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Monday, August 15, 2005

Faith-Based Sex Education

My West Nile headache is making me bitchy, so I just had to make a comment about Planned Parenthood's foray into faith-based sex education, scientific and medical irrationality. I also want to take a good strong whack at those who claim that there is no such thing as a secularist agenda in sex education in this country.

Here's the link to Planned Parenthood's "lesson plan" page. Here's a direct link to this particular lesson, the goal of which is:
Session Objectives:
To clarify the continuum of world views and the cultural polarization we are facing.

Activity Description:
While reading the description of the view of sexuality by the fixed world view and the relativist world view, instruct participants to stand on the continuum of the poles to represent their own values. By seeing the cultural war as a continuum of changing or fixed values, the participants understand their resistance to the open discussion of sexuality.
Here's the link to the PDF. Here's the content, in case you don't want to bring it up:
The Sexual Values of Two Systems
Fixed or Absolutist World View
1. Sexuality is basically animal passion and lust, genital, and must be controlled.
2. The main goal of sex is marriage and reproduction.
3. Sex is only acceptable in heterosexual marriages.
4. Masturbation, oral sex, same-gender relationships, and contraception all thwart God’s purposes for sex and are forbidden.
5. Strict gender roles in relationships with male active and superior.
6. Emphasis on sex as genitality and on genital acts.

Process or Relativist World View
1. Sexuality is a natural and positive life force with both sensual and spiritual aspects.
2. Sex does not have to be confined to marriage; pleasure, love, and celebration are goals in themselves.
3. Tolerance or acceptance of same-gender relationships.
4. God’s purpose for sex is to celebrate life; masturbation, oral sex, and same-gender relationships can express the celebratory and communion nature of sex.
5. Flexible, egalitarian gender roles.
6. Emphasis on people and their relationships rather than on what they do genitally.
Adapted from a summary by Linda L. Hendrixson, 1990.

Note the rather religious framework and the lack of any discussion that maybe, just maybe, the "fixed" worldview might have a point about bad consequences from careless and promiscuous sex. Frankly, I would say this is an attempt to propagandize adolescents into the right "religious" views about sex, which is a very celebratory, spiritual and communion-like affair with random partners until your genitals start itching.

Here's the "Hooray For Birth Control" lesson plan. Hooray! If only it worked more often! The reason that the single most popular method of birth control among married women is surgical sterilization is because it is the only thing that works reliably. That fact is not the focus of this particular lesson. Read it all, but here is item number 3::
Despite recent declines in the teen pregnancy rate in the U.S., nearly one million American teenagers become pregnant every year.2 Why do you think this happens? (Answers can include the following: lack of self-esteem, lack of economic and/or educational opportunities, failed methods of birth control or not using birth control, lack of information, and lack of progressive role models.)
Lack of progressive role models? Lack of economic opportunities? Lack of educational opportunities?

I'll tell you one thing that Planned Parenthood will never include in a lesson plan, and that's how to figure risks over time. They will tell kids that condoms used properly are 98% or 99% effective in preventing pregnancy, but they leave off the "over one year" and they generally omit that the actual results in most studies are more like 85% or 90%. One commonly accepted figure is that proper and consistent use of condoms will lower a woman's chance of getting pregnant to 3% in one year.

Sounds good, until you do this simple calculation. If you have a 3% risk in one year, your risk over 5 years is 15%, and over 10 years it's 30%. If you aren't perfect in their use, and most people aren't, your risks are going to be at least 5% in a year. So in 5 years that means you have a 25% risk, or 1 out of 4 of you will get pregnant. And in 10 years the accumulative risk is 50%. The typical user has more of a 10% chance of getting pregnant, so that gets you to 100% in 10 years. Now it is easier to get pregnant than to get a veneral disease (the process isn't specifically designed to transmit disease, but it sure is designed to get a woman pregnant), so condoms are better at preventing veneral disease than pregnancy.

BUT getting many veneral diseases increases the chance for getting another, so risks balloon for the more sexually active people. This omission might be why some studies have shown that about a third of sexually active women seen at college clinics are testing positive for chlamydia.

And in fact, condom advocates are waging a very serious campaign against the real risks associated with relying only upon condoms to control sexual risks. See this article:
Coburn and like-minded colleagues are now ensconced within the Bush administration, and with the imprimatur of government and the report of an NIH workshop on condom effectiveness to cite, a campaign to disparage the value of condom use is in full swing, itself the cornerstone of an effort to undermine the very notion of sexual risk-reduction, or "safer sex."

