Human Rights

Excerpt: The Anti-Abortion Paradox

Pro-life tactics have actually helped encourage abortions and have led to riskier sex, especially among teens.
(Editor's Note: this is an edited excerpt from Cristina Page's new book, "How the Pro-Choice Movement Saved America," reprinted with permission from Basic Books, 2006.)

For the most part, pro-lifers tend to be absolutists. For them, you are either churchgoer or sinner, procreator or contraceptor, for the culture of life or for the culture of death. Pro-choicers, by contrast, tend to be more pragmatic.

For the pro-life movement, decision making is less complicated. For the unmarried, the right course is abstinence (which we'll discuss later). And for everyone, single or married, the right course never, ever leads to abortion. Unfortunately, if the goal is to reduce abortion, the pro-lifers' morally unambiguous strategies don't seem to work.

To begin with, criminalizing abortion may be a sacred pro-life goal. But in practice, bans have failed to curb rates of abortions. Many countries that have outlawed abortion have higher abortion rates than countries where abortion is legal. Brazil, Chile and Peru -- in which the predominant religion is Catholicism -- are among these. (It's worth noting that the Catholic Church wasn't always pro-life. Until 1869, it supported legalized abortion until quickening, at approximately 19 weeks of pregnancy, which is when it considered the fetus was given a soul.) The truth is that if abortion is outlawed, women don't seek services less frequently; they just survive them less often. This has been true in the United States (when abortion was illegal) as well as in many countries abroad today.

And it's not just pro-choice women who seek abortions, and it never has been. Most people would be startled to learn that even today, when battle lines are drawn, 40 percent of women who have abortions in the United States are Evangelical Christian or Catholic. They are your average morality voter, your above-average churchgoer. In all likelihood, they call themselves pro-life. Even though the great wish of pro-lifers is to cast those seeking abortions as irresponsible daters, the actual statistics are more forgiving. The majority of women in the United States (61 percent) having abortions are already moms.

Unable so far to criminalize abortions in the United States, the pro-life movement has taken up a strategy of incrementalism. It has strived to delay abortions, placing hurdle after hurdle in their way. The result has been, even by pro-life definitions, perverse. After all, the net effect hasn't been to stop abortions, but to postpone them until the fetus is more developed and the woman is at greater risk. This strategy is carried out even if it means forcing a woman to have one of those dreaded late-term abortions. Indeed, some of the later-term abortions -- "partial-birth abortions," as the pro-life side labels them -- no doubt occur as a result of campaigns waged by the pro-life movement.

Let's take a look at how this works. One favorite pro-life strategy is to pass laws that require a waiting period before a woman can obtain an abortion. Twenty-three states have enacted what are called "mandatory delay" laws; all are coupled with mandatory-counseling laws that typically require abortion clinics to dispense information designed to dissuade women from having an abortion.

Once a woman receives the counseling, she must wait, usually 24 hours, before she can obtain the abortion. The 24-hour wait may seem inconsequential, but the effect on real lives is considerable. The series of small barriers often means scheduling two days of missed work or missed school, traveling long distances twice -- don't forget, 87 percent of U.S. counties don't have an abortion provider -- and paying to stay overnight in a hotel.

In fact, the statistics show that the mandatory delays postpone the procedure much more than 24 hours. A study of the Mississippi experience found that after August 1992, when the delay law took effect, 53 percent more women had abortions in the second trimester.

In Minnesota and Missouri, after these states enacted parental-consent laws, second-trimester abortions among teens increased in both states, by 18 percent and 27 percent, respectively.

Another barrier to early abortion is money. Here again the pro-life side has assiduously erected hurdles. The Hyde Amendment, named for its sponsor, Republican congressman Henry Hyde, bans the use of public funds for abortion, meaning that poor women who rely on Medicaid to pay their health bills can't get this governmental insurance program to pay for an abortion. Indeed, half of women who had an abortion after 16 weeks say pro-life restrictions were the cause, including needing time "to raise money" to pay for the procedure.

In the war of words, these kinds of outcomes may provide a strategic advantage to pro-lifers. The pro-life side is able to say that it quite reasonably favors involving parents in this important decision, and it endorses a mere 24-hour waiting period for reflection. In reality, these small barriers have a significant effect, not in reducing the number of abortions, but in creating more later-term abortions. It is perhaps convenient for pro-lifers who, it seems, prefer to rail against late-term abortions rather than prevent them.

