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The Choosing the Best series, one of the more popular abstinence-only-until-marriage curricula series in the country, includes Choosing the Best WAY, Choosing the Best PATH, Choosing the Best LIFE, Choosing the Best JOURNEY, and Choosing the Best SOUL MATE. Each is designed for a specific years of middle school or high school.  For each curriculum, there is a leader guide, a student workbook, and an accompanying video.

 

These curricula are produced and distributed by Choosing the Best, Inc., a non-profit organization founded in 1993. Choosing the Best, Inc. also offers PARENT PREP, aneducation program…ideal for PTA presentations, parents’ groups and teacher in-service trainingand Parents, Teens and SEX: The BIG TALK Book which “offers ten critical steps parents can take to help empower their teens to choose abstinence until marriage” (Choosing the Best PATH, Leader Guide, p. 2).

 

This review focuses on Choosing the Best PATH and Choosing the Best LIFE, which are designed for upper middle school students (seventh and eighth grade, respectively) and written by Bruce Cook, the founder of Choosing the Best, Inc. SIECUS reviewed the 2006 editions.

 

SIECUS’ curricula reviews are based on our Guidelines for Comprehensive Sexuality Education, K–12, which were developed by a task force of professionals from the fields of education, medicine, youth services, and sexuality education. The Guidelines are a framework for comprehensive sexuality education programs and represent a consensus about the necessary components of such programs. Abstinence is one of the 39 topics included in the Guidelines.

 

As is typical of abstinence-only-until-marriage curricula, Choosing the Best PATH and Choosing the Best LIFE provide limited information on human sexuality and do not cover such basic topics as puberty, sexual response, or reproduction. Other important issues such as contraception, abortion, sexual orientation, STDs, and HIV/AIDS are presented in an unbalanced manner that seems designed to promote one point of view rather than simply inform students.

 

In addition to omitting important information, these curricula rely heavily on messages of fear and shame, misleading information, and biased views of marriage, sexual orientation, gender, pregnancy options. While the immediate goal of many sexuality education programs is to delay the initiation of sexual intercourse (possibly until marriage) or increase the use of pregnancy- and disease-prevention methods, many programs also have the long-term goal of promoting sexual health. Because an abstinence-only-until-marriage program is often the only formal setting in which young people learn about sexuality, the information and messages in the curriculum can have a life-long impact on their view of sexuality.

 

Relying on Negative Messages

 

Abstinence is an integral part of any comprehensive sexuality education program. SIECUS’ Guidelines suggest that students be told that abstinence from sexual intercourse is the most effective method of preventing pregnancy and STDs, including HIV. The Guidelines include a number of age-appropriate messages about abstinence for students such as: “Young teenagers are not mature enough for a sexual relationship that includes intercourse”; “Abstinence from intercourse has benefits for teenagers”; and “Teenagers in romantic relationships can express their feelings without engaging in sexual intercourse.”

 

 

Rather than presenting a balanced, complete picture of both abstinence and sexual activity, Choosing the Best PATH and Choosing the Best LIFE puts forth exaggerated messages about both the benefits of abstinence and the dangers of sexual activity. The result is that students are instilled with fear and misunderstandings about sexual activity as well as unrealistic expectations of abstinence.

 

Messages of Fear—Trying To Scare Students

 

In an effort to scare students into abstaining from sexual activity, both curricula name numerous physical and psychological consequences of premarital sexual activity, suggest that sexually active teens will never have a happy future, and imply that only teens with low self-esteem and poor judgment become sexually active.

 

For example, Choosing the Best PATH, asks students “what are some of the risks of having sex?” The suggested answers include: “Teen pregnancy, sexually transmitted diseases, low self-esteem, loss of reputation, feelings of being used” (Choosing the Best PATH, Leader Guide, p. 6).  The curriculum goes on to ask, “what are some of the emotional consequences of being sexually active?” The answers it gives include “guilt, feeling scared, ruined relationships, broken emotional bonds” (Choosing the Best PATH, Leader Guide, p. 6). Exercises like these, underscore the idea that negative emotional consequences are an inevitable result of premarital sex.  

 

Similarly, Choosing the Best LIFE asks, “what could cause a sexually active teen to experience feelings of regret and guilt?” The suggested answers include: “feeling loss when relationship ends, feeling used, guilt about going against personal values” (Choosing the Best LIFE, Leader Guide, p. 8).  It goes on to say: “[A sexually active teen] may turn inward, fail to develop healthy interests and relationships, fail to develop a personal, independent identity, experience feelings of betrayal that can lead to rage” (Choosing the Best LIFE, Leader Guide, p. 8).

 

Both curricula have teachers inform their students that “one study found that sexually active teen girls were six times more likely to attempt suicide than those who were virgins” (Choosing the Best PATH, Leader Guide, p. 6; Choosing the Best LIFE, Leader Guide, p. 9). Clearly the author is suggesting that premarital sex leads to suicide, yet the causal link between teenage depression and sexual activity has not been scientifically established. Even the lead author of the aforementioned study stated that “this is really impossible to prove.”[1]

 

Still, Choosing the Best PATH emphasizes the emotional damage of premarital sex by suggesting that sexually active individuals will be unable to bond with a spouse. In an exercise entitled “A Bonding Experience,” two volunteers (one male and one female) are called to the front of the room. Each has a long piece of clear packing tape placed on one arm. The teacher explains, “this tape represents a relationship between two people who have never had sex before this bonding.” The teacher then asks the class if this relationship will last until marriage. Students are encouraged to say no. The tape is ripped off the students’ arms to emphasize breaking up. The boy’s tape is then placed on another girl’s arm and vice versa and the tape is again ripped off. This process is done two more times.

 

After the last couple has the tape ripped off, the teacher asks the students if they “notice anything different about the tape.” Suggested answers include “it’s no longer sticky” and “it has lost a lot of its bonding ability.” The two pieces of dirty tape are stuck together to symbolize marriage. The teacher then pulls the two pieces of tape apart and says, “although there is a bond, it’s not very strong. A relationship that begins with a weak bonding may not survive the normal pressures that occur in any married relationship.” The teacher then sticks two fresh pieces of tape together and shows students how hard they are to separate. Students are told, “this represents the greater bonding potential of young people who wait until marriage to have sex.”

