Senate Bill 71, sponsored by Sen. Stephen Meredith, R-Leitchfield, requiring that any course that includes curriculum about sexuality or sexually transmitted disease must include abstinence education, but proposing no other provisions, prompts some observations.
This bill would benefit from thoughtful expert advice. Science can be helpful in drafting and considering bills related to preventive services.
I am always surprised that legislators and the Legislative Research Commission do not take advantage of the expertise that is available at Kentucky’s two schools of public health to help with bills that raise scientific questions. Most of us would be delighted to help.
SB 71 is an excellent example of where substantial scientific evidence is available. The Community Preventive Services Task Force, a 15-member independent panel of public health and prevention experts appointed by the director of the Centers for Disease Control and Prevention, has completed a thorough and scientific examination of two approaches to preventing pregnancy, sexually transmitted illnesses and HIV in teens.
The two approaches that the panel studied are abstinence education and comprehensive risk-reduction education.
Comprehensive risk reduction classes “promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other STIs.” This approach “(1) suggests a hierarchy of recommended behaviors, identifying abstinence as the ‘best’ or ‘preferred’ method, but also provides information about sexual risk-reduction strategies; (2) promotes abstinence and sexual risk reduction without placing one strategy above the other; or (3) primarily or solely promotes sexual risk-reduction strategies.”
In comprehensive risk reduction, abstinence education is also included as the preferred strategy.
In abstinence education there is no education in sexual risk-reduction strategies and abstinence may be the only educational intervention.
The federal government now provides funding for both types of school-based education.
Teen pregnancy, which has dropped as both sexual activity and age of initiation have fallen, is still a major problem for teens.
In addition, while teens comprise only about 25 percent of sexually active individuals, they comprise nearly half of the new cases of sexually transmitted diseases and are at high risk for the acquisition of the human immuno deficiency virus (HIV).
Based on a critical review of all the literature, the task force recommends comprehensive risk reduction education. It was unable to determine if abstinence education is effective in preventing pregnancy, STDs and HIV among teens.
Reviews of abstinence education have found minimal or inconclusive effects, which are attributed to too few studies, weak designs and the heterogeneity of program curricula and their implementation.
In contrast, reviews of comprehensive approaches have generally reported positive results, thus the recommendations of the task force.
The recommendations of the American Academy of Pediatrics, the American Academy of Family Physicians and the American Medical Association all are similar to those of the task force.
Should anyone in the legislature consult the Guide to Community Preventive Services or seek the advice of experts or physician organizations, what would they hear?
Suggestions that SB 71 include other elements of risk reduction strategies to achieve the desired outcome, rather than just abstinence education, for fear that only abstinence education would be taught, thus leaving school-aged children less prepared to deal with sex and its consequences.
An abstinence-only strategy would not be cost effective nor produce the preferred outcomes.
Ask us, happy to help.
F. Douglas Scutchfield, M.D., is a professor emeritus in the University of Kentucky colleges of public health and medicine.