America’s Sex Education: How We Are Failing Our Students

When only 13 states in the nation require sex education to be medically accurate, a lot is left up to interpretation in teenage health literacy. Research published by the Public Library of Science shows that when sex education is comprehensive, students feel more informed, make safer choices and have healthier outcomes — resulting in fewer unplanned pregnancies and more protection against sexually transmitted diseases and infection.

“Sex education is about life skills,” said Elizabeth Nash, senior state issues manager at the Guttmacher Institute. “There are so many aspects you take with you for the rest of your life, but you only get it once or twice in school.”

Of course many young students pick up sexual health information from sources other than school — parents, peers, medical professionals, social media and pop culture. However, public schools are the best opportunity for adolescents to access formal information. So what happens when that information isn’t regulated by the state? Teachers are left to interpret vague legislative guidelines, meaning information might not be accurate or unbiased. 

The chart below compares the legislative policies of all 50 states, including how they mandate specific aspects of sex education like contraception, abstinence and sexual orientation.

Read the text-only version of these graphics here. 

What Does Comprehensive Sex Ed Look Like?

Even when sex education is required, state policies still vary widely regarding the inclusion of critical information. In short, comprehensive sex ed “includes age-appropriate, medically accurate information on a broad set of topics related to sexuality including human development, relationships, decision-making, abstinence, contraception, and disease prevention,” according to the Sexuality Information and Education Council of the United States.

USC Suzanne Dworak-Peck School of Social Work Department of Nursing professor Dr. Theresa Granger says that comprehensive sex ed goes beyond the biophysical aspects. 

“It's about focusing on the emotional, psychosocial and economic impacts of what happens when youth and adolescents engage in sexual intercourse and other sexual practices,” she said.

Granger said that in order to be comprehensive, sex education programs have to consider the whole student. But many states leave issues like sexual orientation and contraception unaddressed, and some even prohibit public schools from addressing them.

“It’s hard to get legislators behind comprehensive sex ed,” said Nash, who explained that campaigning on controversial and sensitive topics can make lawmakers uncomfortable.

It can take years for policies to change, even in the most progressive states. California is known for pioneering reforms, but it wasn’t until 2016 that the state passed a law to mandate comprehensive sex education in public schools. Before the new law went into effect last January, California left sex education as an optional component of health curricula for students in grades 7 through 12.

The legislation is part of a nationwide trend — albeit a slow and deliberate one — to transform disjointed sex education laws into comprehensive requirements that lead to better health outcomes for adolescents in public schools, according to Nash, who has tracked sex education policies for over a decade.

Other states have a more volatile history with regulating sex education. In 2010, Wisconsin’s governor and legislature passed a law mandating comprehensive sex ed. Two years later it was replaced with today's abstinence-only policy.

In recent years, states have begun to mandate sex ed to include information about life skills for family communication, avoiding coercion and making healthy decisions. According to Nash, including these skills is part of progressive trends across the country, where states have begun to require discussions of sexual consent, harassment and sexual orientation. Overall, most trends are slow to change.

“Most states will tweak the policies they already have to be more inclusive, or double down on conservative regulations,” Nash said.

Health Outcomes

The impact of sex education policies becomes more clear when considering that in 2016, the United States had higher rates of teen pregnancy and sexually transmitted disease than most other industrialized countries. What feels like progress at the state level can be seen as mere catch-up to the policies of other developed nations that require teachers to discuss sex ed as early as kindergarten.

Granger said school programs need to work on adapting to current health issues and trends that affect the scope of sexual health literacy.

“There are rewards and consequences to our behavior at every age across the lifespan,” she said. “We can't always assume that an adolescent will wait to become an adult before making adult decisions.”

Teen Pregnancy

Read the text-only version of these graphics here. 

Even though the U.S. falls behind other industrialized nations in preventing teen births, its teen pregnancy rates hit an all-time low in 2016, a decade-long trend that has been attributed by many studies to increased education about contraception in public schools.