Despite wide acknowledgment that with abortion, earlier is always safer, for more than a decade the pro-choice movement had to fight staunch pro-life resistance to the abortion method that allows women to end a pregnancy at the earliest moment. That method is medication abortion. Commonly known as RU-486, it is available in more than 29 countries. For decades, millions of women worldwide have used it safely. In the United States this method is called Mifeprex. (The French manufacturers of RU-486 were unwilling to distribute their product in the United States for fear of pro-life violence, so it is distributed by a new company formed for the exclusive purpose of marketing the drug in the United States.)

With all other methods of abortion, a woman must wait approximately seven weeks after her last menstrual period. But Mifeprex, which depends on the action of a pill rather than a surgical intervention, allows women to end a pregnancy as early as four weeks after her last menstrual period (usually meaning she's really only two weeks pregnant). At this stage, the embryo is about the size of the letter "T" as it appears here on this page.

In 2000, after years of struggle, the pro-choice movement succeeded in getting Mifeprex considered by the FDA, which, after extensive review, approved it for distribution. A sad footnote to the pro-life movement's success in keeping Mifeprex out of the United States for years is that U.S. doctors were prevented from studying its other potential uses, like treating many of the most fatal forms of cancer. (As long ago as 1993, the Institute of Medicine of the National Academies of Science, the government's scientific advisers, released a report on the potential life-saving medical uses of RU-486, stating, "Potential benefits of RU-486, other anti-progestins are extensive.")

Today, U.S. medical researchers are making up for lost time, exploring Mifeprex's potential in treating breast cancer, Cushing's syndrome, endometriosis, glaucoma, meningiomas, ovarian cancer, prostate cancer, uterine fibroids, brain tumors and even bipolar depression. With breast cancer alone, it is believed that Mifeprex presents the opportunity to treat 40 percent of all tumors.

Unfortunately, this new research may never reach fruition. The proposed RU-486 Suspension and Review Act of 2005, legislation that originated in the offices of the pro-life Concerned Women for America, would remove this earliest abortion method from the market indefinitely. The reason for wanting a ban, say pro-life groups, is that this simple medication is unsafe. With pro-life groups, supposed "safety" concerns have become one typical way to advance an ideological agenda.

After all, the facts suggest that this early abortion method is extremely safe. Of more than 350,000 American women who have used this drug since 2000, less than 1 percent have had a complication. The likelihood of death resulting from a medication abortion is 0.00085 percent, or less than 1 in 100,000. Compare this to the risk of dying during childbirth, which is 1 in 2,500.

In the case of Mifeprex, it's difficult to see the pro-life concerns with safety as anything but a political ploy. Abortion is one of the safest medical procedures performed in the United States, with less than 1 percent risk of major complication, though, as the pro-life movement well knows, risks do escalate later in pregnancy.

The pro-life movement does have a solution for unwanted pregnancy. It is like the "just say no" campaign against drugs -- the monumentally unsuccessful program of a previous fundamentalist president. The pro-life movement argues, "Just say no to sex until marriage." (This ignores the fact that many abortions, just like unwanted pregnancies, happen to married women too -- nearly 1 in 5 women having an abortion in the United States is married. But put that aside for a moment.) Abstinence for the unmarried may sound like a lovely solution. Clearly, in the religious-tinged, pro-life view, it's more than a solution for the abortion problem. It's an admirable alternative lifestyle, one in which only those who are married have sex, and the sex they have is with the goal of creating a family. Nearly $1 billion in federal and state matching funds has been spent since 1996 on programs that promote chastity until marriage; these programs are directed mainly at teens.

Promoting abstinence has been deemed so important to some that, in the service of this cause, it's been deemed OK to fill kids' heads with half-truths and even untruths. Abstinence programs have at times equated sex with disease, depression and death. Some programs have even tried to convince kids that condoms don't work, so that abstinence seems their only option.

The problem is that abstinence programs don't work. Like many pro-life initiatives, they backfire. Take, for instance, virginity-pledge programs, a main type of abstinence-only program. They are a colossal failure. In these programs, kids publicly promise to stay chaste until marriage

These programs, it should be acknowledged, do lead teens to abstain from intercourse for, on average, 18 months longer than teens not in similar programs. And that's impressive. In the teen years, 18 months is a big chunk of time. Yet, it's worth noting, those 18 intercourse-free months are a special time and not exactly what the pro-life sponsors had in mind. A major study of some 2,500 "virgin pledgers" showed that the kids who pledge to abstain from having intercourse don't abstain from sex. They just have other kinds of sex. Virginity pledgers have porn-star sex (though porn stars appear more likely to use protection). These "virgins" are six times more likely to have oral sex than nonpledgers, and male "virgins" are four times more likely to have anal sex than those who do not take the pledge.

