Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact, John S. Santelli et al., 61 Journal of Adolescent Health 273-80 (2017)

This review of abstinence-only-until-marriage (AOUM) policies and programs in the U.S. concludes they fall short of the goal to raise sexually healthy adults. A number of reviews and meta-analyses of AOUM programs found no scientific evidence that they help delay initiation of sexual intercourse or reduce the number of sexual partners or frequency of vaginal sex, condom use, STIs, or pregnancy. The Centers for Disease Control and Prevention (CDC) was unable to draw any conclusions on the effectiveness of abstinence education. The review further finds that promotion of AOUM by the U.S. government has undermined sexuality education in the United States and in U.S. foreign aid programs and that funding for AOUM continues in the United States.

By contrast, the CDC concluded that comprehensive risk reduction programs were an effective strategy for reducing adolescent pregnancy and STIs, including HIV, among adolescents. The review also finds that health professionals overwhelmingly support comprehensive sexual health education, and public opinion polls also suggest strong support for comprehensive approaches to sex education.

The review also finds serious ethical, human rights, and reproductive rights concerns raised by the United States’ approach to AOUM. For example, AOUM programs often reinforce harmful gender stereotypes: recent large studies of adolescents suggest early sexual intercourse is not associated with physical or emotional symptoms, except to the extent that cultural norms and social sanctions create disparities for girls compared to boys with respect to early sexual behavior. Relatedly, AOUM programs largely shame and ignore the needs of youth already sexually active, including those who are survivors of sexual abuse. AOUM programs also may result in profoundly negative impacts on the well-being of sexual minority youth by failing to meet their health needs and stigmatizing them as deviant and unnatural.