sex education and family planning in the united states

7/31/2019 Sex Education and Family Planning in the United States

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Sex Education and Family Planning 1

Sex Education and Family Planning in the United States: Political Hindrance of Public Health

and Economic Goals

Sarah Compton

Applied Anthropology 3210-001

August 22, 2012

Dr. Sheilah Clarke Ekong


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Sex Education and Family Planning in the United States: Political Hindrance of Public Health

and Economic Goals

Currently, in the United States, issues of sex education and family planning are discussed

in the realms of political strategy, emotion and religion-based morality. This is especially

apparent here, in the spring of an election year. Our news is full of political sound-bites like

Republican presidential candidate, Mitt Romney, saying that he would stop all funding of

Planned Parenthood to help balance the federal budget, and House Democratic Leader Nancy

Pelosi announcing that Republicans have declared Waron Women. These catchy headlines

have replaced most, if not all, scientifically, and economically accurate discussions about sex

education and family planning in the United States legislature and media. This practice has led to

the United States having a rate of unintended pregnancies* that is much higher than most of the

countries in the developed world.

An analysis such as this is important because citizens, public health officials, economists,

and politicians, alike, have marked American reproductive practices as problematic. Among the

objectives set forth in Healthy People 2020 are decreases in unintended pregnancies, decreases in

abortion rates, and increases in the use of contraceptives among sexually active individuals

(healthypeople.gov). The United States sees approximately 1.6 million births as a result of

unintended pregnancies annually. Of these, 64% are covered under Medicaid, meaning the

pregnancy and the first year of medical care for the child is publicly funded. This results in over

$11 billion annually. [6] Since low-income women have the highest instances of unintended

pregnancies and are less likely to end an unintended pregnancy with abortion, the figure of $11

billion is a conservative figure. Many women who give birth due to an unintended pregnancy

also qualify for, and receive other types of publicly funded social support like WIC programs,


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food stamps, and welfare. So, the real public cost of unintended births is drastically higher than

$11 billion annually. [5]

It is apparent that matters of sex education and family planning expand broadly to touch

nearly every facet of cultural existence. The application of an anthropological method of analysis

could help to put this issue into a perspective across the board, and provide a structure for

discussion in the legislative realm that allows for meaningful progress towards the goals outlined

in Healthy People 2020.

Situating the Issues in a Historical Context

The Historical Trends and Effects of Sex Education

Sex education in the United States has gone through many changes in the last few

centuries. The methods and content focused upon in each era reflect the concerns of the times.

Sex education changes in regard to social movements, wars, public health issues, and many other

culture-bound stimuli.

In the mid 19th

century, the great concern of sex education was masturbation. Self-

pollution, as Sylvester Graham called it, was considered, even by medical professionals, to be

detrimental to ones health and vitality. Sex education manuals usually consisted of nutrition

information and messages promoting bodily discipline. [42]

Urbanization in the early 20th century and World War I fueled an interest in formal

education aimed at avoiding syphilis and gonorrhea. The Chamberlain-Kahn Act of 1918 was the

first federal legislation pertaining to sex education. This act allotted money to educate soldiers on

venereal diseases.

The American Hygiene Association, founded in 1914 as part of the Progressive-

era social purity movement, helped teach soldiers about sexual hygiene


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throughout the war. Instructors used a machine called the stereomotorgraph to

show soldiers microscopic slides of syphilis and gonorrhea organisms, as well as

symptoms of the diseases on the body of an actual soldier [42].

This military education inspired similar education in schools. The Sun newspaper of New York

reported in 1914 that sex education was, in fact, being taught in schools. Dr. Maurice A.

Bigelow, a professor of biology at Columbia at the time, said, 75 to 90 percent of the instruction

we are advocating is already included in courses in New York schools . . . unobtrusively through

nature study in elementary schools, the biological courses of high schools and colleges and the

general hygiene courses everywhere[39]. He also noted that there were no courses

distinguished as specifically sex oriented because of the negative connotations of the term

sex as a result of the white slavery crimes that were in the news in the 19th and early 20th

centuries.[39] Advocacy continued, however, and 20 to 40 percent of high schools all over the

country by the 1920s. Films, pamphlets, and classic literature were used to teach about virtue,

sexual hygiene, and to discourage masturbation. [42]

Sex education continued to grow in America over the next 3 decades, but met with great

resistance during the sexual revolution of the 1960s and 1970s. Sex educators aimed at providing

value-neutral education on topics such as hygiene, contraceptives, masturbation, teenage

pregnancy, and homosexuality (R. Lovelace, personal communication, April 23, 2012). It was at

that time that sex education was introduced to the political arena. Anti-sex-education propaganda

was introduced during this time with rumors of sex education teachers having sex in classrooms,

encouraging homosexuality, praising promiscuity, and making young people easy recruits for

