K12 sex ed goes beyond the birds and bees

Sex education focuses on healthy relationships and gender identity, though abstinence still rules in some states
By: | February 8, 2017
At a Baltimore magnet school, students learn about sex ed in an evidence-based program developed by The Healthy Teen Network, which promotes comprehensive health instruction.At a Baltimore magnet school, students learn about sex ed in an evidence-based program developed by The Healthy Teen Network, which promotes comprehensive health instruction.

High school students in the tiny Magazine School District in Arkansas receive three hours of sex education a year in grades 9 through 12—an approach that Superintendent Brett Bunch acknowledges is inadequate.

While Arkansas law mandates teaching abstinence-only sex education, the state ranks in the top five for teen pregnancy rates. And in rural, impoverished farming communities like Magazine, teens wind up having sex—and not always safely—because there’s not much else to do, Bunch says.

Seven of his 600 students are pregnant, and in some households, students don’t learn safe behaviors from parents. Bunch says he wants to provide more comprehensive, age-appropriate sex education—including lessons on date rape and consent.

But he faces resistance, driven by some community members’ concerns that teaching students skills like using condoms would encourage them to become sexually active.

“We can’t just turn a blind eye and tell them they shouldn’t even be thinking about those things—that didn’t work 100 years ago and it’s not going to work today” Bunch says. “We’re here to educate them—not just on calculus and chemistry and history. We’re here to prepare them for full and enriching lives.”

More than biology lessons

To that end, districts that provide comprehensive sex education increasingly add elements of social-emotional learning to teach students about more than just the central topics of contraception, the functions of the reproductive system and sexually transmitted diseases.

In fact, this approach—which tackles issues such as sexism, drugs and alcohol, physical abuse, date rape, and body image—can even be effective in districts that follow abstinence-only policies, says Nicole Haberland, a senior research associate with the Population Council, a nonprofit that operates family health programs in more than 50 countries.

Research done by the Population Council and other organizations has found abstinence-only programs to be ineffective at preventing unintended pregnancies and STDs.

State of sex ed

A range state laws and district policies in the U.S. determine what kind of sex ed students receive: 24 states require it, 20 mandate that lessons be medically accurate and 27 states require that abstinence be stressed, according to the Guttmacher Institute, which researches reproductive health policies.

Although the U.S. had the highest rate of births among girls ages 15 to 19 compared to 10 countries, including the U.K. and Australia in 2011, teen pregnancy rates are lowering in states, such as Massachusetts, where sex ed is taught. Births per 1,000 among girls ages 15-19:

    • Japan: 4.5
    • Italy: 6.3
    • Finland: 7.7
    • Germany: 8.2
    • France: 9.4
    • Canada: 14.1
    • Australia: 15.9
    • Latvia: 18.7
    • United Kingdom: 21.8
    • United States: 31.3

Source: The National Campaign to Prevent Teen and Unplanned Pregnancy

The council’s studies also show that sex ed curricula covering gender equality and healthy relationships—along with basic biology—reduce pregnancies and STDs more effectively than programs that don’t, she says.

“Even if they can’t teach condom use, they can talk about issues of gender equality and power in intimate relationships” Haberland says. “They can increase young people’s knowledge about their bodies and help them recognize their own worth.”

A state abstinence-only policy had to be followed when the Tempe Union High School District in Arizona revised a sexual education curriculum in 2014 that had become outdated, Superintendent Kenneth Baca says.

The district, which has six schools and 14,000 students, set out to implement as comprehensive a sex ed program as would be allowed under the law, and adopted a modified, 10-day version of the FLASH family life education program developed in Seattle schools and King County, Washington, Baca adds.

Abstinence-only ed doesn’t promote birth control, but doesn’t bar it, either. Students are told the sure way to avoid pregnancy is through abstaining, but Tempe’s new curriculum includes basic lessons on contraception and provides better information on HIV/AIDS.

It also covers issues such as date rape and domestic violence so students learn decision-making skills to avoid falling into physically or emotionally abusive relationships, Baca says. “We’re trying to empower students to save their lives” he says.

“Ultimately, their lives are at risk if it comes to HIV/AIDS, and their quality of life is at risk if it comes to unhealthy relationships or a pregnancy they’re not ready for.”

