Sexuality Education

Building an evidence- and rights-based approach to

healthy decision-making

As they grow up, young people face important WHY IS SEXUAL HEALTH EDUCATION
decisions about relationships, sexuality, and IMPORTANT TO YOUNG PEOPLE’S HEALTH
sexual behavior. The decisions they make AND WELL-BEING?
can impact their health and well-being for Comprehensive sexual health education
the rest of their lives. Young people have the covers a range of topics throughout the
right to lead healthy lives, and society has the student’s grade levels. Along with parental and
responsibility to prepare youth by providing community support, it can help young people:
them with comprehensive sexual health
education that gives them the tools they • Avoid negative health consequences.
need to make healthy decisions. But it is not Each year in the United States, about
BRIEF

enough for programs to include discussions 750,000 teens become pregnant, with up to
of abstinence and contraception to help 82 percent of those pregnancies being unin-
young people avoid unintended pregnancy tended.1,2 Young people ages 15-24 account
or disease. Comprehensive sexual health for 25 percent of all new HIV infections in
education must do more. It must provide the U.S.3 and make up almost one-half of the
young people with honest, age-appropriate over 19 million new STD infections Ameri-
cans acquire each year.4 Sex education
FACTS

information and skills necessary to help them

take personal responsibility for their health teaches young people the skills they need
and overall well being. to protect themselves.

This paper provides an overview of research • Communicate about sexuality and sexual
on effective sex education, laws and policies health. Throughout their lives, people
that shape it, and how it can impact young communicate with parents, friends and
people’s lives. intimate partners about sexuality. Learning
to freely discuss contraception and condoms,
as well as activities they are not ready for,
WHAT IS SEXUAL HEALTH EDUCATION?
protects young people’s health throughout
Sex education is the provision of information their lives.
about bodily development, sex, sexuality,
• Delay sexual initiation until they are ready.
POLICY

and relationships, along with skills-building

to help young people communicate about Comprehensive sexual health education
and make informed decisions regarding sex teaches abstinence as the only 100 percent
and their sexual health. Sex education should effective method of preventing HIV, STIs,
occur throughout a student’s grade levels, and unintended pregnancy – and as a valid
with information appropriate to students’ choice which everyone has the right to
development and cultural background. It make. Dozens of sex education programs
should include information about puberty have been proven effective at helping young
and reproduction, abstinence, contraception people delay sex or have sex less often.5
and condoms, relationships, sexual violence
• Understand healthy and unhealthy
THE

prevention, body image, gender identity and

relationships. Maintaining a healthy
sexual orientation. It should be taught by
relationship requires skills many young
trained teachers. Sex education should be
people are never taught – like positive
informed by evidence of what works best to
communication, conflict management,
prevent unintended pregnancy and sexually
and negotiating decisions around sexual
transmitted infections, but it should also
activity. A lack of these skills can lead to
respect young people’s right to complete and
unhealthy and even violent relationships
honest information. Sex education should
among youth: one in 10 high school
treat sexual development as a normal, natural
students has experienced physical violence
part of human development.
from a dating partner in the past year.6 Sex
education should include understanding
and identifying healthy and unhealthy
“Comprehensive sexual developmentally appropriate information on human

health education helps sexuality, including risk-reduction strategies and

contraception helps young people take steps to

young people take steps protect their health, including delaying sex, using
condoms or contraception, and being monogamous.5

