Five questions for Bill Albert, deputy director with the Washington-based
The National Campaign to Prevent Teen and Unplanned Pregnancy
(Interview conducted on Nov. 9, 2007)

Listen to the audio:
Teen pregnancy

Full transcript of the interview:

1. What type of sex education works best to help prevent teen pregnancy?
   Earlier this week, we released a major new examination of effective interventions. And the truth of the matter is that the list of sex education programs that have strong evidence of success is rather limited. However, we do know some things.

   Sex education programs that talk about both the value of delaying sex and talk about the importance of using contraception consistently and carefully, there are a number of programs in that category that have been shown to be successful. In a second category, there are programs that are loosely described as youth development and community service programs. Again, these programs talk about sex little and some not at all. But they also seem to have a beneficial effect on sexual behavior among teens. And then the third category is what I would call more of a “kitchen sink approach,” one that combines sex education, arts education, clinic services, job stipends, etcetera. And that has been shown through careful evaluation to be effective.

   And, of course, there are a number of sort of clinic interventions that seem to help improve contraceptive use, including the advance provision of emergency contraception. That is, providing young women with emergency contraception before they have sex, they are much more likely to have used it after having sex.

2. I know that some people say sex education hastens sexual activity among teenagers. Do you have any sense of how that plays out in your research?
   It’s a very good question and it’s sort of puzzling to me personally that this is a question that’s still out there in the ether that people are asking. Science isn’t always clear on many topics, but it’s crystal clear on this one.

   There is absolutely no evidence out there to suggest that sex education, that again, talks about the value of delaying sexual activity and the value of using contraception if you’re sexually active, in any way hastens the onset of sex or encourages people to have more partners or more sexual contact, etcetera. There really is just no evidence out there. In fact, quite the opposite seems to be true. So I guess while I understand that this might be a concern, I think that this particular issue has, if you’ll excuse the pun, been put to bed.

3. Do you have any sense of how early teenagers should learn about sex? Is there any benefit to learning earlier, when kids are younger?
   I don’t think we know the answer to that question. I think that each parent really needs to make a decision. You know, obviously some young people are more precocious than others. But here is one thing that parents should know: We do know that one in seven young people in this country have sex before they reach age 15. And a small percentage have sex even earlier than age 13. Again, it’s a very small percentage, but it’s not zero. All of which suggest that these conversations about sex and about love and relationships and families and values and family formation, etcetera, probably need to start earlier than parents would like.
4. Do you have any sense of the recent trend in teen pregnancy rates in the U.S.? I don’t know if you see any relation to that in how teens are being educated about sex?
   Oh, absolutely, yeah. The teen pregnancy decline has been, I think, one of the nation’s great success stories. It’s a very difficult social problem and I think a lot of people considered it sort of intractable a number of years ago but, in fact, thanks to the better decision that teens are making, the teen pregnancy rate has declined by 36 percent since 1990, which was its high-water mark. That is extraordinary progress on a very difficult issue. I would dare say that there very few other social problems that have improved so dramatically.
5. There’s been some research recently that’s come out saying that abstinence-only education is not necessarily more effective. Have you seen any relationship between abstinence-only programs and teen pregnancy rates?
   There’s sort of a two-part answer to that. When you look at why the teen pregnancy rates have declined in this country, they’ve declined for two reasons: Number one is more teens are delaying sexual activity, so there’s less sex, and those that are sexually active are using contraception more consistently and carefully. Both are making important contributions to the overall decline. In our view, we need an approach that embraces more of both, if you will.

   The second question is ‘What do we know about abstinence sex education programs?’ which is sort of a different question. And as we note in the report we just published, “Emerging Answers 2007,” at present, there is no evidence to suggest that abstinence-only programs change teens’ sexual behavior. That’s not to say that there may not be programs in the future that are effective, but at present those that have been well-evaluated have not shown any positive results.

*Additional content not included in the audio interview:

1. Are there any particular initiatives that your group does specifically for sex education?
   We do several things. One of the things that we do is publish this report [”Emerging Answers 2007″]. A lot of communities want to know, of all the sex education programs, what, if any, have evidence of success? It’s a very important question a lot of communities want to know the answer to before they invest money in it. So one of the things we do obviously is to look at what the research says and to make that available to communities.
   So that’s one very important thing. But we also take a very broad view of sex education. It doesn’t just happen in the classrooms, of course. Media consumption, what parents say or don’t say, etcetera, all are very important levers in helping shape teen sexual behavior. So in addition to the standard stuff and research on sex education programs, we work with the entertainment media to get more responsible messages in the programming that teens and their parents watch, we work with parent groups to try to get advice out to parents on how to talk to their kids about these issues.
2. The content of sex education curricula varies between states and even among schools in the same city. Is there any way to standardize the curricula?
   I think even if we could all agree on a certain curriculum, I think you’d have a very difficult time assuming that it would be the right fit for each community. Even if you look at, say, an urban, low-income community versus a relatively middle income rural community, my guess is that you’re going to want sex education that’s slightly tailored to the particular communities and sensibilities. I think there’s scientific reasons why you might not want one-size-fits-all sex education. I think from a practical standpoint, it seems extremely unlikely that this country would move toward a universal sex education curriculum. We don’t have it in any other area of our primary education in this country. There’s not one accepted history curriculum. I can’t image there would ever be one standard sex education curriculum.
   
3. Do you have anything else to add?
   What is not known and what is probably unknowable is how sex education in general has moved the needle on teen pregnancy. That’s just a big question and it’s very hard to tease out. So what researchers do is they look at particular programs, kids using this curriculum versus those in a control group. And there’s where we have some evidence. But what the overall impact has been we don’t know.

   I think it’s strange credulity to think that the education that has happened in this country about HIV in particular has not had an impact…If you were to ask me, probably, the single reason why teens are being more cautious, that is delaying sex or using contraception, my answer would be that the education that these young people have gotten about HIV in particular has made a big difference. So it’s not knowable what the particular contribution of sex education programs has been to the overall decline [in teen pregnancy rates], but I think common sense here applies. That many young people have benefited from it [sex education].

   Let me just add that, having said that, it is also true that sex education programs in particular are sort of insufficient to this task. When you look at teen pregnancy in this country, any type of sex education program is probably not going to do it on its own. That’s why we need the involvement of parents…help from the education community…It’s sort of a “kitchen sink” approach that I think we need. And sex education is certainly a critical part of that.

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