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The federal government currently provides $100 million annually to support "abstinence-only-until-marriage" education programs.15 These programs portray abstaining from sexual activity until marriage as the only acceptable behavior for youth, where marriage is defined exclusively as heterosexual marriage in a traditional nuclear family. The Bush Administration has been advocating for an increase in federal funding for these programs to $135 million.16

The bulk of federal funding for abstinence-only programs comes from the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (commonly known as the Welfare Reform Act), which created an entitlement program that allocated an annual appropriation of $50 million per year for abstinence-only education for fiscal years 1998 through 2002. Known as "Section 510(b)" funds after the provision of the Social Security Act affected by the Welfare Reform Act, these monies are provided to states, which must contribute three dollars for every four federal dollars that they receive under this program.17 The states in turn distribute the money in a range of different ways. In some states the department of health has primary authority over the program, while in others the governor's office has this authority; in some states authority is shared between the governor's office and the department of health. With these monies, the states fund a wide variety of activities, including media campaigns, school-based programs and community-based projects.18

Section 510(b) funds are only the latest of three federally funded abstinence-only programs. The federal government first appropriated federal funds for abstinence education in 1981 with the passage of the Adolescent Family Life Act (AFLA).19 The Act provides grants for services to "prevent adolescent sexual relations" by "promot[ing] self discipline and other prudent approaches to the problem of adolescent premarital sexual relations, including adolescent pregnancy," and directs that projects funded "make use of support systems such as other family members, friends, religious and charitable organizations and voluntary associations."20 Consistent with the AFLA's mandate, many AFLA grantees have been associated with religious groups, some of whose curricula have incorporated religious content.21 In fiscal year 2002, the AFLA provided about $10 million for abstinence-only education.22

The Special Projects of Regional and National Significance-Community-Based Abstinence Education program (SPRANS-CBAE), created in 2000, also supports state and local abstinence-only programs. This program was funded at $20 million in fiscal year 2001 and at $40 million in fiscal year 2002.23 The entire funding increase proposed by the Bush Administration is sought through the SPRANS-CBAE program, which provides direct grants to community-based organizations (many of which, in both 2001 and 2002, were faith-based).24

Congressional staffers who worked on the 1996 Welfare Reform Act acknowledged that "the congressional attack on illegitimacy [births to unmarried parents] is based far more on the value position that sex outside marriage is wrong and the consequences severe for mother, child and society than on empirical evidence linking a particular policy with reduced nonmarital births."25 Nonetheless,

Regardless of how one feels about the standard of no sex outside marriage, we believe both the statutory language and . . . the intent of Congress are clear. This standard was intended to align Congress with the social tradition-never mind that some observers now think the tradition outdated-that sex should be confined to married couples. That both the practices and standards in many communities across the country clash with the standard required by the law is precisely the point.26

On May 16, 2002, the House passed a Welfare Reform Act reauthorization bill that would extend the Section 510(b) funding at current levels through 2007.27 On June 27, 2002, the Senate Finance Committee passed a similar reauthorization bill with an amendment that would allocate equal funding to "abstinence-first" programs that would encourage abstinence but also teach children about contraception.28 The full Senate has not yet voted on this bill. The SPRANS-CBAE program and the AFLA programs are funded through annual Labor-Health and Human Services (Labor-HHS) appropriations. The Senate Labor-HHS Committee approved an appropriations bill in July 2002 that maintained SPRANS-CBAE at fiscal 2002 levels and increased AFLA programs by $2.2 million. The full Senate and the House are expected to address the appropriations bill in September.29

All federally funded abstinence-only programs must provide abstinence education as defined by Section 510(b) of the Welfare Reform Act, as follows:

"Abstinence education" means an educational or motivational program which:

(A) has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
(B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
(C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
(D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;
(E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
(F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society;
(G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
(H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.30

Section 510(b) funds also can be used for "mentoring, counseling and adult supervision" activities that promote abstinence.31

Section 510(b) and AFLA programs are not required to emphasize all eight elements of the above definition equally, but cannot provide information that is inconsistent with any of them.32 Since these programs must have as their "exclusive purpose" promoting abstinence outside of marriage and must teach that abstinence outside of marriage and a mutually faithful monogamous relationship in the context of marriage is the expected standard of sexual activity, they cannot also "promote or endorse" condoms or otherwise discuss them, except to provide "factual information, such as failure rates."33 According to Michele Lawler, the director of the Abstinence Education Program at the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, which administers Section 510(b) and SPRANS-CBAE programs, abstinence-only funding recipients cannot say, "if you decide to become sexually active, then here are methods" to prevent pregnancy or sexually transmitted diseases, or provide instruction regarding the use of condoms or contraception.34

SPRANS-CBAE-funded programs are even more restrictive than Section 510(b) and AFLA programs. SPRANS-CBAE grantees must emphasize each of the eight points of the Section 510(b) definition and must target "adolescents" twelve to eighteen years old.35 In addition, except in limited circumstances, SPRANS-CBAE grantees cannot use their own funds to provide any other education regarding sexual conduct (such as information about condoms that they cannot provide in the abstinence-only program) to any children to whom they provide abstinence-only education.36

