Commentary Sexual Health

Should the University of Wisconsin Promote Safer Sex During Spring Break? The Evidence Says Yes, Unequivocally

Francesca M. Maresca

A Wisconsin state representative is criticizing the state university's health center for its decision to distribute condoms before spring break. His arguments—that distributing condoms is like giving students license to have sex—are as old as they are unfounded. 

Wisconsin State Representative Stephen Nass (R-Whitewater) has taken issue with the state University’s Health Services for its decision to distribute free lip balm, sunscreen, and condoms to students before spring break. As reported in The Badger Herald, Representative Nass’s office uses the ever popular (but unfounded) argument that distributing condoms sends a mixed message giving students license to have sex and accuses the health center of poorly prioritizing expenditures.

As a college health educator and public health professional, I am professionally insulted by these arguments. First, because they are based on the shaky foundation of circular reasoning, and second, because I am tired of hearing the same arguments over and over again. (Seriously, it’s been decades.)

Representative Nass believes that distributing condoms before spring break is sending UW-Madison students a mixed message that ultimately encourages them to have sex while on spring break.  I do not believe there is any mixed message at all if one understands the premise behind condom distribution to college students. The most basic tenet of health education is to meet your priority population where they are. Not all college students are sexually active and not all students will have sex on spring break. Distributing condoms before the break isn’t encouraging them to have sex but to think. To think about sex before they do it. To think about safer sex and ways to protect themselves and their partner(s).  And, to think about being prepared with protection if they do indeed decide to have sex. (You’ll note that Nass did not worry that the sunscreen and lip balm will encourage students to bathe in the sun.) Sexual activity is not limited to Caribbean destinations in the months of March and April. Students may have sex while away on spring break, back home with their high school boyfriend/girlfriend, on weekends, over the summer, or during finals.  This is why many college health services distribute free condoms to students all year long.

The idea that condom distribution is akin to granting permission to have sex (actually Nass said sex with strangers) is an argument that has been used against condom distribution since the AIDS crisis bloomed in the mid-1980s and health educators began advocating condom distribution in schools and, well, just about everywhere.  I find this particular argument to be most insulting. It underestimates college students’ ability to make informed decisions about their own sexual behaviors. This is not “if you build it they will come.” The decision to have sex is complex at best and being on the receiving end of a free condom will not send a student straight into a sexual encounter.  If college students were that susceptible to the power of suggestion, I would have been out of a job several years ago as all of my objectives and goals would have been accomplished.  Just as the sunscreen is not permission to spend unlimited time in the sun or a fire extinguisher in every hallway is not permission to light the dorm room on fire, a free condom is not permission to have sex.  That said, if a student decides to have sex on spring break or at any other time, having a condom readily available removes at least one barrier to condom usage.

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Which brings us to Nass’ final argument which suggests the University needs “…to prioritize expenditures to better reflect the economic times.”  The first thought that comes into my mind is that is exactly what UW-Madison Health Services is doing! The second is to quote Benjamin Franklin’s wise words—an ounce of prevention is worth a pound of cure. The cost of condoms, even in mass distribution into the tens of thousands, is dwarfed by the estimated costs of treating the sexually transmitted infections (STIs) those same condoms could prevent. 

The Centers for Disease Control and Prevention states that each year STIs are responsible for $17 billion in health care costs. These costs are generated by the estimated 19 million new STI infections each year. Guess who accounts for 50 percent of those new infections? That’s right—young people ages 15 to 24. Who is the priority population that college health professionals serve? Young people ages 17 to 25. 

The CDC also states that condom distribution programs:

“…are efficacious in increasing condom use, increasing condom acquisition or condom carrying, promoting delayed sexual initiation or abstinence among youth, and reducing incident STIs” and have been shown to be “cost-effective and cost saving.”

When implementing interventions for college-age populations, we college health professionals work to maximize limited budgets. Condoms are a cost-effective, scientifically- proven method for preventing the transmission of STIs, including HIV.

