Contact Name
Barbara Dietsch
562-985-9488

Contact Email
bdietsc@WestEd.org

Marion Howard, Ph.D., Professor
Department of Gynecology and Obstetrics
Emory University School of Medicine
Director: Adolescent Reproductive Health Center

Being abstinent is a behavior, just as having sex is a behavior. Although it is commonly understood that sexual behavior is practiced throughout life, many do not reflect on how often abstinent behavior is also practiced throughout life. For example, many people choose to be abstinent when they are not in a committed relationship, when sex would be inappropriate in a relationship, when they do not want to incur risks or consequences or take on the responsibilities that go along with a sexual relationship. Some people may be abstinent when not doing so would violate principles or social mores, for example, when temporarily separated from a spouse, when a spouse is ill, after a divorce but before remarriage. People choose to be abstinent for many different reasons and at many different times of their lives.

Originally, the outreach education program for adolescents sponsored by Grady Health System's adolescent family planning clinic in Atlanta, Georgia, focused skill-building mostly on teaching young people to manage having sex as safely as possible. For example, to protect themselves, youth need skills to get and effectively use protection, to communicate with and obtain the support of the other person for carrying out protective behaviors. But it became clear that it was equally important to give young people a set of skills for managing abstinent behavior. Skills such as: avoiding situations where they might be tempted to have sex, clearly communicating to the other person the desire to be abstinent, using refusal techniques if pressured to violate a commitment to be abstinent, were needed. So the outreach education effort was revised based on the notion that protective behavior and abstinent behavior require life long skills and both are an important part of youth education. Over the years, the content has changed and improved, but the philosophy has remained the same.

In Atlanta, the abstinence message is first emphasized at the end of elementary school through implementation of the teacher-led Preteen Postponing Sexual Involvement Series. It is felt to be important to prepare 5th grade students for entry into middle school where they will be left more on their own to manage personal behaviors. A companion Series for parents is offered as staffing permits.

The abstinence message is reinforced in middle school in the 8th grade, just before entry into high school, through implementation of the Young Teen Postponing Sexual Involvement Series. Led by older teens, the goal is to prepare youth to manage the dramatic increase in social and peer pressures with respect to dating relationships and sexual behaviors that occur in high school. A companion Series for parents is offered to middle schools as staffing permits.

The Postponing Series in middle school is preceded by a nurse/counselor-led human sexuality education series, Respecting Your Future. It covers the reproductive system, risks and consequences of sexual involvement at a young age, commercially available means of protection, and community resources for obtaining such methods.

When asked to list one important idea that they got from the entire outreach program, last year's middle school students most often listed ideas about waiting/postponing; followed by the consequences/risks of sex, including pregnancy and diseases; then, skills to say no; and finally the notion of using protection, including specific methods. Those students, post program, who indicated they planned to wait before having sex more often listed the notion of waiting, followed by skills to say no; while those who indicated they did not plan to wait or already had had sex, first listed the information about using protection, followed by the concept that teens should wait.

Regardless of whether young people have had sex, it is important that the abstinence message be reinforced in high school. This can be done with one of two interventions, or both: a teacher led Postponing Sexual Involvement Series for high school students or an innovative Video CD-ROM Teens-4-Teens. The CD-ROM Teens-4-Teens is non-linear and allows for independent as well as teacher-led learning and reinforcement for abstinence.

Grady Health System believes that, although abstinence is the best choice for young people, almost everyone will stop abstaining at some point. Whether that first occurs at age 13 or age 30, whether it is in a marital relationship or not, the System believes people need to be prepared to avoid negative outcomes. The System's experience is that the messages of abstinence and use of protection are not incompatible. It appears that young people take from the skills given in both areas, what they most need at the time. Pre- and post-program last year, all 8th grade students were asked whether they planned to postpone sexual involvement and to give the main reason for their answer.

Post-program, those planning to wait offered as main reasons: first, wanting to avoid pregnancy and diseases (36%); second, personal values/beliefs/expectations; such as: don't want to, against beliefs, waiting until marriage, plans for future-finishing school, having career/job (33%); and third, ideas such as: not being ready, not feeling responsible enough to handle sex, and wanting to wait until older, (24%).

The responses of those not planning to wait (19% of all eighth grade students) fell into categories such as: first, having sex and liking it, not being able to stop (43%); next, not wanting to wait-hormones telling them they couldn't, feeling ready, wanting to explore or try out (36%); and, finally, not knowing what will happen in the future(16%).

These kinds of responses tell us that young people range all along the continuum, from those who are clear about wanting to be abstinent to those who already are sexually involved. Just as skills to be abstinent would not meet the needs of all young people, so would skills to manage sexual involvement not help all youth. Hopefully, the polarization created by the various degrees of intolerance for sexual involvement of young people will slowly evaporate in an understanding that adolescents, throughout life, will both be abstinent and sexually involved, and skills to manage both behaviors should be given to them in developmentally and age-appropriate ways.