The Bush Administration has not limited its promotion of abstinence-only programs to the United States. At the U.N. General Assembly Special Session on Children in May 2002, the U.S. delegation, together with Iran, Libya, Pakistan, Sudan and the Holy See, argued that the summit declaration should endorse sexual abstinence "both before and during marriage" as the only way to prevent HIV/AIDS transmission.37 Secretary of Health and Human Services Tommy Thompson, addressing the Special Session on Children, stated, "As President Bush has said, abstinence is the only sure way of avoiding sexually transmitted disease, premature pregnancy and the social and personal difficulties attendant to non-marital sexual activity," and that U.S. efforts "include strengthening close parent-child relationships, encouraging the delay of sexual activity and supporting abstinence education programs."38

Several U.S. states have enacted legislation promoting or mandating abstinence education. In 1995, for example, North Carolina enacted a law requiring public schools, as part of the comprehensive health program for students in kindergarten through ninth grade, to offer an abstinence-only-until-marriage program and to permit schools to offer comprehensive sex education only after the local board of education has held a public hearing and permitted review of instructional materials (among other conditions).39 Since 1996, several states have passed legislation that incorporates some or all of the federal definition of abstinence education, while others have considered the issue.40 (The situation in Texas, case study for this report, is described in detail below.)

Research on Effectiveness of Abstinence-Only Education
The major commitment of federal funding for abstinence-only education has taken place notwithstanding the paucity of evidence that abstinence-only education works to delay adolescent (or extramarital) sexual activity, much less changes sexual behavior that puts adolescents at risk of HIV/AIDS and other sexually transmitted diseases and pregnancy. Secretary Thompson acknowledged as much in January 2002: asked why the administration would want to increase spending on abstinence-only programs, given the lack of scientific data supporting them, he noted that they are very popular with many of his Republican colleagues and said that "[t]he president feels, the administration feels, a lot of people in Congress feel that this is a much better way to attempt to solve this problem of teenage pregnancy. Let's try them out and see if we can't get it to work."41

The Institute of Medicine, the federal body of experts charged with the responsibility of advising the federal government on issues of medical care, research and education, has noted that the scientific literature, as well as experts that had studied the issue, showed that comprehensive sex and HIV/AIDS education programs and condom availability programs can be effective in reducing high-risk sexual behaviors while no such evidence supported abstinence-only programs. The Institute expressed its concern that "investing hundreds of millions of dollars of federal and state funds . . . in abstinence-only programs with no evidence of effectiveness constitutes poor fiscal and health policy," and recommended that "Congress, as well as other federal, state and local policymakers, eliminate requirements that public funds be used for abstinence-only education, and that states and local school districts implement and continue to support age-appropriate comprehensive sex education and condom availability programs in schools."42

Studies of the effectiveness of HIV/AIDS prevention and sexuality education programs have concluded that programs that cover both abstinence and contraceptive use (including condom use) can be effective in reducing sexual risk-taking behavior among adolescents that puts them at risk of HIV/AIDS. A 2001 report analyzing methodologically rigorous outcome evaluation studies of HIV prevention and sexuality education programs concluded that programs that included information about abstinence as well as the use of condoms and contraceptives can successfully delay the onset of sex and increase the use of condoms among sexually active teens.43 This report found that "very little rigorous evaluation of abstinence-only programs has been completed" and that none of the high-quality studies of abstinence-only programs reviewed showed that abstinence-only programs had any effect on sexual behavior or contraceptive use among sexually active teens.44

At least one study comparing the relative efficacy of educating teenagers about safer sex with an abstinence-only intervention found that while both approaches affected sexual behavior in the short term, over a longer period, the safer-sex program proved more effective than the abstinence program in reducing both unprotected sexual intercourse and the frequency of intercourse than did the abstinence-only intervention. The researchers who conducted the study thus concluded that, "Our finding that the safer-sex intervention curbed unprotected sexual intercourse, whereas the abstinence intervention did not, suggests that if the goal is reduction of unprotected sexual intercourse, the safer-sex strategy may hold the most promise, particularly with those adolescents who are already sexually experienced. Moreover, safer-sex interventions may have longer-lasting effects than abstinence interventions."45

In 1997, Congress authorized an evaluation of the impact of abstinence-only programs funded by the Welfare Reform Act of 1996. Four years into the evaluation process, an interim report on evaluation findings has yet to produce any evidence that these programs are effective in reducing teen sex, pregnancy or the transmission of disease.46

The Adolescent Family Life Act (AFLA) requires that each grantee spend a percentage of its grant on independent evaluation of services supported by grant funds. A 1997 analysis of evaluations of AFLA programs concluded that "the quality of the AFLA evaluations funded by the federal government var[ied] from barely adequate to completely inadequate," and that the reviewers were "aware of no methodologically sound studies that demonstrate the effectiveness" of abstinence-only programs.47

A 1997 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) found evidence that demonstrated that sexual health education for children and young people that included the promotion of condom use promoted safer sexual practices and did not increase their sexual activity.48