In Minnesota, the Department of Health commissioned a study of the state's Education Now and Babies Later abstinence-only program. Alarmingly, it found that at three schools sexual activity actually doubled among junior high school students after they participated in the abstinence program. It was as if the program acted as an aphrodisiac. Within just one year, the number of participants who said they would "probably" have sex during high school nearly doubled as well. With the exception of some promising effects on parent-teen communication, the study found no positive impact of the program on teen sexual behavior.

The truth is that half of all teens between 15 and 19 are sexually active in the United States. Whether kids attend abstinence-only programs or not, they appear equally likely to have sex.

[But] it hardly seems likely that an alternative strategy will emerge from the federal government, now run by the abstainer-in-chief. Before George W. Bush took over the presidency in 2000, he had already sunk large sums of public monies into abstinence-only programs. As governor of Texas, he'd spent $10 million on such programs. Yet today, Texas is one of the more dangerous places in the country to be uneducated about safe sex. Texas has the fourth-largest population of people living with HIV/AIDS in the United States.

Despite the high stakes and hefty sums, Texas managed to keep most of its students in the dark about protection. Few, for instance, seemed to know about the effectiveness of condoms. Indeed, Texas students reported to Human Rights Watch investigators reviewing the programs that they were completely unaware of how to protect themselves against STDs other than abstinence. One 16-year-old Texas girl concluded, "I don't know any other way but abstinence to prevent HIV." Another teen, when asked whether he had learned how to prevent HIV, replied, "Other than abstinence? No."

By the end of Bush's term as governor in 2000, Texas ranked dead last in the nation, 50th out of 50, in the decline of teen birthrates among 15- to 17-year-old females. (Overall, the teen pregnancy rate in Texas during Bush's term as governor was one of the highest in the nation, exceeded by only four other states, including Florida -- which his brother governed using the same approach.)

Worse, the administration has attacked programs that actually work -- in particular, if it deems the ideology suspect. Indeed, the Centers for Disease Control and Prevention (CDC) had a batch of curricula in what it called "programs that work," which were scientifically proven effective in reducing risky sexual behaviors "that contribute to HIV and other STD infections and unintended pregnancy." Unfortunately, they were comprehensive sex-ed curricula; none were abstinence-only. At the request of "higher-ups" within the Bush administration, in 2003 the CDC removed all information about these "programs that work" from its website.

Instead, the CDC was directed to contemplate the wisdom of abstinence. According to the Union of Concerned Scientists, top staff scientists at the CDC were required to attend a daylong session on the "science of abstinence." As one scientist who left a high-ranking CDC position reported, "Out of the entire session, conducted by a nonscientist, the only thing resembling science was one study reportedly in progress and another not even begun." Although there were no data showing abstinence-only was an effective message, CDC scientists were "regularly reminded to push the administration's abstinence-only stance."

Not content to stop there, the administration decided to deliver its message more forcefully. In 2004, OMB Watch, a watchdog group that monitors the decisions of the White House Office of Management and Budget, published two reports on intimidation by the Bush administration against those who made the mistake of championing comprehensive sex education for teenagers.

Take Advocates for Youth, a national group that favors comprehensive sex education. In 2001, the Washington Post published a leaked email from the Department of Health and Human Services (HHS) in which Advocates for Youth was described by the agency as "ardent critics of the Bush administration." What the group's president, James Wagoner, had said in the summer of 2003 was that abstinence-only programs "censor young people's access to information about the health benefits of contraception." Soon after Wagoner's statement, his organization, which had received federal funding for 15 years, was hit with its third HHS audit in a single year. The two previous audits had found no wrongdoing. As Wagoner notes, "If they can't bury our heads in the sand about abstinence-only, they're going to try to bury our organizations in audits." The Sexuality Information and Education Council of the United States (SIECUS), another national comprehensive sex-education group, was audited three times in 2003. As with the other audits, no wrongdoing was found.

Lately, the abstinence movement is often the pro-life movement acting as federally sanctioned "educators." As such, they have unfettered access to our kids to promote inaccurate, flawed lessons. Focus on the Family is one of the pro-life groups behind the no-sex-until-marriage movement. Its founder, Dr. James Dobson, has called sex the "hydrogen bomb that permits the destruction of things as they are and a simultaneous reconstruction of the new order."