Critics in the HIV and STD prevention communities worry that the conservative crusade to promote abstinence outside of marriage comes at too high a cost. Undermining people's confidence in the effectiveness of condoms threatens people's health and even lives, they argue, since sex among unmarried people is common in the United States and around the world, and achieving correct and consistent condom use is difficult enough.
There is a bitter battle over not facts, but their implications. This is not a battle between science and religion. It's about far more than that. They aren't teaching kids that using condoms with spermicides may increase the risk of catching a veneral disease. They aren't teaching the kids that condoms don't protect much against skin-transmitting STDs and that studies of condom effectiveness have shown widely varying results:
A 2001 NIH expert panel, convened at Coburn’s request, examined dozens of published studies. It reported that for STDs besides AIDS and gonorrhea, for which condoms cut transmission by 50 percent to 100 percent, the evidence on protection is unclear because of weak and contradictory studies. Individual studies cited in the report give prevention rates ranging from 18 percent to 92 percent, depending on the disease.
Realistically, people who don't sleep around that much and use condoms vastly reduce their risks for STDs and pregnancy. That is the message that organizations like Planned Parenthood don't want kids to get, but it is the most scientifically supportable message.

The truth is that in terms of preventing STD's, the Catholic church has a more scientifically accurate message than most sex ed programs in high schools in North America. Here's what the average kid in high school in America will not hear in sex ed:
In light of the above, go back and read Planned Parenthood's lalala "culture clash" lesson plan again. Nowhere does it explain that the reason why most religions or just plain old-fashioned sexual morality are big on the idea of experiencing the "communion", "spiritual" and "celebratory" nature of sex within monogamous marriage is that it's quite risky, especially for women, to experience too much of it outside of monogamous marriages. Indeed, for gay men in this country sexual promiscuity is a lot like playing Russian roulette.

I guarantee you if you can get the "secret" facts listed above into a teenager's head that they'll be likely to have less random sex, enjoy what they have more, be healthier and live longer.

I am sick to death of the sanctimonious prating of people who complain about prudish or unrealistic outdated sexual morality. We would not accept risk factors like those listed above for any other category of human behavior. The idea that teenagers are unable to control themselves is ridiculous. They aren't getting the facts because of a truly neurotic reverse prudery.

The idea that homosexual men are being discriminated against medically is false. They have the best survival rate after AIDS diagnosis. This is probably attributable to quicker diagnoses and faster treatment, which logically implies that we aren't getting the word out to the rest of the population. However, if gay teenagers aren't getting the correct facts on risks, we may be inadvertently killing a lot of them through ignorance.

The reluctance to advise against the exceptionally high risk of AIDS and other diseases to actively sexual homosexual men in sex ed programs in high schools is because people fear it would create prejudice against them. It wouldn't, of course, if all the kids were taught that promiscuity is extremely dangerous to your health. Practically speaking, the risks from STDs are a function of high-risk behaviors and not sexual orientation. But we can't teach that because it might cause kids to question the relativist world view. So we teach lies by omission.

We need to take a good, long, hard look at what we consider important in this society. There are those who apparently fear that admitting anything that might make the Catholic church (or any church) look less than irrational is cultural suicide. Those types are willing to sacrifice the health of an awful lot of people for the sake of their culture. It's time to confront them about their lies, distortions and irrationality.

Good analysis, you old prude. Also, I'm sick of how people criticize me for my "risky" behavior on the freeways just because I like to celebrate the spiritual euphoria of driving by weaving in and out of traffic at 90 mph without a seatbelt. How dare they make it a moral issue! I'm going to form a driver's ed course for public schools to teach kids about the benefits of enjoying a healthy and expansive and "progressive" driving style, and help them get over archaic and outmoded notions of "risky" and "immoral" behavior on the road. If an accident happens, we can always blame it on Reagan.
If an accident happens, we can always blame it on Reagan.
Or Carl Rove! It's clearly a vast Rethuglican plot.

You crack this old prude up, Pedro.
nearly one million American teenagers become pregnant every year.2 Why do you think this happens?

Because they are having sex? Isn't that the obvious answer?

If you have a 3% risk in one year, your risk over 5 years is 15%, and over 10 years it's 30%.

I'm picking nits, but probability doesn't work like this, you're close enough for the point you are making but it's not exactly correct.
Well - the whole risk percentage thing as commonly taught is incorrect, because it ignores activity. So in practice, your individual risk for an STD is much more a function of who you slept with and who they slept rather than a function of whether you used a condom. But I guess they want to simplify things. So I am simplifying back.

Last year I looked at 10 different studies assessing annual risk and then checked for population statistics and the additive approach does seem to be working out over the population.

If you consider a 100-sided die, the more throws the more chance of coming up with a particular side. In theory, throwing the die 100 times will produce all 100 numbers. In real life that's not what happens, of course - but extended over a large population of throws it is.

