Faith, Hope, and Chastity
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Rose feels that MISH has been portrayed unfairly. “If you were to ask, many people think we’re a right-wing religious organization,” he said. He conceded that there was some religious language early on, as well as a moral tone. The group’s “National Guidelines for Sexuality and Character Education,” published in 1996, stated that “some people who have a homosexual orientation decide for health, moral, or religious reasons not to practice homosexual sex” and “the charge of ‘homophobia’ has been used inappropriately to shut off debate.” Rose contends that the organization has changed, and not just in attitudes toward homosexuality. “We’ve tried to neutralize that [language] as best we can,” he said. “We’re not an abstinence organization. We’re a medical and scientific organization.”
Rose’s insistence that MISH be considered a kind of apolitical research institute is not uncommon in the world of abstinence. Many groups take a similar approach, casting themselves as impartial providers of clinically tested information. Yet on numerous occasions MISH has been found to present highly questionable data in support of abstinence. In 1995 the Texas Department of Health confronted MISH with a report stating that the slide show that McIlhaney was taking around to the high schools contained assertions that were “misleading” and “ridiculous.” More recently, MISH’s tactics were criticized in a 2004 report prepared for California congressman Henry A. Waxman. Called “The Content of Federally Funded Abstinence-Only Education Programs,” the report evaluated thirteen of the most popular federally funded curricula, including one published by MISH titled “Sexual Health Today.” Waxman’s report noted a number of inaccuracies: “The curriculum erroneously states that touching another person’s genitals ‘can result in pregnancy,’ ” and “one curriculum makes a spurious claim about chlamydia’s health effects . . . in fact, the research cited in the curriculum found an association between heart disease and a type of chlamydia (called Chlamydia pneumoniae) that is not sexually transmitted . . . it is an entirely different bacteria from Chlamydia trachomatis, which is sexually transmitted.”
MISH claimed that Waxman’s criticisms had distorted its material and paired with the U.S. Department of Health and Human Services to investigate nine comprehensive curricula in an attempt to show that mistakes were just as common, if not more so, on the other side. But the findings were innocuous compared with the blunders in Waxman’s review. Errors listed in the report included trivial inaccuracies relating to condom failure rates for users with less than one year of condom experience (one curriculum quoted 12 percent, “when the correct statistic is 15 percent”) or the use of the term “dental dam” instead of the FDA-approved term “rubber dam.”
There are other problems with Rose’s claim to a purely objective, research-based position. When I asked him for scientific proof that abstinence education really works, he cited four studies and encouraged me to look them up. Not one of them, it turned out, had achieved as strong a standard of design as the Mathematica study. The author of one study, Murray Vincent, who published his findings in 1987 in the Journal of the American Medical Association, told me he had written four or five letters to MISH over the years, telling MISH that his intervention model, the one they praised in so many newsletters, was not even abstinence-based. It was comprehensive. “I often wonder if the MISH staff have ever read my JAMA article,” he told me.
But it is no surprise that Rose would cite these studies. Methodologically sound research that has focused explicitly on abstinence has generally reported fewer positive findings. “There have been six programs that have been evaluated with really strong design,” said Douglas Kirby, a senior research scientist at ETR Associates, a California nonprofit that studies health promotion. Kirby, who has authored or co-authored more than one hundred volumes, articles, and chapters on adolescent sexual behavior and sex and STD/HIV education programs for major health organizations over the past thirty years, is generally considered a respected, unbiased figure. “All six of them found that the abstinence programs had no positive impact on behavior. Absolutely flat. That’s discouraging. On the other hand, there are a handful of abstinence programs which have studies that are much weaker but do show encouraging results.” Kirby supposes that there are some abstinence programs that are effective. “I would assume there probably are,” he said. “But at this point in time we don’t have any strong evidence that any abstinence program delays the initiation of sex.”
In November of last year, Kirby finished a study called “Emerging Answers 2007.” Released through the National Campaign to Prevent Teen and Unplanned Pregnancy, Kirby’s report summarized 48 studies of curriculum-based comprehensive sex ed that supported use of contraception as well as abstinence and identified seventeen characteristics common among the most effective programs. The evidence overwhelmingly shows that the majority of comprehensive sex ed programs can have a positive impact on behavior. They do not increase the number of sexual partners or hasten the initiation of sex or increase the frequency. In perhaps the greatest irony, many of the students who received comprehensive sex ed were more likely to remain abstinent longer.