 

According to the author, this exercise illustrates “how repeated sexual encounters make it difficult to begin and maintain lasting relationships because the ability to bond emotionally is destroyed” (Choosing the Best PATH, Leader Guide, p. 6).

 

There is no scientific evidence to support the assertion that premarital sexual intercourse leads to everything from ruined relationships to an inability to bond with a future spouse. The author’s focus on the inevitable consequences of premarital sexual activity is clearly designed to scare students rather than to educate them. 

 

Messages of Shame—Instilling Feelings of Guilt

 

In addition to providing endless information on the negative consequences of premarital sexual activity, Choosing the Best PATH and Choosing the Best LIFE utilize a variety of tactics to suggest that teens should feel guilty, embarrassed, and ashamed of sexual behavior.

 

For example, in an exercise entitled “A Rose with No Petals,” the teacher is told to “hold up a beautiful rose. Talk about the petals and how they add color and fragrance to the rose. Hand the rose to a student, telling that student to pull off a petal and pass it on to another student who also pulls off a petal. Continue passing the rose around until there are no more petals. At the end, hold up the rose. Ask: How much value does the rose have now? Share that the rose represents someone who participates in casual sex. Each time a sexually active person gives that most personal part of himself or herself away, that person can lose a sense of personal value and worth. It all comes down to self-respect” (Choosing the Best PATH , Leader Guide, p. 7).

 

In a similar exercise, entitled “A Mint for Marriage,” a peppermint patty is unwrapped and passed around the class. Once returned, the teacher asks if a student would like to eat it. The teacher is instructed to ask, “Why is this patty no longer appealing?” The answer: “No one wants food that has been passed around and neither would you want your future husband or wife to have been passed around” (Choosing the Best PATH, Leader Guide, p. 25).

 

Choosing the Best LIFE also includes a series of questions in which students are asked to name things that make teenagers anxious, worried, or cause low self-esteem. They are then asked to brainstorm the additional concerns for sexually active young people. For example, according to the curriculum, things that make young people feel good or bad about themselves include “success in school or other activities, parents, friends’ opinions of you.”  Students are then asked, “If someone is sexually active, what other factors influence their self-esteem?”  Answers include “concern about their attractiveness, sexual performance, reputation, opinion of their partner.”  The final question asks “What happens to someone who has low self-esteem?”  Answers include, “may feel used or damaged, unhappy or lacking dignity; difficulty accepting love from others” (Choosing the Best LIFE, Leader Guide, p. 9).

 

With exercises like these, the author sets up a dichotomy between those students who chose to be abstinent, who are portrayed as being strong, healthy, and courageous, and those who become sexually active, who are portrayed as lacking self-respect, worth, or personal value and who are simply no longer appealing to others. 

 

It is important to remember that 47 percent of all high school students have had sexual intercourse.[2] It is inappropriate and potentially harmful for an education program to imply that these teens lack value and dignity or suggest that they are less worthy of love, trust, and respect. This type of program could be damaging to these students and serve to alienate them from their peers and the program. 

 

Virginity Pledges—Asking Students to Publicly Promise Purity

 

Both curricula, like many fear-based, abstinence-only-until-marriage programs, include a virginity pledge, in which students vow to remain abstinent until they marry.

 

Choosing the Best PATH states: “your choices say a lot about your character…You’ve seen the emotional impact of sex outside of marriage.  Think about how your life and future can be influenced in a positive way by waiting to have sex until marriage.”  It goes on to say that, “even if you are not a virgin, today can be the first day of the rest of your life....” The teacher is instructed to have the class read the Abstinence Pledge from their student workbook out loud in unison.

 

Today I commit to Abstinence as a way to make the Best preparation for my future by Choosing to wait until marriage to have sex, because I want to be free: from worry, guilt, pregnancy sexually transmitted diseases, and the feeling of being used by another; to control my life, to like myself, to work towards personal goals, to experience healthy relationships, and to enjoy being a teenager… (Choosing the Best PATH, Student Workbook, p. 30).

 

Recent research found that virginity pledges could help a select group of young people delay intercourse under certain circumstances. Pledges taken by an entire class as part of a lesson or presentation, however, were not effective. Moreover, even when they work, pledges help this select group of adolescents delay the onset of intercourse for an average of 18 months—far short of marriage.  Ultimately 88 percent of young people who pledge become sexually active before marriage.   

 

Virginity pledges may, in fact, be detrimental to some teens. The study also found that those young people who took the pledge were one-third less likely to use contraception when they did become sexually active than their peers who had not pledged. Further research has confirmed that although some students who take pledges delay intercourse, ultimately they are equally as likely to contract an STD as their non-pledging peers. Far from providing a solution to the complex problem of unintended pregnancy and disease transmission, these simplistic pledges are undermining the use of contraception among teens, potentially exposing them to greater harm.[3]

 

In addition, these pledges are not appropriate for all students because they show blatant disregard for young people who are gay and lesbian. These students cannot legally marry in most states in this country.[4] Signing this pledge is tantamount to agreeing to a lifetime without sexual behavior. It is unfair and unrealistic to ask a high school student to make such an agreement.

 

Nonetheless, the teacher is told to “encourage those who are ready to make the pledge to sign and date it,” and, if they have time, to ask students to volunteer why they are ready to pledge (Choosing the Best PATH, Leader Guide, p. 30). Choosing the Best LIFE goes even further to guilt young people into taking the pledge saying: “an individual’s choices tell a lot about his/her character. When we choose a certain course of action, we broadcast our true character to others” (Choosing the Best LIFE, Leader Guide, p. 44).

 

It is not the place of any educational program to mandate choices for students. Instead, students must make their own decisions based on their personal values, the values of their families, and the values of their communities. By endorsing the pledge and suggesting that students use class time to sign the pledge, the teacher is putting undue pressure on students. Education programs should foster critical thinking and decision-making skills rather than pressure students to make one choice.