Proponents of abstinence-only programs frequently cite studies of sexuality education programs in Monroe County, New York and rural South Carolina to support the claim that abstinence-only programs are effective.49 But during the period under study, both of these programs provided information about effective contraceptive use as well as information about abstinence and therefore the positive outcomes of these programs may in fact offer evidence to support the effectiveness of comprehensive sex education.50

The National Academy of Sciences' Institute of Medicine, the National Institutes of Health, and the U.S. Centers for Disease Control and Prevention, U.S. government entities responsible for setting public health standards, all advise that adolescents should be given information about the proper use of condoms to reduce the risk of infection by HIV and other sexually transmitted diseases.51 In keeping with this advice, the U.S. Department of Health and Human Services has included among its objectives to "increase the proportion of adolescents who abstain from sexual intercourse or use condoms if sexually active."52

Major professional medical organizations in the U.S.-including the American Medical Association, the American Academy of Pediatrics, the Society for Adolescent Medicine, the American College of Obstetricians and Gynecologists, and the American Nurses Association-also advise that adolescents should be given information about the proper use of condoms to reduce the risk of infection by HIV and other sexually transmitted diseases.53

Texas Abstinence-Only Education Programs
The Texas Governor's Office and the Texas Department of Health share authority for the Texas Abstinence Education Program, which administers Section 510(b) funding.54 Since 1998, when Section 510(b) funds first were made available, Texas has funded thirty-two abstinence contractors.55 Texas has received about $5 million annually in Section 510(b) funding for the first five years of the program.56 In fiscal year 2001, Texas programs received about $2 million in SPRANS-CBAE funding and $1.1 million in funding for AFLA abstinence education projects.57

In addition to funding individual abstinence-only contractors, Texas' Abstinence Education Program funds a statewide abstinence-only media campaign, as well as evaluation of the abstinence-only contractors and of the media campaign.58

In Texas, local school boards have discretion to decide whether to provide students education about sexuality, HIV/AIDS, or sexually transmitted diseases.59 With respect to HIV/AIDS and sexually transmitted disease (STD) education, Texas is in the minority, as thirty-eight states mandate that schools provide HIV/AIDS and STD education.60 Many Texas school districts provide little or no education about HIV/AIDS, sexually transmitted diseases, or sexuality more generally, instead focusing their attention on less controversial subjects, like cardiovascular health, nutrition and obesity prevention.61

According to state law, course materials relating to sexuality, HIV/AIDS, or sexually transmitted diseases must be selected by the board of trustees of the school district with the advice of its appointed local school health education advisory council and must use course materials and instruction that:

(1) "present abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age;
(2) "devote more attention to abstinence from sexual activity than to any other behavior;
(3) "emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100% effective in preventing pregnancy, sexually transmitted diseases, infection with human immunodeficiency virus or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity;
(4) "direct adolescents to a standard of behavior in which abstinence from sexual activity before marriage is the most effective way to prevent pregnancy, sexually transmitted diseases and infection with human immunodeficiency virus or acquired immune deficiency syndrome; and
(5) "teach contraception and condom use in terms of human use reality rates instead of theoretical laboratory rates, if instruction on contraception and condoms is included in curriculum content."62

Human Rights Watch visited four programs in Texas: the McLennan County Collaborative Abstinence Project (McCAP); the Scott & White Sex Education Program; the Medical Institute for Sexual Health; and Laredo's "Mi Futuro/My Future" abstinence education program. All of these programs receive Section 510(b) funding. McCAP and Scott & White also receive SPRANS-CBAE funding.

McCAP provides abstinence-only curriculum materials, speakers and other support materials and literature to all McLennan County public school districts except for Waco (the largest district), and to private schools and foster home facilities in the area.63 The Waco school board rejected the McCAP program reportedly because it was concerned that it would restrict information about contraception and that sexually active teens would respond to the abstinence-only curriculum by forgoing condoms and contraception while continuing to have sex.64

McCAP supports an "aggressive abstinence campaign in the media," as well as community programs in churches, at the workplace and other settings.65 It provides referrals to health care providers "promising to reinforce the abstinence-only message" and offers "seminars, supporting literature, training, on-site education, counseling and support."66 McCAP also trains school district personnel and school health education advisory council members and collaborates with local churches in developing abstinence-only activities. 67

The Scott & White Sex Education Program provides abstinence-only materials and training in ten counties in central Texas, with the goal of educating "adolescents and adults on the ramifications of adolescent sexual activity including the medical, social, economic and legal consequences."68 Scott & White uses "Worth the Wait," a middle-school abstinence-only curriculum that it developed and which it distributes to schools in ten central Texas counties, and which it markets nationwide.69

Scott & White's program is highly structured. The curriculum materials are scripted and include outlines of all supplies, activities and necessary materials. Scott & White holds a two-day seminar to train teachers and other school personnel who use its materials, and district-wide training for all employees in school districts that use its materials. It also provides education for parents, community members and healthcare professionals throughout the state of Texas. Scott & White is also working with Time-Warner Cable to produce public service announcements promoting abstinence.70