Nass’s arguments insult students and the work of college health professionals. We strive to provide students with the tools they need to make the best possible decisions about health and wellness, including sexual health, alcohol and other drugs, nutrition, physical activity, and coping with stress in healthy ways. These tools can include education, prevention, and at times, intervention. Our efforts are based upon scientific research and evidence-informed interventions. To question our use of condom distribution as a preventive measure in the fight against STIs is to question our motives in providing quality health and wellness services to students. 

Commentary Sexuality

Busywork to Keep Teens From ‘Getting Busy’: High School Students Asked to Sign an Abstinence Contract

Martha Kempner

One Utah program makes students choose to promise to uphold several flawed statements on abstinence. I would love to believe that the students would be brave enough to challenge what’s written on the page, but just in case, I decided to explain why some of the most outrageous statements just don't make sense.

A picture of an abstinence-only-until-marriage workbook distributed in a Utah high school is making the rounds on social media, thanks to PopSugar. As the apparent homework for students on Day 12 of a so-called sex education program, the assignment asked them to choose their top five (or more) reasons to remain abstinent out of a list of 28. Students were then told to write those reasons neatly on the next page and sign it as a “contract.”

There are many reasons that I hate this activity, including how closely it resembles virginity pledges—which, though they don’t often go through the same trouble of outlining reasons for abstinence, we all know don’t work. Research has shown that 88 percent of young people who take those pledges end up having sex before their wedding night. And worse, according to those studies, once pledgers become sexually active, they are one-third less likely to use contraception than their non-pledging peers.

What upsets me the most, however, is the degree to which young people are supposed to accept the premise of the 28 so-called justifications for abstinence without question. If they were allowed to think critically about what they are being asked to sign, they might notice that the statements are based on the assumption that all premarital relationships are unhealthy, morally wrong, and overwhelmingly likely to lead to sexually transmitted infections (STIs) or unintended pregnancy. The statements are also based on the flawed idea that abstinence until marriage would be the only way to fulfill the promises they’re putting in the contract.

I would love to believe that the students in these classes would be brave enough to challenge much of what’s written on the page but just in case, I decided to explain why some of the most outrageous statements just don’t make sense. Maybe my arguments can help other kids faced with homework like this challenge assumptions or, even better, help adults realize why this kind of program does not meet the needs of students.

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#1. I refuse to use others for my physical needs.
#2. I refuse to be used by someone else to satisfy his/her physical needs.
I suppose we can give the authors credit for acknowledging that teens have physical needs, but they lose those points for assuming that all teenage sexual relationships involve using each other purely for physical intimacy. Sure, some teens enter into unhealthy relationships in which one person is being used, but this is true of adults as well. Teens can and do have sexual relationships that are based on mutual love, trust, and respect. And some of these relationships include mutually pleasurable sexual experiences. Instead of assuming such relationships can’t exist, we should be teaching teens what is and isn’t healthy, and why mutual consent and pleasure is important. This understanding is critical even for teens who decide to stay abstinent in high school or until they get married, because they’ll need it in adult relationships as well.

#3. I refuse to risk getting pregnant or a girl pregnant.
Awkward phrasing aside, this is a good risk to avoid. But while abstinence is the surest way to ensure that no one gets pregnant, there are other ways to do so. Condoms, if used consistently and correctly, are 98 percent effective in preventing pregnancy. Yes, some teens use them wrong, but the most common mistake is leaving it in their purse or night table drawer. Teaching teens the importance of consistent condom use could allow them to keep this piece of their promise even if they end up having sex before marriage, which the majority of Americans do. Or, we could teach about (and give them access to) contraceptive implants and IUDs, which are over 99 percent effective without any effort on the part of the user and last for at least three years. These methods are a near-guarantee that teens will keep the promise of avoiding pregnancy whether or not they choose abstinence.

#6. I refuse to live through the trauma of an abortion.
First, we have to question the premise that abortion is traumatic. A recent study of women who’d had abortions found that 95 percent believed they’d made the right decision. Moreover, the most common emotion of the women after their abortion was relief. The study found no evidence that “post-abortion trauma syndrome”—a scare tactic frequently used by crisis pregnancy centers—exists. But #6 is flawed for another reason as well: It assumes, again, that sex before marriage is going to end in pregnancy. As I just discussed, a teen can refuse to live through abortion and can do so by using a highly effective form of birth control.