 

Sexual Arousal—Portraying Sex as an Uncontrollable Force

 

After telling students that they should not give in to pressure because premarital sexual behavior is shameful and leads to a plethora of negative consequences, Choosing the Best PATH and Choosing the Best LIFE suggest that sexual arousal is a power that young people cannot control.

 

In an exercise from Choosing the Best PATH called “Setting Boundaries,” the following story is told:

 

On their first date Alan and Susie were both shy. As the night went on, they felt more comfortable and held hands. At the end of the date, Alan gave Susie a short goodnight kiss. The next date, one kiss was not enough. Alan kissed Susie continuously for several minutes. Eventually, that was no longer satisfying. French kissing entered the scene, then bodily caressing, then ‘other stuff.’ Before Alan and Susie knew what had happened, they had sexual intercourse, because there was nothing left to satisfy their desires. Soon their relationship grew bitter, and they broke up, each feeling used, insufficient, and empty.

 

The text goes on to list the following chart of “Sexual Progression:”

 

Holding Hands -> Hugging -> Kissing -> French Kissing -> “Other Stuff” -> Intercourse

 

The teacher then asks students to “draw a line on your chart to indicate where you set your personal boundaries. Call for volunteers to share where they drew their line” (Choosing the Best PATH, Leader Guide, p. 35).

 

After a very similar story in the Choosing the Best LIFE curriculum, students are asked to complete a fill-in-the-blank worksheet that states “sexual arousal is progressive. It takes more sexual activity each time to get back to the same level of excitement” (Choosing the Best LIFE, Leader Guide, p. 48).

 

Leaving students with the impression that sexual arousal is uncontrollable is counterproductive to the mission of helping them make responsible choices. It is actually dangerous to suggest to young people that intercourse can just “happen” before they know it.  Young people need to know that at any point, no matter what they are currently doing or what they have done in the past, they have right, the ability, and the responsibility to set their own sexual boundaries at any point

 

In addition, by labeling a range of activities from massage to oral sex as “other stuff,” the curriculum not only suggests that some sexual activities are too shameful to even mention by name, it misses the opportunity to explain that some activities are relatively low risk while others can expose students to STDs.  It also fails to tell students how to protect themselves if they do engage in potentially risky behavior such as oral sex.

 

Finally, asking students to publicly declare their “line” opens them up to the scrutiny and scorn of their classmates and teachers. When faced with such pressure, many students may say only what they think the teacher wants to hear.

 

Distorting Information

 

Early editions of both curricula included many inaccurate and exaggerated statements mostly centered on the subjects of STDs and condoms. The current editions have corrected many of the inaccurate statements and do provide students with some important information on these topics. Nonetheless, both curricula continue to rely on distorted facts in their discussions on STDs and the effectiveness of condoms.

 

Sexually Transmitted Diseases—Misleading Students

 

For this edition of the Choosing the Best PATH and Choosing the Best LIFE, the author clearly worked to improve the section on sexually transmitted diseases.  The inaccurate information that was once common has been removed, and well-researched fact sheets containing accurate statistics and descriptions of STDs have been added.  Nonetheless the curricula’s discussions of STDs remain problematic as they focus on worst case scenarios, tie STD protection irrevocably to marriage, and reiterate the earlier messages of shame. 

Focus on Worst Case Scenarios

 The STD lessons in the curricula center around videos that include stories of young people who have contracted an STD as well as slides of infected body parts, some of these stories also appear in writing in the student workbook.  For example, the Chalmydia presentation in Choosing the Best LIFE begins with this: 

 The first time I had sex with anybody, I got chlamydia. So one week I was a virgin, and two weeks later, I had an STD….

 

I became violently ill. I had a 105 fever, severe abdominal cramps, and throwing up. The conclusion was yes, that I was infertile. My tubes had been damaged beyond repair.  I was sexually active, and I needed to take care, and I didn’t. And I was an educated person.  Had I had the information maybe this wouldn’t have happened to me (Choosing the Best LIFE Leader Guide, p. 19).

 

While undoubtedly sad, this story may be misleading to students.  In its abridged form, it seems to suggest that the fever, abdominal cramps, and fallopian tube damage all occurred within two weeks of being infected.  These are not, however, symptoms or consequences of initial Chlamydia infection.  Most likely they are the result of Chlamydia that went untreated for a long time and caused Pelvic Inflammatory Disease. 

 

Both curricula do tell students that Chlamydia and gonorrhea are bacterial infections which can be cured, but this information seems purposefully buried under details about PID and lifelong infertility.  Choosing the Best LIFE, for example, includes this bullet on gonorrhea: “Gonorrhea can be cured with antibiotics but remains a major cause of PID and subsequent infertility and tubal pregnancy (outside of the uterus) which require termination of pregnancy” (Choosing the Best LIFE Leader Guide, p. 19). While the author most likely meant that gonorrhea continues to be a cause of PID in the world, this poorly worded bullet seems to suggest that an individual case of Gonorrhea can cause damage to a woman’s reproductive system even after it has been cured with antibiotics, which is not true.

 

Similar language is included in Choosing the Best PATH’s discussion of Chlamydia: “While the infection can be cured, the results of the infection may never heal.”  To underscore this point, students are shown a slide showing scar tissue and adhesions that have formed between a woman’s liver and diaphragm. According to the curriculum, “The disease damages the reproductive system, then the diaphragm above, and finally the lungs” (Choosing the Best PATH, Leader Guide, p. 11).

 

It is important to remember that with proper testing and treatment many cases of Chlamydia and gonorrhea can be cured long before they cause any permanent damage. (According to the Centers for Disease Control and Prevention (CDC) approximately 40 percent of cases of untreated Chlamydia lead to Pelvic Inflammatory Disease, and approximately 10 percent of acute case of PID (not all cases become acute) lead to infertility.[5]) While it is important that young people know that STDs and their consequences are serious, Choosing the Best’s presentation of this information seems designed to suggest that lifelong consequences are inevitable, which is obviously not true.