Laredo's "Mi Futuro/My Future" abstinence education program is a "collaborative effort between the Laredo Independent School District and the City of Laredo Health Department," whereby the health department administers the abstinence-only grant, which it subcontracts to the school district for implementation.71 The program targets middle school students in four Laredo schools and, since the 2001-2002 school year, to freshmen in one Laredo high school. Two "master teachers" coordinate the "Mi Futuro/My Future" program and monitor its activities and progress; five "health trainers" use the "Mi Futuro/My Future" curriculum developed by the program in the classroom and hold meetings and community events for parents.72

The Medical Institute for Sexual Health is a nonprofit organization founded in 1992 by Dr. Joe McIlhaney, an Austin gynecologist, to "confront the worldwide epidemics of nonmarital pregnancy and sexually transmitted disease with incisive health care data."73 The Medical Institute produces resource materials for abstinence education programs, hosts national and statewide conferences and seminars on sexually transmitted diseases, sex education and nonmarital pregnancy and makes regular appearances at meetings of health professionals.

The Medical Institute collaborates with both McCAP and Scott & White in their work. It receives federal abstinence-only funding to hold "Change Makers" seminars to "educate, equip and mobilize local community leaders to build community-wide consensus and to develop an action strategy-based on character development-for promoting abstinence from sexual activity and other risk behaviors among local unmarried teens and young adults."74 These seminars are directed at adult community leaders in government, education, health care, faith communities, social service and community industries and business who can foster the development of a community environment that supports abstinence until marriage.75

15 Although in the U.S., state and local school districts have the primary responsibility for education, the federal government plays an important role in local education policy when it chooses to do so. As the U.N. Special Rapporteur on the Right to Education has observed, "Federal funding encourages and facilitates change in the chosen direction, and federal enforcement powers keep education within the law-and-policy framework." Report Submitted by Katarina Toma_evski, Special Rapporteur on the Right to Education Mission to the United States of America 24 September - 10 October 2001, Commission on Human Rights, 58th sess. of the provisional agenda, Economic, Social and Cultural Rights, U.N. Doc. E/CN.4/2002/60 Add.1 (February 2002), para. 13.
While there is no federal program that supports comprehensive sexuality education as such, the CDC's school health education program, which may support school-based education programs that include discussion of both abstinence and condom use, received $50 million for HIV prevention efforts in 2002--half as much as the federal government allocated for abstinence-only education. The percentage of these funds that directly support student education about both abstinence and risk reduction through condom use is unclear, because at least some of the CDC HIV prevention funds support abstinence-only programs; and, further, the funds also support a wide range of activities, such as training teachers and school personnel in HIV prevention, monitoring risk behaviors among students, and program evaluation. See Section VI below.

16 The White House, "President Announces Welfare Reform Agenda," February 26, 2002, (retrieved on August 2, 2002).

17 States meet the match requirement in a variety of ways: by allocating new state funds for abstinence education; by allocating existing state funds to abstinence education; and by relying on in-kind support. Some states shift the match responsibility to the local level, requiring local program providers to meet the requisite match. State Policy Documentation Project, Summary of Policy Issues: Reproductive Health Provisions and Teen Requirements, (retrieved on May 31, 2002).

18 See Sexuality Information and Education Council of the United States (SIECUS), Between the Lines: States' Implementation of the Federal Government's Section 510(b) Abstinence Education Program in Fiscal year 1998 (Washington D.C.: SIECUS, 1999) (detailing, by state, grantees and programs funded for fiscal year 1998); U.S. Department of Health and Human Services, 1999 Annual Summary for the Abstinence Education Provision of the 1996 Welfare Law P.L. 104-193, March 2000.

19 New Right conservatives' support was instrumental in the passage of the Adolescent Family Life Act, the first federal legislation funding abstinence programs. See Kristin Luker, Dubious Conceptions (Cambridge, MA: Harvard University Press, 1996), pp. 76-79.

20 42 U.S.C. §§ 300z(b)(1), 300z-1(a)(8), 300z-2(a). The AFLA provides funding for "care services," for the provision of care to pregnant and parenting adolescents and "prevention sevices" to prevent adolescent sexual relations. 42 U.S.C. §§ 300z(b)(1)(7,8), 300z-2.

21 See Bowen v. Kendrick, 487 U.S. 589, 597, 625, 630 n. 3 (1988).
On July 24, 2002, a federal court in Louisiana ruled that the Louisiana Governor's Program on Abstinence (GPA) had used some of its Section 510(b) abstinence-only funds unconstitutionally to "convey religious messages and advance religion" by funding, among other things, programs that organized prayer vigils at abortion clinics; Christ-centered skits that advocate sexual abstinence; and programs that focus on the "virgin birth and make it apparent that God's desire [sic] sexual purity as a way of life" and sponsor youth revivals that "proclaim[ed] God's word with power as to why we should live pure and Holy. He made it clear that abstinence is the only way." The court ordered the GPA to "cease and desist from disbursing GPA funds to organizations or individuals that convey religious messages or otherwise advance religion in any way in the course of any event supported in whole or in part by GPA funds . . . ." The court also ordered the GPA to install an oversight program to monitor the use of its money and provide written notification to any group it finds to be using its money in a manner that violates the Constitution. ACLU of Louisiana v. Governor M.J. Foster and Dan Richey, Civil Action No. 02-1440 (E.D. La.) (Order, July 24, 2002).