Marxists. Parents and religious groups began protesting sex-education in public schools. [42]


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The 1980s witnessed the rise of HIV/AIDS. This pandemic created mandates for AIDS

education in every state (although some of this education took place outside of general sex-ed)

by the 1990s. It was during the 1990s that religious conservatives began to push for abstinence-

only education. The Welfare Reform Act of 1996 allotted tens of millions of dollars worth of

provisions for abstinence-only programs. [42]

The Historical Trends and Effects of Contraception

For the purposes of this review, I will begin the history of contraception in the United

States when the subject began to get national attention in the 1910s. It was during this time that

the idea of eugenics was being popularized. Early on, Margaret Sanger, the first real crusader in

the birth control movement, allied herself with the eugenics movement. Sanger had long fought

for, and was even jailed for equal education pertaining to contraception. The New-York Tribune

reported in 1920, The middle and upper classes, says Sanger, have in one way or another

come to measurable sophistication about birth control. That is adequately proved by their small

families. It is the unresourceful poor, on whom large families press most cruelly, who must come

to their knowledge legitimately.and it is for the right to legitimise this knowledge that she

pleads[32]. Sangers allegiance with the eugenics movement, however, bred distrust of birth

control in poor and non-white populations. Headlines such as Woman Favors Race Suicide,

were in newspapers, especially outside of large urban centers, all over the country [37].

Chronicling America, a website sponsored equally by the National Endowment for the

Humanities and The Library of Congress was invaluable source in finding digitized copies of

historic newspapers to see the nations take on the early years of these movements

(http://chroniclingamerica.loc.gov).

Historical Trends and Effects of Induced Abortion
http://chroniclingamerica.loc.gov/http://chroniclingamerica.loc.gov/http://chroniclingamerica.loc.gov/http://chroniclingamerica.loc.gov/


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Abortion methods have been known since ancient times. In the oldest known medical

texts (2737-2696 B.C.), Chinese Emperor Shen Nung provided specific information about

aborting pregnancies [28]. Egyptians, Romans, and, indeed, Hippocrates described several

methods of abortion. The rise of Christianity lessened discussions, but abortions were still

performed, usually by midwives. [28]

In the Western world, the 17th through 19th centuries saw great advances in gynecology,

which included safer methods of abortion. These advances were not only put to use, but were

commonly advertisedby an array of providers as a willingness to help with female problems,

and potions and pills that would bring on the menses[28]. During this time, abortions

performed before quickening were virtually unregulated. It was not until 1850 that a wide-

spread anti-abortion campaign began in the United States, and by the 1880, every state had

legislation banning abortions. [28]

Abortions remained illegal in the United States for nearly a century. Because records

could not be kept, it is not known how many illegal abortions took place during that century,

although, according to one study cited by Rachel Benson Gold of the Guttmacher Institute, in

1967, approximately 829,000 illegal or self-induced abortions occurred in the United States. [24]

Thousands of women died, or were seriously injured as a result of illegal abortions. In

fact, 2,700 death certificates in 1930 listed this as the official cause of death [24]. Antibiotics

brought down the number of deaths drastically. Fewer than 200 abortion-related deaths occurred

in 1965, but because of overall lower maternal mortality rates, these deaths still accounted for

17% of maternity-related deaths [24]. Motivated by sympathetic doctors, the American Medical

Association reversed its former condemnation of abortion, and urged decriminalization in 1970,

and in 1973, essentially as a result of the activism of the medical community and feminist


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groups, the Supreme Court decision,Roe v. Wade, made it illegal for any state to ban abortion

[28].

Methodology

In a conscious effort to avoid discussions based on subjective statements on morality, I

chose to base my analysis on the objectives set forth in Healthy People 2020. Experts from

multiple federal agencies created draft objectives, which were then made available for public

comment and reviewed by the Federal Interagency Workgroup. A specific set of selection

criteria was used to select all the final objectives. Specifics regarding the development and

selection of objectives for Healthy People 2020 are available at HealthyPeople.gov. [2]

The family planning goals of Healthy People 2020 are as follows:

I. Increase the proportion of pregnancies that are intended

II. Reduce the proportion of females experiencing pregnancy despite the use of a reversible

contraception method

III. Increase the proportion of publicly funded family planning clinics that offer the full-rangeof FDA-approved methods of contraception, including emergency contraception, onsite

