What's working — less sex or better contraception?

It should come as good news that in 2005 the teenage birth rate in the United States dropped to a 65-year low. Who's behind ameliorating the problem? Champions of comprehensive sex education and abstinence-only advocates both claim credit for the findings in the Centers for Disease Control and Prevention's National Center for Health Statistics report.

Let's posit this scenario: You're 16. You buy a soda and a pack of condoms at the corner store. That afternoon you have sex. You know how to put on the condom because you were taught in your public high school. Anyway, the condom is just a backup. Your girlfriend is on the pill. Some people say your education has encouraged you to take a life-threatening health risk.

Here's an alternative scenario: You're the federal government. You've thrown over a billion dollars into abstinence-only-until-marriage education. In a decade, you've transformed sex education in many states. Your message? There is no such thing as safe sex. Is your plan working? Your opponents say you're better off throwing your money down a wishing well.

Who's right?

According to Bill Albert, deputy director at the National Campaign to End Teen Pregnancy, "both 'sides' should declare victory."

"The short answer is quite simple: both less sex and more contraception," he wrote in an email. "Researchers disagree about the relative contribution of each to the overall declines in teen pregnancy, but all agree that it is some combination of less sexual activity and greater contraceptive use."

Information equals safe sex

Monica Rodriguez, vice president of education and training at the Sexuality Information and Education Council of the United States, says that the birth rate is down mostly because of an increase in the consistent use of improved hormonal birth control methods, like the pill, the patch, the shot and the implant. Her claims are supported by the widely read report released in late 2006 that found that 86 percent of the decline in pregnancy risk can be attributed to improved contraceptive use and that 14 percent of the decline can be attributed to teens waiting longer to start having sex.

The decrease did not happen overnight. Abstinence didn't instantaneously come into vogue. Nor was there a surge of birth control pill popping. Instead, there has been a steady drop in the number of teenage girls giving birth since 1991. That year the birth rate was at a record high of 61.8 per 1,000 teens. In 2005, the rate dropped to 40.4 births per 1,000 teens. The abortion rate among this age group is also going down.

Albert offers another piece in the puzzle. HIV prevention education may finally be "catching up." It's common, he says, for public health information to take a long time — even decades — to actually effect the way people behave.

Black teens changing course

Here's another great thing: Black teens aged 15 to 17 experienced the steepest reduction in teen births. Some people surmise that the decrease is simply because the group with the highest rate will also have the greatest decline. But Dr. Michael A. Carrera, director of the Children's Aid Society's Stern National Adolescent Sexuality Training Center, thinks there's more to it. He speculates that there is a connection between the declining black teen birthrate and the increased educational efforts — primarily through after school programs and community centers — in underserved urban communities. Many of those programs, he says, wisely take an integrated and holistic approach to preventing teen pregnancy.

"A beautifully framed sex education program will not get the job done unless you link it to all the other things that are getting in the way a making a young person whole … failing in school, poor housing, no primary care, no counselor, no one to confide in, no job or bank account," he says.

No means no — until marriage

Libby Gray Macke who runs the wide-reaching abstinence program Project Reality believes that HIV-prevention education might actually be behind the spike in teen pregnancy close to two decades ago. At the time, Macke says, kids were given a green light on sex — as long as condoms were used. That message, she claims, simply did not prevent teen pregnancy.

Abstinence education, on the other hand, is working, Macke says. And adults are wrong to think that kids don't buy into it. "Teenagers are savvier. They know that condoms may or may not protect them, and abstinence is a more realistic option."

She points to a report released in 2003 that claimed increased abstinence was the major cause for the decline. However, the report has been widely criticized, most notably by the Guttmacher Institute, for having significant methodological flaws.

Young people harbor genuine concerns that they won't be able to find a spouse who has not been scarred by early sexual initiation, Macke says. "I tell them: Don't jump in the pool. If you're already in the pool, get out. Increase number of uninfected people to choose from."

Jumping out of the pool means getting out and staying out — until marriage. Abstinence has always been a part of comprehensive sex education. But Macke points out that waiting longer is not the same as waiting until marriage. This means no sex until you swap vows. No genital touching. No mutual masturbation. Even kissing can quickly escalate into below the neckline activity.

