The Evaluation of Abstinence Education Programs Funded Under Title V Section 510: Interim Report . Chapter I: Background

In 1996, Congress authorized $50 million annually for five years in funding to states for programs that teach abstinence from sexual activity outside of marriage as the expected standard for school-age children.  This funding was established through a new formula grant program created under Title V, Section 510 of the Social Security Act, authorized under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996.  The funds became available to states in 1998 and are administered by the Maternal and Child Health Bureau.  Currently, Title V Section 510 abstinence education is in its last funding cycle, and deliberations regarding reauthorization will begin shortly.

Four years into the Section 510 abstinence education funding, the percentage of teens reporting that they have had sex has decreased, continuing a decline that started in 1991.  At this time, however, no definitive research has linked the abstinence education legislation with these downward trends.  Most people acknowledge that “abstinence works.”  It is certain to prevent unwanted pregnancy, sexually transmitted diseases (STDs), abortions, and out-of-wedlock childbearing.  However, an important question is:  To what extent are abstinence education programs effective in persuading youth to be sexually abstinent and in changing teen sexual behavior?

Empirical evidence on the effectiveness of abstinence education is limited.  Moreover, most studies of abstinence education programs have methodological flaws that prevent them from generating reliable estimates of program impacts.  Even the features of abstinence programs implemented, the curricula used, and the experiences of program staff and program participants are not well documented in a readily accessible way.  To address this gap in information, Congress authorized a federally funded, independent evaluation of Section 510 abstinence education programs in the Balanced Budget Act of 1997 (Public Law 105-33).  Through extensive implementation, process, and impact analyses, the evaluation will strengthen the research base and knowledge about strategies for promoting sexual abstinence among youth and the benefits of various approaches to abstinence education.

This report presents interim findings from the congressionally authorized evaluation. The first in a series of reports from the evaluation, this report draws most heavily on four years of implementation experiences in a selected group of abstinence education programs funded under Title V Section 510.  This report also uses information from federal program monitoring reports, efforts by state and local evaluators, and policy and issue statements by various constituent groups and policy organizations.  Later reports from the evaluation will present estimates of short- and longer-term program impacts, as well as studies on special topical areas.

• What Is the Context for the Title V Section 510 Abstinence Education Program?

  • Despite a steady decline in the teen birthrate between 1991 and the present — from a high in 1991 of 62 births per 1,000 females age 15 to 19, to 49 such births in 2000 — concerns about teen sexual activity persist:

    • In 1999, half of all high school students and nearly two-thirds of graduating seniors reported having had sexual intercourse (Centers for Disease Control and Prevention 2000).
    • In 1999, one in five high school seniors reported having had sex with four or more partners (Centers for Disease Control and Prevention 2000).
    • Nearly 480,000 babies were born to teens in 2000, and 79 percent of these births were out of wedlock (National Center for Health Statistics 2002).

    The consequences of teenage sexual activity and out-of-wedlock childbearing are many and serious for teens, their families, their communities, and society.  Over three-fifths of teen mothers live in poverty at the time of their child’s birth, and over four-fifths eventually live below poverty (Maynard 1996).  Children born to teen mothers often fare badly during infancy, early childhood, and their adolescent and adult lives.  Compared with children born to mothers who delay childbearing until age 21 or older, children of teen mothers are more likely to grow up in homes that are not emotionally supportive or cognitively stimulating, to suffer from abuse and neglect, to repeat a grade in school, and to drop out of high school (Moore et al. 1997; Goerge and Lee 1997; and Haveman et al. 1997).

    In addition to its social and economic consequences, teen sexual activity also brings increased risks of STDs.  In fact, teenage females have the highest rates of STDs of any age group.  In the United States, more than 65 million people have an STD, and most are incurable viral infections (National Institute of Allergy and Infectious Diseases 2000).  STDs may cause such lifelong complications as infertility, ectopic pregnancies, miscarriages, stillbirths, intrauterine growth retardation, and perinatal infections.  One STD, human papillomavirus, is the primary cause of cervical cancer.  Moreover, because of limitations in study design, the scientific evidence on the effectiveness of condoms in preventing STDs is inconclusive (National Institute of Allergy and Infectious Diseases 2000).

• What Is the Title V Section 510 Abstinence Education Program?

  • In this context of high rates of teen sexual activity and their serious public health and socioeconomic consequences, interest in abstinence education has increased over the past decade.  As a result, in 1998 the federal government provided $50 million annually for five years for block grants to states to support abstinence education programs.  States must provide $3 in matching funds for every $4 in federal funds, which results in a total of up to $87.5 million available annually for such programs.