IV. Increase the proportion of health insurance plans that cover contraceptive supplies and

services

V. Reduce the proportion of pregnancies conceived within 18 months of a previous birth

VI. Increase the proportion of females or their partners at risk of unintended pregnancy who

used contraception at most recent sexual intercourse Increase the proportion of females or

their partners at risk of unintended pregnancy who used contraception at most recent

sexual intercourse

VII. Increase the proportion of sexually active persons who received reproductive health

services

VIII. Reduce pregnancy rates among adolescent females

IX. Increase the proportion of adolescents aged 17 years and under who have never had

sexual intercourse


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X. Increase the proportion of sexually active persons aged 15 to 19 years who use condoms

to both effectively prevent pregnancy and provide barrier protection against disease

XI. Increase the proportion of adolescents who received formal instruction on reproductive

health topics before they were 18 years old

XII. Increase the proportion of adolescents who talked to a parent or guardian about

reproductive health topics before they were 18 years old

XIII. Increase the number of States that set the income eligibility level for Medicaid-covered

family planning services to at least the same level used to determine eligibility for

Medicaid-covered, pregnancy-related care Increase the number of States that set the

income eligibility level for Medicaid-covered family planning services to at least the

same level used to determine eligibility for Medicaid-covered, pregnancy-related care

XIV. Increase the proportion of females in need of publicly supported contraceptive services

and supplies who receive those services and supplies Increase the proportion of females

in need of publicly supported contraceptive services and supplies who receive those

services and supplies

Using Healthy People 2020 as my framework, I collected and reviewed secondary

sources obtained from the library databases of University of MissouriSt. Louis and the

Guttmacher Institute**

, and the CDC. I based my selection of sources on the validity of the

evidence presented. To determine validity, I concentrated on empirical data that had remained

consistent despite different methodologies and/or had been consistently reproduced.

Findings

Sex Education

The Era of Abstinence Only Education in United States Policy. Since 1997, over half

a billion dollars has been spent in federal funding for Abstinence-Only Education (AOE)

programs in the United States. In section 510 of the Social Security Act of 1996, $50 million

annually over 5 years starting in fiscal year 1998 was guaranteed to states that accepted the

grants for abstinence-only programs. States could not provide any information that was

inconsistent with the federal definition of abstinence-only education. See box below. [43]


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Table 1: From "Abstinence Promotion and Teen Family Planning: The Misguided Drive for Equal Funding," by Cynthia

Dailard in The Guttmacher Report on Public Policy, February 2002, Vol. 5, No. 1

THE FEDERAL DEFINITION OF ABSTINENCE-ONLY EDUCATION

According to federal law, an eligible abstinence education program is one that:

A) has as its exclusive purpose, teaching the social, physiological, and health gains to be realized by abstaining from sexual

activity;

B) teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;

C) teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually

transmitted diseases, and other associated health problems;

D) teaches that a mutually faithful monogamous relationship in context of marriage is the expected standard of human

sexual activity;

E) teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;

F) teaches that bearing children out-of-wedlock is likely to have harmful consequences for the child, the child's parents, and

society;

G) teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual

advances; and

H) teaches the importance of attaining self-sufficiency before engaging in sexual activity.

Source:U.S. Social Security Act, Sec. 510(b)(2).

Another $10 million dollars annually was funneled into AOE programs through the

Adolescent Family Life Act of 1981, which congress had updated in 1997 to mandate

compliance with the section 510 programs. Another program of AOE funded through the

maternal and child health block grants Special Projects of Regional and National Significance

(SPRANS) further increased federal spending and by 2005, the annual budget was $105 million.

SPRANS differed in that it bypassed state approval by funding community- and faith-based

programs directly, specifically targeted 12-18 year old adolescents, and insisted that no program

benefiting from SPRANS funding could offer any education that was not consistent with section

510, even if those services were provided with funds outside of the SPRANS grants. [43]


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Sex Education and Family Planning

10

Analysis of AOE. Although relatively few studies of AOE have been performed

scientifically, Mathematica Policy Research (MPR) did two rigorous studies evaluating the

effects of AOE programs. Results of both these studies concluded that the programs had no

effect on adolescent sexual behavior. Adolescents who participated in the programs showed no

difference in age of first sexual intercourse, abstinence in the past 12 months, or

contraceptive/condom use. Another study that focused specifically on the abstinence program

Postponing Sexual Involvement, had the same results of finding normative adolescent sexual

behavior, but also showed statistically significant increases in pregnancies and STDs. [44]

Transitioning to Comprehensive Sex Education (CSE). Shortly after taking office in

2009, President Obama initiated an effort to shift funds from AOE programs to comprehensive,

medically accurate education programs. The Community Based Abstinence Education program

was replaced by a $114 million effort to prevent teen pregnancy through comprehensive

education in the Consolidating Appropriations Act. Through healthcare reform, a five-year

Personal Responsibility Education Program (PREP) was created. It is similar to section 510 in

that a certain curriculum must be followed for guaranteed grants. PREPs stated purpose is to

educate adolescents on both abstinence and contraception and prepare them for adulthood with

the teaching of such subjects as healthy relationships, financial literacy, parent-child

communication and decision-making[41]. This will make another $55 million in state grants

and $10 million in public and private grants available for building comprehensive programs.

