In “No Surrender,” Bruce Springsteen sings: “We learned more from a three-minute record than we ever learned in school.” That may not be true for most subjects, but it crystalizes the impact of school-based teen pregnancy prevention classes—and raises serious questions about why we taxpayers continue to finance them.

The Good News

Recently, researchers at the Planned-Parenthood-affiliated Guttmacher Institute announced that teen pregnancies have fallen to their lowest level in 30 years. Since 1990, teen pregnancies have plummeted from 117 per 1,000 to just 45. That’s a drop of 62 percent in a generation. Now, compared with the rest of the Western world, the U.S. still has one of the highest teen pregnancy rates, a real problem. But that does not negate the fact that our rate is down by almost two-thirds in 26 years.

In addition, teens are more likely than ever to use contraception. During the 1990s, sexually active teens used birth control, mostly condoms, around half the time. Today the figure is 86 percent.

Abstinence Only?

During the Presidency of George W. Bush (2001-2009), Congress allocated almost $1 billion to abstinence-only school sex education classes, the idea that young people should just say no to sex until marriage. Social conservatives claim that abstinence-only sex education was a huge success proven by the falling rate of teen pregnancies nationwide.

However, University of Georgia researchers analyzed changes in teen pregnancies by state, and found that as states boosted their emphasis on abstinence-only sex education, teen pregnancy rates increased. Teens in states that taught about all contraceptive methods had much lower rates of teen pregnancy. Their conclusion: “Abstinence-only sex education is ineffective in preventing teen pregnancy and may actually contribute to it.”

Comprehensive Sex Education?

Meanwhile, social liberals claim that teen pregnancies have fallen because of comprehensive school or community-based sex education programs that (1) encourage delay of sexual initiation, (2) emphasize prevention of sexually transmitted infections (STIs), and (3) discuss all birth control methods, especially condoms because they’re easily available and largely prevent both pregnancy and STI transmission. This approach sounds persuasive—until you examine the research.

Recently, the prestigious American Journal of Public Health published a special supplement devoted entirely to evaluations of non-abstinence-only teen pregnancy prevention programs around the United States. The 15 studies evaluated roll-outs of programs that had appeared promising in previous pilot studies. The results were, at best, disappointing:

• Only two (13 percent) showed any decrease in teen sex or pregnancies—and those decreases were small, on the order of 2 percent.

• Two more (13 percent) showed equivocal results—no fewer pregnancies among white and African-American teens, but a slight decrease among Hispanic teens.

• Eleven (74 percent) showed that comprehensive sex education programs have no impact on teen sex, pregnancies, or STIs.

In other words, comprehensive sex education classes are pretty much a bust. But social liberals take their effectiveness as an article of faith. To show how ineffective school-based sex education is, I’ll briefly summarize the 15 new studies.

The two studies that showed a slight decrease in pregnancies in some teens:

• University of Louisville scientists evaluated a sex education program that enrolled 1,448 teens in 23 community-based programs in Louisville (e.g. Boys and Girls Clubs). After six months, participants were slightly less likely to have sex and slightly more likely to use birth control.

• A researcher at California Baptist University in Riverside compared pregnancies among teens in six school districts across Southern California—2,483 who took a comprehensive sex education class versus 1,784 who did not. Participants showed slight behavior changes—intercourse delayed a few months and a bit greater likelihood of using birth control.   

The two studies that showed equivocal results:

• Boston researchers evaluated a three-year teen pregnancy prevention program taught to 1,344 middle-school youth around Massachusetts. It had no impact on teen sex or pregnancies, except in Hispanic girls, who showed a slight decrease.

• University of Colorado researchers assessed the effectiveness of a text-message-based pregnancy prevention program on 852 members of eight Boys and Girls Clubs around Denver. After four years, there were no significant differences, except among Hispanic youth, whose pregnancies dropped 2 percent.

And the 11 studies that showed no benefit:

• Cambridge, Massachusetts, researchers evaluated a 12-month program attended by 1,808 teen girls at sites across Minnesota, Tennessee, and Florida. It had no effect on their sexual activity.

• The same researchers tracked 12-month outcomes among 2,689 high school students in 150 sex education classes in St. Louis, Missouri; Austin, Texas; and San Diego, California. Compared with youths who did not participate, the program ”was unsuccessful in changing sexual behavior.”

• The Cambridge group also evaluated a six-month sex education class aimed specifically at Hispanic youth—2,169 Latino teens who did or did not participate at schools across Arizona, California, and Massachusetts. Participants became more knowledgeable about STIs and birth control, but “these changes did not translate to improvements in teens’ reported sexual risk behaviors.”

• South Carolina researchers recruited 3,143 teens in 24 schools across the state who either did or did not participate in a comprehensive sex education program. After one year, the program showed no benefit.

• New Orleans researchers compared outcomes among teens who either did or did not participate in a sex education program over three summers as part of a jobs program. “We found no statistically significant difference in self-reported frequency of sex or condom use.”

• University of Texas researchers enrolled 1,437 Texas high school students in a pregnancy prevention program. After three school years, compared with controls who did not participate, there were “no differences in pregnancy rates.”

• Hawaii scientists surveyed the sexual knowledge and behavior of 2,203 students at 36 middle schools across Hawaii and then presented a culturally sensitive sex education program. After 12 months, students knew more, but the knowledge “did not lead to detectable changes in behavior.”

• Princeton researchers presented a sex education class at seven Chicago middle schools but not at seven others. After one school year, students who received the program knew more about STIs and contraception, but the two groups did not differ in sexual behavior.

• University of Chicago researchers presented a pregnancy prevention program to 1,455 students at 14 Indiana high schools. After a year, “no statistically significant differences were observed for reported sexual intercourse.”

