The issue of adolescent sexual behavior is one that elicits emotion and passion from all corners of the debate. Unfortunately, solutions to this issue and other public health problems are often governed more by ideology than by an objective and reasoned understanding of medical and behavioral research.

The report entitled "The Declines in Adolescent Pregnancy, Birth and Abortion Rates in the 1990s: What Factors are Responsible," is likely to become a lightning rod in the public debate over teen sexual behavior.

This research report, commissioned by 13 state Physician Resource Councils (PRCs) representing thousands of practicing physicians, supports conclusions that are in direct contradiction to the prevailing notions of government funded health agencies. The key findings of the report, based on the latest government data, are that:

• Total contraceptive use by adolescent females has actually decreased during the 1990s.
• The out-of-wedlock birthrate among sexually experienced and sexually active female teens has increased dramatically since 1988, despite a significant increase in condom use by this cohort.
• Condom use is not positively correlated with a reduction in out-of-wedlock teen births.
• The decline in overall teen birthrates is primarily attributable to abstinent adolescents.
• An unambiguous abstinence message is more consistent than the safer-sex message with the dynamics responsible for the decline in the overall birthrate among teens.
• There is strong evidence that the abstinence message is effective and that abstinence education programs will play an important role in the future of healthy teens.

In contrast, the accepted ideology within the public health community holds that:

• Instruction about safer-sex practices must be combined with the abstinence message—abstinence education alone is not effective.
• The decline in birthrates to teens during the 1990s is due, in large part, to increased contraceptive use.
• Teaching about safer-sex and making condoms available reduces unintended pregnancies among teens.

Precisely because it refutes the current accepted ideology, this research paper may be attacked by some in the public health community whose philosophy, funding, employment and reputation are tied to the safer-sex message. The challenges will be made on technical grounds because the critics of this paper will be unable to refute the basic data and findings, particularly those on the increased out-of-wedlock birthrates among sexually experienced and sexually active teens.

The critics of this paper will have one singular purpose: to direct attention toward peripheral issues and away from the basic conclusions. Why? Because the findings of this paper call into serious question the effectiveness of the current public health policy in this country. Increased condom use and birthrates are occurring within the exact same group of teens. This is data the public health community may not want to eagerly acknowledge.

Challenges to this paper are expected in relation to format, the academic credentials of authors, source material, supposed "hidden agendas," terminology and the like. The research finding that the out-of-wedlock birthrate to sexually experienced and sexually active female teens rose substantially from 1988 to 1995, despite a 33 percent increase in the use of condoms, will either be attacked on the basis of arcane and complex nuances of data analysis or it will be ignored.

The most serious charge against this research paper may be that it did not appear in a peer-reviewed journal. We want to address this charge in advance. Earnest consideration was given to submitting the paper to medical journals. The decision not to submit was made for two reasons. First, we believe that this data is vitally important and needs to be disseminated as expediently as possible. Second, we question whether most peer-reviewed journals would truly consider a research project whose findings bolster an argument for abstinence-only education.

Although not peer-review published, this paper has been subjected to a rigorous peer-review process. Numerous M.D.s and Ph.D.s have critically reviewed this paper. Substantial revisions have been made in the process.

The physicians of the Consortium of State PRCs are eminently qualified to understand both the academic and human aspects of teen sexual behavior. As practicing physicians, the members of PRCs treat the everyday personal and medical conditions of real patients; facing the human tragedy of unintended pregnancy and STDs. These physicians are seeing that abstinence, not safer sex, offers the promise of a fulfilled and healthy life for young people. What the PRCs professionally see, this report now confirms.

We challenge other researchers to expend further on the analysis contained in our study. In particular, the concept of calculating and tracking out-of-wedlock pregnancy and birth rates among various cohort groups could yield valuable information. We believe that our research represents only a starting point in an attempt to statistically apply behavioral outcomes to only those adolescent population subgroups most appropriate and applicable, rather than to the entire teenage cohort.

We also appeal to all those involved in the public debate over teen sexual behavior to deal in a forthright manner with research data. It is with all too much frequency that data is manipulated or selectively chosen for the goal of furthering a philosophical viewpoint. For the sake of the health of young people, this practice must cease.

It is the desire of the PRCs that this research report opens an honest and serious dialog on the solutions to out-of-wedlock pregnancies and STDs; one that is not limited to predetermined politically correct conclusions. Sound public policy should embrace and promote that which is working while at the same time discard that which is not working. Clearly, the decline in births among all adolescents is primarily attributable to the abstinence factor. Equally clear is that increased condom use has not reduced the unintended out-of-wedlock birthrates among sexually experienced and sexually active teens. Future public health policy must understand and address these realities in order to be effective.

For the Consortium of State Physicians Resource Councils,

William Toffler, M.D., Oregon
G. Steven Suits, M.D., South Carolina
Hal Wallis, M.D., Texas