The real scandal here is that kids aren't taught to assess risks as a function of behavior plus prevention, but only as a function of prevention. This is probably a function of genuine innumeracy among the population of sex ed curriculum designers, but the real life consequences are appalling.
actually I have a degree in this stuff and it isn't worth getting into but the theory actually accounts for the "real world" activity. And the 100 sided die tossed 100 times according to the theory the chance of getting all 100 numbers is actually pretty dang small. The math is tedious with what I have here otherwise I'd do it and brag about it.

I apologize for bringing it up, it is irrelevant.
This discussion is meaningless drivel. The most effective birth control method known is Aspirin. All a woman has to do is place one tablet between her knees and presto! No problemo.

Next case.
Maybe I'm just failing to remember my high school math, but how does 3% in one year plus 3% in another year give you a 6% chance of getting pregnant over two years?

I'll put it to you this way. Assume you have a fixed number of sexual encounters in any given year (say, 100, for purposes of ease of math). If you have a 3% chance of getting pregnant using condoms in 2004, that means 3 out of those 100 chances is risky. If you have a 3% chance in 2005 of getting pregnant, that means another 3 out of 100 chances is risky. In total, that's 6 out of 200 chances over two years, which is still a 3% chance. Over ten years, it's 30 out of 1000, which is still a 3% chance. Over 30 years, it's 90 out of 3000, which is ... you guessed it, 3%. There's simply no mathematical proof which will tell you that using condoms over ten years gives you a 100% chance of getting pregnant.

Again, perhaps my math is fuzzy, but percentages are a portion of the whole, not additive over time. Please explain if I'm incorrect.

And not that I'm a full-blooded supporter of all of Planned Parenthood's agenda, but the two "views" of sexuality you mentioned, when read together with the objective "[t]o clarify the CONTINUUM of world views," it seems to me are meant to be the two extremes, and that most people would fit somewhere in the middle of these two extremes. I agree that the "relativist" view is stated in much more positive tones (expressing an inherent bias), but it looks to me like the practice is intended to point out the two ends of the spectrum of options, rather than the only two options available.

And, while I agree that all of the "secret facts" you mentioned should be taught in sex-ed classes, I have a couple of concerns about your conclusions. First, faith-based sex-ed (at least the Presidential administration version) has become more about abstinence, abstinence, abstinence than the real-world statistics that you mentioned. If all kids get is "don't do it until you're married," they're being short-changed just as much as what you claim Planned Parenthood is doing.

Second, I think your ultimate conclusion is that sex-ed without some sort of moral restraint included equals promotion of promiscuity, which just ain't true. Even discussing the "relativist" view doesn't promote promiscuity. There's a difference between being not-necessarily-pro-abstinence (or, more realistically, recognizing that not everyone will submit to abstinence) and being pro-promiscuity. There's a difference between gay sex and promiscuous gay sex. There's a difference between teen sex and promiscuous teen sex. Telling people about sex, the risks associated with it, and the possible ways to prevent such risks (with the percentage chances of success you mentioned) is not the same as telling all teens to go out and recreate the summer of love. You can't make that quantum leap.

"The idea that teenagers are unable to control themselves is ridiculous."

So is the idea that all teenagers will consent to abstinence outside of marriage. Or all adults, for that matter. I won't. Most of the people I know (including the religious ones) won't. So what we really need is a mixture, an education based on sharing the benefits and detriments of BOTH abstinence and birth control/prophylactic use. If we're talking about being honest with teens, why not give them ALL the information, instead of just one morality's side?
Howard - Aspirin! Darn! Why didn't I think of that? I'm cracking up. We could just hand out one of those convenience packs with two of them and then that would be it.

On more sober reflection, I'm not sure I would want to rely on the aspirin method. Enthusiastic frottage has resulted in more than one pregnancy in a technical virgin.

Tommy - I know the math too and I don't think it's irrelevant so don't apologize.
And I do remember just a bit about probability, although tommy could probably school me on the intricacies. But if you roll a 100 sided die once, you have a 1 in 100 chance of any particular number coming up. If you roll it twice, or a thousand times, each time you roll it the same probability of any one particular number coming up is present. EVERY roll is 1 in 100.

You're much more likely to roll the same number twice in a row than to roll all 100 numbers in 100 throws.

Or something like that. Dammit, Jim, I'm a lawyer, not a mathematician.
Math 101 and I'm sorry about this because it's tedious and your life will not be better when it's over.