22 U.S. Department of Health and Human Services, Office of Adolescent Pregnancy Programs, Office of Population Affairs, AFL Abstinence Education Demonstration Projects, (retrieved on June 24, 2002).

23 See Military Construction Appropriations Act of 2001, Pub. L. No. 106-246, 114 Stat. 511 (2000); Consolidated Appropriations Act, 2001, Pub. L. No. 106-554, 114 Stat. 2763 (2001); Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2002, Pub. L. No. 107-116, 115 Stat. 2177 (2002).

24 See U.S. Department of Health and Human Services, "HHS Awards $17.1 Million in Abstinence-only Education Grants," HHS News, July 6, 2001; U.S. Department of Health and Human Services, "HHS Awards Grants Nationwide to Support Abstinence Education, Services to Teens," HHS News, July 2, 2002.

25 Ron Haskins and Carol Statuto Bevan, House Ways and Means Committee, "Abstinence Education Under Welfare Reform," Children and Youth Services Review, vol. 19, nos. 5/6 (1997), pp. 465-484.

26 Ibid., p. 475. Acknowledging that there was "little direct evidence . . . that any particular policy or program reduces the frequency of nonmarital births," Haskins and Bevan noted that "Even so, recent history contains many examples of federal policies, including highly controversial and expensive policies, which enjoyed little empirical support at the time of introduction. Congress passed strong civil rights legislation in 1965, for example, despite the lack of evidence that outlawing discrimination based on race would be effective." Ibid., p. 466.

27 The House rejected a substitute bill that would have required that programs be medically accurate; based on models that have been proven effective in reducing unwanted pregnancy or the transmission of HIV or STDs; and allow states flexibility to craft appropriate interventions. 148 Cong. Rec. H2517-05 (daily ed., May 16, 2002).

28 Senate Committee on Finance, Baucus Amendment #2 to Chairman's Mark for H.R. 4737, June 26, 2002, (retrieved on July 18, 2002). Advocates favoring more broad-based sexuality education have expressed concern that the "abstinence first" provision may result in a doubling of funds for abstinence-only programs, as the latter are not precluded from applying for these funds and because any guidance for such a program would be crafted by the Bush Administration's Department of Health and Human Services. Sexuality Information and Education Council of the United States, "Policy Update - June 2002," (retrieved on August 23, 2002).

29 The Senate Committee on Appropriations approved $40,000,000 for the SPRANS-CBAE program (the same as the fiscal year 2002 level and $32,979,000 less than President Bush's request) and $31,124,000 for the AFLA program ($2,198,000 more than the fiscal year 2002 appropriation and the same as the administration request). Senate Committee on Appropriations, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2003, S. Rep. No. 216, 107th Cong., 2d. Sess. pp. 66, 206 (2002).

30 42 U.S.C. § 710(b)(2).

31 42 U.S.C. § 710(b)(1).

32 Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Application Guidance for the Abstinence Education Provision of the 1996 Welfare Reform Law, P.L. 104-93, p. 9. Since 1997, Congress has required that AFLA-funded prevention programs adhere to the Section 510(b) definition.

33 Human Rights Watch telephone interview with Michele Lawler, director, Abstinence Education Program, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, June 3, 2002. Program participants who want more information about contraception are to be advised to contact a third party (such as a health department) for more information. Ibid.

34 Human Rights Watch telephone interview with Michele Lawler, June 3, 2002. See also Mathematica Policy Research Institute, Inc., The Evaluation of Abstinence Education Programs Funded Under Title V Section 510: Interim Report, p. 4 (noting that "[p]roviding instruction in or promoting the use of birth control would be inconsistent with the A-H guidelines").

35 Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Application Guidance for Special Projects of Regional and National Significance Community-Based Abstinence Education under Title V of the Social Security Act, pp. 1, 2, 7.

36 SPRANS-CBAE grantees must agree that "with respect to an adolescent to whom the entities provide abstinence education under such grant, the entities will not provide to that adolescent any other education regarding sexual conduct, except that, in the case of an entity expressly required by law to provide health information or services the adolescent shall not be precluded from seeking health information or services from the entity in a different setting than the setting in which the abstinence education was provided." Military Construction Appropriations Act of 2001, Pub. L. No. 106-246, 114 Stat. 511 (2000); see also Conference Report for fiscal year 2002 Labor-HHS-Education Appropriations Act, H.R. Conf. Rep. No. 107-342 (2001).

37 Doug Sanders, "Birth Control No Solution for AIDS, U.S. Argues," Globe and Mail, May 8, 2002, p. A7; see also Statement in Explanation of Position by Ambassador Sichan Siv, United States Representative on the United Nations Economic and Social Council, at the Special Session of the United Nations General Assembly on Children, following Adoption of the Outcome Document, May 10, 2002. The U.S. also pushed for the document to define family as a union "based on marriage between a man and woman," but agreed in the end to accept "various forms of the family." Colum Lynch, "Divided U.N. Agrees on Plan for Aiding Children," The Washington Post, May 10, 2002, p. A22. See also United Nations, Report of the Ad Hoc Committee of the Whole of the twenty-seventh special session of the General Assembly, U.N. Doc. A/S-27/19/Rev.1.