to protect their health, - - A 2012 study that examined 66 comprehensive

sexual risk reduction programs found them to be
including delaying sex an effective public health strategy to reduce
adolescent pregnancy, HIV, and STIs.12
until ready, and using -- Research from the National Survey of Family Growth
condoms and contraception assessed the impact of sexuality education on youth
sexual risk-taking for young people ages 15-19 and
when they do become found that teens who received comprehensive sex
education were 50 percent less likely to experience
sexual active.” pregnancy than those who received abstinence-
only-until-marriage programs.13
relationship patterns; effective ways to communicate -- Even accounting for differences in household
relationship needs and manage conflict; and strategies income and education, states which teach sex
to avoid or end an unhealthy relationship.7 education and/or HIV education that covers
abstinence as well as contraception, tend to have
• Understand, value, and feel autonomy over their the lowest pregnancy rates.14
bodies. Comprehensive sexual health education
teaches not only the basics of puberty and development, • National Sexuality Education Standards provide a
but also instills in young people that they have the right roadmap. The National Sexuality Education Standards,
to decide what behaviors they engage in and to say developed by experts in the public health and sexuality
no to unwanted sexual activity. Furthermore, sex education field and heavily influenced by the National
education helps young people to examine the forces Health Education Standards, provide guidance about
that contribute to a positive or negative body image. the minimum essential content and skills needed
to help students make informed decisions about
• Respect others’ right to bodily autonomy. Eight sexual health.15 The standards focus on seven topics
percent of high school students have been forced as the minimum, essential content and skills for K–12
to have intercourse8, while one in ten students say education: Anatomy and Physiology, Puberty and
they have committed sexual violence.9 Good sex Adolescent Development, Identity, Pregnancy and
education teaches young people what constitutes Reproduction, Sexually Transmitted Diseases and HIV,
sexual violence, that sexual violence is wrong, and Healthy Relationships, and Personal Safety. Topics
how to find help if they have been assaulted. are presented using performance indicators—what
• Show dignity and respect for all people, regardless students should learn by the end of grades 2, 5, 8, and
of sexual orientation or gender identity. The past 12.16 Schools which are developing comprehensive
few decades have seen huge steps toward equality sexual health education programs should consult the
for lesbian, gay, bisexual, and transgender (LGBT) National Sexuality Education Standards to provide
individuals. Yet LGBT youth still face discrimination students with the information and skills they need to
and harassment. Among LGBT students, 82 percent develop into healthy adults.
have experienced harassment due to the sexual • Evidence-based interventions are proven effective
orientation, and 38 percent have experienced for schools serving communities at risk. Schools
physical harassment.10 may wish to embed evidence-based interventions
• Protect their academic success. Student sexual (EBIs) in their sexual health education programs.
health can affect academic success. The Centers for Others may wish to provide EBIs as targeted
Disease Control and Prevention (CDC) has found that interventions for groups of students at high risk.
students who do not engage in health risk behaviors To do the latter, these programs should be provided
receive higher grades than students who do engage in an after school setting. Researchers have
in health risk behaviors. Health-related problems identified dozens of EBIs where participants showed
and unintended pregnancy can both contribute to statistically significant declines in teen pregnancy,
absenteeism and dropout.11 HIV, or other STIs. Following are collections of EBIs
targeting youth from a variety of backgrounds.
WHAT DOES THE RESEARCH SAY ABOUT EFFECTIVE
SEX EDUCATION? -- Science and Success: Programs that Work to
Prevent Teen Pregnancy, HIV, and Sexually
• Comprehensive sexual health education works. Transmitted Infections (Advocates for Youth, 2012):
Research has repeatedly found that sex education Advocates for Youth undertook exhaustive reviews
which provides accurate, complete, and of existing programs that work to prevent teen
 pregnancy, HIV, and STIs and compiled a list of • Have been found to contain false information
programs that have been proven effective by
rigorous evaluation. Thirty-six effective programs • Are not supported by the majority of Americans.19
were identified.5
Only one abstinence-only program has ever been proven
-- 16 programs demonstrated a statistically effective at helping young people delay sex; yet in
significant delay in the timing of first sex. withholding information about contraception, it leaves
those who do have sex completely at risk. Studies show
-- 21 programs showed statistically significant that 99 percent of people will use contraception in their
declines in teen pregnancy, HIV or other STIs. lifetimes,20 and that the provision of information about
contraception does not hasten the onset of sexual
-- 16 programs helped sexually active youth
debut or increase sexual activity.10 Meanwhile, thirty
to increase their use of condoms.
years of public health research clearly demonstrate that
-- 9 programs demonstrated success at increasing comprehensive sex education can help young people
use of contraception other than condoms. delay sexual initiation while also assisting them to use
protection when they do become sexually active. We
-- Emerging Answers (The National Campaign want young people to behave responsibly when it comes
to End Teen and Unplanned Pregnancy, to decisions about sexual health, and that means society
2007): Researcher Douglas Kirby examined has the responsibility to provide them with honest, age-
studies of prevention programs which had a appropriate comprehensive sexual health education;
strong experimental design and used other access to services to prevent pregnancy and sexually
appropriate analysis criteria. Two-thirds of the 48 transmitted infections; and the resources to help them
comprehensive sex education programs studied lead healthy lives.
had positive effects:17
-- 40 percent delayed sexual initiation,
reduced number of sexual partners, or TS • SOCIO
increased condom or contraceptive use; INAN ECO
ERM NO
T M
-- 30 percent reduced the frequency of sex, DE I CS
L
including return to abstinence; and A TARGETED
R
INTERVENTIONS