The total probability of everything that could happen is no more that 100%. So if you have a 10% chance each year and you add up the probability over 15 years you get a 150% chance. So there has to be a method of subtracting something out to make the math reflect what really happens. But, continued exposure does increase the chances of something happening so it is additive in a way. You had a 3% chance the first year, if you were celibate the second year, you still had a 3% chance, everything is independent like you said about the dice. So in the 3% chance per year over 2 years it works out like this(simplified version):

.09% chance of getting pregnant twice
94.1% chance that you didn't get pregnant
5% chance that you got pregnant once

Since I don't know, and I'd refuse to do the math if I did, we will not discuss the possibility that having gotten pregnant once affects the probability of it happening a second time. But this is why there is a huge difference between statistics and probability. And if you want we could spend the next 6 months talking about the ramifications of flipping 1 million pennies and seeing what happens and if there is any surprise or significance to all of them coming up heads.
Boomr, predicted risks do accumulate per exposures, which is a polite way of saying that you are dead wrong. Your error comes from assuming that only 3 out of the 100 encounters were risky. All of them were, so more encounters overall translates into great predictive risk.

The logic of your example would indicate that playing Russian roulette once carries no greater chance of death than playing it 6 times. Even if you load the pistol and spin the cylinder separately each time, playing it 6 times does greatly increase your risk of dying over the series of trigger pulls.

Each individual pull of the trigger poses the same risk. Pulling the trigger multiple times still increases the expected death rate.

Think of it this way. Let's suppose that there is an evil Boomr genie living in the attic over my sitting room. He does not like to be disturbed, so whenever I walk into that room he starts jumping up and down hysterically. Conclusive, highly scientific and replicated academic studies have shown that evil Boomr genies are, on average, successful 1 out of 100 times in pounding their way through the ceiling to rebuke an intruder.

So my predicted risk of an abrupt genie encounter each time I walk into my sitting room is 1%. That's 1% chance per each exposure or a predicted 100% risk if I expose myself 100 times.

Given the nature of probabilities, the ceiling may fall in on me the first time I walk in there, but it probably won't. And I am far more likely to find myself with an enraged Boomr genie sitting on my lap if I go in once every day for a year, but in practice I may not ever experience that.

Furthermore, the risk to me of walking into the room on each day in the fourth year is exactly the same as it was the first day of the first year regardless of whether the genie has ever pounded his way through the roof or not.

That truth doesn't negate the fact that exposing myself to the risk more times means that it is more likely that the evil Boomr genie and I will eventually meet face to face, which is why the local reality show paid me to install video cameras in there. Film at eleven.

A 100% predicted risk doesn't work out to certainty for any individual, but it in large populations it does come close for numbers of occurrences. Since you can only control risks before encountering them, you have to use predicted risks to improve your actual results.

Btw, because of the pooling effect of disease exposure, risks for contracting STDs through risky sexual behavior accumulate far more rapidly than they do for pregnancy.
Tommy - actually, I would say that Boomr's predicted risk of paying child support decreases if he understands your example. Therefore you may have improved his life....

What is important to get across is that small risks accumulate over time.
Boomr, abstinence is a false issue, I think. People wave the horrible abstinence flag, but really abstinence is either a religious practice or a practice designed to control risk. There is nothing religious about teaching people how to properly assess risks or how to avoid them.
OK, let's leave STD's out of the equation for now -- I accept your premise on that issue, but the probabilities quoted in your post were in regards to pregnancy.

I understand your point, that if you match the number of exposures to whatever number of times the percentage risk adds up to 100, then you've got more chances to get hit with whatever whammy. But you've got to admit that it's somewhat misleading to say that you have a 100% chance of getting pregnant through using condoms over X number of years. "Predictive risk" and actual individual outcome are completely different, and when we're talking about teaching this stuff to average American teens, the difference is so confusing as to do nothing but support 100% abstinence as a policy -- which is simply unrealistic given human nature (and all animal nature, for that matter). Even under a 3% chance of getting pregnant with a condom, such pregnancy can come on the first encounter (which carries a "predictive risk" of .03%), or it can never arise after 10,000 encounters (which carries a "predictive risk" of 300% [which just sort of defies logic -- how can something occur 300% of the time?]). Using "predictive risk" as a teaching tool is as fraught with misinterpretation as using the Planned Parenthood method.

Like tommy said, it's the difference between probability and statistics. Take his penny example: You've got a generalized 1 in 2 chance that it'll come up heads every time you flip. How many flips would it take to get actual statistics of 50% heads and 50% tails? It could be 2, or it could be 1 billion. So extrapolating data from statistics (which is subject to under- and over-reporting, false answers, and just guesswork, on top of other factors like storage of the condom, vigor of the sexual act, whether the condoms stays on during the act, etc.) into an actual probability of likelihood that an individual would encounter the same outcome, is as much faith as science.

There's got to be a happy medium between the PP's inherent bias and the "predictive risk" oversimplification.
Abstinence is not a false issue if it's the central point in the administration's proposed plans for public education throughout the country.
What is important to get across is that small risks accumulate over time.