Starting in 1992, Focus on the Family ran an ad titled "In Defense of a Little Virginity" in more than 500 newspapers in the United States. Though it's difficult to know what a "little" virginity is, the group's strategy was to promote it as a positive, spiritually restorative cause. In doing so, it not only pushed a positive message of spiritual and sexual redemption but, inevitably, attacked sex outside of marriage as both sinful and unsafe. Indeed, much of its energy seemed to go toward a fire-and-brimstone appeal designed to convince people that safe sex was a dangerous myth.

Comprehensive sex educators were derided as "condom promoters," and condoms were attacked as meaningless protection, a devilish trick of the condom pusher. To "prove" this claim, the group's ads distorted the facts. The ad cited a study of latex, and noted that the AIDS virus is small enough to pass through tiny gaps in the material. What the ad didn't say was that the study was of latex gloves, which are very different from latex condoms. Condoms are double-dipped in latex. And in any event, according to a study cited by the CDC, a condom (even of the poorest quality) reduces the chance of exposure to the AIDS virus 10,000 times compared to using nothing at all.

The Abstinence Clearinghouse is an offshoot of the pro-life movement that refers to those who believe in comprehensive sex education as the "safe sex cartel" and "condom pushers." Its mission is "to promote the appreciation for and practice of sexual abstinence (purity)" through distribution of abstinence-only publications. Its website boasts a "medical advisory board" composed of health professionals who will not prescribe contraceptives to unmarried teens. Abstinence Clearinghouse founder Leslee Unruh has close ties to the pro-life establishment. She spent most of the '80s protesting outside abortion clinics and encouraging people to protest outside the homes of physicians who provide abortions. She also started a "crisis pregnancy center" in Sioux Falls, S.D., about which there were so many complaints that the governor had her investigated. Unruh pleaded no contest to unlicensed adoption and foster care practices as part of a plea bargain in which 19 charges, including four felonies, were dropped. The charges resulted from Unruh's promises to pay teenagers if they remained pregnant so she could put their babies up for adoption. Tim Wilka, one of the state's attorneys at the time, explained, "There were so many allegations about improper adoptions being made [against her] and how teenage girls were being pressured to give up their children," he says. "Gov. George Mickelson called me and asked me to take the case."

Despite the wealth and abundant political connections of the pro-life movement's abstinence-only wing, the majority of the American public do not want their children taught abstinence-only. According to a 2004 poll conducted by National Public Radio, only 30 percent of American adults believe that the government should fund programs in which "abstaining from sexual activity" is the exclusive message. Sixty-seven percent believe "the money should be used to fund more comprehensive sex education programs that include information on how to obtain and use condoms and other contraceptives."

Not only is the federal government sanctioning abstinence-only education against most parents' wishes, but it refuses to even review the contents of the programs. We know the programs don't work. What few know is that as long as educators claim to teach abstinence, they can pretty much teach whatever they like.

When in 2004 a report titled "The Content of Federally Funded Abstinence-Only Education Programs" examined these programs, the results were startling. More than 80 percent of the abstinence-only curricula, used by more than two-thirds of federal grant recipients in 2003, contained false, misleading or distorted information. Students have been told that "5 percent to 10 percent of women who have legal abortions will become sterile"; that "premature birth, a major cause of mental retardation, is increased following an abortion of the first pregnancy"; that "tubal and cervical pregnancies are increased following abortions"; and that "women are more prone to suicide [after abortion]." No research supports these claims.

The congressional report revealed that "erroneous statements are presented as proven scientific facts." For instance, one abstinence-only curriculum claims that the "theory" that condoms help prevent the spread of STDs "is not supported by the data." That same curriculum tells kids that "in heterosexual sex, condoms fail to prevent HIV approximately 31 percent of the time." It also falsely -- why not? -- lets kids know that the exchange of "sweat and tears are risk factors for HIV transmission." One can only imagine how traumatic P.E. class is once you've been told that. The report concluded that "although the curricula purport to provide scientifically accurate information about contraceptive failure rates, many exaggerate these failure rates, providing affirmatively false or misleading information that misstates the effectiveness of various contraceptive methods in preventing disease transmission or pregnancy." Why, in other words, use a condom when you've been taught that pregnancy will occur one out of every seven times you do? Or that HIV will be transmitted one out of every three times?

