No Sex, No Moms

Dr. Joe McIlhaney believes that abstinence education is the best way to prevent the proliferation of welfare mothers.

When President Clinton scrawled his signature on the Welfare Reform Act on August 22, 1996, most Americans understood that the law was meant to sharply curtail entitlements of public assistance to the poor. But fewer knew that another section of the legislation tightly focuses on a most ambitious goal: Doing away with unmarried motherhood altogether. Unwed parents, especially teenage girls, have long been blamed for the drain on the welfare state; now, welfare reform also means stamping out unmarried sex. Consequently, Congress is authorized to appropriate $250 million over the next five years for "abstinence education," to be carried out in schools and communities in every state and the District of Columbia. But this step in the social re-engineering of America is under way without the benefit of research to guide it. Skeptics say that actual costs of the program to Americans will be nearly $500 million -- but whether the programs will have worked when the five years is up will remain largely unknown. Nonetheless, groups or individuals who have a plan approved by their state's maternal and child health office will have access to funds to instill the notion that abstinence outside marriage is the only healthy and socially acceptable sexual behavior these days.

And that delights Austin's Dr. Joe McIlhaney, a retired obstetrician/gynecologist and founder of the Medical Institute for Sexual Health (MISH). McIlhaney's MISH is a private, non-profit "think tank" that aims to bring public attention to the nation's sexually transmitted disease (STD) crisis, and supports sexual abstinence outside marriage as the solution.

It's a message that McIlhaney has hammered on for many years, he says, ever since increasing numbers of his patients could not become pregnant because STDs obtained from their premarital sexual activity had rendered them sterile. He says that what most Americans have come to think of as sex education delivers a "mixed message" and simply hasn't worked to reduce non-marital pregnancy and STDs. The time is right to directly combat, not just attempt to mitigate, the cause of these ills, he believes. The time is right for abstinence education. "When we look at the data on solutions, they haven't worked at all," says McIlhaney. "There's not one sex education program in the United States that has dramatically reduced sexual risk-taking, STD rates, or non-marital pregnancy rates. Not one."

Well-known and respected in many circles, but especially among conservatives (whose congressional representatives were steering welfare reform), McIlhaney was invited to testify in March 1996 before a U.S. House subcommittee on the effects of out-of-wedlock births upon poverty. Some 80% of teen mothers go on welfare at some point, he reminded lawmakers, and their children are likely to follow suit. Though by his own frank admission, McIlhaney's area of expertise is obstetrics and gynecology (and not welfare), he does believe that welfare has a deleterious effect on America's sexual health and non-marital pregnancy rates.

"Clients of the present welfare system represent a large group of people whose lifestyle includes activity that increases out-of-wedlock pregnancy and sexually transmitted disease," he told the committee. "...Therefore, as much as one might like to, there is simply no way of separating welfare from sexually transmitted disease or from teen pregnancy." He says he was later told that his was one of the key testimonies in the welfare reform battle.

McIlhaney readily acknowledges that there is a paucity of data on the efficacy of abstinence programs currently being taught in the U.S. But despite the unproven effects of abstinence teachings, McIlhaney argues that we already know that the "other" approach -- the one that emphasizes contraception rather than abstention -- definitely doesn't work; why not at least try something different? At the very least, five or ten programs could be studied and reported in peer review literature. "I think that if at the end of this five years, if that's all that's happened with this actually fairly small amount of money," says McIlhaney, "then we will at least have something on the table to talk about." (McIlhaney notes that MISH won't apply for the aforementioned grant funds in Texas. The national institute, he explains, does not care to be geographically fettered by taking state funds, but will continue to help other communities all over the country launch their own programs.)

illustration by Doug Potter

But critics dispute many of McIlhaney's claims -- about the inefficacy of sex education, about the links between welfare and unmarried teen motherhood, and about the wisdom of predicating public policy on the unknown. Among his most natural adversaries is the Sexuality Information and Education Council of the United States (SIECUS), which promotes the philosophy that comprehensive sexuality education in the early grades, including contraceptive instruction, paves the way for healthy adult sexuality later on. Daniel Daley, director of public policy in Washington, D.C., for SIECUS, says the fact that the abstinence education piece of the welfare reform law has no empirical evidence supporting it is a major downfall, not cause for hope. "What young people are going to be taught is based in ideology, not science or public health," he says.