Correct for the purposes of this discussion, but it is more complicated than just adding up the numbers. My GPA would have been improved had I grasped the very concept I was attempting to explain one mid term exam sooner. I never liked probability anyway. If we could just move on to abstract algebra I'd be more in my element.
Boomr - no, I think we can count on human nature to ensure that we don't manage to scare all the kids into life-long abstinence. Predictive risk is the only way a human can control their own risks, therefore it is the only tool we can give them.

You wrote:
"Even under a 3% chance of getting pregnant with a condom, such pregnancy can come on the first encounter (which carries a "predictive risk" of .03%), or it can never arise after 10,000 encounters (which carries a "predictive risk" of 300% [which just sort of defies logic -- how can something occur 300% of the time?])."

Three pregnancies! I can tell you aren't a woman....

Although as Tommy observed we are talking about wetware here which behaves a little differently over time.

I absolutely disagree that it's wrong to teach some very basic rules of assessing risk to teens. This is not rocket science. What we are teaching is highly misleading and grossly understates real risks.

To some extent, self-control and picking your risks wisely is the only possible way for any society to prevent sexual epidemics. In effect all human societies practice partial abstinence.

The figures that are taught should be taken from studies so that they do incorporate all the factors you describe. It's as close to science as science can get. You really can't weasel out of this by suddenly claiming the scientific studies are wrong.

Actually the failure rates taught to kids are wrong. See this study, for example. Observed failure rates for contraception are much higher than most would expect:
During a lifetime of using reversible methods, a typical woman will experience 1.8 method failures and will discontinue using a method almost 10 times.
And they list the study of efficacy over one year as:
...long-acting methods such as Norplant and DMPA exhibited the lowest failure rates (2–3%). Failure
rates increased with combined oral contraceptives (8%), the diaphragm and cervical cap (12%), male condoms (14%), periodic abstinence (21%),
withdrawal (24%) and spermicides (26%)4.

Get that? A "method failure" is pregnancy.
Well, let me put it to you this way, then, since challenging the math doesn't seem to be getting through to you.

Do you really think telling kids the risk is 3% failure versus 1% failure will have a drastic effect on their behavior? I'm in total agreement that giving kids an idea of the risks associated with sexual activity is a good idea (I never said it's wrong to teach kids to assess risks -- I just said that it's just as wrong to give them overly dramatic statistics as to give them underly dramatic statistics). But do you really think that telling them condoms have a 3% failure rate will cause rampant promiscuity, but telling them they have a 5% failure rate will cause total abstinence? No, of course not.

Throwing a matrix of numbers at them WILL NOT GET THE RESULTS YOU WANT. Confusing them with "predictive risks" and probabilities WILL NOT GET THE RESULTS YOU WANT. Telling them in plain English "here are the risks, they're higher if you do this, lower if you do this, and there are serious consequences to your actions" works much better than telling them they'll have a 100% chance of getting pregnant if they use condoms over 10 years (which is exactly how they'll perceive a 100% "predictive risk" if taught to them). You can't teach them as if they all have a Ph.D. in statistical analysis and probability theory -- or, for that matter, as if all teenage actions are governed by logical choices after considered thought on the matter.

"Predictive risk is the only way a human can control their [sic] own risks, therefore it is the only tool we can give them [sic]."

Pardon the lack of manners, but what utter nonsense! That's akin to saying "statistics are the only way to prove a point." Just telling kids the risk/reward pattern isn't the only means to prevent promiscuity or unwanted preganancies. There's so much more that goes into the sexual patterns of teens than mere "this feels good and comes with no downside." There's biology (i.e., chemicals running through the body), there's psychology (i.e., social interaction, peer pressure, media), there's the need to experiment (just like driving fast or playing sports or climbing trees or reading "banned" books), there's poverty (which does, in fact, affect a person's ability or desire to obtain contraception), and a host of other reasons why teenagers have sex besides mere risk/reward analysis.

Again, all of the failure rate numbers you provide are statistics, not probabilities. In real life, there's no such thing as 1.8 pregnancies, or .0003 pregancies (I noticed you failed to address that "predictive risk" mentioned earlier when addressing the "three pregancies, oh my!" point). By that logic, using the "1.8 method failure rate" statistical extrapolation, EVERY WOMAN IN AMERICA USING CONTRACEPTION WILL HAVE BECOME PREGNANT at some point in her life. That just ain't the case.

Saying it's the best set of data we have is not the same thing as saying the conclusions you draw from that data are the best science we have. Statistics versus probabilities. Teenagers for the most part hate math, so why confuse them any more?
As I read through the comments, I kept thinking about that pesky coin in "Rosencrantz & Guildenstern are Dead". Was it heads every time, or tails?

In any case, I think that the statistics are just there buttress MoM's point--that we have to be honest about the risks of sex. Most teenagers who are sexually active aren't sexually active with one partner. Back in the day, it was serial monogamy (whoever's ring you were wearing.) I've heard different now.

