Two new papers highlight the scientific and ethical shortcomings of the abstinence-only-until-marriage approach.

Two scientific review papers find abstinence-only-until-marriage programs and policies in the United States are ineffective because they do not delay sexual initiation or reduce sexual risk behaviors. According to the researchers, these programs also violate adolescent human rights, withhold medically accurate information, stigmatize or exclude many youth, reinforce harmful gender stereotypes, and undermine public health programs. Both papers are published online in the Journal of Adolescent Health.



“The weight of scientific evidence shows these programs do not help young people delay initiation of sexual intercourse,” says co-author John Santelli, professor of Population and Family Health at the Mailman School. “While abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail. These programs simply do not prepare young people to avoid unwanted pregnancies or sexually transmitted diseases.”

To study current U.S. policies on abstinence-only-until-marriage programs, the investigators turned to multiple sources, including scientific research, review articles, as well as information from human rights organizations. They report that a rapidly rising age of first marriage has translated to shrinking numbers of young people who abstain from sex before getting married. In the U.S. today, the gap between the age at first sex and first marriage is 8.7 years for young women and 11.7 years for young men.

Abstinence-only-until-marriage approaches have set back sex education, family planning, and HIV-prevention efforts. Between 2002 and 2014, the percentage of schools in the U.S. that require students to learn about human sexuality fell from 67 percent to 48 percent, and requirements for HIV prevention declined from 64 percent to 41 percent. In 1995, 81 percent of adolescent males and 87 percent of adolescent females reported receiving formal instruction about birth control methods; by 2011-2013, only 55 percent of young men and 60 percent of young women said the same.

By contrast, comprehensive sex education programs, have favorable effects on adolescent behaviors, including sexual initiation, number of sex partners, frequency of sexual activity, use of condoms and contraception, frequency of unprotected sexual activity, STIs, and pregnancy.



“Young people have a right to sex education that gives them the information and skills they need to stay safe and healthy,” says Leslie Kantor, assistant professor of Population and Family Health at the Mailman School of Public Health and vice president of Education at Planned Parenthood Federation of America. “Withholding critical health information from young people is a violation of their rights. Abstinence-only-until-marriage programs leave all young people unprepared and are particularly harmful to young people who are sexually active, who are LGBTQ, or have experienced sexual abuse.”

While abstinence-only programs are widely rejected by health professionals who care for young people, including the Society for Adolescent Health and Medicine, Congress has spent over $2 billion on domestic abstinence-only programs between 1982 and 2017; current funding totals $85 million per year. Under current guidelines, U.S. states cannot use funds to educate adolescents about contraceptive use or discuss contraceptive methods, except to emphasize failure rates.

“Adolescent sexual and reproductive health promotion should be based on scientific evidence and understanding, public health principles, and human rights,” says Santelli. “Abstinence-only-until-marriage as a basis for health policy and programs should be abandoned.”



Co-authors represent the Planned Parenthood Federation of America; Gillings School of Global Public Health, University of North Carolina; Guttmacher Institute; University of Massachusetts Amherst; Children’s National Medical Center, George Washington University Medical Center; University of York, North Yorkshire, England; Altarum Institute, Rockville, Maryland; and Indiana University. The authors report no conflicts of interest.