Also alarming in the abstinence-only curricula is the subtle and not-so-subtle view of women that is communicated. The pro-choice movement has struggled, and largely succeeded, in convincing a generation of women that they can be professionals and self-supporters as well as mothers. Abstinence-only curricula inform their young students, male and female, that women need "financial support," whereas men need "admiration"; "women gauge their happiness and judge their success on their relationships," whereas "men's happiness and success hinge on their accomplishments."

Pro-life groups have used their access to kids via abstinence programs not just to scare them about birth control and abortion but also to recruit them to the pro-life cause -- one curriculum calls a 43-day embryo a "thinking person" -- and to the cause of Jesus Christ. Thus, pro-life groups, now reborn as pro-abstinence groups, are using taxpayer dollars for religious indoctrination, focusing on the most impressionable people: children. In fact, proselytizing appears to be the underlying objective of many abstinence-only programs. In 2002, a federal judge ruled that the Louisiana governor's Program on Abstinence had illegally provided funding to organizations that were advancing religion. Evidence included an abstinence group that claimed its program focused on the "virgin birth," maintaining that "God desires sexual purity as a way of life." The group also stated in a monthly reporting form that "there were several young people who did not know about Joseph and Mary nor how they live for God." Another group requested money from the state to purchase Bibles for participants. Still another group used state money to hold prayer rallies outside abortion clinics. According to the terms of the settlement, the Louisiana governor's program agreed to cease using public dollars to advance religion in any way. But in 2005, the program was charged with contempt because many of the abstinence-only programs continued to promote religious doctrine.

The Silver Ring Thing, a national abstinence-only group, received more than $1 million in public funding from 2003 through 2005. Its mission was to saturate the United States with a generation of young people who had taken a vow of sexual abstinence until marriage. To symbolize their vow, teens agreed to wear a specially inscribed silver ring -- the inscription is a biblical verse. A complaint brought against the Department of Health and Human Services and the agency within it that oversees grants to abstinence-only programs charges that the federal government, by funding the group, improperly used public money to promote religion. The complaint states, "The Silver Ring thing is a ministry that uses abstinence education as a means to bring 'unchurched' students to Jesus Christ."

In a British Broadcasting Corporation (BBC) documentary, American Virgins, Silver Ring Thing executive director Dennis Pattyn explained what motivates him. "I believe that the end of the world is approaching very quickly, and I believe that Christ will come back," he said. The BBC reporter seemed surprised. If the end of the world is so close, then should we be all that worried about abstinence? Pattyn didn't miss a beat. "We're not really putting our energy into abstinence as much as we're putting it into faith," he explained. "Abstinence is the tool that we're using to reach children." For those looking for considered answers on how to navigate the sexual pressures of adolescence, you'd better buckle your seat belts. Sexual dalliance, like a failure to accept Christ, leads to a bumpy ride straight to hell, courtesy of taxpayer dollars. "In hell nonbelievers will be doomed to exist in unending torment with the Devil and his demons. … [N]onbelievers will spend eternity in agony," Silver Ring Thingers learn. If you have chosen to reject Christ, then your final destination will be the lake of fire. In August 2005, in response to the complaint over inappropriate use of taxpayer money, the Department of Health and Human Services suspended funding to the group.

Abstinence-only programs tend to have a regional concentration. School districts in the South are almost five times more likely than in the Northeast to teach abstinence-only. The evidence suggests that this may help create another crisis … for the South. After all, Southern states have the highest rate of new HIV/AIDS infections, the highest rate of STDs, as well as the highest rate of teen births. Whereas new cases of AIDS decreased or remained constant in the Northeast, Midwest and West in one recent period, the South experienced an increase. Of the estimated new AIDS cases in 2001, 46 percent were in the South. Seven of the ten states with the highest chlamydia rates, all of the states with the highest rates of gonorrhea and nine of the top ten states for syphilis rates are all in the South. So troubling was this trend that HIV/AIDS experts convened in 2003 to write "The Southern States Manifesto HIV/SIDS & STDs in the South: A Call to Action." They opened their document mincing no words: "There is an emergency under way in the Southern states of the United States. There is a pressing need to address the unique epidemics of HIV, AIDS and STDs in the South and their disparate impact on Southern citizens."