PP's misinformation is dangerous, because the students who learn that information think they know the risks.
Not that it matters much, but the way you calculate the risk over n years of something having p probability per year is:

1 - (1-p)^n

So 10% probability over ten years is:

1 - (0.9)^10


1 - 0.35

or 0.65 = 65%.

Bad odds, but strictly speaking, not 100%. You could never reach exactly 100% no matter how many years you did the risky behavior. Not that I disagree with the post, but there's yer math.
Since I'm an English teacher who bailed out of math at the earliest opportunity, I'm concentrating on the words, not the numbers.

If a couple has protected sex that does not result in pregnacy, is it because the protection worked or because the woman was not fertile at that time?

[obviously STDs are always an equal risk regardless of the women's cycle; or is there a study that suggests that women are more likely to become infected at a particular time of their cycle?]

The worst thing for dangerous behavior is "getting away with them" because success leads to repeats and less healthy fear of repercussions.

There's something to be said for cultural shame. When casual sex was frowned upon, people had a stronger motive to control themselves or at least be more discreet about their behavior. If the physical consequences aren't enough to slow down some teens, peer group pressure could be.
Boomr - no, not every women in America will become pregnant. Those particular stats are extrapolations I didn't make, so don't blame me for them. Why don't you go yell at the scientists and explain why they are wrong? Read the links, check the studies and please send me a copy of your letter to them explaining why their numerical methods are wrong.

These are approximations. They are estimates based on scientific studies. Go back and look at at the HIV figures and the various studies I linked and I think you can get some idea of how this does work out in practice.

The reason you can have a greater than 100% risk in this case is because you can get pregnant more than once. Of course some people never do, and some people do a lot more than others. These are estimates. Forecasts. The broad range of effects is partly from the nature of probability and partly from the range of human fertility plus different behavior patterns.

The issue is not 3% failure or 5% failure, but the net effect of continuous risks over a long period of time which does get greater Fortunately pregnancy doesn't kill people. Very unfortunately, some of the diseases that kids get do.

Unfortunately, Boomr, most women in America who are fertile and sexually active for 20 years do get pregnant at least once while using birth control. This is why surgical sterilization is such a favored method of birth control for married women in their late 30's and 40's.

It's also the reason why health plans pay for surgical sterilization but not for non-reversible measures.
yes, Matteo, but I'm not sure how much we can extrapolate from these types of studies down to individuals.
Matteo (and everyone) To expand on that last, what these studies are really saying that on average from 15% down to 3% of women who are sexually active and rely on condoms will become pregnant during the course of a year.

So one can fairly contemplate a high school assembly with 200 girls in it, and tell them "Studies have shown that if you all have sex and rely on condoms for the next year, we can expect from 6 to 30 of you to become pregnant". The next year one could say the same. Over 4 years, one could expect 24 to 120 pregnancies in that group of 200 girls if they were all sexually active. They would not be distributed evenly, though.

That is the type of risk explanation I would think should be given in sex ed classes. It sharpens the students' attention spans considerably.

Carson - you are right. We can't predict any individual outcome, but we sure can predict group outcomes. Especially with STD's, that is highly relevant. And the above type of explanation is what kids aren't generally getting now. This leads them to underestimate the risks of being sexually active considerably.
Goddess of the Classroom (I love that name!), you wrote:
"When casual sex was frowned upon, people had a stronger motive to control themselves or at least be more discreet about their behavior. If the physical consequences aren't enough to slow down some teens, peer group pressure could be."

I think the message is stronger if it is phrased in terms of responsibility. Explaining to kids what they are actually likely to experience and what they can do to limit their risks is important. Asking them to take responsibility for their own behavior and its effects on others is certainly fair.

Kids who are very sexually active with very little thought of the consequences are very likely to pass on STDs and also cause unwanted pregnancies.

One thing that really peeves me is that I don't think we are giving kids enough information so that they can understand their risks. Then we unfairly blame them for being irresponsible, whereas I believe that many teens are extremely idealistic and if given more realistic figures would adjust their behavior accordingly.
OK, I give up on the math/probability argument, since I'm pretty much out of my league (lawyer, not mathematician, remember). Sometimes I just like to be contrarian, and I apologize if I came off more piqued than I really was. But I'm also a somewhat intelligent guy, and if I have these questions about the statistics you've provided, then I guarantee that teenagers getting them in class will either have more questions, or just ignore the numbers altogether.

I was serious in my last comment, that at some point you hit a critical mass of what kids will absorb. I'm not really sure that attempting to scare them with numbers will really have the effect of reducing the amount of teen sex going on. Yes, explain risk; yes, explain that the risk increases with increased exposure; yes, give them a healthy dose of fright at the possibilities of pregnancy and STDs. But at what point does it become speaking to the wall? I'm not sure even your "200 girls in the auditorium" speech would lessen the rates much, because the factors on the other side of the equation (the, for lack of a better term, "pro-sex" factors) and general teen malaise at sitting through class will likely override whatever is presented.