Congress did, however, choose to keep section 510 funds available for AOE education at the

state level. [41]


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Analysis of CSE. 32 studies were conducted with experimental design and thorough

statistical analysis. Encouraging results were comparatively astonishing, and held true among a

vast array of settings, communities and cultures in the United States. 47% of [CSE]

programs delayed the initiation of sex and none hastened it, while 29% reduced the frequency

of sex or increased the return to abstinence, and none increased the frequency of sex. 46%

reduced the number of sexual partners[44]

The three most promising of these programs are designed as voluntary courses that take

place on Saturdays, and have been replicated over 100 times (combined) and all programs have

shown positive results. Programs implemented in classrooms, however, have shown less

promise. The author of the study attributed it to censorship within the schools that did not allow

for some of the activities involving condoms, as well as the fact that the courses were not

voluntary. [44]

Effects of Family Planning

The consistent use of contraceptives prevents pregnancy. Two-thirds of U.S. women who

are at risk for an unintended pregnancy consistently use contraceptives. This group of women

contributes less than 5% to the annual unintended pregnancies while women who do not use

contraception are only 16% of the at-risk population, yet they carry more than half of the

unintended pregnancies. Also, states that expanded their contraceptive care programs saw

dramatic changes. For instance, in Arkansas, repeat births dropped by 84% in the women

enrolled in the expansion in only four years. [6]


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Figure 1: From "Wise Investment: Reducing the Steep Costs to Medicaid of Unintended Pregnancy in the United States,"

by Rachel Benson Gold. Copyright Guttmacher Institute 1996-2012

Contraceptive services lower not only the proportion of unintended pregnancy while

raising the proportion of intended pregnancies, they also drastically lower the abortion rate. The

lowest abortion rates in the world are associated with a broad range of easily accessible

contraceptive services, widespread contraceptive use, and legal abortion on expansive grounds.

The Netherlands have widely available free contraceptive services and free, safe, legal abortions,

and they only have an abortion rate of 9 per 1000 women. The United States, on the other hand,

has restrictions on family planning and abortion services and has an abortion rate of

approximately 19 per 1000 women. [6]

Public Funding of Family Planning and Reproductive Healthcare

United States Legislation Pertaining to Public Funding of Family Planning. In 1970,

Title X of the Public Health Service Act was enacted. It is the only federal grant program

dedicated solely to family planning and preventative reproductive healthcare services. Title X


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provides funding to over 4,500 community-based clinics. Services of these clinics include

education, counseling, breast and pelvic examinations, breast and cervical cancer screenings,

STD education, counseling, testing and referral, and pregnancy diagnosis and referral. Title X

grants cannot, however, be issued to any clinic that offers abortion as a method of family

planning. The history and scope of Title X is available at HHS.gov from the Office of Population

Affairs of the Department of Health and Human Services.

In fiscal year 2010, Title X accounted for 10% of public expenditures for family

planning. It has been estimated that the services provided at Title X-funded centers saved the

United States $3.4 billion dollars that would have otherwise been shouldered by Medicaid for

unintended births. That is $3.74 saved for every Title X dollar spent on clinic services. [3]

Medicaid, a federal-state insurance program reimburses providers for family planning

care for enrolled individuals. 90% of these costs are absorbed by the federal government, while

the state is responsible for 10%. [10] The Hyde Amendment of 1977 disallows federal funding to

be used for abortions except in cases of rape, incest, or life endangerment. All states Medicaid

programs are required to provide for abortions that at least meet the federal standards.

Mississippi is in violation of the federal law, as it only allows state funding in the case of life

endangerment. Some states will also use Medicaid funding to cover all or most medically

necessary abortions either through court order or voluntarily. [27] Many states have also

expanded Medicaid coverage specifically for family planning services. 24 states now allow

women at or around 200% the federal poverty level (the same for Medicaid eligibility during

pregnancy) to use Medicaid funds for reproductive and preventative care. Medicaid spent

approximately $1.8 billion in family planning services in 2010 (75% of total expenditure). [10]


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States-only sources contribute to 12-13% of total family planning expenditures annually

(about $294 million in 2010), as well as smaller contributions from other federal sources (such as

CDC programs and block-grants) that make up 3%. The total expenditure for family planning

programs in 2010 was $2.37 billion. [10]

Figure 2: From "Facts on Publicly Funded Contraceptive Services in the United States," by The Guttmacher Institute,