38 Somini Sengupta, "U.N. Session Begins to Tally The Perils of Being Young," New York Times, May 9, 2002, p. A14.

39 School Health Education Act, N.C. Gen. Stat. § 115C-81 (2002); see also Anne Dellinger, "Parental Rights and School Health: North Carolina's Legislation," School Law Bulletin, Winter 1997, pp. 1-9 (discussing Act).

40 See, for example, Miss. Code Ann. § 37-13-171 (2002); Mo. Rev. Stat. § 170.015 (2002); Ohio Rev. Code Ann. § 3313.6011 (Baldwin 2002); Virginia Code Ann. § 22.1-207.1 (Michie 2002); see also N.J. Rev. Stat. § 18A:35-4.20 (West 2002) (requiring that sex education, including education with respect to HIV/AIDS, "shall stress that abstinence from sexual activity is the only completely reliable means of eliminating the sexual transmission of HIV/AIDS and other sexually transmitted diseases and of avoiding pregnancy").

41 AP Online, January 30, 2002. Claude Allen, Deputy Secretary of Health and Human Services in charge of the federal government's abstinence initiative, feels the same: "Unless we put money there to find out whether it [`abstinence-only-until-marriage' programs] works, we will never know." Sheryl Gay Stolberg, "Abstinence-Only Initiative Advancing," New York Times, February 28, 2002.

42 Committee on HIV Prevention Strategies in the United States, Institute of Medicine, No Time to Lose: Getting More from HIV Prevention (Washington, D.C.: National Academy Press, 2001), pp. 118-20. The Institute of Medicine is a body of experts that acts under a Congressional charter as an adviser to the federal government. The Institute wrote No Time to Lose at the request of the U.S. Centers for Disease Control and Prevention, which asked that it convene a committee on HIV prevention strategies in the United States to review HIV prevention efforts of the CDC and other U.S. Department of Health and Human Services Agencies, as well as those of other public and private sector organizations, and make recommendations for future prevention efforts. Ibid., pp. xi - xii.

      Under President Clinton, the White House Office of National AIDS Policy, noting that no "abstinence-only" curricula were included in the Centers for Disease Control's Research to Classroom Project, which identified curricula that had shown evidence of reducing sexual risk behaviors, expressed "grave concern that there is such a large incentive to adopt unproven abstinence-only approaches." Office of National AIDS Policy, The White House, Youth and HIV/AIDS 2000: A New American Agenda (Washington, D.C.: Government Printing Office, 2000), p. 14.

43 Douglas Kirby, Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy (Washington, D.C.: National Campaign to Prevent Teen Pregnancy, 2001), pp. 5, 88-91.

44 Ibid., pp. 5, 85-88.

45 John B. Jemmott et al., "Abstinence and Safer Sex HIV Risk-Reduction Interventions for African American Adolescents," Journal of the American Medical Association, vol. 279, no. 19, May 20, 1998, pp. 1529-1536.

46 Mathematica Policy Research Institute, Inc., The Evaluation of Abstinence Education Programs Funded Under Title V Section 510: Interim Report (2002). The final evaluation report, scheduled for summer 2005, will assess the impact of only five of the eleven study subjects, as "rigorous impact studies of the[] community-wide abstinence program initiatives [including McCAP, which is included in the evaluation] are not possible." Ibid., p. 6.

47 Brian Wilcox and Jennifer Wyatt, Adolescent Abstinence Education Programs: A Meta-Analysis, Presented at the 1997 Joint Annual Meeting of the Society for the Scientific Study of Sexuality and the American Association of Sex Educators, Counselors, and Therapists, Arlington, Virginia, November 1997.

48 Joint United Nations Programme on HIV/AIDS, Impact of HIV and Sexual Health Education on the Sexual Behavior of Young People: A Review Update (Geneva: UNAIDS, 1997), p. 15.

49 See, for example, Statement of Joe S. McIlhaney, Jr., M.D., president, Medical Institute for Sexual Health, Testimony Before Subcommittee on Human Resources of the House Committee on Ways and Means, Hearing on Teen Pregnancy Prevention, November 15, 2001 (stating that studies of specific abstinence programs, including Monroe County and South Carolina programs, show "surprising success," and citing to Murray L. Vincent et al., "Reducing Adolescent Pregnancy Through School and Community-based Education," Journal of the American Medical Association, vol. 257, no. 24, June 26, 1987, pp. 3382-3386 and Andrew Doniger, et al., "Impact Evaluation of the `Not Me, Not Now' Abstinence-Oriented, Adolescent Pregnancy Prevention Program, Monroe County, N.Y.," Journal of Health Communication, vol. 6, no. 1, February 2001, pp. 45-60.

