Broken Promises: Abstinence Pledging and Sexual and Reproductive Health

• Author: Kenneth J. Sanchagrin,Anthony Paik,Karen Heimer
• DOI: http://doi.org/10.1111/jomf.12279
• Published date: 01 April 2016
• Date: 01 April 2016

A P University of Massachusetts–Amherst

K J. S Appalachian State University∗

K H University of Iowa∗∗

Broken Promises: Abstinence Pledging and Sexual

and Reproductive Health

Approximately 12% of girls and young women

in the United States pledge abstinence. Yet most

break their pledges, engaging in rst inter-

course before marriage. The extant literature

reports few differences between pledge break-

ers and nonpledgers in sexually transmitted

infections and nonmarital pregnancies. The

present researchmaintains that previous studies

may have obscured important differences in

exposure risk and hypothesizes that female

pledge breakers who have higher exposure risk

are more likely to experience human papillo-

mavirus (HPV) and nonmarital pregnancies.

To test this hypothesis, this study uses the

National Longitudinal Study of Adolescent to

Adult Health, logistic regression, and event

history modeling. The results show that, after

accounting for differences in exposure risk,

pledge breakers have higher risk of HPV and

nonmarital pregnancy. As a set, the results are

consistent with the argument that pledgers use

condoms and contraceptives less consistently

Department of Sociology, Universityof

Massachusetts-Amherst, W33B/D Machmer Hall, Amherst,

MA 01003 (apaik@soc.umass.edu).

∗229B Chapell Wilson Hall, ASU Box 32115, Appalachian

State University,Boone, NC 28608-2115.

∗∗140 Seashore Hall West, Department of Sociology,

University of Iowa, IowaCity, IA 52242-1401.

This article was edited by Jennifer Glass.

Key Words: adolescent sexuality, emerging adulthood, mar-

riage, pregnancy, sex education, sexual health.

and highlight unintended consequences of

abstinence promotion.

Nonmarital pregnancies and sexually transmit-

ted infections (STIs) are signicant threats to the

sexual and reproductive health of adolescents

and young adults. In the United States, approxi-

mately 75% of pregnancies among women aged

15–24 are nonmarital; of those, three quarters are

unintended (Zolna & Lindberg, 2012). Fifteen-

to 24-year-olds also represent half of new

sexually transmitted infections, with human

papillomavirus (HPV) accounting for more than

70% of new cases (Satterwhite et al., 2013).

Given these statistics, identifying individual and

institutional factors promoting nonmarital preg-

nancies and STIs, such as HPV, is an important

concern.

A key institutional practice in the 1990s

and 2000s purportedly addressing nonmari-

tal pregnancies and STIs was the promotion

of abstinence from sexual intercourse until

marriage. Abstinence-only programming was

delivered in primarily two forms. First, the

delivery of abstinence-only sex education

(AOSE) was vastly expanded through $1.5

billion in federal funds during the George

W. Bush administration (SIECUS). A sec-

ond intervention, promoted by religious and

nonprot groups and AOSE programs, was

the use of “virginity pledges” (Bearman &

Brückner, 2001). Pledging typically involves

public declarations by adolescents to remain

abstinent until marriage (Bearman & Brückner

2001; Williams, 2011). Under the Obama

546 Journal of Marriage and Family 78 (April 2016): 546–561

DOI:10.1111/jomf.12279

Abstinence Pledging 547

administration, abstinence-only programming

has been largely displaced in national policy

making designed to reduce nonmarital preg-

nancies and STIs among U.S. teens and young

adults (Joseph, 2012), but its use remains

widespread at the state and local levels. Cur-

rently, 25 states still require that abstinence be

stressed in sex education, and 19 states mandate

content promoting sexual behavior only within

marriages (Boonstra, 2014). On the basis of the

2006–2010 National Survey of Family Growth

(NSFG), 12% and 7% of female and male

respondents under age 25, respectively, reported

pledging to remain a virgin until marriage

(Brewster, Valle, & Harker Tillman, 2013).

A key question centers on the possibility

that abstinence-promotion efforts have per-

verse unintended consequences on the sexual

and reproductive health of teenagers and young

adults. Might they actually increase risks of non-

marital pregnancies and STIs? In this research,

we examine whether virginity pledging is

associated with increased risks of nonmarital

pregnancies and HPV among sexually active

girls and young women. Although the extant

literature has found little evidence of worse

sexual and reproductive health outcomes for

pledge breakers than for sexually active non-

pledgers (e.g., Adamczyk & Felson, 2008;

Brückner & Bearman, 2005; Ford et al., 2005),

none of this research has accounted for the fact

that the two groups may have different levels

of exposure risk for pregnancy and HPV. This

research addresses this critical gap by compar-

ing pledgers and nonpledgers who have similar

exposure risks. Our results on pledge breaking

not only shed light on the health outcomes of

millions of pledge breakers but also highlight,

more generally, the potential consequences of

abstinence beliefs and abstinence-only promo-

tion efforts, which are common at the state and

local policy-making levels and may return as

federal policy in the near future.

This article is organized as follows: We rst

review the literature on pledging and health out-

comes. To develop our theoretical expectations,

we then draw on Swidler’s (1986) notion of

cultural lag, or the idea that individuals nd it

difcult to abandon familiar strategies of action,

scripts, or repertoires even when the associated

underlying cultural beliefs are no longer rele-

vant for the individual. While not completely

protective, condoms are an important means by

which youth can reduce their risks of pregnancy

and STIs, including HPV (Centers for Disease

Control, CDC, 2014a, 2014b). Because of

cultural-lag effects, we argue that pledge break-

ers are less likely to practice safe sex, thereby

increasing their risks of getting pregnant and

contracting HPV over nonpledgers with similar

exposure risk. Because data on condom-use

consistency tend to be relationship specic or

limited to one-year periods and may contain sub-

stantial measurement error, we examine health

outcomes directly linked to inconsistent con-

dom use: nonmarital pregnancy and STIs. HPV

is the most prevalent STI and is untreatable,

which allows for assessment of its relationships

with sexual activity. We use HPV test results

from a representative sample of sexually active

young women. We test our expectations empir-

ically, using the National Longitudinal Study of

Adolescent to Adult Health (Add Health), by

examining whether pledge status among sexu-

ally active female respondents is associated with

HPV acquisition and nonmarital pregnancy.

B

Research on the health implications of pledging

has focused on both sexual behavior and health

outcomes, such as nonmarital pregnancy and

STIs. Pledgers, on average, are more likely to

delay sexual involvement, have fewer sex part-

ners, and marry earlier (Bearman & Brückner,

2001; Brückner & Bearman, 2005; Meier, 2007;

Uecker, 2008). Observed associations between

pledging and more limited sexual behavior,

however, may reect selection effects—that is,

the tendency for individuals prone to eschew-

ing nonmarital sexual behavior to select into

pledging—as opposed to indicating any causal

effect (Rosenbaum, 2009; but see Martino,

Elliott, Collins, Kanouse, & Berry, 2008).

Bearman and Brückner (2001) and Rosenbaum

(2009) also found that pledge breakers tend to

use condoms less consistently than nonpledgers,

whereas Martino et al. (2008) observed no

difference. It is worth noting that the previously

mentioned discrepancies between Rosenbaum

(2009) and Martino et al. (2008), both of which

employed propensity-scoring techniques, may

reect the fact that the latter used substantially

fewer variables to match pledgers and non-

pledgers. Nevertheless, the majority of pledge

takers eventually break their pledges, having

sexual intercourse while unmarried (Brückner &

Bearman, 2005), which highlights the need for

more research on subsequent health outcomes.