Risky Business
Teens are having more sex--and getting more diseases. But is telling them to wait the answer?
From Chicago physician Kushner's point of view, that's a common problem. "I'm seeing more and more of it: simply unsafe sex practices," she says. "The kids love the pledge stuff, they just love it. But if they do make a mistake, and it happens all the time, they're ashamed and don't want to admit it." As a result, she adds, "The kids I'm seeing just aren't using condoms." In addition, she says, "They aren't being taught how, or that it's a way to protect themselves."
That's fine with Joe McIlhaney, an obstetrician and director of the Medical Institute for Sexual Health in Austin, who believes that there has been far too much emphasis on condoms in the past. What's more, he worries that condom effectiveness has been oversold to teens. "No one is telling them how ineffective condoms are," he says. "We don't even know if they do protect--protect is the wrong word," he interrupts himself. "The primary message is that they don't eliminate the risk of any disease." Abstinence, he emphasizes, is the only surefire means of doing that. As an added incentive, McIlhaney does his part to illustrate the risks of sex. His slide shows, graphically depicting the advanced, late-stage ravages of various sexually transmitted diseases, are legendary in abstinence-only circles.
For his part, Allen at Health and Human Services considers discussion of contraceptives to be "inappropriate." It amounts to "mixing messages, of not giving a clear direction of what's expected behavior," he says. "It's like telling your child, `Don't use the car,' but then leaving the keys in the Lamborghini and saying, `But if you do, buckle up.' "
But Tamara Kreinin, president of the Sexuality Information and Education Council of the United States, regularly uses the same analogy--to make the opposite point. "I mean, wouldn't you want your kids to wear a seat belt?" she asks.
And that is the disagreement at the heart of sex education today. It's a debate that began in earnest in 1996, with a companion bill tacked on to the Welfare Reform Act that budgeted $440 million over five years to support abstinence-only sex education. The cash came with some requirements. Specifically, any programs using the funding could not be inconsistent with the federal eight-point definition of abstinence-only education. Among those points: "that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects" and that "a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity." Today, every state except California accepts this funding, which was reauthorized by Congress last week. (A proposed amendment to the Welfare Reform legislation, calling for "medically and scientifically accurate" sex education programs, was rejected.)
But Representative Istook felt that there was still too much leeway and room for misinterpretation in the Welfare Reform funds. So in 2000 he launched his own proposal for sex ed funding. His legislation, which falls under the Special Projects of Regional and National Significance (SPRANS) program, a maternal and child health initiative, uses a more restrictive version of the welfare act's requirements. Programs receiving SPRANS funds must actively teach all eight points of the federal definition of abstinence education. "What they were doing before wasn't enough," says Istook. The result, says Cynthia Dailard, senior public-policy associate at the Alan Guttmacher Institute, is that "the only thing these programs can discuss about contraceptives is their failure rate."
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