March 2012. Copyright 1996-2012 Guttmacher Institute

Impact of Publicly Funded Family Planning. Publicly funded family planning services

helped avoid 1.94 million unintended pregnancies in 2006. These would have likely ended in

860,000 unintended births and 810,000 abortions (the remaining would have likely ended in

miscarriage). [10] In Frost, Finer, and Tapaless article in theJournal of Healthcare for the Poor

and Underserved, they compared the costs of family planning programs to the Medicaid costs

averted and found that for every $1 spent on these programs yields $4.02 in savings. [11] If this

rule is applied to the amount that was spent on family planning in 2010, it amounts to a savings

of $9.53 billion.

Family Planning Restriction Legislation in the United States.

Financial Restrictions. At the state level, there are many restrictions on family planning

services in many states. Some states have either failed to require insurance companies to cover


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all FDA approved methods of contraception, or allowed restrictions based on employers values

or religious beliefs or affiliation. 2 states that mandate contraceptive coverage from insurance

companies exclude emergency contraception from that mandate. [13]

Many states have placed restrictions on funding availability for abortion providers or

their affiliates. This is done in a variety of ways. Some states have restricted insurance coverage.

In some states it is prohibited entirely, others prohibit insurance plans that will be part of the

exchanges in 2014 to cover abortion services. While others prohibit insurance coverage except in

cases of life endangerment, fetal impairment, and/or rape or incest. Most states also have

restrictions for the public funding of abortions, centers that perform abortions, and even affiliates

that provide abortion counseling services and referrals. [25][26][27]

Restrictions like these place obstacles in the way of low-income women that want and

need family planning services. This results in more unintended pregnancies and births in low-

income women than in any other income-based category. [18]

MoralRestrictions. Many states have enacted laws to block or make access to

contraceptive services and abortions more difficult. Here are some of the most common: Some

states require parental consent for minors to obtain contraceptive services, abortion counseling

and referral, and abortions. 46 states allow some healthcare providers to refuse to provide

abortions, 18 states allow some healthcare providers to refuse to provide sterilization services,

and 13 states allow some healthcare providers to refuse to provide contraceptive services [7].

Others require waiting periods and counseling services to obtain an abortion. Informed consent

laws require doctors to provide the patient with information that is often authored by the state,

and that includes medically inaccurate information (eg. abortions are linked to breast cancer and


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are psychologically harmful, or that a fetus of 20 weeks gestation has the ability to perceive

pain). Some states have gestational restrictions on abortion (i.e. an abortion cannot be performed

after x amount of weeks).

Conclusion

While the United States has worthy goals when it comes to family planning, many laws

are passed that bring us further away from those goals. Scientifically and statistically accurate

data needs to be considered when discussing public policy pertaining to sex education and family

planning services. This is not to say that conscience does not have a place. Conscience has its

place as long as it is the conscience of the masses, and it does not exist completely outside of

reality.

Comprehensive sex education has been shown time and again to positively affect

adolescent sexual behaviors. It, however, has not been as effective when it is involuntary and

during school hours. This finding alone allows for a platform on which to begin building a

compromise. It seems that a federal-state funded voluntary program that took place on Saturdays

at public schools and community centers would solve the problem of offending proponents of

abstinence-only education. They could simply not send their children, and discourage their older

adolescents from attending. Granted, a small percentage of the funding would come from AOE

supporters (remember, 87% of parents want CSE), but all can never be satisfied when it comes to

funding. If federal and state funding were never used because a small percentage of a population

didnt agree with the program, we wouldnt have public schools, interstates, WIC, or anything

else that is publicly funded.


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Increasing the knowledge of young people is the first step in achieving the goals set forth

by Healthy People 2020. Through medically accurate knowledge, young people can find out the

value of protecting themselves, how to protect themselves, and how to identify and get the

services they require. Real psychological lessons can help to teach adolescents what relationships

are, and help them to objectively gauge their own maturity and readiness for sexual activity.

Moral lessons can be taught at home, through religious services, or private community centers.

Moral ideals, especially those pertaining to sex, differ drastically between generations,

neighborhoods, faiths, and other cultural identifiers. Adolescents will likely benefit from those

lessons even more if they know that they have all the information available to them, and they are

confident they have made an informed choice to behave within their own cultural standards.

Family planning services must also be considered within the realm of medical accuracy

and examples of systems that have lead other countries to the places we want to be in 8 years

should be considered. The Health Care Reform Act of 2010 is a step in the right direction. The

federal government has seen that accessible preventative care is the common thread that

countries achieving the goals of the United States share. The Health Care Reform Act will make

more methods of contraception available to more people. Hopefully, states will continue to

expand their family planning programs to encourage this. President Obama has also made a

concession for religious employers that allow them to refuse to pay for contraceptives for their

employees. These employees will have their contraceptive services subsidized by the state.

