Saturday, April 14, 2007

Abstinence Education Doesn't Need To Be Medically Accurate

So proclaimeth the U.S. Department of Health and Human Services' Wade F. Horn, Ph.D., Assistant Secretary for Children and Families. [Via RH Reality Check, news that Wade F. Horn has recently resigned.] Ponder this for a moment.

You are to receive information about birth control, and I'm the federally-funded educator. If all I do is go on and on about PregoBloK® abstinence, you might laugh me out of the room for discussing, exclusively, the one method of birth control with an unknown typical use efficacy.

You might also point out that purposefully withholding information--by only talking about abstinence, to the exclusion of all the other available methods--isn't "education". [More like indoctrination, but who's keeping track.]

At the very least you'd be able to rest assured that, by pointing out the medical facts to you--that we don't know how well abstinence really works in real life--I have provided you with correct medical information. But what happens if, on top of giving you incomplete information on purpose, I decide I don't have to give you accurate medical information? Too much? A step too far, you say?

Shows how much you know.

If I decided to only talk to you about abstinence, *and* that I'm under no obligation to insure that the information is medically accurate I'd be entitled to receive millions of your tax dollars to preach teach the misinformation far and wide. At least according to Assistant Secretary for Children and Families Wade F. Horn, that is.

Before we go on, a quick primer on federal programs dedicated to restrictive abstinence-only education and the funding involved.

Note the eight eligibility criteria:

THE FEDERAL DEFINITION OF ABSTINENCE-ONLY EDUCATION

According to federal law, an eligible abstinence education program is one that:

A) has as its exclusive purpose, teaching the social, physiological, and health gains to be realized by abstaining from sexual activity;

B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;

C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;

D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human sexual activity;

E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;

F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and society;

G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and

H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.

Source: U.S. Social Security Act, Sec. 510(b)(2).


In particular, abstinence education for which federal funds may be provided must (1) have as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity; (2) teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems; and (3) teach that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects

These three requirements contain specific health claims--abstaining leads to health gains; abstinence is the only certain way to avoid STIs/other health problems; sexual activity outside marriage is likely to have harmful psychological and physical effects. [Think about this last one for a moment. 95% of Americans are having sex outside marriage. So, basically the government is mandating that abstinence programs tell the public that the majority of Americans are likely psychologically and physically damaged. Heh!]

Now, the government requires that certain educational topics--like the effectiveness of condoms in preventing STIs--be medically accurate. [I know, FSM forbid there should be a requirement that all educational material funded by the government be accurate. But I digress.] In particular, Section 317P of the Public Health Service Act, subsection (c)(2) requires certain educational materials to contain medically accurate information about condom effectiveness (emphasis mine):

Educational material under paragraph (I), and all other relevant educational and prevention materials prepared and printed from this date forward for the public and health care providers by the Secretary (including materials prepared through the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration), or by contractors, grantees, or subgrantees thereof, that are specifically designed to address [sexually transmitted diseases] including [human papillomavirus] shall contain medically accurate information regarding the effectiveness or lack of effectiveness of condoms in preventing the [sexually transmitted disease] the materials are designed to address. Such requirement only applies to materials mass produced for the public and health care providers, and not to routine communications.


So, in order for an abstinence education program to be eligible for federal funds, it has to make certain health claims, some of which concern STIs and condoms. At the same time, the government requires federally-funded educational material to contain medically accurate information about condom effectiveness.

So far, all well and good. Except Wade F. Horn, the Assistant Secretary for Children and Families, doesn't believe that the medical accuracy statue applies to materials used by recipients of federal abstinence education grants.

What to do, what to do?

Well, if you're the U.S. Congress, you ask the GAO to investigate this matter in order to determine if the medical accuracy provision of Section 317P of the Public Health Service Act applies to federally funded abstinence "education".

