by Jane Quinn, The Graduate Center, CUNY
Current national sex education policy in the United States focuses on Abstinence-Only-Until-Marriage (AOUM). This policy is not only based on a very narrow approach to the topic of sex and sexuality, but also advocates for the dissemination of some factually incorrect information. In addition, grantees are explicitly forbidden to discuss several topics, including sexual orientation, gender identification, and contraception. This policy is somewhat surprising in a country in which over 50 percent of adolescents have had sexual intercourse before they turned 18 (Centers for Disease Control, 2017) and in which over 90 percent of adults favor comprehensive approaches to sex education in public schools (Planned Parenthood Federation of America, 2020). The writings of the late French philosopher Michel Foucault offer relevant insights into this dilemma. His landmark analysis, the four-volume History of Sexuality, examined how, from the nineteenth century onward, human sexuality came to be ensnared in the net of government attention and biopower. What this means is that, according to Foucault, sexuality came under the regulatory powers of the state, with its attendant control of minds and bodies. Sex education in public schools, as important sites of disciplinary power, fell into that net.
The history of sex education in the United States is replete with examples of how government actions and biopower affect what is taught, who teaches it, and whose bodies are being controlled by whom. Sex education is part of a larger set of sexual issues that include access to contraception, laws governing access to abortion, and laws forbidding certain kinds of sexual expression. The extensive reach of the state into this aspect of human experience is a relatively recent phenomenon, one that Foucault analyzed at great length. His focus throughout this genealogy of human sexuality–his historical account of how sexuality came to be governable–was meant to provide analytic tools to help people understand, and perhaps push back on, the circumstances in which they found themselves.
Contemporary sex education policy in the United States can be understood as part of this larger history. This paper will examine the elements of, background on, and implications of Abstinence-Only-Until-Marriage (AOUM) as U.S. federal policy, and then will use a Foucauldian lens to assess the intent, outcomes, and effects of the policy as well as the sociopolitical forces that influenced its genesis and, to date, 25-year tenure.
An Overview of Abstinence-Only Sex Education Policy
What is Abstinence-Only-Until-Marriage?
In the mid-1990s, as part of so-called “welfare reform,” sex education promoting abstinence-only-until-marriage (AOUM) was adopted by the U. S. government as its sole approach to addressing adolescent sexual and reproductive health (Hall, Sales, Komro & Santelli, 2016). This strategy has eight central tenets. Under Section 510 of the 1996 Social Security Act, abstinence education was defined as an educational or motivational program that:
- has, as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstinence from sexual activity;
- teaches abstinence from sexual activity outside marriage as the expected standard for all school-age children;
- teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
- teaches that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of human sexual activity;
- teaches that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects;
- teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
- teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances;
- teaches the importance of attaining self-sufficiency before engaging in sexual activity.
Much of the federal funding for both domestic and international aid programs became tied to this one narrow approach, and 49 of the 50 states have accepted federal funds to promote AOUM in the classroom. This funding comes with serious restrictions, including the fact that funded programs “may not in any way advocate contraceptive use or discuss contraceptive methods, except to emphasize their failure rate” (Santelli, Ott, Lyon, Rogers, Summers & Schleifer, 2006, p. 75). In addition, funded programs may not discuss sexual orientation, gender identity, and other aspects of human sexuality–even if they use their own non-federal funds to do so.
What Does Power Have to Do with Sex Education?
The subject of power was central to much of Foucault’s writings. At the most basic level, he viewed power as ubiquitous. He posited that power was not inherently positive or negative, and that it could be both repressive and productive/creative. Foucauldian scholar Ladelle McWhorter (2004) observed that he sought “to reconceive power altogether, not on the analogy of an object that can be possessed and passed around but rather on the analogy of an event. Power is something that happens. It is a kind of tension that emerges when people have different goals or perspectives or conflicting projects” (p. 42). In his introduction to The Foucault Reader, Paul Rabinow (1984) noted that Foucault was not interested in abstract notions of power; rather, he sought to focus on how power operates in society.
One specific form of this kind of control is what Foucault termed “biopower”—the control of entire populations through the managing of individual bodies—here, in the case of sex education. McWhorter observes that, in using the term biopower, Foucault meant “the confluence of disciplinary normalization and population management in vast networks of production and social control” (McWhorter, 2009, p. 11). Examined from this perspective, sex education becomes part of the normalizing power, determining what is viewed as acceptable, expected, and desirable. Foucault (1978) talked frequently about the deployment of sexuality—by which he meant a set of strategies designed to address one basic concern: “to ensure population, to reproduce labor capacity, to perpetuate the form of social relations: in short, to constitute a sexuality that is economically useful and politically conservative” (p. 36-37). As indicated below in two accounts of the history of AOUM, political conservatism in the U.S. Congress—beginning in 1981—laid the groundwork for the adoption of these policies.
