Quick answer: Abstinence-only-until-marriage programs teach abstinence as the only option and usually exclude information about contraception, while comprehensive programs teach that waiting is the safest choice and cover contraception, STI prevention, consent and healthy relationships. Research reviews consistently find that abstinence-only programs don’t delay first intercourse or reduce risk (Santelli et al., 2017), while comprehensive programs are linked to a range of positive outcomes (Goldfarb & Lieberman, 2021).
Few topics in education spark as much debate as how schools should teach about health and relationships. The good news: decades of research give us a clear picture. This post explains the two main approaches, summarizes the evidence and answers common questions.
What’s the difference?
| Abstinence-only-until-marriage | Comprehensive | |
|---|---|---|
| Abstinence | Taught as the only acceptable option | Taught as the most effective way to avoid pregnancy and STIs |
| Contraception and condoms | Usually excluded, or covered only in terms of failure rates | Accurate, evidence-based information on how methods work |
| STI and HIV prevention | Limited | Covered, including testing |
| Consent and healthy relationships | Often limited | Core topics |
| Inclusion | Often assumes one type of relationship | Inclusive of all students |
| Accuracy | A congressional staff review found errors in some federally funded curricula (cited in Stanger-Hall & Hall, 2011) | Designed to be evidence-based and age-appropriate |
Many states fall somewhere in between. According to Guttmacher, 43 states plus D.C. require that abstinence be covered or stressed when sex education is taught, and only 26 states require that the content be medically accurate (Guttmacher).
For a grade-by-grade look at comprehensive topics, read What Comprehensive Health Education Actually Covers.
What the research shows
Abstinence-only programs don’t achieve their own goals
- A large federally funded evaluation of four Title V abstinence education programs found that youth in the programs were no more likely to abstain than youth in control groups; 49% of both groups had remained abstinent at follow-up (Trenholm et al., Mathematica, 2007).
- A 2017 review in the Journal of Adolescent Health concluded that abstinence-only-until-marriage programs are not effective at delaying initiation of intercourse or changing other risk behaviors, and raised ethical concerns about withholding health information (Santelli et al., 2017).
- WHO notes that abstinence-only programs have been found to be ineffective (WHO).
State-level patterns
A 2011 study of 48 states found that the more strongly states emphasized abstinence in their policies, the higher their teen pregnancy and birth rates, even after accounting for income, education and demographics. States that covered abstinence as part of comprehensive education tended to have the lowest rates (Stanger-Hall & Hall, 2011). The authors note the study is correlational, so it can’t prove cause and effect, but it adds to a consistent body of evidence.
Comprehensive programs show broad benefits
A review of three decades of research found that comprehensive programs are associated with outcomes including (Goldfarb & Lieberman, 2021):
- Healthier relationships and lower rates of dating and intimate partner violence.
- Prevention of child sexual abuse, as children learn body safety and how to tell a trusted adult.
- Improved social and emotional learning.
- Greater appreciation of diversity and reduced homophobic bullying.
- Improved media literacy.
Does comprehensive education encourage earlier activity?
No. WHO states that research shows comprehensive education does not increase sexual activity or risk-taking (WHO). Comprehensive programs still teach that delaying is the safest choice; they simply add the information people need for the rest of their lives.
What parents want
Parents are far more united than headlines suggest. In a nationally representative survey of 1,633 parents, 93.5% said sex education in middle school was important and 96% said the same for high school, with high support among both Democrats and Republicans (Kantor & Levitz, 2017). Read more in Sex Education Statistics in America.
Support education that works
The evidence is clear, but many communities still don’t have access to complete, evidence-based health education. Your gift helps change that, one classroom at a time.
Donate securely with Givebutter →
Prefer a different checkout? You can also give through Zeffy. Monthly gifts are welcome on either platform.
Dr Sex Ed (DR SEX ED AI UNIVERSITY INC) is a registered 501(c)(3) nonprofit, EIN 33-4612296. Gifts are tax-deductible to the extent allowed by law.
Common questions from school boards and families
“Isn’t it the parents’ job?”
Parents are a child’s first and most important educators, and comprehensive programs support them. Our Growing Up, Speaking Up program for grades 6–8 includes parent take-home guides in English and Spanish, and our Talking with Kids workshop helps parents start conversations at home. Most states also offer parents notification and opt-out options.