Daley argues that abstinence education, as it has currently been carried out in U.S. public schools, has not been properly evaluated and therefore, it's not known whether it stops or even delays teen sexual activity. Though critics such as McIlhaney often strike back, saying that SIECUS's approach has been given its fair shake and has failed, Daley counters that another federally funded program promoting abstinence, the Adolescent Family Life Program, has been in place since 1981 -- and its results are still unknown and unproven.

What's more, says Daley, Congress wasn't at all curious whether the abstinence education portion of welfare reform is going to work or not (and in fact, this particular facet of the welfare issue was never debated at all). According to the language in the legislation, the funds must be spent on direct services; lawmakers did not set aside monies for evaluating the programs.

---

No Easy Answers

illustration by Doug Potter

Is there some "middle" point of view in this? Sort of. The work of Douglas Kirby, a researcher with Education Training Research (ETR) Associates in Santa Cruz, California, is often invoked by both sides of the "sex-education-works-no-it-doesn't" debate. McIlhaney says that Kirby's research shows that sex education doesn't have a dramatic impact upon teen pregnancy or rates of transmission of STDs; Daley says that Kirby's research shows that sex education does positively affect the onset of teen sexual activity and contraceptive use. Kirby's response? He says that it's true that the effect of sex education hasn't been dramatic; but considering that, overall, the intervention has been modest, positive results are also modest. "Almost no programs have reasonably good evidence that they reduce pregnancy and STDs, whether you're talking about abstinence-only or comprehensive sex ed," he says. "The bottom line is, there are no easy answers."

The problem, Kirby says, is that the abstinence-only programs that have been studied are too diverse; for example, some span several months, others don't. And the "other" approach also has many of the same restrictions. Writing in a March 1997 report entitled "No Easy Answers," Kirby opines that some sexuality education and STD prevention programs "can significantly delay sexual activity and increase contraceptive use" but admits that only two studies were broad enough to be measured, and "neither of these well-designed studies found significant effects upon behavior."

Is it appropriate, then, for the federal government to spend money on abstinence education? "I don't think it's good public policy to fund programs if we don't have evidence that they work," says Kirby. And it isn't a "small" amount of money we're talking about, he adds. When matching funds from the states are combined with federal grant funds, and when the federal government's existing abstinence-only efforts are accounted for, the total figure rises from a "mere" $50 million per year to almost $100 million -- that's nearly half a billion dollars over five years to promote sexual abstinence before marriage in American society. Kirby joins SIECUS's Daley in lamenting the fact that "there are no funds allocated for carefully evaluating the impact of the programs."

While the "abstinence vs. sex ed" question calls for much more study, one issue that has been well explored is the matter of whether there is a cause-and-effect relationship between welfare and teen pregnancy. That doesn't mean, however, that the research points to any definitive conclusion about a link between the two.

It's quite true that teen parenthood can hasten poverty, says Patrick Bressette, associate director at the Center for Public Policy Priorities in Austin. But a summary of studies does not show that welfare somehow precipitates out-of-wedlock births, as many have supposed -- and in fact, it's possible that fertility rates are actually lower among welfare recipients, argues Bressette. So as for the link between the unwed mother problem and the welfare problem, "I would say it's questionable, at best," says Bressette.

According to a 1995 Dept. of Health and Human Services report to Congress on out-of-wedlock childbearing, "There is no typical nonmarital birth." Half of all first out-of-wedlock births happen to teenagers; but teenagers account for only 30% of all out-of-wedlock births. Unmarried mothers, aged 20-24, represent 35% of the nonmarital birth rate, while women aged 25 and up make up the rest. But what about those adolescent, single moms -- don't most of them still end up on welfare? Another report, done in 1990 for the House Ways and Means Committee, says that 50% of unmarried teen mothers go on welfare within three years.

illustrations by Doug Potter

But clearly, since poverty is what causes a person to seek public assistance -- doesn't poverty play into teen parenthood? Sure. A June 1995 report on teenage childbearing from the Urban Institute in Washington says, "Women who have children as teenagers are more likely to be poor than women who defer childbearing." But it's not known whether the teens' dire economic circumstances are caused by their early parenthood or by other, preexisting circumstances, "like growing up in poverty and having limited educational opportunities."

The Urban Institute report also had a very interesting conclusion: "If legislators want to reduce teenage childbearing, they are likely to be most successful with policies and programs that are targeted directly to the behaviors that lead to teenage pregnancies -- sexual activity and contraceptive use."

It's clear which solution is government-approved at this point. It's not clear whether teaching young women to eschew sex will truly have the effect of altering the institution of welfare.