Bringing Bad Sex Ed Back
Trump’s Rebranding of Abstinence-Only
A shocking thing happened at a closed-door United Nations meeting in March, during the annual meeting of the UN Commission on the Status of Women (CSW). In a private session intended to set language for gender equality policies and to brief non-governmental organizations on U.S. priorities for women’s issues, a senior advisor from the U.S. Agency for International Development (USAID), Bethany Kozma, who gained notoriety for her transphobic stance on bathroom policies, declared the United States a “pro-life” nation.
The pronouncement jolted the room like a “record scratch,” one UN official later said.1 At subsequent sessions over the two-week gathering, other Trump officials, including the senior policy advisor for the U.S. Department of Health and Human Services (HHS), Valerie Huber, reiterated the point. Huber, who once headed a national abstinence-only advocacy organization,2 used the term “pro-life” while demanding the removal of key terms such as “modern contraception,” “emergency contraception,” and “unsafe abortion” from outcome documents focused on gender equality.3
But the declaration encompassed more than just abortion. In both cases, the U.S. representatives pushed a far-right agenda not just on abortion but on sex education and contraception, seeking to scrub from the meeting’s outcome documents any mention of sexuality. It was a stunning revelation that the Trump administration’s “pro-life” agenda isn’t just targeting abortion access but sex education as well.
One meeting attendee, Shannon Kowalski, director of advocacy and policy at the International Women’s Health Coalition, called the move simultaneously aggressive and regressive. It caused other stakeholders, such as Sanam Amin, a program officer with the Asia Pacific Forum on Women, to question their continued participation in the CSW, which focuses on addressing barriers for the world’s most vulnerable women.4 It wasn’t just talk of regressive policy changes; the U.S. delegation also extended official invitations to two right-wing organizations, the Heritage Foundation and the Center for Family and Human Rights (C-Fam),5 meaning both could attend restricted CSW sessions off-limits to most other nongovernmental organizations. One delegate, Rashima Kwatra, communications officer for OutRight Action International, expressed concern that this signaled an effort to enshrine discrimination as entities pushing for “religious freedom” co-opted CSW’s message.6
Between 1982 and 2010, the government poured approximately $1.6 billion into abstinence-only initiatives. Each benchmark (notably the Title V Abstinence Only Until Marriage component of the 1996 welfare reform law, and Congress’s funding of Community-Based Abstinence Education in 2001) represented an increase in expenditure and an uptick in governmental control, as lawmakers and proponents sought to define and enshrine traditional family values through increasingly strict requirements for grant recipients. During that time, the government’s position morphed from a general call in the 1981 Adolescent Family Life Act (AFLA) to encourage “chastity and self-discipline” to a full-blown doctrine enshrining monogamous heterosexual marriage as the sexual norm.
By 2004, the George W. Bush administration shifted abstinence-only funding from the Maternal and Child Health (MCH) Bureau, to the Administration for Children and Families (ACF). Bush would also more than double overall spending on abstinence-only education from $60 million in 2000 to an all-time high of $177 million in 2008. Under this more conservative management, ACF hardened funding guidelines. Where MCH grant recipients had merely been prohibited from contradicting Title V’s eight-point definition of abstinence-only programming, ACF grantees had to address each of the eight points with equal weight. ACF also expanded its target population to include all Americans younger than 30. By 2006, organizations receiving ACF grants were specifically prohibited from providing clients with information about safer sex (even with separate funding), and the concept of abstinence had grown to include any sexual contact between unmarried people.
Despite this massive investment, the reality that abstinence-only programs don’t work was becoming obvious. They consistently failed to delay sexual behavior, prevent teen pregnancy, or protect against sexually transmitted infections. They also offered patently false or misleading information about reproductive health; relied on fear- and shame-based methodologies and biased curriculum materials that promoted gender stereotypes and excluded sexual minorities; contained thinly veiled efforts to enshrine religious values as universal standards; and lacked any federal oversight to ensure basic scientific accuracy.