    These abstinence education grants are allotted to states through a formula based on the proportion of low-income children in the state relative to the total number of low-income children for all the states.  States then decide which programs to fund and at what level.  Most states have disbursed their funding to numerous local agencies and organizations.  However, a few states, such as Massachusetts, have retained their entire funding allocation for a single statewide initiative, such as a media campaign.

    Although abstinence education programs have been around for decades, the new investment raised the profile of programs that teach an unambiguous abstinence message to youth.  The main factor that distinguishes the Section 510 abstinence education funding from the previous generation of federally funded abstinence education programs is the “A-H definition” (Title V Section 510 (b)(2)(A-H) of the Social Security Act), which specifies that an abstinence education program funded under the block grant must:

    1. Have as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity
    2. Teach abstinence from sexual activity outside marriage as the expected standard for all school-age children
    3. Teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems
    4. Teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity
    5. Teach that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects
    6. Teach that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child’s parents, and society
    7. Teach young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances
    8. Teach the importance of attaining self-sufficiency before engaging in sexual activity

    The Maternal and Child Health Bureau guidelines for these abstinence education programs offer the following interpretation of the A-H definition:  “It is not necessary to place equal emphasis on each element of the definition.  However, a project may not be inconsistent with any aspect of the abstinence education definition” (Maternal and Child Health Bureau 1997; Haskins and Bevan 1997).  Providing instruction in or promoting the use of birth control would be inconsistent with the A-H definition.

    The A-H definition of abstinence education has generated controversy.  Some abstinence educators and policymakers are critical of Section 510 abstinence education programs that do not emphasize all elements of the A-H definition.  These criticisms have been especially strong for some preexisting health and teenage risk reduction programs that are perceived to have simply added limited abstinence education modules to their services specifically to gain access to Section 510 funding.  On the other hand, some policymakers and health educators object to the Section 510 abstinence education programs primarily because of their restrictive definition of abstinence education.

    Still, since the inception of the Section 510 abstinence education funding, the number of abstinence education providers has increased dramatically.  The funding has stimulated considerable discussion at the state and local level on the problem of teen sexual activity and raised local awareness and consideration of the role of abstinence education in local programs and policies.  Supporters of abstinence education contend that such programs are effective because they are consistent with the developmental needs of adolescents for clear, consistent messages and boundaries.  Their concern with sex education programs that teach about sexuality, contraceptives, and abstinence is that they send the mixed message that (1) teens should be abstinent, but (2), if they are going to have sex, they need information about and access to contraceptives.

    On the other side, proponents of comprehensive sex education programs contend that, while abstinence is preferred, broader sex education is essential because most teens are sexually active by the time they finish high school.  Comprehensive sex educators contend that teens need to be taught about and provided access to contraceptives to reduce their risk of pregnancies and STDs.

    Despite these different perspectives on how best to address high rates of teen sexual activity, a common thread in the ongoing policy debate is an underlying interest in learning about effective program strategies that help youth make good choices that avoid risk-taking behaviors and promote healthy future lives.  The evaluation of Section 510 abstinence education programs is designed to contribute much-needed knowledge on approaches to, and the effectiveness of, selected abstinence education programs.

• What Is the Evaluation of Abstinence Education Programs Funded Under Title V Section 510?

  • In fall 1998, the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, awarded a competitive contract to Mathematica Policy Research to conduct an independent evaluation of Section 510 abstinence education programs.  The evaluation addresses three important questions:

    • What are the nature and underlying theories of the abstinence education programs supported with Section 510 funding?
    • What are the implementation and operational experiences of local communities and schools that have received Section 510 abstinence education funding?
    • What are the impacts of abstinence education programs?
      • How successful are they in changing the knowledge, attitudes, and intentions of youth?
      • How successful are they in reducing teen sexual activity among youth?
      • How do they change the risk of pregnancy and STDs?

    To address these questions, the evaluation includes an extensive implementation and process analysis, focused on 11 abstinence education programs, as well as rigorously designed impact studies of 5 of these programs.  The implementation and process analysis uses program documents; program observations; focus groups with program participants, parents, and other area youth; and interviews with program staff and community leaders to document and understand important features of the range of programs that have been implemented.  The impact study uses longitudinal survey data for groups of youth randomly assigned to the abstinence program in the community or to a control group.

    The evaluation design was developed and implemented with guidance from a technical workgroup composed of individuals with demonstrated expertise in the myriad critical aspects of this complex research agenda (see Appendix A).  In addition, the evaluation team held meetings with numerous interest groups to solicit their input regarding the evaluation questions, site selection criteria, and data collection strategies.