"...most women in America who are fertile and sexually active for 20 years do get pregnant at least once while using birth control."

I'd like to see your source for that. But when you use the quote "During a lifetime of using reversible methods, a typical woman will experience 1.8 method failures," and especially when you use that in class to teenagers, the message becomes "every woman who uses 'reversible' contraception and has sex WILL get pregnant at some point." If we're talking about giving kids the truth, is this what we really want to say? Lying with good cause is still lying.

"Explaining to kids what they are actually likely to experience and what they can do to limit their risks is important. Asking them to take responsibility for their own behavior and its effects on others is certainly fair."

Yes, but in virtually every other aspect of teenage life, we accept the fact that teens aren't capable of taking responsibility for themselves. Teens under 18 don't have the legal capacity to enter into contracts; they get different treatment when they commit crimes; they can only drive under limited circumstances, can't vote, can't drink, can't rent a car or hotel room. Up until -- what, age 16? -- they're actually FORCED to attend school. So why do we suddenly expect them to assess the risks of sexual activity with the same consideration of the data as an adult?

I'm not saying give up on them, or don't teach them anything, or don't throw some numbers at them, but there's a general pick-and-choose attitude out there about when teenagers are responsible enough for their own actions, when they're old enough to assess the risks inherent in adult life. There are some who are capable of accepting that responsibility early -- those are the ones who will listen to the lion's share of sex-ed and who are already at a reduced risk to fall into the traps. Some won't be able to accept that responsibility well into their adult years, and no matter what "predictive risks" and probabilities and statistics are thrown at them, they won't understand, or won't believe, or just won't care. If we're working under a basic societal assumption that kids have less than full capacity to accept adult responsibility, then any education on such responsibility needs to be geared towards someone with such reduced capacity. This, in my mind, means avoiding throwing the entire Handbook on Statistics at them, and speak to them in plain language, without any promotion of promiscuity or any doomsday scenarios.
Lest I be taken as nothing but a rabble-rouser, I should point out that I often haven't made up my mind on some issues, and sometimes post with comments espousing certain views that I'm not entirely advocating myself. It's a learning process, and that's what debates such as these are intended to do. I've learned a lot from you, MoM, so thank you for that.
Boomr, I agree with you about speaking to kids in plain language. I also totally agree with you that kids become capable of taking on adult burdens at very different ages.

Still, I don't think it is complicated to explain to kids either the mechanics or the expected pregancy rates or infection rates (over more than one year!) of different strategies.

I am absolutely opposed to dumbing down sex ed, especially when we substitute lala messages for facts.

When I went to school they did teach us the numbers. We had a very low teen pregnancy rate in that school too. They weren't judgemental about it - they just gave us the facts and let us decide what to do.

What's different now is that there are far more STIs in this age group, so the risks are vastly higher to the kids. I don't think that this example is too hard for kids to understand:
"There are 200 girls in this class. Studies have shown that 3% to 15% of women relying upon condoms for birth control will get pregnant each year. So if all of you do that, over the next year we can expect 6 to 30 pregnancies among you, and over the next 4 years we can expect 24 to 120 pregnancies. Here are ways you can cut that number down."

And there is nothing all that complicated about cutting your exposure to diseases. There's nothing wrong with listing the various types of STI's, which are incurable, probably curable, curable, etc. and which are largely preventable through using a condom. Then you can continue to explain how to calculate your exposure risk:
"Every time you sleep with a person your exposure is to all partners of that person for incurable diseases and all partners since the last examination and testing for curable diseases. If the average teen gets tested once a year and has slept with three different people in the last year, and you sleep with three different people next year, the next person you sleep with with is likely to be exposed to infections from the partners of all the people you slept with (3 X 3 = 9) plus your last 3 partners for a total of 12 people. Given that estimates are that 1 in 8 teens gets an STD each year, unless you take measures to limit your exposure you are likely to have an STI and transmit it to your last partner."

Link for the above.
Here are some more statistics:
• Every year 3 million teens--about 1 in 4 sexually experienced teens--acquire an STD.14

• In a single act of unprotected sex with an infected partner, a teenage woman has a 1% risk of acquiring HIV, a 30% risk of getting genital herpes and a 50% chance of contracting gonorrhea.15

• Chlamydia is more common among teens than among older men and women; in some settings, 10-29% of sexually active teenage women and 10% of teenage men tested for STDs have been found to have chlamydia.16

• Teens have higher rates of gonorrhea than do sexually active men and women aged 20-44.17

• In some studies, up to 15% of sexually active teenage women have been found to be infected with the human papillomavirus, many with a strain of the virus linked to cervical cancer.18

• Teenage women have a higher hospitalization rate than older women for acute pelvic inflammatory disease (PID), which is most often caused by untreated gonorrhea or chlamydia. PID can lead to infertility and ectopic pregnancy.19

This is the type of information that teens need for a lifetime, not just next year.