The GAO obliges, and on October 9, 2006 it issues its findings [GAO Letter Regarding Medical Accuracy of Abstinence Education (.pdf)]:

In responding to a congressional request on federal abstinence education grant programs, we identified a legal matter that requires the attention of the Department of Health and Human Services (HHS). In this regard, section 317P(c)(2) of the Public Health Service Act requires certain educational materials to contain medically accurate information about condom effectiveness. HHS believes that this statute does not apply to materials prepared and used by recipients of federal abstinence education grants. As discussed below, we conclude that this requirement would apply to abstinence education materials prepared and used by federal grant recipients, depending upon the substantive content of those materials. We did not assess any particular abstinence education materials for compliance with section 317P(c)(2) and, therefore, reach no conclusions regarding statutory violations. However, in light of our conclusion, we recommend that HHS reexamine its position and adopt measures to ensure that, where applicable, abstinence education materials comply with this requirement.


You should definitely read the whole thing, but here's the short version. Assistant Secretary for Children and Families Wade F. Horn says that materials prepared by its abstinence education grantees do not fall within the scope of section 317P(c)(2). According to him, the materials need not contain medically accurate STIs/condom information given the purpose of abstinence education programs and the populations targeted by program grantees.

That is, the material doesn't have to be medically accurate because (a) the primary purpose of these programs is not to address sexually transmitted diseases and that, while grantees may address issues related to sexually transmitted diseases in communicating the importance of abstinence, they are to address these issues only within the broader context of abstinence education, and (b) the programs target different populations.

The GAO's answer to both these justifications is blunt: The Assistant Secretary's response is not persuasive.

On the "not the primary purpose" excuse:

Both the statutory definition of abstinence education and grant program materials distributed by HHS suggest that section 317P(c)(2) would apply to materials prepared and used by recipients of abstinence education grants, depending upon the substantive content of those materials. As discussed above, the governing statutory provision and program announcements incorporate multiple references to the physical consequences of sexual activity, specifically requiring information on sexually transmitted diseases to be an integral part of abstinence education programs. Notably, the 2006 program announcement for the community-based abstinence education program instructs grantees to develop curricula around themes and further instructs them to incorporate material around the subtheme of sexually transmitted diseases. In this regard, it offers several illustrations of appropriate program content and endorses the use of disease-specific information. It states that abstinence education programs may contain information on the limitations of contraception to consistently prevent sexually transmitted diseases, as well as information on the epidemiology of sexually transmitted diseases in the United states. This information could include infection rates and modes of transmission for sexually transmitted diseases. Therefore, grantees could incorporate sufficiently specific information about these diseases to lead to the conclusion that the materials were "specifically designed to address" sexually transmitted diseases, whether or not they were primarily designed to do so."
The content of a student workbook commonly used by abstinence education grantees further suggests that section 317P(c)(2) may apply to federally funded abstinence education materials. The workbook contains eight chapters, each of which focuses on a dimension of abstinence. One chapter is dedicated to the topic of sexually transmitted diseases. Among other things, the chapter provides information on several sexually transmitted diseases, including human papillomavirus, in a series of brief paragraphs. For example, it explains that the human immunodeficiency virus or HIV affects the body's T-4 cells, which are central to the immune system and necessary for the body to fight diseases. It also points out that there is no cure for HIV. Although the chapter contains general statements about condom effectiveness, it does not contain information about the effectiveness or lack of effectiveness of condoms in preventing HIV or the other diseases it describes.


On the "different target populations" excuse:

The Assistant Secretary's view that section 317P(c)(2) is inapplicable since ACF grants are made to a variety of grantees and materials are prepared for different target populations is also not persuasive. We do not believe that the applicability of section 317P(c)(2) turns on whether materials are prepared for all members of the public, as the Assistant Secretary suggests. As a general matter, abstinence education programs target broad segments of the population, namely, preadolescents and adolescents. While grantees may not prepare identical materials for all recipients of program services, they nonetheless may produce educational materials in large quantities for those members of the public for whom the materials are appropriate. We also note that the 2004 proposed content guidelines for AIDS-related materials did not reflect the Assistant Secretary's apparent view that section 317P(c)(2) only applies to materials distributed to all members of the public. Those proposed guidelines were designed to apply to materials used by school-based and other assistance programs rather than materials distributed to all members of the public.


So, despite the Assistant Secretary for Children and Families' belief that federally-funded abstinence educational material doesn't have to be medically accurate, the GAO concludes that it does, too.

