Understanding 'Abstinence': Implications for Individuals, Programs and Policies. The word . The same can be said for . What is abstinence in the first place, and what does it mean to use abstinence as a method of pregnancy or disease prevention? What constitutes abstinence ? What specific behaviors are to be abstained from? And what is known about the effectiveness and potential ? Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised. School-based programs to reduce sexual risk. School-based programs to reduce sexual risk behaviors: a review. Adolescent; Adolescent Behavior* Female; Health Education/standards; Humans; Male; Pregnancy; Pregnancy in Adolescence. Buy To expand access to preventive health care services and education programs that help reduce unintended pregnancy, reduce infection with sexually. What works best in sex/HIV education? Sex and HIV education programs have multiple goals: to decrease unintended pregnancy.
Answering questions about what abstinence means at the individual and programmatic levels, and clarifying all of this for policymakers, remains a key challenge. Meeting that challenge should be regarded as a prerequisite for the development of sound and effective programs designed to protect Americans from unintended pregnancy and STDs, including HIV. Abstinence and Individuals. What does it mean to use abstinence? When used conversationally, most people probably understand abstinence to mean refraining from sexual activity. But when it is promoted as a public health strategy to avoid unintended pregnancy or STDs, it takes on a different connotation. Indeed, President Bush has described abstinence as . From a scientific standpoint, a person would be an . Thus, the subgroup of people consciously using abstinence as a method of pregnancy or disease prevention is obviously much smaller than the group of people who are not having sex. The size of the population of abstinence users, however, has never been measured, as it has for other methods of contraception. When does abstinence fail? The definition of an abstinence user also has implications for determining the effectiveness of abstinence as a method of contraception. The president, in his July 2. South Carolina high school students, said . If you're worried about teenage pregnancy, or if you're worried about sexually transmitted disease, abstinence works every single time. But scientifically, is this in fact correct? Researchers have two different ways of measuring the effectiveness of contraceptive methods. For example, women who use oral contraceptives perfectly will experience almost complete protection against pregnancy. However, in the real world, many women find it difficult to take a pill every single day, and pregnancies can and do occur to women who miss one or more pills during a cycle. Thus, while oral contraceptives have a perfect- use effectiveness rate of over 9. As a result, eight in 1. CONTRACEPTIVE EFFECTIVENESS RATES FOR PREGNANCY PREVENTION*Contraceptive Method. Perfect Use. Typical Use. Abstinence. 10. 0??? Female Sterilization. Oral Contraceptives. Male Condom. 97. 86. Withdrawal. 96. 75. Percentage of women who successfully avoid an unintended pregnancy during their first year of use. Family Planning Clinics, 2. Thus, when the president suggests that abstinence is 1. But common sense suggests that in the real world, abstinence as a contraceptive method can and does fail. People who intend to remain abstinent may . Research is beginning to suggest how difficult abstinence can be to use consistently over time. For example, a recent study presented at the 2. American Psychological Society (APS) found that over 6. What is not known is how many of these broken vows represent people consciously choosing to abandon abstinence and initiate sexual activity, and how many are simply typical- use abstinence failures. To promote abstinence, its proponents frequently cite the allegedly high failure rates of other contraceptive methods, particularly condoms. By contrasting the perfect use of abstinence with the typical use of other contraceptive methods, however, they are comparing apples to oranges. From a public health perspective, it is important both to subject abstinence to the same scientific standards that apply to other contraceptive methods and to make consistent comparisons across methods. However, researchers have never measured the typical- use effectiveness of abstinence. Therefore, it is not known how frequently abstinence fails in the real world or how effective it is compared with other contraceptive methods. This represents a serious knowledge gap. People deserve to have consistent and accurate information about the effectiveness of all contraceptive methods. For example, if they are told that abstinence is 1. If they are told that condoms fail as much as 1. Abstinence is 1. 00% effective if 'used' with perfect consistency. But common sense suggests that in the real world, it can and does fail. What behaviors should be abstained from? A recent nationally representative survey conducted by the Kaiser Family Foundation and seventeen magazine found that half of all 1. Even more striking, the APS study found that the majority (5. While the pledgers generally were somewhat less likely to have had vaginal sex than nonpledgers, they were equally likely to have had oral or anal sex. Because oral sex does not eliminate people's risk of HIV and other STDs, and because anal sex can heighten that risk, being technically abstinent may therefore still leave people vulnerable to disease. While the press is increasingly reporting that noncoital behaviors are on the rise among young people, no research data exists to confirm this. Abstinence Education Programs. Defining and communicating what is meant by abstinence are not just academic exercises, but are crucial to public health efforts to reduce people's risk of pregnancy and STDs. For example, existing federal and state abstinence- promotion policies typically neglect to define those behaviors to be abstained from. The federal government will provide approximately $1. FY 2. 00. 4 to fund education programs that exclusively promote . The law, however, does not define . Currently, very little is known about the relationship between abstinence- promotion activities and the prevalence of noncoital activities. This hampers the ability of health professionals and policymakers to shape effective public health interventions designed to reduce people's risk. To date, no education program focusing exclusively on abstinence has shown success in delaying sexual activity. There is no question, however, that increased abstinence. Research by The Alan Guttmacher Institute (AGI) indicates that 2. U. S. A new AGI report also shows that declines in HIV- infection rates in Uganda were due to a combination of fewer Ugandans initiating sex at young ages, people having fewer sexual partners and increased condom use (see related story). But abstinence proponents frequently cite both U. S. Yet neither experience, in and of itself, says anything about the effectiveness of programmatic interventions. In fact, significant declines in U. S. Similarly, informed observers of the Ugandan experience indicate that abstinence- only education was not a significant program intervention during the years when Uganda's HIV prevalence rate was dropping. Thus, any assumptions about program effectiveness, and the effectiveness of abstinence- only education programs in particular, are misleading and potentially dangerous, but they are nonetheless shaping U. S. For example, the administration is defining program success for its abstinence- only education grants to community and faith- based organizations in terms of shaping young people's intentions and attitudes with regard to future sexual activity. In contrast, most public health experts stress the importance of achieving desired behavioral outcomes such as delayed sexual activity. To date, however, no education program in this country focusing exclusively on abstinence has shown success in delaying sexual activity. Perhaps some will in the future. In the meantime, considerable scientific evidence already demonstrates that certain types of programs that include information about both abstinence and contraception help teens delay sexual activity, have fewer sexual partners and increase contraceptive use when they begin having sex. It is not clear what it is about these programs that leads teens to delay. What is clear, however, is that no program of any kind has ever shown success in convincing young people to postpone sex from age 1. Nor is there any evidence that the . This suggests that scarce public dollars could be better spent on programs that already have been proven to achieve delays in sexual activity of any duration, rather than on programs that stress abstinence until marriage. Finally, there is the question of whether delays in sexual activity might come at an unacceptable price. This is raised by research indicating that while some teens promising to abstain from sex until marriage delayed sexual activity by an average of 1. Thus, might strategies to promote abstinence inadvertently heighten the risks for people when they eventually become sexually active? Difficult as it may be, answering these key questions regarding abstinence eventually will be necessary for the development of sound and effective programs and policies. At a minimum, the existing lack of common understanding hampers the ability of the public and policymakers to fully assess whether abstinence and abstinence education are viable and realistic public health and public policy approaches to reducing unintended pregnancies and HIV/STDs.
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