During the first two years of Barack Obama's presidency, advocates for comprehensive sex education saw positive changes. After nearly 30 years of strong support for abstinence-only-until-marriage programs, two-thirds of federal funding for these ineffective programs has been cut. At the same time, nearly $190 million has been provided for evidence-based teen pregnancy prevention and comprehensive sex education. These new programs will help young people make safe and healthy decisions about their sexual health. With the results of the 2010 election, however, it is unknown how much further progress we will be able to make over the next two years.
We must thoughtfully chart our next steps toward the goal of comprehensive sex education -- including discussions of abstinence, contraception, and prevention of HIV, other sexually transmitted diseases (STDs), and unintended pregnancy -- for all school-age youth. Comprehensive sex education programs must also address self-esteem, healthy relationships, communication and decision-making skills, sexual orientation, and gender identity. This article details how far we have come at the federal level, where we need to go, and with the recent election results in mind, what we may see in the coming years.
The President's Teen Pregnancy Prevention Initiative (TPPI) funds medically accurate and age-appropriate programs designed to reduce teen pregnancy. At least $75 million of the funding is for programs that have been proven to reduce teenage pregnancy and its risk factors, while at least $25 million is for testing other models and innovative strategies.
In September, the Office of Adolescent Health (OAH) awarded a total of $110 million to several grantees: $75 million to 75 grantees for pregnancy prevention programs that have been shown to be effective through rigorous evaluation, and $35 million to 40 grantees to test innovative strategies. The OAH had received over 1,000 applications, demonstrating that public health agencies, community-based organizations, and public schools are hungry for funding to carry out effective, innovative, and comprehensive programs.
While sex education advocates support the TPPI, however, some also worry it may fall short of its true potential. Over half of young people have had sexual intercourse by the age of 18 and are at risk of both unintended pregnancy and STDs. It is unfortunate that the funding focuses only on teen pregnancy and does not specifically address the equally important health issues of STDs, including HIV. Nor does TPPI require a discussion of abstinence and contraception when sexual activity is discussed. While, because of strong advocacy efforts, the legislation does ensure that programs that address risk behaviors related to pregnancy can be covered, allowing HIV/STD prevention programs to be funded, the Obama administration and Congress missed an opportunity to provide comprehensive sex education that promotes healthy behaviors and relationships for all young people, including those who are lesbian, gay, bisexual, and transgender (LGBT). Unfortunately, several abstinence-only programs did receive grants through the innovative portion. These programs are far from cutting edge and were proven not to work in the government's own study.
In March, President Obama signed the health care reform bill -- the Patient Protection and Affordable Care Act. While it unfortunately included the extension of an abstinence-only-until-marriage program, it also created the Personal Responsibility Education Program (PREP), which provides $75 million per year from 2010 through 2014 to fund complete, medically accurate, and age-appropriate sex education to help young people reduce their risk of pregnancy and STDs, including HIV. Over $55 million of it is dedicated to state grants. Additional funding is available for Indian tribes and tribal organizations, research and evaluation, and innovative approaches. This new funding stream is the first of its kind and will go a long way toward providing comprehensive sex education across the country. Programs funded by PREP are also required to teach life skills, such as healthy relationships, communication, and decision-making skills.
PREP programs must use approaches that have been proven by research to change behavior or must incorporate elements of effective programs. This includes delaying sexual activity, increasing condom or contraceptive use, or reducing pregnancy. They must place significant attention on both abstinence and contraception for the prevention of pregnancy and STDs, including HIV, and are required to be carried out in a culturally appropriate manner. The response to PREP has been positive: 43 states, the District of Columbia and two U.S. territories submitted funding applications.
For more than two decades, the Division of Adolescent and School Health (DASH) has worked with schools to coordinate an approach to the health issues that affect our nation's 56 million students. DASH was created as a response to the HIV epidemic, and recognizes that schools are uniquely positioned to support prevention programs. It encourages state and local education agencies to work with health departments so young people receive health education that addresses HIV, STDs, and pregnancy.