 

Still, this is also evident in the curricula’s presentation of HPV which starts with this string of facts “Over 30 types of this virus can affect the genital area, including those that lead to cervical cancer in women.  Nearly 4,000 women die of cervical cancer each year” (Choosing the Best PATH, Leader Guide, p. 11).  This presentation seems designed to ensure that young people view HPV as a deadly disease when in truth most cases of HPV clear the body on their own without causing any permanent damage.  Cervical cancer is far from inevitable.  As the CDC explains:  “while infection with high-risk types [of HPV] appears to be ‘necessary’ for the development of cervical cancer, it is not ‘sufficient’ because cancer does not develop in the vast majority of women with HPV infection.”[6]

 

Moreover, though this edition of the curriculum does mention the importance of pap smears, it does not do enough to encourage testing and treatment.  The CDC estimates that approximately half the cases of cervical cancer that occur each year will occur in women who have never had a Pap test and an additional 10% will occur in women who were not screened in the last five years.[7]  Similarly, the CDC reports that screening for Chlamydia can reduce the incidence of Pelvic Inflammatory Disease (PID) by as much as 60%.[8] 

 

Rather than focus exclusively on worst case scenarios, the curricula would better serve students by highlighting the early symptoms young people should look for and emphasizing the need for everyone who has been sexually active to get tested regularly. 

 

Marriage as Protection

 

The curricula’s message that marriage is the only appropriate adult relationship is clear throughout the discussion on STDs. The presentation assumes that heterosexual marriage and parenthood is everyone’s ultimate goal, explains how STDs will destroy that dream, and presents marriage as a means of prevention. 

 

One of the slides shown to students in both curricula uses blue dye to illustrate how one woman’s fallopian tube has been sealed off with scar tissue from a case of PID caused by gonorrhea and Chlamydia.  Students are told “Even after three surgeries, this young married woman still can’t get pregnant.”  They are then asked: “How do you think this young woman and her husband felt when they discovered they could not have a baby because of an STD she caught as a teenager?”  (Choosing the Best LIFE, Leader Guide, p. 20).

 

If this story is true, there were so many points along the way that this young woman could have protected or saved her future fertility.  She could have used a condom consistently and correctly every time she had intercourse (condoms are known to be very effective in preventing fluid-based STDs like Chlamydia and gonorrhea), she could have been tested and treated the initial infections before they led to PID, and she could have been treated for PID earlier before the scar tissue developed.  Young women should understand the importance of protecting their future fertility. Yet if the curriculum wanted to do so, it would focus on these points where sexual health knowledge and decision making could have helped this young woman.

 

Instead, this story seems designed to once again leave students with the impression that STDs will inevitably ruin your future (not to mention the impression that a happy future always contains marriage and children).  It is worth noting that with today’s reproductive technology, a woman with a blocked fallopian tube may very well be able to become pregnant (through in vitro fertilization) and carry a pregnancy to term.  While this may not be ideal, the curricula’s presentation of her shattered dreams is clearly exaggerated. 

 

What is most disturbing about how the curricula tie STDs to marriage is their suggestion that marriage in and of itself provides protection from STDs.  In the unit on HIV, Choosing the Best LIFE says this: “The only way to eliminate 100% of the risk of contracting HIV/AIDS sexually is to be abstinent until marriage, marry an uninfected partner and both people must remain faithful in the marriage relationship  (Choosing the Best LIFE, Leader Guide, p. 37). There is certainly truth to this statement; if two individuals enter into a monogamous relationship when they are uninfected, stay faithful to each other, and both avoid contracting HIV through other means such as infected needles, they will remain HIV free.  The key to this arrangement, however, is the lifelong monogamous relationship. Whether or not these two individuals are legally married is irrelevant from a public health perspective. 

 Even some of the stories used in the curricula prove that a wedding ring is not sufficient protection.

I was rushed to the hospital with intense abdominal pain. Emergency surgery revealed such an extensive infection that my uterus, tubes and ovaries all had to be removed. My husband of six months had infected me with gonorrhea, which he had contracted from a ‘one-night stand’ prior to our engagement. Our dreams of biological children will never be realized (Choosing the Best LIFE, Student Workbook, p. 20).

 It is entirely possible that the narrator of this story followed the advice given by Choosing the Best LIFE and remained abstinent until her wedding night. Her exposure to gonorrhea proves that she would have been better served by a curriculum that provided her with information on how STDs are transmitted, how they can be prevented, and the need for all partners to get tested. Moreover, both she and her husband would have benefited from skills-based lessons on communications around sexual health.

 

STDs and Shame

 

The curricula’s messages of shame are also quite apparent in its STD discussions. One activity, designed to show how “STDs and HIV can be passed from one person to another without either knowing about the infection,” illustrates this quite clearly.  The teacher chooses five girls and five boys and places them in a row facing each other. Each student is given a cup which they then fill with water. The students are asked to rinse their mouths and then spit the water back into the cup. Students are told that the water now represents “body fluids.” The boys are asked to pour some of their “body fluids” into the cup of the girl across from them. The leader then reveals that some of the boys’ cups were labeled with the name of an STD and that the girls now have this virus or bacteria. The boys and girls then complete the exercise in reverse.

 Next, the students empty their cups into a pitcher labeled “multiple partners.” This pitcher is placed next to a pitcher of fresh water labeled “pure fluids.” Two cups are placed on the table labeled “future husband” and “future wife.” A female student is asked to choose either pitcher and pour water into her “future husband” cup. A male student then repeats the same process (Choosing the Best LIFE, Leader Guide, p. 36).

 The exercise gives clear messages: People who have had sexual intercourse are dirty (they are the equivalent of spit), all students in the class will marry a member of the opposite sex, and the person each marries must be “pure.” This is another example of shame as a guiding educational force, and may ultimately discourage sexually active young people from seeking the testing and treatment they need.

 

Condoms—Exaggerating Failure                               

 

To convince students that premarital sexual relationships have unavoidable negative consequences, both Choosing the Best PATH and Choosing the Best LIFE spend a great deal of time explaining that condoms do not prevent pregnancy or disease. The curricula and accompanying videos frequently skew statistics and mischaracterize condom failure in an effort to prove that condoms will not work.