Although this certainly creates an obstacle for many people seeking these services, it shows

willingness for compromise.


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Willingness to compromise with the same goal in mind is a promising starting point. This

holds true, I think, even with abortion; the one issue that the two sides can seemingly never meet

on. The tug-of-war politics has made little or no change in the United States rate of abortion, or

since 1973, its legal status. I think that nearly everyone from both sides of the discussion can

agree that lessening the need for abortions is a worthy cause. When we look at the evidence,

prevention is what lessens that need, not criminalizing. Criminalizing abortion only puts women

at risk. It is apparent throughout the ages and all over the globe, individuals will do whatever it

takes to end an unwanted pregnancy. Laws protecting the provision of safe abortions ensures that

women will not end up losing their lives or suffering from lasting complications that further

drain health care funds.

Since there are examples all over Western Europe of systems that accomplish our

collective goals, they should be used as models or at least foundations that we can then begin to

recreate and build from. Working accessibility and science into our health care and education

standards will very likely result in the same outcomes it has in the countries of Western Europe

which will get us to (or at least much nearer to) accomplishing the goals of Healthy People 2020.

Adding restrictions and obstacles will likely do the opposite. If we emulate the restrictive laws of

the countries we attempt to aid in the developing world, we will likely find ourselves farther

from our goals and experiencing a profound economic crisis.


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References

ABOUT SOURCES:

[1] About the Guttmacher Institute. Retrieved May 3, 2012, from:http://www.guttmacher.org/about/index.html

[2] Healthy People 2020: Objective Development and Selection Process. Retrieved May 3, 2012, from:

http://healthypeople.gov/2020/about/objectiveDevelopment.aspx

FAMILY PLANNING :

[3] Boonstra, H.D. (2008). The impact of government programs on reproductive health disparities: Three case studies. Guttmacher

Policy Review. 11(3). Retrieved April 22, 2012, from Guttmacher Institute database:

http://www.guttmacher.org/pubs/gpr/11/3/gpr110306.pdf

[4] Cohen, S.A. (2011). The numbers tell the story: The reach and impact of Title X. Guttmacher Policy Review. 14(2). Retrieved April 22,

2012, from Guttmacher Institute database:http://www.guttmacher.org/pubs/gpr/14/2/gpr140220.html

[5] Facts on unintended pregnancy in the United States. (2012). In Brief: Fact Sheet. Retrieved April 22, 2012, from Guttmacher Institute

database:http://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html#6

[6] Gold, R.B. (2011). Wise investment: Reducing the steep cost to Medicaid of unintended pregnancy in the United States. Guttmacher

Policy Review. 14(3). Retrieved April 22, 2012, from Guttmacher Institute database:

http://www.guttmacher.org/pubs/gpr/14/3/gpr140306.html

[7] Guttmacher Institute. (2012). Refusing to provide health services. State policies in brief as of April 1, 2012: New York: Guttmacher

Institute. Retrieved April 22, 2012, from the Guttmacher Institute database: http://www.guttmacher.org/statecenter/spibs/spib_RPHS.pdf

[8] Sonfield A., Alrich C., & Gold R.B., (2008). Public funding for family planning, sterilization and abortion services, FY 19802006,

Occasional Report No. 38. Retrieved April 22, 2012, from Guttmacher Institute database:

http://www.guttmacher.org/pubs/2008/01/28/or38.pdf

Contraception:

[9] CDC. Health Promotions Statistics Branch, Office of Analysis and Epidemiology, National Center for Health Statistics. (2011). Final

review: Healthy people 2010: Family planning 9. Retrieved from:

http://www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review_focus_area_09.pdf

[10] Facts on publicly funded contraceptive services in the United States. (2012). In Brief: Fact Sheet. Retrieved April 22, 2012 from

Guttmacher Institute database:http://www.guttmacher.org/pubs/fb_contraceptive_serv.html

[11] Frost, J.J., Finer, L.B., Tapales, A. (2008). The impact of publicly funded family planning clinic services on unintended pregnancies and

government cost savings.Journal of Healthcare for the Poor and Underserved. 19(3) 778-796. Retrieved April 22, 2012, from

Guttmacher Institute database:http://www.guttmacher.org/pubs/09_HPU19.3Frost.pdf

[12] Guttmacher Institute. (2012). Emergency contraception. State policies in brief as of April 1, 2012: New York: Guttmacher Institute.

