teen sexual activity but offers information on contraception and STD prevention.)

Last fall, a congressional report said abstinence-only education fed students false information about pregnancy and birth control, and in the last six months of Horn's tenure, six states announced they would no longer accept federal abstinence funds.

Then a study released in April found no evidence that abstinence-only programs deter sexual activity. Perhaps as a result of these events -- and most certainly due in part to a Democrat-controlled House -- funding for abstinence-only education will run out this summer without assurance of renewal.

"There seems to be increasing concern about spending money on abstinence-only education programs. We don't have evidence that they are successful," said Bill Albert, deputy director of the National Campaign to Prevent Teen Pregnancy. "Over the past four to six months, when a number of states decided not to take the abstinence-only money ... it felt like a sea change."

Albert added that surveys show Americans support teen abstinence but want teens to get information on contraception as well, which is not an option under the current ACF approach.

"The American public sees abstinence and contraception as complementary strategies. They do not see them as conflicting strategies," Albert said.

Nonetheless, abstinence-only education is not expected to die quietly, particularly when several years of federal largesse have nurtured and empowered a coterie of professional chastity activists.

"The legacy of Wade Horn has to do with building up an entire movement in abstinence-only education. There are associations, clearing houses and a medical institute" devoted to the cause, Boonstra from Guttmacher said. "It's not the end. They are fighting hard. It remains to be seen whether policymakers are going to listen to the evidence."

The growth of abstinence-only

Federal support for abstinence education -- and for that matter many of the policies administered by ACF under Wade Horn -- did not originate during the Bush presidency; in fact, many were created as part of the welfare reform package signed by President Clinton in 1996.

But since 2001, federal money allotted for abstinence education has risen from $73 million to $176 million currently.
These amounts fall short of the total money spent, however, since they don't factor in matching state funds.

HHS administers three large abstinence programs, with the majority of the money going to two funding streams at ACF, one of them to states and one directly to abstinence organizations. While funding for the states has remained at consistent levels (the median grant to states is estimated at $569,000), direct funding to community-based abstinence programs, which began under Horn's tenure, has risen dramatically. Initial funding was $20 million in 2001 and $104 million by 2005, with the median grant at $642,000. (A Washington Monthly article in 2002 referred to abstinence funding as "pork for prudes.")

The recent study that called these programs into question found that young people in abstinence-ed programs were no more likely to refrain from sex than their counterparts in a control group. The study was conducted by Mathematica Policy Research Inc., and it tracked the behavior of more than 2,000 youths in four different regions of the country over a four- to six-year period.

Expanding the reach of abstinence-only
From the start of the Bush administration, ACF sought to expand the reach as well as the coffers of its abstinence initiative, making it increasingly inflexible and prohibiting states from applying the money toward programs that discuss contraception alongside abstinence (except to highlight condom failure). But restrictions further tightened in 2006, when ACF required abstinence programs to embody all, rather than just a portion of, the fed's eight principles of abstinence education, including the belief that premarital sex is psychologically harmful and that marriage is the expected standard of human sexual activity.

The eight points of an abstinence program served as the key criteria for review by ACF when awarding hundreds of millions of dollars in grants; meanwhile, the scientific validity of the information presented in the programs was not examined, according to a congressional report last fall. The report, "Abstinence Education: Efforts to Assess the Accuracy and Effectiveness of Federally Funded Programs,"was released in 2006 by the Government Accountability Office.

The report concluded that ACF made no effort to ensure the accuracy of claims by abstinence programs and that the programs spread false information as a result. For example, according to the report, one program taught that condoms are porous and allow the HIV virus to pass through them.

More setbacks

The GAO report, however, was only one of many setbacks to abstinence-only education. Another was the gaffe that occurred last year when ACF clarified that federal abstinence-education money should target people in their 20s and not just teens. Foes were quick to point to the futility of such an effort, citing government figures that more than 90 percent of adults ages 20-29 have had sexual intercourse.

"This idea that you're going to promote abstinence for people age 20-29 is simply unrealistic," said Stephanie Coontz, director of research and publication education at the Council on Contemporary Families. "This was a total capitulation to the wing of the movement that believes that any sexual relationship outside of marriage is immoral and must not be allowed."

By March of this year, six states had declined HHS abstinence-only education altogether, citing the rigid restrictions and lack of evidence of success. Academic studies also drew attention to the nuances of chastity vows and their lack of effectiveness with older teens. In 2001, Columbia University professor Peter Bearman found that younger teens who took a pledge to remain chaste until marriage, presumably a highly committed cohort, delayed sex by a year to 18 months. However, a followup study in 2005 showed that 88 percent of these same youths eventually broke their vows.