 

Condoms as Prevention

 

Both curricula begin their discussion on condoms with a fill-in-the-blank worksheet that suggests condoms are not only ineffective but also hard to use.  The first fact, listed under the heading “Condoms do fail” says: “Because latex condoms are made of rubber; they can break and slip off(Choosing the Best PATH, Leader Guide, p. 18, Choosing the Best LIFE, Leader Guide, p. 25). According to a study in Consumer Reports, however, “with correct use, a condom will break as little as two percent of the time” and “will slip off as little as one percent of the time.”[9]  By leading with this possibility, the author makes it clear that the goal of this conversation is to undermine young people’s faith in condoms. 

 

The negative framing continues throughout the discussion on condoms.  Young people are told that “Condoms are most effective against HIV, reducing the risk by 85 percent versus not using a condom at all.  However, 15 percent of the risk remains for a life-threatening disease with no cure.”  Similar, statistics are given for other STDs including HPV: “Many studies show that condoms are not effective in protecting against HPV, the most common viral STD.  However, some risk reduction may occur with HPV-related symptoms (e.g genital warts and cervical cancer)” Choosing the Best LIFE, Leader Guide, p. 25).

 

These statements are a vast improvement over the inaccurate and misleading statement found in prior drafts of Choosing the Best curricula which suggested that condoms provided no protection for diseases ranging from Chlamydia to Herpes.  Nonetheless they are still clearly framed in the negative.  According to a CDC fact sheet, however, “latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea, chlamydia, and trichomoniasis.”[10]  The CDC also reports that, “several recent studies reported that, for men and women, use of male condoms can reduce the risk of genital herpes….”[11] Moreover, the use of latex condoms has been associated with a 70 percent reduction in HPV in young women and a reduction of HPV-associated diseases such as cervical cancer and genital warts.[12]

 

While it is important for students to understand that condoms cannot eliminate the risk of STDs, every medical professional can agree that it is exceedingly safer to have sex with a condom than without.  These curricula, however, prefer to emphasize the possibility of failure. 

 

Both include a chart comparing the failure rates of different kinds of birth control and accurately explain that condoms have a 15% failure rate under typical use.  The curricula, however, do not take the extra step to help young people understand their own role in these failure rates.

 

To fully understand research on condom effectiveness, students must understand the difference between method failure and user failure. Method failure refers to failure that results from a defect in the product. Method failure of the male condom is very rare.  It is estimated that only three pregnancies result from 8,300 acts of condom use, which is a remarkably low pregnancy rate (.04 %) when calculated on a per-condom basis. [13]

 

In truth, condom failures are most often caused by errors in use, such as the failure of couples to use condoms during every act of sexual intercourse. It is, therefore, important to look at the data on typical use or user failure. User failure is calculated by looking at 100 couples who use condoms as their primary method of birth control over the course of a year. About 15 of these couples will experience an unintended pregnancy during the first year of condom use. It is important to remember that these couples may not have been using condoms or may have been using condoms incorrectly during the act of intercourse that resulted in an unintended pregnancy.

 

To further put this in perspective, it helps to look at other contraceptive methods. For example, 26 percent of women using periodic abstinence as a method of birth control will experience an unintended pregnancy within the first year, as will 85 percent of those using no method.[14]  

 

After presenting the chart on contraceptive failure, the curricula ask rhetorically, “Could you live with a 15% annual failure rate on: A roller coaster ride? “An airline flight? Skydiving?”  Given that 15% represents typical use rates (not the 2% for perfect use), for this to be an accurate analogy the skydiving failure rates, for example, would have to include all of those people who jumped out of an airplane without their parachute. 

 

Equally unfair, the curriculum compares the typical use failures rates of condoms and other contraceptives with what can only be described as the perfect use failure rates for abstinence.  Like any other method of pregnancy- or disease-prevention, abstinence can be used inconsistently or incorrectly.  The fact that 88% of teens who take virginity pledges ultimately have sex before marriage suggests that some teens who plan to use this as a method of contraception are not using it consistently and correctly.[15]  Though researchers have never calculated the user failure rate for abstinence, it surely has one. 

 

The curriculum could better serve students by explaining that although condoms are not 100% effective in preventing pregnancy, there are steps that sexually active couples can take—like using condoms consistently and correctly every time—to improve the chances of avoiding unintended pregnancy and STDs. Teens also need to know that deciding to be abstinent is not enough to protect them against pregnancy and disease unless they always refrain from all potentially unsafe behaviors including oral, anal, and vaginal intercourse.

 

Discouraging Condom Use

 

It is clear that the curricula want to discourage students from using condoms for both pregnancy and disease prevention. One exercise, for example, asks students to “circle the item(s) that can be totally eliminated through the use of a condom?” The list is as follows:

 

Infertility, isolation, jealousy, poverty, heartbreak, substance abuse, AIDS, pregnancy, cervical cancer, genital herpes, unstable long-term commitments, depression, embarrassment, meaningless wedding, sexual violence, personal disappointment, suicide, feelings of being used, loss of honesty, loneliness, loss of personal goals, distrust of others, pelvic inflammatory disease, loss of reputation, fear of pregnancy, disappointed parents, loss of self-esteem, leaving high school before graduation.

 

The correct answer, according to the curriculum, is that none of the things listed can be totally eliminated through the use of a condom. In contrast, however, the curriculum claims that ALL of them can be eliminated by being abstinent until marriage (Choosing the Best PATH, Leader Guide, p. 19).

 

Condoms were never intended to prevent everything from meaningless weddings to distrust of others. They are, however, intended to prevent pregnancy and STDs, and years of scientific research suggest that they are effective at that. For example, when used consistently and correctly, condoms are 98 percent effective in preventing pregnancy and research has shown that using a condom for HIV prevention is 10,000 times safer than not using a condom.[16]

 

Telling students that condoms don’t work will not stop them from having sexual intercourse. It may, however, stop them from using condoms when they do become sexually active. This focus on unrelated issues is clearly designed to discourage condom use rather than inform students.

