ACF and OPA administer the three main federal abstinence-until-marriage  education programs. Federal and State Efforts to Assess the Scientific Accuracy of Materials Used in Abstinence-until- Marriage Education Programs Have Been Limited

In October 2006 we reported that efforts by HHS and states to assess the  scientific accuracy of materials used in abstinence-until-marriage  education programs had been limited. ACF—whose grants to the State  and Community-Based Programs accounted for the largest portion of  federal spending on abstinence-until-marriage education—did not review  its grantees’ education materials for scientific accuracy and did not require  grantees of either program to review their own materials for scientific  accuracy. ACF Neither Reviewed Nor Required Grantees to Review Program Materials for Scientific Accuracy, Although Some State Grantees Had Conducted Such Reviews

As of October 2006, there had been limited efforts to review the scientific  accuracy of educational materials used in ACF’s State and Community- Based Programs—the two programs that accounted for the largest portion  of federal spending on abstinence-until-marriage education. While not all grantees of the State Program had chosen to review the  scientific accuracy of their educational materials, officials from 5 of the   10 states in our review reported that their states chose to do so. We  recommended that in order to provide such assurance, the Secretary could  consider alternatives such as (1) extending the approach currently used by  OPA to review the scientific accuracy of the factual statements included in  abstinence-until-marriage education to materials used by grantees of  ACF’s Community-Based Program and requiring grantees of ACF’s State  Program to conduct such reviews or (2) requiring grantees of both  programs to sign written assurances in their grant applications that the  materials they propose using are accurate. In addition, this official reported that ACF is  implementing a process to review the accuracy of the proposed curricula  of fiscal year 2007 Community-based grantees. The official also reported that, in the  future, ACF will require states to provide the agency with descriptions of  their strategies for reviewing the accuracy of their abstinence-until- marriage education programs. A Variety of Efforts Were Made to Assess the Effectiveness of Abstinence-until- Marriage Education Programs, but a Number of Factors Limit the Conclusions That Can Be Drawn

HHS, states, and researchers have made a variety of efforts to assess the  effectiveness of abstinence-until-marriage education programs; however, a  number of factors limit the conclusions that can be drawn. ACF and OPA  have required their grantees to report on various outcomes used to  measure the effectiveness of grantees’ abstinence-until-marriage education  programs. To assess the effectiveness of the State and Community-Based  Programs, ACF has analyzed national data on adolescent birth rates and  the proportion of adolescents who report having had sexual intercourse. In addition, the results of  some efforts that meet the criteria of a scientifically valid assessment have  varied. Several Factors Limit the Conclusions That Can Be Drawn about the Effectiveness of Abstinence-until-Marriage Education Programs

Most of the efforts of HHS, states, and other researchers to evaluate the  effectiveness of abstinence-until-marriage education programs included in  our review have not met certain minimum criteria that experts have  concluded are necessary in order for assessments of program  effectiveness to be scientifically valid. Statutory Requirement to Include Information on Condom Effectiveness Would Apply to Certain Abstinence-until- Marriage Education Materials

During the course of our work on abstinence-until-marriage education, we  identified a federal statutory provision—section 317P(c)(2) of the Public  Health Service Act—relevant to the grants provided by HHS’s State  Program, Community-Based Program, and AFL Program. However, we concluded that this requirement would  apply to abstinence-until-marriage education materials prepared by and  used by federal grant recipients, depending upon the substantive content  of those materials. Therefore, we recommended in a letter dated October 18, 2006, that HHS  reexamine its position and adopt measures to ensure that, where  applicable, abstinence education materials comply with this requirement. An ACF official also told us  that future State and Community-Based Program announcements would  include this language.
Why GAO Did This Study

Among the efforts of the Department of Health and Human Services (HHS) to reduce the incidence of sexually transmitted diseases and unintended pregnancies, the agency provides funding to states and organizations that offer abstinence-until-marriage education. GAO was asked to testify on the oversight of federally funded abstinence-until-marriage education programs. This testimony is primarily based on Abstinence Education: Efforts to Assess the Accuracy and Effectiveness of Federally Funded Programs, GAO-07-87 (Oct. 3, 2006). In this testimony, GAO discusses efforts by (1) HHS and states to assess the scientific accuracy of materials used in abstinence-until-marriage education programs and (2) HHS, states, and researchers to assess the effectiveness of abstinence-until-marriage education programs. GAO also discusses a Public Health Service Act requirement regarding medically accurate information about condom effectiveness. GAO focused on the three main federally funded abstinence-until-marriage programs and reviewed documents and interviewed HHS officials in the Administration for Children and Families (ACF) and the Office of Population Affairs (OPA). To update certain information, GAO contacted officials from ACF and OPA.

What GAO Found

Efforts by HHS and states to assess the scientific accuracy of materials used in abstinence-until-marriage education programs have been limited. As of October 2006, HHS's ACF--which awards grants under two programs that account for the largest portion of federal spending on abstinence education--did not review its grantees' education materials for scientific accuracy, nor did it require grantees of either program to do so. Not all states that receive funding from ACF had chosen to review their program materials for scientific accuracy. OPA reviewed the scientific accuracy of grantees' proposed education materials, and any inaccuracies found had to be corrected before those materials could be used. The extent to which federally funded abstinence-until-marriage education materials are inaccurate was not known, but OPA and some states reported finding inaccuracies. GAO recommended that the Secretary of HHS develop procedures to help assure the accuracy of abstinence-until-marriage education materials. An ACF official reported that ACF is currently implementing a process to review the accuracy of Community-based grantees' curricula and has required those grantees to sign assurances that the materials they propose using are accurate. The official also reported that, in the future, state grantees will have to provide ACF with descriptions of their strategies for reviewing the accuracy of their programs. As of August 2006, HHS, states, and researchers had made a variety of efforts to assess the effectiveness of abstinence-until-marriage education programs, but a number of factors limit the conclusions that can be drawn about the programs' effectiveness. ACF and OPA have required their grantees to report on various outcomes used to measure program effectiveness. To assess the effectiveness of its grantees' programs, ACF has analyzed national data on adolescent birth rates and the proportion of adolescents who report having had sexual intercourse. Additionally, 6 of the 10 states in GAO's review worked with third-party evaluators to assess the effectiveness of abstinence-until-marriage programs in their states. However, the conclusions that can be drawn are limited because most of the efforts to evaluate program effectiveness have not met certain minimum criteria that experts have concluded are necessary for such assessments to be scientifically valid. Additionally, the results of some efforts that do meet such criteria have varied. While conducting work for its October 2006 report, GAO identified a legal matter that required the attention of HHS. Section 317P(c)(2) of the Public Health Service Act requires certain educational materials to contain medically accurate information about condom effectiveness. GAO concluded that this requirement would apply to abstinence education materials prepared and used by federal grant recipients, depending on their substantive content, and recommended that HHS adopt measures to ensure that, where applicable, abstinence education materials comply with this requirement. The fiscal year 2007 program announcement for the Community-based Program provides information about the applicability of this requirement, and future State and Community-based Program announcements are to include this information.