Health departments are usually unable to incorporate prevention programs into schools without partnering with education agencies. DASH is the only funding stream that coordinates the two. In 2010, DASH received nearly $60 million, with just over $40 million being dedicated to HIV prevention and other sex education.
When President Obama released our nation's first National HIV/AIDS Strategy (NHAS) in July, sex education advocates were pleased, but not overjoyed. While there is mention of sex education, the Strategy does not include a call for comprehensive sex education for all youth in public schools. It also does not target youth, despite the fact that one-quarter of new HIV infections occur among people aged 13 to 29.
The NHAS Implementation Plan does, however, outline several of DASH's ongoing and upcoming activities. This includes its work to ensure that school health education provides scientifically sound information about HIV and risk-reduction strategies. By the end of 2011, the CDC will develop a toolkit and work with states, cities, and school boards to carry out HIV education. It will also consider partnerships, such as with private businesses, to expand HIV/STD prevention.
In the fall of 2009, after nearly 30 years and over 1.5 billion taxpayer dollars spent on abstinence-only-until-marriage programs, we briefly saw the end to all funding for them. Sadly, conservatives in Congress were successful in bringing back the Title V abstinence-only program in the recent health care reform bill. This means another $250 million for these ineffective programs will be available over the next five years.
While the Obama administration did issue new guidance for these programs that allows for more flexibility, programs funded with abstinence-only dollars must still exclusively teach abstinence. To qualify for these funds, programs must be designed so that abstinence is the expected outcome, and no funds can be used in ways that contradict the federal definition of "abstinence education." This means that states still cannot use these funds to provide information about condoms and contraception.
When the Title V abstinence-only program first expired in June 2009, nearly half of the states had chosen not to accept the funding. Now, with the relaxed guidelines, 30 states and Puerto Rico applied for funding in 2010. While some of the states may carry out programs that focus primarily on younger ages or mentoring, this increase may result in even more young people not receiving the information they need to make healthy decisions.
The 2010 election will force those advocating for effective, comprehensive sex education to fight against bringing back old, or creating new, funding streams for abstinence-only-until-marriage programs. Ending the Title V abstinence-only program is key to ensuring that young people are not misinformed and misguided. With a large body of research proving abstinence-only programs ineffective, Senator Frank Lautenberg and Congresswoman Barbara Lee introduced the Repealing Ineffective and Incomplete Abstinence-Only Program Funding Act of 2010. This would eliminate the Title V abstinence-only provision that promotes marriage as the only acceptable lifestyle, marginalizes LGBT youth, and censors information on avoiding pregnancy and STDs, including HIV. If the bill is passed, it will also transfer funding for the Title V abstinence-only program to PREP. This bill will be reintroduced in 2011.
Sexuality education should be a nonpartisan issue. Poll after poll has shown that a majority of voters, no matter their party affiliation, believe young people should be given comprehensive information about both abstinence and contraception to protect themselves from HIV, STDs, and pregnancy. History, however, has shown us that elections matter. The recent shift in the House of Representatives will present new challenges to advocates for more comprehensive approaches to sex education. With the culture wars back in the halls of Congress, federal funding for sex education will likely be in danger. The fight will not only be to quash the new more comprehensive approaches but also to bring back the ideologically driven and ineffective abstinence-only-until-marriage programs sex education advocates have fought against for years.
If Republicans are able to bring back funding for abstinence-only-until-marriage programs, this will be considered a win to their conservative base. In one breath they will be calling for cuts to the federal deficit and "out of control" federal spending, but in the next they will be expecting immediate results that show the far-right is back in power. Science and sanity were once again prevailing in our nation's capital. We must keep up the fight to ensure we hold our ground and build on our successes so we can provide our youth with the information they need and deserve to lead healthy lives.
Jen Heitel Yakush is the Director of Public Policy at the Sexuality Information and Education Council of the United States (SIECUS).