In addition, Foucault assessed that control of bodies was influenced by another phenomenon—one that added to and resulted from the machinations of state involvement in human sexuality —namely, the development of norms. In Discipline and Punish, Foucault (1977) talked about the power of the norm in establishing a “principle of coercion in teaching” (p. 184). The next year, he wrote that “A normalizing society is the historical outcome of a technology of power centered on life…This is the background that enables us to understand the importance assumed by sex as a political issue” (Foucault, 1978, p. 144-145). AOUM is explicit in its language about norms, observing for example that “abstinence from sexual activity outside marriage” is “the expected standard for all school-age children.” Several behavioral norms are mandated in the stated purpose of the program, thus ensuring that states and other localities that apply for funding will have no doubt as to what they are expected to teach—and not to teach.
Foucault’s ideas about the deployment of sexuality and his concept of biopower are directly applicable to Abstinence-Only-Until-Marriage policy, with its clearly prescribed set of values, its prohibitions on discussing certain topics, and its concomitant prohibitions on such behaviors as premarital sex. The eight AOUM tenets outlined earlier demonstrate an intention to use governmental authority and funding to mandate the explicit teaching of arguably narrow and limiting ideas about sexuality (e.g., “a mutually faithful, monogamous relationship in the context of marriage is the expected standard of human sex”).
What Political and Social Context Surrounded the Adoption of AOUM as National Policy?
A cogent analysis of the political and social context leading to the adoption of AOUM as national policy is provided by sociologist Kristin Luker (2006) in her book entitled When Sex Goes to School. She notes that “when the great sexual and gender revolutions swept the United States in the 1960s, sexuality became a way in which different kinds of people sorted themselves out” (p. 216). Groups that shared the same broad socially conservative values around international AIDS policy, contraception, stem cell research, and abortion joined forces in what they termed the “pro-family movement”—with sex education as one of their political targets. When Republican Senators Orrin Hatch and Jeremiah Denton sponsored the Adolescent Family Life Act (AFLA) in 1981, this emerging coalition brought powerful support to this new legislative effort designed “to transfer federal monies away from proponents of comprehensive sex education and toward more pro-family organizations” (p. 222). Luker observed that AFLA is where the idea of abstinence education made its debut on the national scene, a chronology mirroring that outlined in the SIECUS funding history that follows.
A detailed report prepared by the Sexuality Information and Education Council of the U.S. (SIECUS) in 2018 recounts the history of federal funding for AOUM programs, including the political and fiscal battles that have ensued over the decades. According to this report, government funding of AOUM programs began in 1981 under the Reagan administration, then grew exponentially from 1996 through 2006, particularly during the years of the George W. Bush administration. The funding leveled out between 2006 and 2009, and it was then reduced significantly in 2010. The Obama administration fought to eliminate several specific funding streams for AOUM. However, Congressional proponents succeeded in resurrecting the program by inserting it into the Patient Protection and Affordable Care Act, which allocated $50 million a year in mandatory funding for the period from 2010-2014. AOUM proponents in Congress continued to gain traction in subsequent fiscal years, adding a “Competitive Abstinence Education” grants program at $5 million per year for FYs 2012-2015, then rebranding this program as “Sexual Risk Reduction” in FY 2016. As of FY 2018, this part of the overall AOUM program received $25 million in funding—a five-fold increase from the time of its inception (Sexuality Information and Education Council of the United States, 2018, p. 1). Between 1996 and 2018, Federal expenditures on AOUM totaled $2.1 billion.
Biopower has important economic implications: “This biopower was without question an indispensable element in the development of capitalism; the latter would not have been possible without the controlled insertion of bodies into the machinery of production and the adjustment of the phenomena of population to economic processes” (Foucault, 1978, pp. 140-141). Another key tenet of AOUM is the requirement that funded programs teach “the importance of attaining self-sufficiency before engaging in sexual activity”—a clear reference to the economic interests of government in ensuring that its citizens not require assistance of public programs but, rather, that they be in a position to contribute to the tax base. The ability of biopower to influence entire populations is reflected in the reach of AOUM policy, which has been adopted by all but one of the 50 states.
