Do you remember your high school sex education? Did you cringe over a video of a live birth? Wince at images of untreated STIs? Giggle while sliding a condom over a banana?
Or perhaps you didn’t even have sex ed.
If that’s the case, you’re not alone. According to the Guttmacher Institute, only 24 states and the District of Columbia currently mandate sex education in public schools. Only 13 states require what’s taught to be medically accurate.
And unfortunately, what is taught isn’t always enough. A 2014 study found that fewer than half of all high schools were covering the Centers for Disease Control and Prevention’s “critical sex education components,” which includes STI prevention and decision-making skills.
The CDC isn’t the only organization recommending more sex ed than kids get. In 2007, researcher Doug Kirby identified 17 characteristics of sex ed programs that were shown to be effective in preventing STIs and unintended pregnancy. That list includes a curriculum with clear health goals (like preventing pregnancy) with a narrow focus on the behavior (like using contraception) that could lead to that goal. Comprehensive sex education programs like the 3Rs curriculum created by Advocates for Youth aim to incorporate all of these methods. Most sex education programs in U.S. schools do not.
So—what exactly is comprehensive sex ed? The Future of Sex Education defines it as:
A planned, sequential K-12 curriculum that is part of a comprehensive school health education approach which addresses age-appropriate physical, mental, emotional and social dimensions of human sexuality.
Comprehensive sex ed includes not just anatomy, but information on healthy relationships, personal safety, contraception, sexual orientation, sexually transmitted infections, and more.
Here, we break down what sex ed curriculums across the country currently look like for students, through their content in four main subject areas: sexual wellness, reproductive health, sexual orientation and gender identity, and consent and communication.
Rates of sexually transmitted infections have been shown to be higher in areas with abstinence-only programs. According to a 2010 study published in the International Journal of AIDS and STDs that compared chlamydia and gonorrhea infection rates across the U.S.:
States with no mandates for abstinence had the lowest mean rates of infection among the overall population and among adolescents. States with mandates emphasizing abstinence had the highest rates; states with mandates to cover (but not emphasize) abstinence fell in between.
According to Dr. Gillian Dean, Senior Director of Medical Services at the Planned Parenthood Federation of America, inadequate sex education means more than unwanted pregnancies and rampant STIs. “It impacts [students’] ability to just simply access healthcare.” Without a comprehensive understanding of susceptibility, prevention, and treatment, it can become impossible to identify a problem or to figure out how to access care.
For example: A recent CDC analysis found that only a small percentage of the American population that could potentially benefit from taking pre-exposure prophylaxis (PrEP), a daily medicine that can lower the chances of becoming infected with HIV, actually had prescriptions. (According to the report, Black and Latinx people make up two-thirds of those who could benefit, though they account for just a small percentage of people who have been prescribed the drug.)
Tyunique Nelson, a YouthResource participant for Advocates for Youth and member of the education team at the Philadelphia Mazzoni Center for LGBTQ Health and Wellbeing, argues that doctors should be offering PrEP to young people instead of waiting for them to ask for it (which, at a minimum, would require young people to know it exists). “It’s unforgivable that most students get through school without learning that there is a medication that can help them remain HIV negative,” Nelson writes.
A lack of comprehensive state-mandated sex education can easily lead to misinformation from outside groups. Where funding for sex ed isn’t available, the education arms of “crisis pregnancy centers” that are frequently run by religious organizations often offer free abstinence-only programming for public schools. Only two states prohibit sex ed from promoting specific religions, so in the 16 states where abstinence-only education is stressed and medically-accurate information is not required, there is ample space for religious organizations to offer up their services.
These obstacles to education further the cycle of poverty that puts teens at higher risk for pregnancy in the first place. According to a 2019 study published in Pediatrics, one in five women don’t use birth control when they begin having sex. Women in low-income areas are much less likely to have access to birth control, leaving sexually active youth who lack the funds or family insurance without any support.
Perhaps unsurprisingly, states with abstinence-only sex education are also frequently states where abortion access is threatened. Ten of the fourteen states where so-called “fetal heartbeat” bills have been introduced to ban abortion this year require abstinence to be stressed whenever sex education is taught. Three other states require abstinence be covered as part of the program, and don’t mandate medical accuracy.
Comprehensive sex ed is recommended by the World Health Organization as one method of lowering STI rates, including HIV. Sex education programs that don’t adequately address LGBTQ youth can compound the problem, as men who have sex with other men are the most affected population in regards to HIV infection, and queer and trans people are also disproportionately impacted.
Programs focused specifically on cisgender heterosexual relationships and their risks leave both queer and trans kids confused and uninformed at best, and at-risk and discriminated against at worst.
A study by the Gay, Lesbian, and Straight Education Network (GLSEN) found that schools in states with so-called “no promo homo” laws were less likely to educate staff about issues faced by LGBTQ youth. The GLSEN study also found that outside of sex ed, “no homo promo” state schools were less likely to include LGBTQ representation in other subjects overall, but more likely to teach negative representations of LGBTQ people.
Encouragement, acceptance, and exploration saves lives, both in and out of the classroom. According to a review of 42 peer-reviewed studies conducted by Cornell University, LGBTQ youth have a heightened risk of low self-esteem, depression, and suicidality, and that “rejecting behaviors by parents can increase these risks, including contributing to far higher levels of suicidal behavior and depression.”
Only 16 of the states that require skills for avoiding coercion be taught when sex ed is available actually mandate that sex ed be provided; in 8 of those states, abstinence must be stressed. Glossing over or altogether forbidding discussions of sex makes it incredibly challenging to effectively talk about assault and consent.
However, research has shown that students of comprehensive sex education have a lower risk of experiencing sexual violence as young adults. A 2018 study on whether or not receiving sex ed before college could protect students from sexual assault while in college found that, though multiple factors “were associated with experiencing sexual assault in college,” education is a powerful tool:
Our analyses also showed that having received formal education about how to say no to sex formal education about how to say no to sex (refusal skills training) before age 18 was a protective factor against penetrative sexual assault in college; it is important to note that the vast majority of those who received instruction in refusal skills also received other forms of sexual education.
When few or no laws exist about how sex ed should be delivered, it’s hard to convince school boards to make it a priority. Samantha Daley, a reproductive justice organizer with the Power U Center for Social Change in South Florida, is campaigning to implement the 3R curriculum in all Miami-Dade County public schools. “As a state, we are underfunded for public education,” she says, and this is especially true for sex ed.
Sex education, Daley says, is part of a much greater conversation about mental health, student wellness, sexual stigma, and supporting self-care. “We’re talking about the formation of a whole human.” Sex education, like counseling and access to a school nurse, “is part of overall student support.”
National polls suggest that only a small fraction of parents are opposed to comprehensive sex ed, and, in all but five states, such parents can opt-out (or not opt-in) for their children. Still, opposition to comprehensive sex ed is often portrayed as widespread and strong, rather than simply loud.
Gelperin cautions concerned parents to not be misled by headlines suggesting that this is an equal debate. “The vast majority of parents, time and again, over 30 years of public health polling, have shown significant support for a more comprehensive approach to sex education over all grade levels.”
If you already know that your child’s sex education isn’t covering all the bases or want to get involved, you can do something about it. Daley highly recommends power-mapping. “Who has the power to make decisions in your community?” she asks. “How is the budget currently allocated and then how would you like to see it allocated?” Go to school board meetings, talk to the people doing the work, and find out what their priorities are—and why.