Retrieved April 22, 2012, from the Guttmacher Institute database:http://www.guttmacher.org/statecenter/spibs/spib_EC.pdf

[13] Guttmacher Institute. (2012). Insurance coverage of contraceptives. State policies in brief as of April 1, 2012: New York: Guttmacher

Institute. Retrieved April 22, 2012, from the Guttmacher Institute database:

http://www.guttmacher.org/statecenter/spibs/spib_ICC.pdf

[14] Guttmacher Institute. (2012). Minors access to contraceptive services. State policies in brief as of April 1, 2012: New York:Guttmacher Institute. Retrieved April 22, 2012, from the Guttmacher Institute database:

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[15] Jones, R.K. & Dreweke, J. (2011). Countering conventional wisdom: New evidence on religion and contraceptive use. New York:

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[16] Klein, R.J. (2008) Healthy people 2010: Progress review focus area 9 Family planning presentation. CDC. National Center for Health

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[17] Mosher WD, Jones J. (2010). Use of contraception in the United States: 19822008. CDC. National Center for Health Statistics. Vital

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Induced Abortion:

[18] Boonstra, H. & Sonfield, A. (2000) Rights without access: Revisiting public funding of abortion for poor women. The Guttmacher

Report on Public Policy. Retrieved April 22, 2012, from Guttmacher Institute database:http://www.guttmacher.org/pubs/tgr/03/2/gr030208.pdf

[19] Cohen, S.A., (2010). Insurance coverage of abortion: The battle to date and the battle to come. Guttmacher Policy Review. 13(4).

Retrieved April 22, 2012, from Guttmacher Institute database:http://www.guttmacher.org/pubs/gpr/13/4/gpr130402.html

[20] Cohen, S.A. (2006). Toward making abortion rare: The shifting battle ground over the means to an end. Guttmacher Policy Review.

9(1). Retrieved April 22, 2012, from Guttmacher Institute database:http://www.guttmacher.org/pubs/gpr/09/1/gpr090102.html

[21] Facts on induced abortion in the United States. (2011). Guttmacher In Brief: Fact Sheet. Retrieved April 22, 2012, from Guttmacher

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[22] Finer, L.B., Frohwirth, L.F., Dauphinee, L.A., Singh, S. & Moore, A.M. (2005). Perspectives on Sexual and Reproductive Health.37(3).

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[23] Finer, L.B., Frohwirth, L.F., Dauphinee, L.A., Singh, S. & Moore, A.M. (2006). Timing of steps and reasons for delays in obtaining

abortions in the United States. Contraception. 74(4) 334-344. Retrieved April 22, 2012, from Guttmacher Institute database:

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[24] Gold, R.B. (2003). Lessons from before Roe: Will the past be prologue? The Guttmacher report on public policy 6(1). Retrieved May 2,

2012, from Guttmacher Institute database:http://www.guttmacher.org/pubs/tgr/06/1/gr060108.html

[25] Guttmacher Institute. (2012). Restricting insurance coverage of abortion. State policies in brief as of April 1, 2012: New York:

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[26] Guttmacher Institute. (2012). State family planning funding restrictions. State policies in brief as of April 1, 2012: New York:


http://www.guttmacher.org/statecenter/spibs/spib_SFPFR.pdf

[27] Guttmacher Institute. (2012). State funding of abortion under Medicaid. State policies in brief as of April 1, 2012: New York:


http://www.guttmacher.org/statecenter/spibs/spib_SFAM.pdf

[28] Joffe, C.(2009) Chapter 1: Abortion and medicine: A sociopolitical history. In Paul, M., Litchtenberg. E.S., Borgatta, L., Grimes, D.A.,

Stubblefield, P.G., & Creinin, M.D. (2009) Management of Unintended and Abnormal Pregnancy(1st

ed.). Blackwell Publishing.

Retrieved from http://media.wiley.com/product_data/excerpt/62/14051769/1405176962.pdf

[29] Kacanek, D., Dennis, A., Miller, K., & Blanchard, K. (2010). Perspectives on Sexual and Reproductive Health, 42(2) 79-86.[30] Pazol, K., Zane, S.B., Parker, W.Y., Berg, C., & Cook, D.A. (2011). Abortion surveillance --- United States, 2008. CDC. MMWR

Surveillance Summaries, 60 (SS15) 1-41. Retrieved April 22, 2012, from:

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[31] Richardson, C.T., & Nash, E. (2006). Misinformed consent: The medical accuracy of state-developed abortion counseling materials.