By 2008, 16 separate reviews detailed these concerns, including assessments authored by the minority leader of the House Committee on Government Reform, the Government Accountability Office, an investigative firm hired by HHS, as well as 13 state inquiries. Congress convened a hearing on abstinence-only initiatives the same year and declared the programs ineffective and objectively harmful. By this point, almost half of all states were refusing federal funds tied to abstinence-only, and the initiatives seemed destined for the dustbin of history.7
To settle any lingering public debate, researchers combed through decades of data, comparing abstinence-only outcomes with those of an evidence-based comprehensive sex education program endorsed by the National Institutes of Health. They found that the lowest teenage pregnancy and birth rates occurred in states offering comprehensive sex education while the highest were in states that emphasized abstinence-only. The research team also reported clear socioeconomic and racial disparities associated with abstinence-only, as richer, Whiter states emphasized abstinence less and, unsurprisingly, experienced fewer teen pregnancies and births.8
When it comes to sex education, all the major players—the Center for Disease Control and Prevention (CDC), the National Institutes of Health, the American Academy of Pediatrics, the American Medical Association, the Society for Adolescent Health Medicine, the American Public Health Association, and the American Psychological Association—have taken positions against abstinence-only,9 recognizing that it’s bad science and a violation of adolescents’ human rights.10
Still, abstinence proponents—overwhelmingly conservative Christians—pushed forward, insisting that their approach “follows God’s plan for sexuality and reflects a biblical vision of marriage and family.”11
Besides the shared consensus on abstinence-only education’s ineffectiveness, critics also pointed out how the programs marginalized victims of sexual violence and vulnerable communities, and undermined adolescents’ right to make informed decisions.
The essential message of abstinence-only is that there is one correct life path: complete sexual abstinence until marriage. In its earlier iteration under Title V, this was billed as a valuable “social tradition”; today advocates call it a “success sequence.”12 According to abstinence-only proponents, deviation from this norm comes with grievous consequences—physical ailments, psychological distress, lifetime poverty, and societal decline.
Public health experts point out that this messaging marginalizes individuals who are sexually active, including adolescents who are sexually active due to sexual abuse, rape, or intimate partner violence.13 Abstinence-only programs that leverage fear and shame to control student behaviors can be outright abusive from the perspective of sexual violence. One scholar, Tina Schermer Sellers, who leads the Medical Family Therapy Program at Seattle Pacific University, found that young adults exposed to abstinence-only education (as well as related aspects of evangelical “purity culture”) described deep sexual shame akin to the self-loathing experienced by victims of childhood sexual assault.14
That shame is likely compounded by abstinence-only lessons that teach, as one popular curriculum does, that marrying someone with any prior sexual experience at all is like having a wad of already-chewed gum dropped in your hand. Abstinence-only insists that adolescents can avoid sexual violence by simply implementing “sex refusal” and “date rape prevention” skills. These entail erecting Mike Pence-esque boundaries, such as never being alone with someone of another gender. For abstinence-only proponents, the onus for preventing sexual violence lands squarely on the shoulders of potential victims. To drive the message home, one abstinence-only curriculum presents a vignette depicting a young woman who was raped by a relative of her employer during a babysitting job. According to the curriculum, the survivor could have avoided rape if she had simply refused to work if there were any possibility that she would be alone with a member of the opposite sex.15 These stereotypes and rape myths correlate with negative sexual health behaviors like reduced likelihood of engaging in safer sex,16 ignoring consent,17 and adolescent sexual dating violence.18
Abstinence-only also relies so heavily on rigid stereotypes about sex and gender roles that Legal Momentum and the Harvard School of Public Health suggest that this is in fact the initiative’s “hidden curriculum.”19 According to the publication:
When teachers and other adults present such stereotypes as fact, students are less likely to recognize gender discrimination, more likely to excuse acts of male sexual aggression, and less able to develop as ambitious, intelligent, and healthy young adults. Indeed, gender stereotypes are dangerous not only because they undermine female sexual decision-making, but also because they limit opportunities and negatively affect societal expectations for men and women alike.
Stereotypes like these, the authors noted, also stigmatize students of color—since they’re statistically more likely to grow up in single-parent homes or become single parents—and exclude LGBTQ students, who are statistically more likely to experience sexual violence.
It amounts to an agenda that disproportionately targets vulnerable communities. As a Guttmacher Institute report noted, by prescribing “a single life path for young people,” through a “success sequence” that ignores systemic factors like racism, inequality, discrimination, and trauma, abstinence-only programs “stigmatize young people for whom this specific set of prescribed goals may not be desired or obtainable. Ultimately, abstinence-only programs fail to take into account the structural barriers, cultural differences and individual choices and experiences that shape people’s lives.”20
The Obama administration decisively shifted away from abstinence only to comprehensive sex education, cutting funding from $177 million to $50 million and eliminating two major funding streams (AFLA and CBAE). Immediately upon Trump’s taking office, his administration reversed course again, increasing annual federal abstinence-only expenditures to $85 million dollars in 2016 and $90 million dollars in 2017, and installing abstinence-only advocates, mostly conservative evangelicals, into key positions in government, such as HHS’s Valerie Huber, one of the delegates who insisted that the U.S. is now “pro-life” at the UN.”
