School or community-based abstinence-only education

Evidence Rating  
Evidence rating: Mixed Evidence

Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.

Health Factors  
Decision Makers
Date last updated

Abstinence-only education promotes abstinence from sexual activity through delayed initiation or abstinence until marriage. These programs generally mention condoms or other birth control methods only to highlight their failure rates1. Abstinence-only education may take place in schools or in community settings.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced sexual activity

  • Reduced risky sexual behavior

What does the research say about effectiveness?

There is mixed evidence about the effects of abstinence-only education on adolescent sexual activity. Overall, studies find no significant change, positive or negative, to adolescents’ frequency of sex, incidence of unprotected sex, number of partners, sexual initiation, HIV and STI incidence, or condom use as a result of abstinence-only education2, 3, 4, 5, 6. Such programming appears to be associated with increases in pregnancy rates7, 8, 9, 10. In some cases, however, abstinence-only education programs appear to decrease adolescents’ sexual activity and frequency of sex6, 11, 123, 13.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

Legislation regarding sex education varies from state to state. As of 2017, 37 states require the inclusion of abstinence education, and 26 of these require that abstinence be stressed—27 when HIV education is taught. Nineteen states require that instruction emphasize the importance of engaging in sexual activity only within marriage14.


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1 CG-HIV/AIDS and pregnancy - The Guide to Community Preventive Services (The Community Guide). HIV/AIDS, STIs, and pregnancy.

2 Denford 2017 - Denford S, Abraham C, Campbell R, Busse H. A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychology Review. 2017;11(1):33-52.

3 Chin 2012 - Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, Human Immunodeficiency Virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. American Journal of Preventive Medicine. 2012;42(3):272-294.

4 Cochrane-Underhill 2007 - Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in high-income countries. Cochrane Database of Systematic Reviews. 2007;(4):CD05421.

5 Mathematica-Trenholm 2007 - Trenholm C, Devaney B, Fortson K, et al. Impacts of four Title V, Section 510 abstinence education programs. Princeton: Mathematica Policy Research (MPR); 2007.

6 Bennett 2005 - Bennett SE, Assefi NP. School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials. Journal of Adolescent Health. 2005;36(1):72-81.

7 Stanger-Hall 2010 - Stanger-Hall KF, Hall DW. Abstinence-only education and teen pregnancy rates: Why we need comprehensive sex education in the U.S. PLOS One. 2011;6(10):e24658.

8 Yang 2010a - Yang Z, Gaydos LM. Reasons for and challenges of recent increases in teen birth rates: A study of family planning service policies and demographic changes at the state level. Journal of Adolescent Health. 2010;46(6):517–24.

9 Kohler 2008 - Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health. 2008;42(4):344–51.

10 DiCenso 2002 - DiCenso A, Guyatt G, Willan A, Griffith L. Interventions to reduce unintended pregnancies among adolescents: Systematic review of randomised controlled trials. BMJ. 2002;324(7351):1426.

11 Markham 2014 - Markham CM, Peskin MF, Shegog R, et al. Behavioral and psychosocial effects of two middle school sexual health education programs at tenth-grade follow-up. Journal of Adolescent Health. 2014;54(2):151-159.

12 Markham 2012 - Markham CM, Tortolero SR, Peskin MF, et al. Sexual risk avoidance and sexual risk reduction interventions for middle school youth: A randomized controlled trial. Journal of Adolescent Health. 2012;50(3):279-288.

13 Jemmott 2010 - Jemmott JB 3rd, Jemmott LS, Fong GT. Efficacy of a theory-based abstinence-only intervention over 24 months: A randomized controlled trial with young adolescents. Archives of Pediatrics & Adolescent Medicine. 2010;16(2):152–9.

14 Guttmacher-Sex and HIV education - Guttmacher Institute. Sex and HIV education. New York: Guttmacher Institute.