Abstinence-only programs have not been shown to be effective at curbing teen pregnancies or halting the spread of HIV and other sexually transmitted diseases.
Since his tenure as governor of Texas, President Bush has made no secret of his view that sex education should teach teenagers “abstinence only” rather than including information on other ways to avoid sexually transmitted diseases and pregnancy. Unfortunately, despite spending more than $10 million on abstinence-only programs in Texas alone, this strategy has not been shown to be effective at curbing teen pregnancies or halting the spread of HIV and other sexually transmitted diseases. During President Bush’s tenure as governor of Texas from 1995 to 2000, for instance, with abstinence-only programs in place, the state ranked last in the nation in the decline of teen birth rates among 15- to 17-year-old females.38 Overall, the teen pregnancy rate in Texas was exceeded by only four other states.39
The American Medical Association, the American Academy of Pediatrics, the American Public Health Association, and the American College of Obstetricians and Gynecologists all support comprehensive sex education programs that encourage abstinence while also providing adolescents with information on how to protect themselves against sexually transmitted diseases.40 In fact, a recent systematic analysis of pregnancy prevention strategies for adolescents found that, far from reducing unwanted pregnancies, abstinence programs actually “may increase pregnancies in partners of male participants.”41
The fact that the Bush administration ignores the scientific evidence, troubling though that is, is not the primary concern of this report. Rather, it is the fact that the Bush administration went further by distorting the U.S. Centers for Disease Control’s (CDC) science-based performance measures to test whether abstinence-only programs were proving effective, such as charting the birth rate of female program participants.42 In place of such established measures, the Bush administration has required the CDC to track only participants’ program attendance and attitudes, measures designed to obscure the lack of efficacy of abstinence-only programs.43
In addition to distorting performance measures, the Bush administration has suppressed other information at the CDC at odds with its preferred policies. At the behest of higher-ups in the Bush administration, according to a source inside the CDC, the agency was forced to discontinue a project called “Programs that Work,” which identified sex education programs found to be effective in scientific studies.44 All five of the programs identified in 2002 involved comprehensive sex education for teenagers and none were abstinence-only programs. In ending the project, the CDC removed all information about these programs from its website.
Along similar lines, at the instigation of higher- ups in the administration, fact-based information on the CDC’s website has been altered to raise scientifically questionable doubt about the efficacy of condoms in preventing the spread of HIV/AIDS.
A fact sheet on the CDC website that included information on proper condom use, the effectiveness of different types of condoms, and studies showing that condom education does not promote sexual activity was replaced in October 2002 with a document that emphasizes condom failure rates and the effectiveness of abstinence.45 When a source inside the CDC questioned the actions, she was told that the changes were directed by Bush administration officials at the Department of Health and Human Services.46
Similarly, in a case the New York Times labeled “an egregious distortion of the evidence,”47 information suggesting a link between abortion and breast cancer was posted on the National Cancer Institute website despite objections from CDC staff, who noted that substantial scientific study has long refuted the connection. After public outcry on the matter, the information has since been revised and no longer implies a connection.48 While the correct information is currently available on the website, it is troubling that public pressure was necessary to halt this promotion of scientifically inaccurate information to the public.
38 See “Science or Politics? George W. Bush and the Future of Sexuality Education in the United States,” fact sheet published by Advocates for Youth. Online at www.advocatesforyouth.org.
40 Welfare Reform: A Review of Abstinence Education and Transitional Medical Assistance, April 23, 2002: Hearing Before the Subcommittee on Health, House Committee on Energy and Commerce, 107th Congress, 2002, testimony of David W. Kaplan, MD.
41 A. DiCenso, G. Guyatt, A. Willan, and L. Griffi th, “Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials,” British Medical Journal, Volume 324, June 15, 2002.British Medical Journal, Volume 324, June 15, 2002.British Medical Journal
42 These former performance measures can be found at Federal Register 65:69562-65 (November 17, 2000). Federal Register 65:69562-65 (November 17, 2000). Federal Register
43 The new Bush administration performance measures are detailed in U.S. Department of Health and Human Services, SPRANS Community-Based Abstinence Education Program, Pre-Application Workshop (December, 2002).
44 Author interview with current CDC staff member, name withheld on request, November 2003.
45 A. Clymer, “U.S. Revises Sex Information, and a Fight Goes On,” New York Times, December 27, 2002. A comparison of the two versions of the CDC website about condoms can be seen online. The original website, CDC, Condoms and Their Use in Preventing HIV Infection and Other STDS (September 1999); Male Latex Condoms and Sexually Transmitted Diseases (October 2003).
46 Author interview with current CDC staffer, name withheld on request, November 2003.
47 “Abortion and Breast Cancer,” New York Times,January 6, 2003. For a detailed account of this issue, see K. Malek, “The abortion-breast cancer link: how politics trumped science and informed consent,” Journal of American Physicians and Surgeons, Summer 2003. Online at abortionno.org/pdf/breastcancer.pdfabortionno.org/pdf/breastcancer.pdf.abortionno.org/pdf/breastcancer.pdf
48 “Summary Report: Early Reproductive Events and Breast Cancer Workshop,” National Cancer Institute, March 2003.
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