50 The South Carolina study included as one of its objectives the promotion of the consistent use of effective contraception among sexually active teens and provided information about contraception. Vincent et al., "Reducing Adolescent Pregnancy Through School and Community-based Education," p. 3383. The Monroe County program used the Postponing Sexual Involvement curriculum, the 1990 version of which teaches that "teens who have sex must use a method of protection against sexually transmitted infections and pregnancy each time they have sex. The best method of protection against a sexually transmitted diseases is a condom." Marion Howard and Marie E. Mitchell, Postponing Sexual Involvement: An Educational Series for Preteens. Videocassette Version (Atlanta, Georgia: Emory/Grady Teen Services Program, 1990). At some point during the study period the program "modified [Postponing Sexual Involvement] to comply with federal funding guidelines." Doniger, et al., "Impact Evaluation of the `Not Me, Not Now' Abstinence-Oriented, Adolescent Pregnancy Prevention Program, Monroe County, N.Y.," p. 48. Although there is some evidence that programs that encourage students to take a pledge to abstain from sex may help delay teenagers' initiation of intercourse, there also is evidence that teens who break their pledge are less likely to use contraceptives once they become sexually active. See Peter S. Bearman and Hannah Brückner, "Promising the Future: Virginity Pledges as they Affect Transition to First Intercourse," American Journal of Sociology, vol. 106, no. 4 (2001), pp. 859-912.

51 No Time to Lose, pp. 116-120; National Institutes of Health, "Interventions to Prevent HIV Risk Behaviors," NIH Consensus Statement (Feb. 11-13, 1997); Centers for Disease Control and Prevention, Division of Adolescent Health Services, "Guidelines for Effective School Health Education to Prevent the Spread of AIDS," MMWR vol. 37(S-2), Jan. 29, 1998, pp. 1-14 (posted on CDC website, and advising that "school systems, in consultation with parents and health officials, should provide AIDS education programs that address preventive types of behavior that should be practiced by persons with an increased risk of acquiring HIV infection," including, among other things, "[u]sing a latex condom with spermicide if they engage in sexual intercourse").

52 U.S. Department of Health and Human Services, Healthy People 2010: Understanding and Improving Health, second ed. (Washington, D.C.: U.S. Government Printing Office, 2000).

53 See American Medical Association, Council on Scientific Affairs, "Sexuality Education, Abstinence and Distribution of Condoms in Schools"; American Academy of Pediatrics Committee on Pediatric AIDS and Committee on Adolescence, "Adolescents and Human Immunodeficiency Virus Infection: the Role of the Pediatrician in Prevention and Intervention," Pediatrics, vol. 107, no. 1, January 2001, pp. 188-90; American Academy of Pediatrics, Committee on Adolescence, "Condom Use by Adolescents," Pediatrics, vol. 107, no. 6, June 2001, pp. 1463, 1467; Society for Adolescent Medicine, Position Statement and Resolutions: Reproductive Health Care for Adolescents and "Media and Contraception: Position Paper of the Society for Adolescent Medicine," Journal of Adolescent Medicine, vol. 27 (2000), pp. 290-91; the American College of Obstetricians and Gynecologists (ACOG), Committee on Adolescent Health Care, "Condom Availability for Adolescents" (April 1995) and ACOG Statement of Policy, "Limitations of Abstinence-only Legislation" (May 1998).

54 Human Rights Watch interview with Marion Stoutner, director, Child Wellness Division, Bureau of Children's Health, Texas Department of Health, Austin, Texas May 10, 2002; Texas Department of Health Inter-Office Memo from Thomas W. Bever, Jr., deputy regional director, Public Health Region 7 and Becky Berryhill, chief, Bureau of Licensing and Compliance to Debra Stabeno, deputy commissioner for programs and Mark Guidry, M.D., acting associate commissioner for Family Health, regarding review of Texas Department of Health's abstinence-only program, p. 2.

55 Texas funded twenty-one abstinence education contractors during the first funding cycle and an additional eleven contractors during the second funding cycle. One of the contractors has since dropped out. Otherwise, Texas has sustained funding for the same contractors throughout the five-year Section 510(b) funding cycle. Human Rights Watch interview with Marion Stoutner, May 10, 2002. For information about individual contractors, see Texas Department of Health, "Abstinence Education: Current Awardees and Contractors," (retrieved on June 25, 2002).

56 Texas presently allocates $1.6 million per year to Section 510(b) programs for assistance with meeting the federal "match" requirements. Human Rights Watch interview with Marion Stoutner, May 10, 2002.

57 U.S. Department of Health and Human Services, "HHS Awards $17.1 Million in Abstinence-only Education Grants," HHS News, July 6, 2001 (SPRANS-CBAE grant awards); (OPA website on AFLA funding, retrieved on August 2, 2002). In 2001, Texas programs received approximately twelve percent of all SPRANS-CBAE grant awards and more than 10 percent of AFLA grants funded.

58 Human Rights Watch interview with Marion Stoutner, May 10, 2002. Several abstinence-only contractors are also conducting evaluations of their respective programs. Human Rights Watch interview with Marilyn Ammon, executive director, McCAP, Waco, Texas, April 29, 2002; Human Rights Watch interview with Dr. Patricia Sulak, director, Scott & White Sex Education Program, Temple, Texas, May 1, 2002.