#12. I refuse to lose my self-respect.
This one really galls me because it goes back to the dichotomy set up by many abstinence-only curricula that says teens who are abstinent are model citizens and teens who have sex lack character, dignity, and self-respect. Abstinence programs have compared teens who have already had sex to things like used tape, to a cup full of spit, a mushed-up Peppermint Patty, chewed pieces of gum, or a rose with no petals. A person’s value is not wrapped up in their virginity. And teens who have had sex should know that they are no less valuable than any of their peers.

#16. I refuse to disrespect other’s physical boundaries/limitations.
This is a great promise that all teens should make. It is the basis of a lesson on consent. Teens need to learn that everyone has the right to make their own choices when it comes to sexual activity and they must respect those choices. Such a lesson, however, has little to do with staying abstinent until marriage. It’s about respecting an individual’s own boundaries, whatever they may be. So if your partner doesn’t want to have sex until marriage, then yes, you have to abide by that decision. But it’s equally important to abide by their decision if they tell you they don’t want to have sex until, say, next Thursday.

#18. I refuse to enter into marriage with unnecessary baggage from past relationships.
Abstinence-only curricula often focus on the idea that all sexual relationships outside of marriage leave memories and scars that will haunt you forever. You may lose your ability to bond (again, think about the tape game) or you may have flashbacks of prior partners during sex with your spouse. The average adult between the ages of 30 and 44, however, has had between four and eight opposite-sex sexual partners. Although I can’t tell you what images were going through their heads the last time they made love to their husband or wife, many seem to manage marriage without daily PTSD flashbacks of the ones who came before. While some people might consider past relationships as baggage, others see them as opportunities to learn the communication, negotiation, and emotional skills needed to be a good life partner.

Though this assignment might seem extreme, it is actually the kind of thing kids have been made to do in abstinence-only programs for years. Making young people blindly adopt tenets like these and then promise to follow them for years is not going to help them learn to protect themselves against STIs, pregnancy, or even heartache. Nor is it going to help them develop the critical thinking skills they need to make responsible sexual and relationship decisions as they mature. Good programs aim to educate young people rather than indoctrinate them. These teens would be much better off with one that let them think for themselves and question the basic premise that all sex before marriage is wrong.

This contract, as they say, isn’t worth the paper it’s printed on.

Commentary Contraception

Colorado’s Teen Pregnancy Prevention Program Works, and That’s Why Conservatives Want to Kill It

Amanda Marcotte

Republicans in Colorado are coming up with a plethora of reasons to object to funding an IUD program that has dramatically reduced teen pregnancy. But their real concern appears to be that the program is too good at preventing unintended pregnancy.

One of the most interesting political battles over reproductive health-care access is currently going down in Colorado. As has been extensively documented here at Rewire, an experimental program launched in the state in 2009 has resulted in a shocking 40 percent drop in the teen birth rate and a 35 percent drop in the teen abortion rate. Naturally, Colorado anti-choicers are trying to kill it.

This is about more than some budget struggle. Instead, it’s about the escalating battle over contraception access, both in Colorado and in this country as a whole. Make no mistake about it: The better women get at preventing unintended pregnancy, the uglier this fight is going to get. And intrauterine devices (IUDs), which have an extremely low failure rate, are increasingly at the center.

This week, the National Journal released a massive feature by Nora Caplan-Bricker about the battle over Colorado’s IUD fund. Three years ago, a private donation was made to the Colorado Family Planning Initiative and earmarked to give IUDs and other long-acting reversible contraception (LARCs) to low-income women. The program was a smashing success—not only lowering unintended pregnancy rates, but also saving the state an estimated $5.85 for every dollar spent on the program. Now, the private money for the fund has run out. Democrats, and one Republican named Don Coram, want the state to replenish it.

The arguments for doing so are rock-solid: The program has already saved the state piles of money, unintended pregnancy has all sorts of negative outcomes best avoided, and the demand for the subsidized IUDs is clearly there. But Republicans in the state are most likely going to kill the program anyway.

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What becomes clear, especially reading Caplan-Bricker’s piece, is that Republicans are using this battle to beta-test various arguments against any future attempts, on any level, to make it easier for women to get affordable long-term contraception. It’s a classic case of starting with the conclusion—in this case, that low-income women should not get IUDs—and arguing backwards.