Marriage as the new social policy

In addition to abstinence-only education, Horn likely will be most known for his advocacy of marriage and his success in introducing marriage as social policy. At ACF, Horn oversaw a lucrative funding stream to promote marriage and teach marriage skills, which have been funded for a five-year initiative to the tune of $100 million in grant money every year. First-year funding was awarded last year.

Marriage promotion originated as a faith-based policy to promote a moral lifestyle, but it also drew support from economic conservatives who argued that marriage could relieve poverty and curb social problems such as crime and educational underachievement.

Feminists and sociologists challenged this idea on a number of grounds, saying that repeatedly telling poor women that marriage is the answer to their problems could influence them to stay in abusive relationships. Economists have also pointed out that poor women often have few marriage prospects because the men in their communities are more likely to be in jail or in low-wage jobs.

"Lack of marriage is not so much the cause of poverty as it is a result of poverty," Coontz said, adding that in promoting traditional matrimony, Horn's policies failed to address the full spectrum of families that are increasingly the norm in America.

"I think it's important to help people have good marriages, but we need to recognize in the real world, where so many kids are born out of wedlock and almost half of all marriages end in divorce, that it's wishful thinking and dangerous to put all your eggs in one basket," she said. She added that some of the marriage grants have gone to self-proclaimed relationship experts who lack appropriate qualifications.

Follow the money

Jennifer Tucker, the vice president of the Center for Women Policy Studies, was especially blunt about the spending issues related to marriage policy. What is most objectionable about it, she said, is that it hijacks funds intended for poverty relief to programs that target the general public. Further, she added, marriage is becoming entrenched social policy, with four more years of funding ensured.

Tucker calls marriage programming, "the biggest social program we have," one that has grown more robust as welfare has diminished.

"Marriage is now just getting in there. I think it's now hitting its stride," Tucker said, citing six state legislatures that in the last year passed their own marriage programs, apparently inspired by the federal example. "It's hard for policymakers to speak out against marriage right now."

Meanwhile, she noted, a cottage industry of marriage experts and relationship skill experts has been created and nurtured by federal spending -- by the same people who claim to dislike fiscal profligacy.

"Welfare is big government. Well, this is big government, too," Tucker said.

Generous on virtue, stingy on welfare

Not surprisingly, the legislation that lavished money on many of the virtue-based programs that Wade Horn administered -- that is, welfare reform in 1996 -- has proven parsimonious when it comes to supporting welfare.

Last year, for example, single mothers receiving welfare who were pursuing four- or, more likely, two-year degrees, were largely ordered to abandon their studies. The change was a result of new ACF restrictions that increased the number of hours required at menial jobs in order to comply with a work-first mandate.

In the past, states had used a variety of measures to allow welfare recipients to continue their studies, but new federal rules put an end to state flexibility, thus postponing higher education for many women who were seeking a better life for their families. Without at least a two-year degree, low-income single mothers are much less likely to command a livable wage and health benefits upon leaving welfare, making economic self-sufficiency that much more elusive.

"This is just mean-spirited," Tucker said.

Father superior

While welfare reform, marriage promotion and abstinence-only education drew headlines, another Horn initiative went largely unnoticed. Horn's effort to improve fatherhood in America, which had just been funded at $50 million annually for five years, met criticism shortly before his resignation. The National Organization for Women filed a complaint with HHS in March, charging that some fatherhood grant recipients provided educational opportunities and employment services to men only and were thus discriminatory.

The fatherhood initiative also was criticized for favoring programs that focused on marriage -- Horn's true priority -- rather than responsible parenting. In addition, Horn's office awarded a $1 million fatherhood grant to the National Fatherhood Institute, which he founded and ran from 1993-2001 before joining the Bush administration, sparking complaints about cronyism.

Horn also met resistance in his requirement of standardized testing of low-income preschoolers enrolled in Head Start. The testing, which began in 2003, was widely criticized by researchers and teachers as unnecessary and inappropriate, according to Sarah Greene, president and CEO of the National Head Start Association. With so many varieties of children's backgrounds represented in Head Start, including non-English speakers, a single test was considered unworkable, Greene said.

Behind the testing dispute was a greater fear, however: that of reducing or eliminating Head Start. While that fear eventually subsided, and Horn recently restructured Head Start for the better, Greene said, his early years left many of the program's teachers and advocates feeling threatened, and with good reason.

"Initially the first announcement of the assessment was threatening. It said that, based on certain lack of outcomes, the actual contract of the grant could be terminated," Greene said. The test came to be perceived as a way to shut down a Head Start or fire a teacher. Currently, legislators in both the House and Senate have launched efforts to end standardized testing in Head Start.

Unlike with Head Start, it's not likely that recent changes in Congress or even a new administration could easily wash away Horn's footprint on the issue of marriage policy, which appears to be entrenched at the federal level and making its way into the states. Time and political wherewithal will answer the question of whether abstinence-until-marriage and abstinence-only remain federal policy.