59 See Tex. Educ. Code §§ 28.002, 28.004; see also Attorney General Opinion No. DM-465 (Jan. 9, 1998) (regarding state Board of Education and local school district powers with respect to public school sex education).

60 Alan Guttmacher Institute, State Policies in Brief, February 1, 2002.

61 Human Rights Watch telephone interview with Tommy Fleming, director, Health and Physical Education, Division of Curriculum and Professional Development, Texas Education Agency, May 22, 2002; Human Rights Watch interview with David Wiley, professor, Health Education Division, Department of Health, Physical Education and Recreation, Southwest Texas State University, May 8, 2002.

62 Tex. Educ. Code § 28.004(e). Although Texas law requires districts that teach sexuality education to have local school health education advisory councils (SHEACs), there are no timelines, deadlines or other mandates for when such councils must be established nor any penalties for noncompliance. An estimated 50 percent of school districts do not have SHEACs. Human Rights Watch interview with Tommy Fleming, director, Health and Physical Education, Division of Curriculum and Professional Development, Texas Education Agency, May 22, 2002; see also David C. Wiley and Gay James, "The Status of Health Education Advisory Councils in Texas Public Schools: A 2-Year Retrospective Study," Journal of Health Education, vol. 31, no. 6, November/December 2000 pp. 341-345 (finding that 32.7 percent of school districts surveyed had not established school health education advisory councils).

63 According to McCAP's application for funding for fiscal year 2002, twenty-five public school districts, six private schools and two foster home facilities receive McCAP programs on their campuses. McCAP Continuation Request for Proposals for Section 510 abstinence education funding (RFP), p. C1. McCAP provides Teen Aid's Maturity in Body and Character (fifth and sixth grade); Me, My World, My Future (seventh and eighth grade); and Sexuality, Commitment and Family (high school) and Choosing the Best Life (high school); Choosing the Best Path (middle school); PHAT Star (Marlin ISD). Human Rights Watch interviews with Marilyn Ammon, April 29, 2002; Human Rights Watch interview with Becky Mosby, education director, McCAP, Waco, Texas, April 30, 2002; McCAP, A Collaborator's Guide (on file with Human Rights Watch).

64 Polly Ross Hughes, "Waco Schools Criticized for Rejecting Abstinence Project," The Houston Chronicle, November 22, 1998; Jen Sansbury, "WISD Vowing to Keep Present Sex-Ed Program," Waco Tribune-Herald, September 12, 1998, p. 1A. Under the terms of its grant, McCAP was required to reach out to 20,000 students. When the Waco school district, with more than 6,000 students in the sixth to twelfth grade, opted not to participate, McCAP was threatened with a 40 percent cut in its funding. Jen Sansbury, "Group May Lose Funding: County Faces 40 Percent Drop-off After WISD Withdrawal," Waco Tribune-Herald, October 29, 1998, p. 1A.

65 McCAP RFP, p. C1; Human Rights Watch interview with Marilyn Ammon, April 29, 2002; Human Rights Watch interview with Becky Mosby, April 30, 2002; Human Rights Watch interview with Denise Hensley, McCAP corporate abstinence educator, Waco, Texas, April 30, 2002.

66 Ibid., pp. C1-C2. The media campaign includes public service announcements on the local ABC television affiliate and on the radio, as well as advertisements on billboards and in school newspapers.

67 Human Rights Watch interview with Marilyn Ammon, April 29, 2002; McCAP, A Collaborator's Guide.

68 Scott & White Sex Education Program application for Section 510 abstinence education funds for fiscal year 2002, pp. F1-F8; Human Rights Watch interview with Dr. Patricia Sulak, May 1, 2002.

69 "Worth the Wait" materials include Teens and Sex: What are the Effects; What Adults Need to Know About Teens and Sex; and national and Texas editions of Teens, Sex and the Law.

70 Ibid. and Human Rights Watch interview with Dr. Patricia Sulak, May 1, 2002.

71 City of Laredo application for Section 510 abstinence education funds for fiscal year 2002, p. C1.

72 Ibid.; Human Rights Watch interview with Charmaine Heimes, master teacher, "Mi Futuro/My Future" Abstinence Education Program, Laredo, Texas, May 9, 2002.

73 According to its mission statement, the Medical Institute "identifies, evaluates and communicates credible scientific data in practical, understandable and dynamic formats to promote healthy sexual decisions and behavior in order to dramatically improve the welfare of individuals in society." Dr. McIlhaney told Human Rights Watch that the Medical Institute is not an abstinence organization, but a medical educational group that is committed to reducing the risk of sexually transmitted diseases and nonmarital pregnancy. It supports abstinence because it is "clear that abstinence is best for adolescents and young adolescents." Human Rights Watch interview with Dr. Joe McIlhaney, May 10, 2002.

74 Medical Institute for Sexual Health application for Section 510 abstinence education funds for fiscal year 2002, p. C1.

75 Ibid., pp. C1-C2, F1-F10.

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