This is a delicate operation for anti-choice Republicans, because they have to find a way to argue against contraception without appearing to do so, which could hurt them with voters in a swing state like Colorado. For months, they’ve been tossing out arguments to see which ones stick. The whole “IUD is abortion!” lie was an early contender, but it has a couple of problems with it, starting with the fact that it’s not true. It’s also hard to imagine the voters of Colorado being unduly impressed by politicians putting the fortunes of hypothetical fertilized eggs ahead of the desires of teen girls to avoid pregnancy.

Now, as Caplan-Bricker reports, Republicans are trying a new tack: Arguing that the program is a redundancy because Obamacare supposedly gives you all the free IUDs your heart desires. She writes:

When the debate finally commences in earnest, moral and religious arguments are scarcer than the initiative’s proponents had expected. Republican House members have settled on a more pragmatic line of attack: The funding, they argue, is unnecessary because the Affordable Care Act requires insurers to cover all forms of contraception—IUDs and implants included. “We don’t need to spend this money on the same program, which is available otherwise,” Rep. Janak Joshi, a Republican from socially conservative Colorado Springs, asserts. “We can use this money for some better use—maybe education, maybe roads, but not duplicating the same services which are available.”

Caplan-Bricker outlines all the reasons why this isn’t true, mostly that there are a lot of holes in the health-care distribution system this program plugs up. It’s obvious, though, that this redundancy argument isn’t being offered sincerely. It’s just a gambit to shut down the program before it becomes entrenched in Colorado—and certainly before it starts to spread to other states, causing unintended pregnancy rates to plummet across the country. The program’s success is the very reason that anti-choicers want to kill it.

While most Republicans stuck to the boring budgetary talking points in Caplan-Bricker’s piece, the real concern leaked out of state representative Kathleen Conti, who called IUDs the “Cadillac” of contraception and argued, very unpersuasively, that “I see firsthand the devastation that happens to” girls who have sex. In other words, her fear appears to be that IUDs work too well—that they’re Cadillacs, as it were—and that without the danger of unintended pregnancy, more girls might choose to have sex.

Common sense would dictate that a high failure rate would be a negative. But from the anti-choice perspective, it’s a good thing. The fact that contraception fails is used all the time as a way to threaten young people in hopes of scaring them away from sex, in anti-choice propaganda and in abstinence-only or abstinence-focused programs. So the IUD, which has a typical-use failure rate of less than 1 percent—compared to 9 percent for the pill and 18 percent for condoms—threatens to upend conservative narratives demanding abstinence across the board for unmarried people.

The same thing happened when the HPV vaccine came out. Prior to the vaccine, abstinence-only propagandists loved HPV, because nearly everyone who has sex gets it at some point, giving credence to the doom-awaits-all-you-fornicators messaging. The vaccine threatened that, and so anti-choicers subjected it to a scare campaign that has, sadly, worked. Many parents still refuse to vaccinate their girls for HPV for fear that it somehow causes risky sexual activity, even though research shows that vaccinated girls actually take fewer sexual risks.

The same thing has been shown, by the way, for birth control: Women who have access to it don’t have more sex. But so what if they did? Sex is a good thing, and we should be able to enjoy it as much as we want without having to incur unnecessary risks. This argument should not be lost in the mix.

As the situation in Colorado shows, conservatives are willing—eager, even—to keep the teen pregnancy rate sky high on the slim hope that doing so might scare someone, sometime out of having sex. At best, that suggests that their priorities are completely screwed up, because they would literally prefer to have widespread preventable public health issues than to admit that it’s fine if people want to have sex. At worst, it suggests that they want people to suffer unnecessary problems like STIs and unintended pregnancy, to punish them for engaging in sexual activity.

Either way, we are at a crossroads here. Most Americans may have mixed feelings about sex, but would be able to set that aside in the face of overwhelming evidence that a teen pregnancy prevention program works. If the Colorado program is allowed to continue, there is no doubt other states will follow.

So this isn’t just a local story. The fate of this little initiative in Colorado could determine the shape of reproductive health care for generations to come.