Arizona allows parents to opt in to sex education, and 80 percent of the district’s families decided to participate in the new sex ed program. The district’s key role is to supply health information when students don’t get it at home, Baca adds.

“Parents choose for us to do it” Baca says. “I want to make sure we can provide students the best type of education they can receive regarding this issue.”

Teaching responsible behavior

Fears that comprehensive sex ed encourages students to become sexually active are unfounded, many experts say.

In fact, the opposite appears to be true: Youth risk surveys conducted across the nation indicate students are less likely to have sex, get pregnant or contract a sexually transmitted disease if they’ve had comprehensive sex education in school, says Valerie Sedivy, a senior manager at the Baltimore-based Healthy Teen Network.

“There’s no evidence that teaching kids to use condoms causes a spike in sexual activity” says Sedivy, whose national organization promotes comprehensive health instruction.

“But there’s quite a bit of evidence that comprehensive sex ed leads to students being responsible. We’re not seeing rates of sexual activity go up. We’re seeing rates of contraception use going up.”

Comprehensive sex education in Boston begins in elementary school, and is based on the National Sexual Education Standards.

In fourth and fifth grade, for example, students learn about hygiene, what to expect during puberty and how to maintain positive friendships, says Pat Santin, the Boston Public School’s health education director.

As they progress through middle school, they learn about reproductive anatomy, contraception and sexual decision-making. In high school, they begin in-depth discussions about teen-dating violence, gender identity and sexual preferences.

Another key topic is consent—including what consent means and when a person can give it, Santin says.

While Boston public high schools make condoms available to all students, it’s also important for students to know that, according to surveys, only about half of their peers will have had sex by the time they graduate, Santin says.

“The misconception is that everybody’s doing it and that ‘I’m just the odd one out if I haven’t,”’ she says. “Kids don’t want to be the odd one out, so we need to make sure they understand what normal behaviors are.”

Adapting to teen life

The U.S. has made significant progress over the past 20 years: Teen pregnancy rates have dropped by about 50 percent across all ethnic groups and in all 50 states.

But the country remains way ahead of other developed nations for both teen pregnancies and sexually transmitted diseases, says Bill Albert, chief program officer at nonprofit National Campaign to Prevent Teen and Unplanned Pregnancy.

“The not-so-good news is the quality and quantity of sex ed that young people get varies widely among states and even within states” Albert says. “As a general matter, sex ed is not a priority. It’s not always seen as basic health care information, which is unfortunate.”

Within school, the number of evidence-based, effective sex ed programs has grown, especially in the last five years. The U.S. Department of Health and Human Services has identified more than 40 programs it considers effective at impacting teen sexual behavior, Albert says.

“What we’re beginning to see are sex ed programs focused more on future aspirations than on prevention,” Albert says. “They say things like: ‘Raising a child is challenging for even the most stout among us, and having a child when you’re in high school makes it exceedingly difficult to achieve the goals you want to achieve.’”

The 52,000-student Omaha Public Schools, for instance, recently added instruction on social media safety, identifying online predators, sexting and cyberbullying to a comprehensive human growth and development curriculum first implemented in the 1980s, says ReNae Kehrberg, assistant superintendent for curriculum and instruction support.

The new lessons also encourage students to accept people who are gay or transsexual. And though there was some small but vocal opposition to the changes, a district phone survey showed 90 percent of parents supported the updates, Kehrberg says.

The curriculum begins in fourth grade, when boys and girls receive health instruction separately to make them more comfortable asking questions about health or body development.

The updated lessons also attempt to break down outdated gender roles, such as those that say women shouldn’t be police officers.
In high school, students now learn about how women can become victims of sex trafficking and also about abortion—and the emotional impacts of getting pregnant and making a decision to terminate.

Some assignments now require students to talk about certain sex ed topics, such as birth control, with their parents. Parents may be more comfortable having the conversation if it’s prompted by schoolwork—rather than if they’re concerned about a child’s sexual behavior, Kehrberg says.

“Just as we keep current on math and science and reading,” she says, “we also want to help kids stay current on life’s major issues.”

Matt Zalaznick is senior associate editor.