To a certain extent, the whole debate over what to tell kids about sex boils down to condoms. Proponents of comprehensive sex ed say they are a crucial tool, pointing to a 2007 American Journal of Public Health report that found that 86 percent of the decline in teenage pregnancy among fifteen-to nineteen-year- olds from 1995 to 2002 was attributable to improved contraceptive use. This position is supported by the American Medical Association, the Texas Medical Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine.
But Gary Rose charges that comprehensive programs that do not hammer away at the failings of the condom give kids false assurances. For too long, he says, these dangers have been hidden in the comprehensive teaching, which only gives lip service to abstinence before launching into condom instruction. Kids are told that condoms are “very effective,” though when it comes to some STDs, they are not nearly as effective as the user might wish.
MISH presents what are called the “actual use” statistics on condom performance. These percentages reflect the number of times the average user is unable to escape unwanted outcomes. For example, in a chart showing the effectiveness of contraceptives against pregnancy in the highly respected, doctor-authored report Contraceptive Technology, now in its nineteenth edition, the male condom, when used perfectly and consistently, fails (that is, slips off or breaks) only 2 percent of the time. But 15 percent of the time, people who consider themselves “condom users” throw caution to the wind and either neglect to use a condom at all or deploy it only in the final throes.
This means that as far as pregnancy goes, condoms have an “actual use” failure rate of 15 percent. Thus, in some “abstinence-plus” classes—which promote abstinence but discuss condoms—the students hear that condoms are effective in preventing pregnancy only 85 percent of the time. I asked Rose: As an adult, wouldn’t you be concerned upon hearing, without explanation, that sex with condoms results in pregnancy 15 percent of the time? And if you heard that “user failure” was to blame for most of the unintended pregnancies, wouldn’t you want more details instructing you how to prevent such failure?
“Information alone doesn’t change behavior, and so much of the time kids aren’t using condoms consistently,” he said. This, in essence, is the root of the debate. Like many other abstinence advocates, Rose believes that telling teens not to have sex and then giving them detailed instructions on condom use is a mixed message. “It’d be like saying, ‘I urge you not to smoke, but you’re going to smoke anyway, so let me show you how to smoke a filtered cigarette; I want you to smoke it right,” he said.
In the next adoption of health textbooks, tentatively slated for 2014 school year, student editions will have to address the effectiveness of “barrier protection and other contraceptive methods.” The Legislature has insisted on it. Still, the current chairman of the State Board of Education, Don McLeroy, told me he thinks there should be two sets of books.
“I don’t mind [condoms] in a comprehensive plan, but I think there ought to be another one,” he said. “You don’t want to undermine what parents are teaching their children either way. Golly, if you have a kid who can’t keep his hands off a girl, sign him up for the comprehensive one.” After some consideration, McLeroy shifted his position. “You can use the words, but in the context of marriage . . . If you explain it to them neutral and say, ‘Oh, we know you’re going to have sex,’ that’s like a green light.”
Furthermore, a shift away from abstinence-only curricula could be a hard sell to the local school boards, no matter how many studies are published. It will certainly be a hard sell with the State Board of Education. “What’s really realistic?” McLeroy asked me. “Is comprehensive realistic or is abstinence realistic? I went up and looked at the kids I knew at Bryan High School, and I could look at that high school and find lots of kids who were abstinent. That was realistic, in other words. But I was thinking, how many children are being promiscuous and doing what they’re supposed to do—refraining from having sex with only one partner at a time, not multiple at the same time? How many are going to refrain if they don’t have contraception there?” He decided that, given this observation, the comprehensive approach was unrealistic. (During the course of fact-checking this article, McLeroy denied many of the quotes that are attributed to him; the quotes as printed, however, accurately reflect a recording of our interview.)
Monica and Thomas, of course, were among those teens who did not refrain from having sex when they had no condoms. Would a truly comprehensive sex education have taught them to wait until they did? Or would they have been better served by an abstinence program that had instructed them not to have sex at all?
For Monica, those questions are academic. She had her second baby in March, and not surprisingly, she is now more concerned about her future than her past. “I don’t know how it’s going to be with two,” she told me. “I know my first baby will help me take care of the new one.” Thomas was laid off from his job at a roofing company, and Monica won’t be able to work for a while. But she hopes to get her degree, no matter how long it takes. “It’ll all work out,” she said.