Promoting Biases

 In addition to relying on inaccurate information, both curricula are based on a number of underlying biases and assumptions about marriage and sexual orientation. Presenting these biases as universal truths does little to inform students and instead fosters myths and misunderstandings.

 

Marriage—Promoting One View

 

 Other curricula in the Choosing Best series, most notably Choosing the Best SOUL MATE, seem designed specifically to focus on marriage and, in many ways, are marriage promotion and preparation courses more than anything else.  Perhaps because these are intended for younger teens, Choosing the Best LIFE and Choosing the Best PATH do not devote much discussion time to the subject of marriage. Nonetheless, both curricula discuss sexual behavior exclusively in terms of marital status (consequences result from premarital sex) and present marriage as the only positive venue for sexual activity. 

 

 The curricula also suggest that choosing not to have sex until marriage will provide young people with freedom from worries and concerns such as “freedom from getting pregnant, contracting and STD, and emotional consequences.”  While it is true that young people who are not sexually active do not have to worry about pregnancy or STDs, many will experience some sort of emotional pain which is a normal part of growing up.  More importantly, however, the curriculum seems to be suggesting that this freedom is permanent and that unintended pregnancy, STDs, and emotional consequences are never a problem in marriage. 

  

Consider the list of consequences presented in the condom lesson:

 

Infertility, isolation, jealousy, poverty, heartbreak, substance abuse, AIDS, pregnancy, cervical cancer, genital herpes, unstable long-term commitments, depression, embarrassment, meaningless wedding, sexual violence, personal disappointment, suicide, feelings of being used, loss of honesty, loneliness, loss of personal goals, distrust of others, pelvic inflammatory disease, loss of reputation, fear of pregnancy, disappointed parents, loss of self-esteem, leaving high school before graduation.

  

Students are told not just that condoms cannot eliminate these consequences but that abstinence until marriage can.  It is simply untrue that either premarital abstinence or marriage can prevent individuals from suffering from such things as jealousy, poverty, or loneliness.

 

The emphasis Choosing the Best PATH and Choosing the Best LIFE place on marriage as the only appropriate venue for sexual activity also shows a clear bias against gay and lesbian individuals. The curriculum consistently ignores the fact that same-sex couples cannot legally marry in most of this country.

 

At one point, students are told that “sex can be only physical, or it can be a part of a meaningful, committed relationship in marriage” (Choosing the Best PATH, Leader Guide, p. 32). Not only are gay and lesbian teens essentially being told that they should never engage in sexual activity, but quotes such as this suggest that same-sex relationships can never be meaningful or committed.

 

In addition, all references to sexual activity and arousal within both curricula are specific to male-female couples. Once again this shows the author’s assumption that all students are heterosexual.

 

Curricula written exclusively for heterosexual students are not appropriate for a classroom setting in which some students are likely to be gay, lesbian, bisexual, or questioning their sexual orientation. Such curricula will only further marginalize and alienate these students. Gay, lesbian, bisexual, and questioning students, especially young men who have sex with men, are at increased risk for STDs, including HIV, yet Choosing the Best PATH and Choosing the Best LIFE fail to provide these students with any realistic strategies for protecting themselves from those risks.

 

Treatment of Gender—Fostering Myths and Stereotypes

 Choosing the Best LIFE and Choosing the Best PATH often perpetuate long-standing gender stereotypes.

 For example, Choosing the Best LIFE tells the story of Tom and Kristie, a high school couple who just started dating, saying, “Kristie loves how Tom makes her feel pretty, and Tom enjoys how it feels walking down the hall with her next to him” (Choosing the Best LIFE, Leader Guide, p. 43). In another section, the teacher asks students “what do guys talk about in the locker room? (Girls) What do girls talk about at sleepover parties? (Guys)?”  (Choosing the Best LIFE, Leader Guide, p. 47).

 Most notably, the curriculum presents the stereotypical view that men desire casual sexual activity from any and all women while women only agree to sexual activity to get love. In a section entitled, “Guys vs. Girls,” the curriculum asks students, “how do guys and girls sometimes view sex differently?” The suggested answers include: “Guys say sex is more physical, that they are driven by hormones and peer pressure. Girls say sex is an emotional experience, involving strong feelings” (Choosing the Best LIFE, Leader Guide, p. 6).

 The activity presents a shortsighted view of the wide range of emotions that both boys and girls face in dealing with sexual and emotional relationships.  These statements are steeped in stereotypical understandings of gender roles and reinforce the message that boys are uninterested in committed and caring relationships and only concerned with sex, and girls are over-emotional pushovers incapable of standing up for themselves.

 In one exercise designed to dramatize these differences, the teacher goes over six emotional consequences of having premarital sex which include “worry, regret and guilt, impairs personal development, fear of future relationships, lowers self-esteem, and depression.” The teacher then hands out paper hearts to the students and instructs them to keep their heads on the desk as the story of Kendra and Antonio is read. Students are told, “each time you hear one of the six consequences surface in Kendra’s life, tear off a piece of your paper heart. Tear off only the amount that represents how much hurt you would feel in that situation.”

 According to the story, Kendra is 14-year-old freshman who begins dating a 16-year-old sophomore, Antonio. At the start of their relationship they did “simple fun things together.” Then, one night while left alone they had sex. The story explains that afterwards, Kendra felt “empty” and “ashamed.” The story goes on to say that “before she had sex with Antonio, she felt exuberant and free. She felt energized whenever he was with her. Now she feels lonely and trapped. She feels empty and worthless inside. Her self-esteem is shot” (Choosing the Best LIFE, Leader Guide, p. 9).

 After the story is finished, the teacher asks students to look at their piles of torn hearts. “Do you notice any differences in the piles of torn pieces on the guys’ desks and those on the girls’ desks?” The answer: “Girls usually have more torn pieces” (Choosing the Best LIFE, Leader Guide, p. 9).