How Effective is AOUM?
Using effectiveness measures calibrated with program’s own stated goals, rigorous research has documented AOUM’s lack of efficacy in delaying the onset of sexual activity, reducing sexual risk behaviors, or improving reproductive health outcomes (Trenholm, Devaney, Fortson, Clark, Quay & Wheeler, 2008). Meanwhile, a host of other evaluations have proven the effectiveness of comprehensive sex education in increasing contraceptive use and in decreasing pregnancy rate (Sexuality Information and Education Council of the U.S., 2018). According to a recent study funded by the National Institute of Child Health and Adolescent Development, “despite great advances in the science, implementation of evidence-based models of comprehensive sex education remains precluded by sociocultural, political, and systems barriers operating in profound ways across multiple levels of adolescents’ environments” (Hall, Sales, Komro & Santelli, 2016, p. 595). A leading public health specialist, citing a Centers for Disease Control study, made the ironic observation that “comprehensive sexuality education helps young people remain abstinent, while abstinence-only education does not” (Santelli, 2017).
One clear result of the adoption of AOUM as national policy is the documented decline in adolescents’ receipt of school-based sex education in recent years. For example, a 2016 study by researchers at the Guttmacher Institute revealed that, between 2006-2010 and 2011-2013, there were significant declines in adolescent females’ receipt of formal education about birth control (70% to 60%), sexually transmitted disease (94% to 90%), and HIV/AIDS (89% to 86%). There was a substantial decrease in males’ receipt of instruction about birth control (61% to 55%) during this same period. Other studies, including the National Survey of Family Growth, have corroborated these declines (Lindberg, Maddow-Zimet, & Boonstra, 2016).
Have Other Sex Education Approaches Been Tried in the U.S.?
Prior to the exponential growth of AOUM between 1996 and 2006, American adolescents’ access to sex education increased substantially between the mid-1970s through the mid-1990s, largely as a result of concerns about high rates of adolescent pregnancy. These concerns escalated after the 1976 publication of a landmark study entitled Eleven Million Teenagers: What Can Be Done about the Epidemic of Adolescent Pregnancies in the United States, prepared by the Alan Guttmacher Institute (the research arm of Planned Parenthood Federation of America). This study provided the first comprehensive picture of adolescent sexual activity in the United States. It prompted the enactment of new laws in 21 states that ensured minors’ access to contraceptive services and an expansion of comprehensive school-based sex education programs. During this period, the federal government was active not only in funding programs but also in supporting major studies focused on sexuality education in America. Two such research efforts, both conducted by the consulting firm Mathtech and funded by the Centers for Disease Control (a part of the U. S. Department of Health and Human Services), provided a wealth of data on all aspects of the topic, including program availability, comprehensiveness, and effectiveness.
Regarding the amount of sex education in schools, the principal author, Doug Kirby, reviewed multiple studies and concluded that “In general, they indicate that between 60 and 75 percent of students receive at least a small amount of sexuality education by the time they graduate from high school. However, these figures do not provide information on the comprehensiveness or other characteristics of the programs” (Kirby, 1984, p. 20). Elsewhere in the study, Kirby offered data on program content showing that 97% of high school sex education teachers reported teaching about STDs, 96% taught about pregnancy and childbirth, 79% taught about contraceptive methods, 90% taught about anatomy and physiology, 77% about family planning, and 53% about masturbation and homosexuality (Kirby, 1984, p. 18). This variation in program content unearthed by the Kirby study was reiterated in a 1989 national survey of educators (Forrest & Silverman, 1989, p. 65). While these data show a clear focus on the reproductive aspects of human sexuality rather than a truly comprehensive approach, they reflect a broader focus than the one permitted by AOUM.
What Happened to Pleasure?
Foucault’s history of sexuality includes an analysis of the so-called “repressive hypothesis,” in which he recognized and called attention to the ways that the state deploys sexuality as a system of control. He questioned the concept of repression, noting that sexuality represents a preoccupation for a modern society that appears to study it all the time—not so much to find out how to increase sexual pleasure but, rather, to determine how to use sexuality to manage and control the population. Sex education in U.S. public schools has never placed much emphasis on sexual pleasure, as indicated in studies cited earlier (Kirby, 1984). It has focused instead on anatomy and physiology, the mechanics of human reproduction, and the control of unwanted pregnancies and sexually transmitted diseases. This attention to severely limiting the topics to be discussed in sex education programs can be understood in the context of Foucault’s analysis of power as well as in relation to feminist scholar Nancy Tuana’s (2004) ideas about the “epistemology of ignorance” (p. 194). Tuana argues that the refusal to inform about—or the willingness to ignore—certain subjects is a method used by those in power to retain their power and keep others unaware. She describes the “epistemology of ignorance” as, among other things, the intentional withholding of knowledge and cites “practices that suppress or erase bodies of knowledge” (p. 194), an apt description of the methods and results of AOUM.
