Sex education has long been a hotly debated topic in the United States. While some states mandate a full education on everything from contraception to homosexuality, others exclusively go for abstinence-only until marriage education. This disparity has certainly played a part in teen birth rates from state to state, with many of those focusing on abstinence education also having the highest birth rates. But what if we were to pay these teens not to have sex? Antara Ganguli, from The Atlantic, says it might work, just as it did in Malawi.

Mississippi held the record for having the highest birth rates in 2010, with 55 births per 1,000 teens. Although these rates pale in comparison to the birth rates in Malawi — 177 births per 1,000 teens — there are some similarities between the two. For example, even though Mississippi is wealthier, better educated, and less troubled by diseases than Malawi, it’s still the poorest in the nation, with more than half of its population earning a low income.

The Formula For Higher Birth Rates

Evidence has shown a link between poverty and risky sexual behavior. In four African countries, including Malawi, teens, aged 12-19, were interviewed about their sexual experiences, socioeconomic status, school, childbearing, and use of contraception, among other things. Overall, Malawian males were at the highest risk for early sexual activity, with those that were poorer initiating sex earlier. Out of all the countries, only 43 percent of males and females who were sexually active within the 12 months before their interviews had used condoms. The researchers also found that those who were schooled had a significantly higher chance of using a condom.

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Mississippi, however, doesn’t teach about using contraceptives. In fact, it’s the only state that requires localities to obtain permission to teach about contraception from the State Department of Education. The state focuses exclusively on abstinence-only education, which includes stressing the importance of sex only after marriage, the negative outcomes of teen sex, and avoiding coercion by an older person, while skipping over healthy decision making and family communication.

This combination of poverty and low-quality sex education is a formula for higher birth rates.

Abstinence In Malawi

But in Malawi, paying teens over the course of two years to abstain from sex actually worked. The Bill and Melinda Gates Foundation funded a randomized control trial in which 4,000 12- to 22-year-old girls were split into a paid and unpaid group. Those that were paid were given money in exchange for attending school 80 percent of the time and reporting on their sexual activity, from which they were expected to abstain. Sexual activity after the first year was 38 percent later for those receiving the cash than for those that weren’t getting anything. The cash group also reported a 25 percent lower number of sexual partners. For schoolgirls who had dropped out before the study, there was a 40 percent lower chance of pregnancy than those among the control group.

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Although it may have worked for Malawi, there’s no real proof that it could work for Mississippi or other states. But we can base the behavior of teens on other cash-exchange studies that have been done in the U.S. and abroad. The New York City pilot program, NYC Opportunity, offered cash in exchange for poor students to attend school and succeed. In Brazil, the Bolsa Familia program offered cash transfers if parents ensured that their kids attended school and were vaccinated. Mexico’s Oportunidades offered the same incentives.

How could this work in the US?

The program could indeed work, but it is unclear how — if it were to be tested — it would be funded. Mississippi currently spends $155 million a year on teenage pregnancies, so reallocating some of this money toward a cash exchange could be effective without upsetting religious leaders or supporters of abstinence-only sex education, Ganguli wrote in The Atlantic.

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Additionally, a provision of the Affordable Care Act that went into effect in 2010 and is slated to continue until at least the end of next year designated $50 each year to states that taught abstinence-only education. In order to receive the money, the programs are required to teach “that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems,” according to the Department of Health and Human Services. They would also have to teach that sex before marriage is “likely to have harmful psychological and physical effects.”

But organizations that support all avenues for sex education beyond abstinence-only say that $250 per state is a waste of money.

“Just the fact that we continue to pour money into programs that have no evidence of effectiveness at all just doesn’t seem to us to be a good evidence-based health policy,” Heather Boonstra, senior public policy associate for the nonprofit reproductive and health research firm Guttmacher Institute, told CNN.

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Even a 2007 congressionally mandated study on abstinence programs showed that none of the four programs had a significant positive effect on youth sexual behavior. A January 2009 study found that religious teens who pledged virginity were less likely to practice safe sex once they became active, which also started earlier than marriage for many of them, according to CNN.

“The U.S. has some of the most disadvantaged communities in the developed world. Their circumstances and needs are so diverse that all they seem to have in common is the country’s inability to help them without spending trillions of dollars on hotly contested programs,” Ganguli wrote in The Atlantic. “Adapting and trying out tactics from developing countries could achieve specific goals in specific circumstances without getting mired in the politics and bureaucracy of the endless welfare debate.”