Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding


Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm


Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception New and Improved

Don’t Abstain from Your Role in Abstinence
September 2017


Abstinence is making your role as a provider harder. Yes, abstinence can be an effective method to prevent pregnancies and sexually transmitted infections. But as you well know, the pivotal word in that statement is can. What you may be less aware of—though affected by—is that the effort and funding spent on abstinence programs are undermining comprehensive education programs that are proven to promote positive reproductive health behaviors. Washington DC is cutting millions of dollars in funding for programs proven to prevent teen pregnancy and adding millions into abstinence programs proven not to work.

In a 2017 analysis of programs teaching abstinence-only–until-marriage to adolescents, a team led by John Santelli confirmed that comprehensive and factual sex education is diminishing.[1] Between 2000 and 2014, the percentage of middle and high schools requiring programs in human sexuality fell from 67% to 48% and the percentage requiring HIV prevention education fell from 64% to 41%. Only 23% of junior high schools and 61% of high schools instructed students about contraceptives. In contrast, 76% of high school programs and 50% of middle school programs taught abstinence as the best way to avoid pregnancy and STDs.

But isn’t abstinence a good thing? Don’t we want teens to delay having sex? Sure, on both counts. Unfortunately, as the analysis pointed out, “Federal [abstinence-only-until-marriage] programs are inherently coercive, withholding information needed to make informed choices and promoting questionable, inaccurate, and stigmatizing opinions.” Several years ago, an analysis conducted through the Cochrane Database of Systematic Reviews found that those programs did not even achieve their goals.[2] The student participants did not delay sex or decrease their sexual activity and did not have fewer partners. Given that these programs do not promote use of condoms or contraceptives, there was no positive effect on those behaviors either.

In its 2016 review, the Centers for Disease Control and Prevention summarized 224 randomized controlled trials of sex education programs and confirmed that abstinence-only interventions were ineffective.[3] The money funneled into these interventions could have been invested in comprehensive sex education programs, which did have demonstrable effects on reducing the risk factors of unintended pregnancy and sexually transmitted infections: less sex activity, fewer sex partners, and more use of protections in the form of contraceptives and condoms.

Played out on a public health stage, the failure of abstinence education programs have left those States that engage those programs with exceptionally high teen pregnancy rates: “After accounting for other factors, the national data show that the incidence of teenage pregnancies and births remain positively correlated with the degree of abstinence education across states: The more strongly abstinence is emphasized in state laws and policies, the higher the average teenage pregnancy and birth rate.”[4]

Despite the weight of sound evidence, repeatedly reconfirmed, our national effort to prevent teen pregnancy is heading toward a surprising and unsettling direction:

  • The Administration cut more than $200 million that had been dedicated to teen prevention programs.[5]
  • The current Federal budget proposed by the Administration allocates $277 million to fund abstinence programs.[6]
  • The new Chief of Staff to the Assistant Secretary of Health (DHHS) is the national abstinence education advocate Valerie Huber (she says she now prefers to use the phrase ‘sexual risk avoidance’; though as a reproductive health professional, you know that changing the name of the programs won’t change the outcomes).[7]

With the Federal government and too many States failing to step up, it may just take the village. Increasing awareness can be everyone’s responsibility. Abstinence works until it doesn’t, and then the individual needs to know about and how to access contraceptives and protection. Family planning providers do their jobs well, with falling teen pregnancy rates to prove it. But once again, it is time to step out of the office and spread the word.

From the Pages of Contraceptive Technology

And while you’re still in your office? Keep doing the great work you’ve been doing. Plus talk more about abstinence, good as a behavioral goal but not a particularly reliable contraceptive method. People are, after all, human. Including teens. So primary abstinence needs a back-up method.

Abstinence can play a far more effective role in a context different from that promoted by the abstinence-only programs. Spontaneous abstinence is the ever-available back-up method. No other contraceptive on board for protection? Not in the mood? Not the right partner? Either partner drunk or high? These situations call for abstaining. As Santelli notes,

“Although abstinence has become associated with saying “no,” viewed from another perspective, abstinence can mean saying “yes” to a number of other sexual activities and personal priorities. For some people, only penile penetration of the vagina equals intercourse. Not only does this definition fall short in its heteronormity [the restrictive societal norm of heterosexuality], but also most people have a more expansive view of sexual expression…”[8]

[1] Santelli JS, Kantor LM, Grilo SA, et al. Abstinence-only-until-marriage: an updated review of US policies and programs and their impact. J Adol Health 2017;61:283-280.

[2] Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in high-income countries. Cochrane Database Syst Rev 2007:doi: 10.1002/14651858.CD005421.pub2.

[3] 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: Am J Prev Med 2012;42:272e94.

[4] Stanger-Hall KF, Hall DW. Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S. PLoS ONE 6(10): e24658.

[5] McCammon S. abstinence education is infective and unethical, report argues. NPR August 23, 2017.

[6] Merelli A, Timmons H. Trump’s budget would devote $277 million to the least effective contraceptive known to mankind. Quartz May 23, 2017. Accessed Sept. 1, 2017 at

[7]  Hellman J. Abstinence education advocate names to HHS post. The Hill, 06/06/2017. Accessed Sept 1, 2017 at

[8] Santelli J, Kottke M, Grilo SA. Abstinence, noncoital sex, and sexual health:  what every clinician needs to know. In: Hatcher RA, Nelson A, Trussell, J, et al. [Eds.] Contraceptive Technology, 21st edition. New York: Ardent Media, Inc., in preparation.