What Has Been the Response to AOUM?
Given the evidence relating to the ineffectiveness of AOUM programs and expenditures, organized opposition has developed on several fronts. The SIECUS study (2018) referenced above states: “It is past time to end funding for these programs. Decades of research prove that they are ineffective at achieving their intended goal of getting young people to remain abstinent until marriage, and, too often, fail to address, or shame, young people’s lived experiences” (p. 8). Three leading advocacy organizations— SIECUS, Answer, and Advocates for Youth—have mounted a major public awareness campaign entitled The Future of Sex Education, designed to promote the use of National Sex Education Standards developed by leaders in the field and to mobilize public will in support of comprehensive approaches to sexuality education.
Prominent groups in the medical community, including the American Medical Association and the Society for Adolescent Medicine, have taken strong stands in opposition to AOUM and in favor of comprehensive approaches to sex education (Santelli, Ott, Lyon, Rogers & Summers, 2006). An AMA-sponsored journal, the Archives of Pediatric and Adolescent Medicine, published an article stating that, “It appears that current investments in abstinence-only sex education programs do not correspond with either public opinion or scientific consensus on how sex education should be taught in school” (Bleakley, Hennessy & Fishbein, 2016, p. 1155). In addition, some advocates and public health leaders have begun to critique abstinence-only programs in a human rights context. For example, John Santelli and his colleagues have cited the deprivation of scientifically accurate information as unethical—a position supported by the Society for Adolescent Medicine and the American College Health Association (Santelli, 2017).
While these analyses are helpful in their critiques of the limiting and harmful effects of AOUM policies, they are inadequate in addressing more basic questions. These include: the role of the state in governing our private pleasures through a program of sex education; the relationship between power/knowledge, population, health, and sex education; and what strategies individuals or groups can employ to disrupt the limiting discourses on sex in society.
Examining AOUM Policy through a Critical Historical Lens
How Can Foucault Shed Light on U.S. Federal AOUM Policy?
Many of Foucault’s ideas on governmentality, biopower, and population management strategies offer explanatory power in relation to this turn of events. Not only did Foucault develop an extensive body of work on human sexuality—most notably his four-volume History of Sexuality, written between 1978 and 1984—but much of his earlier writing provides important grist for the conceptual and analytical mill in relation to sex education. Foucault’s books on sexuality had the distinct advantage of building on his earlier thinking and writing on such topics as mental illness, medicine, and crime and punishment. He examined these issues through the lens of a critical analysis of history that emphasized systems of power and their ability to influence human thought, discourse, and behavior. As a philosophical historian, Foucault was preoccupied with technologies of domination, but also with technologies of resistance—how people understand and defy these very forces of control in their search for freedom.
How Did Human Sexuality Come Under the Purview of the State?
Foucault viewed contemporary human sexuality as a social construction, one that had developed over the previous 150 years, with input from the scientific, medical, and legal communities. He questioned whether scientific knowledge about sex (scientia sexualis) represented true progress, especially in relation to evidence drawn from erotic art (ars erotica), which conveyed sexual freedoms and pleasures enjoyed by earlier generations in such diverse places as Ancient Greece, Turkey, India, and Japan. In his History of Sexuality, Foucault (1978) observed that the combined forces of the modern scientific, medical, religious, and legal apparatuses put people and their sexual desires and behaviors into clearly defined categories (e.g., heterosexual, homosexual, bisexual, pansexual, asexual) and then went about prescribing and proscribing the kinds of orientations and activities that are either acceptable or not (p. 42-44). In this analysis, Foucault noted that the eighteenth century saw a “veritable discursive explosion” (p. 18) about sexuality, one that brought human sexuality into a place where the mechanisms of power could reach it, where “a policing of sex” addressed “the necessity of regulating sex through useful and public discourses” (p. 25).