•
TU

CU
-- 60 percent reduced unprotected sex.17 YOUTH AT
UC

DISPROPORTIONATE

LT
TR

RISK

UR
-- The Office of Adolescent Health, a division of the
: S

AL
U.S. Department of Health and Human Services,
G ENVIRONMENT

keeps a list of evidence-based interventions, with

ATTIT
SEXUAL HEALTH
ratings based on the rigor of program impact SERVICES
studies and strength of the evidence supporting SEXUALLY ACTIVE YOUTH

UDES • P
the program model. Thirty-one programs meet the
OAH’s effectiveness criteria and that were found
to be effective at preventing teen pregnancies or
births, reducing sexually transmitted infections, or COMPREHENSIVE SEXUAL
HEALTH EDUCATION
LIN

O
reducing rates of associated sexual risk behaviors
ALL YOUTH

L
B

I
(defined by sexual activity, contraceptive use, or

CIE
A
EN

number of partners).18
Advocates for Youth, 2014 S
WHAT’S WRONG WITH ABSTINENCE-ONLY-UNTIL-
MARRIAGE PROGRAMS? YOUTH SEXUAL HEALTH PROMOTION:
Many students receive abstinence-only-until marriage THE BUILDING BLOCKS
programs instead of or in addition to more comprehensive
programs. These programs:
All young people need comprehensive sexual health
• Depict abstinence until heterosexual marriage as the
education, while others also need sexual health
only moral choice for young people
services. Youth at disproportionate risk for sexual
• Mention contraception only in terms of failure rates health disparities may also need targeted interventions
designed specifically to build self efficacy and agency.
• Focus on heterosexual youth, ignoring the needs of Further, administrators and other policy makers must
LGBTQ youth recognize that structural determinants, socio-cultural
factors and cultural norms have been shown to have
• Often use outdated gender roles, urging “modesty” for a strong impact on youth sexual health and must be
all girls while painting all boys as sexual aggressors. tackled to truly redress sexual health disparity fueled
by social inequity.
HOW IS THE CONTENT OF A STUDENT’S SEX a part of the Affordable Care Act of 2010. PREP
EDUCATION DECIDED? provides grants ($75 million over five years) for
Many factors help shape the content of a student’s programs which teach about both abstinence
sex education. These include: and contraception in order to help young people
reduce their risk for unintended pregnancy, HIV,
• State and federal funding the school district receives and STIs. In Fiscal Year 2012, 45 states applied
for PREP. PREP grants are issued to states,
• State laws and standards regarding sex education typically the state health departments. All
• School district level policies and/or standards programs implemented with PREP funding are to
regarding curricula and content educate adolescents about both abstinence and
contraception for the prevention of pregnancy
• The program or curriculum a district or individual and STIs, including HIV/AIDS, and must cover at
school selects least three adulthood preparation subjects such
as healthy relationships, adolescent development,
• The individual(s) who delivers the program. financial literacy, educational and career success,
and healthy life skills.
With thousands of school districts around the nation,
students’ experiences can vary drastically from district -- The President’s Teen Pregnancy Prevention
to district and school to school. Initiative (TPPI) funds medically-accurate and age-
appropriate programs to reduce teen pregnancy.
WHAT ARE FEDERAL, STATE, AND LOCAL Seventy-five grantees in 32 states received TPPI
STRUCTURES THAT AFFECT SEX EDUCATION? funds in FY 2012. TPPI grants are distributed by
In the United States, education is largely a state and the Office of Adolescent Health to local public and
local responsibility, as dictated by the 10th Amendment private entities. Grantees must implement an
of the U.S. Constitution. This amendment states that evidence-based program which has been proven
“the powers not delegated to the United States by the effective at preventing teen pregnancy. According
Constitution, nor prohibited by it to the States, are to OAH, 31 programs meet these criteria, including
reserved to the States respectively, or to the people.”3 one abstinence-only-until-marriage program.
Because the Constitution doesn’t specifically mention -- States may accept PREP, TPPI, or Title V funds.
education, the federal government does not have any Many states accept funds for both abstinence-
direct authority regarding curriculum, instruction, only programs and evidence-based interventions.
administration, personnel, etc. In 1980, the U.S. In 2013, 19 SEAs and 17 LEA received five year
Department of Education was created. While this move cooperative agreements from CDC/DASH to
centralized federal efforts and responsibilities into implement ESHE within their school systems.
one office, it did not come with an increase in federal
jurisdiction over the educational system. In addition, in 2013, CDC/Division of School Health issued
a request for proposals to fund State Education Agencies
The U.S. Department of Education currently has no (SEAs) and Large Municipal Education Agencies (LEAs) to
authority over sexual health education. However, there implement Exemplary Sexual Health Education (ESHE).
have been federal funds allocated, primarily through ESHE is defined as a systematic, evidence-informed
the Department of Health and Human Services that approach to sexual health education that includes the
school systems and community-based agencies have use of grade-specific, evidence-based interventions, but
used throughout the last three decades to provide also emphasizes sequential learning across elementary,
various forms of sex education.21 middle, and high school grade levels.23
• Federal funding: Until FY2010, there was no States may accept PREP, TPPI, or Title V funds.
designated funding for a comprehensive approach to Many states accept funds for both abstinence-only
sex education. In 1982, federal support of abstinence- programs and evidence-based interventions. In 2013,