Huber is also the co-founder of her own abstinence-only organization, Ascend, which she started after she was found guilty of an ethics violation and suspended from directing Ohio’s abstinence education program.21 Through Ascend, she’s argued that comprehensive sexual education constitutes a greater pressure on adolescents to have sex22 than they face from their own dating partners.23 (To back this up, Huber cites a study compiled for Ascend by an evangelical Christian polling firm that self-describes as providing insight to “spiritual influencers.”24) Ascend has also taken aim at the methodology of research supporting comprehensive sex education,25 arguing, for example, that researchers measuring overall condom usage ”did not measure consistent, correct use”—a long-time critique by abstinence-only advocates that conflicts with their insistence that instructing students in correct condom usage is “explicit content” that provokes students to become sexually active.26
But after years of studies demonstrating the failures of abstinence-only, both organizations like Ascend and the Trump administration itself have rebranded their work, as Sexual Risk Avoidance (SRA).27
Sexual Risk Avoidance proponents have sought to recast abstinence-only’s image by poaching scientific language, using terms like “risk avoidance,” “evidence-based,” and “medically accurate”—language that lends the program a veneer of public health legitimacy in ways that “abstinence” could not. Much of this language appears modeled on public health initiatives aimed at decreasing objectively dangerous behaviors. Ascend, for example, directly compares its approach to risk reduction strategies aimed at preventing underage drinking, illegal drug use, smoking, and violence, insisting that the goal is to return sexually active youth to a “healthy lifestyle free from all sexual risk.”28 SRA proponents even push for “cessation intervention support” for sexually active adolescents.29
Therein lies the most insidious rebranding of abstinence-only. Epidemiologists use the term “risk reduction” when exploring outcomes. As a risk reduction program, comprehensive sex education is geared toward minimizing absolute health risks associated with teen sex: teen pregnancy and the transmission of sexually transmitted infections. However, SRA proponents insist that comprehensive sex education does not really reduce harm and should not even be considered a risk reduction program—even if outcomes show an all-time low for teen pregnancy rates30—because, for abstinence-only advocates, the goal is not to reduce the risks associated with teen sex but to recast all premarital sex as inherently unhealthy and destructive to society. According to SRA, any outcome other than complete abstinence is a failure, and all studies demonstrating the efficacy of comprehensive sex education are inherently flawed, since the only acceptable standard for success is total cessation of all premarital sex.
That much is demonstrated by an infographic published by Ascend, taking specific aim at the evidence-based comprehensive sex education program Teen Pregnancy Prevention (TPP, the curriculum endorsed by the National Institutes of Health), claiming the program increases oral sex among teens.31 Ascend’s infographic also makes the demonstrably false claim that TPP increases teen pregnancy, but its focus on oral sex is revealing: an admission that their aim is not to reduce teen pregnancy but to mandate one specific sexual morality.
Now, under Trump, that perspective is policy. Huber’s HHS has adopted SRA, as well as its stated goal: to normalize “the optimal health behavior of avoiding non-marital sexual activity” altogether.32
Despite the façade that SRA is a new public health program, the vast majority of the studies cited by Ascend’s treatise on SRA—23 of 25—are pulled from the previous era of abstinence-only. Additionally, a third of the studies—eight of 25—were authored by a single social psychologist, Stan Weed, whose Institute for Research and Evaluation exclusively focuses on abstinence-only and character education materials. Weed’s reemergence as an SRA expert is particularly notable; his testimony before Congress during the 2008 hearings that ultimately found abstinence-only ineffective and harmful represented a public low point for abstinence-only. In videos of the hearings, Weed argues vociferously with a Republican congressman about the benefits of withholding sexual health information from young people—while seated near a young adult who had just finished testifying that he contracted HIV as an outcome of withheld information.33 Weed’s support staff at the hearing? None other than Valerie Huber.
The alternative is to view sex education through the same lens used by developed countries with substantially lower rates for teen pregnancy. That is, “based on the WHO definition of sexuality as a lifelong process, aiming to create self-determined and responsible attitudes and behavior with regard to sexuality, contraception, relationships and life strategies and planning.”34 But for SRA proponents, this amounts to being “pro teen sex.”35
Back at the UN in March, the U.S. delegation’s “pro-life” declaration and subsequent push to eliminate any mention of phrases such as “modern contraceptives” from outcome documents set the U.S. at odds with the UN Commission on the Status of Women working group, including representatives from nations traditionally far to the Right of U.S. policy on gender equality, such as China, Egypt, Iran, and Russia.36 It also sparked concerns about the broader implications of the United States’ new political orientation.