 The teacher then asks students if it is “possible for Kendra to put her life back together.” Students are told that it is and that the answer to how is printed on the back of their torn hearts. The class then takes the time to “mend their broken hearts” using tape and reveal the term “self-respect” printed on the back. The exercise ends with the teacher asking, “if Kendra respected herself, would she have given herself to Antonio without his commitment to her? (No) What is this commitment called? (Marriage)” (Choosing the Best LIFE, Leader Guide, p. 9).

 By focusing solely on the negative outcomes experienced by Kendra, Choosing the Best LIFE reinforces numerous stereotypes about male-female relationships. It implies that young women who are interested in sex lack self-respect. It suggests that a girl’s life will be ruined by premarital sex while a young man will suffer few, if any, consequences. The exercise also seems to suggest that Kendra’s suffering is her own fault because she lacked self-respect and “gave” herself to Antonio. These messages reinforce a societal double-standard that places all of the responsibility for refusing sexual activity on the shoulders of young women.

 A similar activity in Choosing the Best PATH, asks students to read fictitious internet chat room posts written by sexually confused teens and respond with advice.

 

The first post is written by “AngieAngel” and titled “Might Lose Him!” She asks, “help! I’m afraid if I tell my boyfriend no one more time he’ll break up with me. This is the first guy I’ve dated seriously and I don’t want to lose him. How can I say NO to sex without losing him?

 

The second written by “BigDawg” is titled “When No Doesn’t Mean NO.”  He asks, “My girlfriend keeps saying no to everything I want to try. At least she says no with her words, but everything else-her flirting, her clothes, her kisses- say “Keep going!” Man, am I confused” (Choosing the Best PATH, Leader Guide, p. 42).

 While it is important to teach teens how to manage situations such as these, it is disturbing that the curricula consistently portray females as either the temptress or the helpless victim of male desire.  This activity would have been a very appropriate time to remind students that no always means no, and that clothes, flirting, and kisses can never say, “keep going.”  Unfortunately, that is not what the curriculum does here. Instead, the teacher is instructed to use this activity as a chance to remind students that they still have time to sign their virginity pledges (Choosing the Best PATH, Leader Guide, p. 42).

 Students are never challenged to question the nature, validity, or origin of these gender stereotypes, or to explore how stereotypes affect communication within friendships or sexual relationships. Such a presentation is detrimental to all young people by limiting their options, influencing their behavior, and coloring their expectations for future relationships. Instead, students need to learn that both men and women are sexual beings and are equally responsible for making decisions regarding sexual activity.


Pregnancy Options—Mandating Choices

  

Both of the curricula spend a good deal of time looking at the consequences associated with teen pregnancy and parenting.  The videos include stories from a number of struggling teen parents and the workbooks include things such as “A typical Teen mother’s schedule” which illustrate how difficult parenting can be. 

 

Choosing the Best LIFE asks students to fill out a chart with the physical, emotional, and social consequences of teen parenting, adoption, and abortion. When students finish, the teacher is instructed to say “Notice that all the options carry with them negative consequences. If you choose to be sexually active and there is a pregnancy, your choices are limited, and can result in negative consequences” (Choosing the Best LIFE, Leader Guide, p. 31).

  

In a similar activity, Choosing the Best PATH tells young people that there are four choices if a teen gets pregnant “1. Become a single parent; 2. Get married; 3. Have an abortion; and 4. Place the baby up for adoption.”   Students are then asked to brainstorm the possible consequences of each choice.  The curriculum is relatively even-handed in suggesting that all four choices have negative consequences.  An underlying preference for adoption remains clear, however, as this is the only option in which students are asked to consider the positive consequences which include: “relief in finding a good home for the baby and more economic and emotional stability [for baby]”  (Choosing the Best PATH, Leader Guide, p. 17).

 

In previous drafts of Choosing the Best LIFE, abortion was not even listed as a choice.  This edition has teachers tell students: “…the reason abortion is listed as a choice is because it is legal in the US” (Choosing the Best LIFE, Leader Guide, p. 31).  While it is certainly an improvement, the author’s opposition to abortion does seep out.  Students are told that they may suffer “feelings of guilt, regret, and sadness.” While these feelings are also noted as consequences of adoption, it is never suggested that students might feel any positive emotion such as relief if they choose abortion.   In addition, the author lists “medical complications from the procedure” and problems with “future pregnancies” as likely consequences. Without any further explanation (none is given) students may be left with the inaccurate assumption that abortion is dangerous and likely to impact future fertility. This is simply untrue.  

 

It is never the place of education programs to mandate choices for students. Instead, students need unbiased information about the options they have should they experience an unintended pregnancy as a teen or an adult. It is then up to students to make choices consistent with their own values and the values of their families and communities. By presenting even subtly biased information about abortion and adoption, Choosing the Best does not allow individuals to make informed, personal decisions.

 

Teaching Methods

 

Choosing the Best PATH contains eight lessons: “Sex: Everybody is Talking About It;” “The Risk of STDs and HIV/AIDS;” “Teen Pregnancy and ‘Safe Sex?;” “Pressures to be Sexually Active;” “Choosing the Best Path;” “Set It! The Need for Boundaries;” “Say It! The Need to Speak Up;” and “Show It! The Need to be Assertive.”

 

Choosing the Best LIFE contains eight lessons: “Sex, Emotions and Self-Respect;” “Sex, Alcohol and Respect;” “Sex, STDs and Honesty;” “Sex, Pregnancy and Responsibility;” “Sex, HIV/AIDS and Compassion;” “Sex, Love and Choices;” “Sex, Limits and Self-Discipline;” and “Sex, Saying ‘NO’ and Courage.” 

 

Each lesson in Choosing the Best PATH contains five components.  Each lesson in Choosing the Best LIFE contains four components. Each starts with a short video segment. The teacher then facilitates a “guided discussion,” presents facts and new ideas, and leads the class in experiential activities. Finally, the students are encouraged to take what they have learned home and discuss it with their parent or guardian.