only programs began, and in 1996, expanded 19 SEAs and 17 LEAs received five year cooperative
drastically. From 1996-2010, over $1.5 billion in federal agreements from CDC/DASH to implement ESHE within
funding went to abstinence-only programs, which their school systems.22
were conducted with little oversight and were proven
ineffective. While one large stream of funding for • The Real Education for Healthy Youth Act: While there
abstinence-only programs was cancelled in 2010, at is as yet no law that supports comprehensive sexual
publication one still exists (as authorized by Congress health education, there is pending legislation. The
through Title V funding) and is funded at $50 million Real Education for Healthy Youth Act (S. 372/H.R.
per year.22 725), introduced in February 2013 by the late Senator
Frank Lautenberg (D-NJ) and Representative Barbara
In 2010, two streams of funding became available Lee (D-CA), would ensure that federal funding is
for evidence-based sex education interventions.22 allocated to comprehensive sexual health education
-- PREP: The Personal Responsibility Education programs that provide young people with the skills
Program (PREP) was authorized by Congress as and information they need to make informed,
responsible, and healthy decisions. This legislation
 sets forth a vision for comprehensive sexual health determining the school district budget and priorities;
education programs in the United States. curriculum decisions such as the scope and sequence
of classroom content in all subject areas; and textbook
• State policy: State sex education policy may be approval authority. 21
governed by a state law as passed by the state
legislature and signed into law by the state’s governor Typically, school boards set the sex education policy
and/or the State Department of Education may have for a school district. They must follow state law.
established state sex education standards. State Some school boards provide guidelines or standards,
policy on sex education can vary widely. As of 2012, while others select specific curricula for schools to
deliver. Most school boards are advised by School
-- 30 states have no law that governs sex education, Health Advisory Councils (SHACs). SHAC members are
and schools are not required to provide it individuals who represent the community and who
provide advice about health education.21
-- 25 states mandate that sex education, if taught,
must include abstinence, but do not require it to
include contraception. HOW CAN I WORK FOR COMPREHENSIVE SEXUAL
HEALTH EDUCATION FOR STUDENTS IN MY
-- Six states mandate that sex education include COMMUNITY?
either a ban on discussing homosexuality, or There are a number of ways to help ensure that students
material about homosexuality that is overtly get the information they need to live healthy lives, build
discriminatory.22 healthy relationships, and take personal responsibility
Each state has a department of education headed by for their health and well being.
a chief state school officer, more commonly known • Urge your Members of Congress to support the Real
as the Superintendent of Public Instruction or the Education for Healthy Youth Act, in person, by phone,
Commissioner of Education (titles vary by state). State or online.
departments of education are generally responsible
for disbursing state and federal funds to local school • Contact your school board and urge them to adopt the
districts, setting parameters for the length of school National Sexuality Education Standards and require
day and year, teacher certification, testing requirements, comprehensive sexual health programs.
graduation requirements, developing learning standards
and promoting professional development. Generally, • Join a School Health Advisory Council in your area – both
the chief state school officer is appointed by the Governor, young people and adults are eligible to serve on most.
though in a few states they are elected.23
• Organize within your community – a group of
State departments of education may also have individuals, or a coalition of like-minded organizations
Standards which provide benchmark measures that – to do one or all of the above.
define what students should know and be able to do
at specified grade levels. These sometimes, but not CONCLUSION
always, address sexual health education. For instance,
Connecticut and New Jersey have standards similar Young people have the right to lead healthy lives. As they
to the National Sexuality Education Standards in develop, we want them to take more and more control
place and which address reproduction, prevention of their lives so that as they get older, they can make
of STIs and pregnancy, and healthy relationships. A important life decisions on their own. The balance
number of other states have general health education between responsibility and rights is critical because
standards which do not directly address sexual health, it sets behavioral expectations and builds trust while
while others make mention of HIV/STI prevention providing young people with the knowledge, ability,
and abstinence but don’t demand the most thorough and comfort to manage their sexual health throughout
instruction in sexual health.24 life in a thoughtful, empowered and responsible way.
But responsibility is a two-way street. Society needs
• Local Policy: At the school district level, Pre-K-12 to provide young people with honest, age-appropriate
public schools are generally governed by local information they need to live healthy lives, and build
school boards (with the exception of Hawaii which healthy relationships, and young people need to take
does not have any local school board system). Local personal responsibility for their health and well being.
school boards are typically comprised of 5 to 7 Advocates must also work to dismantle barriers to
members who are either elected by the public or sexual health, including poverty and lack of access to
appointed by other government officials.21 health care.