Of relevance to sex education policy, including AOUM, is his discussion of “the sex of children and adolescents,” which he noted, “has become, since the eighteenth century, an important area of contention around which innumerable institutional devices and discursive strategies have been deployed…all highly articulated around a cluster of power relations” (Foucault, 1978, p. 30). Later in this volume, Foucault discussed the “pedagogization of children’s sex,” which he considered one of the “great strategic unities” in the history of sexuality. As a result of this recognition of children’s sexuality, “parents, families, educators, doctors, and eventually psychologists would have to take charge, in a continuous way, of this precious and perilous, dangerous and endangered sexual potential” (p. 103-104).
AOUM policy indeed “takes charge” in a controlling way, by offering large amounts of federal dollars to cash-starved states in exchange for their agreement to adopt a government-sanctioned form of sex education. Foucault’s genealogical analysis of the government’s role in regulating a variety of sexual matters—a role we now take for granted—applies directly to AOUM, which its proponents claim will protect children and adolescents from harm. While several of the core tenets of AOUM have been judged to be neither scientifically nor medically accurate (as noted above), the overall approach nevertheless appears to have been actively promoted by the conservative religious community. This reflects Foucault’s assessment of the multiple forces at play when the sexuality of young people is under consideration.
But Foucault questioned the value and trustworthiness of all these forces—medical, scientific, legal, religious—in matters of human sexuality, positing that their interest resided in the accrual and uses of power: “To return to sex and the discourses of truth that have taken charge of it, the question we must address, then, is…In a specific type of discourse on sex, in a specific form of extortion of truth, appearing historically and in specific places…what were the most immediate, the most local power relations at work?” (Foucault, 1978, p. 97).
Where and When Does Resistance Enter the Picture?
Consistent with Foucault’s emphatic statement that “where there is power, there is resistance” (Foucault, 1978, p. 95), AOUM policy has encountered push-back across several fronts. The current efforts of the Future of Sex Education initiative, cited above, which opposes AOUM policy and supports comprehensive sex education approaches, stands as one example. Many prominent health education scholars—such as Santelli, cited above—have written extensively and forcefully about the limitations of, and problems generated by, AOUM. Another form of resistance can be seen in the efforts of young people themselves to elicit the information they need—from all available sources. American adolescents have learned that they cannot rely solely on their schools or parents for sexual knowledge. They have instead turned to peers, television, movies, romance novels, and the Internet to supplement organized sex education (Guttmacher Institute, 2017). Their resistance efforts have received adult and peer support through such organized vehicles as sexetc.org, an on-line resource that helps teens navigate and critique the sexual information they find on the Internet. Adolescents’ active form of resistance is consistent with McWhorter’s (2013) assessment that “it is Foucault’s view that we are always formed in networks of power and cannot directly oppose them. Instead, we must work within them to counter specific effects and at the same time transform ourselves” (p. 55). Tuana (2006) suggests that “epistemologies of ignorance are often integral to resistance movements,” including efforts at “reclaiming knowledges that had been denied or suppressed” (p. 2).
Lynn Fendler (1998) raises a key question—one that is applicable to sex education—about what it means to be educated. Using a Foucauldian genealogical approach, she asks: What assumptions about the “educated subject” are being constructed through specific kinds of educational discourses and pedagogical reforms? Applying her line of inquiry to AOUM, we might want to examine what assumptions about American adolescents underlie a government-sanctioned approach to sex education that eschews science and replaces it with scare tactics and value-laden, often religious, mandates? In observing that “partnership negotiations typically are complicated by disparate foci, fluctuating political commitments, competing self-interests, intractable institutional structures, and incompatible perceptions of how the world works” (p. 54), Fendler calls attention to the messy processes that can lead to controversial reforms, such as AOUM.
Stephen Ball (2018) used ideas drawn from Foucault’s later writings to explore some possibilities for thinking differently about education—strategies focused on fostering critical thinking, self-reflection, and resistance. Noting that much in our current education system is “absurd” because it “rests on an assumption of ignorance and a reverence to the past,” (p. 141), he envisioned a Foucauldian education that consists of “a process of creative self-fashioning, the opening up of vulnerability, unruly curiosity and frank speaking” (p. 141). While Ball did not address sex education specifically, his ideas are applicable to what I believe sex education in America could and should be—a system that views young people’s curiosity about human sexuality as a strength, that builds on their prior knowledge, that honors the diversity of their experience, that recognizes the centrality of identify formation in the work of adolescence, and that welcomes the role of young people as active agents of their own healthy development. This vision stands in sharp contrast to Abstinence-Only-Until-Marriage, a highly politicized adult intervention that sets false limits on much-needed discourse about human sexuality, and that insults the intelligence and integrity of our nation’s youth.
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