 

Curricula Strong Points—Appealing to Students and Parents

 

In the past, many fear-based, abstinence-only-until-marriage curricula felt outdated and unlikely to appeal to young people. Choosing the Best PATH and Choosing the Best LIFE have rectified many of the problems with their appearance and the new materials are very polished. The curriculum guides and workbooks are produced in full color and use pictures and graphics that are more likely to appeal to young people. In addition, the video segments contain short interviews with individuals cut together in the style of MTV and other networks geared toward young people.

 

Another strength of the curricula is the dedication to involving parents. After each lesson, students are prompted to have a discussion with their parents about what they learned from the lesson.  SIECUS believes that good parenting involves being able to talk freely with children about sexual health and behavior and so commends Choosing the BEST, Inc. for recognizing this need. 


 

Exercises—Dramatizing Fear and Shame

 

Choosing the Best PATH and Choosing the Best LIFE both attempt to underscore the messages contained in each lesson by using experiential exercises. While such exercises are a very important part of any learning experience, many of the specific activities included in this curriculum simply dramatize the messages of fear and shame that run throughout the program.

 

In an exercise designed to show the importance of boundaries, for example, the teacher brings a live goldfish to class. The teacher explains, “This goldfish looks out of its bowl every day wondering what it would be like to be free from its glass boundaries. Once the fish is free, he could go anywhere and do anything he wants. Well, today I am going to make this goldfish’s dreams come true.” The teacher then places the goldfish on the desk where it will likely wriggle and gasp for air. The teacher is directed to scoop up the goldfish and return it to its bowl “after a brief period of uneasy tension” and then ask students “Why are boundaries important?” Suggested answers include: “They can be protective; allow a lot of freedom within a defined space; and make it easy to know what you’re going to do and how you’re going to act because you know your boundaries” (Choosing the Best PATH, Leader Guide, p. 35). The teacher goes on to ask, “How does this exercise apply to the areas of sexuality?” Suggested answers include: “Boundaries protect from STDs, pregnancy, emotional pain; they provide freedom to reach goals; to reach marriage with a unique experience to share with spouse.”

 

In Choosing the Best LIFE, the teacher is instructed to treat the story of the fish as a thought exercise instead of an actual demonstration. 

 

It is disturbing that both curricula are so intent on denying teenagers the ability to be responsible that they include an exercise that tells them to cage their aspirations and personal decision making skills.  Instead, teens need to be taught how to think critically so they can make important decisions every day as they age. Choosing the Best PATH and Choosing the Best LIFE, consistently berate the population they are charged with protecting, as they ridicule, shame, and scare young students into abstinence-only-until-marriage. 

 

Conclusion

 

Each new addition of a Choosing the Best curriculum seems to be an improvement on the previous one. The outrageous messages of fear have been toned down and the medically inaccuracies corrected.  SIECUS applauds the author for taking these important steps.

 

Nonetheless, Choosing the Best PATH and Choosing the Best LIFE continue to rely on messages of fear and shame, misleading information, and biased views of marriage and sexual orientation. In addition, the format and underlying biases of the curriculum do not allow for cultural, community, and individual values. Instead, they discourage critical thinking and discussions of alternative points of view in the classroom.

 

Ultimately, Choosing the Best PATH and Choosing the Best LIFE fall far short of helping young people develop the skills and knowledge they need to become sexually healthy adults.

 



[1]Karen S. Peterson, “Study links depression, suicide rates to teen sex” USA Today, 3 June 2003, accessed 6 August 6, 2009 <http://www.usatoday.com/news/health/2003-06-03-teen-usat_x.htm> .

[2] J. Grunbaum, et al., “Youth Risk Behavior Surveillance — United States, 2007,” Surveillance Summaries, Morbidity and Mortality Weekly Report, vol. 57, no.SS-4, pp. 1-136., accessed, 5 June 2009, http://www.cdc.gov/nccdphp/dash/yrbs/.

[3] P. Bearman and H. Brückner, "Promising the Future: Virginity Pledges and the Transition to First Intercourse," American Journal of Sociology, vol. 106, no. 4 (2001), pp. 859-912; P. Bearman, et al., “The Relationship Between Virginity Pledges in Adolescence and STD Acquisition in Young Adulthood,” American Journal of Sociology, vol. 110, no. 1 (2004), pp. 44-92.

[4] Recent legislation and court decisions in California, Connecticut, Iowa, Maine, Massachusetts, New Hampshire, and Vermont have granted same-sex couples the right to marry in those states. Some legal and legislative challenges remain though and it is therefore unclear whether this right will be permanently guaranteed in these states or other states in the country.

[5] Pelvic Inflammatory Disease – CDC Fact Sheet, Centers for Disease Control and Prevention (28 August 2007), accessed 24 June 2009, <http://www.cdc.gov/std/PID/STDFact-PID.htm> .

[6] J. L. Gerberding, Report to Congress: Prevention of Genital Human Papillomavirus Infection (Atlanta,GA: Centers for Disease Control and Prevention, 2004), p. 6.

[7] Ibid.

[8] 1999 Division of STD Prevention, STD Surveillance (Atlanta, GA: Center for Disease Control and Prevention, September 1999).

[9] “Condoms Get Better,” Consumer Reports, June 1999, p. 46.

[10] Latex Condoms and Sexually Transmitted Disease—Prevention Messages (Atlanta, GA: National Center for HIV, STD & TB Prevention, Centers for Disease Control and Prevention, undated document).

[11] Gerberding, “Report to Congress,” p. 13.

[12] Rachel L. Winer, et al., "Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women," New England Journal of Medicine, 354.25 (June 22, 2006): 2645-2654; .Latex Condoms and Sexually Transmitted Disease—Prevention Messages.

[13] Robert Hatcher, et al, Contraceptive Technology, 19th revised edition (New York: Ardent Media, Inc., 2007), 328-329.

[14] Ibid.

[15] P. Bearman and H. Brückner, "Promising the Future.” 

[16] Hatcher, et al, Contraceptive Technology; R.F. Carey, et al, “Effectiveness of Latex Condoms as Barrier to Human-Immunodeficiency Virus-sized Particles under Conditions of Simulated Use,” Sexually Transmitted Diseases, 19, no. 4 (July/Aug. 1992), p. 230.