Local school boards are responsible for ensuring that

each school in their district is in compliance with Emily Bridges, MLS, and Debra Hauser, MPH
the laws and policies set by the state and federal Advocates for Youth © May 2014
government. Local school board also have broad
decision and rule-making authority with regards to
the operations of their local school district, including
REFERENCES availability-conflicted-about-morality-what-the-millennial-generation-
tells-us-about-the-future-of-the-abortion-debate-and-the-culture-wars/
1. CDC. Youth Risk Behavior Surveillance, 2011. Atlanta: US Department
on May 13, 2014.
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Prevention; 2012. 20. Daniels K, Mosher WD and Jones J, Contraceptive methods women
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United States, 1994 and 2001, Perspectives on Sexual and Reproductive
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21. Future of Sex Education. “Public Education Primer. “ Accessed from
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http://www.futureofsexed.org/documents/public_education_primer.pdf
Disease Surveillance 2011. Atlanta: U.S. Department of Health and Human
on May 13, 2014.
Services; 2012.
22. Sexuality Information and Education Council of the United States,
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Siecus State Profiles, Fiscal Year 2012. Accessed from http://www.siecus.
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Services; 2013.
23. Centers for Disease Control and Prevention. “In Brief: Rationale for
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Exemplary Sexual Health Education (ESHE) for PS13-1308. Accessed from
that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted
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8. Davis A. Interpersonal and Physical Dating Violence among Teens.

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9. Ybarra ML and Mitchell KJ. “Prevalence Rates of Male and Female

Sexual Violence Perpetrators in a National Sample of Adolescents.” JAMA
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12. Chin B et al. “The effectiveness of group-based comprehensive risk-

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MISSION
Established in 1980 as the Center for Population Options, Advocates for Youth champi-
ons efforts to help young people make informed and responsible decisions about their
reproductive and sexual health. Advocates believes it can best serve the field by boldly
advocating for a more positive and realistic approach to adolescent sexual health.

OUR VISION: THE 3RS

Advocates for Youth envisions a society that views sexuality as normal and healthy and
treats young people as a valuable resource.
The core values of Rights. Respect. Responsibility.® (3Rs) animate this vision:
RIGHTS Youth have the right to accurate and complete sexual health information, confi-
dential reproductive and sexual health services, and a secure stake in the future.
RESPECT Youth deserve respect. Valuing young people means involving them in the
design, implementation and evaluation of programs and policies that affect their health
and well-being.
RESPONSIBILITY Society has the responsibility to provide young people with the tools
they need to safeguard their sexual health, and young people have the responsibility
to protect themselves from too-early childbearing and sexually transmitted infections
(STIs), including HIV.

SOME RELATED PUBLICATIONS FROM ADVOCATES FOR YOUTH

The Facts: Comprehensive Sex Education and Academic Success

The Facts: Comprehensive Sex Education Research and Results

See the complete library of publications at www.advocatesforyouth.org/publications