• Scientists in Louisiana and Rochester, New York, the compared pregnancy rates of 5,739 teens who did or did not participate in a comprehensive sex education class. “We found no differences between the intervention and control youths on delay of sexual onset.”

• Finally, the largest study: Researchers around the country analyzed the Teen Outreach Program (TOP), one of the nation’s most popular teen pregnancy prevention efforts. They tracked 35,000 teens at 193 high schools in 190 cities in 35 states. After two years, “there was little evidence of effectiveness in reducing teen sexual risk-taking.”

The two studies that showed equivocal results produced benefits so scant that, for all practical purposes, they must be considered failures. So we have two studies showing that comprehensive teen sex education classes produce a slight decrease in teen sex and pregnancies (13 percent of trials), and 13 that show no persuasive benefit (87 percent). While abstinence-only sex education is a total bust, comprehensive sex ed is almost as worthless.

Who Deserves the Credit for Falling Teen Pregnancy Rates?

But since 1990, teen pregnancies have plummeted 62 percent. How is this possible? Because parents have become more willing to discuss sex with their children—and the kids listen.

I hasten to add that when my two adult children were teens, they seemed to ignore—or scoff at—everything my wife and I said. But a good deal of research shows that children pay close attention to what parents say about sex and to the behavior they model.

Sex is difficult to discuss with one’s children, and many parents don’t say a word. That’s why, starting in the late 1960s, comprehensive sex education was introduced into schools—because parents were so reluctant to discuss it. But in 1981, AIDS appeared, and for a decade, it meant almost certain death. As a result of AIDS, parents of the 1980s overcame their reticence and spoke up about contraception, particularly condoms, which prevent both pregnancy and HIV transmission. When our children were teens we told them that it was their decision when they became sexual, but that when they did, we would be happy to supply them with all the condoms and lube they needed.

Thanks to parental intervention, teens delayed first intercourse. During the 1980s, well over half of teens reported intercourse by high school graduation. Now the figure is less than half.

And thanks to parents, teen condom use is at an all-time high, and teen pregnancies have fallen to their lowest level in decades.

Compared with a generation ago, today’s teens are more likely to have parents who speak up about sexual responsibility. That suggests that when they become parents, today’s teens should also talk about contraception and STI prevention with their kids.

Instead of spending millions of dollars annually on sex education programs that produce little or no benefit, funding should go to programs that help parents discuss sex with their children—evening and weekend classes for parents.  

References:

Abe, Y. et al. “Culturally Responsive Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program for Middle School Students in Hawaii,” American Journal of Public Health (2016) 106:S110.

Barbee, A.P. et al. “Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial,” American Journal of Public Health (2016) 106:S85.

Boonstra, H. “Teen Pregnancy: Trends and Lessons Learned,” Guttmacher Policy Review (2002) https://www.guttmacher.org/gpr/2002/02/teen-pregnancy-trends-and-lessons....

Bull, S. et al. “Text Messaging, Teen Outreach Program, and Sexual Health Behavior: A Cluster Randomized Trial,” American Journal of Public Health (2016) 106:S117.

Calise, T.V. et al. “’Healthy Futures’ Program and Adolescent Sexual Behaviors in 3 Massachusetts Cities: A Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S103.

Finer, L.B. and M.R.Zolna. “Declines in Unintended Pregnancy in the United States: 2008-2011,” New England Journal of Medicine (2016) 374:843.

Francis, K. et al. “Scalability of an Evidence-Based Adolescent Pregnancy Prevention Program: New Evidence from 5 Cluster-Randomized Evaluations of the Teen Outreach Program,” American Journal of Public Health (2016) 106:S32.

Gelfond, J. et al. “Preventing Pregnancy in High School Students: Observations From a 3-Year Longitudinal, Quasi-Experimental Study,” American Journal of Public Health (2016) 106:S97.

Goesling, B. et al. “Impacts of an Enhances Family Health and Sexuality Module of the Health Teacher Middle-School Curriculum: A Cluster Randomized Trial,” American Journal of Public Health (2016) 106:S125.

Jenner, E. et al. “Impact of an Intervention Designed to Reduce Sexual Health Risk Behaviors of African-American Adolescents: Results of a Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S78.

Kelsey, M. et al. “Replicating “Reducing the Risk:” 12-onth Impacts of a Cluster Randomized Trial,” American Journal of Public Health (2016) 106:S45.

Kelsey, M. et al. “Replicating the Safer Sex Intervention: 9-Month Impact Findings of a Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S53.

Kelsey, M. et al. “Replicating ‘Cuidate!:’ 6-Month Impact Findings of a Randomized Controlled Trial,” American Journal of Public Health (2016) 106:S70.

LaChance, R.B. “A Clustered Randomized Controlled Trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program,” American Journal of Public Health (2016) 106:S91.

Lindberg, L. et al. “Understanding the Decline in Adolescent Fertility in the United States, 2007-2012,” Journal of Adolescent Health (2016) 59:577.

Potter, S.C. et al. “’It’s Your Game…Keep It Real’ in South Carolina: A Group Randomization Trial Evaluating the Replication of an Evidence-Based Adolescent Pregnancy and  Sexually Transmitted Infection Prevention Program,” American Journal of Public Health (2016) 106:S60.

Robinson, W.T. et al. “Randomized Trial of the Teen Outreach Program in Louisiana and Rochester, New York,” American Journal of Public Health (2016) 106:S39.

Stanger-Hall, K.F. and D.W. Hall. “Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.,” PlosOne. http://dx.doi.org/10.1371/journal.pone.0024658.

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