Boomr, the link to the source is above in the comment in which I gave the figures. Click on it. It's not a lie. Really, it isn't. Each individual woman can improve her odds for the outcome cited, and that's what we want to teach in sex ed. They can also greatly lessen their risks for getting STDs and STIs.

HPV isn't totally stopped by condom usage, but it can be greatly lessened. With only 1 and 6 adolescent women using both the condom and another method of birth control, it is easy to see why researchers are anticipating a rise in cervical cancer.

Boomr, this is an excellent resource for teen stats. I'm not making this up.
The best-case estimate for risk of pregnancy per condom use is .02 per event. So if a woman has sex 200 times using a condom consistently and correctly, the minimum expected result is 4 pregnancies. That's four years of once a week. This are the facts that kids aren't being taught. With typical observed usage the rates are much higher.

See Hatcher RA et al. "Contraceptive Technology", 18th rev. ed. New York: Ardent Media, 2004.
MoM: Thanks for the cites. I really am open to changing my views on the subject, and I'm fully willing to recognize when someone else (you) has (have) more education on the subject.

I did want to point out one small thing, though. The link to which you pointed me stated,

"In one year, only two of every 100 couples who use condoms consistently and correctly will experience an unintended pregnancy—two pregnancies arising from an estimated 8,300 acts of sexual intercourse, for a 0.02 percent per-condom pregnancy rate.[3]"

That's 0.02 PERCENT, or 0.0002, not ".02 per event" as you stated. Which means that in your "a woman has sex 200 times using a condom consistently and correctly" scenario, the number of preganancies is actually 0.04, not 4.

I think you and I both agree on the basic things that need to be taught to kids, but we disagree on the way it should be presented. I'm fairly positive that throwing a bunch of numbers and percentages at them will not hit home nearly as well as other methods, and as our discussion has shown, using numbers instead of words leads to misinterpretation and miscalculation.

Again, thanks for continuing this discussion.
Boomr, 2/100 = .02. I'm sorry, I'm too stupid to even understand any numbers any more. My head is pounding.

I wonder if all these studies can be correct. I did trace back a bunch of the HIV studies and their numbers do hang together and seem to match up with observed population studies. I certainly don't have any more education on the subject than you.

What bothers me about the HIV studies and some of the other studies is that according to the efficacy, most gays can't be acting irresponsibly. They've got their infection rate down close to as low as it can go if all these numbers are right.

And that means they aren't lying when they tell the surveyors that they thought they were at low risk. That means that no one's really looking at what those numbers actually mean over the long term for total infection rates.

If I can find some more current figures I will write this up. I think gays are getting undeserved blame.
I hear you about the math hurting my head. I haven't taken a math course since my senior year in high school, and unfortunately was so tired that I had to use a calculator to confirm my 0.0002 number -- something I used to be able to do in my head in a nanosecond. I'm rapidly coming to the conclusion that studying law makes a person stupider in all other areas.

And you're definitely more educated on the subject than I am. Like I said before, sometimes I just post to challenge an idea, even if I don't necessarily believe in the challenge myself.

I think gays are probably getting undeserved blame, too (which may be a function of people blaming the lifestyle and then back-tracking to find something physically wrong with it). In my limited experience, there's far more advertisement about safe sex and education on the topic of disease in the gay community than elsewhere. Every year New Orleans hosts "Southern Decadence," a big festival in the French Quarter for the gay community, and virtually every location is plastered with "Got Latex?" banners and posters advertising risk associated with careless sexual behavior. I would imagine it's probably the same in other locations.
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THIS is how you write with a West Nile Headache? Get better. But it doesn't show in your work. Well done!
I appreciate -really!!- everything you say here, Mama. I just have one word of caution.

When you suggest that the 3% failure rate for condoms is cumulative, you are making a common error. (I have studied and teach psych, and one of the prerequisites is statistics).

The failure risk fir each condom is 3%. given that the "liberated" youth of today know that condoms aren't to be used twice, the rate stays constant. It does not accumulate. It WOULD accumulate if, say, there was a 3% rate with each use of a single condom, and the idiots kept re-using the same condom, or if you had a lot of 100 condoms, and the manufacturer guaranteed that 3 of them would fail. . .and as the libertines plow through their limited supply, then the rate would slowly accumulate (but it would not double with every use).

Sorry. It's a common misconception with stats, and believe me, I wish it weren't true, as we need to discourage their use. But numbers don't lie.

Keep up the good work!!
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