Ah, the smell of bureaucratic efficiency in the morning! The government requires abstinence programs to make some outlandish health claims in order to be eligible for funds, while at the same time mandating that federally-funded educational material be medically accurate, and unleashing a GAO investigation of the outlandish claims made by federally-funded abstinence programs. [That drip-drip-drip sound you're hearing is your tax dollars going down the drain.] In any case, at least you could make a case that, although the problem was created by the government to begin with, it was also investigates and resolved in house, right?

Not quite. It seems the HHS--still part of the government, last time I looked--refuses to take the GAO's findings seriously (or to get a grip on reality, for that matter).

The U.S. Department of Health and Human Services' very own abstinence education site features a response to the October 9, 2006 GAO Letter Regarding Medical Accuracy of Abstinence Education, from the National Abstinence Leadership Council, a broad-based group of abstinence education professionals, curriculum providers, medical professionals, and other support organizations.

Here is the statement, in it's entirety, because I want to make sure you understand that I kid you not (note the date):

National Abstinence Leadership Council Statement on Medical Accuracy (.pdf)
October 30, 2006

Recognizing that there is currently no consistent definition of "medical accuracy," the National Abstinence Leadership Council has taken the initiative to issue the following guidelines to secure the highest standards for properly using and referencing medical information.
• We are committed to providing factual information based on research.
• We affirm that all medical information must be properly referenced from:
o peer-reviewed journals
o government publications
o medical publications
o textbooks or other clearly-identified sources
The unprecedented growth and demand for abstinence education throughout America highlights the need for ongoing concerted efforts to provide accurate information for youth. We support the application of these guidelines for all federally-funded programs. We encourage all efforts by the GAO, HHS, and the FDA to assure that all information given to our nation’s youth is accurate.


Followed by 7 1/2 pages listing assorted people who have expressed their support for the National Abstinence Leadership Council Statement on Medical Accuracy.

Really, what more could I add to this response? Teh propaganda, it makes the brain cells wobbly.

Issuing a response three weeks after a GAO investigation and proclaiming that to be "tak[ing] the initiative" is propaganda 101. As is responding to a made-up issue in a desperate, yet childish, attempt to change the subject.

Oh, and redefining "medical accuracy" as medical information...properly referenced from...other clearly-identified sources is a genuine propaganda gem. 'Cause as long as you clearly identify your sources, you're all set in the medical accuracy department. [Are medical journals aware of this new, groundbreaking definition? And if yes, why did they reject my most accurate article on PregoBloK®, clearly sourced to Madame Zelda? Poopy heads the lot of them!]

To be clear, and in an effort to improve the National Abstinence Leadership Council's reading comprehension, the claim that there is currently no consistent definition of "medical accuracy" is not only a silly lie, it has nothing to do with the price of tea in China. Or more precisely, with the topic under discussion--the GAO's finding that, despite the Assistant Secretary for Children and Families' beliefs to the contrary, the federal statues on medical accuracy do, indeed, apply to materials prepared and used by recipients of federal abstinence education grants.

The problem isn't that there's no accurate definition of medical accuracy. It's that the Assistant Secretary for Children and Families believes abstinence education doesn't need to be medically accurate.

I know this is a serious matter, but come on people, take a moment to savour with me the delicious audacity of this morsel of propaganda, courtesy of the National Abstinence Leadership Council.

Which brings me to this post from feministing, about federally-funded abstinence groups hiring some PR muscle. Because it's all about the propaganda, baby!

Bottom line: The federal funding of abstinence-only "education" appears to be nothing but a racket. There's no medical or public health justification for funding doctrinal educational programs that provide incomplete medical information. There's also no justification to fund programs that offer inaccurate medical information.

Next, I put the National Abstinence Leadership Council's revolutionary novel definition of medical accuracy to the test.

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2 Comments:

At 6:49 PM, Blogger Tiffane said...

Although this is a comment from last year, I stumbled across it by accident. I appreciate what you have compiled. I was wondering if you have ever reviewed an used abstinence education curriculum or attended a class?

There is a lot of information regarding abstinence education out there. You seem to have found several sources, but I think it would be helpful and only fair if you went straight to the source. maybe spoke with a student who has gone through a class or actually talk to someone who teaches abstinence education.

I know a few, if you're interested.

 
At 3:24 AM, Blogger ema said...

Tiffane,

If you'd like to send me something, I'd be happy to review it. Just email me.

 

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