One delegate told BuzzFeed the members came together and “stared down” the U.S., optimistically claiming they succeeded in thwarting the extreme agenda. Yet the final draft of the document was reduced to weak references to “sexual and reproductive health,” stripped of any mention of sex education, contraception, or abortion. A U.S. statement released after the negotiations clarified that even the phrase “sexual and reproductive health” was open to interpretation, leaving participants speculating about the implications for U.S. funding for international family planning, traditionally managed through USAID.37
There is certainly domestic precedent for defunding alternatives to abstinence-only education. Shortly after Valerie Huber’s appointment to HHS, that agency slashed federal funding for the Teen Pregnancy Prevention (TPP) program that Ascend had long denounced, and ended grants awarded to Planned Parenthood and 81 other organizations two years early. In a March 2017 op-ed for The Hill, Huber declared TPP ineffective, despite the Journal of Adolescent Health and the CDC both reporting an all-time low for teen pregnancy in 2016, which medical experts such as the American Congress of Obstetricians and Gynecologists attribute to TPP.38 The piece appears to be backed by research, but many of the hyperlinked sources lead nowhere or don’t reflect the text they are meant to support.39 In one instance, Huber insists that youth who receive training to avoid sex are more likely to use condoms than students who receive comprehensive sex education, yet the study she cites concludes with a recommendation for comprehensive sex education.40 A federal judge blocked HHS’s effort to defund Planned Parenthood’s TPP program in April, stating the potential for substantial harm from cutting the grants.41
After losing five such federal lawsuits brought by defunded grantees,42 HHS resumed TPP funding but seems to have adjusted its course to sidestep judicial oversight. Now, instead of eliminating TPP, current HHS funding guidelines for the program include options to allocate TPP money for SRA programs.43 In the first funding tier, prospective grantees can apply for a total of $61 million earmarked for TPP but they are permitted to use an SRA assessment tool developed by an abstinence-only organization, the Center for Relationship Education, for curriculum selection, essentially providing a means to funnel TPP funds to SRA programs. The second tier enables public and private entities to access $22 million of TPP funds to develop and test “new and innovative strategies to prevent teen pregnancy…by focusing on protective factors,” including those set forth by the SRA tool.44
Restricting people from accessing sexual health services and information is part of a broader conservative agenda that includes the “Global Gag Rule,” which prohibits NGOs receiving U.S. funding from providing or even mentioning abortion. This policy is consistent with the Trump administration’s push for a domestic gag rule, which would similarly withhold funds from U.S. organizations and healthcare providers who discuss abortion with patients, redirecting that money instead to anti-choice groups.
Reproductive healthcare advocates are rightly concerned about the possibility of the U.S.— historically the largest donor for global family planning and reproductive health efforts45—withdrawing their support. In 2017, the Trump administration withheld U.S. funding allocated for the United Nations Population Fund (UNFPA) on the basis of the “Kemp-Kasten amendment,” which allows sitting presidents to alter funding based on the perceived risk of “coercive abortion or involuntary sterilization,” and proposed completely eliminating international family planning and reproductive health funding in 2018.46
Withholding UNFPA funding is not atypical; since Reagan, Republican presidents have used Kemp-Kasten to suppress UNFPA funding and impose funding restrictions, despite no evidence that UNFPA grantees engage in activities that force abortion or sterilization (a fact conceded by the Trump administration in the 2017 memorandum).47 What is atypical, however, is the proposal to eliminate all family planning and reproductive health funding, as well as the fact that withheld funding, which in the past had been reallocated to other reproductive health programs, is now in the hands of anti-choice advocates opposed to sex education and contraception too. (Another atypicality is the administration’s open hostility to the very regions reproductive health funding targets—countries the president notoriously called “shitholes.”)
There’s additional cause for concern regarding the role abstinence-only education may play in what international reproductive health programs Trump does fund. Legal Momentum and the Harvard School of Public Health describes how the earliest iteration of Bush’s HIV/AIDS program, the President’s Emergency Plan for AIDS Relief (PEPFAR), had, as a global abstinence-only mandate, “deprive[d] women and girls of prevention strategies that are, literally, lifesaving.”48 During the Obama administration, PEPFAR’s abstinence-only requirements were relaxed, and the program has grown to be considered a public health success.49 However, after the Trump administration unsuccessfully proposed eliminating PEPFAR funding for 2018, it proposed extending the Global Gag Rule to cover PEPFAR for the first time.50
In a political climate marked by near-constant human rights violations, the resurrection of abstinence-only programs under the guise of “risk avoidance” occurs amid growing outrage fatigue. This is a dangerous perfect storm, given the domestic implications, especially for vulnerable students, and the potential global reach of the policy.