In a culture where sex sells, abstinence can be a tough sell with teenagers.
For years, doctors were reluctant to promote abstinence with teens. They didn't want to preach, so they emphasized safe sex and condoms. But for a growing number of physicians, abstinence is in. Nearly half of America's high school health classes are advocating holding off on sex, and the message is moving from the classroom to the examining room.
"I think you can shift greatly the numbers that are going to be involved in sexual activity by teaching abstinence simply with a lot of good medical information," said Dr. John Whiffen of the National Physicians Center.
Critics say abstinence-only programs are not only seriously out of date, they could cause a lot more harm than good.
"(They don't) deal with the reality of sex in the 21st century," New York University sexologist and sex columnist Yvonne K. Fulbright said.
Whiffen is leading a group of 400 doctors in the uphill battle to get family practitioners to stress abstinence with patients. They warn that the very term "safe sex" is misleading and potentially dangerous. But Whiffen says hard medical facts, not moralizing, will get teenagers thinking twice.
President Bush has said he wants to nearly double federal spending on abstinence programs to $138 million next year. His plan would have Washington give just under $90 million to abstinence-only groups that don't tell kids anything about contraception except their failure rates.
The 1996 Welfare Reform Act allocated $50 million each year for programs that were pro-abstinence and didn't discuss contraception. But Congress has been funding community-based abstinence-only programs since 1981. That's the year it passed the Adolescent Family Life Act, which encourages teens to wait until marriage for sex and to consider giving up babies for adoption instead of getting abortions.
Most teens don't realize condoms offer no protection against six common sexual diseases, or that at least one in four sexually active singles have some form of sexually transmitted disease, Whiffen said.
"To tell a child that a condom is going to protect them when it actually offers less than a 50 percent chance of protecting them is simply not a good argument," Whiffen said.
But abstinence-only programs have come under heavy fire. The American Academy of Pediatrics recommends that, while abstinence should be promoted as the best way to avoid STDs and pregnancy, sexually active teens need to be taught about birth control and where to get advice and health care.
"Abstinence-only programs have not demonstrated successful outcomes with regard to delayed initiation of sexual activity or use of safer sex practices," the AAP said in an August 2001 statement.
And a Columbia University sociology study found that teens who took abstinence pledges but broke them were less likely to use contraception and were thus at a higher risk for pregnancy and STDs.
Fulbright said abstinence-only education only gave teens part of the message they needed to hear.
"The abstinence message is certainly the best advice that we can give our young people as far as protecting them from sexual-health concerns, but it shouldn't be the only message we give our children," she said.
And teens themselves say lectures from teachers, parents and even doctors can often fall on deaf ears.
"They can tell you, like, it's bad for you, but people still do it," high-school senior Yvette Cruz said.