What is so frustrating about the current vogue for abstinence-only programs is that we already know what works to combat the crisis of teen pregnancy (as well as the emergency of sexually transmitted disease, which is linked to it). In 2001, UNICEF conducted a survey of teenage birthrates in the industrialized world -- it wanted to figure out why some rich countries have teenage birthrates that are ten or 15 times higher than others. The United States ranks No. 1 for teen moms, far outpacing the rest of the industrialized world -- four times the European Union average and 60 percent higher than the rate in the United Kingdom, which came in second. In the 28 countries under review, there were 760,000 births to teenagers, two-thirds of which occurred in the United States. The United States is so bad in preventing teen pregnancy that it is the only rich nation smack in the middle of the Third World block for teen births -- ranking just behind Thailand and directly before Rwanda. Some countries have successfully reversed this trend. The Netherlands, for example, has reduced its teenage birthrate by a staggering 72 percent in 30 years while also having the lowest teenage abortion rates in the industrialized world. UNICEF reports, "In general, studies of the Dutch experience have concluded that the underlying reason for success has been the combination of a relatively inclusive society with more open attitudes toward sex and sex education, including contraception." A 1994 international conference called "Can We Learn from the Dutch?" concluded that young people in the Netherlands "feel comfortable discussing sexuality in a warm, mutually supporting atmosphere" in which "requests for contraceptive services are not associated with shame or embarrassment" and in which "the media is willing to carry explicit messages designed for young people about contraceptive services." The result is that teenagers who are having sex in the Netherlands see using contraception "as ingrained as not going through a red light." Interestingly, the Dutch approach has led not to a sex-indulgent teenage culture, but rather, as the report concludes, to a "higher average age at first intercourse."

Another country that successfully reduced its teenage birthrate is Sweden. UNICEF reports that beginning in 1975 Sweden "radically reviewed its school sex-education curriculum. Abstinence and sex-only-within-marriage were dropped. Contraceptive education was made an explicit part of the school curriculum, and a nationwide network of youth clinics was established to provide confidential advice and free contraceptives to young people." In the same year, the abortion law was changed to allow termination of pregnancy free of charge. The Swedes took a practical, nonjudgmental approach to their teenagers' sexuality, considering it "neither as desirable nor undesirable, but as inevitable -- this being the case, teenagers' use of contraceptives is viewed as highly desirable because it will prevent both childbearing and abortion." As a result of these changes, Sweden has nearly half the teen abortion rate than that of the United States (17.7 versus 30.2 per 1,000 teens). Unfortunately, there seems little chance that the United States will move in the direction of encouraging teens to use contraception, or implementing any of the other methods that have actually reduced teen pregnancies and, thereby, abortions. After all, the Bush administration not only likes to fund hell-fearing cheerleaders for abstinence but even puts them in charge. Under Bush's presidency, abstinence-only advocates have been rewarded with appointments to outlandishly inappropriate posts. Many of those appointments have been made to the powerful Department of Health and Human Services, initially run by pro-lifer Tommy Thompson, whose own political strategist described the department as "ground zero for the ideological wars in this country." One of HHS's crucial positions for women's reproductive health is the Office of Population Affairs, which runs the nation's Title X program. Title X's mission is to provide contraceptive services to low-income people and conduct research on teen sex issues.

Each year, approximately 4 million women rely on Title X clinics around the country for contraception. The vast majority of these women (71 percent) are unmarried. In 2002, Thompson put in charge of this program Dr. Alma Golden, who ran an abstinence-only group out of Texas. Much of Dr. Golden's lifework until then had been aimed at discouraging unmarried people from having sex. In her present position, she is charged with providing them with contraception. It would seem that Dr. Golden, and her abstinence-until-marriage philosophy, was chosen specifically to not lead the agency in its assigned mission.

It should come as little surprise that the Title X budget has remained stagnant, even though the number of patients it serves has swollen. The federal government currently spends nearly equal amounts of money promoting abstinence-only programs and the Title X program. Not surprisingly, Dr. Golden's most noteworthy acts in her position overseeing the office have been defending abstinence-only programs against the sea of evidence that they are ineffective.

Golden seems profoundly unsuited for her job, and the inevitable result no doubt is more teen pregnancies and more teen abortions. Perhaps this ought to trouble even pro-lifers. But the truth is that the abstinence-only set takes a different view. Once the virgin lapses, once the abstainer indulges, he or she might as well hurry off to the lake of fire. As a spokesman for the abstinence-only group True Love Waits explained, "If you're talking about a person who is not going to keep the [abstinence] pledge anyway, whether or not they would use contraception isn't really something that concerns us. Waiting is what we're striving for here."
Cristina Page is the author of "How the Pro-Choice Movement Saved America" (Basic Books, 2006).
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