Holding out for a ring may seem like a ludicrous campaign in a society where as high as 95 percent of the population has sex before marriage. But Macke defends the sensibility of her cultural revolution by saying it is the only guarantee against unwanted pregnancy and STDs.

The abstinence-only message also seems to offensively disregard the experience of gay and lesbian youth for whom marriage is not even an option. But Macke says that all kids — gay or straight — understand the concept of "one partner for life." To GLBT teens, she discourages experimentation.

Withholding information greatly alarms opponents who see teen sex as less of a question of "if," but "when." Rodriguez raises this concern: When young people who have only been exposed to abstinence-only education start having sex, will they know how to protect themselves?

"We need to be very clear with the message of protection, whether young people use it today or in the future," Rodriguez says. "Condoms aren't perfect, but they are way more effective than not using a condom at all." She says that when programs focus on the failure rate of condoms, young people hear: Condoms don't work. And that, she says, is misleading.

But this is how abstinence advocates see it: Condoms don't work all of the time, and that means they don't work. Most abstinence-only organizations provide no information on how to use and get contraceptives. "We don't advocate for contraceptives," says Macke. "It is important teenagers receive pure message."

Government gives out big money to abstinence programs

The federal government has been supporting abstinence-only programming since the Reagan administration. But in 1996, the amount of support took a big leap. Through the Title V Welfare Reform Act, the U.S. Department of Health and Human Services now grants abstinence-only funds to the states, which then distribute the money. California is the only state that has never accepted Title V funds. Title V defines abstinence through an eight-point definition that includes statements such as: "Sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects." In 2000 the federal government introduced a new, controversial stream of funding, Community-Based Abstinence Education (CBAE) grants. CBAE grants allow the federal government to bypass the state decision-making process and give directly to community organizations.

The opponents' most vocal complaint against federal funding is that there is no substantial, scientific evidence that abstinence-only education is making teens safer. Here is another serious concern: Many Crisis Pregnancy Centers (CPC) are also receiving funds. Since the '70s, CPCs have dissuaded pregnant women from aborting. But it wasn't until the CPCs developed abstinence programming that they qualified for millions of dollars of federal funding. Opponents, such as SIECUS, claim that many of these organizations are dangerous conduits of false and fear-based information and a religious message.

As an example, SIECUS points to the Alpha Center in Sioux Falls, S.D. It received close to $300,000 in CBAE funds in 2005. The center's navigable website has a medical and professional tone — but misleading information. The passage it provides on suction-aspiration, the most commonly used method of abortion, refers to a fetus as a baby, a doctor as an abortionist, and implies great risk to the woman, which is inaccurate. "The abortionist then inserts a hollow plastic tube with a knife-like edge into the uterus. The suction tears the baby's body into pieces."

"The truth is that the declines in teen pregnancy and birthrates predate the large investment of money in abstinence-only programs," Albert wrote. "Moreover, we simply do not know — nor does anyone — exactly how the investment in abstinence-only programs has played out; whether it has had an impact on the national level is not known and probably unknowable."

Albert says that the same is true of more comprehensive sex education programs. He says we may know if a particular program has had a positive effect, but we can't measure the impact of these programs on a national level.

The problem still exists

The United States has the highest rate of teen pregnancy in the western industrialized world. Whatever is working — abstinence education, comprehensive education, integrated education — we need more of it.

But, like parents arguing about how to teach their kid to skateboard, both abstinent and comprehensive sex advocates adamantly believe there is a right way.

One parent might say skateboarding can be dangerous. But if you're going to do it, here's some information. And wear a helmet. Meanwhile, the other parent says: Skateboarding? No way. It is dangerous. Don't do it.

If the kid doesn't get hurt, is it because she got on the board and was smart? Or lucky? Or because she didn't get on at all?

In Part II we hear from teens. Whom do teens trust for reliable information on sex? Why have some teens made an abstinent commitment? Is being on the pill taboo? Is abstinence realistic?

Originally published at Wire Tap Magazine.