America's Sex Education: How We Are Failing Our Students ...

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 Journal of Adolescent Health 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 infections.
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 school is 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.
State-by-State Sex Education Policies
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.
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 programs include “developmentally and culturally responsive, science-based and medically accurate information on a broad set of topics related to sexuality, including human development, relationships, personal skills, sexual health and society and culture,” according to the Sexuality Information and Education Council of the United States (PDF, 7.1MB).
“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.
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, says 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 Wisconsin’s current abstinence-focused policy.
In recent years, states have begun to mandate sex ed to include information about learning 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.
Even though the United States 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.
A report on comprehensive sex-ed published in the Journal of Adolescent Health in 2008 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 students 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.”
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.
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. 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 inWashington, 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, as indicated in a document on providing health care to minors in Washington state (PDF, 92KB).
“I do, however, tell patients’ parents about the minor’s consent to treatment 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 parents and the child together.”
Encouraging openness and compassion helps parents and teens keep communication flowing with honesty, says Granger, and it is something all family nurse practitioners can do with their patients.
Sometimes the best place to start can be asking pediatric patients to talk about what they already know. Granger recommends asking, “What does having sex mean to you?” 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.”
The following section contains tabular data from the graphics in this post.
Legislation for sex education falls under the jurisdiction of states’ rights, creating disparities in what public school students learn in classrooms across the country. The chart below indicates which states require critical components of comprehensive sex education and whether they mandate sex education at all.
States Where Sex Education Is Mandated
California
Delaware
District of Columbia
Georgia
Hawaii
Iowa
Kentucky
Maine
Maryland
Minnesota
Mississippi
Montana
Nevada
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oregon
Rhode Island
South Carolina
Tennessee: Sex education is required if the pregnancy rate for women ages 15-17 is at least 19.5 or higher.
Utah: State also prohibits teachers from responding to students’ spontaneous questions in ways that conflict with the law’s requirements.
Vermont
West Virginia
States Where Sex Education Must Be Medically Accurate When Taught
California
Colorado
Hawaii
Illinois
Iowa
Maine
Michigan: Sex education “shall not be medically inaccurate.”
New Jersey
North Carolina
Oregon
Rhode Island
Utah
Washington
States Where Sex Education Must Cover Contraception
Alabama
California
Colorado
Delaware
District of Columbia
Hawaii
Illinois
Maine
Maryland
Mississippi: Localities may include topics such as contraception or STIs only with permission from the State Department of Education.
New Jersey
New Mexico
North Carolina
Oregon
Rhode Island
South Carolina
Vermont
Virginia
Washington
West Virginia
States Where Sex Education Must Cover Abstinence
California
Colorado
Hawaii
Kentucky
Maryland
Minnesota
Montana
New Mexico
North Dakota
Vermont
Virginia
West Virginia
States Where Sex Education Must Stress Abstinence
Alabama
Arizona
Arkansas
Delaware
Florida
Georgia
Illinois: Sex education is not mandatory, but health education is required and includes medically accurate information on abstinence.
Indiana
Louisiana
Maine
Massachusetts
Mississippi
Missouri
New Jersey
North Carolina
Ohio
Oklahoma
Oregon
Rhode Island
South Carolina
Tennessee
Texas
Utah
Washington
Wisconsin
States Where Sex Education Must Be Inclusive of Sexual Orientation
California
Colorado
Connecticut
Iowa
New Jersey
New Mexico
Oregon
Rhode Island
Washington
States Where Sex Education Must Be Negative Toward Sexual Orientation
Alabama
Arizona: If HIV education is taught in Arizona, it cannot “promote” a “homosexual lifestyle” or portray homosexuality in a positive manner.
Oklahoma: Mandated HIV education in Oklahoma teaches that, among other behaviors, “homosexual activity” is considered to be “responsible for contact with the AIDS virus.”
Though the teen pregnancy rate has hit a historic low in the United States, the nation still holds one of the highest rates in the developed world. This chart shows states’ disparate birth rates for women ages 15 to 19 in 2015, according to the CDC.
2015 Teen Birth Rates
Births per 1,000 women ages 15 to 19 estimated in each state
Alabama 30.1
Alaska 29.3
Arizona 26.3
Arkansas 38
California: 19
Colorado: 19.9
Connecticut: 10.1
Delaware: 18.1
District of Columbia: 25.6
Florida: 20.8
Georgia: 25.6
Hawaii: 20.6
Idaho: 22.5
Illinois: 21.1
Indiana: 26
Iowa: 18.6
Kansas: 25.5
Kentucky: 32.4
Louisiana: 34.1
Maine: 15.4
Maryland2: 17
Massachusetts: 9.4
Michigan: 19.4
Minnesota: 13.7
Mississippi: 34.8
Missouri: 25
Montana: 25.3
Nebraska: 22
Nevada: 27.6
New Hampshire: 10.9
New Jersey: 12.1
New Mexico: 34.6
New York: 14.6
North Carolina: 23.6
North Dakota: 22.2
Ohio: 23.2
Oklahoma: 34.8
Oregon: 19
Pennsylvania: 17.7
Rhode Island: 14.3
South Carolina: 26.2
South Dakota: 26.4
Tennessee: 30.5
Texas: 34.6
Utah: 17.6
Vermont: 11.6
Virginia: 17.1
Washington: 17.6
West Virginia: 31.9
Wisconsin: 16.2
Wyoming: 29.2
Source: Centers for Disease Control and Prevention, 2015 https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf
People ages 15 to 24 only make up 25% of the American population, but they account for 50% of all new STDs reported in 2013, which raises concerns from medical professionals about the scope of sex education.
Total STD Rate per 1,000 cases
People can report having more than one STD within a year; this data reflects the rate of cases per 1,000 people in the 15–24 age group estimated in a state.
Alabama: 40.388
Alaska: 36.139
Arizona: 25.274
Arkansas: 34.465
California: 20.683
Colorado: 21.065
Connecticut: 20.662
Delaware: 34.614
District of Columbia: 42
Florida: 25.963
Georgia: 31.347
Hawaii: 22.959
Idaho:17.112
Illinois: 31.336
Indiana: 26.039
Iowa: 19.793
Kansas: 21.67
Kentucky: 24.424
Louisiana: 40.515
Maine: 14.916
Maryland: 27.75
Massachusetts: 17.29
Michigan:28.32
Minnesota: 20.877
Missouri: 28.951
Montana: 20.241
Nebraska: 21.84
Nevada: 23.897
New Hampshire: 12.944
New Jersey: 19.689
New Mexico: 29.765
New York: 25.651
North Carolina: 31.963
North Dakota: 20.577
Ohio: 30.583
Oklahoma: 29.578
Oregon: 19.3
Pennsylvania: 26.032
Rhode Island: 20.014
South Carolina: 34.17
South Dakota: 26.481
Tennessee: 30.013
Texas: 28.406
Utah: 11.157
Vermont: 15.603
Virginia: 23.954
Washington: 18.619
West Virginia: 18.32
Wisconsin: 24.407
Wyoming: 18.596
Data Source: National Electronic Telecommunications System for Surveillance, Centers for Disease Control and Prevention, 2013. https://www.cdc.gov/nchhstp/newsroom/2014/std-surveillance-report.html