Joe S. McIlhaney is a board-certified OB/GYN and a member of the Presidential Advisory Council on HIV/AIDS. In 1995, he left his private practice to work with the Medical Institute for Sexual Health, a pro-abstinence medical research organization he established in 1992.

Excerpted from a longer interview by P.O.V. in conjunction with their documentary The Education of Shelby Knox. The film chronicles the debate in a conservative Christian town over sex education in its public schools.

What is your position on abstinence-only, abstinence-plus, and comprehensive sex education in America's high schools? What type of sexuality education would you recommend?

Our thought is that what we should have programs that work. I won't just say any program that works, because that program has to be evaluated in different ways. But the first and the fundamental issue is, does a program work? For example, if I was talking to Shelby, I'd say, "Okay Shelby, now I know that you mean well" - and I believe she does, from what you've described and from what I've read about the movie - "Now I want you send me a program, a model of a program or a curriculum, that has shown an appreciable decline in STD rates and non-marital pregnancy rates, since that's what you want."

That being said, what she'll find is that comprehensive sex-ed programs are not among the [programs] that have ever lowered HIV rates, STD rates or non-marital pregnancy rates--except for one program in New York (Children's Aid Society-Carrera), which did it by becoming basically mothers to the girls in the program there. This program was able to get the girls in to get their Depro-Provera shots every three months. That's the only program that's lowered pregnancy rates in the country that's based on a comprehensive approach, the kind of thing that [Shelby's] advocating.

So what we say and what I believe is that if that's so and those are the programs that have had the majority of the money, the best teachers, the best curriculum writers, the best researchers for years, is that they basically have all failed. In fact, most of them haven't even measured the pregnancy rates and STD rates. And if that's so then it's only good wisdom to try something different. And the obvious other direction to go is in the direction of abstinence education.

We don't like the term abstinence-only because we believe it's a pejorative term. It's sort of saying, "Well, these are just stupid programs that are denying kids information." Well, that's just flat out not true. If you look at most of the new abstinence education programs, they're actually more comprehensive than most of the comprehensive programs are as far as the information they provide.

We interviewed Dr. Douglas Kirby and he said that he feels that there haven't been enough studies of abstinence-only, or abstinence, programs to know whether they work. Would you agree with him?

There are two [studies] that have been published in peer-reviewed literature and there's another one coming out about the Best Friends program--it's been accepted by a peer-reviewed journal and it will be coming out pretty soon. There's a program in a county in Georgia that has had a 47% decrease incidence of sexual intercourse among the kids and a program in Amarillo, Texas that has had a measurable decline in pregnancies. So there are abstinence programs that are beginning to show some real appreciable impact, an impact that has never been shown by comprehensive sex ed programs. And I think we need an open mind to see what these programs actually show us.

Dr. Kirby's study, Emerging Answers concluded that several comprehensive sex ed programs had a positive impact on teen behavior. What would be your response to that?

Well, anyone can set their own standards for what they want to look at, which is what he did. There are lots of other ways to evaluate than the evaluation standards that he set. He set good high standards but the particular design of the program or the evaluation that he was looking at, there are other types of evaluations that are equally legitimate that he ignored.

By what standards would you assert that a program is successful?

Appreciable and practical declines in pregnancy rates. Most of the time, sex ed programs are brought in because pregnancy rates are too high and STD rates are too high. I would like to see appreciable declines in teen pregnancies, the number of kids with STDs, and also a decline in the number of kids having sexual activity, so that a parent can say, "they told me the pregnancy rates are too high here. I can send my girl or my son to this program and be fairly well assured that they will have a good chance of not getting involved sexually and not getting pregnant or not getting a disease."

How would you define an "appreciable decline"?

I would say where you see a 50 percent drop in pregnancy and disease. Ultimately the goal for all of us in this country ought to be an 80 percent decline. I think that's achievable, but it would only happen in a community where the whole community surrounds the children and their families to support those choices. For instance, there's a program that was done in Denmark, South Carolina that was funded by the Office of Adolescent Pregnancy Prevention, the OAPP, by a guy that was a comprehensive sex ed-oriented person, Murray Vincent, but because OAPP was an abstinence program, he saw a pot of money and designed a program that was abstinence-based. Now, Dr. Kirby denies that it was an abstinence program because there was a nurse in the high school that was recommending condoms and giving out condoms, but he personally told me way back in the early days of our argument about this that he didn't really think it made any difference whether she was there or not in his eventual outcome because pregnancy rates weren't going down until he came in with his program.
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