Research published in the Journal of Adolescent Health concluded that when sex education included information about contraception, teens had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education. The findings could alleviate a common fear of parents and teachers who worry that students are more likely to increase their sexual activity after receiving comprehensive sex education.

The more teens can access accurate information from a trusted provider, the more prepared they can be when making decisions about their bodies and relationships. Granger said that in her clinical experience, teens will make a decision to engage in sexual activity whether or not they feel adequately informed, leaving health professionals with an opportunity to promote sexual health literacy.

“Teens will often reach out for education after they have made their decision,” Granger said. “When they reach out, it’s important for this education to be accurate and comprehensive, not biased or based on judgment.”

Sexually Transmitted Diseases and Infections

Read the text-only version of these graphics here. 

According to the CDC, teens who identify with LGBTQ communities can be at higher risk of contracting STDs, but safeguarding against transmissions becomes difficult when states prohibit teachers from discussing sexual orientation in class.

Some states expect that sexual orientation will get discussed at home, but the reality is that many students feel they lack the relationships to comfortably ask parents, teachers or peers about health information related to orientation.

“Teens who are healthy and in supportive relationships involving friends and family will often make much different decisions than those who aren't,” said Granger, who has conducted research on the impact of relationships on adolescent development. “Stable, present and meaningful relationships with parents and other family members are all protective factors from a variety of interrelated risky behaviors.”

“In some states, teachers are allowed to answer questions from students, even if it focuses on a forbidden topic like STDs or sexual orientation,” Nash said. Though this loophole is disappearing in some states like Tennessee, it allows students to stay engaged in discussions that would otherwise exclude them because of focus on heterosexual relationships.

“More students are becoming open about their sexual identities and preferences, and schools have to address that,” Nash said. But discrepancies persist across communities over the responsibility of providing meaningful sex education.   

Having ‘The Talk’

One of the main challenges of mandating comprehensive sex education is considering everyone involved in the process: students, their classmates, parents, teachers and legislators. Teachers feel pressure from parents to deliver just the right amount of information, but students tune out when educators fail to address their individual questions.

So whose responsibility is it to make sure young people have the information they need to make healthy choices? In areas where sex ed isn’t required, states can assume that parents will educate their children at home, but studies show that adolescents are increasingly more likely to seek information from social media and online communities, which can be more inclusive of gender and sexual minorities, but not consistently reliable for medical accuracy.

Granger said assigning responsibility for “The Talk” is part of the problem that leaves teens uninformed.

“One of the weaknesses in our current system is that we're trying to assign primary responsibility and it is too tall of an order for any single entity to try to tackle,” she said.

When there’s a disconnect between the information students get at school and what they can find on the Internet, mixed messaging makes it harder for teens to rely on the people they trust.

That’s where medical professionals can step in, according to Granger. She currently practices in Washington, one of few states that allows minors to seek testing and treatment for STDs, as well as contraception, without consent from a parent or guardian. 

“I do, however, tell patients' parents about the minor’s consent to treat law, and the fact that it was designed to help youth seek treatment for communicable disease,” Granger said. Though the conversations can be difficult, she said acknowledging the awkwardness can alleviate the tension around discussions of sexual health for parents and their children.

“Every practitioner handles this differently,” she said. “However, I always try to talk to the parents separately, the child separately, and then the parent and the child together.”

Encouraging openness and compassion helps both parents and teens keep communication flowing with honesty, according to Granger, and is something all family nurse practitioners can do with their patients.

Sometimes the best place to start can be asking teenage patients to talk about what they already know. “What does having sex mean to you?” Granger recommends asking as a jumping off point to deeper conversations.

“People developing these curricula, myself included, need to think about the common goal to help youth maintain a positive sense of self-esteem, work toward healthy life goals and make responsible decisions with their bodies,” Granger said. “We all need to do our part. We need to educate teens whenever and wherever they are.”

 

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