“Is it age-appropriate?”
Yes. Comprehensive education follows a scope and sequence, such as the National Sex Education Standards, so topics build gradually from body safety and friendships in early grades to more detailed health information in high school (NSES, 2020).
“Doesn’t abstinence-only respect our values?”
Comprehensive programs include abstinence and encourage students to talk with their families about values. The difference is that they also provide accurate information, because students will need it eventually, whether in high school, college or adulthood.
Why the approach matters beyond the classroom
What students learn, or don’t learn, follows them into adulthood. The National Academies’ 2021 report on sexually transmitted infections called for reducing STI stigma and for comprehensive, medically accurate, age-appropriate health education in elementary, middle and high schools, backed by trained staff and resources for parents (National Academies, 2021). Adults who never received complete information may be less likely to seek testing, use protection consistently or recognize an unhealthy relationship.
Comprehensive education also supports skills that aren’t only about health: communicating clearly, setting boundaries, evaluating online information and asking for help. Those skills matter in friendships, workplaces and families. That’s why many educators see comprehensive health education as part of preparing young people for life, not just for a test.
What this means for your community
- Ask your school what curriculum it uses and whether it’s evidence-based.
- Review your state’s requirements on Guttmacher’s state policy page.
- Attend school board meetings and share sourced information, like this post.
- Talk with your kids at home. Our puberty scripts by age can help.
- Support organizations that provide comprehensive education.
Learn more about our programs, our evidence-based approach in Why Sex Education Matters, and our free resources.
Frequently asked questions
What is the difference between comprehensive and abstinence-only education?
Abstinence-only programs teach abstinence as the only option and usually exclude contraception. Comprehensive programs teach that abstinence is the most effective choice and also cover contraception, STI prevention, consent and healthy relationships.
Does abstinence-only education work?
Research reviews and a large federal evaluation found that abstinence-only programs did not increase abstinence or delay first intercourse.
Does comprehensive education lead to earlier activity?
No. WHO states that research shows comprehensive education does not increase sexual activity or risk-taking.
Do comprehensive programs still teach abstinence?
Yes. Comprehensive programs present abstinence as the most effective way to avoid pregnancy and STIs, alongside other accurate, evidence-based information.
Do parents support comprehensive education?
Yes. In a national survey, 93.5% of parents said sex education in middle school was important and 96% said it was important in high school, across political parties.
How many states require medically accurate education?
According to Guttmacher, only 26 states require sex education to be medically accurate.
Sources
- Santelli JS, et al. Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact. J Adolesc Health. 2017;61(3):273–280. https://doi.org/10.1016/j.jadohealth.2017.05.031
- Goldfarb ES, Lieberman LD. Three Decades of Research: The Case for Comprehensive Sex Education. J Adolesc Health. 2021;68(1):13–27. https://doi.org/10.1016/j.jadohealth.2020.07.036
- Trenholm C, et al. Impacts of Four Title V, Section 510 Abstinence Education Programs. Mathematica Policy Research, 2007 (via ASPE). https://aspe.hhs.gov/reports/impacts-four-title-v-section-510-abstinence-education-programs-1
- Stanger-Hall KF, Hall DW. Abstinence-Only Education and Teen Pregnancy Rates. PLoS ONE. 2011;6(10):e24658. https://doi.org/10.1371/journal.pone.0024658
- WHO. Comprehensive sexuality education. https://www.who.int/news-room/questions-and-answers/item/comprehensive-sexuality-education
- Guttmacher Institute. Sex and HIV Education. https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education
- Kantor L, Levitz N. Parents’ views on sex education in schools. PLoS ONE. 2017. https://doi.org/10.1371/journal.pone.0180250
- National Academies of Sciences, Engineering, and Medicine. Sexually Transmitted Infections: Adopting a Sexual Health Paradigm. 2021. Recommendations: https://nap.nationalacademies.org/resource/25955/Sexually%20Transmitted%20Infections_Adopting%20a%20Sexual%20Health%20Paradigm_Recommendations.pdf
- Future of Sex Education. National Sex Education Standards, 2nd ed. 2020. https://siecus.org/wp-content/uploads/2020/03/NSES-2020-2.pdf