Guttmacher Policy Review. 9(4). Retrieved April 22, 2012 from Guttmacher Institute database:

http://www.guttmacher.org/pubs/gpr/09/4/gpr090406.html

HISTORICAL MEDIA:

[32] Birth control brief. (1920, October 3). New-York Tribune. pp. 9. Retrieved April 22, 2012, from Library of Congress, Chronicling

America database:http://chroniclingamerica.loc.gov/lccn/sn83030214/1920-10-03/ed-1/seq-93/

[33] Eugenics and birth control. (1917, August 17). New-York Tribune. pp.5. Retrieved April 22, 2012, from Library of Congress,

Chronicling America database:http://chroniclingamerica.loc.gov/lccn/sn83030214/1917-08-19/ed-1/seq-39/

[34] [New York*] doctors against legalizing birth control. (1916, December 27). The Day Book. Retrieved April 22, 2012, from Library ofCongress, Chronicling America database: http://chroniclingamerica.loc.gov/lccn/sn83045487/1916-12-27/ed-1/seq-5/

[35] Fielding, W. J. (1922, August 20). Margaret Sanger: Humanist. New-York Tribune. pp. 5. Retrieved on April 22, 2012, from Library of

Congress, Chronicling America database: http://chroniclingamerica.loc.gov/lccn/sn83030214/1922-08-20/ed-1/seq-47/

[36] Mrs. Sanger free; Resisted keepers. (1917, March 7). The Sun. pp.6. Retrieved April 22, 2012, from Library of Congress, Chronicling

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[37] Woman favors race suicide. (1917, February 1). Hopkinsville Kentuckian. Retrieved April 22, 2012, from Library of Congress,

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[38] Aims to prevent birth of children likely to be weak. (1912, September 20). The Washington Times. Retrieved April 29, 2012, from

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[39] Sex hygiene taught here. (1914, February 20). The Sun. pp. 5. Retrieved April 29, 2012, from Library of Congress, Chronicling America

database:http://chroniclingamerica.loc.gov/lccn/sn83030272/1914-02-20/ed-1/seq-5/

SEX ED

[40] Boonstra, H.D. (2009). Advocates call for a new approach after the era of abstinence-only sex education. Guttmacher Policy Review.

12(1). Retrieved April 22, 2012, from Guttmacher Institute database:http://www.guttmacher.org/pubs/gpr/12/1/gpr120106.html

[41] Boonstra, H.D. (2010). Sex education: Another big step forward and a big step back. Guttmacher Policy Review 13(2). Retrieved from

Guttmacher Institute database:http://www.guttmacher.org/pubs/gpr/13/2/gpr130227.html

[42] Cornblatt, J. (2009, October 27). The sin of yielding to impure desire: A brief history of sex ed in America. Newsweek.Retrieved April

30, 2012 from:http://www.thedailybeast.com/newsweek/2009/10/27/the-sin-of-yielding-to-impure-desire.html

[43] Dailard, C. (2002, February). Abstinence promotion and teen family planning: The misguided drive for equal funding. Guttmacher

Report on Public Policy 5(1). Retrieved from Guttmacher Institute database:

http://www.guttmacher.org/pubs/tgr/05/1/gr050101.html

[44] Kirby, D. & The National Campaign to Prevent Teen and Unplanned Pregnancy. (2007) Emerging Answers 2007: Research Findings on

Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Full Report. Retrieved from:

http://www.thenationalcampaign.org/EA2007/EA2007_full.pdf

[45] McCarthy, B. & Grodsky, E. (2011). Sex and school: Adolescent sexual intercourse and education. Social Problems, 58 (2), 213-234.

Retrieved April 28, 2012, from JSTOR database: http://www.jstor.org/stable/10.1525/sp.2011.58.2.213

[46] Yanda, K. (2000). Forum: Teenagers educating teenagers about reproductive health and their rights to confidential care. Family

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Endnotes

*An unintended pregnancy refers to a pregnancy that was either unwanted (did not want to become pregnant then

or any time in the future) or mistimed (did not want to become pregnant at that time, but did want to become

pregnant at some point in the future).

White Slavery refers to sex trafficking in Europe and the United States, in which young girls (usually 13 to 17

years old) were lured with love at first sight, and promises of wealth and marriage, only to be raped, and sold into

prostitution rings.

Eugenics: a science that deals with the improvement (as by control of human mating) of hereditary qualities of a

race or breed.

Quickening: When the movement of a fetus is perceived by the mother.

** The Guttmacher Institute produces resources pertaining to sexual and reproductive health. In 2009, they were

designated an Official Collaborating Center by the World Health Organization and its regional office, the Pan

American Health Organization. [1]

Sex education in the United States is considered either Abstinence-Only, or comprehensive (sometimes referredto as Abstinence-Plus). Abstinence-Only education presents abstinence until marriage as the only option forstudents. Comprehensive sex education presents abstinence as the preferred choice, but also provides information ona variety of other subjects, like contraception and disease prevention.

sex education and family planning in the united states

Documents