Abstinence-Only Education: Politics, Science, and Ethics

John S. Santelli Abstinence-Only Education: Politics, Science, and Ethics INTRODUCTION UNTIL AUGUST 2 0 0 4 , 1W ORKED ATTHE US CENTERS FOR DISEASE CONTROL and Prevention (CDC) as a researcher on adolescent health issues, an Institutional Review Board chairm an, and a supervisor of other public health scientists.* This opportunity to do im portant public health research in a supportive, collaborative environm ent was a trem endous personal experience. CDC prided itself on excellence in epidemiologic and social science research and on science as the prim ary basis for its public health policy. I joined the CDC in 1991 because doing research w ith the centers m eant that a scientist could influence critical public health issues—he or she could make a difference. Sadly, toward the end of my 13-year stay at CDC, it was becom­ ing increasingly difficult to conduct research on certain sensitive social issues. Although I was never overtly censored, scientific review became m ore labored and colleagues began to talk, somewhat ironically, about “self censorship,” that is, avoiding research that m ight not be received favorably in W ashington. A paper I had w ritten on teen pregnancy declines, which examined the contributions of fewer teens having sex and m ore teens using contraception, made reviewers nervous because it could be used to support a conclusion that would have been contrary to the adm inistration’s em phasis on abstinence-only education for social research Vol 73 : No 3 : Fall 200 6 835 teenagers. Although scientific review in my own division and center seemed fair, I began to hear stories from other centers about papers and projects that had been stopped by scientific reviewers. Then, one day in 2003, under the Departm ent of Health and Human Services (DHHS) Secretary Tommy Thompson’s “one voice” initiative, the entire com m u­ nications group at CDC, the group that helped us to clarify and hone our scientific messages for the public, was transferred from CDC headquar­ ters in Atlanta to DHHS headquarters in D.C. It seemed that control­ ling the message in term s o f its policy im pact suddenly had become m ore im portant than getting the scientific content right. I became increasingly beleaguered and began to feel that creativity, an essential elem ent of research, was not longer valued, particularly if it challenged orthodoxy. Also, after September 11th, the surgeon general had begun to discuss the idea of retraining CDC and National Institutes of Health (NIH) scientists, regardless of their specialty, as disaster preparedness experts. Feeling th at my skill set was no longer as valued inside the governm ent sector, and having an outside opportunity present itself, I joined the exodus of senior researchers from the agency. Suddenly, my shoulders felt lighter, and the air seemed clearer. In January 2006, colleagues and I published two papers in the Journal ofAdolescent Health. One (Santelli, 2006) was a scientific review and analysis of federal funding for “abstinence-only” education (AOE), or abstinence until marriage programs; the other was a position paper from the Society for Adolescent Medicine (SAM) on the same subject (SAM, 2006). The review paper, at considerable length, pointed out num erous scientific problem s w ith US governm ent support for AOE. Building upon writing from the 1990s on reproductive rights as hum an rights, we also pointed to w hat we saw as the inherently coercive aspects of a governm ent policy that suppresses inform ation or provides only half-truths. In February, I spoke on the issue of AOE at the New School’s Politics and Science conference. And in May, I experienced an example of the current adm inistration’s interference w ith science. I had subm itted an abstract, w hich was then accepted through the peer review process, to the National STD Prevention Conference, 836 social research co-sponsored by the CDC Division of STD Prevention and three profes­ sional groups. Others, including a state STD director, a graduate student, and an advocate for comprehensive sexuality education, also subm itted abstracts that were each accepted through the same process. Two weeks before the m eeting date in May, we began to receive...